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Table 2 Study characteristics and quality assessment of included studies

From: The application of theories of the policy process to obesity prevention: a systematic review and meta-synthesis

Author, year Study setting Policy level Policy focus area ‘Stages’ of policy processes investigated
(agenda setting, policy formulation, implementation; evaluation; or any combinations of the above)
Design and methods Study participant information Critical appraisal ratinga Other strengths/ limitations (e.g., sampling strategy; ethics approval)
Credibility
Do the findings represent the views of participant?
Transferability
Were there contextual details provided?
Dependability
Was the process logical, traceable?
Confirmability
Are findings qualitatively confirmable through an analysis of audit trail?
Craig et al. 2010 [68] Arkansas, United States of America (USA) State level Healthy eating environment policy
Legislation to support healthy eating. The Act 1220 including the following components:
• Child Health Advisory Committee (Education and Health representation).
• Local regional schools PA and nutrition committee
• State wide screening of BMI reporting back to parents
• Vending machine legislation (restrictions)
• Community health professionals within school setting
Stages of focus not specified however appears to focus on policy process stages leading to policy adoption (i.e., agenda setting and policy formulation) Qualitative using secondary document data collected as part of a comprehend-sive evaluation of Arkansas Act 1220. Key informant interviews were also conducted with persons knowledge-eable of or involved in the passage of Act 1220. No details were provided regarding study participants demo-graphics. M M M-H L Secondary data source means that the theory did not inform the type of questions that were asked, potentially limiting what was able to be deduced.
No details regarding ethics approval.
Dodson et al. 2009 [69] Multiple states across USA State level policy making (across several states) General childhood obesity prevention legislation. Not a specific policy or set of policies. Stages of focus not specified however appears to focus on policy process stages leading to policy adoption (i.e., agenda setting and policy formulation) Qualitative study using interviews There were 16 participants from 11 states, from various political parties, their professional background and length of tenure within their organisation, and geographical area represented also varied. H M-H M L This was not a study of a specific policy process but rather of obesity prevention policy processes generally.
Freundenberg et al. 2015 [62] Comparison of London and New York Municipal level Food policies, which included strategies to reduce obesity Focused on election cycles providing opportunities for policies to be developed, and hence to stage of policy adoption only. Document analysis NA- document analysis M L-M L L Secondary data source means that the theory did not inform the type of questions that were asked, potentially limiting what was able to be deduced.
Gladwin et al. 2008 [70] Alberta, Canada Provincial and local (local school board networks) and individual school level. Daily physical activity mandatory requirements in schools as well as policy processes relating to decisions to not adopt the walking to school bus program. Stages of focus not specified however appears to focus on policy process stages leading to policy adoption (i.e., agenda setting and policy formulation) Qualitative comparative study of case study of two policies. Collected interviews (primary data) and documents related to the policy (secondary data). None provided. M L-M M L Only four of the interviewees were from the provincial level. The remainder were with parents, health professionals or school board members.
Gomez, 2015 [51] Comparative study of USA and Brazil National policy level General obesity prevention policy. Stages not specified however long term perspective allowed consideration of all aspects of the policy process (including feedback feeding into subsequent decision making) Qualitative comparative case study drawing on secondary data sources of various documents (peer reviewed journal articles, government documents, and reports) NA- document analysis L M M L Secondary data source means that the theory did not inform the type of questions that were asked, potentially limiting what was able to be deduced.
Houlihan et al. 2006 [52] England, and Wales, United Kingdom (UK) National policy level Policy focused on incorporation of physical activity/sport into school curriculum Not specified however the use of two ‘synthesis’ theories could potentially include all ‘stages’ Qualitative study drawing on key informant interviews. Nine participants in total, Including senior civil servants or senior members of interest/ professional organizations or senior academics. M M-H L L No information regarding ethics approval.
Khayesi et al. 2011 [71] Curitiba, Brazil State level policy Transport sector policy to increase
active transport (through car dependence reduction policies)
No stages specified Historical case study utilising documents.
Two key informants assisted to inform the selection process of documents but did not provide any primary data.
NA- Document analysis L-M. M L-M L Secondary data source means that the theory did not inform the type of questions that were asked, potentially limiting what was able to be deduced.
McBeth et al.2013 [72] USA Federal level policy Obesity prevention policy generally Agenda setting and the potential subsequent influence on policy formulation Cross-sectional study documents (newspaper articles) using content analysis NA- document analysis H H H L Secondary data source means that the theory did not inform the type of questions that were asked, potentially limiting what was able to be deduced.
Milton et al. 2015 [75] England, UK National level policy Walking promotion policy Stages of focus not specified however appears to focus on policy process stages leading to policy adoption (i.e., agenda setting and policy formulation) Qualitative case study drawing on document analysis and interview Participants included representatives from relevant government departments and not for profit organisations, as well as, several independent consultants and other known advocates. H H H L Details of ethics approval provided.
Mosier et al. 2013 [64] USA, states of Colorado and Kansas State level Sales and excise tax policy
on Sugar Sweetened Beverages (SSB)
Stages of focus not specified however appears to focus on policy process stages leading to policy adoption (i.e., agenda setting and policy formulation) Qualitative comparative study, utilising observations, interviews and document analysis. Nine individuals, involved in the policy processes were interviewed. No further details were reported. M-H M M-H L No information regarding ethics approval.
Olstad, et al. 2015 [73] Canada State and provincial level School based physical activity policy (legislation, rules, requirements) All stages of policy process (including implementation) Historical multiple case study. Systematic document review was used (no interviews or observation) NA- no interviews H H H L Secondary data source means that the theory did not inform the type of questions that were asked, potentially limiting what was able to be deduced.
Phillpots, 2012 [53] England, United Kingdom National policy Sport and physical activity integration into school curriculum All stages of policy process (including decision to cease the implemented policy) Qualitative study design, drawing upon interviews, and document analysis. Twenty-three interviewees from a range of government sport and education agencies who had been involved in the policy area for at least 5 years. H M L-M L No information regarding ethics approval.
Quinn et al. 2015 [65] King County, Washington, USA Local level Non-regulatory nutritional guidelines for food and beverages sold in vending machines. Stages of focus not specified however appears to focus on policy process stages leading to policy adoption (i.e., agenda setting and policy formulation) Qualitative case study design, using focus group, interview, and document review methods. Focus groups: local health department staff interviews: Local Board of Health members, local elected, municipal staff, department directors officials, health expert from across 5 local jurisdictions M L M-H L Ethics was obtained and details of the duration and timing of the interviews were given.
Reid and Thornburn 2011 [54] Scotland, United Kingdom National level Physical education and activity policy No stages specified, although clear focus on agenda setting Field research involved key informant interviews Participants from: various government departments (education, sport), local government sports development staff, relevant peak bodies, not for profit organizations, and politicians. H M-H M-H M-H No information regarding ethics approval.
Thow et al. 2014 [63] Ghana National Level A food standards policy to limit the amount of fat in meat and meat cuts All stages from agenda setting, formulation, adoption and evaluation Mixed methods case study Participants were policy makers, implement-ers, producers, processors and retailers and respresented numerous government departments and stakeholder groups/ organisations M H M L Ethics was obtained.
Ulmer et al. 2012 [74] New Orleans, USA State level A Fresh Food Retailer policy Initiative Stages of focus not specified however appears to focus on policy process stages leading to policy adoption (i.e., agenda setting and policy formulation) Qualitative study using interviews Participants were from various organizations and included city agency staff, city council members, grocers, representatives from trade associations and fınancial institutions, public health professionals, and food advocates. L-M L-M L L No information regarding ethics approval.
Yeatman, 2003 [76] Australia Local level policies (four case studies) Food policy Stages of focus not specified however appears to focus on policy process stages leading to policy adoption (i.e., agenda setting and policy formulation) Case studies using interviews and document analysis Participants included local food policy councils, local elected members and local government middle managers. L-M M L L No information regarding ethics approval.
  1. aScore for each aspects found in rigorous and ‘trustworthy’ qualitative research [49]. ‘L’ indicates a low quality assessment, M medium, H high quality