Search

BackgroundObesity is a global epidemic affecting all age groups, populations and income levels across continents, though is known to disproportionately affect socioeconomically disadvantaged populations. The causes of obesity are complex, informed by diet and weight practices, but shaped by social, commercial and environmental factors and government policy. Consequently, a Whole System Approach (WSA) – which considers the many causes of obesity and shifts the focus away from individuals as points of intervention and puts an emphasis on understanding and improving the system in which people live – is required. This scoping review of reviews aims to: determine how WSAs to diet and healthy weight have been implemented and evaluated nationally and internationally; to determine what models or theories have been used to implement WSAs; describe how WSAs have been evaluated; determine if WSAs are effective; and to identify the contribution of the public and/or service users in the development of WSAs. MethodSystematic searches were carried out using CINAHL, Scopus, PsycINFO (ProQuest), the Cochrane Library, and MEDLINE. Included review papers were those that focused on the application of a whole system approach to diet and/or healthy weight, and/or reported the theory/model used to implement or simulate this approach. Databases were searched from 1995 to March 2022 using a combination of text and Medical Subject Headings (MeSH terms). In addition, reference sections of identified articles were examined for additional relevant articles. Covidence software was used to screen titles and abstracts from the electronic databases and resolve conflicts.Results A total of 20,308 articles were initially retrieved; after duplicate removal 7,690 unique title and abstracts were reviewed, and 110 articles were selected for full text review. On completion of full text review, 8 review articles were included for data extraction. These included: one umbrella review, four systematic reviews, a rapid review, and two literature reviews (one of which was on strategic reports written for government and public health policy). Evaluations of WSA were mainly process evaluations although health outcomes were assessed in some studies. Several conceptual frameworks or mathematical modelling approaches have been applied to WSAs for diet, healthy weight and obesity to inform their planning or delivering, and to understand/map the associated systems. Common mathematical approaches include agent based or system dynamic modelling. Underlying both conceptual and mathematical models is an understanding how the elements of the complex systems impact each other to affect diet, healthy weight and obesity. WSA implementations have reported some success in positively impacting health outcomes including reducing Body Mass Index, reducing sugary food intake and increasing physical activity. Public and user involvement in WSA was not widely reported.ConclusionThe application of WSA to diet and healthy weight shows promise, yet the research is lagging behind their implementation. Further robust evidence for using WSA to address diet and healthy weight are required, including incorporating process and outcome evaluations (perhaps using established approaches such as Systems Dynamic Modelling). Furthermore, the analysis of epidemiological data alongside longitudinal process and outcome evaluation regarding the implementation of a WSA is required.

Additional file 3.

Additional file 1.

Additional file 2.

Manual to guide administration of the Recovery Assessment Scale - Domains and Stages (RAS-DS). The RAS-DS has 38 items or statements for the consumer to rate. It is a Likert scale with 4 rating categories for consumers to select from: “untrue”; “a bit true”; “mostly true” and “completely true”. The items have been divided into 4 recovery domains: Doing Things I Value (functional recovery); Looking Forward (personal recovery); Mastering My Illness (clinical recovery) and Connecting and Belonging (social recovery).

The aim of this working paper is to present preliminary analyses of longitudinal data from Australia that addresses various aspects of the dynamic nature of disability over time. Disability research is dominated by cross-sectional studies that have examined the prevalence and correlates of disability at a particular point in time. As a result, little is known about the duration of disability or the factors that may be associated with disability offset. This reliance on cross-sectional data has served to reinforce the notion that disability once acquired is a relatively permanent state. In recent years, the increasing availability of longitudinal data (especially from well-constructed population-based surveys) has opened up new opportunities for disability research. These have included the possibility of investigating the dynamic nature of disability over time. The data presented in this working paper are based on analysis of ten years of data collected by the study of Household Income and Labour Dynamics in Australia (HILDA). Our analyses focused on the most recent consecutive five year period in which the study participants provided information on their disability status. Centre for Disability Research and Policy

Policy makers, service agencies and people with mental illness themselves view employment for people with mental illness as a major concern. This is due to the low rate of employment of people with mental illness, the difficulties many experience in finding and keeping satisfactory jobs, and the perception of paid employment as highly desirable for people with mental illness. The most extensive research on employment for people with mental illness has focused on establishing statistical relationships between various hypothesised predictors of employment success and vocational outcomes. While some attention has been paid to how individuals with mental illness view being employed, this has primarily focused on specific areas such as the benefits of employment, difficulties encountered and coping techniques used. My aim in this research was to develop a theoretical formulation which explains the processes that people with mental illness engage in with regard to employment. Data was gathered by way of in-depth interviews with users of psychiatric services. Some of these participants were employed, others were seeking employment, while others were not engaged in employment-related activities. At the centre of the theoretical formulation is a process I have called negotiating an appropriate vocational place. Using this process, people with mental illness make decisions about actions to take in relation to employment and these may or may not include trying to get and keep a job. Decisions are made by weighing up the benefits and drawbacks of employment and the advantages and risks of different vocational strategies. In doing so, people with mental illness are influenced by the Australian societal context, their individual social networks, their individual characteristics and circumstances (including their mental illness), and their employment options. This process of negotiating an appropriate vocational place is cyclical, ongoing and dynamic, as individuals' views and circumstances change. Knowing that people with mental illness strive toward an appropriate vocational place rather than taking for granted that they are working towards getting a job presents a challenge to policy and practice in which a successful outcome is defined as obtaining and maintaining a paid position in the workforce. Detailing and elaborating the process by which people with mental illness go about negotiating an appropriate vocational place provides a framework for practitioners, policy makers and researchers to understand the decisions made by people with mental illness and their actions in relation to employment. The understanding provided by the findings from this study will assist those working with people with mental illness and those responsible for employment policies to tailor their work more closely to individuals' desired goals. Immediate and longer term research opportunities are identified to apply the theoretical formulation derived from this study to vocational service practice with people with mental illness.