A Review of Obesity-Themed Policy Briefs

Abstract

Context

Policy approaches are one of the most promising population-based means of addressing the epidemic of obesity in the U.S., especially as they create supportive environments for healthy living. Policy briefs can be an effective means of disseminating research information to inform obesity prevention efforts; however, they are often ineffective due to length, density, and inaccessibility. The purposes of this project were to identify a collection of obesity-related policy briefs, analyze the content, and make recommendations for model policy briefs.

Evidence acquisition

In 2010, online searching strategies were developed with criteria that included: a primary topical focus on obesity, written between 2000 and 2010, targeting any population age group, including a policy-change message, and being readily available online. The research team developed a coding tool and used it to analyze briefs. A subsample of the briefs was used for further analysis on dissemination.

Evidence synthesis

Analyses were conducted on 100 briefs. Most (72%) were developed between 2005 and 2010; the average length was five pages. The majority had no tables, few figures, and only 36% included photos. The average reading level was high. A lack of monitoring or evaluating dissemination efforts prevailed.

Conclusions

Policy briefs represent an effective, often-preferred, potent tool for public health practitioners and researchers to communicate information to policymakers. Recommendations include presenting information clearly, using a concise format, including design elements, noting reference and contact information, employing active and targeted dissemination efforts, and conducting evaluation.

Context

In the U.S., over 63% of adults and 27% of children are now overweight or obese, contributing to over $147 billion, in 2008 dollars, in medical costs annually, or nearly 10% of all healthcare costs.^1–3 Environmental and policy approaches represent one of the most promising means of addressing this problem. The nature of policy interventions makes them useful for several reasons. Unlike interventions designed to address specific individuals, policy interventions are aimed at changing physical and sociopolitical environments; as such, policy interventions have potential to affect entire populations.⁴

Also, policy interventions are designed to provide opportunities, support, and cues to help people develop healthier behaviors and make healthy choices. Policies may directly affect behaviors. For example, research shows that when the price of tobacco is increased, tobacco consumption decreases.⁵ Additionally, policies may alter social norms. This can be observed in the way that policies regarding the creation or design of sidewalks and bike lanes may increase the presence of physically active people in public spaces, which can encourage others to engage in physical activity.⁴ Finally, policies are often more permanent and far-reaching than many public health programs that are focused on individual-level behavioral change.

As researchers and public health practitioners work to identify and measure effective policies, they populate the scientific literature with their results. Unfortunately, those in positions to implement effective policies are rarely exposed to the dissemination outlets used by researchers (e.g., peer-reviewed research journals, scientific conferences). Indeed, researchers and policymakers operate in very different worlds, utilizing dissimilar types of communication and working on vastly different timelines.⁶ For example, while researchers share important information in long written reports or publications, policymakers rely on oral communication and brief summaries of crucial details.⁷ Further, policymakers indicate a preference for information that is presented clearly and concisely (e.g., materials are one to two pages long and use bullet points rather than long paragraphs), includes tables and figures, and provides references and contact information for follow-up and more in-depth study.^8–10

Researchers and practitioners are identifying important research findings with policy implications that may be translated to those in positions to introduce and enact policies. With limited time and resources, it is crucial to understand how to most effectively and efficiently communicate this information to policymakers. Policy briefs, which include brief reports or summaries of information relevant to policy issues, are a common means of doing so.¹⁰

There are many benefits to disseminating evidence through policy briefs in advance of peer-reviewed publications. Indeed, the issue of timing is an important one that will likely best be addressed through system changes that improve the timeliness with which evidence can be published. The advantages of producing policy briefs before published papers include the alacrity with which important findings can reach policymakers, who often need to make decisions immediately. Unfortunately, if journals require that authors agree not to publish findings in advance of journal publication, authors may be limited in their ability to quickly disseminate findings and important, time-sensitive decisions may be made without all the evidence.

Regardless of when policy briefs are created, researchers are still faced with questions such as: What makes a good policy brief? Through what channels should they be shared? What information should they include and in what format? Are researchers and practitioners producing materials that incorporate policymakers’ stated preferences? To address some of these questions, the goals of this project were to identify a selection of readily available, obesity-related policy briefs, analyze the content, evaluate whether they reflect current knowledge about what policymakers want, and make recommendations for model policy briefs.

Evidence Acquisition

The research team, experienced in health communication and policy content analysis, began by determining criteria to search for policy briefs. These criteria included: a primary topical focus on obesity, being written between 2000 and 2010, targeting or discussing any population age group, having a message about policy change, and being readily available online. Materials that were designed as annual or full reports or program plans were excluded in favor of those serving as fact sheets or briefs.

The team also devised a search protocol designed to locate a wide range of obesity-related policy briefs from a variety of websites. Initial searches included the websites of the following organizations, which are leaders in chronic disease prevention research or advocacy, and/or which are respected resources for policy information: Active Living Research, American Cancer Society, American Heart Association, National Association of Chronic Disease Directors, National Conference of State Legislatures, Center for Science in the Public Interest, CDC, and National Policy and Legal Analysis Network. The second tier of searches included websites of state health departments and Prevention Research Centers. Search terms included, “policy brief” and “obesity,” “physical activity,” or “nutrition.” Finally, searches were conducted using Google online search engine.

A set of evaluation criteria for analysis of the briefs was also developed through several iterations and in consideration of current knowledge about policymaker preferences. The criteria included a variety of characteristics about the briefs: year published; numbers of pages, tables, figures, text boxes, and photos (count); whether briefs contained personal stories or quotations (yes/no); whether briefs referred to the Ecological Model (yes/no)¹¹; use of color (yes/no); font size; provision of contact information for readers seeking additional information; citation of a funding source (yes/no); average words per page (calculated by exporting policy briefs into Microsoft Word and dividing total number of words by number of pages); and number of references cited (count). The Flesch-Kincaid grade level was also determined for each brief by exporting it into Microsoft Word and utilizing the reading-level function.^12,13

The briefs were also evaluated based on more-subjective characteristics, such as ease of access (based on number of mouse-clicks needed to locate brief from an agency’s home page: (<3=easy; ≥3=challenging); clarity of message (clear/unclear to the reader, evaluated on whether an obvious, understandable message was well conveyed); quality of tables, figures, and photos (high/low quality evaluated by whether visual presentation of data was clear and understandable to the reader); whether the brief could be modified or tailored for other audiences (yes/no; could messages be changed or targeted for different audiences); and whether the message was actionable (yes/no; were specific actions suggested that readers could take to address the issue described).

Two additional criteria regarding dissemination were evaluated in a subsample of the policy briefs (n=50). The subsample was selected by ordering the briefs alphabetically by title and selecting every other brief for inclusion. Telephone numbers and e-mail addresses provided on the policy briefs (or websites, when no contact information was given) were used to contact authors or collaborators to inquire about the method of dissemination that was used with the briefs, and whether dissemination efforts had been evaluated.

To ensure consistency in analysis of the briefs, four coders were trained to use the evaluation criteria. As part of the training, all coders analyzed the same set of briefs and then compared results. Based on this process, the evaluation tool was revised by the team of coders until all four were in agreement and confident about how to use it. The evaluation tool was then entered into an online survey system. Using this system, each of the four coders completed analysis of 25 briefs each (N=100). Ten percent of the briefs were double-coded to verify reliability. All entered data were exported to SPSS 17.0, and basic frequencies were run. Percent agreement was calculated on the ten briefs that were double-coded for reliability.

Evidence Synthesis

A total of 100 policy briefs were collected and coded from February 2010 through June 2010. The briefs selected may be viewed at prcstl.wustl.edu. Many other materials were identified but were excluded from the analysis because they were deemed annual reports or program plans rather than fact sheets or policy briefs. Reliability analysis resulted in 70% agreement on two items; others had 80% or 90% agreement.

Seventy-two percent of the policy briefs were published between 2005 and 2010 (Table 1). The mean number of pages in the briefs was five, but 25% had between seven and eighteen pages. Though tables and figures can be helpful ways to convey ideas and decrease the amount of text in a brief, 73% of briefs had no tables and 44% of briefs had no figures. While 36% of briefs included at least one photo, 24% of photos were determined to be of poor quality. Many policy briefs were easy to access (68%) and made use of color (85%).

Table 1.

Summary of obesity-related policy-brief characteristics, N=100

Characteristic	% or M (range)
Year
None given	17
1999–2004	11
2005–2010	72
Is brief easy to access? (Less than three mouse-clicks needed to locate brief from agency’s home page), yes	68
Number of pagesa
1–2	35
3–6	40
7–18	25
Number of tables
0	73
1–3	27
Number of figures
0–2	84
3–8	16
Number of boxes
0–2	75
3–11	25
Quality of tables and figures (3-point scale: clear, somewhat clear, unclear/confusing), clear	92
Number of photos
0	64
1	16
2–9	20
Quality of photos (2-point scale: high/low-quality), high	76
Brief contains personal stories or quotes, yes	15
Brief refers to the ecological model, yes	27
Use of color, yes	85
Font size (point)
9	10
10	46
11	34
≥12	10
Brief provides contact information
Name	39
USPS address	45
Phone	62
E-mail	39
Website	65
None	14
Brief is actionable (specific actions were suggested for reader to take to address issue described), yes	78
Funding sources are cited, yes	39
Flesch-Kincaid grade level	13 (6–19)
Average words per page	420 (78–722)
≤305	25
≥427	50
Number of references cited, n	14 (0–68)

^aM=5.

USPS, U.S. Postal Service

Fifteen percent of policy briefs included stories or quotes. Fourteen percent of briefs provided no contact information at all, and only 65% provided a website address. The grade reading level of briefs varied widely (6–19), with a mean of 13. The average number of words per page also varied (78–772), with a mean of 420. Although the goal of many policy briefs is to incite some action, almost one quarter of the briefs did not contain messages that were deemed actionable.

When contact was initiated with half of the policy-brief authors (n=50) to ascertain whether and how policy briefs had been disseminated and if dissemination efforts had been evaluated, almost half of those contacted did not respond after multiple attempts (n=24). Thirteen of the briefs chosen for this subset did not provide any contact information. The remaining 13 briefs contained contact information that was used to successfully discuss dissemination with policy-brief authors or others who had worked with the materials.

Most of those contacted said that the briefs were passively disseminated on websites. Several respondents said that briefs were made available at various events attended by stakeholders and the media. Others mentioned that briefs were mailed (e-mail or paper copy) to school districts, school board members, health staff in state legislatures, targeted congressional offices, and those they thought might be interested in the topic. Finally, some said they disseminated their briefs through community partners, e-newsletters, and the media. Of the 13 contacts who responded, 12 said they did not evaluate dissemination efforts. Only one organization had a dissemination evaluation plan, which included keeping extensive media-tracking logs of press coverage and hits from the materials they create as well as tracking the number of downloads of policy materials they make available online.

Discussion

The purpose of this study was to review existing obesity-themed policy briefs readily available online, analyze their contents and formats, report on application of current knowledge about how policymakers prefer to receive information, and use findings to make recommendations about model policy briefs. The majority of policy briefs identified had been created since 2005, which may indicate an increase in the use of the Internet as a means of policy brief dissemination, as well as a growing awareness of the utility of policy to address obesity. Many policy briefs were easy to access and colorful, but almost one quarter did not provide actionable steps, leaving readers without specific guidance on practical ways to apply information. Other characteristics of policy briefs reviewed, however, were less optimal when considered in light of policymakers’ stated preferences reported in the literature.

In one such study, researchers sought to identify public health decision makers’ preferred format for receiving research evidence to inform decisions. This work revealed that respondents value systematic reviews, research summaries, and clear, concise explanations of real-world research implications.⁹ However, the mean grade reading level of policy briefs identified in the current study was 13, which is considerably higher than what is generally recommended for materials created for a wide audience (i.e., experts suggest utilizing reading levels two to five grades lower than those of intended audience).¹⁴

Additionally, 73% and 44% of briefs reviewed did not utilize tables or figures, respectively, despite the utility of these tools to clearly communicate data and ideas while minimizing text. This may impede the likelihood that these policy briefs or research summaries are “clear and concise.” Other studies suggest that there are benefits to using narrative communication and personal stories to communicate policy information and persuade policymakers.^15,16 However, only 15% of the policy briefs examined in this review made use of personal stories.

Another set of studies has examined the relative effectiveness of policy dissemination through various communication methods. Sorian and Baugh⁸ reported on a survey of nearly 300 state government policymakers that sought to understand their methods of obtaining information about policy topics. Respondents in this study discussed being overwhelmed with information and therefore never even reading 35% of what they receive.⁸ Policymakers also reported finding summaries and brief reports more useful than e-mail lists, conferences, and press releases. State policymakers in this survey were divided regarding preferred information media, with younger (aged <30 years) respondents reporting much more frequent use of electronic information compared to the hard-copy materials preferred by older officials.

Given the clear preferences of policymakers for brief reports, the fact that 40% of the briefs reviewed for this study were three to six pages long and an additional 25% were seven to eighteen pages long indicates that those creating policy briefs must make every effort to produce materials with only the most important points (i.e., one page front/back maximum).⁹ One way to accomplish this is to create policy briefs with bullet points of main ideas and ample resources indicating where additional information can be found. In fact, policymakers say that they prefer brief materials that include ways to find more information when they have interest^7,8; however, 14% of briefs provided no contact information, and only 65% provided a website address. Researchers and practitioners creating policy briefs should take care to provide clear, updated contact information, and additional resources where more information about the topic can be obtained.

A few study limitations warrant mention. First, the research team was unable to determine the intended audience of most policy briefs; thus, some evaluation criteria may be less applicable to certain briefs. Second, while the research team took care to search widely and diversely for obesity-related policy briefs most likely to be found by researchers and practitioners using the same search engine and terms, the process could have missed briefs not caught by the search terms or have been biased to larger organizations or those appearing nearer the top of a list on an Internet search engine. Also, other policy-brief authors may have dissemination plans in place but were unable to be reached by the study team; thus, the numbers of those reporting dissemination activities and evaluation may be under-represented.

Further, dissemination efforts may be determined by organizational capacity (e.g., amount of staff, funding, and other resources) which was not captured in this study. In spite of these limitations, the authors believe this study provides insight into the most readily available briefs. These are the briefs most likely to be obtained by a nonresearcher or practitioner in a simple website search.

Conclusion and Recommendations

Most of the dissemination activities described in this study are passive and often less effective at ensuring that the intended message is clearly and accurately communicated to the desired audience.¹⁷ After working hard to create clear and concise policy-brief materials for decision makers, researchers and practitioners should employ more active, intentional dissemination activities (e.g., sharing policy briefs with targeted health staff in legislatures, key congressional offices, and those they think might have a special interest in the topic). Also, such dissemination activities should be evaluated, where possible, to measure the impact of policy materials created by researchers and public health practitioners. Quantifying this impact can encourage additional policy communications and may even help ensure that adequate resources are allocated to the communication of research to policymakers. Additionally, tracking and evaluation can help provide information for changes and updates of the briefs.

Obesity is an overwhelming public health problem in the U.S., and policy interventions are a powerful means of addressing it (e.g., increasing usable sidewalks and bike lanes, ensuring healthy foods are available at schools and worksites). Evidence-based interventions tested by researchers are often not effectively shared with those in positions to implement policy interventions. Policy briefs represent an effective, often-preferred, and potent tool for public health practitioners and researchers to communicate this information to policymakers. Even though the briefs in this study varied greatly, several key points emerged that can be used to make communication through policy briefs more effective:

• The information in the briefs should be clear and concise.

• One to two pages inclusive of tables, figures, and photos should be a target length for most policy audiences.

• The briefs should include references and contact information for follow-up.

• Authors of policy briefs should use active, targeted means of dissemination.

• Dissemination should be monitored and evaluated.