Reviewer s report. Version: 0 Date: 11 Apr Reviewer: Ruth Kipping. Reviewer's report:

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1 Reviewer s report Title: Translating an early childhood obesity prevention program for local community implementation: A Case Study of the Melbourne InFANT Program Version: 0 Date: 11 Apr 2016 Reviewer: Ruth Kipping Reviewer's report: This is an interesting paper, which uses a case study approach to evaluate the implementation of the Melboure InFANT program in 5 areas in Australia, using well conducted qualitative methods to explore the perspective of policy makers, researchers and practitioners. This is a useful paper because of the lack of studies evaluating the implementation of public health interventions at scale. The paper is well written, however it would benefit from greater clarity about the terminology of those delivering the intervention in the case studies particularly because in 4/5 case studies dieticians didn't deliver the intervention as per the original study. The qualitative study was conducted by one researcher without anyone else involved in data collection, coding or analysis. However, the researcher does present her perspective and level of independence from the original study and acknowledges this as a limitation. There are a number of additional limitations of the study which should be included in the discussion. The study benefited from gaining the perspective of a range of different players, however it was limited to focus groups, interviews and observation of two meetings. It would have benefited from a broader range of methods of triangulation such as observation of the delivery of the sessions, interviews with parents and analysis of key documents to check for differences between the implementation in each of the case studies. The case studies were limited to the 5/12 areas which chose to implement the InFANT program; the study would have benefited from at least an interview with the policy makers in the other 7 areas to understand why they did not implement the intervention. If it is not too late for this data to be collected, analysed and included, the study would be greatly enhanced by adding this perspective. If this is not practically possible with respect to funding and availability of staff time it shouldn't preclude the publication of the paper.

2 Abstract, Page 2, Line 16 Change 'young children' to the mean age of the children Abstract, Page 2, Line 26 Give more information about how the five local government areas were selected and the context with respect to 12 areas had the option of adopting InFANT. Abstract, Page 2, Line 33 Explain who the researchers were (involved in design of InFANT, conduct of InFANT RCT, level - principal investigator, co-applicants, researchers?) Abstract, Page 2, Line 48 'Program specific factors' is too broad - this needs explaining in more detail. The Results paragraph of the abstract would more helpfully be presented as a summary of the barriers and facilitators; the presentation of key themes does not allow the reader to understand which were barriers or facilitators. Abstract, Page 2, line 60 Add fullstop. Background Page 4, line 51 Another obesity related public health intervention which could be cited is the evaluation of the MEND community intervention in the UK which was implemented at scale with 21,132 families. Fagg J, Chadwick P, Cole TJ, Cummins S, Goldstein H, Lewis H, Morris S, Radley D, Sacher P, Law C. From trial to population: a study of a family-based community intervention for childhood overweight implemented at scale. Int J Obes (Lond) Oct;38(10): doi: /ijo Epub 2014 Jun 12.

3 Page 4, line 61 The 2011 Cochrane review should be cited: Waters E, de Silva-Sanigorski A, Burford BJ, Brown T, Campbell KJ, Gao Y, Armstrong R, Prosser L, Summerbell CD. Interventions for preventing obesity in children. Cochrane Database of Systematic Reviews 2011, Issue 12. Art. No.: CD DOI: / CD pub3. Study context Page 5, line 42, In this sentence add that it was delivered by dieticians Page 5, line 52 Delete, 'program delivery was undertaken by (because this is now given earlier) and start the sentence with 'Dietician.' Page 5, line 57 It is not clear that child diet quality is also just for sub-groups, therefore add semi-colon after [19] Page 6, line 1 Add semi-colon after [24]. Add when these outcomes were measured (months post intervention) and add that it was assessed in a cluster RCT. Dissemination Context Page 6, line 6 Add "(DHSS)" Page 6, line 20

4 Add "(LGA)" Dissemination process Page 7, line 1 Please clarify who are the facilitators are - are they the dieticians? Methods Page 7, line The case studies were limited to the 5/12 areas which chose to implement the InFANT program; the study would have benefited from at least an interview with the policy makers in the other 7 areas to understand why they did not implement the intervention. If it is not too late for this data to be collected, analysed and included, the study would be greatly enhanced by adding this perspective. If this is not practically possible with respect to funding and availability of staff time it shouldn't preclude the publication of the paper. Page 7, line 33 Add fullstop Page 7, line 42 Explain who the researchers were (involved in design of InFANT, conduct of InFANT RCT, level - principal investigator, co-applicants, researchers?) Page 7, line 54 Clarify who the facilitators were - did they deliver the intervention? Page 7 line 57 to page 8 line 3 You refer here to a number of different staff and later on page 17 say that in the case studies staff other than dieticians delivered the intervention in 4/5 case studies. It would be helpful here if you

5 could clarify which staff are delivering the intervention and that this is a broad group of staff than dieticians because of local decisions about who would deliver the intervention in the case studies. Page 8, line 6 Explain why in some areas focus groups were used and in some areas interviews were used. Data collection Page 8, line 27 Add here who conducted the research and collected the data and RL's independence from the original trial (this is included later on page 12 but it would be helpful here as well). Page 8, line 40, n=8 but in the paragraph above it says 12 program facilitators agreed to be interviewed - please explain why only 8 were interviewed. Results Page 12, line 32 Add context for how the 5 case study areas differed from the area where the original study took place. Page 19, line 1 Remove duplicate comma Page 20, line 19 You also need to include cost of delivery here

6 Discussion Page 23, line 10 Add 'a' before 'health promotion program'. Page 23, Lines Move the two sentences, starting 'It also suggests..' before the previous sentence 'This underscores ' to emphasise the importance of design. Page 24, line 38 Give example of a method of delivering implementation nationally and ensuring fidelity: in the UK a not-for-profit company (DECIPHer Impact) has been set up to license the 'ASSIST' peersmoking intervention to schools to ensure fidelity: Page 25, line 23. Add that another method to help researchers to focus on translation is when the independent assessment of Universities' research output includes a measure of 'impact' which is linked to national funding for research. In the UK the Research Assessment Exercise process for assisting quality of research in higher education institutions (which informs funding to universities) has 20% of the assessment focused on impact. OS%20including%20addendum.pdf Page 27, line 38 Please add the following limitations: The study benefited from gaining the perspective of a range of different players, however it was limited to focus groups, interviews and observation of two meetings. It would have benefited

7 from a broader range of methods of triangulation such as observation of the delivery of the sessions, interviews with parents and analysis of key documents to check for differences between the implementation in each of the case studies. The case studies were limited to the 5/12 areas which chose to implement the InFANT program; the study would have benefited from at least an interview with the policy makers in the other 7 areas to understand why they did not implement the intervention. If it is not too late for this data to be collected, analysed and included, the study would be greatly enhanced by adding this perspective. If this is not practically possible with respect to funding and availability of staff time it shouldn't preclude the publication of the paper. Page 28, line 43 'Lead' should be 'led' Page 31, line 16 Reference 22 should be updated to the 2011 Cochrane review: Waters E, de Silva-Sanigorski A, Burford BJ, Brown T, Campbell KJ, Gao Y, Armstrong R, Prosser L, Summerbell CD. Interventions for preventing obesity in children. Cochrane Database of Systematic Reviews 2011, Issue 12. Art. No.: CD DOI: / CD pub3. Are the methods appropriate and well described? If not, please specify what is required in your comments to the authors. Yes Does the work include the necessary controls? If not, please specify which controls are required in your comments to the authors. Yes Are the conclusions drawn adequately supported by the data shown? If not, please explain in your comments to the authors. Yes Are you able to assess any statistics in the manuscript or would you recommend an additional statistical review? If an additional statistical review is recommended, please specify what aspects require further assessment in your comments to the editors.

8 Not relevant to this manuscript Quality of written English Please indicate the quality of language in the manuscript: Acceptable Declaration of competing interests Please complete a declaration of competing interests, considering the following questions: 1. Have you in the past five years received reimbursements, fees, funding, or salary from an organisation that may in any way gain or lose financially from the publication of this manuscript, either now or in the future? 2. Do you hold any stocks or shares in an organisation that may in any way gain or lose financially from the publication of this manuscript, either now or in the future? 3. Do you hold or are you currently applying for any patents relating to the content of the manuscript? 4. Have you received reimbursements, fees, funding, or salary from an organization that holds or has applied for patents relating to the content of the manuscript? 5. Do you have any other financial competing interests? 6. Do you have any non-financial competing interests in relation to this paper? If you can answer no to all of the above, write 'I declare that I have no competing interests' below. If your reply is yes to any, please give details below. I declare that I have no competing interests. I agree to the open peer review policy of the journal. I understand that my name will be included on my report to the authors and, if the manuscript is accepted for publication, my named report including any attachments I upload will be posted on the website along with the authors' responses. I agree for my report to be made available under an Open Access Creative Commons CC-BY license ( I understand that any comments

9 which I do not wish to be included in my named report can be included as confidential comments to the editors, which will not be published. I agree to the open peer review policy of the journal