Adapting Connect for Health pediatric weight management program for telehealth in response to the COVID-19 pandemic.
Adapting Connect for Health pediatric weight management program for telehealth in response to the COVID-19 pandemic.
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DOI：
10.1186/s43058-023-00523-2
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发表时间：
2023-11-16
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为应对COVID-19大流行带来的不断变化的需求和环境变化，我们调整了“健康连接”，这是一项基于证据的初级保健儿科体重管理干预措施。本研究的目的是描述计划的适应过程，以确保在大流行期间持续和公平的计划吸收。在适应框架的指导下，我们确定了健康连接的核心功能和形式，然后根据不断变化的医疗环境调整干预措施。我们与利益相关者合作，调查了BMI ≥ 85 th百分位数儿童的父母和儿科临床医生，并检查了他们使用远程医疗进行儿科体重管理的经验以及需求和偏好。使用多变量逻辑回归，我们研究了英语水平有限的父母对儿童体重管理关键方面的偏好。我们调查了200名父母，其中43%的父母的主要语言是西班牙语。父母希望护理是面对面和虚拟访问的结合（80%）。我们发现，英语水平有限的父母肯定亲自访问比虚拟访问更好，以确保他们的孩子的健康问题可以得到照顾（OR：2.91; 95% CI：1.36，6.21），在讨论个人信息时感到舒适（OR：3.91; 95%CI：1.82，8.43）、谈论健康行为和设定目标（OR：3.09; 95%CI：1.39，6.90），谈论心理健康和总体幸福感（OR：4.02; 95%CI：1.83，8.87）。我们调查了75名临床医生，60%的人认为远程医疗是一种有用的工具，可以为儿科体重管理提供护理。临床医生认为虚拟访问并没有对护理的各个方面构成障碍。根据调查和利益相关者的意见，我们在保留项目功能的同时，对临床医生和家庭进行了调整。通过让利益相关者参与并调整远程医疗计划，我们优化了Connect for Health的覆盖范围和适应性，以确保其持续发展。我们提供了一个现实世界的例子，说明临床创新如何发展，以及如何系统地规划适应不断变化的医疗环境。Clinicaltrials.gov（NCT 04042493），注册于2019年8月2日。在线版本包含补充材料，可通过10.1186/s43058-023-00523-2获得。
To address the evolving needs and context changes due to the COVID-19 pandemic, we adapted Connect for Health, an evidence-based, primary care, pediatric weight management intervention. The objective of this study is to describe the planned adaptation process to ensure continued and equitable program uptake during the pandemic. Guided by adaptation frameworks, we identified the core functions and forms of Connect for Health and then adapted the intervention in response to a changing healthcare context. We engaged stakeholders and surveyed parents of children with a BMI ≥ 85th percentile and pediatric clinicians and examined their experiences using telehealth for pediatric weight management and needs and preferences. Using multivariable logistic regression, we examined the preferences of parents with limited English proficiency regarding key aspects of pediatric weight management. We surveyed 200 parents and 43% had a primary language of Spanish. Parents wanted care to be a combination of in-person and virtual visits (80%). We found that parents with limited English proficiency had a higher odds ratio of affirming in-person visits are better than virtual visits for ensuring their child’s health concern can be taken care of (OR: 2.91; 95% CI: 1.36, 6.21), feeling comfortable when discussing personal information (OR: 3.91; 95% CI: 1.82, 8.43), talking about healthy behaviors and setting goals (OR: 3.09; 95% CI: 1.39, 6.90), and talking about mental health and overall well-being (OR: 4.02; 95% CI: 1.83, 8.87) than parents without limited English proficiency. We surveyed 75 clinicians and 60% felt telehealth was a useful tool to provide care for pediatric weight management. Clinicians felt virtual visits did not pose barriers to all aspects of care. Informed by the surveys and stakeholder input, we made clinician- and family-level adaptations while retaining the program’s function. By engaging stakeholders and adapting the program for telehealth, we optimized the reach and fit of Connect for Health to ensure its continued uptake. We have provided a real-world example of how clinical innovations can evolve and how to systematically plan adaptations in response to changing healthcare contexts. Clinicaltrials.gov (NCT04042493), Registered on August 2, 2019. The online version contains supplementary material available at 10.1186/s43058-023-00523-2.