Engaging stakeholders in the adaptation of the Connect for Health pediatric weight management program for national implementation.
Engaging stakeholders in the adaptation of the Connect for Health pediatric weight management program for national implementation.
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DOI：
10.1186/s43058-020-00047-z
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发表时间：
2020-01-01
影响因子：
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通讯作者：
Taveras, Elsie M
中科院分区：
文献类型：
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作者：
Simione, Meg;Frost, Holly M;Taveras, Elsie M
背景技术背景：Connect for Health是一项基于证据的体重管理计划，具有面向临床和家庭的组件，适用于2至12岁儿童家庭的儿科初级保健。我们使用了实施研究综合框架（CFIR）来指导国家实施之前的形成工作。本研究的目的是描述的过程和结果的利益相关者的参与和程序adaptation.METHODS：我们使用混合定性和定量的方法，以迭代适应和优化程序，通过评估的需求和角度的临床医生和家长，以及上下文的障碍，促进者，和组织准备的摄取建议的程序工具和实施策略。我们对来自马萨诸塞州波士顿、科罗拉多州丹佛和南卡罗来纳州格林维尔的四家医疗机构的初级保健临床医生进行了采访，并使用浸入结晶原理进行定性分析。我们还对体重指数≥ 85百分位数的儿童的父母进行了调查。结果：在52位临床医生访谈后，我们达到了主题饱和。代表干预特征、外部和内部环境以及过程的CFIR领域的新兴主题包括（1）整合到工作流程中且不延长就诊时间的循证临床决策支持工具的重要性，（2）开发响应家庭需求的资源，（3）使用家庭资源的多模式交付选项，（4）在平衡竞争需求的同时解决儿童肥胖，（5）强调病人护理而不是文件和建立可持续发展计划，以及（6）提供多种培训方法，包括绩效反馈。在接受调查的400名父母中，约50%讲西班牙语，超过75%的人报告年收入<50 000美元。家长们肯定了在健康儿童访问期间解决体重管理的重要性，为他们提供转介和资源，并提供多种资源提供方法。有关方案修改的决定是在方案和卫生保健系统层面上根据利益相关者参与的结果作出的。修改包括文化，地理和目标受众的适应，以及不同的资源交付选项.CONCLUSIONS：为了确保连接健康计划和国家实施设置之间的配合，通过临床医生和家长利益相关者的参与，以支持采用，可持续性和健康outcomes.TRIAL注册之间进行了系统的调整：NCT 04042493。
BACKGROUND: Connect for Health is an evidence-based weight management program with clinical- and family-facing components for delivery in pediatric primary care for families of children ages 2 to 12years. We used the Consolidated Framework for Implementation Research (CFIR) to guide formative work prior to national implementation. The purpose of this study was to describe the process and results of stakeholder engagement and program adaptation.METHODS: We used mixed qualitative and quantitative methods to iteratively adapt and optimize the program by assessing needs and perspectives of clinicians and parents, as well as contextual barriers, facilitators, and organizational readiness for the uptake of the proposed program tools and implementation strategies. We conducted interviews with primary care clinicians from four health care organizations in Boston, MA; Denver, CO; and Greenville, SC, and used principles of immersion-crystallization for qualitative analyses. We also conducted surveys of parents of children with a body mass index ≥ 85th percentile.RESULTS: We reached thematic saturation after 52 clinician interviews. Emergent themes representing the CFIR domains of intervention characteristics, outer and inner setting, and process included (1) importance of evidence-based clinical decision support tools that integrate into the workflow and do not extend visit time, (2) developing resources that respond to family's needs, (3) using multimodal delivery options for family resources, (4) addressing childhood obesity while balancing competing demands, (5) emphasizing patient care rather than documentation and establishing sustainability plans, and (6) offering multiple training methods that incorporate performance feedback. Of the parents surveyed (n = 400), approximately 50% were Spanish-speaking and over 75% reported an annual income < $50,000. Parents affirmed the importance of addressing weight management during well-child visits, being provided with referrals and resources, and offering multiple methods for resource delivery. Decisions about program modifications were made at the program and healthcare-system level and based on stakeholder engagement findings. Modifications included cultural, geographic, and target audience adaptations, as well as varied resource delivery options.CONCLUSIONS: To ensure the fit between the Connect for Health program and national implementation settings, adaptations were systematically made through engagement of clinician and parent stakeholders to support adoption, sustainability, and health outcomes.TRIAL REGISTRATION: NCT04042493.