A narrative account of implementation lessons learnt from the dissemination of an up-scaled state-wide child obesity management program in Australia: PEACH™ (Parenting, Eating and Activity for Child Health) Queensland
A narrative account of implementation lessons learnt from the dissemination of an up-scaled state-wide child obesity management program in Australia: PEACH™ (Parenting, Eating and Activity for Child Health) Queensland
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DOI：
10.1186/s12889-018-5237-8
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发表时间：
2018-03-13
影响因子：
4.5
通讯作者：
Daniels, Lynne
中科院分区：
文献类型：
--
作者：
Croyden, Debbie L.;Vidgen, Helen A.;Daniels, Lynne
背景：PEACH(TM)QLD将旨在管理小学生超重/肥胖的PEACH(TM)计划从有效的随机对照试验和小规模社区试验转变为更大规模的全州计划。方法：这项为期6个月、以家庭为重点的项目于2013年至2016年在澳大利亚昆士兰州开展。它的实施是由研究人员计划的，他们开发了该计划并进行了随机对照试验，并在整个健康连续体系中拥有经验丰富的项目经理和实践者。这项干预的目标是家长作为变革的推动者，并通过仅限家长参加的小组会议进行。与此同时，孩子们参加了有趣的、非竞争性的活动。课程由接受标准化培训的主持人主持，并受雇于一系列服务提供商。参与者由卫生专业人员推荐或在广泛的宣传和营销中自我推荐。计划了一个试点阶段和一个质量改进框架，以应对新出现的挑战。结果：实施挑战包括卫生系统的参与度、参与者招募和参与度。共有1513名儿童(1216个家庭)报名，其中面对面计划(50个独特场地的105个小组)的1122名儿童(919个家庭)和在线PEACH(TM)的391名儿童(297个家庭)。自我推荐产生了68%的注册人数。意想不到的、同时发生的和影响深远的公共卫生系统变化导致该部门(只有56[53%]个由公共资助的卫生组织提供的团体)较差地采用了方案，需要对原始实施计划进行重大修改。试点阶段的过程评估和持续的质量改进框架为项目调整提供了信息，包括根据学校学期从每两周一次改为每周一次，修订家长材料，修改资格标准以纳入健康体重儿童，并私下提供服务。试点和全州范围的WAVE的比较显示，没有参加任何课程的家庭比例相当(25%比28%)，但参加课程的数量(中位数=5比7)和完成率(43%比56%)有所改善。结论：在研究背景下开发的旨在实现规模化实施的项目翻译是复杂的，面临着巨大的挑战。规划必须确保具有灵活性，以适应和主动管理随着时间推移不可避免的系统更改。
Background: PEACH (TM) QLD translated the PEACH (TM) Program, designed to manage overweight/obesity in primary school-aged children, from efficacious RCT and small scale community trial to a larger state-wide program. This paper describes the lessons learnt when upscaling to universal health coverage.Methods: The 6-month, family-focussed program was delivered in Queensland, Australia from 2013 to 2016. Its implementation was planned by researchers who developed the program and conducted the RCT, and experienced project managers and practitioners across the health continuum. The intervention targeted parents as the agents of change and was delivered via parent-only group sessions. Concurrently, children attended fun, non-competitive activity sessions. Sessions were delivered by facilitators who received standardised training and were employed by a range of service providers. Participants were referred by health professionals or self-referred in response to extensive promotion and marketing. A pilot phase and a quality improvement framework were planned to respond to emerging challenges.Results: Implementation challenges included engagement of the health system; participant recruitment; and engagement. A total of 1513 children (1216 families) enrolled, with 1122 children (919 families) in the face-to-face program (105 groups in 50 unique venues) and 391 children (297 families) in PEACH (TM) Online. Self-referral generated 68% of enrolments. Unexpected, concurrent and, far-reaching public health system changes contributed to poor program uptake by the sector (only 56 [53%] groups delivered by publicly-funded health organisations) requiring substantial modification of the original implementation plan. Process evaluation during the pilot phase and an ongoing quality improvement framework informed program adaptations that included changing from fortnightly to weekly sessions aligned with school terms, revision of parent materials, modification of eligibility criteria to include healthy weight children and provision of services privately. Comparisons between pilot versus state-wide waves showed comparable prevalence of families not attending any sessions (25% vs 28%) but improved number of sessions attended (median = 5 vs 7) and completion rates (43% vs 56%).Conclusions: Translating programs developed in the research context to enable implementation at scale is complex and presents substantial challenges. Planning must ensure there is flexibility to accommodate and proactively manage the system changes that are inevitable over time.