A hybrid effectiveness-implementation trial of Go NAPSACC: a childcare-based obesity prevention program

摘要 儿童保育环境在塑造许多幼儿的饮食和体育活动习惯方面发挥着重要作用。这些 计划可以通过提供健康食品和限制获得不健康食品，整合时间， 积极发挥，限制屏幕时间，提供健康的榜样，并教孩子们的知识和技能 需要选择健康的生活方式解决儿童肥胖问题的国家努力越来越多地要求儿童保育 实施这些循证实践的方案;然而，遵守情况仍然很低。实施研究 这是帮助推进以儿童保健为基础的健康促进和肥胖预防工作的关键下一步。的 拟议的研究（作为对健康传播和实施研究的回应，PAR-16-238）将 使用随机对照试验和混合有效性-实施设计来评估 Go NAPSACC对中心实施循证实践的影响，并评估其覆盖范围，采用率， 实现和维护，可以通过增强与基本实现模型来实现。我们将瞄准 肯塔基州的儿童保育中心，该州是美国儿童肥胖率第六高的州。 肯塔基州卫生部和他们现有的八个区域技术援助（TA）提供者招募97名儿童 护理中心（每个地区约12个中心）。提供增强型Go NAPSACC的区域TA提供商将整合步骤 质量执行框架，以支持儿童保育的一般和具体干预能力建设 中心，这是假设，以改善基于证据的最佳做法的实施。结果，以 RE-AIM和实施研究综合框架将评估中心的证据实施情况- 基于实践，在儿童保育期间儿童的饮食质量和身体活动的变化，Go NAPSACC的标志 实施、影响实施的背景因素和成本。

ABSTRACT Child care settings play a significant role in shaping the eating and physical activity habits of many young children. These programs can foster healthy behaviors by serving healthy foods and limiting access to unhealthy foods, integrating time for active play, limiting screen time, providing healthy role models, and teaching children the knowledge and skills needed to make healthy lifestyle choices. National efforts to address childhood obesity increasingly call upon child care programs to implement these evidence-based practices; however, compliance remains low. Implementation studies represent a critical next step in helping to advance child care-based health promotion and obesity prevention efforts. The proposed study (submitted in response to Dissemination and Implementation Research in Health, PAR-16-238), will address these gaps using a randomized controlled trial and hybrid effectiveness-implementation design to evaluate the impact of Go NAPSACC on centers' implementation of evidence-based practices and assess the reach, adoption, implementation, and maintenance that can be achieved with an Enhanced vs. Basic implementation model. We will target child care centers in Kentucky, the state with the sixth highest rate of child obesity in the U.S. We will work with The Kentucky Department of Health and eight of their existing regional technical assistance (TA) providers to recruit 97 child care centers (~12 centers per region). Regional TA providers delivering Enhanced Go NAPSACC will integrate steps from the Quality Implementation Framework to support general and intervention-specific capacity building by child care centers, which are hypothesized to improve the implementation of evidence-based best practices. Outcomes, guided by RE-AIM and Consolidated Framework for Implementation Research, will assess centers' implementation of evidence- based practices, changes in the diet quality and physical activity of children while at child care, markers of Go NAPSACC implementation, contextual factors influencing implementation, and costs.