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

摘要 托儿环境在塑造许多幼儿的饮食和身体活动习惯方面发挥着重要作用。这些 项目可以通过提供健康食品和限制不健康食品的获取来培养健康行为，整合时间 对于积极的游戏，限制屏幕时间，提供健康的榜样，并教孩子们知识和技能 需要做出健康的生活方式选择。国家解决儿童肥胖症的努力越来越多地呼吁照顾儿童 实施这些循证做法的方案；然而，遵从性仍然很低。实施研究 在帮助推进以儿童保育为基础的健康促进和肥胖预防工作方面，这是至关重要的下一步。这个 拟议研究(针对传播和实施健康研究提交，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，并评估覆盖范围、采用 实施和维护，可以通过增强的实施模型与基本的实施模型来实现。我们的目标是 肯塔基州的儿童保育中心，该州的儿童肥胖率在美国排名第六。我们将与 肯塔基州卫生局和他们现有的八个地区技术援助(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GO NAPSACC的地区性TA提供商将整合步骤 从质量实施框架到支持儿童保育的一般和针对干预的能力建设 中心，假设这些中心旨在改进循证最佳做法的实施。结果，由 Re-AIM和实施研究综合框架，将评估中心对证据的实施- 基于实践，儿童在托儿所期间饮食质量和体力活动的变化，围棋NAPSACC的标志 执行、影响执行的背景因素和成本。

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.