A Rigorous Application of the RE-AIM Framework to Examine a Pediatric Obesity Intervention

项目总结/摘要 儿童肥胖症是一种终身慢性疾病，缩短了预期寿命，使其成为一种公共卫生问题。 要务农村儿童超重/肥胖率高于城市儿童， 三分之一，获得治疗选择的机会有限。即使参与治疗干预， 根据专家指南，高达76%的参与者可能无法成功保持或减少他们的身体 质量指数z评分（BMIz）。至关重要的是，我们的治疗方案对个人有效， 很容易就能送到农村地区。因此，本研究的目的是了解 与儿童肥胖干预成功相关的农村人口特有的因素， 个人和地点（学校）一级。这将通过严格应用RE-AIM框架来实现， 检查个人的有效性和干预措施的实施，以儿科肥胖治疗间， 预防。我们将通过两个独特的目标来实现这一目标;目标1将调查两个新的个人水平的预， 久坐行为的参与和改变对治疗成功的影响（降低BMIz）。这一目标将使用 数据收集自农村地区两项随机儿童肥胖临床试验（N = 105）的干预组 由Dr. Davis（主要申办者）进行。干预措施包括录像的小组会议; 这些视频将被编码，以应用我们的一种新的参与度衡量标准，即小组参与度衡量标准， 当然。此外，我们将分析久坐行为的变化（在基线和干预后收集）。 参与和久坐行为的变化将被添加到具有参与者的典型预测因子的模型中 成功;预计新模型比仅使用典型预测因子的模型更好地预测成功。目的2 将系统地确定现场（学校）层面的背景因素，包括障碍和促进因素，并测试其 与成功的网站级实施的关联。为了实现目标2，我们将邀请现场（学校）代表- 参与半结构化访谈，以了解与学习相关的障碍和促进因素， 执行顺利。代表将根据干预措施的通过情况分为三类： 在他们的研究中心：1）没有采用2）最初采用或3）采用干预措施。本研究的培训目标 （1）发展和应用与干预和实施研究设计有关的战略技能， 方法学（临床试验，实施科学，定性方法和行为编码），2）进步 能量平衡培训，包括久坐行为分析和营养测量方法， 分析，3）提高多层次建模的统计技能，以及4）提高专业发展技能 在科学写作和展示研究中。拟议中的项目将通过研究各种因素来推进研究 在个体有效性水平和研究中心水平上有助于儿科干预的成功 可伸缩性此外，这项研究将推进Forseth博士（申请人）的培训，并加强她的知识 和技能，成为一个独立资助的研究人员在该地区的儿童肥胖研究。

PROJECT SUMMARY/ABSTRACT Pediatric obesity contributes to life-long chronic diseases and shortened life expectancy, making it a public health priority. Rural children have disproportionately higher rates of overweight/obesity compared to their urban coun- terparts and have limited access to treatment options. Even when participating in a treatment intervention created from expert guidelines, up to 76% of participants may not be successful at maintaining or reducing their body mass index z-score (BMIz). It is critical that we have treatment programs that are effective for individuals and are easily delivered and adopted to rural areas. Therefore, the objective of the current study is to understand factors specific to rural populations that are related to success of pediatric obesity interventions at both the individual and site (school)-level. This will be done through rigorously applying the RE-AIM framework, which examines both individual effectiveness and intervention implementation, to a pediatric obesity treatment inter- vention. We will accomplish this through two unique aims; Aim 1 will investigate two novel individual-level pre- dictors, engagement and change in sedentary behavior, on treatment success (reducing BMIz). This aim will use data collected from intervention arms of two randomized pediatric obesity clinical trials (N = 105) in rural areas conducted by Dr. Davis (primary sponsor). The intervention included group-sessions that were video recorded; these videos will be coded for our application of a novel measure of engagement, the Group Engagement Meas- ure. Additionally, we will analyze change in sedentary behavior (collected at both baseline and post intervention). Engagement and change in sedentary behavior will be added into a model with typical predictors of participant success; the new model is expected to predict success better than a model using only typical predictors. Aim 2 will systematically identify site (school)-level contextual factors, including barriers and facilitators, and test their associations with successful site-level implementation. To address Aim 2, we will invite site (school) represent- atives to participate in a semi-structured interview to understand barriers and facilitators associated with suc- cessful implementation. Representatives will fall into one of three categories based on adoption of the interven- tion at their site: 1) did not adopt 2) initially adopted or 3) adopted the intervention. Training goals for this study are to: 1) develop and apply strategic skills related to intervention and implementation research designs and methodology (clinical trials, implementation science, qualitative methods and behavioral coding), 2) advance training in energy balance, including sedentary behavior analysis and nutritional measurement methods and analyses , 3) advance statistical skills for multi-level modeling, and 4) enhance professional development skills in scientific writing and presenting research. The proposed project will advance research by examining factors that contribute to the success of pediatric interventions, at an individual level of effectiveness and at site-level scalability. Further, this research will advance Dr. Forseth’s (applicant) training and strengthen her knowledge and skillset to become an independently funded investigator in the area of pediatric obesity research.