Testing an Adaptive Implementation Strategy to Optimize Delivery of Obesity Prevention Practices in Early Care and Education Settings

项目总结 食用健康的饮食和保持健康的体重可以有效地预防癌症 和癌症相关的死亡率。早期干预是必要的，以降低以后患癌症的风险 生活。早期护理和教育(欧洲经委会)是预防癌症的一个有希望的环境。 “我们一起激励智能饮食”(WISE)是一项旨在改善幼儿教育儿童饮食的干预措施。明智的 包括4个关键的循证实践(EBP)：(1)实际接触水果和蔬菜，(2)作用 教育工作者的榜样，(3)积极的喂养做法，(4)与水果和蔬菜有关的吉祥物。 WISE的标准实施方法会导致WISE EBPS的次优实施。其他内容 需要实施战略，以提高对EBPS的采用率和忠诚度。 到目前为止，大多数研究都采用了“要么全有要么全无”的方法，将多方面的策略与 没有实施支持的控制组。因此，迫切需要量身定做的优化战略 加强执行支助力度，以应对欧洲经委会的独特挑战和有限的资源。这个 此应用程序的总体目标是确定自适应 执行办法，以改进采用WISE的EBPS，同时也审查执行情况 机械装置。我们的中心假设是，在没有反应的地点增加高强度的策略 转向低强度战略将改善执行情况和健康结果。 具体目标1.确定适应执行战略的有效性 执行支持的强度与低强度的战略相比。使用增强型无响应器 在试验中，我们将比较持续低强度策略和高强度增强策略的效果 战略。我们假设，接受高强度策略的网站将表现优于继续低强度策略的网站- 关于干预保真度的主要结果和次要儿童健康结果的强度战略。 具体目标2.以混合方式审查执行成果的主持人和调解人-- 方法设计。我们将测试组织准备情况和教师作为响应的主持人的经验 实施策略。我们将测试教育工作者对障碍、当地实施环境、 和执行领导，作为战略对执行成果的影响的调解人。 定性数据将探索其他未定量衡量的潜在主持人和调解人。 具体目标3.评估适应性执行战略的增量成本效益。 在这个目标中，我们将估计与自适应实施战略相关的单位保真度成本。 结果还将确定应用自适应战略的增量成本效益 继续实施低强度战略，以改善BMI和其他儿童健康结果。

PROJECT SUMMARY Consuming a healthy diet and maintaining a healthy weight provide significant protection against cancer and cancer-related mortality. Early interventions are needed to decrease the risk of developing cancer later in life. Early care and education (ECE) is a promising setting for cancer prevention. “Together, We Inspire Smart Eating” (WISE) is an intervention that improves children's diets in ECE. WISE includes 4 key evidence-based practices (EBPs): (1) hands-on exposures to fruits and vegetables, (2) role modeling by educators, (3) positive feeding practices, and (4) a mascot associated with fruits and vegetables. Standard implementation approaches to WISE result in suboptimal implementation of WISE EBPs. Additional implementation strategies are needed to increase adoption and fidelity to EBPs. To date, most studies have employed an “all-or-nothing” approach, comparing multifaceted strategies to control groups without implementation support. Thus, there is an urgent need for optimized strategies that tailor implementation support intensity to the unique challenges and limited resources of the ECE context. The overall objectives of this application are to determine the effectiveness and cost-effectiveness of an adaptive implementation approach to improve adoption of the EBPs of WISE while also examining implementation mechanisms. Our central hypothesis is that the addition of high-intensity strategies at sites that do not respond to low-intensity strategies will improve implementation and health outcomes. Specific Aim 1. Determine the effectiveness of an adaptive implementation strategy that tailors the intensity of implementation support versus a low-intensity strategy. Using an enhanced non-responder trial, we will compare the effect of continuing low-intensity strategies vs. augmenting with high-intensity strategies. We hypothesize that sites receiving high-intensity strategies will outperform sites continuing the low- intensity strategies on the primary outcome of intervention fidelity and on secondary child health outcomes. Specific Aim 2. Examine moderators and mediators of implementation outcomes in a mixed- methods design. We will test organizational readiness and teacher experience as moderators of response to the implementation strategies. We will test educators' perceptions of barriers, local implementation climate, and implementation leadership as mediators of the effect of the strategies on implementation outcomes. Qualitative data will explore other potential moderators and mediators not measured quantitatively. Specific Aim 3. Assess the incremental cost-effectiveness of the adaptive implementation strategy. In this aim, we will estimate the cost per unit of fidelity associated with the adaptive implementation strategy. Results will also determine the incremental cost-effectiveness of applying the adaptive strategy compared to continuing low-intensity strategies for improving BMI and other child health outcomes.