Packaging and Disseminating the JOIN for ME Program in Low-Income Settings

项目概要/摘要 儿童和青少年超重/肥胖症的流行仍然是公共卫生的优先事项。 一个趋同的证据支持全面的以家庭为基础的生活方式的方法， 治疗儿童肥胖症，如美国预防服务工作组（USPSTF）B级所示 建议临床医生将已确定的青少年转介到此类方案。尽管有这一行动呼吁， 大多数与肥胖作斗争的儿童无法获得循证护理。最紧迫的 低收入家庭的年轻人最需要，他们肥胖的风险最大， 在乎通过社区环境提供干预措施是增加获得机会的一项战略。联接 作为联合健康集团和Y-美国之间的合作开发的ME计划，是一项儿科体重 可以在社区环境中提供的管理干预措施，有可能在全国推广。 与经验支持的以家庭为基础的干预措施相一致，“为我加入”计划包括强有力的 父母的参与，使用有效的行为策略，如自我监控，以及干预目标 重点是减少高能量、营养不良的食品和饮料的消费， 久坐行为和增加体力活动。开放试验（N=115）和后续试验的结果 一项随机对照试验（N=75）显示， 6-12岁儿童;超重百分比下降4.3%和5.5%。 我们建议将JOIN for ME计划打包，以提高交付的可接受性和可行性， 低收入社区和测试实施两个新的设置：房屋委员会和病人- 中心医疗之家修订后的JOIN for ME包将在严格的实施研究中进行测试， 其目标是：1）检查计划可接受性，可行性，保真度， 通过对过程措施、定性数据和成本分析的综合评估， 和2）评估患者结果，包括儿童和父母体重状况的变化以及健康相关的 生活质量（HRQL）。共有128名来自低收入家庭的BMI > 85th%的儿童（6-12岁）， 一名主要护理人员将被登记参加通过以下四种方式之一提供的JOIN for ME计划： 使用延迟治疗开始设计的设置。我们将评估一系列实施成果， 通过过程测量和多信息提供者检查可及性、可接受性和可行性的结构 定性访谈。据推测，首先接受JOIN for ME计划的儿童将 显示出比中位BMI更大的百分比下降和HRQL的更大改善， 延迟治疗的患者在4个月后接受干预。实施和有效性 将与社区和付款人咨询委员会一起汇编、检查和审查结果， 计划大规模推广JOIN for ME计划。

PROJECT SUMMARY/ABSTRACT The prevalence of overweight/obesity among children and adolescents remains a public health priority. A convergence of evidence supports the efficacy of comprehensive family-based lifestyle approaches for the treatment of pediatric obesity, as reflected in the U.S. Preventive Services Task Force (USPSTF) Grade B recommendation for clinicians to refer identified youth to such programs. Despite this call to action, the vast majority of children struggling with obesity do not have access to evidence-based care. The most pressing need is in youth from low-income families, who are at greatest risk of obesity and least likely to have access to care. Delivering interventions through community settings offers one strategy for increasing access. The JOIN for ME program, developed as a collaboration between United HealthGroup and Y-USA, is a pediatric weight management intervention that can be delivered in community settings, with potential for national dissemination. Consistent with empirically supported family-based interventions, the JOIN for Me program includes strong parental involvement, use of effective behavioral strategies such as self-monitoring, and intervention targets that focus on reducing consumption of energy dense, nutrient poor foods and beverages, decreasing sedentary behavior, and increasing physical activity. Findings from an open trial (N=115) and subsequent randomized controlled trial (N=75) demonstrate significant and meaningful reductions in weight status in children 6-12 years of age; 4.3% and 5.5% decrease in percent overweight. We propose to package the JOIN for ME program to increase acceptability and feasibility for delivery in low-income communities and test implementation in two novel settings: the housing authority and the patient- centered medical home. The revised JOIN for ME package will be tested in a rigorous implementation study, the goals of which are to: 1) examine key implementation metrics of program acceptability, feasibility, fidelity, reach, and cost through comprehensive assessment of process measures, qualitative data, and cost analyses and 2) evaluate patient outcomes, including changes in child and parent weight status and health-related quality of life (HRQL). A total of 128 children (ages 6-12 years) with BMI > 85th% from low-income families and a primary caregiver will be enrolled to participate in the JOIN for ME program offered through one of four settings using a delayed treatment onset design. We will evaluate a series of implementation outcomes to examine constructs of reach, acceptability and feasibility through process measures and multi-informant qualitative interviews. It is hypothesized that children who receive the JOIN for ME program first will demonstrate greater decrease in percent over median BMI and greater improvements in HRQL than those in the delayed treatment onset who receive the intervention four months later. Implementation and effectiveness outcomes will be compiled, examined, and reviewed with Community and Payer Advisory Boards to develop a plan for large scale dissemination of the JOIN for ME program.