My weight-their weight: eHealth intervention for managing obesity in child care settings

摘要 儿童保育中心─和他们的提供者─是公共卫生努力解决当今肥胖问题的关键合作伙伴 流行病。饮食和体力活动(PA)习惯很早就形成，会影响即刻和长期肥胖 在形成儿童与体重相关的习惯方面，中心和提供者都发挥着关键作用。然而，标准是 以儿童保育为基础的肥胖预防计划的范例主要针对中心主任进行改变 组织一级的政策和做法；未能认识到儿童保育提供者的需求。这些 提供商的肥胖率高得不成比例，研究表明，提供商自己的穷人 饮食和PA行为降低了他们塑造和促进健康生活方式行为的信心和能力 他们照顾的孩子们。然而，关于改善提供者健康的有效性的信息 或者这种改善是否会在儿童保育环境和儿童中引起有意义的变化 对他们的照顾是有限的。利用我们团队的专业知识实施基于证据的行为改变和 减肥干预，拟议的研究将整合基于证据的体重管理干预 为儿童保育提供者提供GO NAPSACC现有的儿童肥胖预防计划(GO NAPSACC+)。 GO NAPSACC+计划将使用群集化随机对照试验进行评估，以评估是否有改善 儿童保育者的健康行为在2-5岁儿童的饮食和PA行为方面产生了有意义的变化 儿童在他们的照料和托儿环境中。我们将招聘84个中心，其中包括168个供应商，672个 2-5岁儿童参加评估。中心将被随机分配到1)标准的围棋 NAPSACC“或2)”Go NAPSACC+“(带有提供商权重管理组件)。结果衡量标准将 评估2-5岁儿童在6个月(主要目标)和12个月时饮食摄入量和PA行为的影响 月份。其次，我们将比较干预对中心实施健康体重的影响 以及在6个月和12个月时对提供者级别的体重、饮食质量和/或PA的影响。粗放式加工 在RE-AIM框架的指导下，分析将记录干预措施的忠实性、挑战和障碍 以有效地实施和利用程序规定的活动。如果成功，调查结果将提供高度的 可实施、可扩展和可持续的战略，将加强幼儿的标准范式 预防肥胖的举措。

ABSTRACT Child care centers ─ and their providers ─ are critical partners in public health efforts to address today’s obesity epidemic. Diet and physical activity (PA) habits are formed early, influencing immediate and long-term obesity risk, and both centers and providers play key roles in forming children’s weight-related habits. Yet, the standard paradigm of child care-based obesity prevention initiatives primarily target only center directors to change organizational-level policies and practices; failing to recognize the needs of the child care providers. These providers suffer disproportionally high prevalence of obesity and research has shown that providers’ own poor eating and PA behaviors reduce their confidence and ability to model and promote healthy lifestyle behaviors to the children in their care. However, information regarding the effectiveness of improving provider health behaviors or whether such improvements elicit meaningful change in the child care environment and the children in their care is limited. Leveraging our team’s expertise with implementing evidence-based behavior change and weight loss interventions, the proposed study will integrate an evidence-based weight management intervention for child care providers into Go NAPSACC’s existing childhood obesity prevention program (Go NAPSACC+). Go NAPSACC+ program will be assessed using a clustered randomized controlled trial to evaluate if improving child care providers’ health behaviors elicit meaningful change in dietary and PA behaviors in 2-5-year-old children in their care and the child care environment. We will recruit 84 centers, including 168 providers, and 672 2–5-year-old children to participate in the evaluation. Centers will be randomly assigned to 1) standard “Go NAPSACC” or 2) “Go NAPSACC+” (with a provider weight management component). Outcome measures will assess impact on dietary intake and PA behaviors of 2-5-year-old children at 6 months (primary aim) and 12 months. Secondarily we will compare the impact of the intervention on centers’ implementation of healthy weight practices and the effect on provider-level weight, diet quality and/or PA at 6 and 12-months. Extensive process analysis, guided by the RE-AIM framework, will document the fidelity of the interventions, challenges and barriers to effective implementation, and use of program specified activities. If successful, findings will provide a highly implementable, scalable, and sustainable strategy that would enhance the standard paradigm of early childhood obesity prevention initiatives.