TRANSLATING A WEIGHT LOSS INTERVENTION THROUGH A NATIONAL HOME VISITING PROGRAM

描述（由申请人提供）：背景。肥胖女性患2型糖尿病的可能性是保持苗条体重的女性的80倍。代际肥胖很常见，母亲肥胖是幼儿超重的一个重要危险因素。糖尿病预防计划（DPP）确定了通过改变生活方式实现减肥的策略，但将其转化为现实世界的环境仍然具有挑战性。目标。本研究将测试“健康饮食与积极生活在家教学”（HEALTH），该研究将DPP生活方式干预融入到“家长当老师”（PAT）的全国家访计划中。家长教育工作者将通过36次家访、24次小组会议和18次助推器电话，向超重/肥胖学龄前儿童的肥胖母亲提供健康服务。我们的主要假设是，健康组的参与者将在12个月时实现7%的体重减轻，并在24个月时保持5%的体重减轻，这将至少是常规护理对照组的两倍。次要目标将确定健康参与者的“母亲对孩子”行为的改善是否将解释参与者超重/肥胖学龄前儿童体重轨迹的全部或部分变化。广泛的项目评估将处理外部有效性的要素。方法与评价。在基线、12个月和24个月收集数据的两组随机嵌套队列设计将评估随机分配到接受标准PAT计划的对照点（N=8个点，128名参与者）或接受健康的干预点（N=8个点，128名参与者）的参与者的体重、临床和行为结果。评估将包括覆盖面和代表性、实施和适应、决策结果、维护和制度化以及成本等要素。创新。该建议将克服翻译障碍，优化循证实践与实践环境之间的契合。《健康》有可能在所有50个州向2200个PAT站点和9600名教育工作者传播，覆盖大约58 000名肥胖母亲和儿童。

DESCRIPTION (provided by applicant): Background. Obese women are 80 times more likely to develop Type 2 diabetes than those who maintain a lean weight. Intergenerational obesity is common, with maternal obesity a strong risk factor for the development of overweight in young children. The Diabetes Prevention Program (DPP) identified strategies for achieving weight loss through lifestyle change, but translation to real world settings remains challenging. Aims. This study will test Healthy Eating & Active Living Taught at Home (HEALTH), which adapts and integrates the DPP lifestyle intervention within Parents As Teachers (PAT), a national home visiting program. HEALTH will be delivered by parent educators to obese mothers of overweight/obese preschoolers through 36 home visits, 24 group meetings, and 18 booster telephone calls. Our primary hypothesis is that participants in HEALTH will achieve a 7% weight loss at 12 months and maintain a 5% weight loss at 24 months, which will be at least two-fold greater than that achieved in the usual care control group. Secondary aims will determine whether improvements in 'mother to child' behaviors of HEALTH participants will explain all or part of changes in the weight trajectory of the participant's overweight/obese preschool child. An extensive program evaluation will address elements of external validity. Methods and Evaluation. A two group randomized nested cohort design with data collected at baseline, 12, and 24 months, will evaluate weight, clinical, and behavioral outcomes of participants randomized to either control sites (N=8 sites; 128 participants) receiving the standard PAT program or intervention sites (N=8 sites; 128 participants) receiving HEALTH. Evaluation will include elements of reach and representativeness, implementation and adaptation, decision making outcomes, maintenance and institutionalization, and cost. Innovation. This proposal will overcome translational barriers and optimize the fit between evidence-based practice and the practice context. HEALTH has the potential for dissemination across all 50 states to 2200 PAT sites and 9600 educators reaching approximately 58,000 obese mothers and children.