Sustainability of Nutrition and Physical Activity Interventions in Childcare

项目摘要 消费健康的饮食，从事体力活动（PA），并保持健康的体重9，12，13提供 显著预防癌症和癌症相关死亡率。考虑到早期的生活模式 成年后，14，15需要早期干预，以降低以后患癌症的风险。 儿童保育方面的干预措施有望促进健康约会、PA和预防肥胖。 执行科学主要侧重于提高方案初步采用率的战略。 然而，很少有证据表明，战略，可以有效地促进方案的可持续性。在 事实上，可能需要采取不同的方法来促进循证医学的初步吸收和长期使用， 在社区设置的方案。进展的一个关键障碍是，我们不完全了解哪些因素 预测可持续性，18，20，这种知识差距构成了我们目前工作的前提。 该项目的总体目标是确定整个系统的保真度和可持续性的预测因素。 针对儿童保育环境的两个营养/PA方案，以确定成功的可持续性战略 从那些依靠自己持续发展的项目中，并利用学到的经验教训来发展可持续性 以利益相关者的投入为基础的战略。这两个节目-食物朋友21-24和在一起，我们共同努力 智能饮食（智慧）25-28-是美国农业部资助的营养教育和PA计划。Food Friends最多有20个 WISE在该领域的使用时间长达6年，但使用量正在下降; WISE长达6年，使用量正在增加。像其他项目一样， 这两个团队都没有研究为什么有些设置在最初采用后继续使用程序，而另一些设置则继续使用程序 没有为了实现我们的目标，我们提出了两个具体目标： 具体目标1：确定与儿童保育环境中持续营养/PA计划相关的因素。 我们将使用解释性的顺序混合方法设计（a）收集调查数据并进行 多变量分析，以了解可持续性的预测因素，以及（B）进行现场访问，以执行关键的 采访知情人并验证自我报告的可持续性;确定环境贡献者， 可持续性;并记录方案调整。我们还将与外部利益相关者进行访谈 了解影响营养/PA计划支持的决策。 具体目标2：在利益相关者的投入下制定多方面的可持续发展战略。 我们将利用循证质量改进（EBQI）会议30 -32， 制定一项多组成部分的可持续性战略。目标1中关于可持续性预测因素的数据， 可持续性高的场地的创新将用于为业主选定的战略提供信息。 这项工作将提供对支持可持续发展和生产的因素的基本了解 重要的信息，以推动更广泛的可持续性研究。

Project Summary Consuming a healthy diet, engaging in physical activity (PA), and maintaining a healthy weight9,12,13 provide significant protection against cancer and cancer-related mortality. Given that early life patterns track into adulthood,14,15 early interventions are needed to decrease the risk of developing cancer later in life. Interventions in childcare are promising to promote healthy date, PA and obesity prevention. Implementation science has largely focused on strategies for increasing the initial adoption of programs.19 However, there is little evidence for strategies that may effectively promote the sustainability of programs. In fact, different approaches may be needed to promote the initial uptake and long-term use of evidence-based programs in community settings. A critical barrier to progress is that we do not fully understand what factors predict sustainability,18,20 and this gap in knowledge forms the premise of our current work. The overarching goals of this project are to identify predictors of fidelity and sustainability across two nutrition/PA programs for the childcare setting, to identify successful sustainability strategies from programs who have sustained on their own, and use lessons learned to develop sustainability strategies based with stakeholder input. The two programs—Food Friends 21–24 and Together, We Inspire Smart Eating (WISE)25–28—are USDA-funded nutrition education and PA programs. Food Friends has up to 20 years in the field, but use is declining; WISE has up to 6 years, and use is increasing. Like other programs, neither team has studied why some settings continue to use a program after initial adoption, while others do not. Toward our goals, we propose two specific aims: Specific Aim 1: Identify factors associated with sustaining nutrition/PA programs in childcare settings. We will use an explanatory, sequential mixed-methods design to (a) collect survey data and conduct multivariate analyses to understand predictors of sustainability and (b) conduct site visits to perform key informant interviews and validate self-reports on sustainability; identify environmental contributors to sustainability; and document program adaptations. We will also conduct interviews with external stakeholders to understand decisions affecting support for nutrition/PA programs. Specific Aim 2: Develop a multi-faceted sustainability strategy with stakeholder input. We will use evidence-based quality improvement (EBQI) sessions30–32 to engage stakeholders in developing a multi-component sustainability strategy. Data from Aim 1 on the predictors of sustainability and innovation from sites with high sustainment will be used to inform stakeholder-selected strategies. This work will provide a foundational understanding of factors that support sustainability and produce essential information to advance the study of sustainability more broadly.