Developing and Testing Implementation Strategies for Evidence-Based Obesity Prevention in Childcare

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Project Summary Dr. Swindle is an outstanding candidate for a NIDDK Mentored Research Scientist Development Award. She is an Assistant Professor of Family and Preventive Medicine with a strong background of training and experience. She has a Master of Science degree in Human Development and Family Sciences and a Doctoral Degree in Educational Psychology. She has held leadership roles in obesity-related research efforts for over 8 years and has 18 publications related to child health and development. At present, she is pursuing a Master of Science in Clinical Nutrition with an anticipated graduation date of December 2016. Dr. Swindle's previous research illustrates a commitment to serving at-risk populations through research. Recently, she has studied the personal characteristics and beliefs of early childcare educators that may influence their ability to implement and sustain best child nutrition practices in their classrooms. She has also been a Co-Investigator on a USDA-funded effort to develop and evaluate WISE (Together, We Inspire Smart Eating), an evidence-based obesity prevention and nutrition promotion for childcare settings. This study will build logically upon that work. The proposed research plan has three specific aims: (1) Identify factors associated with degree of fidelity in a previously developed and tested basic implementation strategy of WISE; (2) Develop an enhanced implementation strategy to support uptake of the WISE intervention using stakeholder input; and (3) Pilot test the enhanced implementation strategy on implementation and child health outcomes using formative evaluation. To execute these aims, we will use innovative methodologies including an explanatory mixed methods approach (Aim 1), a stakeholder-driven Evidence-Based Quality Improvement (EBQI) process (Aim 2), and a Hybrid Type 3 implementation design using formative evaluation (Aim 3). We expect that implementation strategies developed with stakeholders will lead to improved implementation fidelity. We will test the hypothesis that improved WISE fidelity is positively related to child outcomes (e.g., child fruit and vegetable intake, BMI). This research will provide critical knowledge on the value of investments in implementation support strategies to existing obesity prevention interventions The career development objectives will complement the proposed research aims in three distinct areas. Dr. Swindle will advance her expertise and skills in (1) Implementation Science (2) Child and community nutrition, and (3) Community Engagement. Dr. Swindle has proposed a comprehensive plan of mentored research, didactic education, cross-disciplinary collaborations, and structured field studies to achieve competency in these areas. The activities of the career development plan will integrate effectively with her research plan and support her research activities. The University of Arkansas for Medical Sciences (UAMS) will provide the ideal environment to support the proposed career development and research activities. UAMS has already supported Dr. Swindle's career success through the provision of a KL2 award through the Translational Research Institute (TRI; UAMS CTSA). The TRI will continue to provide training, equipment, consultation, and mentoring to Dr. Swindle. Further, the Center for Implementation Research (CIR) at UAMS led by Dr. Swindle's primary mentor will provide a supportive context for her career development and mentored research experience in Implementation Science. Dr. Swindle also has the full backing of her department (Family and Preventive Medicine) which will continue to provide office space, protected time, equipment, and professional development funds. The candidate's primary mentor, Dr. Geoffrey Curran, is a nationally-recognized expert in Implementation Science. Co-mentor, Dr. Susan Johnson is well known for her expertise in child nutrition and child feeding, particularly in childcare settings. Further, Dr. Swindle will build on the mentoring relationship she has had with Dr. Leanne Whiteside-Mansell for the last 5 years in community-based intervention for children impacted by poverty. These mentors have the experience and knowledge needed to mentor Dr. Swindle to independence. Together, the research strategy, career development objectives, and mentoring plan will support Dr. Swindle's achievement of her short-term goal of establishing independence as an investigator in obesity prevention efforts in childcare. This award will also lay the foundation for the accomplishment of her long-term career goal of becoming a leader in the study of factors that promote or hinder successful uptake and sustainability of obesity prevention efforts in real world settings.