An Individually Tailored, Family-Centered Intervention for Childhood Obesity: Connecting Services in Pediatric Primary Healthcare, the Home, and the Community

针对儿童肥胖的个性化定制、以家庭为中心的干预措施：将儿科初级保健、家庭和社区的服务联系起来

• 批准号: 9280858
• 负责人: Cady Berkel
• 金额: $ 209.97万
• 依托单位: ARIZONA STATE UNIVERSITY-TEMPE CAMPUS
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-06-01 至 2018-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9280858
• 关键词: Individually; Tailored; Family; Centered; Intervention

PROJECT SUMMARY Pediatric obesity is a multifaceted public health concern. Nearly one-third of children with obesity, defined as a body mass index (BMI) ≥ 95th percentile for age and gender, exhibit cardiometabolic risk factors (CRF), which are associated with accelerated cardiovascular disease, many cancers, and morbidity. Small changes in diet, weight loss, or physical activity can significantly reduce risk for CRF. Although evidence-based interventions delivered by healthcare providers (physicians, nurses, dieticians) exist for the prevention of pediatric obesity for high-risk youth, low participation rates and program availability, as well as nonadherence to recommendations, are significant barriers to positive outcomes. Although they are not widely used, family-centered behavioral interventions are an evidence-based approach that has been found to significantly prevent obesity in children and adolescents. The proposed study uses an adaptation of the Family Check-Up (FCU) to target health behavior (HB) change, termed the FCU-HB program, in youth with elevated BMI. Extensive data support the original FCU's efficacy in improving child outcomes across domains of health and functioning, including the prevention of obesity, through family-level mechanisms of action. The FCU-HB is an assessment-driven approach to tailoring services and increasing motivation to address the behavioral health needs of overweight and obese children and their families. We will conduct a pragmatic randomized trial to test the effects of the FCU-HB program in pediatric primary care with a multiethnic sample of 350 families with children ages 6 to 12 years who are identified as obese (BMI≥95th percentile) or overweight (BMI≥85th percentile) with risk identified through the electronic health records (EHR). The FCU-HB will be coordinated with care in three primary care clinics: the general pediatrics clinic at Phoenix Children's Hospital and two federally qualified health centers. All three clinics serve predominantly Medicaid patients and a large ethnic minority population of Mexican Americans and American Indians, who face disparities in pediatric obesity, CRF, and access to care when compared with Non-Latino Whites. Consistent with the literature, providers have reported barriers to pediatric obesity treatment with respect to family functioning, motivation, and adherence to recommendations. The FCU- HB was designed to reduce BMI by improving family engagement and behavioral health practices. This trial aims to facilitate sustainability and scale up. Community and scientific boards will provide guidance on study and program design to ensure the program achieves this aim and is found to improve children's weight. We will use a multi-method and multi-informant assessment strategy including EHR data, behavioral observation, questionnaires, and interviews to assess the impact of the FCU-HB on BMI as a primary outcome, child health behaviors, parenting, and service utilization. We will also assess implementation outcomes, including acceptability, adoption, feasibility, appropriateness, fidelity, and cost, which will provide actionable information for sustainable delivery in other healthcare systems.

项目摘要 儿童肥胖是一个多方面的公共卫生问题。近三分之一的肥胖儿童，定义为 体重指数（BMI）≥年龄和性别的第95百分位数，表现出心脏代谢风险因素（CRF）， 与加速心血管疾病、许多癌症和发病率有关。饮食上的小变化， 体重减轻或体力活动可以显著降低CRF的风险。虽然基于证据的干预措施 由医疗保健提供者（医生，护士，营养师）提供的用于预防儿童肥胖的药物， 高风险青年、低参与率和方案可用性，以及不遵守建议， 是取得积极成果的重大障碍。虽然它们没有被广泛使用，但以家庭为中心的行为 干预措施是一种循证方法，已被发现可显著预防儿童肥胖 和青少年。拟议的研究采用了适应家庭检查（FCU），以目标健康 行为（HB）的变化，称为FCU-HB计划，在青年与BMI升高。大量数据支持 最初的FCU在改善儿童健康和功能领域的成果方面的功效，包括 通过家庭一级的行动机制预防肥胖。FCU-HB是一个评估驱动的 量身定制服务的方法，并增加解决超重行为健康需求的动力 肥胖儿童和他们的家庭。我们将进行一项实用的随机试验，以测试 儿科初级保健中的FCU-HB计划，包括350个6至12岁儿童家庭的多种族样本 被确定为肥胖（BMI ≥第95百分位数）或超重（BMI ≥第85百分位数）且存在已确定风险的 电子健康记录（EHR）。FCU-HB将与三个初级保健中心的护理协调 诊所：凤凰城儿童医院的普通儿科诊所和两个联邦合格的健康中心。所有 三家诊所主要为医疗补助患者和大量墨西哥少数民族人口提供服务。 美国人和美国印第安人，他们在儿童肥胖、CRF和获得护理方面面临着差异， 与非拉丁裔白人相比。与文献一致，供应商报告了儿科 肥胖治疗与家庭功能、动机和坚持建议有关。FCU- HB旨在通过改善家庭参与和行为健康实践来降低BMI。本试验 旨在促进可持续性和扩大规模。社区和科学委员会将提供学习指导 和程序设计，以确保该计划达到这一目的，并发现改善儿童的体重。我们将 使用多方法和多信息评估策略，包括EHR数据，行为观察， 问卷调查和访谈，以评估FCU-HB对BMI的影响，作为主要结局，儿童健康 行为、养育和服务利用。我们还将评估实施成果，包括 可接受性、采用性、可行性、适当性、忠实性和成本，这些将提供可操作的信息 在其他医疗保健系统中实现可持续发展。

项目成果

Race/Ethnicity, Dietary Acid Load, and Risk of End-Stage Renal Disease among US Adults with Chronic Kidney Disease.

• DOI: 10.1159/000487715
• 发表时间: 2018
• 期刊: American journal of nephrology
• 影响因子: 4.2
• 作者: Crews DC;Banerjee T;Wesson DE;Morgenstern H;Saran R;Burrows NR;Williams DE;Powe NR;Centers for Disease Control and Prevention Chronic Kidney Disease Surveillance Team
• 通讯作者: Centers for Disease Control and Prevention Chronic Kidney Disease Surveillance Team

An individually tailored family-centered intervention for pediatric obesity in primary care: study protocol of a randomized type II hybrid effectiveness-implementation trial (Raising Healthy Children study).

• DOI: 10.1186/s13012-017-0697-2
• 发表时间: 2018-01-15
• 期刊: Implementation science : IS
• 作者: Smith JD;Berkel C;Jordan N;Atkins DC;Narayanan SS;Gallo C;Grimm KJ;Dishion TJ;Mauricio AM;Rudo-Stern J;Meachum MK;Winslow E;Bruening MM
• 通讯作者: Bruening MM

Baseline Targeted Moderation in a Trial of the Family Check-Up 4 Health: Potential Explanations for Finding Few Practical Effects.

家庭检查 4 健康试验中的基线目标调节：几乎没有发现实际效果的潜在解释。

• DOI: 10.1007/s11121-021-01266-z
• 发表时间: 2023
• 期刊: Prevention science : the official journal of the Society for Prevention Research
• 作者: Smith,JustinD;Carroll,AllisonJ;Fu,Emily;Berkel,Cady
• 通讯作者: Berkel,Cady

Motivational Interviewing and Caregiver Engagement in the Family Check-Up 4 Health.

在家庭检查4健康方面的动机面试和照料者参与。

• DOI: 10.1007/s11121-020-01112-8
• 发表时间: 2021-08
• 期刊: Prevention science : the official journal of the Society for Prevention Research
• 作者: Berkel C;Mauricio AM;Rudo-Stern J;Dishion TJ;Smith JD
• 通讯作者: Smith JD

Health behaviour outcomes of a family based intervention for paediatric obesity in primary care: A randomized type II hybrid effectiveness-implementation trial.

初级保健中儿童肥胖家庭干预的健康行为结果：一项随机 II 型混合有效性实施试验。

• DOI: 10.1111/ijpo.12780
• 发表时间: 2021
• 期刊: Pediatric obesity
• 影响因子: 3.8
• 作者: Smith,JustinD;Berkel,Cady;Carroll,AllisonJ;Fu,Emily;Grimm,KevinJ;Mauricio,AnneM;Rudo-Stern,Jenna;Winslow,Emily;Dishion,ThomasJ;Jordan,Neil;Atkins,DavidC;Narayanan,ShrikanthS;Gallo,Carlos;Bruening,MegM;Wilson,Charlton