Adaptive Implementation & Costs of Obesity Prevention in Early Care and Education

在优化欧洲经委会预防肥胖症方面存在两个重大差距：1)缺乏适应执行支助交付强度的适应性执行战略；2)关于欧洲经委会预防肥胖症和促进营养努力的成本效益的文献有限。该应用程序的总体目标是收集利益攸关方对欧洲经委会预防肥胖症的适应性执行战略和可接受的成本效益阈值的具体规定的看法。为此，我们将一起关注循证营养计划，我们激励智能饮食(WISE)。与欧洲经委会的通常做法相比，WISE显示，儿童在家中水果和蔬菜的消费量增加，类胡萝卜素的摄入量有所改善，快餐和含糖饮料的消费量减少。我们先前的工作表明，对于WISE来说，由8个独立的、利益攸关方选定的一揽子实施战略优于基本的实施办法(即，培训和提醒)。鉴于现实世界中的可行性和潜在的高昂成本，可能不可能在未来向所有地点提供所有实施战略；此外，实现预期结果可能不需要所有战略。此外，关于WISE成本的数据还没有得到审查。今后的研究将需要基线比较数据，以便在没有执行战略支助的情况下了解WISE的成本和成本效益，以便了解诸如适应性办法等执行战略的相对效益。我们将通过在目标1中对教育工作者和主要利益攸关方进行开放式访谈以及在目标2中进行成本效益分析来解决这些差距。

There are two crucial gaps to optimizing obesity prevention in ECE: 1) the lack of adaptive implementation strategies that tailor the intensity of implementation support delivery and 2) limited literature surrounding cost-effectiveness of obesity prevention and nutrition promotion efforts in ECE. The overarching goal of this application is to gather stakeholder perspectives on specification of an adaptive implementation strategy and acceptable cost-effectiveness thresholds for obesity prevention in ECE. To this end, we will focus on the evidence-based nutrition program Together, We Inspire Smart Eating (WISE). Compared to usual practices in ECE, WISE has demonstrated an increase in fruit and vegetable consumption at home for children, improvements in carotenoid intake, and reductions in fast food and sugar sweetened beverage consumption. Our prior work that a package of 8 discrete, stakeholder-selected implementation strategies outperformed a basic implementation approach (i.e., training an reminders) for WISE. Given feasibility and potential prohibitive costs in the real-world, it is likely not possible to provide all implementation strategies to all sites in the future; in addition, all strategies may not be necessary to achieve the desired outcomes. Further, data on costs of WISE have not been examined. Future studies will need baseline comparator data to understand the costs and cost effectiveness of WISE without implementation strategy support to understand the relative benefit of implementation strategies such as adaptive approaches. We will address these gaps through open-ended interviews with educators and key stakeholders in Aim 1 as well as a cost effectiveness analysis in Aim 2.