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

在欧洲经委会中，优化肥胖预防存在两个关键的空白：1)缺乏适应的实施策略，以定制实施支持交付的强度；2)关于欧洲经委会中肥胖预防和营养促进工作的成本效益的文献有限。本应用程序的总体目标是收集利益相关者对欧洲经委会肥胖预防的适应性实施策略和可接受的成本效益阈值的规范的观点。为此，我们将把重点放在以证据为基础的营养项目“我们共同激励明智饮食”（WISE）上。与欧洲经委会的通常做法相比，WISE已经证明，儿童在家中的水果和蔬菜消费量增加，类胡萝卜素摄入量增加，快餐和含糖饮料消费量减少。我们之前的工作表明，一个由8个离散的、利益相关者选择的实施策略组成的包优于WISE的基本实施方法（即培训提醒）。考虑到现实世界的可行性和潜在的高昂成本，将来可能不可能为所有站点提供所有的实施策略；此外，并非所有策略都能达到预期的结果。此外，关于WISE费用的数据尚未审查。未来的研究将需要基线比较数据来了解没有实施战略支持的WISE的成本和成本效益，以了解实施战略（如适应性方法）的相对效益。我们将通过与目标1中的教育工作者和主要利益相关者的开放式访谈以及目标2中的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.