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

在优化欧洲经委会肥胖预防方面存在两个关键差距：1）缺乏适应性实施战略，以调整实施支持交付的强度; 2）欧洲经委会肥胖预防和营养促进工作的成本效益文献有限。这一应用程序的首要目标是收集利益攸关方对具体说明适应性实施战略和可接受的成本效益阈值的看法，以预防欧洲经委会肥胖症。为此，我们将专注于循证营养计划一起，我们倡导智能饮食（智慧）。与ECE的常规做法相比，WISE已经证明了儿童在家水果和蔬菜消费的增加，类胡萝卜素摄入量的改善，以及快餐和含糖饮料消费的减少。我们之前的工作是，一个由8个离散的、由业主选择的实施策略组成的包的性能优于一个基本的实施方法（即，为WISE培训提醒）。考虑到现实世界中的可行性和潜在的高昂成本，未来不可能向所有地点提供所有实施策略;此外，可能不需要所有策略来实现预期结果。此外，还没有审查WISE的费用数据。未来的研究将需要基线比较数据，以了解WISE的成本和成本效益，而无需实施策略支持，以了解实施策略（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.