The ADAPT Trial: Adapting Evidence-Based Obesity Interventions in Community Settings

项目总结 在美国，大多数儿童无法接受以证据为基础的肥胖治疗。这种访问权限的缺乏是一种 健康不平等的根源，农村和少数族裔社区的儿童，他们的发病率最高 儿童肥胖也是最不可能接受循证干预的人群。制定战略，以 改善以证据为基础的肥胖干预措施的可及性可通过改善覆盖范围来减少健康差距 这些服务不足的社区。这项研究的前提是使用一个系统的框架来适应 对儿童肥胖的社区行为干预，包括个人、家庭和 社区因素将增加低收入、少数民族和农村人口的覆盖面和有效性。 Coach是一种多层次的肥胖干预措施，通过1)在发育过程中支持个别儿童 适当的健康行为课程，2)通过直接解决父母减肥和参与的家庭 父母作为子女变革的推动者，以及3)通过建设当地儿童的能力来促进社区 社区中心提供亲子节目。Coach在之前的RCT中进行了测试， 在1年的随访中证明了降低儿童BMI的有效性。我们建议测试这一过程 在一项整群随机试验中调整教练。在目标1中，我们会进行社区准备情况评估。 为50个社区中心的教练服务，服务于中等田纳西州的农村、少数民族和低收入家庭。这 评估是由我们的团队开发和试点测试的，评估研究实施的障碍 多个域。在随机选择的25个社区中心，我们将使用一个系统的过程来适应 基于评估结果的干预方案，同时保持对教练核心的忠诚度 组件。在目标2中，在一项整群随机试验中，我们将测试每种方法的比较有效性 实施战略(适应与原始计划)关于REACH、采用、 实施和维护。在目标3中，我们将测试改编的和 6个月随访时对儿童BMI-Z的原始干预。6-11岁肥胖儿童(体重指数≥95百分位数) 他们的家庭(N=750；15个指标儿童/中心)将从每个中心所服务的社区招募。 这项研究具有创新性，因为它将适应科学作为降低健康的潜在解决方案 儿童肥胖症的差异。通过在2.3亿人可用的社区资源中测试这种干预 美国人(社区中心)，我们将创建一个可扩展的肥胖干预措施，可以在 全国各地传统上服务不足的人口。这项研究还将开发和测试基于理论的 针对不同农村人群的肥胖和其他健康结果调整行为干预措施的过程 和城市社区。这项研究与NHLBI的使命一致，即确定 确保成功地将循证干预措施纳入公共卫生环境。

PROJECT SUMMARY Evidence-based obesity treatment is inaccessible to most children in the United States. This lack of access is a source of health inequity, whereby children from rural and minority communities, who have the highest rates of childhood obesity, are also the least likely to receive an evidence-based intervention. Developing strategies to improve access to evidence-based obesity interventions could reduce health disparities by improving reach to these underserved communities. The premise of this study is that using a systematic framework to adapt a community-based behavioral intervention for childhood obesity that accounts for individual, family, and community factors will increase reach and effectiveness among low-income, minority, and rural populations. COACH is a multi-level obesity intervention that supports 1) the individual child through developmentally appropriate health behavior curriculum, 2) the family by directly addressing parent weight loss and engaging parents as agents of change for their children, and 3) the community by building the capacity of local community centers to offer parent-child programming. COACH has been tested in a prior RCT and demonstrated effectiveness at reducing child BMI at 1-year follow-up. We propose testing the process of adapting COACH in a cluster-randomized trial. In Aim 1, we will conduct a community readiness assessment for COACH in 50 community centers serving rural, minority, and low-income families in middle TN. This assessment was developed and pilot-tested by our team and assesses barriers to study implementation in multiple domains. In 25 randomly selected community centers, we will use a systematic process to adapt the intervention protocol based on the assessment results, while maintaining fidelity to COACH’s core components. In Aim 2, in a cluster-randomized trial, we will test the comparative effectiveness of each implementation strategy (adaptation vs. original program) on the implementation outcomes of reach, adoption, implementation, and maintenance. In Aim 3, we will test the comparative effectiveness of the adapted and original intervention on child BMI-Z at 6-month follow-up. Children with obesity (BMI percentile ≥95th) ages 6-11 and their families (N=750; 15 index children/center) will be recruited from communities served by each center. This research is innovative because it uses adaptation science as a potential solution to reduce health disparities in childhood obesity. By testing this intervention in a community resource available to 230 million Americans (community centers), we will create a scalable obesity intervention that could be implemented in traditionally underserved populations across the country. This study will also develop and test a theory-based process for adapting behavioral interventions for both obesity and other health outcomes among diverse rural and urban communities. This research aligns with the NHLBI’s mission to identify the best strategies for ensuring successful integration of evidence-based interventions within public health settings.