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

项目摘要 在美国，大多数儿童无法获得循证肥胖治疗。这种缺乏机会是一个 健康不平等的根源，农村和少数民族社区的儿童， 儿童肥胖，也是最不可能接受循证干预的。制定战略以 改善获得循证肥胖干预措施的机会，可以通过改善 这些服务不足的社区。本研究的前提是，使用一个系统的框架，以适应一个 以社区为基础的儿童肥胖行为干预，考虑到个人，家庭， 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是一个多层次的肥胖干预，支持1）个别儿童通过发展 适当的健康行为课程，2）直接解决父母减肥和参与家庭 父母作为子女变革的推动者，以及3）通过建设当地 社区中心提供亲子节目。COACH已在之前的RCT中进行了测试， 在1年随访时，证明了降低儿童BMI的有效性。我们建议测试 在一项随机分组试验中调整COACH。在目标1中，我们将进行社区准备评估， 为教练在50个社区中心服务的农村，少数民族和低收入家庭在TN中部。这 评估是由我们的团队开发和试点测试，并评估研究实施的障碍， 多个域。在25个随机选择的社区中心，我们将使用一个系统的过程，以适应 基于评估结果的干预方案，同时保持对COACH核心的忠实性 件.在目标2中，在一项随机分组试验中，我们将测试每种药物的比较有效性。 实施战略（适应与原始方案）对普及、采用、 实施和维护。在目标3中，我们将测试适应和 在6个月随访时对儿童BMI-Z进行初始干预。6 - 11岁肥胖儿童（BMI百分位数≥ 95） 及其家庭（N = 750; 15名索引儿童/中心）将从每个中心服务的社区招募。 这项研究是创新的，因为它使用适应科学作为减少健康的潜在解决方案。 儿童肥胖的差异。通过在社区资源中测试这种干预措施， 美国人（社区中心），我们将创建一个可扩展的肥胖干预，可以在 传统上得不到充分服务的人群。这项研究还将开发和测试一个基于理论的 在不同的农村人口中调整肥胖和其他健康结果的行为干预措施的过程 和城市社区。这项研究符合NHLBI的使命，以确定最佳战略， 确保在公共卫生环境中成功整合循证干预措施。

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.