Effective Training Models for Implementing Health-Promoting Practices Afterschool

项目摘要。在过去的二十年里，过量的饮食摄入和低体力活动 导致了美国儿童肥胖症患病率的上升， 影响到三分之一的儿童，对少数民族和经济造成不成比例的影响， 弱势儿童。鉴于肥胖是日后健康状况的一个危险因素， 包括癌症在内的各种疾病，早期肥胖预防工作对人口健康至关重要。校外 时间（OST）计划是解决儿童肥胖的重要环境，因为10.2 有1000万美国儿童参加课外活动。校外营养与体育 活动（OSNAP）组随机试验表明，儿童的活力 身体活动，供应和消费的食物和饮料的健康性，以及健康- 推动政策方案。既然OSNAP干预措施已经过严格测试， 培训模式的有效性已经确立，迫切需要对培训模式进行评估， 传播这一干预措施，以扩大人口覆盖面和影响。我们的长期目标是 调查循证预防干预措施的实施和传播情况， OST设置。本建议的总体目标是建立两个 现有的培训模式，以扩大OSNAP干预和了解的影响， 关于有效执行的背景。与基督教青年会合作，我们将进行一个三臂 一组随机试验，比较两种提供学习协作的方法， 对照组本申请涉及以下具体目标： 1.比较两种学习协作模式的有效性和实施成本 OSNAP干预的培训模式。我们假设这两种训练模型都将 在OST营养和身体活动实践中产生健康的变化， 与对照组相比，验证了观察评估。的次要结局 具体的健康做法，如提供体力活动和水，以及过程 成本和可接受性等成果因培训模式而异。 2.使用混合方法来确定实施环境中的可操作因素 影响OSNAP干预的有效性， 合作培训模式。我们假设， 实施环境将更有效地实施OSNAP比计划， 支持性背景。定性数据将有助于解释执行的各个方面 背景影响更深入地有效实施每一种培训模式。

Project Summary. Over the past two decades, excess dietary intake and low physical activity have contributed to an increase in the prevalence of childhood obesity in the United States, affecting a third of children and disproportionately impacting minority and economically disadvantaged children. Given that obesity is a risk factor for health outcomes later in life, including cancer, early obesity prevention efforts are critical for population health. Out-of-school time (OST) programs are an important setting for addressing childhood obesity given that 10.2 million U.S. children are enrolled in afterschool. The Out-of-school Nutrition and Physical Activity (OSNAP) group-randomized trial demonstrated improvements in children’s vigorous physical activity, the healthfulness of foods and beverages served and consumed, and health- promoting program policies. Now that the OSNAP intervention has been rigorously tested and effectiveness has been established, there is a critical need to evaluate training models to disseminate this intervention for broad population reach and impact. Our long-term goal is to investigate the implementation and dissemination of evidence-based prevention interventions in OST settings. The overall objective of this proposal is to establish the effectiveness of two existing training models for scaling up the OSNAP intervention and understand the influence of context on effective implementation. In collaboration with the YMCA, we will conduct a 3-arm group randomized trial to compare two methods of delivering the learning collaborative with a control group. This application addresses the following specific aims: 1. Compare the effectiveness and implementation cost of two learning collaborative training models for the OSNAP intervention. We hypothesize that both training models will produce healthy changes in OST nutrition and physical activity practices as measured by a validated observational assessment, compared to the control group. Secondary outcomes of specific healthy practices, such as offerings of physical activity and water, and process outcomes, such as cost and acceptability, will vary by training model. 2. Use mixed methods to identify actionable factors within the implementation context that influence the effectiveness of the OSNAP intervention delivered by two learning collaborative training models. We hypothesize that programs with more supportive implementation contexts will more effectively implement OSNAP than programs with less supportive contexts. Qualitative data will help explain how aspects of the implementation context influence effective implementation of each training model in greater depth.