Development and Validation of an Observational Rating System for Individual Tailoring in Family-Based Pediatric Obesity Interventions

项目摘要/摘要 儿童肥胖是一种与昂贵的心血管和慢性疾病有关的公共健康危机， 生活质量下降。肥胖儿童人数不成比例，定义为身体质量指数 (BMI)≥年龄和性别的第95个百分位数，是种族/民族少数群体或社会经济上的弱势群体。 以家庭为基础的儿童肥胖症治疗已显示出有效性，但仍在与高 参与者辍学和出席率参差不齐，限制了干预效果和改善的机会 健康结果。照顾者经常因程序超载无关信息而退出 满足他们的期望。由于儿童肥胖的复杂性，导致儿童体重增加的因素可能 每个家庭都有很大的不同。个人定制的基于家庭的项目使用严格的评估来 制定个性化的治疗计划，满足家庭的独特需求和治疗优先事项。这个 家庭体检4健康(FCU4Health)是一项以评估为导向的个人定制的以家庭为基础的儿科 以育儿技能和健康行为为目标的肥胖计划，参与率和 在以少数民族为主的低收入样本中保留。尽管个人承诺 裁剪，量化个人裁剪过程的工具研究不足，阻碍了评估能力 个人裁剪并分析裁剪影响项目参与度和结果的理论。这个 拟议的研究将开发并验证观察性评级系统，以衡量 以家庭为基础的儿童肥胖干预中的个体定制。录制的会议、文字记录和 来自FCU4Health，养育健康儿童(RHC)项目的已完成试验的多方法数据将是 用于开发观察性评级系统。接下来，FCU4Health的第二次试验，健康的 社区4健康学生(HC4HS)项目，将用于验证新的评级系统。最后， 来自新评级系统的分数将被用来测试个人裁剪、节目 联合使用RHC和RHC的健康行为和人体测量结果的参与度和变化 六六六样本。这项新的研究将使用视频观察编码、心理测量学、结构方程 建模和实施科学方法。新的工具将推动儿童肥胖领域的发展 通过提供评级系统来指导儿童肥胖的设计、实施和评估的研究 具有个人定制组件的干预措施。量化个体裁剪将阐明它们之间的关系 项目参与度和结果，为循证干预的适应提供信息。这个 加强干预措施将适应参与者的需求，促进健康行为的改变，并最终 预防和管理儿童肥胖，降低相关疾病的风险。

Project Summary/Abstract Pediatric obesity is a public health crisis associated with costly cardiovascular and chronic diseases and decreased quality of life. A disproportionate number of children with obesity, defined as a body mass index (BMI)≥95th percentile for age and gender, are racial/ethnic minorities or socioeconomically disadvantaged. Family-based treatments for childhood obesity have demonstrated effectiveness but struggle with high participant drop-out and inconsistent attendance, limiting opportunities for intervention effects and improving health outcomes. Caregivers frequently drop out due to a program overloading irrelevant information or not meeting their expectations. Due to the complexity of pediatric obesity, contributors to children's weight gain can greatly vary from family to family. Individually tailored family-based programs use rigorous assessment to develop individualized treatment plans that address a family's unique needs and treatment priorities. The Family Check-Up 4 Health (FCU4Health) is an assessment-driven individually tailored family-based pediatric obesity program that targets parenting skills and health behaviors and has had high rates of participation and retention among a low-income predominantly ethnic minority sample. Despite the promise of individual tailoring, tools to quantify the process of individual tailoring are understudied, hindering the ability to evaluate individual tailoring and analyze the theory that tailoring affects program engagement and outcomes. The proposed study will develop and validate an observational rating system to measure the process and degree of individual tailoring in family-based pediatric obesity interventions. Videorecorded sessions, transcripts and multimethod data from a completed trial of the FCU4Health, the Raising Healthy Children (RHC) project, will be used to develop the observational rating system. Next, a second trial of the FCU4Health, the Healthy Communities 4 Healthy Students (HC4HS) project, will be used to validate the new rating system. Finally, scores from the new rating system will be used to test the relationship between individual tailoring, program engagement and changes in health behaviors and anthropometric outcomes using a combined RHC and HC4HS sample. This novel research will employ video observation coding, psychometrics, structural equation modeling, and implementation science methods. The new tool will advance the field of pediatric obesity research by providing a rating system to guide the design, implementation, and evaluation of pediatric obesity interventions with an individual tailoring component. Quantifying individual tailoring will elucidate its relationship with program engagement and outcomes to inform adaptations for evidence-based interventions. The enhanced interventions will accommodate participants' needs, facilitate health behavior change and ultimately prevent and manage pediatric obesity and reduce risk for associated diseases.