A Rigorous Application of the RE-AIM Framework to Examine a Pediatric Obesity Intervention

项目摘要/摘要 儿童肥胖会导致终生慢性病和缩短预期寿命，使其成为一种公共健康 优先考虑。与城市儿童相比，农村儿童超重/肥胖率高得不成比例。 而且获得治疗选择的机会有限。即使在参与创建的治疗干预时 根据专家指南，高达76%的参与者可能无法成功地保持或减少他们的身体 质量指数z得分(BMIz)。至关重要的是，我们有对个人和 很容易交付和采用到农村地区。因此，当前研究的目标是了解 农村人群特有的与儿童肥胖干预成功相关的因素 个人和现场(学校)级。这将通过严格应用RE-AIM框架来实现，该框架 同时考察个体有效性和干预实施情况，以期对儿童肥胖进行治疗 发明。我们将通过两个独特的目标来实现这一点；目标1将研究两个新颖的个人层面的预 决定因素，参与和改变久坐行为，治疗成功(减少体重指数)。这一目标将使用 来自农村地区两个随机儿童肥胖临床试验(N=105)干预组的数据 由戴维斯博士(主要赞助人)主持。干预包括视频记录的小组会议； 我们将对这些视频进行编码，以应用一种新的参与度衡量标准--团队参与度-- 尤尔。此外，我们将分析久坐行为的变化(在基线和干预后收集)。 参与度和久坐行为的变化将被添加到具有参与者典型预测因子的模型中 成功；新模型预计会比只使用典型预测因子的模型更好地预测成功。目标2 将系统地确定现场(学校)级别的背景因素，包括障碍和促进者，并测试其 与成功的现场级实施相关联。为了实现目标2，我们将邀请现场(学校)代表- 让员工参加半结构化面试，以了解与解决问题相关的障碍和促进者 成功的实施。代表将根据干预措施的采用情况分为三类之一- 他们在现场的行为：1)没有采取；2)最初采取；3)采取了干预措施。本研究的培训目标 是：1)开发和应用与干预和实施研究设计和实施相关的战略技能 方法论(临床试验、实施科学、定性方法和行为编码)，2)进展 能量平衡培训，包括久坐行为分析和营养测量方法以及 分析，3)多层次建模的高级统计技能，4)增强专业发展技能 在科学写作和发表研究报告方面。拟议的项目将通过检查因素来推进研究。 有助于在个人一级和现场一级取得成功的儿科干预措施 可扩展性。此外，这项研究将促进Forseth博士(申请者)的培训，并加强她的知识 和技能，成为一名独立资助的儿科肥胖研究领域的研究员。

PROJECT SUMMARY/ABSTRACT Pediatric obesity contributes to life-long chronic diseases and shortened life expectancy, making it a public health priority. Rural children have disproportionately higher rates of overweight/obesity compared to their urban coun- terparts and have limited access to treatment options. Even when participating in a treatment intervention created from expert guidelines, up to 76% of participants may not be successful at maintaining or reducing their body mass index z-score (BMIz). It is critical that we have treatment programs that are effective for individuals and are easily delivered and adopted to rural areas. Therefore, the objective of the current study is to understand factors specific to rural populations that are related to success of pediatric obesity interventions at both the individual and site (school)-level. This will be done through rigorously applying the RE-AIM framework, which examines both individual effectiveness and intervention implementation, to a pediatric obesity treatment inter- vention. We will accomplish this through two unique aims; Aim 1 will investigate two novel individual-level pre- dictors, engagement and change in sedentary behavior, on treatment success (reducing BMIz). This aim will use data collected from intervention arms of two randomized pediatric obesity clinical trials (N = 105) in rural areas conducted by Dr. Davis (primary sponsor). The intervention included group-sessions that were video recorded; these videos will be coded for our application of a novel measure of engagement, the Group Engagement Meas- ure. Additionally, we will analyze change in sedentary behavior (collected at both baseline and post intervention). Engagement and change in sedentary behavior will be added into a model with typical predictors of participant success; the new model is expected to predict success better than a model using only typical predictors. Aim 2 will systematically identify site (school)-level contextual factors, including barriers and facilitators, and test their associations with successful site-level implementation. To address Aim 2, we will invite site (school) represent- atives to participate in a semi-structured interview to understand barriers and facilitators associated with suc- cessful implementation. Representatives will fall into one of three categories based on adoption of the interven- tion at their site: 1) did not adopt 2) initially adopted or 3) adopted the intervention. Training goals for this study are to: 1) develop and apply strategic skills related to intervention and implementation research designs and methodology (clinical trials, implementation science, qualitative methods and behavioral coding), 2) advance training in energy balance, including sedentary behavior analysis and nutritional measurement methods and analyses , 3) advance statistical skills for multi-level modeling, and 4) enhance professional development skills in scientific writing and presenting research. The proposed project will advance research by examining factors that contribute to the success of pediatric interventions, at an individual level of effectiveness and at site-level scalability. Further, this research will advance Dr. Forseth’s (applicant) training and strengthen her knowledge and skillset to become an independently funded investigator in the area of pediatric obesity research.