Packaging and Disseminating the JOIN for ME Program in Low-Income Settings

项目摘要/摘要 儿童和青少年超重/肥胖的流行仍然是一个公共卫生优先事项。 一系列证据支持以家庭为基础的综合生活方式对老年人的有效性 儿童肥胖的治疗，反映在美国预防服务工作组(USPSTF)B级 建议临床医生推荐已确定的年轻人参加此类计划。尽管有这样的行动呼吁，但广大的 大多数与肥胖作斗争的儿童无法获得循证护理。最紧迫的 需要的是来自低收入家庭的年轻人，他们肥胖的风险最大，而且最不可能获得 关心。通过社区环境提供干预措施提供了一种增加机会的战略。联结 For ME计划是由United HealthGroup和Y-USA合作开发的，是一项儿科体重 管理干预可以在社区环境中提供，有可能在全国范围内传播。 与经验支持的以家庭为基础的干预措施一致，加入我的计划包括Strong 父母参与，使用有效的行为策略，如自我监控和干预目标 重点是减少能量密集、营养不良的食品和饮料的消耗，减少 久坐的行为，以及增加体力活动。公开试验(N=115)和后续试验的结果 随机对照试验(N=75)显示体重状况显著和有意义地降低 6-12岁儿童；超重百分比分别下降4.3%和5.5%。 我们建议将Join for ME计划打包，以提高在#年交付的接受度和可行性 低收入社区并在两个新的环境中测试实施：住房管理局和患者- 中心医疗院。修订后的Join for ME包将在严格的实施研究中进行测试， 其目标是：1)检查计划的可接受性、可行性、保真度、 通过对流程措施、定性数据和成本分析的全面评估，覆盖范围和成本 以及2)评估患者的结果，包括儿童和父母体重状况的变化以及与健康相关的 生活质量(HRQL)。共有128名儿童(6-12岁)患有BMI&GT；85%来自低收入家庭和 主要照顾者将注册参加通过以下四种方式之一提供的加入ME计划 设置采用延迟治疗起效设计。我们将评估一系列实施成果，以 通过过程措施和多个信息者检查REACH的结构、可接受性和可行性 定性访谈。假设最先收到加入ME计划的孩子将 表现出比中位数BMI更大的百分比下降和更大的HRQL改善 延迟治疗的患者在四个月后接受干预。实施和成效 将与社区和支付者咨询委员会一起汇编、审查和审查结果，以制定 计划大规模传播Join for ME计划。

PROJECT SUMMARY/ABSTRACT The prevalence of overweight/obesity among children and adolescents remains a public health priority. A convergence of evidence supports the efficacy of comprehensive family-based lifestyle approaches for the treatment of pediatric obesity, as reflected in the U.S. Preventive Services Task Force (USPSTF) Grade B recommendation for clinicians to refer identified youth to such programs. Despite this call to action, the vast majority of children struggling with obesity do not have access to evidence-based care. The most pressing need is in youth from low-income families, who are at greatest risk of obesity and least likely to have access to care. Delivering interventions through community settings offers one strategy for increasing access. The JOIN for ME program, developed as a collaboration between United HealthGroup and Y-USA, is a pediatric weight management intervention that can be delivered in community settings, with potential for national dissemination. Consistent with empirically supported family-based interventions, the JOIN for Me program includes strong parental involvement, use of effective behavioral strategies such as self-monitoring, and intervention targets that focus on reducing consumption of energy dense, nutrient poor foods and beverages, decreasing sedentary behavior, and increasing physical activity. Findings from an open trial (N=115) and subsequent randomized controlled trial (N=75) demonstrate significant and meaningful reductions in weight status in children 6-12 years of age; 4.3% and 5.5% decrease in percent overweight. We propose to package the JOIN for ME program to increase acceptability and feasibility for delivery in low-income communities and test implementation in two novel settings: the housing authority and the patient- centered medical home. The revised JOIN for ME package will be tested in a rigorous implementation study, the goals of which are to: 1) examine key implementation metrics of program acceptability, feasibility, fidelity, reach, and cost through comprehensive assessment of process measures, qualitative data, and cost analyses and 2) evaluate patient outcomes, including changes in child and parent weight status and health-related quality of life (HRQL). A total of 128 children (ages 6-12 years) with BMI > 85th% from low-income families and a primary caregiver will be enrolled to participate in the JOIN for ME program offered through one of four settings using a delayed treatment onset design. We will evaluate a series of implementation outcomes to examine constructs of reach, acceptability and feasibility through process measures and multi-informant qualitative interviews. It is hypothesized that children who receive the JOIN for ME program first will demonstrate greater decrease in percent over median BMI and greater improvements in HRQL than those in the delayed treatment onset who receive the intervention four months later. Implementation and effectiveness outcomes will be compiled, examined, and reviewed with Community and Payer Advisory Boards to develop a plan for large scale dissemination of the JOIN for ME program.