Testing an Adaptive Implementation Strategy to Optimize Delivery of Obesity Prevention Practices in Early Care and Education Settings

项目摘要 健康的饮食和保持健康的体重可以有效预防癌症 和癌症相关的死亡率。早期干预是必要的，以降低癌症发生的风险。 生活早期护理和教育（ECE）是预防癌症的一个有希望的环境。 “共同努力，我们倡导智能饮食”（WISE）是一项改善幼儿教育中儿童饮食的干预措施。明智 包括4个关键的循证实践（EBP）：（1）亲自接触水果和蔬菜，（2）角色 教育者的示范，（3）积极的喂养方法，（4）与水果和蔬菜有关的吉祥物。 WISE的标准实现方法导致WISE EBP的次优实现。额外 需要实施战略，以增加采用和忠实于EBP。 到目前为止，大多数研究都采用了“全有或全无”的方法，将多方面的策略与 没有实施支持的对照组。因此，迫切需要优化战略， 在欧洲经委会的背景下，执行支助的强度因其独特的挑战和有限的资源而有所不同。的 该应用程序的总体目标是确定自适应的有效性和成本效益 实施方法，以改善WISE EBP的采用，同时还检查实施情况 机制等我们的中心假设是，在没有反应的位点增加高强度策略， 低强度战略将改善执行情况和健康成果。 具体目标1。确定适应性实施战略的有效性， 执行支助强度与低强度战略之间的差异。使用增强型无应答者 在一项试验中，我们将比较持续低强度策略与增加高强度策略的效果 战略布局我们假设，接受高强度策略的网站将优于继续低强度策略的网站。 针对干预忠诚度的主要结果和次要儿童健康结果的强度战略。 具体目标2。审查执行结果的主持人和调解人， 方法设计我们将测试组织准备和教师经验作为响应的调节器， 实施战略。我们将测试教育工作者对障碍、当地实施气候、 和执行领导作为战略对执行结果的影响的调解人。 定性数据将探索其他潜在的主持人和调解人没有定量测量。 具体目标3。评估适应性执行战略的增量成本效益。 为此，我们将估计与自适应实施策略相关的每单位保真度的成本。 结果还将确定应用自适应战略的增量成本效益， 继续实施低强度策略，以改善BMI和其他儿童健康结果。

PROJECT SUMMARY Consuming a healthy diet and maintaining a healthy weight provide significant protection against cancer and cancer-related mortality. Early interventions are needed to decrease the risk of developing cancer later in life. Early care and education (ECE) is a promising setting for cancer prevention. “Together, We Inspire Smart Eating” (WISE) is an intervention that improves children's diets in ECE. WISE includes 4 key evidence-based practices (EBPs): (1) hands-on exposures to fruits and vegetables, (2) role modeling by educators, (3) positive feeding practices, and (4) a mascot associated with fruits and vegetables. Standard implementation approaches to WISE result in suboptimal implementation of WISE EBPs. Additional implementation strategies are needed to increase adoption and fidelity to EBPs. To date, most studies have employed an “all-or-nothing” approach, comparing multifaceted strategies to control groups without implementation support. Thus, there is an urgent need for optimized strategies that tailor implementation support intensity to the unique challenges and limited resources of the ECE context. The overall objectives of this application are to determine the effectiveness and cost-effectiveness of an adaptive implementation approach to improve adoption of the EBPs of WISE while also examining implementation mechanisms. Our central hypothesis is that the addition of high-intensity strategies at sites that do not respond to low-intensity strategies will improve implementation and health outcomes. Specific Aim 1. Determine the effectiveness of an adaptive implementation strategy that tailors the intensity of implementation support versus a low-intensity strategy. Using an enhanced non-responder trial, we will compare the effect of continuing low-intensity strategies vs. augmenting with high-intensity strategies. We hypothesize that sites receiving high-intensity strategies will outperform sites continuing the low- intensity strategies on the primary outcome of intervention fidelity and on secondary child health outcomes. Specific Aim 2. Examine moderators and mediators of implementation outcomes in a mixed- methods design. We will test organizational readiness and teacher experience as moderators of response to the implementation strategies. We will test educators' perceptions of barriers, local implementation climate, and implementation leadership as mediators of the effect of the strategies on implementation outcomes. Qualitative data will explore other potential moderators and mediators not measured quantitatively. Specific Aim 3. Assess the incremental cost-effectiveness of the adaptive implementation strategy. In this aim, we will estimate the cost per unit of fidelity associated with the adaptive implementation strategy. Results will also determine the incremental cost-effectiveness of applying the adaptive strategy compared to continuing low-intensity strategies for improving BMI and other child health outcomes.