Translating Efficacious Pediatric Weight Management Interventions into Rural & Micropolitan Communities

摘要 有大量的文献关于有效的干预策略， 儿童肥胖症不幸的是，有效的方案在多大程度上 在小都市和周边农村地区的翻译包装是不清楚的，一个重要的 考虑到农村地区的肥胖患病率高于 市区爱泼斯坦的交通灯饮食（英语：Traffic Light Diet）可能是研究最多的儿科体重 管理干预（PWMI），并已在广泛的 6-12岁儿童的随机对照试验。建立健康家庭（BHF）是一个 在中西部的一个小都市， 成功实现了儿童BMI z评分的临床和统计学显著降低（- 0.27±0.22）-相对于先前的疗效试验，效应幅度相似。我们创造了 为有兴趣提供PWMI的组织提供在线资源， 干预措施和面向参与者的计划材料，可以组合成一个'交钥匙' 对减少儿童肥胖感兴趣的社区采用、调整和维持这一方法的方法 在其他小城市/农村社区。主要目标是协同改进和开发 为BHF提供干预一揽子计划，其中包括其他人实施所需的材料 在新的大都市/农村地区进行干预。我们的第二个目标是执行一个严格， 使用创新社区应用程序的混合方法试点实施研究 确定4至8个新社区的过程，以试点测试一揽子PWMI的效用， 培训材料，同时确定预测采用、实施和 持续发展我们还将使用学习协作实施策略， 执行工作的忠实性和当地情况，以及感兴趣的社区的促进能力， 提供BHF。我们的第三个目标是利用试点评估数据和结果的可持续性 行动计划，以完善方案和培训材料，并制定传播计划， 该计划向其他社区。我们的方法将使用一个实施研究 解释过程和结果模型，使我们能够测试相关的假设， 实施和可持续性，让社区/临床合作伙伴参与实施 和可持续发展过程，并评估个人和组织的成果 水平

Abstract There is a large body of literature regarding efficacious intervention strategies for treating childhood obesity. Unfortunately, the degree to which efficacious programs have been packaged for translation in micropolitan and surrounding rural areas is unclear—an important issue when considering the prevalence of obesity is higher in rural areas when compared to urban areas. Epstein’s Traffic Light Diet (TLD) is likely the most studied pediatric weight management intervention (PWMI) and has demonstrated efficacy across a wide range of randomized controlled trials in children 6-12 years of age. Building Healthy Families (BHF) is an adaptation of the TLD and has been implemented in a Midwestern micropolitan city and successfully achieved clinically and statistically significant reductions in child BMI z-score (- 0.27±0.22)—a similar magnitude of effect relative to previous efficacy trials. We have created online resources for organizations interested in delivering PWMIs, training modules for related interventions, and participant-facing program materials that could be combined into a ‘turn-key’ approach for communities interested in reducing childhood obesity to adopt, adapt and sustain it in other micropolitan/rural communities. The primary aim is to collaboratively refine and develop an intervention package for the BHF that includes materials necessary for others to implement the intervention in new metropolitan/rural locations. Our second aim is to perform a rigorous, mixed-methods pilot implementation research study using an innovative community application process to identify 4 to 8 new communities to pilot test the utility of the packaged PWMI and training materials while determining factors that predict adoption, implementation and sustainability. We will also use a learning collaborative implementation strategy to improve implementation fidelity and local context and facilitation capacity in communities interested in delivering BHF. Our third aim is to use the pilot evaluation data and results of the sustainability action plan to refine program and training materials and develop a dissemination plan to move the program to other communities. Our approach will use an implementation research explanatory process and outcome model to allow us to test hypotheses related to implementation and sustainability, engaging community/ clinical partners in the implementation and sustainability process, and evaluate outcomes at both the individual and organizational level.