Promoting healthy weight across the pregnancy and postpartum period through dissemination of an evidence based intervention

项目摘要 生育年龄对妇女来说是一个特别脆弱的时期， 与男性或其他生命阶段相比，体重不成比例地增加。体重增加期间 怀孕和产后时期后保留有助于肥胖的发展和进展。我们 一个研究小组与全国性的家长教师组织（PAT）合作，开发了一种生活方式改变干预措施。 家访，社区组织，在这一人群中有很大的影响力。PAT提供亲子 从产前到产后每年定期家访，向家庭提供免费教育和服务; 直到孩子进入幼儿园。干预措施（EMPOWER）防止妊娠期体重过重 通过在现有PAT访问结构中嵌入内容来增加和产后体重保持。本研究 将通过一项实用的随机对照试验来扩展这些发现，以评估传播情况， 在多个层面（母亲、家长教育工作者、PAT站点）实施增强权能方案， 冲击我们将评估EMPOWER对妊娠期体重增加和产后体重保持的影响 在美国超重和肥胖的母亲中（N= 266 EMPOWER; N= 266常规护理）。母 来自28个现有PAT站点（14个EMPOWER，14个常规护理）的教育工作者将接受EMPOWER培训 通过PAT国家中心利用现有的培训基础设施，了广泛评估 在RE-AIM的指导下，将确定实施结果（可接受性、采用、适当性、可行性， 适应性（adaptation）。实施研究的概念框架将描述决定因素 影响到增强权能方案在多个层面（母亲、家长教育者、PAT）的传播和实施 网站），以提高外部有效性（达到和维护）和人口水平的影响。这一发现 一项创新的研究将覆盖那些肥胖患病率增长最快的年轻女性， 与其他群体相比，过去45年中，部分原因是与生育有关的体重增加。

PROJECT SUMMARY The childbearing years are a particularly vulnerable time period for women during which they tend to gain disproportionately large amounts of weight when compared to men or other life periods. Weight gained during pregnancy and retained after the postpartum period contributes to obesity development and progression. Our team developed a lifestyle modification intervention in partnership with Parents as Teachers (PAT), a national home visiting, community based organization with significant reach in this population. PAT provides parent-child education and services free-of-charge to families through frequent home visits every year from the prenatal period until the child enters kindergarten. The intervention (EMPOWER) prevented excessive gestational weight gain and postpartum weight retention by embedding content within the existing PAT visit structure. This study will extend these findings with a pragmatic cluster randomized controlled trial to evaluate dissemination and implementation of EMPOWER across multiple levels (mother, parent educator, PAT site) to achieve widespread impact. We will evaluate the impact of EMPOWER on gestational weight gain and postpartum weight retention among mothers with overweight and obesity across the US (N= 266 EMPOWER; N= 266 usual care). Parent educators from 28 existing PAT sites (14 EMPOWER, 14 usual care) will receive the EMPOWER training curriculum through the PAT National Center using the existing training infrastructure. An extensive evaluation guided by RE-AIM, will determine implementation outcomes (acceptability, adoption, appropriateness, feasibility, fidelity, and adaptation). The Conceptual Framework for Implementation Research will characterize determinants that influence EMPOWER dissemination and implementation at multiple levels (mother, parent educator, PAT site) to enhance external validity (reach and maintenance) and population level impact. The findings from this innovative study will reach young women who have experienced the greatest increase in obesity prevalence in the past 45 years compared to other groups, due in part to weight gain associated with child bearing.