Stakeholder selected strategies for obesity prevention in childcare: results from a small-scale cluster randomized hybrid type III trial

Implementation Science

Audra Staley¹  James P. Selig²  Janna Martin³  Leanne Whiteside-Mansell³  Taren Swindle³  Susan L. Johnson⁴  Geoffrey M. Curran⁵  Nicole M. McBride⁶ 

[1] College of Medicine, University of Arkansas for Medical Sciences, 4301 W. Markham St, #530, 72205-7199, Little Rock, AR, USA;College of Public Health, Department of Biostatistics, University of Arkansas for Medical Sciences, 4301 W. Markham St., #781, 72205, Little Rock, AR, USA;Department of Family and Preventive Medicine, University of Arkansas for Medical Sciences, 4301 W. Markham St, #530, 72205-7199, Little Rock, AR, USA;Department of Pediatrics, University of Colorado Anschutz Medical Campus, 12700 East 19th Avenue Box C225, 80045, Aurora, CO, USA;Department of Pharmacy Practice and Psychiatry, University of Arkansas for Medical Sciences, 4301 W. Markham St, #522-4, 72205-7199, Little Rock, AR, USA;Central Arkansas Veterans Healthcare System, 72114, North Little Rock, AR, USA;Embedded Preventive Behavioral Health Capability, Marine Corps Community Services, III MEF, United State Marine Corps, Okinawa, Japan;

关键词: Implementation strategies;    Childcare;    Obesity prevention;    Implementation science;    Early care and education;    Nutrition;   

DOI  :  10.1186/s13012-021-01119-x

来源: Springer

【 摘 要 】

BackgroundTogether, We Inspire Smart Eating (WISE) is an intervention for the early care and education setting to support children’s exposure to and intake of fruits and vegetables. WISE emphasizes 4 evidence-based practices (EBPs): (1) use of a mascot; (2) educators’ role modeling; (3) positive feeding practices; and (4) hands-on exposures. The current study reports on a small-scale implementation trial aimed at improving the use of WISE EBPs by teachers.MethodsA Hybrid Type III Cluster Randomized Design compared a Basic and Enhanced implementation strategy. The Basic Strategy included training and reminders only; the Enhanced strategy was a multi-faceted package of stakeholder-selected strategies including a leadership commitment, an implementation blueprint, a local champion, an environmental reminder of the EBPs, facilitation, and tailored educational resources and incentives. All study sites were Head Starts. Sites were randomized using a balancing technique that considered site characteristics; 4 sites (20 classrooms, 39 educators, 305 children) received Enhanced support; 5 sites (18 classrooms, 36 educators, 316 children) received Basic support. RE-AIM guided the evaluation, and implementation fidelity was the primary outcome. Strategies were assessed using examination of data distributions and unadjusted comparisons (t tests) as well as general linear and mixed effects models controlling for covariates.ResultsFor the primary outcome of fidelity, the Enhanced group had significantly higher means for 3 of 4 EBPs. Multivariate models explained a significant portion of variance for both mascot use and hands-on exposure with a significant positive effect observed for treatment condition. The Enhanced group also had higher rates of Appropriateness and Organizational Readiness for Implementing Change (as indicators of implementation and adoption, respectively). There was no significant difference between groups for indicators of Reach, Effectiveness or Maintenance. Formative interviews indicated key targets for iteration and potential mechanisms. Key events were catalogued to provide context for interpretation (e.g., 61% of classrooms with turnover).ConclusionsFindings were mixed but suggested promise for the Enhanced strategy, especially considering key events of the study. Implementation fidelity improvements occurred mainly in the last 3 months of the school year; additional time may be needed to translate to improvements in child outcomes.Trial registrationNCT03075085 Registered 20 February 2017.

【 授权许可】

CC BY