Scale-out of a community-based behavioral intervention for childhood obesity: pilot implementation evaluation

Abstract

BackgroundExpanding the use of evidence-based behavioral interventions in community settings has met with limited success in various health outcomes as fidelity and dose of clinical interventions are often diluted when translated to communities. We conducted a pilot implementation study to examine adoption of the rigorously evaluated Healthier Families Program by Parks and Recreation centers in 3 cities across the country (MI, GA, NV) with diverse socio-cultural environments.MethodsUsing the RE-AIM framework, we evaluated the program both quantitatively (pre/post surveys of health behavior change; attendance & fidelity) and qualitatively (interviews with Parks and Recreation staff and participants following the program).ResultsThe 3 partner sites recruited a total of 26 parent-child pairs. REACH: Among the 24 participants who completed pre/post surveys, 62.5% were 25–34 years old, and average child age was 3.6 (SD 0.7) years. The distribution of self-reported race/ethnicity was 54% non-Hispanic White, 38% non-Hispanic Black, and 8% Latino. EFFECTIVENESS: Qualitative interviews with participants demonstrated increased use of the built environment for physical activity and continued use of key strategies for health behavior change. ADOPTION: Three of five (60%) collaborating sites proceeded with implementation of the program. IMPLEMENTATION: The average attendance for the 12-week program was 7.6 (SD 3.9) sessions, with 71% attending > 50% of sessions. Average fidelity for the 12 weekly sessions was 25.2 (SD 1.2; possible range 9–27). MAINTENANCE: All 3 partner sites continued offering the program after grant funding was complete.ConclusionsThis pilot is among the first attempts to scale-out an evidence-based childhood obesity intervention in community Parks and Recreation centers. While this pilot was not intended to confirm the efficacy of the original trial on Body Mass Index (BMI) reduction, the effective and sustained behavior change among a geographically and ethnically diverse population with high attendance and fidelity demonstrates an effective approach on which to base future large-scale implementation efforts to reduce childhood obesity in community settings.Electronic supplementary materialThe online version of this article (10.1186/s12889-018-5403-z) contains supplementary material, which is available to authorized users.

Scaling‐up evidence‐based obesity interventions: A systematic review assessing intervention adaptations and effectiveness and quantifying the scale‐up penalty

“…Table (characteristics of included studies) provides information on the 10 included scaled‐up trials, four of which were conducted in Australia, two each from the United Kingdom and the United States, and one each from New Zealand and the Netherlands …”

“…Two of the scaled‐up interventions included women only (40 y or older and 18‐40 y old), and one scaled‐up intervention included men only who are 30 to 65 years old . The remaining trials focused on parent/child dyads, preschool children (3‐5 y old), children (6‐11 y old), adolescents (aged 12‐14 y), and adolescent boys (in their first year of high school, aged approximately 11‐12 y) …”

“…Four scaled‐up trials used a before‐and‐after design, three used cluster RCT, and one study each employed an RCT, historical comparison, or a cluster‐controlled implementation trial . Six studies were classified as obesity prevention programmes, and the other four were concerned with weight treatment (Table ). Six of the 10 scaled‐up interventions were classified as effectiveness trials, and four as implementation or dissemination trials.…”

“…Six studies were classified as obesity prevention programmes, and the other four were concerned with weight treatment (Table ). Six of the 10 scaled‐up interventions were classified as effectiveness trials, and four as implementation or dissemination trials.…”

“…The most common type of adaptation for prevention programmes (five of six) and obesity treatment interventions (three of four) were mode of delivery adaptations (Table , also see Supplement File S3 for description of adaptations). Mode of delivery adaptations included increases (four prevention) and reductions (three prevention and two treatment interventions) in the number of intervention element, in the frequency or duration of intervention contacts, or in the training and resources provided to those responsible for intervention delivery. Some trials included adaptations that increased some intervention elements while reducing the intensity of others (three prevention and one treatment intervention); and one treatment trial was judged to represent neither an increase nor reduction in intensity .…”