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

William J Heerman,David Schludnt,Leah Teeters,Rachel Apple,Dawn Harris,Shari L Barkin

doi:10.1186/s12889-018-5403-z

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.

Highlights

Expanding 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
Community-based implementation research is an emerging field that focuses on how efficacious interventions should be modified so that similar results can be achieved in different settings with more diverse populations [10]
We have learned from other effective health-behavior change programs, such as the Diabetes Prevention Program (DPP), that to translate effective interventions into a real-world settings requires: community collaboration, adaptation that contains costs while maintaining fidelity, and considerations for maintenance [12]

Summary

Introduction

Expanding 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. Aarons et al, have recently described these efforts as “scale-out” interventions, where researchers employ the “deliberate use of strategies to implement, test, improve, and sustain an evidence based intervention as it is delivered to new populations and/or through new delivery systems that differ from those in effectiveness trials.” [8] With the burden of childhood obesity affecting 17% of children in the United States [9], the future of obesity research needs to include rigorous methods for “scalingout” efficacious studies into real-world contexts and evaluating their impact [10]. Community-based implementation research is an emerging field that focuses on how efficacious interventions should be modified so that similar results can be achieved in different settings with more diverse populations [10] In their qualitative evaluation of 19 community-based obesity programs in Missouri, Dreisinger et al developed a framework of individual, organizational, community, and intervention factors that are critical for widespread obesity program distribution [11]. We have learned from other effective health-behavior change programs, such as the Diabetes Prevention Program (DPP), that to translate effective interventions into a real-world settings requires: community collaboration, adaptation that contains costs while maintaining fidelity, and considerations for maintenance [12]

Methods

Results

Discussion

Conclusion