Division of General Pediatrics, Vanderbilt University Medical Center, 2146 Belcourt Ave, Nashville, 37212, TN, USA.
Department of Psychology, Vanderbilt University, 2301 Vanderbilt Place, Nashville, 37240, TN, USA.
BMC Public Health. 2018 Apr 13;18(1):498. doi: 10.1186/s12889-018-5403-z.
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. 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.
Using 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).
The 3 partner sites recruited a total of 26 parent-child pairs.
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.
Qualitative interviews with participants demonstrated increased use of the built environment for physical activity and continued use of key strategies for health behavior change.
Three of five (60%) collaborating sites proceeded with implementation of the program.
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).
All 3 partner sites continued offering the program after grant funding was complete.
This 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.
在社区环境中扩大使用基于证据的行为干预措施在各种健康结果方面收效甚微，因为当将临床干预措施转化为社区时，其保真度和剂量往往会降低。我们进行了一项试点实施研究，以检查经过严格评估的健康家庭计划在全国 3 个城市（密歇根州、佐治亚州、内华达州）的公园和娱乐中心的采用情况，这些城市具有不同的社会文化环境。
使用 RE-AIM 框架，我们从定量（健康行为改变的前后调查；出勤率和保真度）和定性（项目结束后对公园和娱乐中心工作人员和参与者的访谈）两个方面评估了该计划。
3 个合作地点共招募了 26 对父母和子女。
在完成前后调查的 24 名参与者中，62.5%的人年龄在 25-34 岁之间，平均孩子年龄为 3.6（SD 0.7）岁。自我报告的种族/族裔分布为 54%是非西班牙裔白人，38%是非西班牙裔黑人，8%是拉丁裔。
对参与者的定性访谈表明，他们更多地利用了建筑环境进行体育活动，并继续使用健康行为改变的关键策略。
五个合作地点中有三个（60%）继续实施该计划。
为期 12 周的计划平均出勤率为 7.6（SD 3.9）节，71%的人参加了>50%的课程。12 周每周课程的平均保真度为 25.2（SD 1.2；可能范围为 9-27）。
在赠款资金用完后，所有 3 个合作伙伴站点都继续提供该计划。
这是首次尝试在社区公园和娱乐中心推广基于证据的儿童肥胖干预措施。虽然本试点研究的目的不是确认原始试验在体重指数（BMI）降低方面的疗效，但在地理和种族多样化、高出勤率和保真度的人群中，有效的、持续的行为改变表明，这是一种有效的方法，可以为未来在社区环境中减少儿童肥胖的大规模实施工作提供基础。
