Prevention Research Center in St. Louis, The Brown School, Washington University in St. Louis, 1 Brookings Dr, St. Louis, MO, 63130, USA.
Division of General Medical Sciences, Department of Medicine, Washington University School of Medicine, 4523 Clayton Avenue, Campus Box 8005, St. Louis, MO, 63110, USA.
BMC Public Health. 2018 Nov 16;18(1):1265. doi: 10.1186/s12889-018-6176-0.
Describing how and why an evidence-based intervention is adapted for a new population and setting using a formal evaluation and an adaptation framework can inform others seeking to modify evidence-based weight management interventions for different populations or settings. The Working for You intervention was adapted, to fit a workplace environment, from Be Fit Be Well, an evidence-based intervention that targets weight-control and hypertension in patients at an outpatient clinic. Workplace-based efforts that promote diet and activity behavior change among low-income employees have potential to address the obesity epidemic. This paper aims to explicitly describe how Be Fit Be Well was adapted for this new setting and population.
To describe and understand the worksite culture, environment, and policies that support or constrain healthy eating and activity in the target population, we used qualitative and quantitative methods including key informant interviews, focus groups, and a worker survey; these data informed intervention adaptation. We organized the adaptations made to Be Fit Be Well using an adaptation framework from implementation science.
The adapted intervention, Working for You, maintains the theoretical premise and evidence-base underpinning Be Fit Be Well. However, it was modified in terms of the means of delivery (i.e., rather than using interactive voice response, Working for You employs automated SMS text messaging), defined as a modification to context by the adaptation framework. The adaptation framework also includes modifications to content; in this case the behavioral goals were modified for the target population based on updated science related to weight loss and to target a workplace population (e.g., a goal to avoiding free food at work).
If effective, this scalable and relatively inexpensive intervention can be translated to other work settings to reduce obesity and diabetes risk among low-SES workers, a group with a higher prevalence of these conditions. Using a formal evaluation and framework to guide and organize how and why an evidence-based intervention is adapted for a new population and setting can push the field of intervention research forward.
ClinicalTrials.gov: NCT02934113 ; Received: October 12, 2016; Updated: November 7, 2017.
使用正式评估和改编框架来描述如何以及为何针对新人群和环境改编基于证据的干预措施，可以为其他试图为不同人群或环境修改基于证据的体重管理干预措施的人提供信息。“为你工作”干预措施是从针对门诊患者的体重控制和高血压的基于证据的干预措施“保持健康”改编而来的，以适应工作场所环境。在低收入员工中开展促进饮食和活动行为改变的基于工作场所的工作，有可能解决肥胖流行问题。本文旨在明确描述如何将“保持健康”改编为新的环境和人群。
为了描述和了解支持或限制目标人群健康饮食和活动的工作场所文化、环境和政策，我们使用了定性和定量方法，包括关键知情人访谈、焦点小组和工人调查；这些数据为干预措施的改编提供了信息。我们使用实施科学的改编框架来组织对“保持健康”的改编。
改编后的干预措施“为你工作”保留了“保持健康”的理论前提和证据基础。然而，它在交付方式上进行了修改（即，“为你工作”采用自动短信文本消息，而不是使用交互式语音应答），根据改编框架，这被定义为对背景的修改。改编框架还包括对内容的修改；在这种情况下，根据与体重减轻相关的最新科学和针对工作场所人群的目标（例如，避免在工作时吃免费食物的目标），对行为目标进行了修改。
如果有效，这种可扩展且相对廉价的干预措施可以推广到其他工作场所，以降低低收入工人的肥胖和糖尿病风险，这些工人的这些疾病发病率更高。使用正式评估和框架来指导和组织如何以及为何针对新人群和环境改编基于证据的干预措施，可以推动干预研究领域的发展。
ClinicalTrials.gov：NCT02934113；接收日期：2016 年 10 月 12 日；更新日期：2017 年 11 月 7 日。
