Lew Mei Sien, L'Allemand Dagmar, Meli Damian, Frey Peter, Maire Micheline, Isenschmid Bettina, Tal Kali, Molinari Beatrice, Auer Reto
Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.
Pädiatrische Endokrinologie/Diabetologie, Fachbereich Jugendmedizin, Ostschweizer Kinderspital, St. Gallen, Switzerland.
Prev Med Rep. 2019 Jan 24;13:321-326. doi: 10.1016/j.pmedr.2019.01.017. eCollection 2019 Mar.
Primary care providers can use behavioral lifestyle interventions to effectively treat children with overweight and obesity, but implementing these interventions is challenging. Most childhood obesity intervention evaluation studies focus on effectiveness. Few studies describe implementation. Our goal was to evaluate critical components of a childhood obesity intervention in primary care. We conducted a pilot implementation study of an existing structured lifestyle intervention in the Canton of Bern, Switzerland from 2013 to 2015. The intervention consisted of 10 sessions, led by a primary care physician. It included children aged 6-8 years old, with BMI over the 90th age-adjusted percentile. We used the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) evaluation framework to describe the pilot implementation study. We stratified description of RE-AIM components at the patient- and physician-level. For Reach: 864 children were screened; 65 were overweight; 394 physicians were invited to participate in the study. For Effectiveness: BMI z-score significantly decreased (-5.6%, p = 0.01). For Adoption: 14 participating physicians treated 26 patients. Implementation: the mean number of consultations was 8. For Maintenance: 9 (35%) children discontinued the intervention; 7 (50%) of physicians continued to apply at least one component of the intervention. The summarized components of the program within the RE-AIM framework suggest the program was successful. Stakeholders can use our results if they intend to disseminate and evaluate similar interventions in different settings.
初级保健提供者可以使用行为生活方式干预措施来有效治疗超重和肥胖儿童,但实施这些干预措施具有挑战性。大多数儿童肥胖干预评估研究都侧重于有效性。很少有研究描述实施情况。我们的目标是评估初级保健中儿童肥胖干预的关键组成部分。2013年至2015年,我们在瑞士伯尔尼州对现有的结构化生活方式干预措施进行了一项试点实施研究。该干预由一名初级保健医生主持,包括10次课程。参与者为6至8岁、BMI超过年龄调整后第90百分位数的儿童。我们使用“覆盖、有效性、采用、实施和维持”(RE-AIM)评估框架来描述该试点实施研究。我们在患者和医生层面分层描述了RE-AIM的各个组成部分。关于覆盖:筛查了864名儿童;65名超重;邀请了394名医生参与研究。关于有效性:BMI z评分显著下降(-5.6%,p = 0.01)。关于采用:14名参与的医生治疗了26名患者。关于实施:平均会诊次数为8次。关于维持:9名(35%)儿童停止了干预;7名(50%)医生继续应用该干预措施的至少一个组成部分。RE-AIM框架内该项目的总结组成部分表明该项目是成功的。如果利益相关者打算在不同环境中推广和评估类似干预措施,可以使用我们的结果。