Department of Family and Preventive Medicine, University of Arkansas for Medical Sciences, 4301 W. Markham St, #530, Little Rock, AR, 72205-7199, USA.
Embedded Preventive Behavioral Health Capability, Marine Corps Community Services, III MEF, United State Marine Corps, Okinawa, Japan.
Implement Sci. 2021 May 1;16(1):48. doi: 10.1186/s13012-021-01119-x.
Together, We Inspire Smart Eating (WISE) is an intervention for the early care and education setting to support children's exposure to and intake of fruits and vegetables. WISE emphasizes 4 evidence-based practices (EBPs): (1) use of a mascot; (2) educators' role modeling; (3) positive feeding practices; and (4) hands-on exposures. The current study reports on a small-scale implementation trial aimed at improving the use of WISE EBPs by teachers.
A Hybrid Type III Cluster Randomized Design compared a Basic and Enhanced implementation strategy. The Basic Strategy included training and reminders only; the Enhanced strategy was a multi-faceted package of stakeholder-selected strategies including a leadership commitment, an implementation blueprint, a local champion, an environmental reminder of the EBPs, facilitation, and tailored educational resources and incentives. All study sites were Head Starts. Sites were randomized using a balancing technique that considered site characteristics; 4 sites (20 classrooms, 39 educators, 305 children) received Enhanced support; 5 sites (18 classrooms, 36 educators, 316 children) received Basic support. RE-AIM guided the evaluation, and implementation fidelity was the primary outcome. Strategies were assessed using examination of data distributions and unadjusted comparisons (t tests) as well as general linear and mixed effects models controlling for covariates.
For the primary outcome of fidelity, the Enhanced group had significantly higher means for 3 of 4 EBPs. Multivariate models explained a significant portion of variance for both mascot use and hands-on exposure with a significant positive effect observed for treatment condition. The Enhanced group also had higher rates of Appropriateness and Organizational Readiness for Implementing Change (as indicators of implementation and adoption, respectively). There was no significant difference between groups for indicators of Reach, Effectiveness or Maintenance. Formative interviews indicated key targets for iteration and potential mechanisms. Key events were catalogued to provide context for interpretation (e.g., 61% of classrooms with turnover).
Findings were mixed but suggested promise for the Enhanced strategy, especially considering key events of the study. Implementation fidelity improvements occurred mainly in the last 3 months of the school year; additional time may be needed to translate to improvements in child outcomes.
NCT03075085 Registered 20 February 2017.
“携手智育健康饮食”（WISE）是一项针对早期儿童照护和教育环境的干预措施，旨在支持儿童接触和摄入水果和蔬菜。WISE 强调了 4 项循证实践（EBP）：（1）使用吉祥物；（2）教育者的示范作用；（3）积极喂养实践；以及（4）亲身接触。本研究报告了一项小规模实施试验的结果，旨在提高教师对 WISE EBP 的使用。
混合类型 III 集群随机设计比较了基础和增强实施策略。基础策略仅包括培训和提醒；增强策略是一系列利益相关者选择的策略，包括领导力承诺、实施蓝图、地方冠军、EBP 的环境提醒、促进以及量身定制的教育资源和激励措施。所有研究地点均为“Head Start”。使用考虑到站点特征的平衡技术对站点进行随机化；4 个站点（20 个教室、39 名教育者、305 名儿童）接受增强支持；5 个站点（18 个教室、36 名教育者、316 名儿童）接受基础支持。RE-AIM 指导了评估，实施一致性是主要结果。使用数据分布的检查和未调整的比较（t 检验）以及控制协变量的广义线性和混合效应模型来评估策略。
对于一致性的主要结果，增强组在 4 项 EBP 中有 3 项的平均值显著更高。多变量模型解释了吉祥物使用和亲身接触的大部分方差，并且治疗条件观察到显著的正效应。增强组在适当性和实施变革的组织准备就绪方面的得分也更高（分别作为实施和采用的指标）。两组在可及性、效果或维持方面没有显著差异。形成性访谈表明了迭代的关键目标和潜在机制。关键事件被记录下来，为解释提供了背景（例如，61%的班级有人员流动）。
结果喜忧参半，但增强策略有希望，特别是考虑到研究的关键事件。实施一致性的提高主要发生在学年的最后 3 个月；可能需要更多时间才能转化为儿童结果的改善。
NCT03075085 于 2017 年 2 月 20 日注册。
