Division of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston, MA, United States.
Division of Health Systems Innovation and Research, Department of Population Health Sciences, School of Medicine, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, UT, United States.
Front Public Health. 2022 Aug 25;10:954063. doi: 10.3389/fpubh.2022.954063. eCollection 2022.
Multi-sector stakeholder engagement is essential in the successful implementation, dissemination, and sustainability of pediatric weight management interventions (PWMI), particularly in low-income settings where sustainability relies on external policies and reimbursement. The objective of this study was to engage stakeholders (1) to inform the creation of the intervention with adaptations needed for a successful PWMI in a primary care and community setting and (2) to identify barriers and facilitators to implementation and dissemination.
We sought to examine the perspectives of local, state, and national clinic and community stakeholders during the pre-implementation period of a two-arm, randomized trial of a Health Weight Clinic PWMI conducted in two health centers and a modified-Healthy Weight and Your Child PWMI at two local YMCAs that serve a predominantly lower income, Hispanic community. The Consolidated Framework for Implementation Research interview guide served as a template for the study but was modified to fit the PWMIs and the various professional roles. Interviews were transcribed and analyzed using the framework analysis approach and themes were linked to the CFIR domains and constructs.
Twenty-six stakeholders perceived the following as needed components of a PWMI: a formal curriculum with illustrative examples, a patient- and family-centered program, group visits, and high-quality multidisciplinary personnel. These findings led to the creation of a group visit curriculum, implementation trainings and cross-site collaborative technical assistance. Additionally, creating partnerships between community and clinical organizations, and addressing patient barriers and unmet social needs (i.e., transportation, food) were identified as facilitators to successful implementation. These results led to the creation of community resource guides, connections to community organizations, and screening and referring for unmet social needs. Perceived facilitators of dissemination included proving cost-effectiveness of the PWMI to inform insurance reimbursement for long-term sustainability. Therefore, we collected cost data and engaged with Medicaid officials to discuss reimbursement.
Findings highlight the importance of engaging multi-sector stakeholders pre-implementation to ensure the components valued are included, ensuring the program minimizes barriers to participation, considering how staff training can improve implementation and how collected outcomes can inform sustainability and dissemination of PWMIs in clinic and community settings.
多部门利益相关者的参与对于成功实施、传播和维持儿科体重管理干预措施（PWMI）至关重要，特别是在低收入环境中，可持续性依赖于外部政策和报销。本研究的目的是让利益相关者参与进来：（1）为在初级保健和社区环境中成功实施 PWMI 提供信息，制定干预措施，并进行必要的调整；（2）确定实施和传播的障碍和促进因素。
我们在一项针对两家健康中心的健康体重诊所 PWMI 及两家服务于以低收入、西班牙裔为主的社区的当地基督教青年会实施的两臂随机试验的实施前阶段，寻求当地、州和国家诊所和社区利益相关者的意见。实施研究综合框架访谈指南作为研究模板，但进行了修改以适应 PWMI 和各种专业角色。访谈记录被转录并使用框架分析方法进行分析，主题与 CFIR 领域和结构相关联。
26 名利益相关者认为 PWMI 需要以下组成部分：一个有实例说明的正式课程、以患者和家庭为中心的计划、小组访问和高质量的多学科人员。这些发现导致创建了小组访问课程、实施培训和跨站点协作技术援助。此外，建立社区和临床组织之间的伙伴关系，以及解决患者障碍和未满足的社会需求（即交通、食物），被确定为成功实施的促进因素。这些结果导致创建社区资源指南、与社区组织的联系，以及筛查和转介未满足的社会需求。传播的促进因素包括证明 PWMI 的成本效益，以获得保险报销以实现长期可持续性。因此，我们收集了成本数据，并与医疗补助官员进行了讨论，以探讨报销问题。
研究结果强调了在实施前阶段让多部门利益相关者参与的重要性，以确保纳入有价值的组成部分，确保该计划最大限度地减少参与障碍，考虑如何通过员工培训来提高实施效果，以及如何收集结果来为诊所和社区环境中的 PWMI 的可持续性和传播提供信息。
