Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Science, Deakin University, Geelong, VIC, Australia.
Transforming Obesity Prevention in CHILDren (TOPCHILD) Collaboration, Sydney, NSW, Australia.
Front Public Health. 2023 Jan 13;10:1026856. doi: 10.3389/fpubh.2022.1026856. eCollection 2022.
Early life parent-focused interventions can effectively improve infant and child nutrition and movement (physical activity and sedentary behavior) as well as parents' health behaviors. Scale-up of such interventions to real-world settings is essential for population-wide benefits. When progressing to scale-up, intervention components may be modified to reflect contextual factors and promote feasibility of scale-up. The INFANT program, an efficacious early life nutrition and movement behavioral intervention began as a randomized controlled trial (RCT), was modified after a small-scale translation, and is currently being scaled-up in Victoria, Australia. This study mapped and compared discrete intervention components of both the original RCT and the scaled-up version of INFANT to examine modifications for scaling up.
Discrete intervention components, specifically the target behaviors (child-related and parent-related behaviors), delivery features and behavior change techniques (BCTs) from the RCT and the scaled-up program were coded and mapped using established frameworks and taxonomies. Publications and unpublished materials (e.g., facilitator notes, handouts, videos, app) were coded. Coding was performed independently in duplicate, with final coding validated in a meeting with interventionists. Interventionists reported the rationale for modifications made.
The INFANT RCT and scaled-up version targeted the same obesity prevention-related nutrition and movement behaviors. Key modified delivery features at scale-up included reduced number of sessions, a broader range of professionals facilitating groups, the addition of a mobile app for parents replacing hard-copy materials and tangible tools (e.g., pedometers), and broadening of content (e.g., early feeding, updated 24-h movement guidelines). BCTs used across the RCT and scale-up sessions were unchanged. However, the BCTs identified in the between-session support materials were almost double for the scale-up compared with the RCT, primarily due to the reduced number of sessions and the app's capacity to include more content.
INFANT is one of few early life nutrition and movement behavioral interventions being delivered at scale. With INFANT as an example, this study provides critical understanding about what and why intervention components were altered as the RCT was scaled-up. Unpacking these intervention modifications provides important insights for scale-up feasibility, outcome effects, and how to optimize implementation strategies for population-level benefits.
早期以父母为中心的干预措施可以有效改善婴儿和儿童的营养和运动（身体活动和久坐行为）以及父母的健康行为。将此类干预措施推广到真实环境对于实现人群效益至关重要。在推广过程中，干预措施的组成部分可能会进行修改，以反映背景因素并促进推广的可行性。INFANT 计划是一项有效的早期生活营养和运动行为干预措施，最初是一项随机对照试验 (RCT)，在小规模翻译后进行了修改，目前正在澳大利亚维多利亚州进行推广。本研究对原始 RCT 和 INFANT 扩大版本的离散干预措施进行了映射和比较，以检查扩大规模的修改。
使用既定框架和分类法对 RCT 和扩大计划中的离散干预措施，特别是目标行为（儿童相关和父母相关行为）、传递特征和行为改变技术 (BCT) 进行编码和映射。对出版物和未发表的材料（例如，辅导员笔记、讲义、视频、应用程序）进行编码。编码由两位独立人员进行，最终编码在与干预人员的会议上进行验证。干预人员报告了进行修改的理由。
INFANT RCT 和扩大版本针对的是相同的肥胖预防相关的营养和运动行为。扩大规模的关键修改传递特征包括减少课程数量、更多专业人员为小组提供服务、为父母添加移动应用程序以替代纸质材料和有形工具（例如计步器）以及拓宽内容（例如早期喂养、更新 24 小时运动指南）。RCT 和扩大课程中使用的 BCT 保持不变。然而，与 RCT 相比，扩大课程的支持材料中的 BCT 几乎增加了一倍，这主要是由于课程数量减少以及应用程序可以包含更多内容。
INFANT 是少数正在推广的早期生活营养和运动行为干预措施之一。以 INFANT 为例，本研究深入了解了 RCT 扩大规模时干预措施发生变化的原因。剖析这些干预措施的修改为推广可行性、结果效果以及如何优化实施策略以实现人群效益提供了重要见解。
