Department of Biology, University of Nebraska at Kearney, Kearney, NE, USA.
Department of Kinesiology and Sport Sciences, University of Nebraska at Kearney, Kearney, NE, USA.
Prev Sci. 2024 Apr;25(Suppl 1):72-84. doi: 10.1007/s11121-023-01557-7. Epub 2023 Jul 21.
Current childhood obesity treatment programs do not address medically underserved populations or settings where all members of an interdisciplinary team may not exist-either within one organization or within the community. In this paper, we describe the use of a community-academic partnership to iteratively adapt Epstein's Traffic Light Diet (TLD), into Building Healthy Families (BHF), a community-placed evidence-based pediatric weight management intervention (PWMI) and evaluate its effectiveness in reducing BMI z scores. Nine cohorts of families completed BHF. Participants included children aged 6-12 years with obesity (M = 9.46, SD = 1.74). The Framework for Reporting Adaptations and Modifications-Expanded guided our classification of modifications across BHF cohorts. Using the FRAME reporting structure, the changes that were documented were (1) planned and occurred pre-implementation, (2) based on decisions from local stakeholders (e.g., school administrator, members of the implementation team), and (3) specific to changes in content and context-with a focus on implementation and potential for local scale-up. The nature of the adaptations included adding elements (whole of family approach), removing elements (calorie counting), and substituting elements (steps for minutes of physical activity). Across 9 cohorts, 84 families initiated the BHF program, 69 families successfully completed the 12-week program, and 45 families returned for 6-month follow-up assessments. Results indicated that the BMI z score in children was reduced by 0.31 ± 0.17 at 6 months across all cohorts. Reduction in BMI z score ranged from 0.41 in cohort 4 to 0.13 in cohort 5. Iterative adaptations to BHF were completed to improve the fit of BHF to the setting and participants and have contributed to a sustained community PWMI that adheres to the underlying principles and core elements of other evidence-based PWMIs. Monitoring adaptations and related changes to outcomes can play a role in long-term sustainability and effectiveness.
当前的儿童肥胖治疗方案并未针对医疗服务不足的人群或可能无法配备跨学科团队所有成员的环境进行治疗——无论是在一个组织内还是在社区内。在本文中，我们描述了使用社区学术伙伴关系对 Epstein 的红绿灯饮食法（TLD）进行迭代改编，形成“建立健康家庭”（BHF），这是一种基于社区的、经过验证的儿科体重管理干预措施（PWMI），并评估其降低 BMI z 分数的效果。共有 9 个家庭组完成了 BHF。参与者包括年龄在 6-12 岁、患有肥胖症的儿童（M=9.46，SD=1.74）。“适应和修改扩展框架”（FRAME）指导了我们对 BHF 各个家庭组的修改分类。使用 FRAME 报告结构，记录的变化包括：（1）计划并在实施前发生；（2）基于当地利益相关者（例如，学校管理员、实施团队成员）的决策；（3）特定于内容和背景的变化——重点是实施和潜在的地方扩展。改编的性质包括添加元素（整个家庭方法）、删除元素（计算卡路里）和替换元素（用于体育活动分钟的步骤）。在 9 个家庭组中，有 84 个家庭启动了 BHF 项目，69 个家庭成功完成了 12 周的项目，45 个家庭参加了 6 个月的随访评估。结果表明，所有家庭组的儿童 BMI z 分数在 6 个月时平均降低了 0.31±0.17。BMI z 分数的降低范围从第 4 组的 0.41 到第 5 组的 0.13。对 BHF 的迭代改编旨在提高 BHF 与环境和参与者的适应性，并促成了一种持续的社区 PWMI，该 PWMI坚持了其他基于证据的 PWMI 的基本原则和核心要素。监测适应性及其对结果的相关变化可以在长期可持续性和效果方面发挥作用。
