Background
Suboptimal use of evidence for obesity prevention and nutrition promotion
Implementation studies to improve adoption of evidence for obesity prevention in childcare
Aims
Component | Outcomes | References | Type of Evidence |
---|---|---|---|
Positive ECE feeding practices (e.g., cues children to hunger, allows food exploration) | Children learn to self-regulate and listen to their body’s cues of satiety. Children are less likely to reject foods and more likely to taste new foods. | RCTs, Quasi-Experimental Trials; American Dietetic Assoc. (ADA) Guidelines; Head Start guidelines | |
Appropriate role modeling by ECE (e.g., eats healthy foods, talks positively about new foods) | Children are more likely to try new foods and eat healthy foods served. | Quasi-experimental trials, systematic review; ADA guidelines; Head Start guidelines | |
Multiple, hands-on exposures to fruits and vegetables (FV) | Repeat exposure results in increased intake and liking of FV for children. | RCTs, quasi-experimental trials, systematic review; Head Start guidelines | |
Use of mascot puppet to promote FV to children | Children are more likely to select and prefer foods associated with familiar characters. | RCT, quasi-experimental trials, systematic review |
WISE component | Fall (month 1) (%) | Winter (month 5) (%) | Spring (month 8) (%) |
---|---|---|---|
Role modelinga
| 35.0 | 43.4 | 46.7 |
Use of mascota
| 15.8 | 26.0 | 26.6 |
Hand-on exposuresa
| 57.0 | 30.3 | 43.3 |
Positive feeding practicesb
| 30.0 | 38.2 | 20.5 |
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Aim 1. Identify factors associated with degree of fidelity in a previously developed and tested basic implementation strategy of WISE. An explanatory mixed methods approach will use secondary data to identify positive deviance and implementation failures among ECEs in a previous WISE implementation study that observed notable variability in fidelity to best practices for obesity prevention.
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Aim 2. Develop an enhanced implementation strategy to support uptake of the WISE intervention using stakeholder input. An evidence-based quality improvement (EBQI) process [23] will be used to engage stakeholders to develop implementation support strategies consistent with an implementation framework (i-PARiHS: integrated Promoting Action on Research Implementation in Health Services) and matched to identified barriers/facilitators.
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Aim 3. Test the impact of the enhanced implementation strategy on implementation and child health outcomes using a Hybrid Type III Cluster Randomized Trial [24] and continuous formative evaluation. We will determine whether the enhanced strategy is feasible, acceptable, and demonstrates improved implementation, fidelity, and sustainability. Further, we will test the hypothesis that better WISE fidelity is positively related to child outcomes (e.g., child fruit and vegetable intake, BMI). A cluster randomization at the center level will be used to avoid cross-over effects among ECEs.
Theoretical framework
Methods
Aim 1
Study design
Participants, setting, and sample size
Data analysis
Aim 2
Study design
Participants, setting, and sample size
Outcomes
Data analysis
Aim 3
Study design
Participants, setting, and sample size
Intervention and center randomization
Primary outcomes
Construct | Measures | Level of measurement |
---|---|---|
Reach | Number of children impacted | Cluster |
Effectiveness | Child Food Frequency Questionnaire (parent report); child Body Mass Index (record review); child Resonance Raman Spectroscopy scan | Individual |
Adoption | Food purchase records reflecting the number of WISE lessons completed; Resources distributed, Organizational Readiness to Change Assessment | Cluster; individual |
Implementation | WISE fidelity, acceptability, feasibility | Individual |
Maintenance | Proportion of ECEs maintaining/ increasing in fidelity after 6 months | Cluster |