Obesity prevention practices in early care and education settings: an adaptive implementation trial

Taren Swindle; Julie M Rutledge; James P Selig; Jacob Painter; Dong Zhang; Janna Martin; Susan L Johnson; Leanne Whiteside-Mansell; Daniel Almirall; Tracey Barnett-McElwee; Geoff M Curran

doi:10.1186/s13012-021-01185-1

Obesity prevention practices in early care and education settings: an adaptive implementation trial

Implement Sci. 2022 Mar 18;17(1):25. doi: 10.1186/s13012-021-01185-1.

Authors

Affiliations

¹ Department of Family and Preventive Medicine, University of Arkansas for Medical Sciences, 4301 W. Markham St, #530, Little Rock, AR, 72205-7199, USA. tswindle@uams.edu.
² ENRICH Center, College of Applied and Natural Sciences, Louisiana Tech University, Ruston, USA.
³ College of Public Health, Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, USA.
⁴ College of Pharmacy, Division of Pharmaceutical Evaluation & Policy, University of Arkansas for Medical Sciences, Little Rock, USA.
⁵ Department of Family and Preventive Medicine, University of Arkansas for Medical Sciences, 4301 W. Markham St, #530, Little Rock, AR, 72205-7199, USA.
⁶ Department of Pediatrics, University of Colorado Anschutz Medical Campus, 12700 East 19th Avenue Box C225, Aurora, CO, 80045, USA.
⁷ Institute for Social Research, College of Literature, Science, and the Arts, University of Michigan, 2448 ISR-Thompson 426 Thompson St, Ann Arbor, MI, 48109, USA.
⁸ School of Social Work, College of Business, Health, and Human Services, University of Arkansas at Little Rock, 2801 South University Ave, Little Rock, AR, 72204, USA.
⁹ Department of Pharmacy Practice and Psychiatry, University of Arkansas for Medical Sciences, 4301 W. Markham St, #522-4, Little Rock, AR, 72205-7199, USA.

Abstract

Background: Despite the potential for Early Care and Education (ECE) settings to promote healthy habits, a gap exists between current practices and evidence-based practices (EBPs) for obesity prevention in childhood.

Methods: We will use an enhanced non-responder trial design to determine the effectiveness and incremental cost-effectiveness of an adaptive implementation strategy for Together, We Inspire Smart Eating (WISE), while examining moderators and mediators of the strategy effect. WISE is a curriculum that aims to increase children's intake of carotenoid-rich fruits and vegetables through four evidence-based practices in the early care and education setting. In this trial, we will randomize sites that do not respond to low-intensity strategies to either (a) continue receiving low-intensity strategies or (b) receive high-intensity strategies. This design will determine the effect of an adaptive implementation strategy that adds high-intensity versus one that continues with low-intensity among non-responder sites. We will also apply explanatory, sequential mixed methods to provide a nuanced understanding of implementation mechanisms, contextual factors, and characteristics of sites that respond to differing intensities of implementation strategies. Finally, we will conduct a cost effectiveness analysis to estimate the incremental effect of augmenting implementation with high-intensity strategies compared to continuing low-intensity strategies on costs, fidelity, and child health outcomes.

Discussion: We expect our study to contribute to an evidence base for structuring implementation support in real-world ECE contexts, ultimately providing a guide for applying the adaptive implementation strategy in ECE for WISE scale-up. Our work will also provide data to guide implementation decisions of other interventions in ECE. Finally, we will provide the first estimate of relative value for different implementation strategies in this setting.

Trial registration: NCT05050539 ; 9/20/21.

Keywords: Child nutrition sciences; Childcare; Early care and education; Early intervention; Implementation science; Obesity.

Publication types

Clinical Trial
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Child
Evidence-Based Practice
Health Promotion* / methods
Humans
Obesity* / prevention & control

Associated data

ClinicalTrials.gov/NCT05050539

Abstract

Publication types

MeSH terms

Associated data

Grants and funding