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, 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

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.

Conflict of interest statement

Dr. Leanne Whiteside-Mansell, Dr. Taren Swindle, and UAMS have a financial interest in the technology (WISE) discussed in this presentation/publication. These financial interests have been reviewed and approved in accordance with the UAMS conflict of interest.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Cluster-randomized enhanced non-responder trial
Fig. 2
Fig. 2
Conceptual model of proposed moderators & mediators

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Source: PubMed

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