Engaging stakeholders in the adaptation of the Connect for Health pediatric weight management program for national implementation

Meg Simione, Holly M Frost, Rachel Cournoyer, Fernanda Neri Mini, Jackie Cassidy, Cassie Craddock, Jennifer Moreland, Jessica Wallace, Joshua Metlay, Caroline J Kistin, Kerry Sease, Simon J Hambidge, Elsie M Taveras, Meg Simione, Holly M Frost, Rachel Cournoyer, Fernanda Neri Mini, Jackie Cassidy, Cassie Craddock, Jennifer Moreland, Jessica Wallace, Joshua Metlay, Caroline J Kistin, Kerry Sease, Simon J Hambidge, Elsie M Taveras

Abstract

Background: Connect for Health is an evidence-based weight management program with clinical- and family-facing components for delivery in pediatric primary care for families of children ages 2 to 12 years. We used the Consolidated Framework for Implementation Research (CFIR) to guide formative work prior to national implementation. The purpose of this study was to describe the process and results of stakeholder engagement and program adaptation.

Methods: We used mixed qualitative and quantitative methods to iteratively adapt and optimize the program by assessing needs and perspectives of clinicians and parents, as well as contextual barriers, facilitators, and organizational readiness for the uptake of the proposed program tools and implementation strategies. We conducted interviews with primary care clinicians from four health care organizations in Boston, MA; Denver, CO; and Greenville, SC, and used principles of immersion-crystallization for qualitative analyses. We also conducted surveys of parents of children with a body mass index ≥ 85th percentile.

Results: We reached thematic saturation after 52 clinician interviews. Emergent themes representing the CFIR domains of intervention characteristics, outer and inner setting, and process included (1) importance of evidence-based clinical decision support tools that integrate into the workflow and do not extend visit time, (2) developing resources that respond to family's needs, (3) using multimodal delivery options for family resources, (4) addressing childhood obesity while balancing competing demands, (5) emphasizing patient care rather than documentation and establishing sustainability plans, and (6) offering multiple training methods that incorporate performance feedback. Of the parents surveyed (n = 400), approximately 50% were Spanish-speaking and over 75% reported an annual income < $50,000. Parents affirmed the importance of addressing weight management during well-child visits, being provided with referrals and resources, and offering multiple methods for resource delivery. Decisions about program modifications were made at the program and healthcare-system level and based on stakeholder engagement findings. Modifications included cultural, geographic, and target audience adaptations, as well as varied resource delivery options.

Conclusions: To ensure the fit between the Connect for Health program and national implementation settings, adaptations were systematically made through engagement of clinician and parent stakeholders to support adoption, sustainability, and health outcomes.

Trial registration: NCT04042493.

Keywords: Adaptations; Childhood obesity; Implementation science; Pre-implementation; Stakeholder engagement.

Conflict of interest statement

Competing InterestsThe authors declare that they have no competing interests.

© The Author(s) 2020.

Figures

Fig. 1
Fig. 1
Implementation approach for Connect for Health drawing from the Consolidated Framework for Implementation Research
Fig. 2
Fig. 2
Parent perceptions of weight management programs (a), resource delivery methods (b), and text messaging preferences (c)

References

    1. Ogden C, Fryar CD, Hales C, Carroll MD, Aoki Y, Freedman D. Differences in obesity prevalaence by demographics and urbanization in US children and adolescents, 2013-2016. JAMA. 2018;319(23):2410–2418.
    1. Ogden CL, Carroll MD, Fakhouri TH, Hales CM, Fryar CD, Li X, et al. Prevalence of obesity among youths by household income and education level of head of household - United States 2011-2014. Morb Mortal Wkly Rep. 2018;67(6):186–189.
    1. Rossen LM, Schoendorf KC. Measuring health disparities: Trends in racial-ethnic and socioeconomic disparities in obesity among 2- to 18-year old youth in the United States, 2001-2010. Ann Epidemiol. 2012;22(10):698–704.
    1. Seburg E, Olson-Bullis B, Bredeson D, Hayes M, Sherwood N. A review of primary care-based childhood obesity prevention and treatment interventions. Curr Obes Rep. 2015;4(2):157–173.
    1. Bhuyan SS, Chandak A, Smith P, Carlton EL, Duncan K, Gentry D. Integration of public health and primary care: a systematic review of the current literature in primary care physician mediated childhood obesity interventions. Obes Res Clin Pract. 2015;9(6):539–552.
    1. Planning Committee for the Workshop on Funding Opportunities for Evidence-Based Prevention and Interventions to Promote Children’s Cognitive Affective and Behavioral Health. Opportunities to promote children’s behavioral health: health care reform and beyond. 2016.
    1. Leslie LK, Mehus CJ, Hawkins JD, Boat T, McCabe MA, Barkin S, et al. Primary health care: potential home for family-focused preventive interventions. Am J Prev Med. 2016;51(4):S106–S118.
    1. Taveras EM, Marshall R, Sharifi M, Avalon E, Fiechtner L, Horan C, et al. Comparative effectiveness of clinical-community childhood obesity interventions. JAMA Pediatr [Internet]. 2017;171(8) Available from: .
    1. Taveras EM, Marshall R, Sharifi M, Avalon E, Fiechtner L, Horan C, et al. Connect for Health: design of a clinical-community childhood obesity intervention testing best practices of positive outliers. Contemp Clin Trials. 2015;45:287–295.
    1. Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci. 2009;4(1):1–15.
    1. Kirk MA, Kelley C, Yankey N, Birken SA, Abadie B, Damschroder L. A systematic review of the use of the Consolidated Framework for Implementation Research. Implement Sci. 2016;11(1). Available from: 10.1186/s13012-016-0437-z.
    1. Barrera M, Berkel C, Castro FG. Directions for the advancement of culturally adapted preventive interventions: local adaptations, engagement, and sustainability. Prev Sci. 2017;18(6):640–648.
    1. Chambers DA, Glasgow RE, Stange KC. The dynamic sustainability framework: Addressing the paradox of sustainment amid ongoing change. Implement Sci. 2013;8(1):1.
    1. Chambers DA, Norton WE. The Adaptome: advancing the science of intervention adaptation. Am J Prev Med. 2016;51(4):S124–S131.
    1. Stirman SW, Baumann AA, Miller CJ. The FRAME: an expanded framework for reporting adaptations and modifications to evidence-based interventions. Implement Sci. 2019;14(1):1–10.
    1. Stirman SW, Miller CJ, Toder K, Calloway A. Development of a framework and coding system for modifications and adaptations of evidence-based interventions. Implement Sci. 2013;8(1):1–12.
    1. Saldana L, Chamberlain P, Wang W, Brown CH. Predicting program start-up using the stages of implementation measure. Adm Policy Ment Heal Ment Heal Serv Res. 2012;39(6):419–425.
    1. Saldana L. The stages of implementation completion for evidence-based practice: protocol for a mixed methods study. Implement Sci. 2014;9(1):1–11.
    1. Smith JD, Berkel C, Jordan N, Atkins DC, Narayanan SS, Gallo C, et al. An individually tailored family-centered intervention for pediatric obesity in primary care: study protocol of a randomized type II hybrid effectiveness-implementation trial (Raising Healthy Children study) Implement Sci. 2018;13(1):1–15.
    1. Sheridan S, Schrandt S, Forsythe L, Hilliard TS, Paez KA. The PCORI engagement rubric: promising practices for partnering in research. Ann Fam Med. 2017;15(2):165–170.
    1. Agency for Healthcare Research and Quality. Denver Health: How a safety net system maximizes its value [Internet]. 2019 [cited 2019 Jan 10]. Available from: .
    1. Gabow PA, Mehler PS. A broad and structured approach to improving patient safety and quality: Lessons from Denver Health. Health Aff. 2011;30(4):612–618.
    1. CFIR Research Team. The Consolidated Framework for Implementation Research [Internet]. 2019 [cited 2019 Jan 10]. p. Evaluation Design-Qualitative Data. Available from: .
    1. Borkan J. Immersion/Crystallization. Thousand Oaks: Sage Publications; 1999.
    1. Glasgow RE, Wagner E, Schaefer J, Mahoney L, Reid R, Greene S. Development and validation of the Patient Assessment of Chronic Illness Care (PACIC) Med Care. 2005;43(5):436–444.
    1. R Core Team. R: A language and environment for statistical computing. Vienna, Austria; 2013.
    1. Heerman WJ, Schludnt D, Harris D, Teeters L, Apple R, Barkin SL. Scale-out of a community-based behavioral intervention for childhood obesity: pilot implementation evaluation. BMC Public Health. 2018;18(1):1–11.
    1. Swindle T, Johnson SL, Whiteside-Mansell L, Curran GM. A mixed methods protocol for developing and testing implementation strategies for evidence-based obesity prevention in childcare: a cluster randomized hybrid type III trial. Implement Sci. 2017;12(1):1–10.
    1. Burgermaster M, Gray HL, Tipton E, Contento I, Koch P. Testing an integrated model of program implemnation: The Food, Health & Choices school-bases childhood obesity prevention intervention process evaluation. Prev Sci. 2017;18(1):71–82.
    1. Hill JL, Zoellner JM, You W, Brock DJ, Price B, Alexander RC, et al. Participatory development and pilot testing of iChoose: an adaptation of an evidence-based paediatric weight management program for community implementation. BMC Public Health. 2019;19(1):1–16.
    1. Hayes CB, O’Shea MP, Foley-Nolan C, McCarthy M, Harrington JM. Barriers and facilitators to adoption, implementation and sustainment of obesity prevention interventions in schoolchildren- a DEDIPAC case study. BMC Public Health. 2019;19(1):1–13.
    1. Feldstein DA, Hess R, McGinn T, Mishuris RG, McCullagh L, Smith PD, et al. Design and implementation of electronic health record integrated clinical prediction rules (iCPR): A randomized trial in diverse primary care settings. Implement Sci. 2017;12(1):1–11.
    1. Benjamin Wolk C, Van Pelt AE, Jager-Hyman S, Ahmedani BK, Zeber JE, Fein JA, et al. Stakeholder perspectives on implementing a firearm safety intervention in pediatric primary care as a universal suicide prevention strategy: a qualitative study. JAMA Netw Open. 2018;1(7):e185309.
    1. Huang K-Y, Kwon SC, Cheng S, Kamboukos D, Shelley D, Brotman LM, et al. Unpacking partnership, engagement, and collaboration research to inform implementation strategies development: theoretical frameworks and emerging methodologies. Front Public Heal. 2018;6(July):1–13.
    1. Glasgow RE, Phillips SM, Sanchez MA. Implementation science approaches for integrating eHealth research into practice and policy. Int J Med Inform. 2014;83(7):e1–11.
    1. Ross J, Stevenson F, Lau R, Murray E. Factors that influence the implementation of e-health: a systematic review of systematic reviews (an update). Implement Sci. 2016;11(1):1–12. Available from: 10.1186/s13012-016-0510-7.
    1. Gallo KP, Hill LC, Hoagwood KE, Olin SCS. A narrative synthesis of the components of and evidence for patient- and family-centered care. Clin Pediatr (Phila). 2016;55(4):333–346.
    1. Davison KK, Lawson HA, Coatsworth JD. The family-centered action model of intervention layout and implementation (FAMILI): The example of childhood obesity. Health Promot Pract. 2012;13(4):454–461.
    1. Miech EJ, Rattray NA, Flanagan ME, Damschroder L, Schmid AA, Damush TM. Inside help: An integrative review of champions in healthcare-related implementation. SAGE Open Med. 2018;6:1–11.
    1. Powell BJ, Waltz TJ, Chinman MJ, Damschroder LJ, Smith JL, Matthieu MM, et al. A refined compilation of implementation strategies: results from the Expert Recommendations for Implementing Change (ERIC) project. Implement Sci. 2015;10(1):1–14.

Source: PubMed

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