Packaging and Disseminating the JOIN for ME Program in Low-Income Settings

在低收入环境中包装和传播 JOIN for ME 计划

• 批准号: 10517266
• 负责人: ELISSA JELALIAN
• 金额: $ 50万
• 依托单位: MIRIAM HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-04-01 至 2024-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10517266
• 关键词: Packaging; Disseminating; JOIN; ME; Program

PROJECT SUMMARY/ABSTRACT The prevalence of overweight/obesity among children and adolescents remains a public health priority. A convergence of evidence supports the efficacy of comprehensive family-based lifestyle approaches for the treatment of pediatric obesity, as reflected in the U.S. Preventive Services Task Force (USPSTF) Grade B recommendation for clinicians to refer identified youth to such programs. Despite this call to action, the vast majority of children struggling with obesity do not have access to evidence-based care. The most pressing need is in youth from low-income families, who are at greatest risk of obesity and least likely to have access to care. Delivering interventions through community settings offers one strategy for increasing access. The JOIN for ME program, developed as a collaboration between United HealthGroup and Y-USA, is a pediatric weight management intervention that can be delivered in community settings, with potential for national dissemination. Consistent with empirically supported family-based interventions, the JOIN for Me program includes strong parental involvement, use of effective behavioral strategies such as self-monitoring, and intervention targets that focus on reducing consumption of energy dense, nutrient poor foods and beverages, decreasing sedentary behavior, and increasing physical activity. Findings from an open trial (N=115) and subsequent randomized controlled trial (N=75) demonstrate significant and meaningful reductions in weight status in children 6-12 years of age; 4.3% and 5.5% decrease in percent overweight. We propose to package the JOIN for ME program to increase acceptability and feasibility for delivery in low-income communities and test implementation in two novel settings: the housing authority and the patient- centered medical home. The revised JOIN for ME package will be tested in a rigorous implementation study, the goals of which are to: 1) examine key implementation metrics of program acceptability, feasibility, fidelity, reach, and cost through comprehensive assessment of process measures, qualitative data, and cost analyses and 2) evaluate patient outcomes, including changes in child and parent weight status and health-related quality of life (HRQL). A total of 128 children (ages 6-12 years) with BMI > 85th% from low-income families and a primary caregiver will be enrolled to participate in the JOIN for ME program offered through one of four settings using a delayed treatment onset design. We will evaluate a series of implementation outcomes to examine constructs of reach, acceptability and feasibility through process measures and multi-informant qualitative interviews. It is hypothesized that children who receive the JOIN for ME program first will demonstrate greater decrease in percent over median BMI and greater improvements in HRQL than those in the delayed treatment onset who receive the intervention four months later. Implementation and effectiveness outcomes will be compiled, examined, and reviewed with Community and Payer Advisory Boards to develop a plan for large scale dissemination of the JOIN for ME program.

项目摘要/摘要 儿童和青少年超重/肥胖的患病率仍然是公共卫生的重中之重。 证据的融合支持全面基于家庭生活方式的方法的功效 如美国预防服务工作队（USPSTF）B级的治疗儿科肥胖 建议临床医生将确定的青年推荐给此类计划。尽管采取了这种呼吁，但很大 大多数与肥胖症一起挣扎的儿童无法获得基于证据的护理。最紧迫的 需求是来自低收入家庭的青年，他们有肥胖的风险最大，最不可能获得 关心。通过社区设置提供干预措施为增加访问权限提供了一种策略。加入 对我的计划而言，是联合健康小组和Y-USA之间的合作，是小儿体重 可以在社区环境中提供的管理干预措施，并具有国家传播的潜力。 与经验支持的基于家庭的干预措施一致，《我的联盟》计划包括强大 父母的参与，使用有效的行为策略，例如自我监控以及干预目标 专注于减少能源密集，营养不良的食物和饮料的消费，减少 久坐的行为，并增加体育锻炼。开放式试验（n = 115）和随后的发现 随机对照试验（n = 75）显示体重状态的显着且有意义的减少 6-12岁的儿童；超重百分比降低了4.3％和5.5％。 我们建议为我打包加入计划，以提高可接受性和可行性 低收入社区和在两个新颖环境中的测试实施：住房管理局和患者 - 中心医疗之家。修订后的我的包裹将在严格的实施研究中进行测试， 其目标是：1）检查计划可接受性，可行性，忠诚度的关键实施指标 通过全面评估过程措施，定性数据和成本分析来达到和成本 2）评估患者的预后，包括儿童和父母体重状况的变化以及与健康有关 生活质量（HRQL）。低收入家庭的总共128名儿童（6-12岁），BMI> 85％。 一名初级护理人员将被招募参加为我参加的“为我的加入计划”。 使用延迟的治疗开始设计进行设置。我们将评估一系列实施结果 通过过程度量和多信息检查覆盖范围，可接受性和可行性的结构 定性访谈。假设获得我的加入计划的孩子首先将 比中位BMI的百分比更大，而HRQL的改进比中的百分比更大 四个月后接受干预的延迟治疗发作。实施和有效性 成果将与社区和付款人咨询委员会进行编译，检查和审查，以开发一个 计划大规模传播我的计划。