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首页> 外文期刊>Frontiers in Public Health >The Family Check-Up 4 Health (FCU4Health): Applying Implementation Science Frameworks to the Process of Adapting an Evidence-Based Parenting Program for Prevention of Pediatric Obesity and Excess Weight Gain in Primary Care
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The Family Check-Up 4 Health (FCU4Health): Applying Implementation Science Frameworks to the Process of Adapting an Evidence-Based Parenting Program for Prevention of Pediatric Obesity and Excess Weight Gain in Primary Care

机译：家庭健康检查4健康（FCU4Health）：将实施科学框架应用于适应性循证育儿计划的过程，以预防小儿肥胖和基层医疗中体重增加

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Implementation experts have recently argued for a process of “scaling out” evidence-based interventions, programs, and practices (EBPs) to improve reach to new populations and new service delivery systems. A process of planned adaptation is typically required to integrate EBPs into new service delivery systems and address the needs of targeted populations while simultaneously maintaining fidelity to core components. This process-oriented paper describes the application of an implementation science framework and coding system to the adaptation of the Family Check-Up (FCU), for a new clinical target and service delivery system—prevention of obesity and excess weight game in primary care. The original FCU has demonstrated both short- and long-term effects on obesity with underserved families across a wide age range. The advantage of adapting such a program is the existing empirical evidence that the intervention improves the primary mediator of effects on the new target outcome. We offer a guide for determining the levels of evidence to undertake the adaptation of an existing EBP for a new clinical target. In this paper, adaptation included shifting the frame of the intervention from one of risk reduction to health promotion; adding health-specific assessments in the areas of nutrition, physical activity, sleep, and media parenting behaviors; family interaction tasks related to goals for health and health behaviors; and coordinating with community resources for physical health. We discuss the multi-year process of adaptation that began by engaging the FCU developer, community stakeholders, and families, which was then followed by a pilot feasibility study, and continues in an ongoing randomized effectiveness-implementation hybrid trial. The adapted program is called the Family Check-Up 4 Health (FCU4Health). We apply a comprehensive coding system for the adaptation of EBPs to our process and also provide a side-by-side comparison of behavior change techniques for obesity prevention and management used in the original FCU and in the FCU4Health. These provide a rigorous means of classification as well as a common language that can be used when adapting other EBPs for context, content, population, or clinical target. Limitations of such an approach to adaptation and future directions of this work are discussed.
机译：实施专家最近提出了“扩大”基于证据的干预措施，计划和实践（EBP）的过程，以改善对新人群和新服务提供系统的影响。通常需要有计划的适应过程，以将EBP集成到新的服务交付系统中，满足目标人群的需求，同时保持对核心组件的忠诚度。这份面向过程的论文描述了实施科学框架和编码系统在适应家庭检查（FCU）方面的应用，以适用于新的临床目标和服务提供系统-预防初级保健中的肥胖和超重游戏。最初的FCU已证明，对于年龄分布较广的家庭服务不足的家庭，肥胖对肥胖有短期和长期影响。改编此类程序的优势在于，现有的经验证据表明，干预措施可以改善对新目标结果产生影响的主要媒介。我们为确定证据水平进行现有的EBP适应新的临床目标提供了指南。在本文中，适应包括将干预措施的框架从降低风险转变为促进健康。在营养，身体活动，睡眠和媒体养育行为方面增加针对健康的评估;与健康和健康行为目标有关的家庭互动任务;并与社区资源进行身体健康协调。我们讨论了适应的多年过程，该过程从吸引FCU开发人员，社区利益相关者和家庭开始，然后进行了可行性试验研究，并在正在进行的随机有效性实施混合试验中继续进行。修改后的程序称为“家庭检查4健康”（FCU4Health）。我们将一个全面的编码系统应用于EBP适应我们的过程，还提供了原始FCU和FCU4Health中用于肥胖预防和管理的行为改变技术的并排比较。这些提供了严格的分类方法以及可以在根据环境，内容，人群或临床目标调整其他EBP时使用的通用语言。讨论了这种适应方法的局限性以及这项工作的未来方向。

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