Adaptive Implementation & Costs of Obesity Prevention in Early Care and Education

Swindle, Taren

Abstract

There are two crucial gaps to optimizing obesity prevention in ECE: 1) the lack of adaptive implementation strategies that tailor the intensity of implementation support delivery and 2) limited literature surrounding cost-effectiveness of obesity prevention and nutrition promotion efforts in ECE. The overarching goal of this application is to gather stakeholder perspectives on specification of an adaptive implementation strategy and acceptable cost-effectiveness thresholds for obesity prevention in ECE. To this end, we will focus on the evidence-based nutrition program Together, We Inspire Smart Eating (WISE). Compared to usual practices in ECE, WISE has demonstrated an increase in fruit and vegetable consumption at home for children, improvements in carotenoid intake, and reductions in fast food and sugar sweetened beverage consumption. Our prior work that a package of 8 discrete, stakeholder-selected implementation strategies outperformed a basic implementation approach (i.e., training an reminders) for WISE. Given feasibility and potential prohibitive costs in the real-world, it is likely not possible to provide all implementation strategies to all sites in the future; in addition, all strategies may not be necessary to achieve the desired outcomes. Further, data on costs of WISE have not been examined. Future studies will need baseline comparator data to understand the costs and cost effectiveness of WISE without implementation strategy support to understand the relative benefit of implementation strategies such as adaptive approaches. We will address these gaps through open-ended interviews with educators and key stakeholders in Aim 1 as well as a cost effectiveness analysis in Aim 2.