Evidence-based treatment for childhood obesity exists, yet a fundamental knowledge-to-action gap has significantly limited the uptake of recommendations into clinical practice, particularly in low-income settings. Persistence of this gap represents a large-scale public health threat, as the earliest generation of children living through the obesity epidemic now enters adulthood, they are the first in US history to have a shorter life expectancy than their parents, mainly due to rising rates of obesity-related cancers and cardiovascular disease. A central challenge in delivering recommended treatment is the intensity; ?26 hours of face-to-face contact are necessary to achieve health benefits and risk reduction. The long-term goal is to close the knowledge-to-action gap by disseminating effective implementation tools that will deliver the current child obesity treatment recommendations in diverse community settings. The objective of the proposed project is to develop and test an implementation strategy that pairs primary care pediatric clinics with municipal Parks and Recreation (P&R) centers to deliver the current treatment recommendations with high fidelity, while allowing crucial adaptations for the local and cultural context. The central hypothesis is that effective pediatric obesity treatment is possible to achieve, but only with strong implementation supports to ensure fidelity to evidence- based recommendations and adaptability to local resource constraints and population needs. Guided by strong preliminary data on effectiveness and implementation feasibility, this hypothesis will be tested through three specific aims: 1) Develop a web-based platform that will support the implementation and broad dissemination of the shared clinic-P&R model in low-resource settings; 2) Evaluate the implementation platform using an interrupted time series design anchored in the Process Redesign Framework and reporting qualitative and quantitative measures of provider and organizational characteristics, implementation process and outcomes, child outcomes, and caregiver outcomes; and 3) Design a dissemination and sustainability strategy, using the PCORI Dissemination Framework, that considers relevant factors including community resources, funding stability, organizational capacity, partnership development, program requirements, and sustainability. The approach is innovative because it is a strong example of value-based care, a new horizon for alternative payment models in the current environment of health care reform. The proposed research is significant, because it will deliver implementation tools into the hands of front-line pediatric health care providers and over 33,000 park and recreation centers nationally. If successful, the expected outcomes will dramatically improve access to effective treatment in diverse communities, and deliver on the existing recommendations for millions of children with obesity in the United States.
The proposed research is relevant to public health because the translation of evidence-based recommendations for effective childhood obesity treatment into diverse community settings has the potential to delay or reverse the development of adult obesity, diabetes and cardiovascular disease; leading causes of morbidity and mortality in the US today. Thus, the proposed research is relevant to the part of the NIH?s mission that pertains to application of knowledge to enhance health, lengthen life, and reduce illness and disability. In addition, the research is relevant to the NICHD?s mission to enhance the lives and optimize abilities for all children.
