Background Family doctor contract services (FDCS) began in China in 2016. Shenzhen, one of the most developed cities in China, also implemented a family doctor (FD) policy in 2017. The objectives of this study were to identify the impact of awareness of FDCS and signing service contracts with FDs on utilization of community health care centers (CHCs). Methods Cross-sectional secondary data based on residents living in Luohu district was used for analysis. Descriptive analysis was conducted to identify utilization of CHCs by awareness of FDCS and signing service contracts with FDs, respectively. Linear probability models (LPM) were used to determine the association of utilization of CHCs with awareness of FDCS and signing service contracts with FDs, respectively. Results Among 1205 adults included in the analysis, 27 % of the participants knew about the FDCS, 5 % signed with FD, and 20 % had chronic disease. Both awareness of the FDCS and signing service contracts with FDs significantly increased the probability of using CHCs as a first choice. Conclusions This study provided evidence that both awareness of FDCS and signing service contracts with FDs had a positive impact on utilization of primary health care services at the community level. More interventions to improve awareness of FDCS are needed to increase the utilization of primary health care services.

Adolescents with autism spectrum disorder are at increased risk of unhealthy eating behaviors and obesity. This study examined feasibility of a virtual implementation of Bringing Adolescent Learners with Autism Nutrition and Culinary Education, an 8-week nutrition intervention based on social cognitive theory that addresses autism spectrum disorder–specific eating behaviors and food environment challenges. The implementation process was measured with fidelity checklists, engagement records, and field notes. Feasibility of virtually assessing adolescents’ outcomes (food frequency questionnaire, psychosocial survey, height, and weight) was also evaluated. Adolescents with autism spectrum disorder aged 12–21 years were recruited through a local community partner. Six groups (n = 27; group size ranged 2–7) participated. Univariate data analyses were performed. Mean lesson attendance was 88%, participation was 3.5/4 (4 = Frequently), homework completion was 51.9%, fidelity was 98.9%, and technical difficulty prevalence was 0.4/2 (2 = Major technical difficulties). Assessment completion rate was 100% (98.9%–100%) at baseline and 92.6%–96.3% (99.5%–100%) at post-intervention. Data quality was high for 88% of food frequency questionnaires and 100% of psychosocial surveys. Findings suggest that a virtual implementation and evaluation of Bringing Adolescent Learners with Autism Nutrition and Culinary Education was feasible. Bringing Adolescent Learners with Autism Nutrition and Culinary Education may be implemented virtually to reach diverse populations of adolescents with autism spectrum disorder. Future research should examine the impact of the intervention on dietary behavior and obesity outcomes. Lay abstract Adolescents with autism spectrum disorder are at an increased risk of unhealthy eating behaviors and obesity compared to their typically developing peers. Many nutrition interventions for this population focus on improving autism spectrum disorder symptoms or managing weight rather than addressing participants’ healthy eating self-efficacy. The purpose of this study was to examine a virtual implementation of a new intervention for adolescents with autism spectrum disorder, Bringing Adolescent Learners with Autism Nutrition and Culinary Education. We used fidelity checklists, engagement records, and field notes to measure implementation. We also examined the feasibility of assessing outcome measures, including a food frequency questionnaire (FFQ), psychosocial survey, height, and weight. We recruited adolescents with autism spectrum disorder aged 12–21 years. Six groups of 2–7 adolescents (27 total) participated in the intervention and pre-/post-intervention measurements. Bringing Adolescent Learners with Autism Nutrition and Culinary Education consisted of eight weekly lessons: exploring taste, flavor, and texture; mealtimes and rules; food groups and nutrients; moderation; beverages; cooking; well-being; sustaining healthy eating habits. The virtual implementation was feasible based on lesson attendance, participation, homework completion, fidelity, and prevalence of technical difficulties. Evaluation was also feasible based on response rate, completion, and data quality for the food frequency questionnaire, psychosocial survey, and height and weight measurements. Bringing Adolescent Learners with Autism Nutrition and Culinary Education may be used in virtual settings to reach diverse populations of adolescents with autism spectrum disorder. Future research is needed to evaluate the impact of Bringing Adolescent Learners with Autism Nutrition and Culinary Education on dietary behavior and obesity outcomes.

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Objectives Adolescents with autism spectrum disorder (ASD) are at an increased risk of obesity and unhealthy eating behaviors. This study examined the feasibility of a virtual implementation of a nutrition intervention for adolescents with ASD, as well as feasibility of virtually assessing outcome measures, including anthropometric measures, dietary intake, and psychosocial determinants of dietary intake. Methods BALANCE (Bringing Adolescent Learners with Autism Nutrition and Culinary Education) is an 8-week theory-driven nutrition intervention for adolescents with ASD. The intervention is based on Social Cognitive Theory. Six groups of adolescents (n = 27; group size ranged 2–7) participated in the intervention and pre-/post-intervention assessments. Fidelity checklists included measures on attendance, participation, homework, fidelity, and technical difficulties. Feasibility of assessing outcome measures, including the Block Kids Food Frequency Questionnaire (FFQ), a validated psychosocial survey, and height and weight, was evaluated on response rate, completion, and data quality. Results Mean lesson attendance was 88%, participation was 3.5 of 4, homework completion was 51.9%, fidelity was 98.9%, and prevalence of technical difficulties was 0.4 of 2 (no technical difficulties or minor difficulties for all lessons). Baseline response rate was 100% for all outcome measures, with 100% completion for the FFQ and 98.9% for the psychosocial survey. Post-intervention response rate was 92.6% for the FFQ and 96.3% for the psychosocial survey and anthropometric measures, with 100% completion for the FFQ and 99.5% for the psychosocial survey. Data quality was high for 88% of the matched FFQs and 100% of the psychosocial surveys. Conclusions Findings of the study suggest that a virtual implementation and evaluation of BALANCE was feasible, indicating that BALANCE may be implemented in virtual settings to reach diverse populations of adolescents with ASD. Future research is warranted to examine the impact of BALANCE on dietary behavior changes and obesity outcomes. Funding Sources This work was funded by the University of South Florida College of Public Health Internal Grant & Student Research Scholarship.