Engaging Stakeholders in the Adaptation of the Connect for Health Pediatric Weight Management Program for National Implementation

Abstract

Background: Connect for Health is an evidence-based weight management program with clinical- and family-facing components for delivery in pediatric primary care for families of children ages 2 to 12 years. We used the Consolidated Framework for Implementation Research (CFIR) to guide formative work prior to national implementation. The purpose of this study was to describe the process and results of stakeholder engagement and program adaptation. Methods: We used mixed qualitative and quantitative methods to iteratively adapt and optimize the program by assessing needs and perspectives of clinicians and parents, as well as contextual barriers, facilitators and organizational readiness for the uptake of the proposed program tools and implementation strategies. We conducted interviews with primary care clinicians from four health care organizations in Boston, MA, Denver, CO, and Greenville, SC and used principles of immersion-crystallization for qualitative analyses. We also conducted surveys of parents of children with a body mass index ≥ 85th percentile.Results: We reached thematic saturation after 52 clinician interviews. Emergent themes representing the CFIR domains of intervention characteristics, outer and inner setting, and process included: (1) importance of evidence-based clinical decision support tools that integrate into the workflow and do not extend visit time; (2) developing resources that respond to family’s needs; (3) using multimodal delivery options for family resources; (4) addressing childhood obesity while balancing competing demands; (5) emphasizing patient care rather than documentation and establishing sustainability plans; and (6) offering multiple training methods that incorporate performance feedback. Of the parents surveyed (n=400), approximately 50% were Spanish-speaking and over 75% reported an annual income < $50,000. Parents affirmed the importance of addressing weight management during well-child visits, being provided with referrals and resources, and offering multiple methods for resource delivery. Decisions about program modifications were made at the program and healthcare-system level and based on stakeholder engagement findings. Modifications included cultural, geographic, and target audience adaptations, as well as varied resource delivery options. Conclusions: To ensure the fit between the Connect for Health program and national implementation settings, adaptations were systematically made through engagement of clinician and parent stakeholders to support adoption, sustainability, and health outcomes.

Adapting the Namaste Care Program for Use with Caregivers of Community-Dwelling Older Adults with Moderate to Advanced Dementia: A Qualitative Descriptive Study

“…In the present study, modifications to training are considered as an implementation strategy that has the potential to increase the successful delivery of the intervention. The framework has been used in previous studies to provide a coding framework for modifications to an evidence-based psychotherapy program (Stirman et al, 2015) and pediatric weight management program (Simione et al, 2020). It has also been used to inform the development of a questionnaire to assess adaptations to evidence-based practices by community health care providers offering children's mental health services (Lau et al, 2017).…”

Planned Evaluation of the Healthy Weight Clinic Pediatric Weight Management and Implementation: Massachusetts-CORD 3.0

“…Two other studies have used CFIR constructs to explore the preimplementation environment of community health centers planning to implement childhood obesity interventions. 16,17 Of these, the original Connect for Health program identified key adaptations for implementation in additional community health centers nationally. These included changes to delivery of a best practice alert flagging elevated BMI in the EHR to noninterruptive, cultural adaptations to patient handouts and text messages, translation of patient handouts, and customized community resource guides by site, among others.…”

“…These included changes to delivery of a best practice alert flagging elevated BMI in the EHR to noninterruptive, cultural adaptations to patient handouts and text messages, translation of patient handouts, and customized community resource guides by site, among others. 16 In a similar manner, by using CFIR constructs to inform our implementation strategies for Healthy Weight Clinic PWMI we expect to identify the adaptations that are needed. This strategy aligns with the previously recognized need to include implementation science frameworks early on to increase likelihood of the intervention's adoption and sustainability.…”

“…Its constructs are organized into five domains: intervention characteristics, inner setting, outer setting, characteristics of individuals, and process. 12 The CFIR has been used in the evaluation of weight management programs for children and adults, [13][14][15][16][17][18] but a smaller number of these have been conducted within the context of structured weight management interventions in the health care system. 14,16,18 We aim at extending the literature by using this comprehensive determinant framework to inform our implementation strategies for the Healthy Weight Clinic PWMI.…”