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Treatment adherence and facilitator characteristics in a community based pediatric weight control intervention
Elissa Jelalian1, Gary D Foster, Amy F Sato
1Bradley Hasbro Children's Research Center, Alpert Medical School of Brown University, Providence, RI 02903, USA. Elissa_Jelalian@brown.edu.
Insights
High facilitator adherence to protocol in pediatric weight control interventions is crucial for improving youth outcomes. Training paraprofessionals effectively leads to successful evidence-based program delivery.
Area of Science:
- Public Health
- Pediatrics
- Behavioral Science
Background:
- Pediatric obesity requires accessible interventions.
- Evaluating intervention fidelity and facilitator requirements is key for community translation.
Purpose of the Study:
- Assess paraprofessional adherence and characteristics in a community-based pediatric weight control program.
- Examine the link between facilitator adherence/characteristics and youth weight change over 24 weeks.
Main Methods:
- Intervention conducted Feb-Sept 2011 with children (6-16 years) and parents.
- Outcome measures collected at baseline, 12, and 24 weeks.
- A two-part rating form assessed facilitator adherence and characteristics at two time points.
Main Results:
- Facilitators achieved high adherence: 96.0% at Time 1 and 92.6% at Time 2.
- Higher adherence at both time points correlated with greater reduction in percent overweight.
- Youth participants averaged 11.3 years old, with most under 13.
Conclusions:
- Paraprofessionals can be trained to deliver evidence-based pediatric weight control interventions.
- Training facilitators on protocol adherence is critical for intervention success.
- Limitations include a modified assessment tool and lack of inter-rater reliability.
Background:
There is a pressing need to develop effective and broadly accessible interventions to address pediatric obesity. An important dimension in translating interventions to community settings is evaluating the fidelity with which the intended treatment is delivered and the level of facilitator needed to deliver the intervention with efficacy.
Purpose:
The primary objectives of this study were to: 1) provide descriptive information regarding adherence to protocol and non-specific facilitator characteristics (e.g. interpersonal characteristics, group management skills) within the context of a community based pediatric weight control intervention delivered by paraprofessionals; and 2) examine the relationships among facilitator adherence and characteristics and rate of change in percent overweight demonstrated by youth over the course of the 24-week intervention.
Methods:
The intervention was conducted between February and September of 2011. Children (6-16 years) and parents completed primary outcome measures at baseline, 12, and 24 weeks (i.e. end of treatment). A 2-part rating form was developed to assess facilitator adherence to weekly content and general provider characteristics at two different time points during the intervention.
Results:
Youth participating in this study were on average 11.3 years old (SD = 2.8), with most being under the age of 13 years (74.2%). Over half were female (54.8%) and over two-thirds were White (68.4%). On average, facilitators adhered to 96.0% (SD = 5.2%) of the session content at Time 1 and 92.6% (SD = 6.8%) at Time 2. Higher Content Adherence at Time 1 and Time 2 were associated with greater loss in percent overweight.
Conclusions:
Our data suggest that paraprofessionals without prior expertise in pediatric weight control can be trained to successfully deliver an intervention that is evidence based and incorporates behavioral and educational components. These findings need to be considered in light of some limitations, including the fact that facilitator domains were assessed with a modification of a standardized tool and we did not obtain inter-rater reliability of observations. These limitations not withstanding, investing time in training facilitators to adhere to a given protocol is critical and may be of higher priority than focusing on more general facilitator characteristics.
