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Evaluating a childhood obesity program with the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM)
Mei Sien Lew1, Dagmar L'Allemand2, Damian Meli3
1Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.
Insights
A pilot study found a lifestyle intervention effectively reduced childhood obesity in primary care. The RE-AIM framework guided the evaluation of this behavioral intervention, showing promising results for implementation and maintenance.
Area of Science:
- Pediatric Endocrinology
- Public Health
- Implementation Science
Background:
- Behavioral lifestyle interventions are effective for childhood overweight and obesity but challenging to implement in primary care.
- Existing research often prioritizes intervention effectiveness over implementation details.
- Evaluating the practical application of such interventions is crucial for successful dissemination.
Purpose of the Study:
- To evaluate critical components of a childhood obesity intervention within a primary care setting.
- To assess the implementation of a structured lifestyle intervention using the RE-AIM framework.
- To understand the reach, effectiveness, adoption, implementation, and maintenance of the intervention.
Main Methods:
- A pilot implementation study of a 10-session lifestyle intervention for children aged 6-8 with obesity was conducted in Switzerland (2013-2015).
- The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework was utilized for evaluation.
- Data were stratified at both patient and physician levels.
Main Results:
- The intervention resulted in a significant decrease in BMI z-score (-5.6%, p=0.01).
- 14 physicians adopted the intervention, treating 26 patients, with an average of 8 consultations.
- Maintenance showed 35% of children discontinued and 50% of physicians continued using intervention components.
Conclusions:
- The pilot study demonstrated the successful implementation and positive outcomes of a childhood obesity intervention in primary care.
- The RE-AIM framework provided valuable insights into the intervention's practical application and sustainability.
- Results offer guidance for stakeholders aiming to disseminate and evaluate similar interventions in diverse settings.
Abstract:
Primary care providers can use behavioral lifestyle interventions to effectively treat children with overweight and obesity, but implementing these interventions is challenging. Most childhood obesity intervention evaluation studies focus on effectiveness. Few studies describe implementation. Our goal was to evaluate critical components of a childhood obesity intervention in primary care. We conducted a pilot implementation study of an existing structured lifestyle intervention in the Canton of Bern, Switzerland from 2013 to 2015. The intervention consisted of 10 sessions, led by a primary care physician. It included children aged 6-8 years old, with BMI over the 90th age-adjusted percentile. We used the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) evaluation framework to describe the pilot implementation study. We stratified description of RE-AIM components at the patient- and physician-level. For Reach: 864 children were screened; 65 were overweight; 394 physicians were invited to participate in the study. For Effectiveness: BMI z-score significantly decreased (-5.6%, p = 0.01). For Adoption: 14 participating physicians treated 26 patients. Implementation: the mean number of consultations was 8. For Maintenance: 9 (35%) children discontinued the intervention; 7 (50%) of physicians continued to apply at least one component of the intervention. The summarized components of the program within the RE-AIM framework suggest the program was successful. Stakeholders can use our results if they intend to disseminate and evaluate similar interventions in different settings.
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