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Testing an Adaptive Implementation Strategy to Optimize Delivery of Obesity Prevention Practices in Early Care and Education Settings

Award Number: R37CA252113
ORGANIZATION: NATIONAL CANCER INSTITUTE
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

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PROJECT SUMMARY Consuming a healthy diet and maintaining a healthy weight provide significant protection against cancer and cancer-related mortality. Early interventions are needed to decrease the risk of developing cancer later in life. Early care and education (ECE) is a promising setting for cancer prevention. “Together, We Inspire Smart Eating” (WISE) is an intervention that improves children's diets in ECE. WISE includes 4 key evidence-based practices (EBPs): (1) hands-on exposures to fruits and vegetables, (2) role modeling by educators, (3) positive feeding practices, and (4) a mascot associated with fruits and vegetables. Standard implementation approaches to WISE result in suboptimal implementation of WISE EBPs. Additional implementation strategies are needed to increase adoption and fidelity to EBPs. To date, most studies have employed an “all-or-nothing” approach, comparing multifaceted strategies to control groups without implementation support. Thus, there is an urgent need for optimized strategies that tailor implementation support intensity to the unique challenges and limited resources of the ECE context. The overall objectives of this application are to determine the effectiveness and cost-effectiveness of an adaptive implementation approach to improve adoption of the EBPs of WISE while also examining implementation mechanisms. Our central hypothesis is that the addition of high-intensity strategies at sites that do not respond to low-intensity strategies will improve implementation and health outcomes. Specific Aim 1. Determine the effectiveness of an adaptive implementation strategy that tailors the intensity of implementation support versus a low-intensity strategy. Using an enhanced non-responder trial, we will compare the effect of continuing low-intensity strategies vs. augmenting with high-intensity strategies. We hypothesize that sites receiving high-intensity strategies will outperform sites continuing the low- intensity strategies on the primary outcome of intervention fidelity and on secondary child health outcomes. Specific Aim 2. Examine moderators and mediators of implementation outcomes in a mixed- methods design. We will test organizational readiness and teacher experience as moderators of response to the implementation strategies. We will test educators' perceptions of barriers, local implementation climate, and implementation leadership as mediators of the effect of the strategies on implementation outcomes. Qualitative data will explore other potential moderators and mediators not measured quantitatively. Specific Aim 3. Assess the incremental cost-effectiveness of the adaptive implementation strategy. In this aim, we will estimate the cost per unit of fidelity associated with the adaptive implementation strategy. Results will also determine the incremental cost-effectiveness of applying the adaptive strategy compared to continuing low-intensity strategies for improving BMI and other child health outcomes.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2023 ( Subtotal = $603,498 )
2023	2023	UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES	4301 W MARKHAM ST	LITTLE ROCK	AR	72205	PULASKI	USA	Cancer Detection and Diagnosis Research	001	3	8/23/2023	NON-COMPETING CONTINUATION	$603,498
2023	2022	UNIVERSITY OF ARKANSAS SYSTEM	4301 W MARKHAM ST SLOT 812 BIO-MED BLDG 1 STE 102	LITTLE ROCK	AR	72205	PULASKI	USA	Cancer Detection and Diagnosis Research	000	2	10/21/2022	NON-COMPETING CONTINUATION	$0
														Subtotal = $603,498

Issue Date FY: 2022 ( Subtotal = $615,895 )
2022	2022	UNIVERSITY OF ARKANSAS SYSTEM	4301 W MARKHAM ST SLOT 812 BIO-MED BLDG 1 STE 102	LITTLE ROCK	AR	72205	PULASKI	USA	Cancer Detection and Diagnosis Research	000	2	8/30/2022	NON-COMPETING CONTINUATION	$615,895
														Subtotal = $615,895

Issue Date FY: 2021 ( Subtotal = $642,818 )
2021	2021	UNIVERSITY OF ARKANSAS SYSTEM	4301 W MARKHAM ST SLOT 812 BIO-MED BLDG 1 STE 102	LITTLE ROCK	AR	72205	PULASKI	USA	Cancer Detection and Diagnosis Research	000	1	7/15/2021	NEW	$642,818
														Subtotal = $642,818

Grand Total All Awards = $1,862,211

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Testing an Adaptive Implementation Strategy to Optimize Delivery of Obesity Prevention Practices in Early Care and Education Settings

Award Number: R37CA252113

ORGANIZATION: NATIONAL CANCER INSTITUTE

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

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