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Background: Efficacious pediatric weight management (PWM) programs have existed for over two decades, but there is limited evidence that these programs have been translated into regular practice. There is even less evidence that they have reached communities experiencing health disparities where access to care is limited. The purpose of this project was to use a community-engaged approach to select an evidence-based PWM program that could be delivered with the available resources in a community that is experiencing health disparities. Methods: The project was developed by the Partnership for Obesity Planning and Sustainability Community Advisory Board (POPS-CAB) in the Dan River Region of southwest Virginia. The POPS-CAB included representatives from a local pediatric health care center, the Danville/Pittsylvania Health Department, Danville Parks and Recreation, the Boys and Girls Club, and the Fralin Center for Translational Obesity Research (n=15). Three PWM programs were identified that met the criteria of demonstrating short and longer-term efficacy, across multiple studies and diverse populations, in reducing childhood obesity for children between the ages of 8 to 12 years across multiple studies. The programs included the Traffic Light Diet, Bright Bodies, and Golan and colleagues' Home Environmental Change Model. All three programs included a high frequency of in-person sessions delivered over a 6-month period, but one included an adapted version that delivered the content via interactive technology and could be delivered with far fewer resources (Family Connections adapted from the Home Environmental Change Model). A mixed-methods approach was used to determine program selection. This approach included individual POPS-CAB member rating of each program, followed by small group discussions, a collective quantitative rating, and, once all programs were reviewed a rank ordering of programs across characteristics. Finally, a large group discussion was conducted to come to agreement on the selection of one program for future local adaptation and implementation. All small and large group discussions were audio recorded and transcribed verbatim to identify themes that influenced the program selection decision. The quantitative results were averaged across individuals and across the groups. Qualitative results were reduced to meaning units, and then grouped into categories, and lastly, themes. Results: Individual ratings across Bright Bodies, Family Connections, and Traffic Light were 3.9 (0.3), 3.6 (0.5), and 3.4 (0.4), respectively. The ratings differed slightly between community and academic partners demonstrated by a higher rating for Bright Bodies by community members and a higher rating for Family Connections by academic members. After small group discussions the average group ratings across the programs was 3.8 (0.4) for Bright Bodies, 3.5 (0.6) for Family Connections, and 3.4 (0.6) for Traffic Light. Finally, the rank order of programs for potential implementation was Bright Bodies, Family Connections, and Traffic Light. Qualitative information for each program was broken down into four main themes of discussion, (1) the importance for the chosen program to have a balance of nutrition and physical activity, (2) negative perceptions of calorie counting, (3) a desire to target both the parent and the child, as well as (4) the need for practicality and usability the target settings. During the final large group discussion, the above themes suggest that the primary reasons that Bright Bodies was selected included the availability of nutrition information, structured physical activity sessions, presence of a usable workbook, as well as the balance of parent and child involvement. Conclusion: Key considerations in program selection were related more to the program content, delivery channel, and available resources for replication rather than simply selecting a program that was less resource intensive. / Master of Science

Child maltreatment (CM) and unintentional childhood injury affects millions of children and cost society billions of dollars annually. The population at risk for CM has congruent demographic characteristics as children that are more likely to have unintentional injuries. Preventing CM through evidence-based home-visiting programs has been shown effective and cost efficient, and the inclusion of home safety in such programs, demonstrates significant reduction of hazards in the home. The overarching goal of the current research is to make a statistical connection between the population at risk for CM and amount of hazards in the home; that these two populations have enough overlap to validate the inclusion of home safety components in CM prevention programs. This study uses data from an ongoing research project that braids two evidence-based parenting programs: SafeCare® and Parents as Teachers. Findings indicate that the correlation between potential for abuse, measured by BCAP scores, and hazards in the home, measured by the HAPI, show a significant correlation r = .23, p < .05. Other variables such as loneliness, distress, and marital status were also found to contribute to this relationship.

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As more evidence-based programs are implemented in community settings, there is a strong need to ensure those models are implemented with integrity. Implementation of programs should be evaluated for fidelity, the degree of adherence to treatment protocols, and competence, the level of skill in implementation (Schoenwald et al., 2011). The purpose of this study was to review audio recordings of SafeCare home visiting sessions to discover the relationship between the measures of fidelity and competence. Six coders were assigned 209 SafeCare home visiting audiotapes to be coded for fidelity and competence. A sample of audios were double coded to evaluate fidelity and competence scores for inter-rater reliability. Fidelity and competence items were classified into process and content categories, forming the six main variables of process fidelity, content fidelity, total fidelity, process competence, content competence, and total competence. Total fidelity correlated with total competence at a level of .615, with process fidelity and process competence correlating at a much lower level than content items. The total correlation level can be interpreted as that fidelity and competence are strongly related measures, but are not identical constructs. The goal for SafeCare coders would be to continue refining competence definitions and attempting to remove the subjective nature from the competence coding process. With these two efforts, competence reliability should increase to an acceptable level. Given the main fidelity and competence correlation level, it is advisable for SafeCare coders to continue to code both fidelity and competence to avoid missing valuable components of the session. Additional research may be needed once the competence scale becomes better established.

Thesis (M.A.)--Miami University, Dept. of Psychology, 2007. / Title from first page of PDF document. Includes bibliographical references (p. 21-23).

The aging population and burden of chronic conditions have led researchers and practitioners to develop, implement, and evaluate evidence-based programs (EBPs) for older adults. The Healthy Aging Regional Collaborative (HARC) was established to make EBPs including Diabetes Self-Management Program, Chronic Disease Self-Management Program, Matter of Balance, and EnhanceFitness (EF) accessible in south Florida. According to the REAIM model, reach, effectiveness, adoption, implementation, and maintenance determine the impact of EBPs. Evaluation of HARC demonstrated widespread adoption of EBPs by community organizations that reached diverse participants and effectiveness among participants attending the recommended number of sessions, but only 19% of EBP participants were male, and only 25% of EF participants met attendance criteria for adherence. This mixed-methods dissertation explored program instructor and coordinator perspectives on barriers and strategies related to male participation in EBPs, examined predictors of short-term and long-term adherence to EF, and applied a theoretical framework to explore participant and instructor perspectives on factors influencing adherence to EF. Fourteen program coordinators participated in a focus group to identify barriers and strategies to improve male participation, and 49 instructors participated in a survey to triangulate findings. Themes among barriers to male participation included women outnumbering men in programs, incompatibility of programs with male gender roles, and preference for other activities. Themes among strategies included endorsement by male community leaders, advertisements featuring males, and content adaptation. Among 5,619 EF participants, logistic regression confirmed age, race/ethnicity, gender, and health status as significant predictors of adherence. The likelihood of short-term and long-term adherence increased with age and health. Black participants were less likely than whites to adhere short-term (OR=0.82, p=.05) but more likely to adhere long-term (OR=1.77, p=.000). Hispanics were more likely than whites to adhere short-term (OR=1.25, p=.008) and long-term (OR=1.30, p=.001). Men were more likely to meet the criteria for short-term (OR=1.47, p=.001) and long-term adherence (OR=1.19, p=.04). Interviews with 12 adherent EF participants and 10 instructors revealed cues to action, goals, beliefs, intentions, program factors, social factors, and benefits that supported adherence. Findings inform efforts to improve participation and adherence in EBPs and maximize their impact on health among older adults.

Family level data was collected from those served in a state-wide rollout of SafeCare® in Georgia between January of 2010 and November of 2011. Families who received SafeCare were trained in the intervention’s three modules: Parent-Child or Parent-Infant Interaction, Home Safety, and Child Health. The purpose of this study was to measure changes in parental skill demonstration by analyzing pre- and post-training assessments. Additionally, parental demographic characteristics were also assessed for associations with skill acquisition within each module. Follow-up analysis concluded that families displayed increases in parenting skills among all SafeCare modules. Moderator analysis showed that those with only one child showed greater decreases in home hazards as did those with two children. Also, it was found that income level moderated performance in the Parent-Child Interaction module with participants below the median income level exhibiting a greater increase in PCI skill demonstration than those above the median income level. Further research should consider modeling multiple parental characters (e.g. CPS status and income) with skill performance over time. Lastly, additional research should aim to determine if those who exhibit increases in parenting skills are also less likely to experience future child maltreatment reports.

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