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Table 4 Classifying adaptations to the Connect for Health pediatric weight management program

From: Engaging stakeholders in the adaptation of the Connect for Health pediatric weight management program for national implementation

Core componentsWhat are the modifications?At what delivery level was the modification made?Who made the decision to modify?
Flagging of children with elevated BMIsChanged from interruptive BPA to non-interruptive BPAHealthcare system level customized for each organizationBased on stakeholder engagement
Changed to who received the BPA depending on workflow of healthcare system (i.e., physician v. medical assistant)Healthcare system level customized for each organizationBased on stakeholder engagement
Additional content and actions included in the BPA depending on healthcare system’s needsHealthcare system level customized for each organizationBased on stakeholder engagement
Clinical decision support toolsPatient education materials, community resource guide, and clinician educational materials accessible through EHRHealthcare system level customized for each organizationBased on stakeholder engagement
Enrollment for text messaging program through order as part of clinical decision support tools. In the original trial, parents were enrolled by a health coachProgram level across all sitesProgram developer
Aligned the clinical decision support tools with internal performance metricsHealthcare system level customized for each organizationBased on stakeholder engagement
Patient education materialsMaterials translated into Spanish and Haitian Creole. In the original trial, materials were only available in EnglishProgram level across all sitesProgram developer
Consolidated patient educational materials into one page handouts per behaviorProgram level across all sitesProgram developer
Revised to be geographically and culturally appropriateProgram level across all sitesBased on stakeholder engagement
Addition of “Establish a balanced nutrition plan” as a primary behavioral goal with a corresponding handoutProgram level across all sitesProgram developer
Community resource guideCustomized for each healthcare system and for health centers within each systemHealthcare system level customized for each organizationProgram developer
Created an additional one page handout of top resources for each practiceHealthcare system level customized for each organizationBased on stakeholder engagement
Text messagingMessages revised to be geographically and culturally appropriateProgram level across all sitesBased on stakeholder engagement
Messages revised to be unidirectional v. bidirectionalProgram level across all sitesProgram developer
Health coachHealth coaching component of program removed. Information incorporated into educational materials, community resource guide, and text messaging programProgram level across all sitesProgram developer
Implementation strategiesSelected clinician champions who are embedded within the clinical practices to facilitate implementation by engaging other clinicians and providing support and feedbackProgram level across all sitesProgram developer/ Based on stakeholder engagement
Added practice coaches to provide clinicians with “at the elbow” supportProgram level across all sitesProgram developer
In-person trainings to include all practice staff (i.e., clinicians, medical assistants, and front-desk staff) and to occur throughout the implementation period for continued education and feedbackProgram level across all sitesBased on stakeholder engagement
Offered continuing educational units and quality improvement bonuses to incentive trainings and likelihood that all clinicians would be familiar with the programHealthcare system level customized for each organizationBased on stakeholder engagement
Added a virtual learning community to provide on-demand support to clinicians with best practice management of childhood obesityProgram level across all sitesBased on stakeholder engagement
  1. BMI body mass index, BPA best practice alert, EHR electronic health record