Table 4 Classifying adaptations to the Connect for Health pediatric weight management program
Core components | What are the modifications? | At what delivery level was the modification made? | Who made the decision to modify? |
|---|---|---|---|
Flagging of children with elevated BMIs | Changed from interruptive BPA to non-interruptive BPA | Healthcare system level customized for each organization | Based 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 organization | Based on stakeholder engagement | |
Additional content and actions included in the BPA depending on healthcare system’s needs | Healthcare system level customized for each organization | Based on stakeholder engagement | |
Clinical decision support tools | Patient education materials, community resource guide, and clinician educational materials accessible through EHR | Healthcare system level customized for each organization | Based 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 coach | Program level across all sites | Program developer | |
Aligned the clinical decision support tools with internal performance metrics | Healthcare system level customized for each organization | Based on stakeholder engagement | |
Patient education materials | Materials translated into Spanish and Haitian Creole. In the original trial, materials were only available in English | Program level across all sites | Program developer |
Consolidated patient educational materials into one page handouts per behavior | Program level across all sites | Program developer | |
Revised to be geographically and culturally appropriate | Program level across all sites | Based on stakeholder engagement | |
Addition of “Establish a balanced nutrition plan” as a primary behavioral goal with a corresponding handout | Program level across all sites | Program developer | |
Community resource guide | Customized for each healthcare system and for health centers within each system | Healthcare system level customized for each organization | Program developer |
Created an additional one page handout of top resources for each practice | Healthcare system level customized for each organization | Based on stakeholder engagement | |
Text messaging | Messages revised to be geographically and culturally appropriate | Program level across all sites | Based on stakeholder engagement |
Messages revised to be unidirectional v. bidirectional | Program level across all sites | Program developer | |
Health coach | Health coaching component of program removed. Information incorporated into educational materials, community resource guide, and text messaging program | Program level across all sites | Program developer |
Implementation strategies | Selected clinician champions who are embedded within the clinical practices to facilitate implementation by engaging other clinicians and providing support and feedback | Program level across all sites | Program developer/ Based on stakeholder engagement |
Added practice coaches to provide clinicians with “at the elbow” support | Program level across all sites | Program 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 feedback | Program level across all sites | Based on stakeholder engagement | |
Offered continuing educational units and quality improvement bonuses to incentive trainings and likelihood that all clinicians would be familiar with the program | Healthcare system level customized for each organization | Based on stakeholder engagement | |
Added a virtual learning community to provide on-demand support to clinicians with best practice management of childhood obesity | Program level across all sites | Based on stakeholder engagement |