Stakeholder perspectives and sustainability of an integrated care model for the prevention and management of obesity: The Childhood Obesity Research Demonstration (CORD) project

Authors: LEE, REBECCA - Arizona State University; PARKER, NATHAN - Md Anderson Cancer Center; HALLETT, ALLEN - University Of Texas Health Science Center; KAO, DENNIS - Carleton University - Canada; MODELSKA, MARTA - University Of Houston; RIFAI, HANADI - University Of Houston; SOLTERO, ERICA - Children'S Nutrition Research Center (CNRC); O'CONNOR, DANIEL - University Of Houston

Submitted to: Translational Behavioral Medicine
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 6/1/2020
Publication Date: 7/15/2020
Citation: Lee, R.E., Parker, N.H., Hallett, A.M., Kao, D., Modelska, M.J., Rifai, H.S., Soltero, E.G., O'Connor, D.P. 2020. Stakeholder perspectives and sustainability of an integrated care model for the prevention and management of obesity: The Childhood Obesity Research Demonstration (CORD) project. Translational Behavioral Medicine. https://doi.org/10.1093/tbm/ibaa058.
DOI: https://doi.org/10.1093/tbm/ibaa058

Interpretive Summary: Pediatric obesity rates continue to increase in the U.S. and present one of the most significant and costly public health challenges to date. Many studies have tested strategies for improving health behaviors like diet and physical activity to reduce obesity risk in children and youth. While some of these strategies have successfully improved health behaviors and reduced weight in youth, many of these strategies are not sustainable. The purpose of this study was to identify factors that might contribute to project sustainability in order to inform future obesity prevention studies. We interviewed investigators from three demonstration projects that implemented multi-level childhood obesity interventions that focused on improving health behaviors. This study identified that complex childhood obesity interventions are more sustainable when strong and complementary, interagency connections, and partnerships are developed. This study also found that health benefits from interventions are more sustainable when researchers use evidence-based strategies that employ best practices and when participating institutions make staffing or policy changes that support continued intervention activities. Future studies are needed to develop sustainability strategies and frameworks to develop sustainable interventions that lead to long-term improvements in health behaviors.

Technical Abstract: Although reliable strategies exist to promote healthy habits that reduce childhood obesity, the sustainability of these strategies remains an ongoing public health challenge. This study aimed to identify factors experienced in a large, multisite project aimed at reducing childhood obesity that might contribute to project sustainability. Hypothesized constructs underpinning sustainability included replicability, continuation of benefits, institutionalization, and community capacity. Key informants (n=27) completed 60 min, in-depth interviews, which were audio recorded and transcribed. Transcripts were first coded using a combined deductive and inductive approach. Four major themes emerged (with numerous subthemes): developing partnerships, challenges to the sustainability of implemented programming, the importance of intervening in multiple settings, and ongoing implementation and evaluation strategies. Replicability of complex childhood obesity interventions is possible when there are strong partnerships. Benefits can continue to be conferred from programming, particularly when evidence-based strategies are used that employ best practices. Implementation is facilitated by institutionalization and policies that buffer challenges, such as staffing or leadership changes. Community capacity both enhances the sustainability of interventions and develops as a result of strengthening partnerships and policies that support childhood obesity programming.