Scaling up Building Healthy Families in Rural Areas and Small Towns

This project addresses the lack of access to evidence-based childhood obesity interventions (EBI-CO) in rural areas where both poverty and obesity is prevalent. Building Healthy Families (BHF) is an adapted EBI-CO designed for, and implemented in, rural areas and has successfully achieved clinically and statistically significant reductions in child BMI z-score (-0.27±0.22)—a similar magnitude of effect relative to previous efficacy trials. To increase the likelihood of broad dissemination and implementation of BHF to other rural communities we piloted the development and implementation of the BHF Online Training Resources and Program Package (BHF Program Resources). The BHF Program Resources is a ‘turn-key’ online resource that includes a train-the-trainer system, program materials and a data portal for use by community-based implementation teams. In our pilot study we compared the use of the BHF Program Resources with and without community participation in an action learning collaborative (LC) in changing RE-AIM outcomes. We found the learning collaborative was related to improved Reach (94% vs 74% attendance), Effectiveness (BMI z-score change -0.15±.08 vs -0.09±0.11), and Implementation (91% vs 73% adherence to protocol). Further, Adoption and Maintenance were successfully achieved, but did not differ by condition (100% of enrolled communities initiated the program and planned a second cohort of families). We propose to expand our pilot into a fully powered Hybrid Type 3 effectiveness-implementation, cluster RCT to test the utility of the BHF Program Resources Only (BHF-PO) with and without a BHF Learning Collaborative (BHF-LC). We will scale up a bundled adoption strategy we used successfully in our pilot to engage 30 micropolitan and rural communities across the 6-state region served by the Mountain West Family Healthy Weight Collaborative and Huntsman Cancer Institute (NM, ID, MT, NV, WY, UT; See Letters of Support). We will randomly assign communities to either the BHF-PO (n=15) or in combination with the BHF-LC (n=15) to determine the relative effects on RE- AIM outcomes of reach, effectiveness (secondary outcome), implementation (primary outcome), and program maintenance. In addition, we will assess potential mechanisms of change across RE-AIM outcomes using the Integrated Promoting Action on Research in Health Sciences (iPARIHS) framework. Finally, economic evaluation will be conducted to determine costs and benefits across RE-AIM outcomes.