Graduation Date

Spring 5-6-2023

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Programs

Health Promotion and Disease Prevention Research

First Advisor

Jennie Hill

Second Advisor

Paul Estabrooks

Third Advisor

Tzeyu Michaud

Fourth Advisor

Kate Heelan

Abstract

Despite substantial prevention and treatment efforts, childhood obesity remains a pressing public health concern. Disparities persist in obesity prevalence among children of lower socioeconomic status, racial and ethnic minority groups, and those residing in rural areas. The vast majority of efficacious pediatric weight management interventions (PWMIs) have been based in larger cities and urban areas delivered through inter-disciplinary teams in a hospital or medical center, and the degree to which these or other efficacious PWMIs have been translated to, and are feasible in, typical rural or micropolitan areas is unclear. This dissertation describes a dissemination strategy and a systematic approach to identify communities that are ready and have demonstrated the capacity to disseminate a PWMI and the potential mechanisms that lead to both effectiveness at the participant-level (child weight status reduction) and implementation quality at the provider/setting-level.

First, a qualitative comparative analysis (QCA) was used to determine potential causal conditions or combination of conditions associated with larger reductions in BMI z-score of children who participated in a PWMI, Building Healthy Families (BHF). Second, a three-phased process was used to test the feasibility of a fund and contract dissemination strategy for a PWMI in identifying and engaging communities to adopt BHF in rural and micropolitan areas of Nebraska. Third, a mixed methods design was used to determine the mechanisms that lead to high implementation quality in communities implementing BHF. These studies aim to provide guidance for translating pediatric weight management programs in medically underserved geographic areas to inform adaptations and maximize the probability of successful adoption, implementation, and sustainability.

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