University Of Virginia-Main Campus receives $807K Minority Health and Health Disparities Research grant from the National Institutes of Health

Leveraging digital tools and adaptive precision facilitation to enhance teacher implementation fidelity and promote student health in rural appalachian schools: a hybrid type 3 trial - modified project summary/abstract section. Relative to their urban counterparts, youth residing in rural regions have poorer diets, including excessive sugar-sweetened beverage (ssb) consumption, and disproportionately suffer from obesity and related chronic conditions. Kids sipsmarter (kss) is multi-level, school-based, behavioral and health literacy intervention that has yielded statistically and clinically meaningful improvements in ssb behaviors among middle school students and their caregivers. Our R01 application builds from our success in appalachia middle schools, addresses prominent gaps in implementation science literature, and is guided by the integrated promoting action on research implementation in health services (i-parihs) framework. Phase 1 uses a human-centered design process to understand teachers’ needs and experiences to guide development of the automated bundled implementation strategies for kss. Phase 2 is a hybrid type 3 effectiveness-implementation trial and cluster, adaptive randomized trial designed to evaluate kss’s implementation strategies and outcomes in 60 rural appalachia middle schools. All schools will receive the automated bundle that includes an intervention action plan to proactively plan fidelity-consistent kss modifications and set teacher-specific fidelity benchmarks as well as a web-based application for teacher training, fidelity monitoring with feedback, and reminders. Some schools will achieve fidelity benchmarks (i.e., >80% of fidelity benchmarks) with the automated bundled, but others will need adaptive precision human-supported facilitation strategies - which will be tested in our cluster, adaptive randomized trial. Specifically, we will implement strategies intended to promote fidelity-consistent intervention adaptations throughout all implementation phases and use a mixed-methods evaluation approach guided by the framework for reporting adaptations and modifications (aim 1). We will also evaluate impacts of the automated bundled implementation strategies vs. The automated bundled implementation strategies + adaptive precision human-supported virtual facilitation on intervention fidelity (primary outcome, aim 2) and cost of implementation strategies and incremental cost effectiveness of the adaptive strategy (aim 2A). Kss’s intervention effectiveness on student ssb behaviors and bmi will also be evaluated (secondary aim). Finally, we will explore preliminary mechanisms of action and their impact on implementation outcomes using a mixed-methods approach (exploratory aim). In sum, this study will develop and evaluate an automated bundle of implementation strategies to support fidelity in school settings. By assessing the impact of adaptive, precision-based virtual facilitation on implementation fidelity and cost, we aim to advance the sustainable delivery of evidence-based dietary interventions in real-world schools. Our long-term goal is to develop cost-effective implementation strategies that fit school contexts, improve dietary behaviors—particularly by reducing ssb intake—and help prevent diet-related chronic conditions, including obesity and metabolic disorders, among rural appalachian youth and beyond.