Translation of a family-based behavioral intervention for adolescent obesity using the RE-AIM framework and common steps from adaptation frameworks Free

Abstract

Interventions for adolescent weight management that are ready to use in clinical settings are needed to address the obesity epidemic and improve the health and wellbeing of affected adolescents. This report describes the systematic process our team followed to adapt an evidence-based intervention (EBI) for adolescent weight management from its randomized control trial protocol to a package for delivery in a group-based telehealth format within a medical center. The EBI adaptation was clinician initiated, prompted by identified practice needs, and involved collaboration of the clinical team with the EBI developer. The process was guided by the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework and followed key steps for adapting EBIs to new contexts. RE-AIM-aligned adaptations included telehealth delivery and broader inclusion criteria, separate clinical and research evaluation batteries, adaptations to fit the clinical practice, practical fidelity checklists to guide and record session delivery, and continuous quality improvement processes aimed to facilitate program longevity and family engagement. The process culminated in a package of adapted intervention materials deemed by stakeholders as appropriate to the practice and congruent with the EBI model. This report provides a much-needed practical demonstration of the translation of an EBI for adolescent weight management from research protocol to group telehealth delivery in a medical center. Key lessons include the value of clinician-researcher collaboration, the breadth of resources needed to adapt EBIs for real-world delivery, and the importance of considering delivery context in implementation and evaluation decisions, including defining inclusion criteria, staffing, and outcomes assessments.

INTRODUCTION

Randomized clinical trials have demonstrated efficacy of family-based behavioral weight management interventions for treating pediatric obesity [1, 2]. Unfortunately, dissemination of evidence-based interventions (EBIs) from the research setting to clinic and community settings has lagged [3], leaving clinicians without ready-to-deliver intervention packages and left to create or adapt intervention materials. Further, barriers to family participation such as busy schedules and the cost and time to travel to a clinic indicate need for innovation in EBI delivery, such as use of telehealth [4]. Thus, there is an urgent need to identify efficacious, ready-to-use, developmentally tailored, and accessible interventions, particularly for adolescents with higher weight.

Although translational science has made progress in the dissemination of EBIs for behavioral weight management programs, many gaps remain. Behavioral interventions for adults have been adapted for clinical settings [5], the workplace [6], and community settings [7]. Less translational work has been done for EBIs with children [8]. The Childhood Obesity Research Demonstration (CORD) 3.0 project, spearheaded by the Centers for Disease Control in 2019, is anticipated to result in “off-the-shelf” interventions specifically serving lower income families [3]. Thus far, reports of EBI translation have focused on the outcomes of adapted interventions more than the process of translating the intervention. Further, although clinicians routinely adapt EBIs in their practice, our team has not found reports of processes that clinical teams have followed to adapt EBIs for pediatric weight management into real-world practice. Practical descriptions of the translation process are critical for improving the rate and reliability of translation and improving health outcomes in adolescents with obesity.

As such, this report describes the systematic process our team followed to adapt the Families Improving Together (FIT) for Weight Loss intervention [9, 10] from its RCT protocol to a group-based telehealth format in a clinical setting, namely at Mayo Clinic in Rochester, Minnesota, USA. This translation was clinician initiated, prompted by identified practice needs, and involved collaboration of the clinical team with the research team that developed FIT. Our process was guided by the RE-AIM framework [11, 12] and followed key steps for adapting EBIs to new contexts [13]. RE-AIM, an acronym for the dimensions of an intervention’s reach, effectiveness, adoption, implementation, and maintenance, was proposed by Glasgow et al. over 20 years ago [11] and is a leading framework for behavioral intervention development, translation, and evaluation [12]. Whereas RE-AIM guided our thinking about developing an intervention for broad impact (see Table 1), our selection and adaptation of an EBI was guided by a recent scoping review by Escoffery et al. [13] of steps included in leading adaptation frameworks. Specifically, we followed 11 steps across four phases identified in that review: (a) Select the EBI, (b) Adapt the EBI, (c) Prepare for Adapted EBI Delivery, and (d) Implement and Evaluate the Adapted EBI. Consistent with RE-AIM, our adaptation focused on maintaining fidelity to the intervention’s core elements (implementation) while making it fit the clinical practice (adoption) and group telehealth delivery (reach). We established a plan for continuous quality improvement and evaluation guided by all elements of the RE-AIM model. Below, we describe our process and share lessons learned as well as implications for practice, intervention development research, and translational science.

PHASE I: SELECTION OF THE EBI, FIT FOR WEIGHT LOSS

Step 1: assess the community

The first step for most adaptation frameworks is to understand the needs of the target population and host organization, including identifying which behaviors to target and assessing the capacity and needs of the organization to implement the intervention [13]. In this case, target behaviors for the treatment of pediatric obesity are clearly established in best practice guidelines [14, 15] and include healthy eating and physical activity habits (e.g., increase fruits and vegetable intake, reduce sweetened beverage intake, increase engagement in physical activity). In terms of assessing organization needs, implicit in descriptions of this adaptation step is that an implementation team is disseminating the EBI to an unfamiliar setting and population. In this case, the needs of the setting and population were well known to the implementation team, as clinicians leading the practice initiated the EBI identification and translation and were leading members of the adaptation team. Specifically, the clinical team sought a structured EBI package to ensure care met best practice standards, provided ready-made materials for participating families, facilitated training and consistency of care with additional staff and learners (e.g., fellows, residents), and supported group formats for capacity and social support. The practice identified need for adolescent-appropriate intervention based on referral patterns and availability of interventions for younger children in the community. Delivery formats conducive to the regional catchment area of the clinic was identified as desirable. In terms of capacity, staffing for pediatric psychology evaluation and behavioral interventions has been consistently one doctoral level psychologist and one masters level psychologist/licensed clinical counselor, both with additional clinical responsibilities. In sum, the practice needed an intervention package consistent with best practices in family-based behavioral weight management that was ready for delivery in a busy clinical practice and deemed suitable and accessible for adolescents and their parents living a significant distance from the clinic.

Step 2: understand the interventions

A second step included in most adaptation frameworks involves reviewing available EBIs to understand their underlying theory and core components [13]. For our team, this process occurred over the course of about 10 years and, in this time frame, the lag in development and translation of EBIs for adolescents [1, 3, 16] complicated our search for a practice-relevant EBI. Not finding an adolescent-focused intervention package that fit our practice, we trialed a few available packages that had been tested in clinical trials with children or adults. Using these programs further familiarized our team with core cognitive-behavioral components that met patients’ needs and were consistent with literature on best practices, including self-monitoring, goal setting, problem-solving, stimulus control, shaping alternative behaviors, and self-talk [17, 18]. At the same time, participant and clinician feedback highlighted the importance of developmentally relevant content and parent involvement for adolescents as well as congruence of nutritional guidance between the intervention and clinic practices.

Difficulty finding an EBI package that fit practice needs and a growing desire to offer intervention to the clinic’s broader catchment area, our team adapted a brief, intensive adult program at our institution and trialed it with adolescents in 2019. The intervention combined a three-day intensive behavioral intervention with telephonic wellness coaching follow-up. Adaptations for the adolescent population included parent content related to social support [19], autonomy support, and positive communication [20]. A pilot of this intervention determined that full-day sessions were too long for families and that more ongoing structured parental involvement was needed to sustain adolescents’ engagement in health behavior change over time [21]. The increased availability and familiarity with telehealth during the COVID-19 pandemic provided an unprecedented opportunity to offer behavioral EBIs to a larger catchment area.

In the meantime, adolescent behavioral weight management intervention research advanced and suggests promise for interventions rooted in Social Cognitive Theory (SCT), Family Systems Theory (FST), and Self-Determination Theory (SDT) [22]. Interventions including adolescent–parent communication, shared decision-making, and autonomy support around the development of healthy habits are particularly well suited for adolescence, a developmental period characterized by growing autonomy with continued influence of family on health behaviors.

Step 3: select the intervention

Seven of the 13 frameworks reviewed by Escoffery et al. explicitly included a step of selecting the intervention that best fit needs of the population and practice identified in prior steps [13]. Accordingly, our practice selected the FIT for Weight Loss intervention because of its attention to the developmental needs of adolescents, developmentally relevant parenting components, and its inclusion of behavioral skills foundational to evidence-based weight management interventions across the lifespan [10]. By teaching and modeling autonomy support and shared decision-making along with behavioral skills, FIT aimed to promote intrinsic motivation and self-efficacy for adolescents to establish lifelong habits for healthy weight management [10, 22, 23]. In a randomized controlled trial, FIT led to increases in physical activity for parents with a similar trend for adolescents [9]. Further, the FIT intervention was moderated by authoritative parenting and autonomy-supportive communication in demonstrating greater frequency of family mealtime [24], and has been associated with greater adolescent physical activity [25] and lower body mass index (BMI) [26], supporting the potential benefits of its parenting components. FIT was developed and tested with African American families, which provides evidence of being acceptable and effective with a population traditionally underrepresented in intervention research. At the same time, the core concepts and skills are consistent with broader best practices in behavioral weight management, are tailored to the unique needs of adolescents, and were deemed by our team as amenable to adaptation for a more diverse population in our clinical setting.

PHASE II: ADAPTATION OF FIT TO FIT-TELEHEALTH (FIT-T)

Step 4: consult with experts

A less frequently described adaptation step that is arguably important for intervention fidelity is consulting with content experts, particularly intervention developers, as needed to ensure adaptations remain true to the original model [13]. Our clinical team established a collaboration with the original FIT developer (D.K.W.), who conveyed expertise on FIT theoretical underpinnings and key content, reviewed proposals for adaptation, reviewed adapted patient and facilitator materials, trained facilitators, and consulted on the design of program evaluation plans.

Step 5: consult with stakeholders

Frameworks that include this step suggest working with stakeholders where program implementation will take place to identify champions of implementation and to identify adaptations to the EBI that might be needed in the new setting. This step can include seeking input from advisory boards and systematic review of the EBI by stakeholders [13]. Our team gathered additional patient perspectives by consulting with the institution’s Pediatric Patient Advisory Board (PAB) during the process of adapting FIT to our clinical practice and telehealth delivery. The Pediatric PAB is an organized group of pediatric patients ages 11–18 years who provide input into the planning stages of research and clinical innovation projects. Suggestions from the PAB were to aim for racial and gender diversity among facilitators, include adolescent-only discussion and support during sessions, and allow “space” for emotional responses and reflective discussion around the sensitive topic of weight. Although opportunities for staff hires have not presented, we were able to integrate the other recommendations into the facilitator guides.

Clinical practice stakeholder input was organized around a program adaptation advisory team consisting of program facilitators (i.e., a doctoral level psychologist B.K.B., a masters level psychologist K.V.R., a postdoctoral psychology fellow S.J.N.), other members of the multidisciplinary pediatric weight management specialty practice (i.e., a physician with expertise in pediatric obesity medicine S.K., a dietitian R.P.), a fitness expert (D.G.), and two primary care physicians (pediatrics B.A.L. and family medicine T.I.R.). The professional advisory team met once every 1–2 months during the adaptation process and, as described below, reviewed original FIT materials to provide guidance on its adaptation. They also provided valuable input regarding referral processes. For example, primary care providers gave actionable suggestions to streamline referrals (e.g., create orders, documentation short-cuts, and informational flyers for providers and patients) and to reduce barriers to participation (e.g., billing information for families).

Steps 6 and 7: decide what needs adaptation and adapt the original program

The most common adaptation step mentioned across adaption frameworks is to identify what aspects of the intervention need to be adapted. This step may flow from the prior step of systematic stakeholder review of the EBI and involves determining what adaptations need to be made for the intervention to fit the new population and/or setting as well as core intervention elements to which to retain fidelity [13]. In our case, members of the professional advisory team reviewed the FIT materials independently to identify content that aligned with current clinical practice and adaptations needed based on patient population, practice norms, and telehealth delivery. Table 2 summarizes results of this process including elements to maintain as well as adaptation themes, recommended modifications, and rationale for those modifications. Not surprising, the panel recommended maintaining core elements of the intervention that were consistent with weight management best practices (e.g., behavioral skills) and/or were related to parent content leading to the selection of the EBI. Notably, the psychology and dietitian members of the panel had substantial experience with eating disorders and extreme weight management behaviors in adolescents, including those with elevated BMI. This experience and the panel’s knowledge of the literature on dieting, weight focus, and risk for weight gain and on the role of healthy lifestyle modification in successful adolescent weight loss [27–29] informed several recommendations to shift emphasis away from weight and calories to behaviors conducive to health promotion and healthy weight trajectories. Other recommendations were anticipated based on the goal of adapting the intervention for a broader population (e.g., modifying visual representation in materials, cultural tailoring) and telehealth context (e.g., different processes for check in and individual goal review).

The advisory panel and FIT developer reviewed and approved all recommended adaptations summarized in Table 2. Our clinical team revised the facilitator guides accordingly and worked with a graphic artist at our institution to create a workbook that incorporated the recommended adaptations and was consistent with institutional media standards and visual representation of the ages and racial, cultural, and body size diversity of our patient population.

PHASE III: PREPARATION TO DELIVER FIT-T

Step 8: train staff

Although training staff was mentioned in only a quarter of adaptation frameworks [13], we agreed with experts who declare this step important for ensuring fidelity to the original model [30, 31]. During the FIT review and adaptation stage, the FIT developer (D.K.W.) and a member of her team (H.L.) conducted a series of five 120-min trainings with the FIT-T facilitators via videoconference. The purpose of the trainings was to orient facilitators to the theoretical foundation and provide opportunities to discuss and practice interventions following the adapted facilitator guides. The research team discussed and demonstrated essential elements of the program and techniques for guiding advanced behavioral skills while promoting a positive social environment. The FIT-T team practiced facilitation skills through both didactic and role-playing activities. A 90-min refresher training was conducted 2 weeks prior to the start of FIT-T.

Step 9: test the adapted material

Several of the adaptation frameworks reviewed by Escoffery and colleagues encourage pilot testing the adapted intervention or materials with the new population or representatives to identify need for additional refinements [13]. The FIT-T facilitators used the new facilitator guides and workbook with individual families in their clinical practice prior to implementing FIT-T as a group telehealth program. Consistent with our recent practice norms, appointments occurred in both telehealth and in-person formats. In using the FIT-T materials with individual families, facilitators observed the program content and materials were well received by adolescents and their parents based on family engagement in sessions, completion of assigned activities between sessions, and ability of youth and parents to read and respond to printed information and activities in the workbook. Facilitators identified a need for a brief checklist summarizing session content and activities to support fidelity and fluid delivery. This observation led the facilitators to create a session checklist in collaboration with the FIT developer and informed by the FIT evaluation model [9, 23] to be used in the implementation and evaluation phase. In sum, initial use of FIT-T with individual families suggested feasibility of the adapted intervention in practice and acceptability with facilitators and participating families. It also informed development of session checklists to decrease session preparation time and prompt delivery of key content.

PHASE IV: IMPLEMENTATION AND EVALUATION OF FIT-T

Step 10: implementation

Five of the 13 frameworks included in the scoping review specify a step of implementation planning, which may include making decisions about the implementation staffing and delivery processes and sequences that will work in the new delivery context [13]. The primary driver of developing FIT-T was to provide a needed clinical service; thus, the implementation and evaluation approaches prioritize patient care and practice needs. Whereas participants in intervention research are recruited into studies, participants in clinical interventions are referred by clinicians who deem the intervention clinically indicated. Thus, decisions needed to be made about patient candidacy, referral sources, and processes to move participants from referral to enrollment. Candidacy requirements targeted patients ages 11–17 years old with a BMI at or above the 95th percentile for age referred by a Mayo Clinic medical care provider for lifestyle weight management, and family ability and willingness to participate in scheduled appointments and assignments. The age range was based on youngest age included in FIT trials and the oldest based on practice needs. The decision to accept referrals from specialty care (e.g., multidisciplinary weight management clinic housed within pediatric endocrinology) or primary care at the main clinic and health system sites within Minnesota was dictated by a desire to fill a practice-gap in the institution, importance of medical oversight for obesity care, ease of internal referrals and communications relative to outside sources, and state-specific licensure of the FIT-T facilitators. Presence of an eating disorder, substance use problem, and/or acute psychiatric illness (i.e., condition needing treatment for stabilization first such as suicidal ideation or poorly managed depression) were determined to be contraindications prompting referral to other interventions.

Referral processes were guided by input from physician stakeholders obtained through discussions at division meetings and from physician members of the adaptation advisory team. Per their suggestions, informational flyers for referring clinicians and families were created and shared across the practice. Capitalizing on tools within the electronic medical record, an order and short-cut text were created for medical care providers to request a pre-program evaluation (PPE) and document the referral. The PPE is conducted by program facilitators during a 60-min face-to-face or virtual session per family preference. During collaborative discussion, the program and expectations for participation are reviewed, initial goals are discussed, potential barriers to participation are explored, and readiness is assessed based on adolescents’ and parents’ interests, needs, and goals. If the family meets program requirements and wishes to participate, they are scheduled into an available cohort. If barriers are identified, recommendations are discussed (e.g., prioritizing depression treatment) and arrangements made to revisit future candidacy.

Staffing was dictated by the clinical practice. Whereas facilitators of the original FIT included psychology graduate student trainees and members of the community, including past parent participants, health care institutions typically require all interventionists to be credentialed or supervised by a credentialed clinician. Accordingly, FIT-T facilitators are licensed clinicians, a doctoral level psychologist (B.K.B.) and a master’s level psychologist (K.V.R.) with over 25 years’ collective experience in behavioral health and weight management. A postdoctoral fellow (S.J.N.) with interest in health promotion and program development is also trained and supervised as a facilitator. A single cohort of up to six families—the referred patient and parent(s)—are scheduled at a time. The nine group sessions are scheduled the same day and time each week. All sessions include adolescents and at least one parent; most sessions include adolescent- and parent-only breakout discussions. Two or more individual family sessions are scheduled as a typical outpatient appointment on one of the facilitators’ calendars toward the beginning and end of the course. In the case of family absences, make up sessions may be available depending on availability of family and facilitator. Sessions are scheduled during clinic hours through the electronic medical record, and participants access group sessions via a secure ­teleconference link sent via the secure messaging feature of Mayo Clinic Patient Online Services.

Step 11: program evaluation

Most adaptation frameworks include a program evaluation step. Descriptions of the evaluation step include a focus on identifying key processes and outcomes, selecting data sources and assessment tools, and creating a data collection plan [13]. For the evaluation of FIT-T, our plan was guided by the RE-AIM model and is summarized in Table 1. We encountered several challenges in creating this plan, largely stemming from differences in norms across research and practice. First, choosing assessments of behavioral outcomes was challenging. In our experience, “gold standard” research assessments such as accelerometers and 24-hr dietary recall fit poorly in clinical practice. For example, 24-hr dietary recall protocols require additional staff to administer and score them. Online assessment tools that offer automated administration and scoring store individuals’ responses on a service external to the clinic, raising issues of compliance with the Health Insurance Portability Accountability Act (HIPPA). Use of accelerometers require additional staff and processes for making the data clinically useful (e.g., individualized reports). On the other hand, self-report assessments are subject to reporter bias [32, 33] and their clinical utility is not well studied. However, they are routinely used in clinical encounters and can utilize existing processes and resources for administration and scoring. Second, we had to make a clear distinction between assessments necessary for clinical care or continuous quality improvement and assessments purely for research purposes. To designate all assessments as research would mean participants have to consent/assent to a research study to participate in the intervention. To include only clinical assessments would create limitations in comparing FIT-T intervention outcomes to results from the FIT RCT and comparable studies. We thus determined our clinical assessment battery by selecting questionnaire-based assessments that would inform clinical care, fit with capacity of the practice, and minimize participant burden. The remaining assessments deemed useful for research purposes were designated as the research battery requiring additional consent and assent. Third, assessments needed to be integrated into the clinical encounter flow, including linking assessment completion to appointments and determining best means to make data available to facilitators and families for clinical decision-making and progress monitoring. Integrating assessment into clinical care also means additional burden on clinicians. For example, because processes of receiving referrals, determining program fit with families, enrollment, and awareness of session participation all go through the FIT-T facilitators, they are in the best position to track participant flow. To balance the need for data with minimizing clerical burden, we created a spreadsheet housed on a protected shared drive and use weekly clinic meetings to ensure essential information is recorded, with a plan to extract further data from the medical record relevant to addressing RE-AIM-guided evaluation questions.

DISCUSSION

This paper provides a much-needed demonstration of the translation of an EBI for adolescent weight management from research protocol to group telehealth delivery in a ­medical center and adds a unique perspective of this process as led by a clinical team aiming to implement an EBI in a real-world health care setting. Specifically, we illustrate translation of the FIT for Weight Loss intervention to Mayo Clinic FIT-Telehealth (FIT-T) guided by the RE-AIM framework and common steps from leading adaptation frameworks within implementation science. The process resulted in FIT-T materials—that is, facilitator manual, participant workbook, and session fidelity checklists—deemed by expert stakeholders as appropriate to the practice and congruent with the theoretical basis and key content of the original FIT intervention. Moreover, the demonstration provides an example and valuable lessons for clinicians, scientists, and the field of implementation science as we work toward increasing reach of scientifically sound, clinically relevant, and effective interventions for adolescent weight management. Our demonstration is unique in that it was initiated by clinicians and involved collaboration between clinical practice stakeholders and the original EBI developer.

Clinician-researcher collaborations are valuable to translational work and should be considered early in the process of intervention development, not only during translation and dissemination work following RCTs. Science has produced and tested multiple interventions for adolescent weight management but has yet to produce an intervention that meets full criteria for “efficacious” for this developmental stage [1]. Our translational work focused on use of a promising intervention for this developmental period. Consideration of clinician experience not only guided adaptation of an EBI to fit the practice and target population, it also led to intervention changes and enhancements that have potential for improving the intervention. For example, research on adolescent weight management practices and weight gain trajectories suggests that our intentional shift to emphasize healthy habits and de-emphasize weight and calorie counting might not only prevent unhealthy weight management practices, but also promote healthy behaviors and healthier weight trajectories [27, 29].

It is important to highlight other key lessons related to operational factors that are different in research and clinical settings. First, instead of participant recruitment, patient referral procedures need to be defined and strengthened in clinical settings. This distinction is likely to result in different “samples” with implications for external versus internal validity of outcome findings. It also has implications for the reach of the intervention within the RE-AIM framework, raising questions for implementation science related to factors influencing likelihood of referral and enrollment. Second, we noted our staffing options were different from the FIT RCT due to requirements for our facilitators to be credentialed. This difference has implications for training of facilitators as well as capacity. Third, outcomes assessment needed to be markedly different in the clinical setting. To determine whether EBIs can be effective in real-world settings, the field of pediatric weight management has important work to do to identify practical, clinically relevant, and reasonably reliable assessment batteries, ideally with user-friendly scoring and reporting software.

Translational work takes a lot of time and resources. The work described in this paper would not have been possible without generous benefactor funding to Mayo Clinic to develop behavioral lifestyle interventions for adolescent obesity and access to institutional resources. Few practices likely have the resources for substantive EBI adaptation to fit their practice and to ensure fidelity. Efforts are currently ­underway by the Centers for Disease Control to package pediatric weight management programs for dissemination [34]. Policymakers and funding agencies should be aware that the development and dissemination of effective intervention packages fitting a diverse array of populations and service settings in the USA and elsewhere will take substantial dedication of resources, coordination of efforts, and ongoing communication of progress and lessons learned.

This manuscript describes translation of a single intervention to a single site with a particular population, namely adolescents in the Upper Midwest, USA. Practice needs and norms and the translational process may be different for other settings, populations, and types of interventions. The processes described in this report were driven by the aim of creating a clinical service. Triangulation of lessons learned from clinically driven translation reports with results of EBI adaptation studies using more rigorous implementation science methodologies are needed to provide a complete and valid protocol for translation. Whereas some of the assessment procedures used in our process are less rigorous than more formalized approaches (e.g., survey or interview stakeholders) and subject to threats of internal validity, they are fitting with calls for a rapid science approach and attention to external validity [35]. Finally, although we followed a systematic process aimed at retaining key content, we do not yet have data on whether this process will lead to fidelity in implementation and to an effective intervention. Implementation of the evaluation plan will be needed to answer these questions. Next steps will focus on evaluating implementation fidelity, intervention reach, and acceptance and on continuous quality improvement to maximize reach and engagement, while collecting pre- and postintervention data on desired proximal (retention, self-efficacy, parental support) and distal outcomes (health behavior change).

CONCLUSIONS

Developmentally tailored interventions for adolescent weight management that are ready to use in service delivery settings are sorely needed to address the obesity epidemic and to improve the health and wellbeing of affected adolescents. Our report illustrates a systematic process for adapting an evidenced-based weight management program to clinical practice following steps outlined by prominent adaptation frameworks. In doing so, we aimed to provide a practical demonstration of how fidelity to key elements of an intervention can be identified and maintained while adapting an intervention to fit the target population and setting. Consistent with our overall goal to offer an intervention that is effective and reaches a substantial proportion of our clinic catchment population, we have presented a plan for implementation and evaluation as a practical example of the RE-AIM framework and key EBI adaptation steps applied within a real-world clinical setting. We anticipate that our example and lessons learned, including the value of research-clinician collaboration in translational science, will be useful to policymakers, scientists, and clinicians engaged in translation of EBIs within clinical and community settings.

Funding

This project was funded by gifts from the Delaney Family and the Vincent Dowling Family Foundation to Mayo Clinic Development aimed at improving care for adolescents with obesity. The Families Improving Together (FIT) for Weight Loss randomized clinical trial was funded by a grant (R01 HD072153) funded by the National Institutes of Child Health and Human Development to Dawn K. Wilson.

Acknowledgments

The authors are grateful to Rose Prissel, MS, RDN, and Daniel Gaz, MS, for their time and expertise in reviewing the Families Improving Together for Weight Loss curriculum and providing recommendations for adaptation to the practice setting.

Compliance with Ethical Standards

Conflict of Interest: None declared.

Ethical Approval: The research protocol for the Mayo Clnic FIT-T intervention has been approved by the Mayo Clinic Institutional Review Board.

Informed Consent: This article does not include any data from human participants, and informed consent was therefore not required.

Welfare of Animals: This article does not contain any studies with animals performed by any of the authors.

Transparency Statements: The article does not contain data from studies that were formally registered, included a preregistered analysis plan, or used analytic code. Deidentified data from stakeholders’ reviews used for intervention adaptation will be made available by emailing the corresponding author. Intervention materials described in this article are not publically available.

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