O3031: COMMIT to Scale and Spread of Family Healthy Weight Programs: A 5-year Dissemination and Implementation Evaluation in Fqhcs

Background: Beginning in 2018, the National Association of Community Health Centers (NACHC) received support from the Centers for Disease Control as part of its CORD 3.0 funding to implement Family Healthy Weight programs/Intensive Health Behavior and Lifestyle Treatment in Federally Qualified Health Centers (FQHCs) around the country. As a national membership organization, NACHC supports FQHCs in their mission to care for 30 million US patients regardless of their ability to pay. Branded as “COMMIT: Child Obesity Management Models in Teams,” the NACHC team, together with support from Subject Matter Experts implementing an adapted MEND program in an FQHC network in Denver, Colorado, has convened FQHC teams in Illinois, North Carolina, Mississippi, Florida, and Arizona in the planning, adaptation, implementation, and evaluation of their own COMMIT programs.

Methods: The COMMIT program, which is based off the proven MEND: Mind, Exercise, Nutrition – Do It! curriculum, was initially implemented in 16 FQHCs in 4 states, with a primary emphasis on fidelity and effectiveness. The COVID pandemic beginning in 2020 significantly disrupted health centers’ ability to safely implement group in-person programming and necessitated local adaptations. While not every FQHC was able to or chose to continue to implement the program, COMMIT legacy teams successfully implemented local innovations during the five years of the grant, and these adaptations proved crucial to their success. The dissemination and implementation of COMMIT is evaluated utilizing the Reach-Effectiveness-Adoption-Implementation-Maintenance (REACH)/Pragmatic Robust Implementation and Sustainability Model (PRISM).

Results: In-depth results using the RE-AIM/PRISM model will be shared. Of the initial 16 FQHC COMMIT sites in year 1-2, five have been able to have continuous implementation through 2023 (representing Arizona, Florida, and Mississippi), and reaching roughly 500 children and families. COMMIT participants have demonstrated changes in health behaviors, self-esteem, changes in BMI and blood pressure, and high satisfaction with the program. Importantly, these five legacy COMMIT sites have identified pathways to sustainability beyond grant funding.

Conclusion: The NACHC experience implementing COMMIT has demonstrated the importance of encouraging and supporting pragmatic adaptations and innovations to effective interventions in order to ensure their success at scale. This is particularly important when attempting to meet the needs and requests of diverse communities with otherwise limited resources and disproportionate burden of disease. Funders should increase opportunities to pilot, test, and spread these adapted programs, with equity as a primary goal. And primary care systems should feel confident that, while challenging, implementing Family Healthy Weight Programs internally is feasible, popular, and effective.