Challenges and adaptations for a cluster-randomized control trial targeting parents of pediatric cancer survivors with obesity during the COVID-19 pandemic.

Although the COVID-19 pandemic has increased the importance of digital technology in clinical trial implementation, there is a dearth of literature reporting on challenges and strategies related to multi-site randomized controlled trials (RCTs) among pediatric cancer survivors during the pandemic. This paper discusses challenges faced in the implementation of the NOURISH-T+ trial so far (December 2019-March 2022) and describes adaptations made as a result of these disruptions in the areas of recruitment, data collection, and overall engagement. This reflection is based on a multisite cluster-RCT that aims to examine whether an intervention targeting parents as agents of change to promote healthy eating and physical activity in pediatric cancer survivors, NOURISH-T+ (Nourishing Our Understanding of Role modeling to Improve Support and Health for Healthy Transitions), reduces body mass and improves health behaviors compared to Brief NOURISH-T (Enhanced Usual Care/EUC). The COVID-19 pandemic has created and exacerbated challenges for our trial related to participant recruitment and engagement, technology access and literacy, and data collection and management, as well as COVID-related challenges (e.g., Zoom fatigue). Strategies used to address these challenges might prove helpful in future virtual or hybrid RCTs, including developing trust and rapport with participants, providing support through multiple routes of dissemination, and using data management applications (e.g., REDCap™) for automation and project management. Extra efforts to build families' trust and rapport, offering multiple routes of support, and automating as many tasks as possible are critical to ensuring the continuation of high-quality clinical trials during the COVID-19 pandemic.

Challenges and strategies among research on pediatric cancer survivors during the COVID-19 pandemic have not been well described. Our intervention, NOURISH-T+ (Nourishing Our Understanding of Role modeling to Improve Support and Health for Healthy Transitions), aims to promote healthy eating and physical activity in pediatric cancer survivors. The COVID-19 pandemic has created challenges for our trial related to participant recruitment and engagement, technology, data collection, and management, and COVID-related challenges (e.g., Zoom fatigue). Strategies that have been helpful for us include developing trust and rapport with participants, providing support through multiple routes of dissemination (e.g., website, videos), and using data management applications (e.g., REDCap™) to optimize tasks.

Recommended practices for virtual nutrition education interventions for adolescents with autism spectrum disorder: A reflection from two pilot interventions during the COVID-19 pandemic.

Youth with autism spectrum disorder (ASD) demonstrate unhealthy eating behaviors and dietary patterns compared to their neurotypical counterparts. Given the increased risk of unhealthy weight gain and the onset of the COVID-19 pandemic, modified nutrition programs in this population are warranted. The authors independently conducted two virtual pilot interventions during COVID-19 that offered feasible and acceptable alternatives to in-person delivery, providing unique opportunities for participant engagement and family involvement. Future virtual nutrition education programs for adolescents with ASD may include visual and verbal aids through Zoom, more parent/family integration, and accommodations for those with varying ASD severity levels.

Exploration of Multilevel Barriers and Strategies That Affected Early COVID-19 Vaccination and Testing in Rural Latino Communities in Southwest Florida.

The COVID-19 pandemic has disproportionately impacted multiple racial and ethnic minority groups, including Latinos residing in rural communities. Low rates of vaccination and testing combined with social determinants of health have contributed significantly to this disparate impact. Given the needs and constraints unique to rural Latino migrant and immigrant communities, this qualitative study examined multilevel barriers and strategies that affect COVID-19 vaccination and testing uptake among these communities in southwest Florida. Four focus groups (n = 25) were conducted between March and April 2021 with various key stakeholders, including rural Latino community members, local leaders, and community health workers ('Promotoras de Salud'). Themes that aligned with barriers to COVID-19 vaccination and testing included fear, lack of control, misinformation, lack of accessibility, and institutional/policy issues; themes that aligned with strategies to improve COVID-19 vaccination and testing uptake included faith, taking care of self, and community and family resilience. Recommendations for improving future pandemic responses for rural Latino communities include incorporating multiple levels of intervention, such as consideration of the role of the family, involving trusted community members, and ensuring the development and implementation of fair and consistent policies.

Feasibility of a virtual nutrition intervention for adolescents with autism spectrum disorder.

LAY ABSTRACT: Adolescents with autism spectrum disorder are at an increased risk of unhealthy eating behaviors and obesity compared to their typically developing peers. Many nutrition interventions for this population focus on improving autism spectrum disorder symptoms or managing weight rather than addressing participants' healthy eating self-efficacy. The purpose of this study was to examine a virtual implementation of a new intervention for adolescents with autism spectrum disorder, Bringing Adolescent Learners with Autism Nutrition and Culinary Education. We used fidelity checklists, engagement records, and field notes to measure implementation. We also examined the feasibility of assessing outcome measures, including a food frequency questionnaire (FFQ), psychosocial survey, height, and weight. We recruited adolescents with autism spectrum disorder aged 12-21 years. Six groups of 2-7 adolescents (27 total) participated in the intervention and pre-/post-intervention measurements. Bringing Adolescent Learners with Autism Nutrition and Culinary Education consisted of eight weekly lessons: exploring taste, flavor, and texture; mealtimes and rules; food groups and nutrients; moderation; beverages; cooking; well-being; sustaining healthy eating habits. The virtual implementation was feasible based on lesson attendance, participation, homework completion, fidelity, and prevalence of technical difficulties. Evaluation was also feasible based on response rate, completion, and data quality for the food frequency questionnaire, psychosocial survey, and height and weight measurements. Bringing Adolescent Learners with Autism Nutrition and Culinary Education may be used in virtual settings to reach diverse populations of adolescents with autism spectrum disorder. Future research is needed to evaluate the impact of Bringing Adolescent Learners with Autism Nutrition and Culinary Education on dietary behavior and obesity outcomes.

O01 Optimizing a Theoretical Framework for Virtual Nutrition Education Programs for Adolescents With Autism Spectrum Disorder

Adolescents with autism spectrum disorder (ASD) demonstrate more problematic eating behaviors and unhealthy dietary patterns than their neurotypical peers. As the COVID-19 pandemic has resulted in a continued need for virtual interventions, a tailored framework to guide virtual nutrition education programs for this population is warranted. To optimize a theoretical framework based on empirical data from a virtual nutrition education intervention study for adolescents with ASD. This is a secondary analysis of qualitative data collected from a pre-post intervention study with 27 adolescents with ASD aged 12-21 years. Six adolescent focus groups (n = 12) and 21 parent interviews were conducted after the intervention. The initial framework based on social cognitive theory (SCT) was applied to a virtual nutrition education intervention, BALANCE (Bringing Adolescent Learners Nutrition and Culinary Education), that consisted of eight weekly sessions. The framework had 6 domains (ASD-related Barriers, SCT Constructs, Environmental Context, Eating Habits, Other Lifestyle Behaviors, and Health Outcomes) and 21 constructs. Focus group and interview data were analyzed for emergent themes, and the framework was refined based on key findings. Emergent themes that were overlooked in the initial framework development included that adolescents improved 'Self-regulation';parents particularly liked that children's 'Autonomy and independence' were encouraged;and 'Family support' for healthy eating increased, e.g., parents teaching their children how to prepare food themselves, after participating in BALANCE. The optimized framework included 3 new constructs based on these results: Self-regulation, Autonomy, and Supportive Social Environment, which can be well-explained with self-determination theory (SDT). The findings suggest that future versions of the BALANCE intervention should incorporate SDT constructs to improve adolescents' intrinsic motivation to make healthy food choices. The optimized framework can be used to inform future virtual nutrition education programs for this population. University of South Florida College of Public Health.

Statewide Implementation of Virtual Perinatal Home Visiting During COVID-19.

PURPOSE: This evaluation describes efforts taken by MIECHV administrators and staff during the pandemic using data collected from 60 MIECHV staff surveys and nine statewide weekly focus groups. DESCRIPTION: The Florida Maternal, Infant and Early Childhood Home Visiting (MIECHV) Initiative funds perinatal home visiting for pregnant women and families with infants throughout the state. Florida MIECHV has shown resilience to disasters and times of crises in the past, while generating a culture of adaptation and continuous quality improvement among local implementing agencies. Florida MIECHV responded to the COVID-19 pandemic crisis within the first few days of the first reported case in Florida by providing guidance on virtual home visits and working remotely. ASSESSMENT: Findings highlight the role of administrative leadership and communication, staff willingness/morale, logistical considerations, and the needs of enrolled families who face hardships during the pandemic such as job loss, limited supplies, food insecurity, technology limitations, and stress. Home visitors support enrolled families by connecting them with resources, providing public health education and delivering evidence-based home visiting curricula virtually. They also recognized the emotional burden surrounding COVID-19 impacts and uncertainties along with achieving work-life balance by caring for their own children. CONCLUSION: This evaluation helped in understanding the impact of the pandemic on this maternal and child health program and fundamentals of transition to virtual home visiting services. Virtual home visiting appears to be feasible and provides an essential connection to supports for families who may not otherwise have the means or knowledge to access them.