Purpose: To determine the next step in implementation for postpartum lifestyle, through the assessment of penetration (the proportion of women invited within the target population), implementation (fidelity), participation (the proportion of those invited who enrolled) and effect (weight loss compared to controls) (PIPE) of lifestyle interventions for weight management in postpartum women.

Methods: Systematic review and meta-analysis of randomised controlled trials involving lifestyle modification of diet, exercise or behavioural interventions for postpartum women (within 2 years after birth), with PIPE Impact Metric analysis. MEDLINE, EMBASE and other databases were searched up to 3rd May 2019. The quality of the studies was appraised using the Cochrane Risk of Bias tool (2.0). Progress in implementation was mapped against the Monash Health Learning Health System (LHS) framework.

Results: Thirty-six trials (49 publications) were included (n=5315 women, age 18-36 years). A single study provided sufficient information to calculate the population penetration rate (2.5%). All studies provided implementation information, but over half had low programme fidelity with no reported intervention manual or structured curriculum, checklist or other measures of quality assurance. The participation rate was calculated for nine studies (0.94% to 86%). Effect was reported with a pooled mean difference (MD) (95% confidence interval, CI) of -2.33 (-3.10 to -1.56) kg change in body weight (25 RCTs), BMI (MD -1.03 kg/m2[ 95% CI -1.43, -0.63], 18 studies) and physical activity (standardized MD 0.57 [95% CI 0.31, 0.82], 24 RCTs) with no change in energy intake (MD -0.52 [95% CI -1.06, 0.03], 12 RCTs). Fidelity or participation rate did not explain heterogeneity in weight loss effect. Postpartum lifestyle is stagnated at Step 3 of the LHS framework.

Conclusions: The limited evidence identified low penetration and participation, likely to translate to very low population impact. The implementation of postpartum lifestyle is halted at the evidence generation phase. This highlights the inadequacy of conventional RCTs in developing complex, yet implementable interventions. It is now vital to focus on pragmatic trials to translate the existing substantive clinical research investment into real-world settings and to develop implementable solutions for postpartum weight management.

Purpose: This study reports on a cluster-randomized Hybrid III trial designed to test stakeholder-selected implementation strategies to support Together, We Inspire Smart Eating (WISE). The 8 implementation strategies selected by stakeholders and tested in this study included formal leadership commitments, preparation of champions, an implementation blueprint, reminders, educational materials, incentives, and facilitation.

Methods: A stratified randomization approach allocated 4 preschool centers serving children in families affected by poverty sites (18 classrooms) to receive enhanced implementation support (i.e., treatment) and 5 sites (20 classrooms) to standard support (i.e., control) before school began.  The study was conducted in the 2018-2019 school year, and the Re-AIM framework guided the evaluation. T-test comparisons examined differences between conditions at the end of the school year. Additional multilevel regression analyses are planned that account for nesting of the data structure and control for key demographics. Maintenance assessments are ongoing, and those results will be added before the presentation.

Results:  Indicators of Adoption and Implementation were significantly different between groups.  Specifically, teachers in the enhanced condition reported greater readiness for change (p =.04), fewer barriers to implementation (p =.008), and higher feasibility (p=.05) and appropriateness (p=.03) of WISE.  For Implementation fidelity, there were significant differences for 3 of the 4 WISE practices (all p < .03, effect sizes > .80).  Educators reported reach of lessons was greater in the enhanced group, but not significantly so (69% basic, 76% enhanced). Child carotenoid levels increased in both groups but did not differ between conditions. Changes in child Body Mass Index were not different between groups.  The cost of the enhanced implementation averaged $274 per classroom per year.

Conclusions: A set of stakeholder-driven implementation strategies improved the adoption, reach, and implementation of the WISE intervention in Head Start. Engagement of key stakeholders in the selection and tailoring of implementation strategies may prove a key approach to improving uptake of evidence in the early care and education setting.

Purpose: Globally, a significant number of children bring a packed lunch from home for consumption at school. In Australia, more than 6 million serves of discretionary foods are packed in lunchboxes each day. At a population level, supporting small changes to the nutritional content of school lunchboxes may result in significant health gains. We report the development and implementation of a scalable lunchbox intervention called ‘SWAP IT’ that has been piloted, optimised and evaluated at a population level.

Methods: A six step program of work has been undertaken including:

      I.          Identification of the evidence practice gap through the conduct of a lunchbox prevalence study and systematic review of effective school lunchbox interventions;

    II.          Formative research to identify school and parental barriers and corresponding behaviour change techniques that underpin an intervention that support parents to pack healthy lunchboxes;

  III.          A pilot RCT delivered (n, 12 schools) to evaluate acceptability, feasibility and potential efficacy;

 IV.          Intervention optimization prior to a fully powered trial;

   V.          Conduct of a hybrid implementation-effectiveness trial (n, 36 schools) and;

 VI.          Evaluation of potential dissemination methods suitable for scale-up.

Results: The ‘SWAP IT’ lunchbox intervention targets five common parental barriers to packing healthy lunchboxes including time, cost, convenience, child preference and knowledge. The intervention consisted of four core strategies including the implementation of school nutrition guidelines and nutrition curriculum, the delivery of electronic messages to parents delivered using an existing school-communication app and parental resources. The pilot RCT found an increase in mean lunchbox energy from ‘healthy’ foods (79.21 kJ, p=0.04), a decrease in mean lunchbox energy from discretionary foods (-211.6 kJ, p=0.05) and was acceptable to 95% of parents and school principals. Optimized lunchbox messages were incorporated into the hybrid implementation-effectiveness trial currently being conducted in schools. Results from the hybrid RCT and dissemination trials will be presented.

Conclusions: ‘SWAP IT’ is a scalable lunchbox intervention that has been developed with consideration of large scale implementation. Given its phased development and early results, it has significant potential for population-wide effects to improve the nutritional quality of school lunchboxes.