Table 4.

Classifying adaptations to the Connect for Health pediatric weight management program

Core components	What are the modifications?	At what delivery level was the modification made?	Who made the decision to modify?
Flagging of children with elevated BMIs	Changed from interruptive BPA to non-interruptive BPA	Healthcare system level customized for each organization	Based on stakeholder engagement
	Changed to who received the BPA depending on workflow of healthcare system (i.e., physician v. medical assistant)	Healthcare system level customized for each organization	Based on stakeholder engagement
	Additional content and actions included in the BPA depending on healthcare system’s needs	Healthcare system level customized for each organization	Based on stakeholder engagement
Clinical decision support tools	Patient education materials, community resource guide, and clinician educational materials accessible through EHR	Healthcare system level customized for each organization	Based on stakeholder engagement
	Enrollment for text messaging program through order as part of clinical decision support tools. In the original trial, parents were enrolled by a health coach	Program level across all sites	Program developer
	Aligned the clinical decision support tools with internal performance metrics	Healthcare system level customized for each organization	Based on stakeholder engagement
Patient education materials	Materials translated into Spanish and Haitian Creole. In the original trial, materials were only available in English	Program level across all sites	Program developer
	Consolidated patient educational materials into one page handouts per behavior	Program level across all sites	Program developer
	Revised to be geographically and culturally appropriate	Program level across all sites	Based on stakeholder engagement
	Addition of “Establish a balanced nutrition plan” as a primary behavioral goal with a corresponding handout	Program level across all sites	Program developer
Community resource guide	Customized for each healthcare system and for health centers within each system	Healthcare system level customized for each organization	Program developer
	Created an additional one page handout of top resources for each practice	Healthcare system level customized for each organization	Based on stakeholder engagement
Text messaging	Messages revised to be geographically and culturally appropriate	Program level across all sites	Based on stakeholder engagement
	Messages revised to be unidirectional v. bidirectional	Program level across all sites	Program developer
Health coach	Health coaching component of program removed. Information incorporated into educational materials, community resource guide, and text messaging program	Program level across all sites	Program developer
Implementation strategies	Selected clinician champions who are embedded within the clinical practices to facilitate implementation by engaging other clinicians and providing support and feedback	Program level across all sites	Program developer/ Based on stakeholder engagement
	Added practice coaches to provide clinicians with “at the elbow” support	Program level across all sites	Program developer
	In-person trainings to include all practice staff (i.e., clinicians, medical assistants, and front-desk staff) and to occur throughout the implementation period for continued education and feedback	Program level across all sites	Based on stakeholder engagement
	Offered continuing educational units and quality improvement bonuses to incentive trainings and likelihood that all clinicians would be familiar with the program	Healthcare system level customized for each organization	Based on stakeholder engagement
	Added a virtual learning community to provide on-demand support to clinicians with best practice management of childhood obesity	Program level across all sites	Based on stakeholder engagement

BMI body mass index, BPA best practice alert, EHR electronic health record