Objective:
Effective behavioral nutrition interventions promoting adherence to cystic fibrosis (CF) dietary guidelines and promoting weight gain in children have been demonstrated in research studies but not translated to clinical care. Achieving recommended dietary intake is important as body mass index percentile is positively associated with lung function. The current implementation study aims to test a digital version of behavioral nutrition intervention (be in charge [BIC] Digital) in the care setting. Aims: (a) to understand feasibility, acceptability, fidelity, and satisfaction and (b) to assess changes in caloric intake and weight gain.
Method:
A quality improvement-based implementation design was used to implement BIC Digital across seven CF centers. Measures of feasibility, acceptability, fidelity, and satisfaction from caregivers of children with CF and their CF Care team were assessed. Child weight and caloric intake were assessed pre- and postintervention and analyzed using Wilcoxon signed-rank tests and corresponding effect size estimates were produced using Mann–Whitney U tests.
Results:
Thirty-four families out of 64 enrolled (53%) completed the study. The majority of families and care teams reported high satisfaction with the program including ease of enrollment in the clinic setting. Children (n = 34) significantly increased their average daily caloric intake by 246 kcal/day (p < .05) and gained an average of 1.2 kg (p < .05), both large effect sizes, pre- to postintervention.
Conclusions:
Among those who completed all sessions, BIC Digital showed promise as an approach to implement a behavioral nutrition program into clinical care with associated improvements in caloric intake and weight gain.
Implications for Impact Statement
This study tests an accessible avenue for providing behavioral nutrition intervention in pediatric cystic fibrosis (CF) that previously has been limited by access barriers including lack of trained clinicians, cost, time, and distance from providers. The digital intervention was created through deep collaboration across diverse stakeholders including parents of children with CF, physicians, dietitians, psychologists, informatics specialists, and a user experience designer to develop patient- and clinician-facing technology, as well as to develop clinical workflows. This study is among the first to demonstrate the promise of a digital intervention to deliver behavioral nutrition intervention in CF.
