Carlin F. Aloe

Background: Pediatricians support families in establishing healthy behaviors, yet there is limited information on valid and pragmatic questionnaires for assessing weight-related health behaviors in early childhood (≤24 months). The objective of this review is to summarize the evidence on parent-reported measures of weight-related health behaviors and/or parenting practices (e.g., feeding practices, dietary intake, sleep duration/routine, physical activity/sedentary behavior, and screen time) in early childhood. Methods: We conducted a scoping review by searching MEDLINE, Embase, PsycINFO, CINAHL, Web of Science, and Cochrane from inception to May 2025 (Open Science Framework Protocol https://doi.org/10.17605/OSF.IO/ME5KW ). Articles included were peer reviewed, original research, published in English, and parent-reported measures of weight-related health behaviors in early childhood that reported psychometric results and/or were used in primary care. Trained reviewers systematically extracted details on the setting, questionnaire, and psychometrics. Findings were summarized using descriptive analysis. Results: Our search yielded 26,642 articles with a final data set of 223 articles. Of the 100 unique questionnaires identified, most (90%) assessed parents’ feeding practices and/or children’s dietary intake; few assessed sleep duration/routine (13%), screen time (13%), and/or physical activity/sedentary behavior (12%). Of the 52 articles describing questionnaires used in primary care, 35% reported psychometric analyses. Conclusions: Most questionnaires measuring weight-related health behaviors in early childhood assessed parent feeding practices and/or children’s dietary intake. Few questionnaires used in primary care reported psychometric results. Comprehensive, valid, reliable, and pragmatic questionnaires of health behaviors in early childhood are needed in the primary care settings to standardize screening for obesity risk in early childhood.

Background: Electronic health record–based clinical decision support (CDS) tools can facilitate the adoption of evidence into practice. Yet, the impact of CDS beyond single-site implementation is often limited by dissemination and implementation barriers related to site- and user-specific variation in workflows and behaviors. The translation of evidence-based CDS from initial development to implementation in heterogeneous environments requires a framework that assures careful balancing of fidelity to core functional elements with adaptations to ensure compatibility with new contexts. Objective: This study aims to develop and apply a framework to guide tailoring and implementing CDS across diverse clinical settings. Methods: In preparation for a multisite trial implementing CDS for pediatric overweight or obesity in primary care, we developed the User-Centered Framework for Implementation of Technology (UFIT), a framework that integrates principles from user-centered design (UCD), human factors/ergonomics theories, and implementation science to guide both CDS adaptation and tailoring of related implementation strategies. Our transdisciplinary study team conducted semistructured interviews with pediatric primary care clinicians and a diverse group of stakeholders from 3 health systems in the northeastern, midwestern, and southeastern United States to inform and apply the framework for our formative evaluation. Results: We conducted 41 qualitative interviews with primary care clinicians (n=21) and other stakeholders (n=20). Our workflow analysis found 3 primary ways in which clinicians interact with the electronic health record during primary care well-child visits identifying opportunities for decision support. Additionally, we identified differences in practice patterns across contexts necessitating a multiprong design approach to support a variety of workflows, user needs, preferences, and implementation strategies. Conclusions: UFIT integrates theories and guidance from UCD, human factors/ergonomics, and implementation science to promote fit with local contexts for optimal outcomes. The components of UFIT were used to guide the development of Improving Pediatric Obesity Practice Using Prompts, an integrated package comprising CDS for obesity or overweight treatment with tailored implementation strategies. Trial Registration: ClinicalTrials.gov NCT05627011; https://clinicaltrials.gov/study/NCT05627011

BACKGROUND Electronic health record–based clinical decision support (CDS) tools can facilitate the adoption of evidence into practice. Yet, the impact of CDS beyond single-site implementation is often limited by dissemination and implementation barriers related to site- and user-specific variation in workflows and behaviors. The translation of evidence-based CDS from initial development to implementation in heterogeneous environments requires a framework that assures careful balancing of fidelity to core functional elements with adaptations to ensure compatibility with new contexts. OBJECTIVE This study aims to develop and apply a framework to guide tailoring and implementing CDS across diverse clinical settings. METHODS In preparation for a multisite trial implementing CDS for pediatric overweight or obesity in primary care, we developed the User-Centered Framework for Implementation of Technology (UFIT), a framework that integrates principles from user-centered design (UCD), human factors/ergonomics theories, and implementation science to guide both CDS adaptation and tailoring of related implementation strategies. Our transdisciplinary study team conducted semistructured interviews with pediatric primary care clinicians and a diverse group of stakeholders from 3 health systems in the northeastern, midwestern, and southeastern United States to inform and apply the framework for our formative evaluation. RESULTS We conducted 41 qualitative interviews with primary care clinicians (n=21) and other stakeholders (n=20). Our workflow analysis found 3 primary ways in which clinicians interact with the electronic health record during primary care well-child visits identifying opportunities for decision support. Additionally, we identified differences in practice patterns across contexts necessitating a multiprong design approach to support a variety of workflows, user needs, preferences, and implementation strategies. CONCLUSIONS UFIT integrates theories and guidance from UCD, human factors/ergonomics, and implementation science to promote fit with local contexts for optimal outcomes. The components of UFIT were used to guide the development of Improving Pediatric Obesity Practice Using Prompts, an integrated package comprising CDS for obesity or overweight treatment with tailored implementation strategies. CLINICALTRIAL ClinicalTrials.gov NCT05627011; https://clinicaltrials.gov/study/NCT05627011