PROJECT SUMMARY Evidence-based obesity treatment is inaccessible to most children in the United States. This lack of access is a source of health inequity, whereby children from rural and minority communities, who have the highest rates of childhood obesity, are also the least likely to receive an evidence-based intervention. Developing strategies to improve access to evidence-based obesity interventions could reduce health disparities by improving reach to these underserved communities. The premise of this study is that using a systematic framework to adapt a community-based behavioral intervention for childhood obesity that accounts for individual, family, and community factors will increase reach and effectiveness among low-income, minority, and rural populations. COACH is a multi-level obesity intervention that supports 1) the individual child through developmentally appropriate health behavior curriculum, 2) the family by directly addressing parent weight loss and engaging parents as agents of change for their children, and 3) the community by building the capacity of local community centers to offer parent-child programming. COACH has been tested in a prior RCT and demonstrated effectiveness at reducing child BMI at 1-year follow-up. We propose testing the process of adapting COACH in a cluster-randomized trial. In Aim 1, we will conduct a community readiness assessment for COACH in 50 community centers serving rural, minority, and low-income families in middle TN. This assessment was developed and pilot-tested by our team and assesses barriers to study implementation in multiple domains. In 25 randomly selected community centers, we will use a systematic process to adapt the intervention protocol based on the assessment results, while maintaining fidelity to COACH’s core components. In Aim 2, in a cluster-randomized trial, we will test the comparative effectiveness of each implementation strategy (adaptation vs. original program) on the implementation outcomes of reach, adoption, implementation, and maintenance. In Aim 3, we will test the comparative effectiveness of the adapted and original intervention on child BMI-Z at 6-month follow-up. Children with obesity (BMI percentile ≥95th) ages 6-11 and their families (N=750; 15 index children/center) will be recruited from communities served by each center. This research is innovative because it uses adaptation science as a potential solution to reduce health disparities in childhood obesity. By testing this intervention in a community resource available to 230 million Americans (community centers), we will create a scalable obesity intervention that could be implemented in traditionally underserved populations across the country. This study will also develop and test a theory-based process for adapting behavioral interventions for both obesity and other health outcomes among diverse rural and urban communities. This research aligns with the NHLBI’s mission to identify the best strategies for ...