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Cho J, Park J, Park C, Lee J, Oh J, Hwang G. What Are the Challenges of School Nurses in South Korea in Managing Obese Children From Low-Income Households? J Sch Nurs 2023; 39:506-516. [PMID: 34662202 DOI: 10.1177/10598405211045888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Given that the obesity rate among school-age children is increasing, school nurses can play a vital role in managing obesity and encouraging healthy living in school settings. Obese children from low-income backgrounds are more vulnerable than other students and require more careful attention and intervention. This qualitative study aimed to explore and understand the barriers recognized by school nurses in managing obesity in low-income household children. A focus group interview was conducted with 17 school nurses working at an elementary school. Children, home, school, political and structural, and social areas were revealed as intricate factors in obesity management. This study can help understand school nurses' obstacles in managing obese children from low-income families and can help them prepare practical measures to overcome these obstacles.
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Affiliation(s)
- Jeonghyun Cho
- College of Nursing, Institute for Health Science Research, Inje University, Busan, South Korea
| | - Jiyoung Park
- College of Nursing, Institute for Health Science Research, Inje University, Busan, South Korea
| | - Chongwon Park
- Division of English Language and Literature, Pukyong National University, Busan, South Korea
| | - Jinah Lee
- Department of Social Welfare and Counseling, Catholic University of Pusan, Busan, South Korea
| | - Jina Oh
- College of Nursing, Institute for Health Science Research, Inje University, Busan, South Korea
| | - Gahui Hwang
- College of Nursing, Yonsei University, Seoul, South Korea
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Braxton ME, Nwabichie E, Diaz M, Lish E, Ayers SL, Williams AN, Tornel M, McKim P, Treichel J, Knowler WC, Olson ML, Shaibi GQ. Preventing diabetes in Latino families: A protocol for a randomized control trial. Contemp Clin Trials 2023; 135:107361. [PMID: 37852533 PMCID: PMC10790650 DOI: 10.1016/j.cct.2023.107361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 09/18/2023] [Accepted: 10/15/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Latino families are disproportionately affected by type 2 diabetes (T2D) and lifestyle intervention is the first-line approach for preventing T2D. The purpose of this study is to test the efficacy of a culturally-grounded lifestyle intervention that prioritizes health promotion and diabetes prevention for Latino families. The intervention is guided by a novel Family Diabetes Prevention Model, leveraging the family processes of engagement, empowerment, resilience, and cohesion to orient the family system towards health. METHOD Latino families (N = 132) will be recruited and assessed for glucose tolerance as measured by an Oral Glucose Tolerance Test (OGTT) and General and Weight-Specific Quality of Life (QoL) at baseline, four months, and 12 months. All members of the household age 10 and over will be invited to participate. Families will be randomized to the intervention group or a control group (2:1). The 16-week intervention includes weekly nutrition and wellness classes delivered by bilingual, bicultural Registered Dietitians and community health educators at a local YMCA along with two days/week of supervised physical activity classes and a third day of unsupervised physical activity. Control families will meet with a physician and a Registered Dietitian to discuss the results of their metabolic testing and recommend lifestyle changes. We will test the efficacy of a family-focused diabetes prevention intervention for improving glucose tolerance and increasing QoL and test for mediators and moderators of long-term changes. CONCLUSION This study will provide much needed data on the efficacy of a family-focused Diabetes Prevention Program among high-risk Latino families.
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Affiliation(s)
- Morgan E Braxton
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, USA
| | - Eucharia Nwabichie
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, USA
| | - Monica Diaz
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, USA; Ivy Center for Family Wellness, The Society of St Vincent de Paul, USA
| | - Elvia Lish
- Ivy Center for Family Wellness, The Society of St Vincent de Paul, USA
| | - Stephanie L Ayers
- Southwest Interdisciplinary Research Center, Arizona State University, USA
| | - Allison N Williams
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, USA
| | - Mayra Tornel
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, USA
| | | | | | - William C Knowler
- National Institute of Diabetes and Digestive and Kidney Diseases, USA
| | - Micah L Olson
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, USA; Division of Pediatric Endocrinology and Diabetes, Phoenix Children's Hospital, USA
| | - Gabriel Q Shaibi
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, USA; Southwest Interdisciplinary Research Center, Arizona State University, USA; Division of Pediatric Endocrinology and Diabetes, Phoenix Children's Hospital, USA.
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Moreira-Rosário A, Ismael S, Barreiros-Mota I, Morais J, Rodrigues C, Castela I, Mendes IC, Soares MI, da Costa LS, Oliveira CB, Henriques T, Pinto P, Pita D, de Oliveira CM, Maciel J, Serafim T, Araújo J, Rocha JC, Pestana D, Silvestre MP, Marques C, Faria A, Polonia J, Calhau C. Empowerment-based nutrition interventions on blood pressure: a randomized comparative effectiveness trial. Front Public Health 2023; 11:1277355. [PMID: 38026295 PMCID: PMC10679749 DOI: 10.3389/fpubh.2023.1277355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 10/27/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Empowerment lifestyle programs are needed to reduce the risk of hypertension. Our study compared the effectiveness of two empowerment-based approaches toward blood pressure (BP) reduction: salt reduction-specific program vs. healthy lifestyle general program. Methods Three hundred and eleven adults (median age of 44 years, IQR 34-54 years) were randomly assigned to a salt reduction (n = 147) or a healthy lifestyle program (n = 164). The outcome measures were urinary sodium (Na+) and potassium (K+) excretion, systolic (SBP) and diastolic (DBP) blood pressure, weight, and waist circumference. Results There were no significant differences in primary and secondary outcomes between the two program groups. When comparing each program to baseline, the program focused on salt reduction was effective in lowering BP following a 12-week intervention with a mean change of -2.5 mm Hg in SBP (95% CI, -4.1 to -0.8) and - 2.7 mm Hg in DBP (95% CI, -3.8 to -1.5) in the intention-to-treat (ITT) analysis. In the complete-case (CC) analysis, the mean change was -2.1 mm Hg in SBP (95% CI, -3.7 to -0.5) and - 2.3 mm Hg in DBP (95% CI, -3.4 to -1.1). This effect increases in subjects with high-normal BP or hypertension [SBP - 7.9 mm Hg (95% CI, -12.5 to -3.3); DBP - 7.3 mm Hg (95% CI, -10.2 to -4.4)]. The healthy lifestyle group also exhibited BP improvements after 12 weeks; however, the changes were less pronounced compared to the salt reduction group and were observed only for DBP [mean change of -1.5 mm Hg (95% CI, -2.6 to -0.4) in ITT analysis and - 1.4 mm Hg (95% CI, -2.4 to -0.3) in CC analysis, relative to baseline]. Overall, improvements in Na+/K+ ratio, weight, and Mediterranean diet adherence resulted in clinically significant SBP decreases. Importantly, BP reduction is attributed to improved dietary quality, rather than being solely linked to changes in the Na+/K+ ratio. Conclusion Salt-focused programs are effective public health tools mainly in managing individuals at high risk of hypertension. Nevertheless, in general, empowerment-based approaches are important strategies for lowering BP, by promoting health literacy that culminates in adherence to the Mediterranean diet and weight reduction.
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Affiliation(s)
- André Moreira-Rosário
- NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
- CINTESIS@RISE, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Shámila Ismael
- NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
- CINTESIS@RISE, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
- CHRC, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Inês Barreiros-Mota
- NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
- CHRC, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Juliana Morais
- NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
- CINTESIS@RISE, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Catarina Rodrigues
- NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
- CHRC, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Inês Castela
- NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
- CINTESIS@RISE, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
- CHRC, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
| | | | | | | | | | | | - Patrícia Pinto
- CUF Academic and Research Medical Center, Lisbon, Portugal
| | - Débora Pita
- CUF Academic and Research Medical Center, Lisbon, Portugal
| | | | - Janaína Maciel
- CUF Academic and Research Medical Center, Lisbon, Portugal
| | - Thaina Serafim
- CUF Academic and Research Medical Center, Lisbon, Portugal
| | - João Araújo
- NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
- CINTESIS@RISE, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Júlio César Rocha
- NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
- CINTESIS@RISE, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Diogo Pestana
- NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
- CINTESIS@RISE, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Marta P. Silvestre
- NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
- CINTESIS@RISE, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Cláudia Marques
- NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
- CINTESIS@RISE, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Ana Faria
- NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
- CINTESIS@RISE, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
- CHRC, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Jorge Polonia
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS@RISE, Faculty of Medicine, University of Porto, Porto, Portugal
- Hypertension and Cardiovascular Risk Unit, Unidade Local de Saúde Matosinhos, Matosinhos, Portugal
| | - Conceição Calhau
- NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
- CINTESIS@RISE, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
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Guo L, Li L, Lu Y, Li T, Chen L, Jiang L, Zhang S, Yuan M. Effects of empowerment education on the self-management and self-efficacy of liver transplant patients: a randomized controlled trial. BMC Nurs 2023; 22:146. [PMID: 37118749 PMCID: PMC10140724 DOI: 10.1186/s12912-023-01298-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 04/11/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND Despite the increasing survival rates, liver transplant patients experience numerous postoperative complications and encounter significant challenges in long-term self-management. This study aims to examine the effectiveness of empowerment education in enhancing self-management skills and self-efficacy among liver transplant recipients. METHODS A randomized, single-blind, single-center trial was conducted in China between August 2019 and September 2020, involving liver transplant recipients. The intervention group received 12 weeks of empowerment education, while the control group received 12 weeks of routine education. .The study assessed the patients' self-management and self-efficacy using the Liver Transplant Recipient Self-Management Questionnaire and the Self-efficacy for Managing Chronic Disease 6-Item Scale. Follow-up assessments were conducted at 1, 3, and 6 months after the intervention. RESULTS Eighty-four patients were initially randomized to either the intervention group (n1 = 42) or the routine education group (n2 = 42). Twelve patients were excluded from the analysis due to loss of follow-up or discontinuation of the intervention, leaving 72 patients (n1 = 35, n2 = 37) for the final analysis. The scores for exercise and lifestyle management were significantly higher in the intervention group than in the control group at 1, 3, and 6 months after the intervention (t = 3.047, 5.875, 8.356, and t = 5.759, 4.681, 11.759, respectively; P < 0.05). At 3 and 6 months after the intervention, the scores for cognitive symptom management, communication with physicians, and self-efficacy were significantly higher in the intervention group than in the control group (t = 5.609, 6.416, and t = 5.576, 11.601, and t = 6.867, 15.071, respectively; P < 0.001). Within the intervention group, self-management scores increased significantly over time, while within the control group, the scores for communication with physicians, lifestyle, and self-efficacy showed a significant decline from 3 to 6 months after routine health education. CONCLUSIONS The results of this study suggest that empowerment education is an effective means of improving the self-management and self-efficacy of liver transplant patients, with better outcomes compared to routine health education. These findings have important implications for nursing practice and provide valuable guidance for clinical education of liver transplant patients. TRIAL REGISTRATION ChiCTR2200061561.
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Affiliation(s)
- Limin Guo
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Changsha, 410011, China
- Liver transplant department, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Lezhi Li
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Changsha, 410011, China.
| | - Yanfang Lu
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Changsha, 410011, China
- Liver transplant department, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Ting Li
- Liver transplant department, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Linjun Chen
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Changsha, 410011, China
- Liver transplant department, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Liya Jiang
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Changsha, 410011, China
- Liver transplant department, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Shihan Zhang
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Changsha, 410011, China
- Liver transplant department, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Meijiao Yuan
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Changsha, 410011, China
- Liver transplant department, The Second Xiangya Hospital, Central South University, Changsha, China
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Gago C, Aftosmes-Tobio A, Beckerman-Hsu JP, Oddleifson C, Garcia EA, Lansburg K, Figueroa R, Yu X, Kitos N, Torrico M, Leonard J, Jurkowski JK, Mattei J, Kenney EL, Haneuse S, Davison KK. Evaluation of a cluster-randomized controlled trial: Communities for Healthy Living, family-centered obesity prevention program for Head Start parents and children. Int J Behav Nutr Phys Act 2023; 20:4. [PMID: 36631869 PMCID: PMC9832428 DOI: 10.1186/s12966-022-01400-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 12/08/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND This study reports the outcomes of Communities for Healthy Living (CHL), a cluster randomized obesity prevention trial implemented in partnership with Head Start, a federally-funded preschool program for low-income families. METHODS Using a stepped wedge design, Head Start programs (n = 16; Boston, MA, USA) were randomly assigned to one of three intervention start times. CHL involved a media campaign and enhanced nutrition support. Parents were invited to join Parents Connect for Healthy Living (PConnect), a 10-week wellness program. At the beginning and end of each school year (2017-2019), data were collected on the primary outcome of child Body Mass Index z-score (BMIz) and modified BMIz, and secondary outcomes of child weight-related behaviors (diet, physical activity, sleep, media use) and parents' weight-related parenting practices and empowerment. Data from 2 years, rather than three, were utilized to evaluate CHL due to the COVID-19 pandemic. We used mixed effects linear regression to compare relative differences during intervention vs. control periods (n = 1274 vs. 2476 children) in (1) mean change in child BMIz and modified BMIz, (2) the odds of meeting child health behavior recommendations, (3) mean change in parenting practices, and (4) mean change in parent empowerment. We also compared outcomes among parents who chose post-randomization to participate in PConnect vs. not (n = 55 vs. 443). RESULTS During intervention periods (vs. control), children experienced greater increases in BMIz and modified BMIz (b = 0.06, 95% CI = 0.02,0.10; b = 0.07, 95% CI = 0.03, 0.12), yet were more likely to meet recommendations related to three of eight measured behaviors: sugar-sweetened beverage consumption (i.e., rarely consume; Odds Ratio (OR) = 1.5, 95% CI = 1.2,2.3), water consumption (i.e., multiple times per day; OR = 1.6, 95% CI = 1.2,2.3), and screen time (i.e., ≤1 hour/day; OR = 1.4, 95% CI = 1.0,1.8). No statistically significant differences for intervention (vs. control) periods were observed in parent empowerment or parenting practices. However, parents who enrolled in PConnect (vs. not) demonstrated greater increases in empowerment (b = 0.17, 95% CI = 0.04,0.31). CONCLUSIONS Interventions that emphasize parent engagement may increase parental empowerment. Intervention exposure was associated with statistically, but not clinically, significant increases in BMIz and increased odds of meeting recommendations for three child behaviors; premature trial suspension may explain mixed results. TRIAL REGISTRATION ClinicalTrials.gov, NCT03334669 , Registered October 2017.
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Affiliation(s)
- Cristina Gago
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Alyssa Aftosmes-Tobio
- School of Social Work, Boston College, 140 Commonwealth Ave, 115 McGuinn Hall, Chestnut Hill, MA, 02467, USA
| | - Jacob P Beckerman-Hsu
- School of Social Work, Boston College, 140 Commonwealth Ave, 115 McGuinn Hall, Chestnut Hill, MA, 02467, USA
| | - Carly Oddleifson
- School of Social Work, Boston College, 140 Commonwealth Ave, 115 McGuinn Hall, Chestnut Hill, MA, 02467, USA
| | - Evelin A Garcia
- Department of Global Health & Population, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Kindra Lansburg
- Action for Boston Community Development (ABCD), Boston, MA, 02111, USA
| | - Roger Figueroa
- Division of Nutritional Sciences, College of Human Ecology, Cornell University, Ithaca, NY, 14853, USA
| | - Xinting Yu
- School of Social Work, Boston College, 140 Commonwealth Ave, 115 McGuinn Hall, Chestnut Hill, MA, 02467, USA
| | - Nicole Kitos
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Merieka Torrico
- Action for Boston Community Development (ABCD), Boston, MA, 02111, USA
| | - Jessie Leonard
- Community Action Agency of Somerville (CAAS), Somerville, MA, 02143, USA
| | - Janine K Jurkowski
- Department of Health Policy, Management, and Behavior, State University of New York, Albany, NY, 12222, USA
| | - Josiemer Mattei
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Erica L Kenney
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Sebastien Haneuse
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Kirsten K Davison
- School of Social Work, Boston College, 140 Commonwealth Ave, 115 McGuinn Hall, Chestnut Hill, MA, 02467, USA.
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Ramji R, Carlson E, Kottorp A, Rämgård M. Impact of a CBPR-informed physical activity intervention before and during COVID-19 among women from a disadvantaged neighborhood in Sweden. Front Public Health 2022; 10:997329. [PMID: 36478727 PMCID: PMC9719947 DOI: 10.3389/fpubh.2022.997329] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 10/07/2022] [Indexed: 11/22/2022] Open
Abstract
Background Public health practitioners have been striving to reduce the social gradient and promote physical activity among citizens living in disadvantaged neighborhoods. The emergence of the COVID-19 pandemic, which has affected these citizens extensively, has posed a significant challenge to efforts to maintain a physically active lifestyle. Thus, the aim of this study was to explore the impact of a CBPR-informed physical activity intervention before and during the COVID-19 pandemic from the perspective of women from a socially disadvantaged neighborhood. Methods A total of 34 women participated in a CBPR-informed physical activity intervention previously developed in collaboration with lay health promoters and other citizens from the same neighborhood. Focus group discussions were conducted at four time points, namely, at baseline prior to the intervention, post-intervention, 6 months after the intervention ended, and during the COVID-19 pandemic. The data were analyzed using qualitative content analysis following an inductive approach. Results In total, four themes emerged from the discussions: "Wavering between frustration and action," "Shifting from prioritizing family needs to taking control of self," "Between isolation and social support," and "Restricted access to health-related knowledge vs. utilizing internalized knowledge". Conclusion The results of this study reveal that building on CBPR-informed health promotion initiatives has the potential to foster individual empowerment and assist during acute situations like the COVID-19 pandemic through mobilizing communities and their resources, which leads to increased community resilience and health. This study is regarded as unique in that it involves evaluation of a CBPR intervention that was initiated ahead of the pandemic and followed even during the pandemic.
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Gill PJ, Bayliss A, Sozer A, Buchanan F, Breen-Reid K, De Castris-Garcia K, Green M, Quinlan M, Wong N, Frappier S, Cowan K, Chan C, Arafeh D, Anwar MR, Macarthur C, Parkin PC, Cohen E, Mahant S. Patient, Caregiver, and Clinician Participation in Prioritization of Research Questions in Pediatric Hospital Medicine. JAMA Netw Open 2022; 5:e229085. [PMID: 35471568 PMCID: PMC9044112 DOI: 10.1001/jamanetworkopen.2022.9085] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
IMPORTANCE The research agenda in pediatric hospital medicine has seldom considered the perspectives of young people, parents and caregivers, and health care professionals. Their perspectives may be useful in identifying questions on topics for research. OBJECTIVE To prioritize unanswered research questions in pediatric hospital medicine from the perspectives of young people, parents/caregivers, and health care professionals. DESIGN, SETTING, AND PARTICIPANTS Between August 4, 2020, and August 19, 2021, two online surveys and a virtual workshop were conducted, using modified Delphi technique and nominal group technique. Young people, parents/caregivers, and health care professionals with experiences in pediatric hospital medicine in Canada were included. INTERVENTIONS The established James Lind Alliance Priority Setting Partnership method was used. In phase 1, a survey collected unanswered questions regarding pediatric hospital medicine via 3 open-ended questions. Survey responses were used to develop summary questions that went through an evidence-checking process. Unanswered questions were brought to a phase 2 interim prioritization survey. The top 10 unanswered research questions in pediatric hospital medicine were established at the final priority setting workshop. MAIN OUTCOMES AND MEASURES Survey responses, top 10 research questions. RESULTS The phase 1 survey was completed by 188 participants (148 of 167 [89%] females; 17 of 167 [10%] males; mean [SD] age, 39.5 [12.4] years) and generated 495 unanswered research questions and comments, of which 58 were deemed out of scope. The remaining 437 responses were grouped into themes (eg, communication, shared decision-making, health service delivery, and health service management) and then refined to 75 unanswered research questions. Of these 75, only 4 questions had sufficient evidence. To make the number of questions in phase 2 manageable, 21 questions submitted by only 1 respondent were eliminated. Fifty unanswered research questions were included in the phase 2 survey, which was completed by 201 participants (165 of 186 [89%] females; 19 of 186 [10%] males; mean [SD] age, 40.0 [11.0] years). A short list of 16 questions-the top 10 questions from patient partners (youths, parents/caregivers) and clinicians-was presented at the final priority setting workshop and the top 10 questions were prioritized. The top 10 questions focused on the care of special inpatient populations (eg, children with medical complexity), communication, shared decision-making, support strategies in the hospital, mental health supports, shortening length of stay, and supporting Indigenous patients, parents/caregivers, and families. CONCLUSIONS AND RELEVANCE This patient-oriented pediatric hospital medicine priority setting partnership identified the most important unanswered research questions focused on the care of children in the hospital. These questions provide a possible roadmap for research on areas deemed important to young people, parents/caregivers, and clinicians.
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Affiliation(s)
- Peter J. Gill
- Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Ann Bayliss
- Trillium Health Partners, Department of Pediatrics, University of Toronto, Mississauga, Ontario, Canada
| | - Aubrey Sozer
- Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Francine Buchanan
- Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Research Family Advisory Committee, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Karen Breen-Reid
- Lawrence Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | | | - Mairead Green
- Department of Pediatrics, University of Ottawa, Children’s Hospital of Eastern Ontario (CHEO), Ottawa, Ontario, Canada
| | - Michelle Quinlan
- Department of Pediatrics, University of Ottawa, Children’s Hospital of Eastern Ontario (CHEO), Ottawa, Ontario, Canada
| | - Noel Wong
- Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Learning Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Shelley Frappier
- Department of Pediatrics, University of Ottawa, Children’s Hospital of Eastern Ontario (CHEO), Ottawa, Ontario, Canada
| | | | - Carol Chan
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
| | - Dana Arafeh
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mohammed Rashid Anwar
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
| | - Colin Macarthur
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Patricia C. Parkin
- Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Eyal Cohen
- Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Sanjay Mahant
- Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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8
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Gago CM, Jurkowski J, Beckerman-Hsu JP, Aftosmes-Tobio A, Figueroa R, Oddleifson C, Mattei J, Kenney EL, Haneuse S, Davison KK. Exploring a theory of change: Are increases in parental empowerment associated with healthier weight-related parenting practices? Soc Sci Med 2022; 296:114761. [PMID: 35123371 PMCID: PMC8894077 DOI: 10.1016/j.socscimed.2022.114761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 01/25/2022] [Accepted: 01/27/2022] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Parent health-related empowerment is defined as the process by which parents realize control over their life situation and take action to promote a healthier lifestyle. For decades, researchers have described the theoretical potential of empowerment in health promotion efforts, though few have empirically examined this hypothesized relationship. This study is one of the first to examine the relationship between parental empowerment and healthy weight parenting practices (i.e., food, physical activity, sleep, and media parenting), as a mechanism for early childhood health promotion in community settings. METHODS Low-income parents of preschool-aged children attending Head Start in Greater Boston between fall 2017 and spring 2019 were invited to complete a survey in the fall and spring of each academic school year (n = 578 with two surveys and n = 45 with four). Parental empowerment and healthy weight parenting practices were assessed using validated surveys. We used a multilevel difference-in-difference approach to estimate changes in healthy weight parenting practices score by changes in parental empowerment score. RESULTS Out of a possible score of four, the unadjusted mean (SD) score in fall was 3.20 (0.40) for empowerment and 3.01 (0.40) for parenting. An increase in parental empowerment was associated with an increase in healthier parenting practices (b = 0.14; 95% CI = 0.08, 0.20; p < 0.0001). CONCLUSIONS Parent empowerment may be an important target in interventions to prevent obesity in low-income children.
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Affiliation(s)
- Cristina M. Gago
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Janine Jurkowski
- Department of Health Policy, Management, and Behavior, State University of New York, Albany, NY, 12222, USA
| | | | | | - Roger Figueroa
- Division of Nutritional Sciences, College of Human Ecology, Cornell University, Ithaca, NY, 14853, USA
| | - Carly Oddleifson
- School of Social Work, Boston College, Chestnut Hill, MA, 02467, USA
| | - Josiemer Mattei
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Erica L. Kenney
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Sebastien Haneuse
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
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9
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Wang ML, Sprague Martinez LS, Weinberg J, Alatorre S, Lemon SC, Rosal MC. A youth empowerment intervention to prevent childhood obesity: design and methods for a cluster randomized trial of the H 2GO! program. BMC Public Health 2021; 21:1675. [PMID: 34525990 PMCID: PMC8441230 DOI: 10.1186/s12889-021-11660-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 08/25/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Reducing sugar-sweetened beverage (SSB) consumption is a promising dietary target for childhood obesity prevention. This paper describes the design and methods of a cluster randomized trial of H2GO!, a youth empowerment intervention to prevent childhood obesity through reducing SSB consumption among a low-income, ethnically diverse sample of youth. METHODS This cluster randomized controlled trial is an academic-community partnership with the Massachusetts Alliance of Boys and Girls Clubs (BGC). Ten BGC sites will be randomly assigned to the H2GO! intervention or a wait-list, usual care control. Eligible study participants will be N = 450 parent-child pairs (youth ages 9-12 years and their parents/caregivers) recruited from participating BGCs. The 6-week in-person H2GO! intervention consists of 12 group-based sessions delivered by BGC staff and youth-led activities. An innovative feature of the intervention is the development of youth-produced narratives as a strategy to facilitate youth empowerment and parental engagement. Child outcomes include measured body mass index z scores (zBMI), beverage intake, and youth empowerment. Parent outcomes include beverage intake and availability of SSBs at home. Outcomes will be measured at baseline and at 2, 6, and 12 months. With a 75% retention rate, the study is powered to detect a minimum group difference of 0.1 zBMI units over 12 months. DISCUSSION Empowering youth may be a promising intervention approach to prevent childhood obesity through reducing SSB consumption. This intervention was designed to be delivered through BGCs and is hypothesized to be efficacious, relevant, and acceptable for the target population of low-income and ethnically diverse youth. TRIAL REGISTRATION ClinicalTrials.gov NCT04265794 . Registered 11 February 2020.
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Affiliation(s)
- Monica L Wang
- Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA, 02118, USA.
- Office of Narrative, Boston University Center for Antiracist Research, Boston, MA, 02215, USA.
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, 02215, USA.
| | - Linda S Sprague Martinez
- Macro Department, Boston University School of Social Work, 264 Bay State Rd, Boston, MA, 02215, USA
- Center for Social Work Innovation in Health, Boston University School of Social Work, 801 Massachusetts Avenue, Boston, MA, 02118, USA
| | - Janice Weinberg
- Department of Biostatistics, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA, 02118, USA
| | - Selenne Alatorre
- Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA, 02118, USA
| | - Stephenie C Lemon
- Division of Preventive and Behavioral Medicine, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation St, Worcester, MA, 01655, USA
| | - Milagros C Rosal
- Division of Preventive and Behavioral Medicine, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation St, Worcester, MA, 01655, USA
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10
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Cepni AB, Taylor A, Crumbley C, Thompson D, Moran NE, Olvera N, O’Connor DP, Arlinghaus KR, Johnston CA, Ledoux TA. Feasibility and Efficacy of the "FUNPALs Playgroup" Intervention to Improve Toddler Dietary and Activity Behaviors: A Pilot Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18157828. [PMID: 34360118 PMCID: PMC8345510 DOI: 10.3390/ijerph18157828] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 07/14/2021] [Accepted: 07/20/2021] [Indexed: 11/16/2022]
Abstract
This study evaluated the feasibility and effects of the Families Understanding Nutrition and Physically Active Lifestyles (FUNPALs) Playgroup on toddler (12–36-month-old) diet and activity behaviors. Parent–toddler dyads were recruited from disadvantaged communities and randomly assigned to receive 10-weekly sessions of the FUNPALs Playgroup (n = 24) or dose-matched health education control group (n = 26). FUNPALs Playgroups involved physical and snack activities, delivery of health information, and positive parenting coaching. The control group involved group health education for parents only. Process outcomes (e.g., retention rate, fidelity) and focus groups determined feasibility and perceived effects. To evaluate preliminary effects, validated measures of toddler diet (food frequency questionnaire and a carotenoid biomarker), physical activity (PA; accelerometers), general and feeding parenting (self-report surveys), and home environment (phone interview) were collected pre and post. The sample comprised parents (84% female) who self-identified as Hispanic/Latino (38%) and/or African American (32%). Retention was high (78%). Parents from both groups enjoyed the program and perceived improvements in their children’s health behaviors. Objective measures demonstrated improvement with large effects (η2 = 0.29) in toddler diet (p < 0.001) but not PA (p = 0.099). In conclusion, the FUNPALs Playgroup is feasible and may improve toddler eating behaviors.
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Affiliation(s)
- Aliye B. Cepni
- Department of Health and Human Performance, University of Houston, Houston, TX 77204, USA; (A.B.C.); (C.C.); (D.P.O.); (C.A.J.)
| | - Ashley Taylor
- Department of Psychological, Health and Learning Sciences, University of Houston, Houston, TX 77204, USA;
| | - Christine Crumbley
- Department of Health and Human Performance, University of Houston, Houston, TX 77204, USA; (A.B.C.); (C.C.); (D.P.O.); (C.A.J.)
| | - Debbe Thompson
- USDA/ARS Children’s Nutrition Research Center and Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA; (D.T.); (N.E.M.)
| | - Nancy E. Moran
- USDA/ARS Children’s Nutrition Research Center and Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA; (D.T.); (N.E.M.)
| | - Norma Olvera
- Department of Psychological, Latino Health Disparities Lab, University of Houston, Houston, TX 77204, USA;
| | - Daniel P. O’Connor
- Department of Health and Human Performance, University of Houston, Houston, TX 77204, USA; (A.B.C.); (C.C.); (D.P.O.); (C.A.J.)
| | - Katherine R. Arlinghaus
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN 55455, USA;
| | - Craig A. Johnston
- Department of Health and Human Performance, University of Houston, Houston, TX 77204, USA; (A.B.C.); (C.C.); (D.P.O.); (C.A.J.)
| | - Tracey A. Ledoux
- Department of Health and Human Performance, University of Houston, Houston, TX 77204, USA; (A.B.C.); (C.C.); (D.P.O.); (C.A.J.)
- Correspondence: ; Tel.: +1-713-743-1870
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11
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Soltero EG, Ayers SL, Avalos MA, Peña A, Williams AN, Olson ML, Konopken YP, Castro FG, Arcoleo KJ, Keller CS, Patrick DL, Jager J, Shaibi GQ. Theoretical Mediators of Diabetes Risk and Quality of Life Following a Diabetes Prevention Program for Latino Youth With Obesity. Am J Health Promot 2021; 35:939-947. [PMID: 33949215 DOI: 10.1177/08901171211012951] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE This study tested self-efficacy and social support for activity and dietary changes as mediators of changes in type 2 diabetes related outcomes following a lifestyle intervention among Latino youth. SETTING AND INTERVENTION Latino adolescents (14-16 years) with obesity (BMI% = 98.1 ± 1.4) were randomized to a 3-month intervention (n = 67) that fostered self-efficacy and social support through weekly, family-centered sessions or a comparison condition (n = 69). MEASURES Primary outcomes included insulin sensitivity and weight specific quality of life. Mediators included self-efficacy, friend, and family social support for health behaviors. Data was collected at baseline, 3-months, 6-months, and 12-months. ANALYSIS Sequential path analysis was used to examine mediators as mechanisms by which the intervention influenced primary outcomes. RESULTS The intervention had a direct effect on family (β = 0.33, P < .01) and friend social support (β = 0.22, P < .001) immediately following the intervention (3-months). Increased family social support mediated the intervention's effect on self-efficacy at 6-months (β = 0.09, P < .01). However, social support and self-efficacy did not mediate long-term changes in primary outcomes (P > .05) at 12-months. CONCLUSIONS Family social support may improve self-efficacy for health behaviors in high-risk Latino youth, highlighting the important role of family diabetes prevention. Fostering family social support is a critical intervention target and more research is needed to understand family-level factors that have the potential to lead to long-term metabolic and psychosocial outcome in vulnerable youth.
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Affiliation(s)
- Erica G Soltero
- Children's Nutrition Research Center, Department of Pediatrics, 3989Baylor College of Medicine, Houston, TX, USA
| | - Stephanie L Ayers
- Southwest Interdisciplinary Research Center, 7864Arizona State University, Phoenix, AZ, USA
| | - Marvyn A Avalos
- Southwest Interdisciplinary Research Center, 7864Arizona State University, Phoenix, AZ, USA
| | - Armando Peña
- Center for Health Promotion and Disease Prevention, 7864Arizona State University, Phoenix, AZ, USA
| | - Allison N Williams
- Center for Health Promotion and Disease Prevention, 7864Arizona State University, Phoenix, AZ, USA
| | - Micah L Olson
- Center for Health Promotion and Disease Prevention, 7864Arizona State University, Phoenix, AZ, USA.,Department of Pediatric Endocrinology and Diabetes, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Yolanda P Konopken
- Family Wellness Program, St. Vincent De Paul Medical and Dental Clinic, Phoenix, AZ, USA
| | - Felipe G Castro
- Center for Health Promotion and Disease Prevention, 7864Arizona State University, Phoenix, AZ, USA
| | | | - Colleen S Keller
- Center for Health Promotion and Disease Prevention, 7864Arizona State University, Phoenix, AZ, USA
| | - Donald L Patrick
- Department of Health Services, 49462School of Public Health, University of Washington, Seattle, WA, USA
| | - Justin Jager
- Southwest Interdisciplinary Research Center, 7864Arizona State University, Phoenix, AZ, USA.,T. Denny Sanford School of Social and Family Dynamics, 7864Arizona State University, Tempe, AZ, USA
| | - Gabriel Q Shaibi
- Center for Health Promotion and Disease Prevention, 7864Arizona State University, Phoenix, AZ, USA
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12
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Rhee KE, Herrera L, Strong D, DeBenedetto AM, Shi Y, Boutelle KN. Design of the GOT Doc study: A randomized controlled trial comparing a Guided Self-Help obesity treatment program for childhood obesity in the primary care setting to traditional family-based behavioral weight loss. Contemp Clin Trials Commun 2021; 22:100771. [PMID: 33997462 PMCID: PMC8095104 DOI: 10.1016/j.conctc.2021.100771] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 03/11/2021] [Accepted: 04/05/2021] [Indexed: 11/26/2022] Open
Abstract
Currently one-third of children in the United States have overweight or obesity (OW/OB). The goal of Healthy People 2020 is to reduce the proportion of children with OW/OB and increase the proportion of primary care visits that include nutrition and weight-related counseling. Unfortunately, many health care providers find it difficult to offer effective weight-related counseling and treatment in the primary care setting. Therefore, new models of care are needed that allow a greater proportion of children with OW/OB and their parents to access care and receive quality weight management treatment. The current paper describes the GOT Doc study which is designed to test the effectiveness of a Guided Self-Help (GSH) model of obesity treatment that can be delivered in the primary care setting compared to a traditional Family-Based Behavioral weight loss treatment (FBT) delivered at an academic center. We will assess the impact of this program on attendance (access to care) and changes in child BMI percentile/z-score. We will also examine the impact of this treatment model on change in child lifestyle behaviors, parent support behaviors, and parent self-efficacy and empowerment to make behavior change. Finally, we will assess the cost-effectiveness of this model on changes in child BMI percentile/z-score. We believe the GSH intervention will be a cost-effective model of obesity management that can be implemented in community practices around the country, thereby increasing access to treatment for a broader proportion of our population and decreasing rates of childhood obesity. Effective childhood obesity treatment is not widely available or easily accessible. Guided Self-Help (GSH) model of treatment has been developed for pediatric obesity. GSH is easier to implement and can be delivered in the primary care setting. GSH can increase access to much needed treatment. Evaluation of its effectiveness in the primary care setting is needed.
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Key Words
- Childhood obesity
- Community-based intervention
- Early and Periodic Screening, Diagnosis, and Treatment program, EPSDT
- Electronic health record, EHR
- Family-Based Behavioral Therapy, FBT
- Family-based behavioral therapy
- Guided Self-Help, GSH
- Guided self-help
- Guided self-help Obesity Treatment in the primary care setting, GOT Doc
- Overweight or obesity, OW/OB
- Primary care
- Primary care provider, PCP
- Quality of Lifev, QOL
- Treatment
- U.S. Preventive Services Task Force, USPSTF
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Affiliation(s)
- Kyung E Rhee
- University of California, San Diego, Department of Pediatrics, United States
| | - Lourdes Herrera
- University of California, San Diego, Department of Pediatrics, United States.,Wake Forrest University, Department of Pediatrics, United States
| | - David Strong
- University of California, San Diego, Department of Family Medicine and Public Health, United States
| | | | - Yuyan Shi
- University of California, San Diego, Department of Family Medicine and Public Health, United States
| | - Kerri N Boutelle
- University of California, San Diego, Department of Pediatrics, Department of Family Medicine and Public Health, And Department of Psychiatry, United States
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13
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Mado FG, Sirajuddin S, Muis M, Maria IL, Darmawansyah D, Arifin MA. Intervention empowerment of families in preventing and controlling overweight and obesity in children: A systematic review. J Public Health Res 2021; 10. [PMID: 33855425 PMCID: PMC8129762 DOI: 10.4081/jphr.2021.2185] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 03/17/2021] [Indexed: 12/18/2022] Open
Abstract
There have been an increasing overweight and obesity in very anxious children. Furthermore, obesity is a condition that occurs due to the accumulation of excess or abnormal fat. This disorder is believed to be the most significant public health problem that affects children in the 21st century. This study aimed to examine the literature review, articles and research results analyzing the effectiveness of family or parent empowerment interventions through health education. Many research articles were searched on several databases such as PubMed and PreQuest, using the following keywords which include “family empowerment”, “overweight”, “obesity”, “health lifestyle”, “BMI”, “children”, “RCT” starting from 2014 to 2019. The searched results obtained 162 articles on family empowerment, overweight and obesity. Out of the 162 articles, 20 were selected that discussed family empowerment interventions for overweight and obesity. Critical analysis of the 20 articles was carried out based on design, sample, treatment, parameters, findings and conclusions. The literature review analysis showed that family empowerment interventions in the form of health education or promotion activities vary widely in terms of methods, components, duration, individuals involved, specificity and effectiveness. Furthermore, this intervention consists of training activities, courses, and teaching practices. Statistical analysis showed that all these methods significantly increased the ability and independence of the family in controlling overweight and obesity. In conclusion, health education interventions that are packaged in various programs are proven to significantly improve the ability of families or parents in preventing and controlling overweight and obesity in children. Significance for public health Overweight and obesity are disorders that occur as a result of the accumulation of nutrients and fats which exceeds the normal body weight. The presence of this disorders in school children is a major problem because it continues into adulthood and act as risk factors for the incidence of metabolic and degenerative diseases. The Prevention and therapy of obesity in children is carried out by regulating their diet, increasing their physical activities and changing their pattern of behavior. One of the effective way of preventing overweight and obesity is through a family-based approach. Family empowerment interventions through Health Education and behavior change ultimately prevents and controls overweight and obesity. This study describes the strong relationship between family empowerment interventions and the efforts to prevent and control overweight and obesity.
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Affiliation(s)
- Fransiskus Geroda Mado
- Hasanuddin University, Makassar; Faculty of Public Health, Nusa Cendana University, Kupang.
| | | | - Masyta Muis
- Faculty of Health Public, Hasanuddin University, Makassar.
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14
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Fernández CR, Lee J, Duroseau N, Vargas-Rodriguez I, Rieder J. Child Health Behaviour and Parent Priorities for a School-Based Healthy Lifestyle Programme. HEALTH EDUCATION JOURNAL 2021; 80:361-372. [PMID: 35747426 PMCID: PMC9217183 DOI: 10.1177/0017896920972152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE The purpose of this study was to characterise parents' concerns for their children's health behaviours and perceptions of motivators and barriers to positive child health behaviour change, and to determine associations between motivators and barriers and parents' priorities for a school-based healthy lifestyle programme. DESIGN Cross-sectional study of 46 parents who had completed an un-validated survey distributed during school-wide events. SETTING School for children aged 5-14 years in The Bronx, New York City, USA. METHODS Wilcoxon Rank Sum tests compared motivators and barriers to positive child health behaviour change by heath behaviour concern; Spearman's correlation measured associations between motivators and barriers and programme priorities. RESULTS Parents concerned about child weight significantly ranked keeping up with others and decreasing clothing size as motivators, while parents concerned about child food choices significantly ranked improving food choices and decreasing BMI and clothing size as motivators. Food-, play-, and self-esteem-related motivators were associated with nutrition education (rs ≥ .41, p ≤ .01), physical activity classes (rs ≥ .29, p ≤ .04) and child involvement in programme decision-making (rs ≥ .43, p ≤ .01) priorities. Consistency-, child resistance-, and home rules-related barriers were associated with nutrition education (rs ≥ .37, p=.02), physical activity classes (rs ≥ .32, p = .02), and child involvement (rs ≥ .40, p ≤ .02) priorities. CONCLUSIONS Despite the study sample size, selection bias, and generalisability limitations, prioritising nutrition, physical activity and child involvement in programme decision-making may enhance parent support for school-based healthy lifestyle programmes.
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Affiliation(s)
- Cristina R Fernández
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA
| | - Janet Lee
- Department of Pediatrics, Mount Sinai Health System, New York, NY, USA
| | - Nathalie Duroseau
- Adolescent Medicine Fellow, Department of Pediatrics, Mount Sinai Health System, New York, NY, USA
| | | | - Jessica Rieder
- Department of Pediatrics, Albert Einstein College of Medicine, The Children's Hospital at Montefiore, Bronx, NY, USA
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15
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Figueroa R, Gago CM, Beckerman-Hsu J, Aftosmes-Tobio A, Yu X, Davison KK, Jurkowski JJ. Development and Validation of a Parental Health-Related Empowerment Scale with Low Income Parents. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228645. [PMID: 33233860 PMCID: PMC7699877 DOI: 10.3390/ijerph17228645] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 10/20/2020] [Accepted: 11/18/2020] [Indexed: 01/21/2023]
Abstract
Objectives: Consistent with empowerment theory, parental empowerment acts as a mechanism of change in family-based interventions to support child health. Yet, there are no comprehensive, validated measures of parental health-related empowerment to test this important perspective. Informed by empowerment theory and in the context of a community-based obesity intervention, we developed a self-report measure of parental health-related empowerment and tested its preliminary validity with low-income parents. Methods: The Parental Empowerment through Awareness, Relationships, and Resources (PEARR) is a 21-item scale designed to measure three subdimensions of empowerment including resource empowerment, critical awareness, and relational empowerment. In the fall of 2017 or the fall of 2018, low-income parents (n = 770, 88% mothers) from 16 Head Start programs in Greater Boston completed the PEARR. The resulting data were randomly split into two equal samples with complete data. The factorial structure of the PEARR was tested in the first half of the sample using principal component analysis (PCA) and exploratory factor analysis (EFA) and subsequently confirmed with the second half of the sample using confirmatory factor analysis (CFA). Internal consistency coefficients were calculated for the final subscales. Results: Results from the PCA and EFA analyses identified three component factors (eigenvalues = 8.25, 2.75, 2.12) with all items loading significantly onto the hypothesized subdimension (β > 0.59 and p < 0.01). The three-factor model was subsequently confirmed with the second half of the sample using CFA (β > 0.54 and p < 0.01). Fit indices met minimum criteria (Comparative Fit Index = 0.95, Root Mean Square Error of Approximation = 0.05 (0.05, 0.06), Standardized Root-Mean-Square Residual = 0.05). Subscales demonstrated strong internal consistency (α= 0.83–0.90). Conclusions: Results support initial validity of a brief survey measuring parental empowerment for child health among Head Start parents. The PEARR can be utilized to measure changes in parental empowerment through interventions targeting empowerment as a mechanism of change.
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Affiliation(s)
- Roger Figueroa
- Division of Nutritional Sciences, College of Human Ecology, Cornell University, Ithaca, NY 14853, USA
- Correspondence:
| | - Cristina M. Gago
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA 02115, USA; (C.M.G.); (X.Y.)
| | - Jacob Beckerman-Hsu
- School of Social Work, Boston College, Chestnut Hill, MA 02467, USA; (J.B.-H.); (A.A.-T.); (K.K.D.)
| | - Alyssa Aftosmes-Tobio
- School of Social Work, Boston College, Chestnut Hill, MA 02467, USA; (J.B.-H.); (A.A.-T.); (K.K.D.)
| | - Xinting Yu
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA 02115, USA; (C.M.G.); (X.Y.)
| | - Kirsten K. Davison
- School of Social Work, Boston College, Chestnut Hill, MA 02467, USA; (J.B.-H.); (A.A.-T.); (K.K.D.)
| | - Janine J. Jurkowski
- Department of Health Policy, Management, and Behavior, University at Albany School of Public Health, State University of New York, Albany, NY 12144, USA;
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16
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Borges Rodrigues S, Parisod H, Barros L, Salanterä S. Two sides of the same well-child visit: Analysis of nurses' and families' perspectives on empowerment in health counselling. J Adv Nurs 2020; 76:3448-3463. [PMID: 32996623 DOI: 10.1111/jan.14554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 07/09/2020] [Accepted: 07/29/2020] [Indexed: 11/27/2022]
Abstract
AIMS To explore the degree of empowering health counselling in well-child visits, considering nurse and family perspectives and to examine its associated factors. BACKGROUND Empowerment has gained high priority in the world health strategy, being claimed for its benefits for people's health and well-being. DESIGN The design includes an exploratory cross-sectional, correlational study. METHODS We collected data between January 2018-October 2019 from a convenience sample of 82 families attending a 5-year-old well-child visit and 25 nurses at Portuguese health centres. Families and nurses assessed the same counselling session using parallel statements of the Portuguese Empowering Speech Practice Scale, grouped in two subscales (nurses' action and families' action). Questionnaires also included the Parent's Longitudinal Continuity in Primary Care scale, the Family Nutrition and Physical Activity tool and anthropometric and sociodemographic questions. We employed descriptive statistics, paired-samples t-test, analysis of variance and regression analysis. RESULTS Both nurses and families reported that empowerment had been practiced in high degree. The most practiced elements were those from nurses' action subscale (e.g. constructing a positive atmosphere) and the least practiced were from families' action (e.g. disclosure). A discrepancy between nurses' and families' ratings were found for individualized information and advice, disclosure and asking questions, with families reporting higher scores. Nurses' formal training in empowerment and obesity was associated with higher scores on the nurses' action subscale. The families' limited experience with a regular health centre and nurse and families having children with overweight were both associated with lower scores on the two subscales. CONCLUSIONS Although the positive experience by nurses and families is an important finding, the reasons for the differences in perceptions of empowerment require further research. IMPACT The Portuguese Empowering Speech Practice Scale can be a useful tool to evaluate services, both from professionals' and families' perspectives and to identify areas of improvement.
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Affiliation(s)
| | - Heidi Parisod
- Department of Nursing Science, University of Turku, Turku, Finland.,Nursing Research Foundation, Helsinki, Finland
| | - Luísa Barros
- Faculty of Psychology, University of Lisbon, Lisbon, Portugal.,CICPsi, Center for Research in Psychological Science, University of Lisbon, Lisbon, Portugal
| | - Sanna Salanterä
- Department of Nursing Science, University of Turku, Turku, Finland.,Turku University Hospital, Turku, Finland
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Biggs BK, Tolleson E, Millerbernd J, Bronars C, Meiers SJ, Slowiak K, Olson M, Lebow J, Ridgeway JL, Patten CA, Clark MM, Sia IG, Wieland ML. Identifying Opportunities to Promote Physical Activity in a Diverse Low-Income Population: A Mixed-Method Study at a Boys & Girls Club Site. CHILD & YOUTH CARE FORUM 2020; 49:171-200. [PMID: 33833490 PMCID: PMC8025775 DOI: 10.1007/s10566-019-09521-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Prevalence and consequences of obesity and sedentary lifestyle are well-documented public health concerns for youth in the United State of America (U.S.A) that disproportionally affect children from low income and minority families. OBJECTIVE This mixed-method study focused on estimating levels of physical activity and sedentary behavior and prevalence of overweight and obesity among the child members served in one Boys and Girls Club in the Midwest U.S.A. We aimed to better understand opportunities for improving children's engagement in physical activity through focus groups with members, staff, and parents/caregivers of members. METHODS Social cognitive learning theory, the ecological model of health behavior, and community based participatory research principles provided the study framework. Members completed assessments of physical activity, sedentary activity, height, and weight. Focus groups with members, staff, and parents/caregivers identified barriers, facilitators, and opportunities for promoting physical activity. RESULTS: Nearly 50% of members were overweight or obese. Most (87%) participants reported at least 60 minutes physical activity every day across the 3-day recall. Fewer than half (41%) reported 2 hours or less of sedentary screen time every day across the 3 day recall. Focus group themes identified opportunities for addressing needs associated with health disparities in physical activity and pediatric obesity. CONCLUSIONS Findings suggest stakeholder interest in physical activity promotion through afterschool programs. We discuss study implications regarding needs specific to individuals from diverse, low-income households that may not be adequately addressed with existing empirically-supported treatments and opportunities to address health disparities in physical activity and pediatric obesity through afterschool programs.
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18
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Martínez-Villanueva J, González-Leal R, Argente J, Martos-Moreno GÁ. Parental obesity is associated with the severity of childhood obesity and its comorbidities. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.anpede.2018.06.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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19
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Beckerman JP, Aftosmes-Tobio A, Kitos N, Jurkowski JM, Lansburg K, Kazik C, Gavarkovs A, Vigilante A, Kalyoncu B, Figueroa R, Klabunde R, Barouch R, Haneuse S, Taveras E, Davison KK. Communities for healthy living (CHL) - A family-centered childhood obesity prevention program integrated into Head Start services: Study protocol for a pragmatic cluster randomized trial. Contemp Clin Trials 2019; 78:34-45. [PMID: 30630109 PMCID: PMC6487308 DOI: 10.1016/j.cct.2019.01.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 12/15/2018] [Accepted: 01/04/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Childhood obesity is highly prevalent and carries substantial health consequences. Childhood obesity interventions have had mixed results, which may be partially explained by the absence of theory that incorporates broader family context and methods that address implementation challenges in low-resource settings. Communities for Healthy Living (CHL) is an obesity prevention program for Head Start preschools designed with careful focus on theory and implementation. This protocol paper outlines the design, content, implementation, and evaluation of CHL. METHODS/DESIGN CHL integrates a parenting program co-led by Head Start staff and parents, enhanced nutrition support, and a media campaign. CHL content and implementation are informed by the Family Ecological Model, Psychological Empowerment Theory, and Organizational Empowerment Theory. The intervention is directed by community-based participatory research and implementation science principles, such as co‑leadership with parents and staff, and implementation in a real world context. CHL is evaluated in a three-year pragmatic cluster-randomized trial with a stepped wedge design. The primary outcome is change in child Body Mass Index z-score. Secondary outcomes include children's weight-related behaviors (i.e., diet, physical activity, screen use, and sleep), parenting practices targeted at these behaviors (e.g., food parenting), and parent empowerment. The evaluation capitalizes on routine health data collected by Head Start (e.g., child height and weight, diet) coupled with parent surveys completed by subsamples of families. DISCUSSION CHL is an innovative childhood obesity prevention program grounded in theory and implementation science principles. If successful, CHL is positioned for sustained implementation and nationwide Head Start scale-up.
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Affiliation(s)
- Jacob P Beckerman
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, United States.
| | - Alyssa Aftosmes-Tobio
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, United States.
| | - Nicole Kitos
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, United States
| | - Janine M Jurkowski
- Department of Health Policy, Management & Behavior, University at Albany School of Public Health, 1 University Place, Rensselaer, NY 12144, United States.
| | - Kindra Lansburg
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, United States; Action for Boston Community Development, 178 Tremont Street, Boston, MA 02111, United States.
| | - Crystal Kazik
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, United States; Community Action Agency of Somerville, 66 Union Square, Somerville, MA 02143, United States
| | - Adam Gavarkovs
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, United States.
| | - Adrienne Vigilante
- Community Action Agency of Somerville, 66 Union Square, Somerville, MA 02143, United States.
| | - Begum Kalyoncu
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, United States
| | - Roger Figueroa
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, United States.
| | - Rachel Klabunde
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, United States.
| | - Rachel Barouch
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, United States
| | - Sebastien Haneuse
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, United States.
| | - Elsie Taveras
- Department of Pediatrics, Massachusetts General Hospital for Children, 125 Nashua St, Suite 860, Boston, MA 02114, United States.
| | - Kirsten K Davison
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, United States; Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, United States.
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Hill JL, Zoellner JM, You W, Brock DJ, Price B, Alexander RC, Frisard M, Brito F, Hou X, Estabrooks PA. Participatory development and pilot testing of iChoose: an adaptation of an evidence-based paediatric weight management program for community implementation. BMC Public Health 2019; 19:122. [PMID: 30696420 PMCID: PMC6352451 DOI: 10.1186/s12889-019-6450-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 01/17/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND To describe the identification, adaptation, and testing of an evidence-based pediatric weight management program for a health disparate community. METHODS A community advisory board (CAB) of decision-makers and staff from local health care, public health, and recreation organizations engaged with academic partners to select an evidence-based program (EBP) for local implementation. Three EBPs were identified (Traffic Light, Bright Bodies, Golan and colleagues Home Environmental Model) and each EBP was rated on program characteristics, implementation and adaptation, and adoptability. Following selection of the EBP that was rated highest, the POPS-CAB made adaptations based on the program principles described in peer-reviewed publications. The adapted intervention, iChoose, was then pilot tested in 3 iterative phases delivered initially by research partners, then co-delivered by research and community partners, then delivered by community partners. The RE-AIM framework was used to plan and evaluate the iChoose intervention across all waves with assessments at baseline, post program (3 months), and follow-up (6 months). RESULTS Bright Bodies rated highest on program characteristics and adoptability (p's < 0.05), while Home Environmental Model rated highest on implementation factors (p < 0.05). Qualitatively, the selection focused on important program characteristics and on matching those characteristics to the potential to fit within the community partner services. The adapted program-iChoose-had 18% reach and with participants that were representative of the target population on age, gender, ethnicity, and race. Effectiveness was demonstrated by modest, but significant reductions in BMI z-scores at post-program compared to baseline (MΔ = - 0.047; t = - 2.11, p = 0.046). This decrease returned to values similar to baseline 3 months (MΔ = 0.009) after the program was completed. Implementation fidelity was high and implementation fidelity did not differ between community or research delivery agents. CONCLUSION The process to help organizations identify and select evidence-based programs appropriate for their community led to consensus on a single EBP. While iChoose was successful in initiating changes in BMI z-scores, could be implemented in a low resource community with fidelity, it was insufficient to lead to sustained child BMI z-scores. In response to these data, maintenance of program effects and delivery are the current focus of the CBPR team.
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Affiliation(s)
- Jennie L. Hill
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, USA
| | - Jamie M. Zoellner
- Department of Public Health Sciences, School of Medicine, P.O. Box 800717, Charlottesville, VA 22908-0717 USA
| | - Wen You
- Department of Agricultural and Applied Economics, Virginia Tech, Blacksburg, VA 24061 USA
| | - Donna J. Brock
- Department of Public Health Sciences, School of Medicine, P.O. Box 800717, Charlottesville, VA 22908-0717 USA
| | - Bryan Price
- Education and Outreach Specialist, University of Virginia and Cancer Center, P.O. Box 800717, Charlottesville, VA 22908-0717 USA
| | - Ramine C. Alexander
- Department of Family and Consumer Sciences, North Carolina Agricultural and Technical State University, Benbow 202-A, Greensboro, NC 27405 USA
| | - Madlyn Frisard
- Department of Human Nutrition, Foods and Exercise, Virginia Tech, 1981 Kraft Drive (0913), ILSB 23, Rm 1085, Blacksburg, VA 24061 USA
| | - Fabiana Brito
- College of Public Health, University of Nebraska Medical Center, 984365 Nebraska Medical Center, Omaha, NE 68198-4365 USA
| | - Xiaolu Hou
- Virginia Tech University, Blacksburg, USA
| | - Paul A. Estabrooks
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, 986075 Nebraska Medical Center, Omaha, NE 68198-6075 USA
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Brock DJP, Estabrooks PA, Hill JL, Barlow ML, Alexander RC, Price BE, Marshall R, Zoellner JM. Building and Sustaining Community Capacity to Address Childhood Obesity: A 3-Year Mixed-Methods Case Study of a Community-Academic Advisory Board. FAMILY & COMMUNITY HEALTH 2019; 42:62-79. [PMID: 30431470 PMCID: PMC6713197 DOI: 10.1097/fch.0000000000000212] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Guided by a community-based participatory research and systems-based approach, this 3-year mixed-methods case study describes the experiences and capacity development of a Community-Academic Advisory Board (CAB) formed to adapt, implement, and evaluate an evidence-based childhood obesity treatment program in a medically underserved region. The CAB included community, public health, and clinical (n = 9) and academic partners (n = 9). CAB members completed capacity evaluations at 4 points. Partners identified best practices that attributed to the successful execution and continued advancement of project goals. The methodological framework and findings can inform capacity development and sustainability of emergent community-academic collaborations.
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Affiliation(s)
- Donna-Jean P Brock
- Public Health Sciences (Ms Brock and Dr Zoellner) and Cancer Center (Mr Price), University of Virginia, Charlottesville; Departments of Health Promotions (Dr Estabrooks) and Epidemiology (Dr Hill), University of Nebraska Medical Center, Omaha; DukeImmerse, Office of Undergraduate Education, Duke University, Durham, North Carolina (Ms Barlow); Department of Family and Consumer Sciences, North Carolina A&T State University, Greensboro (Dr Alexander); and Sovah Health, Danville, Virginia (Ms Marshall)
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Martínez-Villanueva J, González-Leal R, Argente J, Martos-Moreno GÁ. [Parental obesity is associated with the severity of childhood obesity and its comorbidities]. An Pediatr (Barc) 2018; 90:224-231. [PMID: 30054225 DOI: 10.1016/j.anpedi.2018.06.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 05/24/2018] [Accepted: 06/15/2018] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The influence of parental obesity on their obese offsprings is acknowledged but insufficiently characterised. PATIENTS AND METHODS Retrospective study of 800 obese patients (45.2% girls; age: 10.35±3.40 years, body mass index [BMI]:+4.22±1.68 standard deviation score [SDS]). Group comparison according to the presence of obesity in none (n=347) or any of the parents (n=453), and then whether the obese parent was the father (n=185), the mother (n=151), or both parents (n=117) were performed. The parameters analysed were: Age at the onset of the obesity and at their first visit, birth weight (BW), BMI-SDS, blood glucose, insulin level, homeostatic model assessment (HOMA) index, total cholesterol (TC), HDL, LDL, triglycerides, 25-OH-vitamin-D, area under the curve (AUC) for insulin in the oral glucose tolerance test (OGTT), whole body insulin sensitivity index (WBISI), LDL/HDL and TC/HDL ratios, and weight loss after 12 month follow-up. RESULTS No differences were observed between groups as regarding gender, ethnic background, or pubertal stage. Patients with one obese parent showed higher BW-SDS and BMI-SDS (P<.01), more severe impairment of carbohydrate metabolism (blood insulin, insulin-AUC, HOMA, HbA1c [P<.01] and lower WBISI [P<.05]) than those with no obese parent. Among those patients with a single obese parent, higher BW-SDS, insulin, HOMA, and lower 25-OH-vitamin D (P<.05) was observed when obesity was present in the mother. There was a higher prevalence of metabolic syndrome when both parents were obese (χ2=5.96, P<.05). A total of 132 patients reduced their BMI by ≥1.5SDS, or their weight by ≥10%, with no influence of the background of parental obesity. CONCLUSIONS Obesity in any parent determines a higher severity of their offspring obesity and metabolic comorbidities, more importantly when obesity is present in the mother or in both parents, but without interference in the options of therapeutic success.
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Affiliation(s)
| | - Rocío González-Leal
- Servicio de Endocrinología, Hospital Infantil Universitario Niño Jesús, Madrid, España
| | - Jesús Argente
- Servicio de Endocrinología, Hospital Infantil Universitario Niño Jesús, Madrid, España; Departamento de Pediatría, Universidad Autónoma de Madrid, Madrid, España; Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y la Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, España; IMDEA Food Institute, Madrid, España
| | - Gabriel Ángel Martos-Moreno
- Servicio de Endocrinología, Hospital Infantil Universitario Niño Jesús, Madrid, España; Departamento de Pediatría, Universidad Autónoma de Madrid, Madrid, España; Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y la Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, España.
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Ruiz‐Zaldibar C, Serrano‐Monzó I, Mujika A. Parental competence programs to promote positive parenting and healthy lifestyles in children: a systematic review. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2018. [DOI: 10.1016/j.jpedp.2017.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
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Ruiz-Zaldibar C, Serrano-Monzó I, Mujika A. Parental competence programs to promote positive parenting and healthy lifestyles in children: a systematic review. J Pediatr (Rio J) 2018; 94:238-250. [PMID: 29112860 DOI: 10.1016/j.jped.2017.07.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 06/19/2017] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE To analyze the available evidence regarding the efficacy of interventions on parents whose children were aged 2-5 years to promote parental competence and skills for children's healthy lifestyles. SOURCE Articles published in English and Spanish, available at PubMed, Psycinfo, CINAHL, Web of Science, Eric, and Cochrane Library were reviewed. SUMMARY OF THE FINDINGS The literature search yielded 2282 articles. Forty-one full texts were retrieved and assessed for inclusion using the PRISMA flow diagram. Twenty-six articles were excluded, as they did not meet the inclusion criteria. In the end, 15 studies were included. The studies were conducted between 2003 and 2016, nine in North America, four in Europe, and two in Asia. Extracted data were synthesized in a tabular format. CASPe guide was used to assess the quality of studies that was moderate overall. Parental self-efficacy was the main construct assessed in most studies. Four studies reported an increase in parental self-efficacy, although most of them were studies without control groups. CONCLUSIONS Outcomes of interventions to improve parental competence in order to promote children's lifestyles are promising, but inconsistent. Additional studies with higher methodological and conceptual quality are needed.
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Affiliation(s)
- Cayetana Ruiz-Zaldibar
- Universidad de Navarra, Facultad de Enfermería, Pamplona, Spain; Universidad de Navarra, Grupo de Investigación IMPULS, Pamplona, Spain; Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain.
| | - Inmaculada Serrano-Monzó
- Universidad de Navarra, Facultad de Enfermería, Pamplona, Spain; Universidad de Navarra, Grupo de Investigación IMPULS, Pamplona, Spain; Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Agurtzane Mujika
- Universidad de Navarra, Facultad de Enfermería, Pamplona, Spain; Universidad de Navarra, Grupo de Investigación IMPULS, Pamplona, Spain; Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
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Taveras EM, Marshall R, Sharifi M, Avalon E, Fiechtner L, Horan C, Gerber MW, Orav EJ, Price SN, Sequist T, Slater D. Comparative Effectiveness of Clinical-Community Childhood Obesity Interventions: A Randomized Clinical Trial. JAMA Pediatr 2017; 171:e171325. [PMID: 28586856 PMCID: PMC6075674 DOI: 10.1001/jamapediatrics.2017.1325] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Novel approaches to care delivery that leverage clinical and community resources could improve body mass index (BMI) and family-centered outcomes. OBJECTIVE To examine the extent to which 2 clinical-community interventions improved child BMI z score and health-related quality of life, as well as parental resource empowerment in the Connect for Health Trial. DESIGN, SETTING, AND PARTICIPANTS This 2-arm, blinded, randomized clinical trial was conducted from June 2014 through March 2016, with measures at baseline and 1 year after randomization. This intent-to-treat analysis included 721 children ages 2 to 12 years with BMI in the 85th or greater percentile from 6 primary care practices in Massachusetts. INTERVENTIONS Children were randomized to 1 of 2 arms: (1) enhanced primary care (eg, flagging of children with BMI ≥ 85th percentile, clinical decision support tools for pediatric weight management, parent educational materials, a Neighborhood Resource Guide, and monthly text messages) or (2) enhanced primary care plus contextually tailored, individual health coaching (twice-weekly text messages and telephone or video contacts every other month) to support behavior change and linkage of families to neighborhood resources. MAIN OUTCOMES AND MEASURES One-year changes in age- and sex-specific BMI z score, child health-related quality of life measured by the Pediatric Quality of Life 4.0, and parental resource empowerment. RESULTS At 1 year, we obtained BMI z scores from 664 children (92%) and family-centered outcomes from 657 parents (91%). The baseline mean (SD) age was 8.0 (3.0) years; 35% were white (n = 252), 33.3% were black (n = 240), 21.8% were Hispanic (n = 157), and 9.9% were of another race/ethnicity (n = 71). In the enhanced primary care group, adjusted mean (SD) BMI z score was 1.91 (0.56) at baseline and 1.85 (0.58) at 1 year, an improvement of -0.06 BMI z score units (95% CI, -0.10 to -0.02) from baseline to 1 year. In the enhanced primary care plus coaching group, the adjusted mean (SD) BMI z score was 1.87 (0.56) at baseline and 1.79 (0.58) at 1 year, an improvement of -0.09 BMI z score units (95% CI, -0.13 to -0.05). However, there was no significant difference between the 2 intervention arms (difference, -0.02; 95% CI, -0.08 to 0.03; P = .39). Both intervention arms led to improved parental resource empowerment: 0.29 units (95% CI, 0.22 to 0.35) higher in the enhanced primary care group and 0.22 units (95% CI, 0.15 to 0.28) higher in the enhanced primary care plus coaching group. Parents in the enhanced primary care plus coaching group, but not in the enhanced care alone group, reported improvements in their child's health-related quality of life (1.53 units; 95% CI, 0.51 to 2.56). However, there were no significant differences between the intervention arms in either parental resource empowerment (0.07 units; 95% CI, -0.02 to 0.16) or child health-related quality of life (0.89 units; 95% CI, -0.56 to 2.33). CONCLUSIONS AND RELEVANCE Two interventions that included a package of high-quality clinical care for obesity and linkages to community resources resulted in improved family-centered outcomes for childhood obesity and improvements in child BMI. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT02124460.
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Affiliation(s)
- Elsie M. Taveras
- Division of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston, MA
- Department of Nutrition, Harvard School of Public Health; Boston, MA
| | - Richard Marshall
- Department of Pediatrics, Harvard Vanguard Medical Associates, Boston, MA
| | - Mona Sharifi
- Section of General Pediatrics, Department of Pediatrics, Yale University School of Medicine, New Haven, CT
| | | | - Lauren Fiechtner
- Division of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston, MA
- Division of Gastroenterology and Nutrition, MassGeneral Hospital for Children, Boston, MA
| | - Christine Horan
- Division of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston, MA
| | - Monica W. Gerber
- Division of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston, MA
| | - E. John Orav
- Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Sarah N. Price
- Division of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston, MA
| | | | - Daniel Slater
- Department of Pediatrics, Harvard Vanguard Medical Associates, Boston, MA
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Fiechtner L, Puente GC, Sharifi M, Block JP, Price S, Marshall R, Blossom J, Gerber MW, Taveras EM. A Community Resource Map to Support Clinical-Community Linkages in a Randomized Controlled Trial of Childhood Obesity, Eastern Massachusetts, 2014-2016. Prev Chronic Dis 2017; 14:E53. [PMID: 28682745 PMCID: PMC5510302 DOI: 10.5888/pcd14.160577] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background Novel approaches to health care delivery that leverage community resources could improve outcomes for children at high risk for obesity. Community Context We describe the process by which we created an online interactive community resources map for use in the Connect for Health randomized controlled trial. The trial was conducted in the 6 pediatric practices that cared for the highest percentage of children with overweight or obesity within a large multi-specialty group practice in eastern Massachusetts. Methods By using semistructured interviews with parents and community partners and geographic information systems (GIS), we created and validated a community resource map for use in a randomized controlled trial for childhood obesity. We conducted semistructured interviews with 11 parents and received stakeholder feedback from 5 community partners, 2 pediatricians, and 3 obesity–built environment experts to identify community resources that could support behavior change. We used GIS databases to identify the location of resources. After the resources were validated, we created an online, interactive searchable map. We evaluated parent resource empowerment at baseline and follow-up, examined if the participant families went to new locations for physical activity and food shopping, and evaluated how satisfied the families were with the information they received. Outcome Parents, community partners, and experts identified several resources to be included in the map, including farmers markets, supermarkets, parks, and fitness centers. Parents expressed the need for affordable activities. Parent resource empowerment increased by 0.25 units (95% confidence interval, 0.21–0.30) over the 1-year intervention period; 76.2% of participants were physically active at new places, 57.1% of participant families shopped at new locations; and 71.8% reported they were very satisfied with the information they received. Interpretation Parents and community partners identified several community resources that could help support behavior change. Parent resource empowerment and use of community resources increased over the intervention period, suggesting that community resource mapping should inform future interventions.
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Affiliation(s)
- Lauren Fiechtner
- Division of Gastroenterology and Nutrition, Massachusetts General Hospital for Children, 175 Cambridge St, 5th FL, Boston, MA 02114. .,Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, Massachusetts
| | - Gabriella C Puente
- Columbia University, the College of Physicians and Surgeons, New York, New York
| | - Mona Sharifi
- Section of General Pediatrics, Yale University School of Medicine, New Haven, Connecticut
| | - Jason P Block
- Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Sarah Price
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, Massachusetts
| | | | - Jeff Blossom
- Center for Geographic Analysis, Harvard University, Cambridge, Massachusetts
| | - Monica W Gerber
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, Massachusetts
| | - Elsie M Taveras
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, Massachusetts.,Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts
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27
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Lim J, Davison KK, Jurkowski JM, Horan CM, Orav EJ, Kamdar N, Fiechtner LG, Taveras EM. Correlates of Resource Empowerment among Parents of Children with Overweight or Obesity. Child Obes 2017; 13:63-71. [PMID: 27875076 PMCID: PMC5278806 DOI: 10.1089/chi.2016.0136] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Few studies have examined correlates of resource empowerment among parents of children with overweight or obesity. METHODS We studied baseline data of 721 parent-child pairs participating in the Connect for Health randomized trial being conducted at six pediatric practices in Massachusetts. Parents completed the child weight management subscale (n = 5 items; 4-point response scale) of the Parent Resource Empowerment Scale; items were averaged to create a summary empowerment score. We used linear regression to examine the independent effects of child (age, sex, and race/ethnicity), parent/household characteristics (age, education, annual household income, BMI category, perceived stress, and their ratings of their healthcare quality), and neighborhood median household income, on parental resource empowerment. RESULTS Mean (SD) child age was 7.7 years (2.9) and mean (SD) BMI z-score was 1.9 (0.5); 34% of children were white, 32% black, 22% Hispanic, 5% Asian, and 6% multiracial/other. The mean parental empowerment score was 2.95 (SD = 0.56; range = 1-4). In adjusted models, parents of older children [β -0.03 (95% CI: -0.04, -0.01)], Hispanic children [-0.14 (-0.26, -0.03)], those with annual household income less than $20,000 [-0.16 (-0.29, -0.02)], those with BMI ≥30.0 kg/m2 [-0.17 (-0.28, -0.07)], and those who reported receiving lower quality of obesity-related care [-0.05 (-0.07, -0.03)] felt less empowered about resources to support their child's healthy body weight. CONCLUSIONS Parental resource empowerment is influenced by parent and child characteristics as well as the quality of their obesity-related care. These findings could help inform equitable, family-centered approaches to improve parental resource empowerment.
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Affiliation(s)
| | - Kirsten K. Davison
- Department of Nutrition, Harvard School of Public Health, Harvard University, Boston, MA
| | - Janine M. Jurkowski
- Department of Health Policy, Management, and Behavior, School of Public Health, University at Albany, State University of New York, Albany, NY
| | - Christine M. Horan
- Department of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston, MA
| | - E. John Orav
- Department of Biostatistics, Harvard School of Public Health, Harvard University, Boston, MA
| | - Neil Kamdar
- Department of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston, MA
- Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, MI
| | - Lauren G. Fiechtner
- Department of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston, MA
- Department of Pediatric Gastroenterology, Massachusetts General Hospital for Children, Boston, MA
| | - Elsie M. Taveras
- Department of Nutrition, Harvard School of Public Health, Harvard University, Boston, MA
- Department of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston, MA
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28
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Bryant LL, Quissell DO, Braun PA, Henderson WG, Johs N, George C, Smith V, Toledo N, Thomas J, Albino JE. A Community-Based Oral Health Intervention in Navajo Nation Head Start: Participation Factors and Contextual Challenges. J Community Health 2017; 41:340-53. [PMID: 26467679 DOI: 10.1007/s10900-015-0102-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Successful interventions require consistent participation by intended recipients. We utilized mixed methods to describe participation of 518 parent-child dyads enrolled in a randomized cluster trial of a 2-year oral health intervention for Head Start (HS) families across Navajo Nation delivered by native Community Oral Health Specialists (COHS). We quantitatively assessed factors that contributed to participation and qualitatively examined barriers and strategies. The intervention offered fluoride varnish (FV) and oral health promotion (OHP) activities for two cohorts (enrolled in 2011, N = 286, or 2012, N = 232) of children in the HS classrooms and OHP for parents outside the classroom. Child participation was good: FV: 79.7 (Cohort 1) and 85.3 % (Cohort 2) received at least 3 of 4 applications; OHP: 74.5 (Cohort 1) and 78.4 % (Cohort 2) attended at least 3 of 5 events. Parent participation was low: 10.5 (Cohort 1) and 29.8 % (Cohort 2) attended at least three of four events. Analysis of survey data found significant effects on parent participation from fewer people in the household, Cohort 2 membership, greater external-locus of control, and a greater perception that barriers existed to following recommended oral health behaviors. Qualitative analysis of reports from native field staff, COHS, community members, and the research team identified barriers (e.g., geographic expanse, constraints of a research trial) and suggested strategies to improve parent participation (e.g., improve communication between COHS and parents/community). Many challenges to participation exist when conducting interventions in rural areas with underserved populations. Working with community partners to inform the development and delivery of interventions is critical.
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Affiliation(s)
- Lucinda L Bryant
- Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, 13001 East 17th Place B119, Aurora, CO, 80045, USA
| | - David O Quissell
- Department of Craniofacial Biology, School of Dental Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Patricia A Braun
- Adult and Child Center of Outcomes Research and Dissemination Science, University of Colorado Anschutz Medical Campus, 13199 E. Montview Blvd., Suite 300 F443, Aurora, CO, 80045, USA.
| | - William G Henderson
- Adult and Child Center of Outcomes Research and Dissemination Science, University of Colorado Anschutz Medical Campus, 13199 E. Montview Blvd., Suite 300 F443, Aurora, CO, 80045, USA.,Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, 13001 E. 17th Avenue, Aurora, CO, 80045, USA
| | - Nikolas Johs
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Nighthorse Campbell Native Health Building, 13055 E. 17th Avenue, Mail Stop F800, Aurora, CO, 80045, USA
| | - Carmen George
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Nighthorse Campbell Native Health Building, 13055 E. 17th Avenue, Mail Stop F800, Aurora, CO, 80045, USA
| | - Vong Smith
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Nighthorse Campbell Native Health Building, 13055 E. 17th Avenue, Mail Stop F800, Aurora, CO, 80045, USA
| | - Nikola Toledo
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Nighthorse Campbell Native Health Building, 13055 E. 17th Avenue, Mail Stop F800, Aurora, CO, 80045, USA
| | - Jacob Thomas
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Nighthorse Campbell Native Health Building, 13055 E. 17th Avenue, Mail Stop F800, Aurora, CO, 80045, USA
| | - Judith E Albino
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Nighthorse Campbell Native Health Building, 13055 E. 17th Avenue, Mail Stop F800, Aurora, CO, 80045, USA
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Abstract
Guided by the social cognitive theory, this randomized controlled trial tested the “Make a Move,” a provider-led intervention for Head Start parents aimed to produce changes in the outcomes of knowledge, attitude, and behavior of physical activity and healthy eating. Participants were parents of children ages 3–5 years enrolled in a Head Start program. Participants completed a 57-item questionnaire at baseline and postintervention. The Wilcoxon rank-sum test revealed a statistically significant difference between the intervention and control groups in scores on knowledge of healthy eating ( z = 1.99, p = .05), attitude of physical activity ( z = 2.71, p < .01), and behavior of physical activity ( z = 2.03, p = .04). Ten participants (77%) completed all four intervention sessions. This study provided new insights into the relationship of a provider-led intervention with respect to knowledge, attitude, and behaviors in healthy eating and physical activity.
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Affiliation(s)
- Kimberly Nerud
- Nursing Department, Health Science Center, University of South Dakota, Sioux Falls, SD, USA
| | - Haifa (Abou). Samra
- Nursing Department, Health Science Center, University of South Dakota, Sioux Falls, SD, USA
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30
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Han E, Jones-Smith J, Surkan PJ, Kharmats AY, Vedovato GM, Trude ACB, Anderson Steeves E, Gittelsohn J. Low-income African-American adults share weight status, food-related psychosocial factors and behaviours with their children. Obes Sci Pract 2015; 1:78-87. [PMID: 27774251 PMCID: PMC5064723 DOI: 10.1002/osp4.10] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 07/28/2015] [Accepted: 09/04/2015] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE This study aims to examine the extent to which low-income African-American children's weight status, psychosocial characteristics and food-related behaviours are associated with that of their adult caregivers. METHODS Cross-sectional data from baseline evaluation of B'More Healthy Communities for Kids obesity prevention trial were used. Outcomes of interest were children's overweight and/or obesity status, food-related self-efficacy, knowledge, intentions and healthier/less healthy food acquisition scores. The primary exposures were adult caregiver's overweight and/or obesity status, their psychosocial factors and food acquisition scores. Multiple logistic regression analyses were used to assess associations. RESULTS Children had higher odds of overweight or obesity if they had an overweight/obese caregiver (odds ratio [OR] 4.04, 95% confidence interval [95%CI] 1.59-10.28) or an obese caregiver (OR 2.50, 95%CI 1.39-4.51). Having a caregiver in the highest quartile of self-efficacy, food intentions and healthy food acquisition patterns was associated with higher odds of their child also having a higher score on these factors (self-efficacy: OR 3.77 [95%CI 1.76-8.04]; food intentions: OR 1.13 [95%CI 1.01-1.27]; and healthy food acquisition: OR 2.19 [95%CI 1.05-4.54]). CONCLUSIONS Child and adult caregiver weight status and psychosocial characteristics were positively associated in this low-income, urban population. These findings may help inform obesity treatment or prevention programmes and interventions aimed at parents and families.
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Affiliation(s)
- E Han
- Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore MD USA
| | - J Jones-Smith
- Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore MD USA
| | - P J Surkan
- Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore MD USA
| | - A Y Kharmats
- Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore MD USA
| | - G M Vedovato
- Health and Society Institute Federal University of São Paulo Santos SP Brazil
| | - A C B Trude
- Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore MD USA
| | - E Anderson Steeves
- Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore MD USA
| | - J Gittelsohn
- Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore MD USA
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Taveras EM, Marshall R, Sharifi M, Avalon E, Fiechtner L, Horan C, Orav J, Price SN, Sequist T, Slater D. Connect for Health: Design of a clinical-community childhood obesity intervention testing best practices of positive outliers. Contemp Clin Trials 2015; 45:287-295. [PMID: 26427562 PMCID: PMC4753774 DOI: 10.1016/j.cct.2015.09.022] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 09/25/2015] [Accepted: 09/27/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND The Connect for Health study is designed to assess whether a novel approach to care delivery that leverages clinical and community resources and addresses socio-contextual factors will improve body mass index (BMI) and family-centered, obesity-related outcomes of interest to parents and children. The intervention is informed by clinical, community, parent, and youth stakeholders and incorporates successful strategies and best practices learned from 'positive outlier' families, i.e., those who have succeeded in changing their health behaviors and improve their BMI in the context of adverse built and social environments. DESIGN Two-arm, randomized controlled trial with measures at baseline and 12 months after randomization. PARTICIPANTS 2-12 year old children with overweight or obesity (BMI ≥ 85th percentile) and their parents/guardians recruited from 6 pediatric practices in eastern Massachusetts. INTERVENTION Children randomized to the intervention arm receive a contextually-tailored intervention delivered by trained health coaches who use advanced geographic information system tools to characterize children's environments and neighborhood resources. Health coaches link families to community-level resources and use multiple support modalities including text messages and virtual visits to support families over a one-year intervention period. The control group receives enhanced pediatric care plus non-tailored health coaching. MAIN OUTCOME MEASURES Lower age-associated increase in BMI over a 1-year period. The main parent- and child-reported outcome is improved health-related quality of life. CONCLUSIONS The Connect for Health study seeks to support families in leveraging clinical and community resources to improve obesity-related outcomes that are most important to parents and children.
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Affiliation(s)
- Elsie M Taveras
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA, United States; Department of Nutrition, Harvard School of Public Health, Boston, MA, United States.
| | - Richard Marshall
- Department of Pediatrics, Harvard Vanguard Medical Associates, Boston, MA, United States
| | - Mona Sharifi
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA, United States
| | | | - Lauren Fiechtner
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA, United States
| | - Christine Horan
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA, United States
| | - John Orav
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, United States
| | - Sarah N Price
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA, United States
| | - Thomas Sequist
- Partners HealthCare System, Inc., Boston, MA, United States
| | - Daniel Slater
- Department of Pediatrics, Harvard Vanguard Medical Associates, Boston, MA, United States
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Abstract
AbstractObjectiveThe present review aimed to identify and synthesize studies that used an empowerment approach within the field of healthy nutrition.DesignA systematic review was conducted. Studies were identified by database searching (PubMed, PsycINFO, Web of Science and Psyndex). Searching, selecting and reporting were done according to the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) Statement.SettingHealth promotion including the subject of healthy nutrition.SubjectsIndividuals from non-clinical populations.ResultsA total of 1226 studies were screened for eligibility, eight studies were finally included. Three studies used the empowerment approach within a qualitative research paradigm and five studies within (quasi-) experimental intervention studies. Heterogeneity in settings, samples and evaluation methods was high. Most studies referred to the key message of empowerment, i.e. taking control over one’s own life. However, the ways in which this key message was implemented in the interventions differed considerably.ConclusionsThe number of studies included was very low. Furthermore, most studies had some limitations in terms of reporting how the empowerment approach was actually applied. The empowerment approach still seems to be unfamiliar within the field of healthy nutrition.
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