Feasibility and acceptability of a 1-page tool to help physicians assess and discuss obesity with parents of preschoolers

Screening tools used in primary health care settings to identify health behaviours in children (birth-16 years); A systematic review of their effectiveness, feasibility and acceptability

BACKGROUND

Child health behaviour screening tools have potential to enhance the effectiveness of health promotion and early intervention. This systematic review aimed to examine the effectiveness, acceptability and feasibility of child health behaviour screening tools used in primary health care settings.

METHODS

A systematic review of studies published in English in five databases (CINAHL, Medline, Scopus, PsycINFO and Web of Science) prior to July 2022 was undertaken. Eligible studies described: 1) screening tools for health behaviours (dietary, physical activity, sedentary or sleep-related behaviours) used in primary health care settings in children birth to 16 years; 2) tool effectiveness for identifying child health behaviours and changing practitioner behaviour; 3) tool acceptability or feasibility from child, caregiver or practitioner perspective and/or 4) implementation of the screening tool.

RESULTS

Of the 7145 papers identified, 22 studies describing 14 screening tools were included. Only four screening tools measured all four behaviour domains. Fourteen studies reported changes in practitioner self-reported behaviour, knowledge and practice. Practitioners and caregivers identified numerous benefits and challenges to screening.

CONCLUSIONS

Health behaviour screening can be an acceptable and feasible strategy to assess children's health behaviours in primary health care. Further evaluation is needed to determine effectiveness on child health outcomes.

Obesity and Eating Disorders in Children and Adolescents: The Bidirectional Link

Obesity, eating disorders and unhealthy dieting practices among children and adolescents are alarming health concerns due to their high prevalence and adverse effects on physical and psychosocial health. We present the evidence that eating disorders and obesity can be managed or prevented using the same interventions in the pediatric age. In the presence of obesity in the pediatric age, disordered eating behaviors are highly prevalent, increasing the risk of developing eating disorders. The most frequently observed in subjects with obesity are bulimia nervosa and binge-eating disorders, both of which are characterized by abnormal eating or weight-control behaviors. Various are the mechanisms overlying the interaction including environmental and individual ones, and different are the approaches to reduce the consequences. Evidence-based treatments for obesity and eating disorders in childhood include as first line approaches weight loss with nutritional management and lifestyle modification via behavioral psychotherapy, as well as treatment of psychiatric comorbidities if those are not a consequence of the eating disorder. Drugs and bariatric surgery need to be used in extreme cases. Future research is necessary for early detection of risk factors for prevention, more precise elucidation of the mechanisms that underpin these problems and, finally, in the cases requiring therapeutic intervention, to provide tailored and timely treatment. Collective efforts between the fields are crucial for reducing the factors of health disparity and improving public health.

Communication tools used in childhood obesity discussions: A scoping review

BACKGROUND

Paediatric healthcare professionals (HCPs) play an essential role in the prevention and management of childhood obesity; however, many report considerable barriers to having weight-related conversations, including a lack of confidence. One way to address this is to use communication tools, such as charts, pictures and handouts. This scoping review's objective was to identify the extent and nature of available tools in the published literature that aimed to support HCPs in having positive weight-related conversations with children and families.

METHODS

CINAHL, Medline and PsycINFO were systematically searched from 2005 to 2019. Articles were selected based on (a) use of an identified communication tool; (b) tool designed for use with children between the ages of 2 and 18 and/or their parents; (c) tool designed to be used in weight-related discussions; and (d) tool designed to be used by HCPs in a formal healthcare setting.

RESULTS

Of the 3,596 articles yielded after deduplication, 13 unique communication tools were identified. Tools were grouped according to three themes: (a) help communicate child's weight status; (b) provide a communication framework for HCPs; and (c) actively engage children and/or parents in discussions. Many of the tools were recently developed and had not been evaluated in clinical practice. The clinical utility of each tool was evaluated.

CONCLUSION

This study identified 13 communication tools HCPs could use when having weight-related discussions. However, there was a lack of evaluation and clinical utility. Only one tool had high clinical utility, and not all tools would be recommended for use in practice.

How to Translate Self-Management Support Tools Into Clinical Practice: A Report From the INSTTEPP Trial and Meta-LARC Consortium

PURPOSE

Patient self-management is an inevitable part of the work of being a patient, and self-management support (SMS) has become increasingly important in chronic disease management. However, the majority of SMS resources available in the Agency for Healthcare Research and Quality SMS Resource Library were developed without explicit collaboration between clinicians and patients.

METHODS

Translation of SMS tools derived from the library into primary care practices occurred utilizing boot camp translation in four different practice-based research networks (PBRNs). The typical model of boot camp translation was adapted for the purpose of the Implementing Networks' Self-management Tools Through Engaging Patients and Practices (INSTTEPP) study to develop SMS tools for implementation in the participating practices. Clinicians, clinic staff members, and patients were involved throughout the translation process. Existing resources from the SMS library were reviewed and adapted by each boot camp translation group to create tools unique to the patients in each network.

RESULTS

There was no preexisting resource within the library that was deemed suitable for implementation without modification. Each network adapted tools from the SMS library to create different products. Common themes emerged from each network's translation process that highlighted the importance of patient engagement in the translation process. Boot camp translation, in conjunction with PBRNs, can be implemented to adapt SMS tools for implementation in member practices.

CONCLUSIONS

Boot camp translation with a combination of practices and patients can be implemented to facilitate a process of local adaptation that improves the local applicability of SMS tools in primary care clinics.

Tailored communications for obesity prevention in pediatric primary care: a feasibility study

Recommendations for the prevention of childhood obesity encourage providers to counsel parents and their children on healthy diet and activity behaviors. This study evaluated the feasibility of a theory-based, tailored communication intervention for obesity prevention (Team Up for Health) delivered during a well-child visit. A two-armed randomized controlled trial was used. Parents of children aged 4-10 years were recruited from a list of patients due for a well-child visit at a pediatric primary care clinic. Parents were randomized to either the 'immediate' condition (parent and pediatrician received the tailored report at the well-child visit) or the 'delayed' condition (parent received the report at the end of the study). Self-report measures assessed physical activity, fruits, vegetables, television time, sugary drinks, and 100% fruit juice. Parents completed assessments at baseline, <48 h and 4-week follow-up. Providers were interviewed at the end of the study. Independent t-tests were used to examine between group differences. Seven areas of feasibility were evaluated: Recruitment, randomization, measurement, retention, acceptability, implementation and demand. Results showed high rates of measurement (85%) and acceptability (89%) and implementation (80%) of the intervention. In conclusion, Team Up for Health was feasible; however, a larger study is needed to evaluate its efficacy.

Design and rationale of the STRIVE trial to improve cardiometabolic health among children and families

BACKGROUND

Many of the health behaviors known to contribute to cardiometabolic risk and disease (CMRD), including physical activity, diet, sleep, and screen time, begin during childhood. Given the population-wide burden of CMRD, novel ways of assessing risk and providing feedback to support behavior change are needed.

PURPOSE

This paper describes the design and rationale for the Study for using Technology to Reach Individual Excellence (STRIVE), a randomized controlled trial testing the use of an integrated, closed-loop feedback system that incorporates longitudinal, patient-generated, mobile health technology (mHealth) data on health behaviors and provides clinical recommendations to help manage CMRD among at-risk families.

METHODS

STRIVE is a 6-month trial among 68 children, ages 6-12year olds with a body mass index≥85th percentile from Massachusetts with at least one parent with CMRD. Data on several health behaviors will be collected daily over 6months. Children and parents will each wear wristbands that collect objective physical activity, sleep, and screen time data via accelerometry, noise, and infrared detection. Sugar sweetened beverage consumption will be assessed by self-report via a smartphone application. Weight will be collected using a wireless scale. Intervention group parents receive feedback on their child's health behaviors and personalized CMRD counseling via mobile messaging. Control parents receive standard of care recommendations and weekly health behavior reports for self-guided care.

CONCLUSION

The STRIVE trial will test the use of mHealth and closed-loop feedback systems to improve health behaviors among families at-risk for or with established CMRD.

Tools and resources for preventing childhood obesity in primary care: A method of evaluation and preliminary assessment

OBJECTIVES

To pilot-test a mixed methods approach to evaluate tools and resources (TRs) that healthcare providers (HCPs) use for preventing childhood obesity in primary care, and report a preliminary descriptive assessment of commonly-used TRs.

METHODS

This mixed methods study included individual, semi-structured interviews with purposefully-sampled HCPs in Alberta, Canada; interviews were digitally recorded and analyzed thematically (phase I). Two independent reviewers used three assessment checklists to evaluate commonly-used TRs (phase II). HCPs provided feedback on our coding scheme and checklist data (phase III).

RESULTS

Three themes described how HCPs (n=19) used TRs: purpose of use (e.g., clinical support), logistical factors (e.g., accessibility), and decision to use (e.g., suitability). The latter theme overlapped with constructs of suitability on the checklists. Overall, participants used 15 TRs, most of which scored 'average' on the checklists.

CONCLUSION

Phases I and II provided unique insights on the evaluation of TRs used for preventing childhood obesity. Criteria on the checklists overlapped with HCPs' perceptions of TR suitability, but did not reflect logistical factors that influenced their use of TRs.

PRACTICE IMPLICATIONS

Developers of TRs should collaborate with HCPs to ensure that subjective and objective criteria are used to optimize TR suitability in the primary care setting.

Promoting conversations between physicians and families about childhood obesity: evaluation of physician communication training within a clinical practice improvement initiative

Childhood obesity rates have incrementally increased since the 1980s, sparking calls for initiatives focused on addressing this public health concern. In response, the family medicine residency clinic profiled in this research designed, executed, and evaluated a practice improvement initiative focused on physician communication behaviors and clinic processes that impact the management of unhealthy pediatric weight. The results of the evaluation effort demonstrated increased physician knowledge of communication principles, improvements in weight management counseling rates, and opportunities for health delivery system changes to promote the effective clinical management of unhealthy pediatric weight.

Practice adaptive reserve and colorectal cancer screening best practices at community health center clinics in 7 states

BACKGROUND

Enhancing the capability of community health centers to implement best practices (BPs) may mitigate health disparities. This study investigated the association of practice adaptive reserve (PAR) with the implementation of patient-centered medical home (PCMH) colorectal cancer (CRC) screening BPs at community health center clinics in 7 states.

METHODS

A convenience sample of clinic staff participated in a self-administered, online survey. Eight PCMH CRC screening BPs were scored as a composite ranging from 0 to 32. The PAR composite score was scaled from 0 to 1 and then categorized into 3 levels. Multilevel analyses examined the relation between PAR and self-reported implementation of PCMH BPs.

RESULTS

There were 296 respondents, and 59% reported 6 or more PCMH BPs at their clinics. The mean PAR score was 0.66 (standard deviation, 0.18), and the PCMH BP mean scores were significantly higher for respondents who reported higher clinic PAR categories. In comparison with the lowest PAR level, adjusted PCMH BP means were 25.0% higher at the middle PAR level (difference, 3.2; standard error, 1.3; t = 2.44; P = .015) and 63.2% higher at the highest PAR level (difference, 8.0; standard error, 1.9; t = 4.86; P < .0001).

CONCLUSIONS

A higher adaptive reserve, as measured by the PAR score, was positively associated with self-reported implementation of PCMH CRC screening BPs by clinic staff. Future research is needed to determine the PAR levels most conducive to implementing CRC screening and to develop interventions that enhance PAR in primary care settings.

Translation of clinical practice guidelines for childhood obesity prevention in primary care mobilizes a rural Midwest community

PURPOSE

The purpose of this project was to implement clinic system changes that support evidence-based guidelines for childhood obesity prevention. Adherence rates for prevention and screening of children in a rural Midwest primary care setting were used to measure the success of the program.

DATA SOURCES

Retrospective chart reviews reflected gaps in current practice and documentation. An evidence-based toolkit for childhood obesity prevention was used to implement clinic system changes for the identified gaps.

CONCLUSIONS

The quality improvement approach proved to be effective in translating knowledge of obesity prevention guidelines into rural clinic practices with significant improvements in documentation of prevention measures that may positively impact the childhood obesity epidemic.

IMPLICATIONS FOR PRACTICE

Primary care providers, including nurse practitioners (NPs), are at the forefront of diagnosing, educating, and counseling children and families on obesity prevention and need appropriate resources and tools to deliver premier care. The program successfully demonstrated how barriers to practice, even with the unique challenges in a rural setting, can be overcome. NPs fulfill a pivotal primary care role and can provide leadership that may positively impact obesity prevention in their communities.

Applying systems engineering to implement an evidence-based intervention at a community health center

Impressive results in patient care and cost reduction have increased the demand for systems-engineering methodologies in large health care systems. This Report from the Field describes the feasibility of applying systems-engineering techniques at a community health center currently lacking the dedicated expertise and resources to perform these activities.

Fitwits: preparing residency-based physicians to discuss childhood obesity with preteens

OBJECTIVE

To evaluate the Fitwits MD office tool and games for obesity discussions with 9- to 12-year-olds.

METHODS

A nonrandomized intervention study using pre- and posttest assessments in 2 residency programs compared 31 control group and 55 intervention physicians (34 previously trained, 21 newly trained to use Fitwits). Surveys addressed comfort and competence regarding: obesity prevention and treatment, nutrition, exercise, portion size, body mass index (BMI), and the term "obesity." We surveyed all groups at baseline and 5 months (post 1) and new trainees 3 months later (post 2).

RESULTS

In post 1, prior trainees reported significantly increased comfort and competence for discussing obesity prevention, portion size, BMI, and "obesity." In post 2, new trainees reported significantly increased comfort and competence discussing obesity prevention and treatment, portion size, and BMI.

CONCLUSIONS

Experience using Fitwits improved residency-based physician comfort and competence in obesity prevention and treatment, portion size, BMI, and "obesity" discussions with preadolescents.

Pediatric obesity: a review for the child psychiatrist

Child and adolescent psychiatrists frequently encounter children who are obese in their practices and may be asked to work alongside primary care physicians and other specialists who treat youngsters with obesity. To offer expert consultation, they must understand all aspects of the pediatric obesity epidemic. By summarizing the relevant endocrinology, cardiology, nutrition, exercise science, and public health literature, this review of pediatric obesity assesses the epidemic's background, delineates the challenges of clinical care, and appraises the therapeutic recommendations for this population of patients and their families.

Childhood obesity: update on predisposing factors and prevention strategies

Obesity is a global epidemic and children are affected in increasing numbers. Overweight children are at increased risk of becoming overweight adults with associated chronic diseases. In this update, we present key findings from a review of the current literature focused on potential causes and strategies for preventing childhood obesity. We highlight recent evidence regarding the role of genetics, maternal body mass index, postnatal influences, and environmental effects throughout childhood in predicting overweight. We also summarize the results of new research that examined the effectiveness of intervention strategies implemented in a variety of settings: home, school, community, and health care system. Statements recently released by the Centers for Disease Control and Prevention (CDC) and the US Department of Health and Human Services emphasize the need for effective policy and environmental change to promote healthy lifestyle change at the individual and population levels.

Pediatric obesity: a review for the child psychiatrist

Child and adolescent psychiatrists frequently encounter children who are obese in their practices and may be asked to work alongside primary care physicians and other specialists who treat youngsters with obesity. To offer expert consultation, they must understand all aspects of the pediatric obesity epidemic. By summarizing the relevant endocrinology, cardiology, nutrition, exercise science, and public health literature, this review of pediatric obesity assesses the epidemic's background, delineates the challenges of clinical care, and appraises the therapeutic recommendations for this population of patients and their families.