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Simione M, Ferreira P, Luo M, Hoover C, Perkins M, Fiechtner L, Taveras EM. Psychometrics of the modified Family-Centered Care Assessment short version for childhood obesity. RESEARCH SQUARE 2024:rs.3.rs-4365570. [PMID: 38798356 PMCID: PMC11118706 DOI: 10.21203/rs.3.rs-4365570/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
Background Incorporating principles of family-centered care into pediatric weight management interventions can improve the effectiveness and quality of treatment and reduce attrition rates. To assess the family-centeredness of interventions, reliable, valid, and easy-to-administer scales are needed. The purpose of the study was to develop a shortened version of the modifed Family Centered Care Assessment (mFCCA) and assess its psychometric properties. Methods The mFCCA, a scale to assess the family-centeredness of interventions for childhood obesity, was administered to families following the Connect for Health randomized control trial evaluating the effectiveness of a primary care-based pediatric weight management intervention. We iteratively removed items from the mFCCA and used Rasch modeling to examine the reliability and validity of the shortened scale. Results We included data from 318 parents and the exploratory factor analysis showed the presence of a single factor. The results of the Rasch modeling demonstrated acceptable internal consistency of the scale (0.7) and strong validity as evidenced by the overall model fit and range of item difficulty. Following the psychometric analyses, we reduced the number of items from 24 to 8 items. Conclusions The mFCCA short version demonstrates good psychometrics and can be used to evaluate the family-centeredness of childhood obesity interventions with reduced participant burden, thereby improving outcomes for children with obesity. Trial registration Clinicaltrials.gov NCT02124460 registered on April 24, 2014.
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Simione M, Aschbrenner K, Farrar-Muir H, Luo M, Granadeno J, Caballero-Gonzalez A, Price SN, Torres C, Boudreau AA, Fiechtner L, Hambidge SJ, Sease K, Taveras EM. Adapting Connect for Health pediatric weight management program for telehealth in response to the COVID-19 pandemic. Implement Sci Commun 2023; 4:139. [PMID: 37974245 PMCID: PMC10652425 DOI: 10.1186/s43058-023-00523-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 10/28/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND To address the evolving needs and context changes due to the COVID-19 pandemic, we adapted Connect for Health, an evidence-based, primary care, pediatric weight management intervention. The objective of this study is to describe the planned adaptation process to ensure continued and equitable program uptake during the pandemic. METHODS Guided by adaptation frameworks, we identified the core functions and forms of Connect for Health and then adapted the intervention in response to a changing healthcare context. We engaged stakeholders and surveyed parents of children with a BMI ≥ 85th percentile and pediatric clinicians and examined their experiences using telehealth for pediatric weight management and needs and preferences. Using multivariable logistic regression, we examined the preferences of parents with limited English proficiency regarding key aspects of pediatric weight management. RESULTS We surveyed 200 parents and 43% had a primary language of Spanish. Parents wanted care to be a combination of in-person and virtual visits (80%). We found that parents with limited English proficiency had a higher odds ratio of affirming in-person visits are better than virtual visits for ensuring their child's health concern can be taken care of (OR: 2.91; 95% CI: 1.36, 6.21), feeling comfortable when discussing personal information (OR: 3.91; 95% CI: 1.82, 8.43), talking about healthy behaviors and setting goals (OR: 3.09; 95% CI: 1.39, 6.90), and talking about mental health and overall well-being (OR: 4.02; 95% CI: 1.83, 8.87) than parents without limited English proficiency. We surveyed 75 clinicians and 60% felt telehealth was a useful tool to provide care for pediatric weight management. Clinicians felt virtual visits did not pose barriers to all aspects of care. Informed by the surveys and stakeholder input, we made clinician- and family-level adaptations while retaining the program's function. CONCLUSIONS By engaging stakeholders and adapting the program for telehealth, we optimized the reach and fit of Connect for Health to ensure its continued uptake. We have provided a real-world example of how clinical innovations can evolve and how to systematically plan adaptations in response to changing healthcare contexts. TRIAL REGISTRATION Clinicaltrials.gov (NCT04042493), Registered on August 2, 2019.
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Affiliation(s)
- Meg Simione
- Division of General Academic Pediatrics, Department of Pediatrics, Mass General for Children, 125 Nashua St, Suite 860, Boston, MA, 02114, USA.
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
| | - Kelly Aschbrenner
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Haley Farrar-Muir
- Division of General Academic Pediatrics, Department of Pediatrics, Mass General for Children, 125 Nashua St, Suite 860, Boston, MA, 02114, USA
| | - Man Luo
- Division of General Academic Pediatrics, Department of Pediatrics, Mass General for Children, 125 Nashua St, Suite 860, Boston, MA, 02114, USA
| | - Jazmin Granadeno
- Division of General Academic Pediatrics, Department of Pediatrics, Mass General for Children, 125 Nashua St, Suite 860, Boston, MA, 02114, USA
| | - Ariadne Caballero-Gonzalez
- Division of General Academic Pediatrics, Department of Pediatrics, Mass General for Children, 125 Nashua St, Suite 860, Boston, MA, 02114, USA
| | - Sarah N Price
- Division of General Academic Pediatrics, Department of Pediatrics, Mass General for Children, 125 Nashua St, Suite 860, Boston, MA, 02114, USA
| | - Carlos Torres
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
- MGH Chelsea HealthCare Center, Chelsea, MA, USA
| | - Alexy Arauz Boudreau
- Division of General Academic Pediatrics, Department of Pediatrics, Mass General for Children, 125 Nashua St, Suite 860, Boston, MA, 02114, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Lauren Fiechtner
- Division of General Academic Pediatrics, Department of Pediatrics, Mass General for Children, 125 Nashua St, Suite 860, Boston, MA, 02114, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Simon J Hambidge
- Ambulatory Care Services, Denver Health, Denver, CO, USA
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Kerry Sease
- Department of Pediatrics, University of South Carolina School of Medicine, Greenville, SC, USA
- Prisma Health, Greenville, SC, USA
| | - Elsie M Taveras
- Division of General Academic Pediatrics, Department of Pediatrics, Mass General for Children, 125 Nashua St, Suite 860, Boston, MA, 02114, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
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Persaud A, Castro I, Simione M, Smith JD, O'Connor G, Sharifi M, Perkins M, Torres S, Taveras EM, Kuhlthau K, Fiechtner L. Multi-sector stakeholder's perceptions of determinants of successful implementation of a pediatric weight management intervention. Front Public Health 2022; 10:954063. [PMID: 36091513 PMCID: PMC9454190 DOI: 10.3389/fpubh.2022.954063] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 07/25/2022] [Indexed: 01/24/2023] Open
Abstract
Background Multi-sector stakeholder engagement is essential in the successful implementation, dissemination, and sustainability of pediatric weight management interventions (PWMI), particularly in low-income settings where sustainability relies on external policies and reimbursement. The objective of this study was to engage stakeholders (1) to inform the creation of the intervention with adaptations needed for a successful PWMI in a primary care and community setting and (2) to identify barriers and facilitators to implementation and dissemination. Methods We sought to examine the perspectives of local, state, and national clinic and community stakeholders during the pre-implementation period of a two-arm, randomized trial of a Health Weight Clinic PWMI conducted in two health centers and a modified-Healthy Weight and Your Child PWMI at two local YMCAs that serve a predominantly lower income, Hispanic community. The Consolidated Framework for Implementation Research interview guide served as a template for the study but was modified to fit the PWMIs and the various professional roles. Interviews were transcribed and analyzed using the framework analysis approach and themes were linked to the CFIR domains and constructs. Results Twenty-six stakeholders perceived the following as needed components of a PWMI: a formal curriculum with illustrative examples, a patient- and family-centered program, group visits, and high-quality multidisciplinary personnel. These findings led to the creation of a group visit curriculum, implementation trainings and cross-site collaborative technical assistance. Additionally, creating partnerships between community and clinical organizations, and addressing patient barriers and unmet social needs (i.e., transportation, food) were identified as facilitators to successful implementation. These results led to the creation of community resource guides, connections to community organizations, and screening and referring for unmet social needs. Perceived facilitators of dissemination included proving cost-effectiveness of the PWMI to inform insurance reimbursement for long-term sustainability. Therefore, we collected cost data and engaged with Medicaid officials to discuss reimbursement. Conclusion Findings highlight the importance of engaging multi-sector stakeholders pre-implementation to ensure the components valued are included, ensuring the program minimizes barriers to participation, considering how staff training can improve implementation and how collected outcomes can inform sustainability and dissemination of PWMIs in clinic and community settings.
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Affiliation(s)
- Alicia Persaud
- Division of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston, MA, United States
| | - Ines Castro
- Division of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston, MA, United States
| | - Meg Simione
- Division of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston, MA, United States
| | - Justin D. Smith
- Division of Health Systems Innovation and Research, Department of Population Health Sciences, School of Medicine, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, UT, United States
| | - Giselle O'Connor
- Division of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston, MA, United States
| | - Mona Sharifi
- Section of General Pediatrics, Department of Pediatrics, Yale University School of Medicine, New Haven, CT, United States
| | - Meghan Perkins
- Division of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston, MA, United States
| | - Shioban Torres
- Bureau of Community Health and Prevention, Massachusetts Department of Public Health, Boston, MA, United States
| | - Elsie M. Taveras
- Division of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston, MA, United States
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Karen Kuhlthau
- Division of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston, MA, United States
| | - Lauren Fiechtner
- Division of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston, MA, United States
- Division of Gastroenterology and Nutrition, Massachusetts General Hospital for Children, Boston, MA, United States
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Russ SA, Hotez E, Berghaus M, Verbiest S, Hoover C, Schor EL, Halfon N. What Makes an Intervention a Life Course Intervention? Pediatrics 2022; 149:186916. [PMID: 35503318 PMCID: PMC9847411 DOI: 10.1542/peds.2021-053509d] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/27/2021] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVES To develop an initial list of characteristics of life course interventions to inform the emerging discipline of life course intervention research. METHODS The Life Course Intervention Research Network, a collaborative national network of >75 researchers, service providers, community representatives, and thought leaders, considered the principles, characteristics, and utility of life course interventions. After an in-person launch meeting in 2019, the steering committee collaboratively and iteratively developed a list of life course intervention characteristics, incorporating a modified Delphi review process. RESULTS The Life Course Intervention Research Network identified 12 characteristics of life course interventions. These interventions (1) are aimed at optimizing health trajectories; (2) are developmentally focused, (3) longitudinally focused, and (4) strategically timed; and are (5) designed to address multiple levels of the ecosystem where children are born, live, learn, and grow and (6) vertically, horizontally, and longitudinally integrated to produce a seamless, forward-leaning, health optimizing system. Interventions are designed to (7) support emerging health development capabilities; are (8) collaboratively codesigned by transdisciplinary research teams, including stakeholders; and incorporate (9) family-centered, (10) strengths-based, and (11) antiracist approaches with (12) a focus on health equity. CONCLUSIONS The intention for this list of characteristics of life course interventions is to provide a starting point for wider discussion and to guide research development. Incorporation of these characteristics into intervention designs may improve emerging health trajectories and move critical developmental processes and pathways back on track, even optimizing them to prevent or reduce adverse outcomes.
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Affiliation(s)
- Shirley A. Russ
- Center for Healthier Children, Families, and Communities,Departments of Pediatrics,Address correspondence to Shirley Russ, MD, MPH, Center for Healthier Children, Families, and Communities, University of California, Los Angeles, 10960 Wilshire Blvd, Ste 960, Los Angeles, CA 90024. E-mail:
| | - Emily Hotez
- Center for Healthier Children, Families, and Communities,Medicine, Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Mary Berghaus
- Center for Healthier Children, Families, and Communities,Departments of Pediatrics
| | - Sarah Verbiest
- Jordan Institute for Families, School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | | | - Neal Halfon
- Center for Healthier Children, Families, and Communities,Departments of Pediatrics,Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California,Department of Public Policy, Luskin School of Public Affairs, University of California, Los Angeles, Los Angeles, California
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Viana JN, Edney S, Gondalia S, Mauch C, Sellak H, O'Callaghan N, Ryan JC. Trends and gaps in precision health research: a scoping review. BMJ Open 2021; 11:e056938. [PMID: 34697128 PMCID: PMC8547511 DOI: 10.1136/bmjopen-2021-056938] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 10/08/2021] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE To determine progress and gaps in global precision health research, examining whether precision health studies integrate multiple types of information for health promotion or restoration. DESIGN Scoping review. DATA SOURCES Searches in Medline (OVID), PsycINFO (OVID), Embase, Scopus, Web of Science and grey literature (Google Scholar) were carried out in June 2020. ELIGIBILITY CRITERIA Studies should describe original precision health research; involve human participants, datasets or samples; and collect health-related information. Reviews, editorial articles, conference abstracts or posters, dissertations and articles not published in English were excluded. DATA EXTRACTION AND SYNTHESIS The following data were extracted in independent duplicate: author details, study objectives, technology developed, study design, health conditions addressed, precision health focus, data collected for personalisation, participant characteristics and sentence defining 'precision health'. Quantitative and qualitative data were summarised narratively in text and presented in tables and graphs. RESULTS After screening 8053 articles, 225 studies were reviewed. Almost half (105/225, 46.7%) of the studies focused on developing an intervention, primarily digital health promotion tools (80/225, 35.6%). Only 28.9% (65/225) of the studies used at least four types of participant data for tailoring, with personalisation usually based on behavioural (108/225, 48%), sociodemographic (100/225, 44.4%) and/or clinical (98/225, 43.6%) information. Participant median age was 48 years old (IQR 28-61), and the top three health conditions addressed were metabolic disorders (35/225, 15.6%), cardiovascular disease (29/225, 12.9%) and cancer (26/225, 11.6%). Only 68% of the studies (153/225) reported participants' gender, 38.7% (87/225) provided participants' race/ethnicity, and 20.4% (46/225) included people from socioeconomically disadvantaged backgrounds. More than 57% of the articles (130/225) have authors from only one discipline. CONCLUSIONS Although there is a growing number of precision health studies that test or develop interventions, there is a significant gap in the integration of multiple data types, systematic intervention assessment using randomised controlled trials and reporting of participant gender and ethnicity. Greater interdisciplinary collaboration is needed to gather multiple data types; collectively analyse big and complex data; and provide interventions that restore, maintain and/or promote good health for all, from birth to old age.
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Affiliation(s)
- John Noel Viana
- Responsible Innovation Future Science Platform, Commonwealth Scientific and Industrial Research Organisation, Brisbane, Queensland, Australia
- Australian National Centre for the Public Awareness of Science, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Sarah Edney
- Physical Activity and Nutrition Determinants in Asia (PANDA) programme, Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Shakuntla Gondalia
- Precision Health Future Science Platform, Commonwealth Scientific and Industrial Research Organisation, Adelaide, South Australia, Australia
- Health and Biosecurity, Commonwealth Scientific and Industrial Research Organisation, Adelaide, South Australia, Australia
| | - Chelsea Mauch
- Health and Biosecurity, Commonwealth Scientific and Industrial Research Organisation, Adelaide, South Australia, Australia
| | - Hamza Sellak
- Precision Health Future Science Platform, Commonwealth Scientific and Industrial Research Organisation, Adelaide, South Australia, Australia
- Data61, Commonwealth Scientific and Industrial Research Organisation, Melbourne, Victoria, Australia
| | - Nathan O'Callaghan
- Precision Health Future Science Platform, Commonwealth Scientific and Industrial Research Organisation, Adelaide, South Australia, Australia
| | - Jillian C Ryan
- Precision Health Future Science Platform, Commonwealth Scientific and Industrial Research Organisation, Adelaide, South Australia, Australia
- Health and Biosecurity, Commonwealth Scientific and Industrial Research Organisation, Adelaide, South Australia, Australia
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Clarke R, Heath G, Nagakumar P, Pattison H, Farrow C. "He's not fat, he just has asthma": a qualitative study exploring weight management in families living with pediatric asthma. J Asthma 2021; 59:1750-1757. [PMID: 34470559 DOI: 10.1080/02770903.2021.1975739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Children and young people living with asthma have an increased risk of overweight/obesity, leading to increased severity of asthma symptoms. Weight management has been recommended to improve asthma symptoms, however, there is limited understanding of how this is experienced or how children and young people with asthma and their families wish to be supported. The aim of this study was to explore parents and children/young people's views and experiences of managing weight while living with asthma, and to identify acceptable strategies for support.Methods: A qualitative methodological approach was taken to facilitate rich understanding of families' insights into weight management while living with asthma. In-depth interviews were conducted with nine families living with pediatric asthma (n = 9 parents, 9 young people). Data were analyzed using a Framework approach.Results: Findings indicated that family engagement with weight management behaviors was primarily influenced by perceptions of risk regarding asthma outcomes and beliefs about asthma control. Families also reported weight management engagement to be influenced by perceptions of the food environment, perceptions of the exercise environment (e.g. weather, anticipated social outcomes) and the availability of weight management support. Participants sought tailored support which gave consideration to the asthma-obesity interaction. It was suggested that this would help reduce perceptions of weight stigma in consultations, thereby supporting behavioral changes.Conclusions: Individualized weight management plans that consider families concerns about asthma-related risk are needed to manage weight in children and young people living with asthma.
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Affiliation(s)
- Rebecca Clarke
- School of Psychology, College of Health & Life Sciences, Aston University, Birmingham, UK
| | - Gemma Heath
- School of Psychology, College of Health & Life Sciences, Aston University, Birmingham, UK
| | - Prasad Nagakumar
- Department of Paediatric Respiratory Medicine and Cystic Fibrosis, Birmingham Women's and Children's Hospital, Birmingham, UK
| | - Helen Pattison
- School of Psychology, College of Health & Life Sciences, Aston University, Birmingham, UK
| | - Claire Farrow
- School of Psychology, College of Health & Life Sciences, Aston University, Birmingham, UK
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