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Ahmed U, Mahmood MS, Parsons M, O'callaghan H, Pawlik O, Chaudhary S, Ahmed M. A Systematic Review Looking at the Current Best Practices as well as Primary Care Practitioner's Views on the Diagnosis and Treatment of Childhood Obesity. Cureus 2023; 15:e34346. [PMID: 36874666 PMCID: PMC9977081 DOI: 10.7759/cureus.34346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2023] [Indexed: 01/31/2023] Open
Abstract
Childhood obesity is a significant and growing issue, with the WHO recognising worldwide childhood obesity rates as an epidemic. Primary care is often the first point for monitoring a child's development over time, hence could play an integral part in recognising and addressing childhood obesity. As a result, our systematic review has two objectives. The primary objective is to review the current evidence on best practices in diagnosing and treating childhood obesity. The secondary objective is to review recent qualitative studies looking into the view of primary care practitioners on the treatment and diagnosis of childhood obesity. The rationale for this is to help determine what opportunities there are in primary care in the NHS to tackle childhood obesity. Using searches in MEDLINE, EMBASE, PSYCHINFO, HMIC and NHS evidence over a five-year period from March 2014 to March 2019, a total of 37 studies were eligible for inclusion in the review. Out of these, 25 studies identified exploring the diagnosis and treatment of childhood obesity. A few key themes in these studies were identified, including motivational interviewing, m-health, tools and resources used in consultations, the use of dieticians in the primary care team and factors concerned with the identification of obesity in children. The rest of the 12 qualitative studies involved eliciting the views of direct stakeholders about the diagnosis and treatment of obesity in children. Eight of the studies investigated providers' views towards the role of primary care practitioners in treating childhood obesity, two investigated the parents of obese children's perspectives and the other two investigated general practitioners' (GPs) views towards specific tools and resources. Regarding our primary objective, our findings showed many studies looking at interventions to reduce the BMI in obese children fail to do so in a statistically significant way. However, a few interventions have been more consistent in reducing BMI and obesogenic behaviours. Those interventions include ones utilising the motivational interviewing technique and those targeting families, rather than children. Another key finding was that tools and resources available to primary care providers can significantly impact their ability to diagnose and treat obesity, particularly when looking at the detection. Finally, evidence regarding the clinical effectiveness of e-health is limited, with views on their use also mixed. Regarding our secondary objective, the qualitative research identified demonstrated many common views from GPs across different countries. It showed healthcare providers (HCPs) perceiving the parents as lacking in motivation to address the issue, HCPs not wanting to damage the relationship with their patients due to it being a sensitive topic to bring up, and a lack of time, training and confidence. However, some of these views may not be generalisable to the UK due to cultural and system differences.
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Affiliation(s)
- Umar Ahmed
- Ophthalmology, Surrey and Sussex Healthcare NHS Trust, London, GBR
| | - Mohammed S Mahmood
- Hospital-Based Medicine, University Hospitals of Morecambe Bay NHS Foundation Trust, Lancaster, GBR
| | - Matt Parsons
- Hospital-Based Medicine, Hampshire Hospitals NHS Foundation Trust, Hampshire, GBR
| | - Hyatt O'callaghan
- Hospital-Based Medicine, Swansea Bay University Health Board, Swansea, GBR
| | - Olga Pawlik
- General Medicine, Nepean Hospital, Kingswood, AUS
| | - Saif Chaudhary
- Hospital-Based Medicine, Imperial College London, London, GBR
| | - Maryam Ahmed
- Orthopaedics and Trauma, Royal Surrey County Hospital, Guildford, GBR
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Exploring healthcare professionals' views of the acceptability of delivering interventions to promote healthy infant feeding practices within primary care: a qualitative interview study. Public Health Nutr 2021; 24:2889-2899. [PMID: 33317663 PMCID: PMC9884767 DOI: 10.1017/s1368980020004954] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Early-life nutrition plays a key role in establishing healthy lifestyles and preventing chronic disease. This study aimed to (1) explore healthcare professionals' (HCP) opinions on the acceptability of and factors influencing the delivery of interventions to promote healthy infant feeding behaviours within primary care and (2) identify proposed barriers/enablers to delivering such interventions during vaccination visits, to inform the development of a childhood obesity prevention intervention. DESIGN A qualitative study design was employed using semi-structured telephone interviews. Data were analysed using qualitative content analysis; findings were also mapped to the Theoretical Framework of Acceptability (TFA). SETTING Primary care in Ireland. PARTICIPANTS Twenty-one primary care-based HCP: five practice nurses, seven general practitioners, three public health nurses, three community dietitians and three community medical officers. RESULTS The acceptability of delivering interventions to promote healthy infant feeding within primary care is influenced by the availability of resources, HCP's roles and priorities, and factors relating to communication and relationships between HCP and parents. Proposed barriers and enablers to delivering interventions within vaccination visits include time constraints v. opportunistic access, existing relationships and trust between parents and practice nurses, and potential communication issues. Barriers/enablers mapped to TFA constructs of Affective Attitude, Perceived Effectiveness and Self-Efficacy. CONCLUSIONS This study provides a valuable insight into HCP perspectives of delivering prevention-focused infant feeding interventions within primary care settings. While promising, factors such as coordination and clarity of HCP roles and resource allocation need to be addressed to ensure acceptability of interventions to HCP involved in delivery.
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Toomey E, Matvienko-Sikar K, Doherty E, Harrington J, Hayes CB, Heary C, Hennessy M, Kelly C, McHugh S, McSharry J, O'Halloran J, Queally M, Heffernan T, Kearney PM, Byrne M. A collaborative approach to developing sustainable behaviour change interventions for childhood obesity prevention: Development of the Choosing Healthy Eating for Infant Health (CHErIsH) intervention and implementation strategy. Br J Health Psychol 2020; 25:275-304. [PMID: 31999887 DOI: 10.1111/bjhp.12407] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 01/10/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES AND DESIGN There is growing recognition of the need for effective behaviour change interventions to prevent chronic diseases that are feasible and sustainable and can be implemented within routine health care systems. Focusing on implementation from the outset of intervention development, and incorporating multiple stakeholder perspectives to achieve this, is therefore essential. This study explores the development of the Choosing Healthy Eating for Infant Health (CHErIsH) childhood obesity prevention intervention and implementation strategy to improve infant feeding behaviours. METHODS Five qualitative and quantitative evidence syntheses, two primary qualitative studies, and formal/informal consultations were conducted with practice, policy, research, and parent stakeholders. The Behaviour Change Wheel was used to guide the integration of findings. RESULTS The CHErIsH intervention targets parent-level behaviour change and comprises (1) brief verbal messages and (2) trustworthy resources, to be delivered by health care professionals (HCPs) during routine infant vaccination visits. The implementation strategy targets HCP-level behaviour change and comprises (1) a local opinion leader, (2) incentivized training, (3) HCP resources and educational materials, (4) electronic delivery prompts, (5) awareness-raising across all primary care HCPs, and (6) local technical support. CONCLUSIONS This study provides a rigorous example of the development of an evidence-based intervention aimed at improving parental infant feeding behaviours, alongside an evidence-based behaviour change strategy to facilitate implementation and sustainability in primary care. This approach demonstrates how to systematically incorporate multiple stakeholder perspectives with existing literature and move from multiple evidence sources to clearly specified intervention components for both the intervention and implementation strategy. Statement of Contribution What is already known? Incorporating insights from practice, policy, and public/patient stakeholders plays a key role in developing behaviour change interventions that are feasible and sustainable and can be implemented within routine health care systems. However, there are limited examples that provide in-depth guidance of how to do this using a systematic approach. What this study adds? This study describes an innovative use of the Behaviour Change Wheel to integrate multiple sources of evidence collected from practice, policy, research, and parent stakeholders to concurrently develop an evidence-based intervention to improve parental infant feeding behaviours and an implementation strategy to facilitate sustainable delivery by health care professionals in routine primary care.
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Affiliation(s)
- Elaine Toomey
- Health Behavior Change Research Group, School of Psychology, National University of Ireland, Galway, Ireland
| | | | - Edel Doherty
- Discipline of Economics, National University of Ireland, Galway, Ireland
| | | | - Catherine B Hayes
- Discipline of Public Health and Primary Care, Institute of Population Health, Trinity College Dublin, Ireland
| | - Caroline Heary
- School of Psychology, National University of Ireland, Galway, Ireland
| | - Marita Hennessy
- Health Behavior Change Research Group, School of Psychology, National University of Ireland, Galway, Ireland
| | - Colette Kelly
- Health Promotion Research Centre, School of Health Promotion, National University of Ireland, Galway, Ireland
| | - Sheena McHugh
- School of Public Health, University College Cork, Ireland
| | - Jenny McSharry
- Health Behavior Change Research Group, School of Psychology, National University of Ireland, Galway, Ireland
| | | | - Michelle Queally
- Discipline of Economics, National University of Ireland, Galway, Ireland
| | - Tony Heffernan
- Cork Road Clinic, Mallow Primary Healthcare Centre, Co. Cork, Ireland
| | | | - Molly Byrne
- Health Behavior Change Research Group, School of Psychology, National University of Ireland, Galway, Ireland
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Linville D, McClure H, Martinez C, Mena Morales C. Latinx Immigrant Farmworker Community Health Promotion: A Needs Assessment. Health Promot Pract 2019; 21:372-382. [PMID: 31448630 DOI: 10.1177/1524839919869923] [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]
Abstract
The present study examined the health promotion intervention needs of Latinx immigrant farmworker families residing in Oregon. Grounded theory qualitative procedures were used to analyze the needs assessment data from 31 Latinx immigrant farmworker residents and key informant interviews as well as four focus groups with resident youth and parents. A theoretical model of how key family-based health behaviors can both confer risk for and protection against negative physical, mental, and social health outcomes among Latinx farmworking communities emerged. Six primary areas of concern emerged from these data, leading to the identification of primary health promotion intervention needs with three foci: (a) the provision of sustainable supports and resources, (b) skill development so that individuals could successfully negotiate identified challenges, and (c) greater community efficacy. Findings underscore the importance of social support and resource accessibility for Latinx immigrant populations.
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Kakkad A, Chandler C, Coel M, Spann A, Struhar S, Wilkinson S, Crocker T. Partnering with Panama: Exploring Anthropometrics, Dietary Patterns, and the Built Food Environment of School-aged Children. Ecol Food Nutr 2019; 59:21-34. [PMID: 31430200 DOI: 10.1080/03670244.2019.1652821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Childhood obesity is a global public health concern in developed and developing countries. Approximately 3 in 10 Panamanian children suffer from obesity, and overweight/obesity is responsible for the highest number of premature or avoidable deaths in this country. A formative community assessment and exploration of the built food environment was conducted. Analysis suggests that almost one-third of the children measured were overweight or obese, and the availability of foods recommended for optimal health is limited in this community. Actionable recommendations for intervention and future collaboration were provided, and stakeholders from all groups will continue to explore opportunities.
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Affiliation(s)
- Astha Kakkad
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Chelsea Chandler
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Mikaela Coel
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Adeeba Spann
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Stacey Struhar
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Shannon Wilkinson
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Theresa Crocker
- College of Public Health, University of South Florida, Tampa, FL, USA
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Lidgate ED, Li B, Lindenmeyer A. A qualitative insight into informal childcare and childhood obesity in children aged 0-5 years in the UK. BMC Public Health 2018; 18:1229. [PMID: 30400788 PMCID: PMC6219155 DOI: 10.1186/s12889-018-6131-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 10/19/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Previous studies in various countries have found that informal childcare (provided by relatives, friends etc.) was associated with an increased risk of obesity in children aged 0-5 years. However, no qualitative research has been done to explore possible reasons for such a relationship and potential interventions to tackle it. We conducted a qualitative study with both parents and informal carers to explore their 1) experiences in receiving or giving informal childcare for British children aged 0-5 years; 2) perceived explanations of the relationship between informal childcare and childhood obesity and 3) preferred intervention ideas and delivery strategies for preventing obesity among those children under informal care. METHODS Four in-depth focus groups with a total of 14 participants (7 parents, 7 informal caregivers) were conducted in Birmingham and Edinburgh (1 parent group and 1 informal caregiver group in each city). Data were audio recorded, transcribed verbatim and analysed using a thematic approach. RESULTS The significance of informal care to parents, carers, and society was recognised (theme one). Informal carers were identified to have practical and emotional support roles for the parents (theme two). Informal care was perceived to contribute to childhood obesity in four ways (theme three): cross-generation conflict preventing adoption of healthy practices; the trade-off for parents between receiving childcare and maintaining control; reduced energy capacity of carers; and increased snacking. Potential intervention ideas and delivery strategies (theme four) were identified. Examples of identified ideas included providing carers with up-to-date weaning advice, and suggestions of healthy snacks and ways to increase physical activity level in informal care. The suggestion of utilising existing primary care platforms (e.g. health visitor check-ups) to reach and deliver low-cost information based interventions, to all children aged 0-5 years who receive informal care, was highlighted. CONCLUSIONS This exploratory qualitative study provided novel insights into potential explanations for the evidenced link between informal care and childhood obesity in children aged 0-5 years, despite a small size and limited participants in each focus group. Our findings support the idea of and inform the development towards an information based and low-cost intervention delivered through existing primary care platforms.
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Affiliation(s)
- Eleanor Diana Lidgate
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, West Midlands UK
| | - Bai Li
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, West Midlands B15 2TT UK
| | - Antje Lindenmeyer
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, West Midlands B15 2TT UK
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Houlden RL, Yen HH, Mirrahimi A. The Lifestyle History: A Neglected But Essential Component of the Medical History. Am J Lifestyle Med 2018; 12:404-411. [PMID: 30245606 PMCID: PMC6146369 DOI: 10.1177/1559827617703045] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 03/13/2017] [Accepted: 03/15/2017] [Indexed: 12/22/2022] Open
Abstract
There is increased recognition that lifestyle factors, including nutrition, physical activity, emotional well-being and stress management, tobacco use, alcohol consumption, and sleep habits, are major determinants of health. There is a need to teach practicing physicians, medical trainees, and other health care providers how to perform a "lifestyle history." This article proposes 13 screening questions physicians should consider exploring with patients. It provides the rationale and scientific evidence supporting each question and includes key lifestyle counseling points for clinicians to consider.
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Affiliation(s)
- Robyn L. Houlden
- Robyn L. Houlden, MD, FRCPC, Division of Endocrinology, Kingston General Hospital, Queen’s University, 76 Stuart Street, Kingston, ON K7L 2V7, Canada; e-mail:
| | - Hope H. Yen
- Division of Endocrinology and Metabolism, Queen’s University, Kingston, ON, Canada (RLH, HHY)
- School of Medicine, Faculty of Health Sciences, Queen’s University, Kingston, ON, Canada (AM)
| | - Arash Mirrahimi
- Division of Endocrinology and Metabolism, Queen’s University, Kingston, ON, Canada (RLH, HHY)
- School of Medicine, Faculty of Health Sciences, Queen’s University, Kingston, ON, Canada (AM)
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Wray CV, Brauer PM, Heuberger RA, Logomarsino JV. Improving Documentation of Pediatric Height, Weight, and Body Mass Index by Primary Care Providers. CAN J DIET PRACT RES 2018; 79:186-190. [PMID: 30014715 DOI: 10.3148/cjdpr-2018-019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The regular documentation of anthropometric data in an electronic medical record (EMR) is one tracking method used by primary care providers to follow the growth trajectory and development of children in their health care practices. EMR reminders have been proposed as a method to increase recording of pediatric height and weight by primary care providers, leading to potentially better detection and management of children classified as overweight or obese. The aim of this pre-post study was to improve a Family Health Team's physician documentation of pediatric height and weight through the implementation of an EMR reminder alert tool. The documentation rate for children 4-7 years old in the 6 months before intervention was 36% of children seen. After implementation of EMR reminder alerts, primary care physicians' documentation rate rose to 45% (9% increase; P < 0.01), but it was below the 15% target increase. Better documentation of pediatric height and weight by family physicians is needed to improve monitoring of children's growth trajectories. Additional strategies to increase documentation rates are needed.
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Affiliation(s)
| | - Paula M Brauer
- b Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, ON
| | - Roschelle A Heuberger
- c Department of Human Environmental Studies, Central Michigan University, Mount Pleasant, MI
| | - John V Logomarsino
- d Department of Human Environmental Studies, Central Michigan University, Mount Pleasant, MI
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Development of a patient experience questionnaire to improve lifestyle services in primary care. Prim Health Care Res Dev 2018; 19:542-552. [PMID: 29334045 DOI: 10.1017/s1463423617000937] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
AimWe developed a self-report tool to assess patients' experiences with lifestyle services in team-based primary care and pilot tested the questionnaire as part of a lifestyle intervention study to reverse metabolic syndrome. BACKGROUND Older client satisfaction questionnaires have been generally inadequate for quality improvement purposes, as they have been focused mainly on interpersonal skills of providers and/or in the context of one disease. New approaches to assessing the patient experience of lifestyle programs in primary care are needed and could inform quality improvement efforts over time. METHODS The first phase in developing the questionnaire involved a group-administered questionnaire distributed to 38 healthcare providers in five groups to prioritize variables to include in the survey. Concepts were taken from a previous review of available questionnaires assessing primary care services. The draft questionnaire was reviewed by 11 participants from a lifestyle program using think-aloud cognitive interviewing techniques. The modified self-administered questionnaire (paper and online versions) was then pilot tested with 164 recipients of a nutrition and physical activity intervention program.FindingsProviders ranked the top variables to include in the questionnaire as: 'trust,' 'general communication,' 'first-contact accessibility,' 'whole-person care,' and 'respectfulness.' After cognitive interviewing and revisions, 21 multiple choice and two open-ended questions were used for pilot testing. Pilot testing identified additional minor wording changes that were needed for clarity, a decreased number of questions for redundant concepts, and decreased options for ceiling effects, resulting in 20 multiple choice and one open-ended question. CONCLUSIONS The modified self-administered patient experience questionnaire to assess lifestyle services in primary care has undergone rigorous development. Further validation is needed. The assessment of patient experience of lifestyle programs can be used to supplement other data to assess the overall effectiveness of such programs.
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Matvienko-Sikar K, Toomey E, Delaney L, Harrington J, Byrne M, Kearney PM. Effects of healthcare professional delivered early feeding interventions on feeding practices and dietary intake: A systematic review. Appetite 2017; 123:56-71. [PMID: 29225141 DOI: 10.1016/j.appet.2017.12.001] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 11/18/2017] [Accepted: 12/01/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Childhood obesity is a global public health challenge. Parental feeding practices, such as responsive feeding, are implicated in the etiology of childhood obesity. PURPOSE This systematic review aimed to examine of effects of healthcare professional-delivered early feeding interventions, on parental feeding practices, dietary intake, and weight outcomes for children up to 2 years. The role of responsive feeding interventions was also specifically examined. METHODS Databases searched included: CINAHL, the Cochrane Library, EMBASE, Medline, PubMed, PsycINFO, and Maternity and Infant Care. INCLUSION CRITERIA participants are parents of children ≤2 years; intervention includes focus on early child feeding to prevent overweight and obesity; intervention delivered by healthcare professionals. RESULTS Sixteen papers, representing 10 trials, met inclusion criteria for review. Six interventions included responsive feeding components. Interventions demonstrated inconsistent effects on feeding practices, dietary intake, and weight outcomes. Findings suggest some reductions in pressure to eat and infant consumption of non-core beverages. Responsive feeding based interventions demonstrate greater improvements in feeding approaches, and weight outcomes. CONCLUSIONS The findings of this review highlight the importance of incorporating responsive feeding in healthcare professional delivered early feeding interventions to prevent childhood obesity. Observed inconsistencies across trials may be explained by methodological limitations.
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Affiliation(s)
| | - Elaine Toomey
- School of Psychology, National University of Ireland Galway, Ireland
| | - Lisa Delaney
- School of Public Health, University College Cork, Ireland
| | | | - Molly Byrne
- School of Psychology, National University of Ireland Galway, Ireland
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Management of Childhood Obesity and Overweight in Primary Care Visits: Gaps Between Recommended Care and Typical Practice. Curr Nutr Rep 2017. [DOI: 10.1007/s13668-017-0221-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Rashid A. Yonder: Workplace violence, childhood obesity, somatoform disorders and 'selfies'. Br J Gen Pract 2016; 66:374. [PMID: 27364668 PMCID: PMC4917038 DOI: 10.3399/bjgp16x685933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Affiliation(s)
- Ahmed Rashid
- NIHR Academic Clinical Fellow in General Practice, University of Cambridge, Cambridge. E-mail: , mar74@Dr_A_Rashid
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