Connect for Health : Design of a clinical-community childhood obesity intervention testing best practices of positive outliers

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.

Comparative Effectiveness of Clinical-Community Childhood Obesity Interventions

“…15–17 Clinicians also gave parents a set of evidence-supported educational materials focusing on specified behavioral targets to support self-guided behavior change. 17 The materials focused primarily on decreases in screen time and sugar-sweetened beverages; improving diet quality; increases in moderate and vigorous physical activity; and improvement in sleep duration and quality.…”

Efficacious Approach to Integrating Health and Wellness Coaching Into the Clinical Care for Weight Management: A Systematic Review and Proposal

“…Literature extensively shows health and wellness coaching is efficacious for weight management in a variety of primary care settings for obese and overweight patients ranging from children to adults (Table 1). Coaching has been successfully implemented in the care of children [44,45] , adolescents [46] , and adults [10,[47][48][49][50][51][52] . Coaching has also been incorporated into patient care with a variety of health professionals.…”

“…Coaching has also been incorporated into patient care with a variety of health professionals. This has been achieved with coaches plus PCP collaboration [8,10,4244,53] , with coaches alone [31,[44][45][46][47][48][49][50]52,53] , with physician coaches [34,46] , and with auxiliary health professional coaches such as Medical Assistants [38,47,54] , Nurse Practitioners [50] , and Registered Dietician Nutritionists [31] .…”

“…As to a method of implementing coaching in a clinical care process, this has been done for groups of patients [10] , parent-child groups [44,45] , via one-on-one sessions [10,31,34,38,[45][46][47][48][49][50]52] . Coaching was also integrated in-person [10,31,34,[46][47][48][49][50][51]54] and remotely via telephone [10,45,49,52] , a study-specific website [10] , email support [10,14] , as well as general mail, text message, and virtual video visit [45] .…”

Correlates of Resource Empowerment among Parents of Children with Overweight or Obesity

“…Details of study design, randomization, and recruitment are described elsewhere. 19 This analysis examined baseline data of parentchild pairs enrolled in the study.…”