Development and use of an index for measuring implementation of a weight management program in children in primary care clinics in Texas

Abstract

BackgroundThe Texas Childhood Obesity Research Demonstration study was an integrated, systems-oriented intervention that incorporated primary and secondary obesity prevention approaches targeting multiple sectors, including primary care clinics, to address childhood obesity. The primary care clinic component included the American Academy of Pediatrics’ Next Steps weight management counseling materials that support brief healthy lifestyle-focused visits. The current study describes the methodology and assesses the implementation of the Next Steps program in the participating primary care clinics, as well as the association of implementation with enrollment of children with overweight and obesity in the secondary prevention intervention.MethodsThe study used a serial cross-sectional study design to collect data from 11 primary care clinics in Houston (n = 5) and Austin (n = 6), Texas, in 2013–2014. Responses of primary care providers on 42 self-reported survey questions assessing acceptability, adoption, appropriateness, and feasibility of the program were utilized to create a mean standardized clinic implementation index score. Provider scores were aggregated to represent Next Steps implementation scores at the clinic level. A mixed effects logistic regression test was conducted to determine the association between program implementation and the enrollment of children in the secondary prevention.ResultsMean implementation index score was lower at Year 2 of implementation (2014) than Year 1 (2013) although the decrease was not significant [63.2% (12.2%) in 2013 vs. 55.3% (16.5%) in 2014]. There were no significant associations between levels of implementation of Next Steps and enrollment into TX CORD secondary prevention study.ConclusionsThe development of an index using process evaluation measures can be used to assess the implementation and evaluation of provider-based obesity prevention tools in primary care clinics.

Communication tools used in childhood obesity discussions: A scoping review

“…With one exception, tools were developed in North America (Sen et al, 2018). Only two tools reported pre‐administration training requirements, with the remaining deemed self‐explanatory or providing simple directions for use (Salahuddin et al, 2018; Wislo et al, 2013). Three tools focused on discussion related to a child's BMI classification, (Cloutier et al, 2013; Oettinger et al, 2009; Vaczy et al, 2011), whereas two tools were intended to gather information related to diet and physical activity (Rutkowski & Connelly, 2016; Townsend et al, 2018).…”

“…Three tools focused on discussion related to a child's BMI classification, (Cloutier et al, 2013; Oettinger et al, 2009; Vaczy et al, 2011), whereas two tools were intended to gather information related to diet and physical activity (Rutkowski & Connelly, 2016; Townsend et al, 2018). Six tools centred on discussions related to client lifestyle (Ball et al, 2013; Polacsek et al, 2009; Salahuddin et al, 2018; Sen et al, 2018; Wislo et al, 2013; Woolford et al, 2009), three of which also incorporated goal setting components (Polacsek et al, 2009; Salahuddin et al, 2018; Woolford et al, 2009). Two tools were manuals with evidence‐based counselling recommendations (Pollak et al, 2016; Provvidenza et al, 2017).…”

“…Two tools were manuals with evidence‐based counselling recommendations (Pollak et al, 2016; Provvidenza et al, 2017). Five of the articles displayed a full visual copy of the tool described (Cloutier et al, 2013; Kraschnewski et al, 2013; Polacsek et al, 2009; Rutkowski & Connelly, 2016;Vaczy et al, 2011), and five tools could be accessed on the web (Ball et al, 2013; Pollak et al, 2016; Provvidenza et al, 2017; Salahuddin et al, 2018;Townsend et al, 2018). One tool could not be accessed directly through the article or online but was provided after contacting the author by email (Sen et al, 2018).…”

“…One tool could not be accessed directly through the article or online but was provided after contacting the author by email (Sen et al, 2018). All tools were intended for use as printed resources and ranged from 1‐page resources (Cloutier et al, 2013; Oettinger et al, 2009; Rutkowski & Connelly, 2016; Townsend et al, 2018;Vaczy et al, 2011) to compendiums of resources packaged in toolkits (Polacsek et al, 2009; Pollak et al, 2016; Provvidenza et al, 2017; Woolford et al, 2009), whereas others were designed as board games or flash cards (Ball et al, 2013; Salahuddin et al, 2018; Sen et al, 2018; Wislo et al, 2013). Of the five tools available online, two were immediately accessible (Provvidenza et al, 2017;Townsend et al, 2018) and three needed to be ordered at a cost (Ball et al, 2013; Pollak et al, 2016; Salahuddin et al, 2018; ).…”

“…The majority of tools were used in primary care settings (Ball et al, 2013;Cloutier et al, 2013;Oettinger et al, 2009;Polacsek et al, 2009;Rutkowski & Connelly, 2016 Woolford et al, 2009). All tools were described for use by paediatricians (Ball et al, 2013;Cloutier et al, 2013;Oettinger et al, 2009;Polacsek et al, 2009;Pollak et al, 2016;Provvidenza et al, 2017;Rutkowski & Connelly, 2016;Salahuddin et al, 2018;Sen et al, 2018;Townsend et al, 2018;Vaczy et al, 2011;Wislo et al, 2013;Woolford et al, 2009), with two also aimed at nurse practitioners (Rutkowski & Connelly, 2016;Vaczy et al, 2011), three at nurses (Ball et al, 2013;Provvidenza et al, 2017;Rutkowski & Connelly, 2016) and one for physician assistants (Salahuddin et al, 2018). Four articles described tool use with other HCPs, including nutritionists, dieticians and exercise specialists (Ball et al, 2013;Polacsek et al, 2009;Provvidenza et al, 2017;Vaczy et al, 2011).…”