Feasibility of enhancing well‐child visits with family nutrition and physical activity risk assessment on body mass index

Bailey‐Davis, Lisa; Kling, Samantha M.R.; Wood, G. Craig; Cochran, William; Mowery, Jacob; Savage, Jennifer S.; Stametz, Rebecca; Welk, Gregory J.

doi:10.1002/osp4.339

Cited by 13 publications

(24 citation statements)

References 27 publications

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“…The interventions were delivered and evaluated in Geisinger’s service region, a rural area of Pennsylvania, from April 2019 to May 2020. Pediatrician counseling on obesity prevention is supported through institutionalized screening called PREVENT ( 21 ). As standard of care at well-child visits, parents complete the Family Nutrition and Physical Activity (FNPA) tool ( 22 ) and results are integrated into children’s electronic health record (EHR).…”

Section: Methodsmentioning

confidence: 99%

Family-Based Telehealth Initiative to Improve Nutrition and Physical Activity for Children With Obesity and Its Utility During COVID-19: A Mixed Methods Evaluation

et al. 2022

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Guidelines recommend primary care providers refer children with obesity to behavioral interventions, but given limited program availability, access, and parental engagement, referrals remain rare. We developed telehealth coaching interventions for families whose children received care at a health system in Pennsylvania, United States in 2019-2020. Intervention referrals were facilitated by the pediatrician and/or project team for 6–12-year-old children with obesity following well-child visits. Participants chose one of three 26-week interventions focused on healthy eating, physical activity, or a hybrid clinical/nutrition intervention. Interventions engaged parents as change agents, enhancing self-efficacy to model and reinforce behavior and providing resources to help create a healthy home environment. We enrolled 77 of 183 eligible parent/child dyads. We used mixed methods to evaluate the interventions. Repeated measures models among participants showed significant reductions in obesogenic nutrition behaviors post-intervention and at 1-year follow-up, including a reduction in sugar-sweetened beverage intake of 2.14 servings/week (95% confidence interval: −3.45, −0.82). There were also improvements in obesoprotective nutrition behaviors (e.g., frequency of family meals, parental self-efficacy related to meal management). One year post-baseline, we observed no significant differences in changes in body mass index (BMI) z-scores comparing child participants with matched controls. Given potential impacts of COVID-19 community restrictions on study outcomes, we conducted qualitative interviews with 13 participants during restrictions, which exemplified how disrupted routines constrained children’s healthy behaviors but that intervention participation prepared parents by providing cooking and physical activities at home. Findings support the potential of a telehealth-delivered nutrition intervention to support adoption of healthy weight behaviors.

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Section: Methodsmentioning

confidence: 99%

Family-Based Telehealth Initiative to Improve Nutrition and Physical Activity for Children With Obesity and Its Utility During COVID-19: A Mixed Methods Evaluation

et al. 2022

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“…PCPs randomized to the PRO WCV arm utilize the EHR system to enhance the WCV by collecting and integrating a PRO measure in the patient’s EHR and clinical workflow [ 30 ]. The FNPA is a validated 20-item PRO measure designed to identify behavioral and environmental risk factors for obesity during childhood [ 28 , 29 , 37 ].…”

Section: Methodsmentioning

confidence: 99%

“…The primary outcome for this study is change in child BMIz at 12 months post-baseline WCV. Preliminary data comparing change in child BMIz between WCV versus PRO WCV showed a change of 0.05 units corresponding to an effect size of 0.20 [ 30 ]. To determine sample size, we used an effect size of 0.20, an overall significance level of 0.05 (0.025 for each comparison, i.e., WCV versus PRO WCV and WCV versus PRO WCV plus Food Care), an intra-cluster correlation coefficient at 0.005, and a coefficient of variation at 0.25.…”

Section: Methodsmentioning

confidence: 99%

“…WCVs can be enhanced with PRO measures to engage parents in self-assessment of behaviors, practices, and home environments that are associated with obesity and predict risk before obesity is established [25][26][27]. Our previous work demonstrated that using a validated questionnaire, the Family Nutrition and Physical Activity (FNPA) [28,29], systematically collected at WCVs in a large health system, prevented obesity among preschool-age children [30]. Other studies have demonstrated that family-centered health coaching with parents related to nutrition and physical activity and referrals to community resources, such as grocery store tours, following WCVs are efficacious approaches to preventing childhood obesity [31,32] and promoting food resource management to help reduce food insecurity among low-income families [33].…”

Section: Introductionmentioning

confidence: 99%

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Comparing enhancements to well-child visits in the prevention of obesity: ENCIRCLE cluster-randomized controlled trial

et al. 2022

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Background Obesity disproportionally impacts rural, lower-income children in the United States. Primary care providers are well-positioned to engage parents in early obesity prevention, yet there is a lack of evidence regarding the most effective care delivery models. The ENCIRCLE study, a pragmatic cluster-randomized controlled trial, will respond to this gap by testing the comparative effectiveness of standard care well-child visits (WCV) versus two enhancements: adding a patient-reported outcome (PRO) measure (PRO WCV) and PRO WCV plus Food Care (telehealth coaching and a grocery store tour). Methods A total of 2,025 parents and their preschool-aged children (20–60 months of age) will be recruited from 24 Geisinger primary care clinics, where providers are randomized to the standard WCV, PRO WCV, or PRO WCV plus Food Care intervention arms. The PRO WCV includes the standard WCV plus collection of the PRO—the Family Nutrition and Physical Activity (FNPA) risk assessment—from parents. Parents complete the PRO in the patient-portal or in the clinic (own device, tablet, or kiosk), receive real-time feedback, and select priority topics to discuss with the provider. These results are integrated into the child’s electronic health record to inform personalized preventive counseling by providers. PRO WCV plus Food Care includes referrals to community health professionals who deliver evidence-based obesity prevention and food resource management interventions via telehealth following the WCV. The primary study outcome is change in child body mass index z-score (BMIz), based on the World Health Organization growth standards, 12 months post-baseline WCV. Additional outcomes include percent of children with overweight and obesity, raw BMI, BMI50, BMIz extended, parent involvement in counseling, health behaviors, food resource management, and implementation process measures. Discussion Study findings will inform health care systems’ choices about effective care delivery models to prevent childhood obesity among a high-risk population. Additionally, dissemination will be informed by an evaluation of mediating, moderating, and implementation factors. Trial registration ClinicalTrials.gov identifier (NCT04406441); Registered May 28, 2020.

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“…The study found that integrating the risk assessment into the clinic visit/EMR/ providers' workflow is feasible but clinician utilization and counseling practices should be continuously evaluated. 48 This could also serve as a point for referral to community intervention like those provided by EFNEP.…”

Section: Sustainabilitymentioning

confidence: 99%

Feasibility of Colocating a Nutrition Education Program into a Medical Clinic Setting to Facilitate Pediatric Obesity Prevention

Shilts

Rios

Panarella

et al. 2021

J Prim Care Community Health

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Purpose: Within a medical clinic environment, pediatric obesity prevention education for families faces challenges. Existing long-term government-funded nutrition education programs have the expertise and staff to deliver. The purpose is to determine feasibility of colocating the Expanded Food and Nutrition Education Program (EFNEP) into a medical clinic setting to support pediatric obesity prevention. Methods: Physicians from a large university teaching and research hospital (n = 73) and 4 small Medicaid-serving community clinics (n = 18) in the same geographic area in northern California were recruited and trained in the patient-referral protocol for a primary prevention intervention provided by EFNEP. The 8-week intervention deployed in the medical clinics, included general nutrition, physical activity and parenting topics anchored with guided goal setting and motivational modeling. Referral, enrollment, and attendance data were collected for 2 years. Parent and physician feasibility surveys, parent interviews and parent risk assessment tools were administered. Paired-sample t-test analysis was conducted. Results: Twenty intervention series with parents of patients (n = 106) were conducted at 5 clinics. Physicians (n = 92) generated 686 referrals. Every 6 referrals generated 1 enrolled parent. Physicians (91%, n = 34) reported the intervention as useful to families. Parents (n = 82) reported improved child behaviors for sleep, screen time, physical activity, and food and beverage offerings ( P < .0001) and at family mealtime ( P < .001). Focus group interviews (n = 26) with 65 participants indicated that parents (97%) reacted positively to participating in the intervention with about a third indicating the classes were relevant to their needs. Conclusion: The intervention is a feasible strategy for the 5 medical clinics. Physicians referred and parents enrolled in the intervention with both physicians and parents indicating positive benefits. Feasibility is contingent upon physician awareness of the intervention and motivation to refer patients and additional EFNEP and clinic staff time to enroll and keep parents engaged.

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Feasibility of enhancing well‐child visits with family nutrition and physical activity risk assessment on body mass index

Cited by 13 publications

References 27 publications

Family-Based Telehealth Initiative to Improve Nutrition and Physical Activity for Children With Obesity and Its Utility During COVID-19: A Mixed Methods Evaluation

Family-Based Telehealth Initiative to Improve Nutrition and Physical Activity for Children With Obesity and Its Utility During COVID-19: A Mixed Methods Evaluation

Comparing enhancements to well-child visits in the prevention of obesity: ENCIRCLE cluster-randomized controlled trial

Feasibility of Colocating a Nutrition Education Program into a Medical Clinic Setting to Facilitate Pediatric Obesity Prevention

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