The Massachusetts BMI letter: A qualitative study of responses from parents of obese children

Abstract

Objectives Massachusetts (MA) public schools conduct mandated body-mass index (BMI) screening and until recently, communicated results in a letter to parents/caregivers, to encourage primary care visits and provide aggregate data to the state Department of Public Health. This study assessed the letter's readability and qualitatively explored parents’ responses to it. Methods Readability of the BMI letter was calculated. Audio-taped 1-h focus groups were conducted with parents/caregivers of 8- to 14-year-old obese (≥95th BMI-for-age percentile) children. A semistructured interview guide was used to elicit responses. Qualitative content analysis was conducted on transcripts to identify emergent themes. Results Readability analysis showed higher grade levels than recommended. Eight focus groups consisting of two to six parents each were conducted (n = 29); 83% were female, mean age 41 ± 9 years, and 65% self-identified as Hispanic/Latino. Key themes identified included usefulness of the BMI letter, concerns about utility of BMI for screening, concerns about impacting self-esteem, and failure to understand the letter. Conclusions The MA BMI letter may not have been achieving its desired goal with some parents. Practice implications: Emergent themes from this study could be used to test effectiveness of similar BMI letters nationwide and develop strategies to improve communication to parents.

The Report Card on BMI Report Cards

“…using report language and formatting that is easy-to-understand) have not been employed. [9, 10] Further, the practice of school-based BMI screening and reporting has been controversial, and debate persists about the potential for unintended consequences related to weight stigmatization. [4, 5]…”

Massachusetts Pediatricians’ Views Toward Body Mass Index Screening in Schools

“…Future public health and research interventions for pediatric obesity may benefit from exploring how health care information can be sensitively relayed to families in a manner that is informative yet minimizes negative impact on emotions and self-esteem. 15 Limitations of our study include a relatively low overall survey response rate (18.6%). The target population for our survey was primary care physicians.…”

“…For example, one analysis of the Massachusetts BMI notification letter revealed confusion among urban parents about the interpretation of their child's weight status. 15 Pediatricians' differing views toward school-based BMI screening across practice settings might therefore stem from systematic differences in understanding among patient populations. Practice characteristics may also indirectly reflect patient-level factors, including self-perceptions of weight status and health literacy.…”

Extracts of Seven Indian Plants Inhibit Human Topoisomerase I and Partially Inhibit Human Topoisomerase II

“…If a child is found to be overweight or obese, many school nurses notify the parent by sending a letter home with the child describing their placement on a BMI growth chart [35]. Since many parents do not favour 'official' methods of identifying overweight (i.e., BMI and/or percentiles), showed limited understanding of how overweight is defined for children, limited comprehension of the measures, and felt that they were irrelevant for their child [36,37], the letters from school nurses identifying weight status may not be effective. An evaluation of school based BMI and body composition screenings in California showed that only 12% of the letter formats contained an explanation of the measures used to determine the child's weight status [38] further limiting the parent's comprehension of the weight status conclusions.…”