1
|
Darling KE, Ruzicka EB, Shields C, Putt GE, Sato AF. Barriers to weight management in adolescence: Measure adaptation among adolescents presenting to an interdisciplinary weight management clinic. J Child Health Care 2023; 27:643-653. [PMID: 35435044 DOI: 10.1177/13674935221087573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A range of barriers may negatively impact adolescents' ability to successfully alter or sustain healthy weight-related behaviors. However, there is a lack of validated measures to empirically assess these barriers. This study developed a measure of adolescent-reported barriers to healthy weight-related behaviors by adapting the previously validated parent-report Barriers to Child Weight Management. Adolescents (N = 154) ages 11-17 presenting to a tertiary weight management program completed Barriers to Weight Management in Adolescence (BWMA). This measure assessed adolescents' perspectives of barriers to healthy weight-related behaviors. Confirmatory factor analysis was used to examine model fit, with four hypothesized subscales-Parental Disengagement, Cost, Lack of Family Support, and Adolescent Disengagement. Overall, good model fit was model demonstrated, χ2 (98) = 130.44, p = .02, CFI = .92, RMSEA = .05, SRMR = .06, supporting a four-factor structure. A final 16-item measure demonstrated good initial psychometric properties. As hypothesized, BWMA was significantly associated with general healthy habits [r = -.25, 95% CI(-.46, -.12)] and parent-reported barriers [r = .40, 95% CI (.264, .586)]. This study adapted and tested preliminary validation of a quantitative measure of adolescent-reported barriers to weight-related behaviors. Identification of barriers may prompt providers to adequately assess, and in turn address, factors impeding adolescents' success in modifying eating and physical activity patterns.
Collapse
Affiliation(s)
- Katherine E Darling
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University; Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI, USA
| | | | - Clarissa Shields
- Department of Psychological Sciences, Kent State University, Kent, OH, USA
| | - Geoffrey E Putt
- Department of Psychiatry and Psychology, Akron Children's Hospital, Akron, OH, USA
| | - Amy F Sato
- Department of Psychological Sciences, Kent State University, Kent, OH, USA
| |
Collapse
|
2
|
Darling KE, Warnick J, Guthrie KM, Santos M, Jelalian E. Weight Management Engagement for Teens From Low-Income Backgrounds: Qualitative Perspectives From Adolescents and Caregivers. J Pediatr Psychol 2023; 48:593-601. [PMID: 36794640 PMCID: PMC10357942 DOI: 10.1093/jpepsy/jsad008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/31/2023] [Accepted: 01/31/2023] [Indexed: 02/17/2023] Open
Abstract
OBJECTIVE Adolescents from low-income backgrounds are at increased risk for obesity and related negative health outcomes. Furthermore, these adolescents have less access to, and success in, weight management (WM) programs. This qualitative study sought to better understand engagement in a hospital-based WM program from the perspective of adolescents and caregivers at different levels of program initiation and engagement. METHODS Qualitative interviews were conducted with 55 participants (29 adolescents and 26 caregivers). This included: (a) those that were referred to, but never initiated, WM treatment (non-initiators); (b) those that prematurely disengaged from treatment (drop-outs); and (c) those that had ongoing participation in treatment (engaged). Data were analyzed using applied thematic analysis. RESULTS Related to program initiation, participants across all groups (including adolescents and caregivers) noted that they did not have a full understanding of the scope or goals of the WM program following initial referral. In addition, many participants identified misperceptions of the program (e.g., perceptions of a screening visit as compared to an intensive program). Both caregivers and adolescents identified caregivers as drivers of engagement, with adolescents often hesitant about participation in the program. However, engaged adolescents found the program valuable and sought ongoing participation following caregiver initiation. CONCLUSIONS When considering initiation and engagement in WM services for adolescents at highest risk, healthcare providers should provide more detailed information concerning WM referrals. Future research is needed to improve adolescent perception of WM, especially for adolescents from low-income backgrounds, which could increase initiation and engagement for this population.
Collapse
Affiliation(s)
- Katherine E Darling
- Weight Control and Diabetes Research Center, The Miriam Hospital, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, USA
| | - Jennifer Warnick
- Weight Control and Diabetes Research Center, The Miriam Hospital, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, USA
| | - Kate M Guthrie
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, USA
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, USA
| | - Melissa Santos
- Division of Pediatric Psychology, Connecticut Children’s, USA
| | - Elissa Jelalian
- Weight Control and Diabetes Research Center, The Miriam Hospital, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, USA
| |
Collapse
|
3
|
Moore WS, Maldonado-Molina MM, Mobley AR, Shelnutt KP, McVay MA. Parental Factors Associated With Intentions to Initiate a Family-Based Pediatric Weight Management Program. Child Obes 2023. [PMID: 37366662 DOI: 10.1089/chi.2023.0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
Background: Childhood obesity can be addressed through family-based pediatric weight management; however, treatment enrollment in the United States is low. This study aimed to identify parental factors associated with intentions to initiate a family-based pediatric weight management program. Methods: Cross-sectional survey data were collected from an online panel of US parents with at least one 5- to 11-year-old child identified as likely to have overweight or obesity. Participants viewed a video about a hypothetical family-based pediatric weight management program, rated their 30-day initiation intentions for that program, and answered additional related questionnaires. Results: Participants (n = 158) identified as White/Caucasian (53%) or Black/African American (47%), were primarily female (61.4%) and married/cohabitating (81.6%) with children who were predominantly girls (53.2%) and, on average, 9-year-olds. Higher parents' perception of program effectiveness predicted initiation intentions (p < 0.001), while concern for their child's weight and parent depression and anxiety levels did not. Higher initiation intentions and perceived program effectiveness were reported by Black/African American participants (p < 0.01) and those with at least a bachelor's degree (p < 0.01) compared to White/Caucasian participants and those without a bachelor's degree, respectively. Initiation intentions were higher for those with greater financial security (p = 0.020) and fewer than three children in the home (p = 0.026). Participants endorsed initiation barriers of time constraints (25%), possible lack of enjoyment for the child (16.9%), and lack of family support (15%). Conclusions: Future program enrollment efforts may need to focus on strategies to increase perceived program effectiveness, although further research is needed that measures actual enrollment in real-world contexts.
Collapse
Affiliation(s)
- Wendy S Moore
- Department of Health Education and Behavior, College of Health and Human Performance, University of Florida, Gainesville, FL, USA
| | - Mildred M Maldonado-Molina
- Department of Health Education and Behavior, College of Health and Human Performance, University of Florida, Gainesville, FL, USA
| | - Amy R Mobley
- Department of Health Education and Behavior, College of Health and Human Performance, University of Florida, Gainesville, FL, USA
| | - Karla P Shelnutt
- Department of Family, Youth, and Community Sciences, Institute of Food and Agricultural Science (IFAS), University of Florida, Gainesville, FL, USA
| | - Megan A McVay
- Department of Health Education and Behavior, College of Health and Human Performance, University of Florida, Gainesville, FL, USA
| |
Collapse
|
4
|
Kone J, Bartels IM, Valkenburg-van Roon AA, Visscher TLS. Parents' perception of health promotion: What do parents think of a healthy lifestyle in parenting and the impact of the school environment? A qualitative research in the Netherlands. J Pediatr Nurs 2022; 62:e148-e155. [PMID: 34556369 DOI: 10.1016/j.pedn.2021.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 09/03/2021] [Accepted: 09/04/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE This study aimed at gaining insight into parents' perceptions towards health behaviour in parenting and the impact of the school environment. Healthcare professionals experience barriers to discuss health behaviour in families where levels of overweight and obesity are elevated. There is a need to understand parents' perception and perceived significance of health behaviour. DESIGN AND METHODS Sixty-three semi-structured interviews were conducted with parents of children from three primary schools located in two different neighbourhoods in Zwolle, the Netherlands. Parents were asked to formulate their top three priority goals in parenting, additionally supplemented with 15 predetermined goals, including a health behaviour related goal. Parents ranked the goals in order of importance and gave an explanation. Finally, parents shared their opinions regarding the school environment in promoting health behaviour, according to the EnrG framework. RESULTS In 8 out of 63 interviews, health was reported in the top three self-formulated goals. Other goals considered important were happiness and being respectful to others. When health was ranked as less important in parenting, routine of health behaviour, own beliefs and religion were given as explanations. The physical school environment and teachers were mentioned as important factors in promoting health behaviour. CONCLUSIONS Parents indicate health behaviour as a key-element in parenting, even when health behaviour is not considered as the most important priority. PRACTICE IMPLICATIONS Since school is perceived as a logical and powerful environment, healthcare professionals should collaborate with school staff to empower their own, teachers' and parents' roles to address health promotion.
Collapse
Affiliation(s)
- Jordy Kone
- Windesheim University of Applied Sciences, Research Group Healthy Cities, Zwolle, the Netherlands; Windesheim University of Applied Sciences, School of Nursing, Zwolle, the Netherlands; Hanze University of Applied Sciences, School of Health Care Studies, Groningen, the Netherlands.
| | - Ine-Marije Bartels
- Windesheim University of Applied Sciences, Research Group Healthy Cities, Zwolle, the Netherlands
| | | | - Tommy L S Visscher
- Hanze University of Applied Sciences, Research and Education, Groningen, the Netherlands
| |
Collapse
|
5
|
McPherson AC, Perez A, Buchholz A, Forhan M, Ball GDC. "It's not a simple answer." A qualitative study to explore how healthcare providers can best support families with a child with autism spectrum disorder and overweight or obesity. Disabil Rehabil 2021; 44:3540-3546. [PMID: 33399017 DOI: 10.1080/09638288.2020.1867909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE This qualitative study aimed to explore the experiences of parents supporting their child with Autism Spectrum Disorder (ASD) and overweight or obesity (OW/OB), including their weight management support needs. METHODS Interview transcripts were analysed using inductive thematic analysis. Nine parents (n = 9 mothers) of ten children with ASD (7 males, 3 females) participated in individual semi-structured interviews. RESULTS The three themes developed were: (1) Our journey to obtain weight management support; (2) I need real-world solutions; and (3) The what, who and how of our weight management needs. Parents reported being proactive in seeking weight management support for their child but were disappointed with the services offered. Resources were not tailored to the child's complex nutrition and behavioural issues or their abilities and functioning. A multidisciplinary approach that integrated both disability and weight management expertise was desired, but not experienced. A range of formal and informal programs were recommended. CONCLUSION This study provides a call to action for supports that ensure children with ASD and OW/OB receive integrated, individualised support to maximise their health and wellness.Implications for rehabilitationChildren with autism spectrum disorder (ASD) are at high risk of developing overweight or obesity.The weight management support needs of parents of children with ASD and overweight or obesity are not being met.Support must be tailored to the child's needs, which are often complex.Health services that integrate expertise in both disability and weight management are needed for children with ASD and their families.
Collapse
Affiliation(s)
- Amy C McPherson
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada.,Dalla Lana School of Public Health and Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | - Arnaldo Perez
- Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
| | - Annick Buchholz
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Mary Forhan
- Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | - Geoff D C Ball
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
| |
Collapse
|
6
|
Abstract
Background: Childhood overweight and obesity, in addition to weight stigma, can result in numerous physical and psychosocial conditions. Children with Autism Spectrum Disorder (ASD) are at a higher risk of developing overweight/obesity than their typically developing peers, yet we know little about what matters to them with regards to weight and their bodies.Methods: Eight semi-structured interviews were conducted with youth with ASD. Interviews were transcribed and analyzed using a phenomenological approach within an interpretive paradigm.Results: Participants mostly showed little concern about their weight. Participants highly valued moving their bodies and reported feeling good about their bodies.Discussion: Findings suggest that children with ASD may be more engaged in healthcare discussions focusing on growth and health rather than size and weight. This approach can also reduce stigmatizing discussions.
Collapse
Affiliation(s)
- Meaghan Walker
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Stephanie Nixon
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada.,Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Jess Haines
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, Canada
| | - Amy McPherson
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| |
Collapse
|
7
|
Walker M, Nixon S, Haines J, McPherson AC. Examining risk factors for overweight and obesity in children with disabilities: a commentary on Bronfenbrenner's ecological systems framework. Dev Neurorehabil 2019; 22:359-364. [PMID: 30307382 DOI: 10.1080/17518423.2018.1523241] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Globally, overweight and obesity (OW/OB) levels are high among children, with rates surpassing the adult population. With such high pediatric OW/OB rates, it is imperative that risk factors are identified and explored. Thus, Davison and Birch developed an adapted framework, based on Bronfenbrenner's Ecological Systems Theory, which identifies and categorizes the factors in a child's life that put them at risk for OW/OB. While a socioecological perspective has been a useful tool for examining risk factors in typically developing pediatric populations, this holistic approach has not yet been applied to populations of children with disabilities, who are at an even higher risk of OW/OB than their typically developing peers. This commentary, therefore, explores Bronfenbrenner's Ecological Framework as applied to OW/OB by Davison and Birch, and critically examines its application to children with disabilities.
Collapse
Affiliation(s)
- Meaghan Walker
- a Bloorview Research Institute , Holland Bloorview Kids Rehabilitation Hospital , Toronto , ON , Canada.,b Rehabilitation Sciences Institute , University of Toronto , Toronto , ON , Canada
| | - Stephanie Nixon
- b Rehabilitation Sciences Institute , University of Toronto , Toronto , ON , Canada.,c Dalla Lana School of Public Health , University of Toronto , Toronto , ON , Canada.,d Department of Physical Therapy , University of Toronto , Toronto , ON , Canada
| | - Jess Haines
- e Department of Family Relations and Applied Nutrition , University of Guelph , Guelph , ON , Canada
| | - Amy C McPherson
- a Bloorview Research Institute , Holland Bloorview Kids Rehabilitation Hospital , Toronto , ON , Canada.,b Rehabilitation Sciences Institute , University of Toronto , Toronto , ON , Canada.,c Dalla Lana School of Public Health , University of Toronto , Toronto , ON , Canada
| |
Collapse
|
8
|
Kelleher E, McHugh SM, Harrington JM, Perry IJ, Shiely F. Understanding engagement in a family-focused, multicomponent, childhood weight management programme delivered in the community setting. Public Health Nutr 2019; 22:1471-82. [PMID: 30724148 DOI: 10.1017/S1368980018003828] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To describe public health nurses' (PHN) experiences of referring to, and families' experiences of being referred to, a multicomponent, community-based, childhood weight management programme and to provide insight into families' motivation to participate in and complete treatment. DESIGN Qualitative study using semi-structured interviews and the draw-and-write technique. SETTING Two geographical regions in the south and west of Ireland.ParticipantsNine PHN involved in the referral process, as well as ten parents and nine children who were referred to and completed the programme, participated in the present study. RESULTS PHN were afraid of misclassifying children as obese and of approaching the subject of excess weight with parents. Peer support from other PHN as well as training in how best to talk about weight with parents were potential strategies suggested to alleviate these fears. Parents recalled the anxiety provoked by the 'medical terminology' used during referral and their difficulty interpreting what it meant for the health of their child. Despite initial fears, concern for their children's future health was a major driver behind their participation. Children's enjoyment, the social support experienced by parents as well as staff enthusiasm were key to programme completion. CONCLUSIONS The present study identifies the difficulties of referring families to community weight management programmes and provides practical suggestions on how to support practitioners in making referrals. It also identifies key positive factors influencing parents' decisions to enrol in community weight management programmes. These should be maximised by staff and policy makers when developing similar programmes.
Collapse
|
9
|
Affiliation(s)
- Meaghan Walker
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | - Amy C. McPherson
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| |
Collapse
|
10
|
Morrison KM, Ball GDC, Ho J, Mackie P, Buchholz A, Chanoine JP, Hamilton J, Laberge AM, Legault L, Thabane L, Tremblay M, Zenlea I. The CANadian Pediatric Weight management Registry (CANPWR): lessons learned from developing and initiating a national, multi-centre study embedded in pediatric clinical practice. BMC Pediatr 2018; 18:237. [PMID: 30025530 DOI: 10.1186/s12887-018-1208-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 07/02/2018] [Indexed: 01/25/2023] Open
Abstract
Background There is increasing recognition of the value of “real-world evidence” in evaluating health care services. Registry-based, observational studies conducted in clinical settings represent a relevant model to achieve this directive. Starting in 2010, we undertook a longitudinal, observational study (the CANadian Pediatric Weight management Registry [CANPWR]), which is embedded in 10 multidisciplinary, pediatric weight management clinics across Canada. The objective of this paper was to share the lessons our team learned from this multi-centre project. Methods Data sources included a retrospective review of minutes from 120 teleconferences with research staff and investigators, notes taken during clinical site visits made by project leaders, information from quality control processes to ensure data accuracy and completeness, and a study-specific survey that was sent to all sites to solicit feedback from research team members (n = 9). Through an iterative process, the writing group identified key themes that surfaced during review of these information sources and final lessons learned were developed. Results Several key lessons emerged from our research, including the (1) value of pilot studies and central research coordination, (2) need for effective and regular communication, (3) importance of consensus on determining outcome measures, (4) challenge of embedding research within clinical practice, and (5) difficulty in recruiting and retaining participants. The sites were, in spite of these challenges, enthusiastic about the benefits of participating in multi-centre collaborative studies. Conclusion Despite some challenges, multi-centre observational studies embedded in pediatric weight management clinics are feasible and can contribute important, practical insights into the effectiveness of health services for managing pediatric obesity in real-world settings. Electronic supplementary material The online version of this article (10.1186/s12887-018-1208-6) contains supplementary material, which is available to authorized users.
Collapse
|
11
|
Abstract
Many children and their families do not benefit from multidisciplinary clinical care (MCC) for paediatric weight management because they do not enrol in (initiate) treatment. The purpose of this report was to highlight practical recommendations to enhance the enrolment of Canadian children in MCC, which were drawn from multisite Canadian studies (quantitative and qualitative) that we completed recently. Recommendations to stakeholders, including primary care providers, MCC providers and decisions makers, were organized according to opportunities, motivation and barriers to enrol. Findings from our research suggested that enrolment in MCC can be improved by increasing opportunities and motivation to enrol as well as reducing the impact of enrolment barriers.
Collapse
Affiliation(s)
- Arnaldo J Perez
- Department of Pediatrics, University of Alberta, Edmonton, Alberta
| | - Geoff D C Ball
- Department of Pediatrics, University of Alberta, Edmonton, Alberta
| |
Collapse
|
12
|
Johnson RE, Oyebode O, Walker S, Knowles E, Robertson W. The difficult conversation: a qualitative evaluation of the 'Eat Well Move More' family weight management service. BMC Res Notes 2018; 11:325. [PMID: 29784021 DOI: 10.1186/s13104-018-3428-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 05/10/2018] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE The Eat Well Move More (EWMM) family and child weight management service is a 12-week intervention integrating healthy eating and physical activity education and activities for families and children aged 4-16. EWMM service providers identified low uptake 12 months prior to the evaluation. The aims of this study were to describe referral practices and pathways into the service to identify potential reasons for low referral and uptake rates. RESULTS We conducted interviews and focus groups with general practitioners (GPs) (n = 4), school nurses, and nursing assistants (n = 12). Data were analysed using thematic analysis. School nurses highlighted three main barriers to making a referral: parent engagement, child autonomy, and concerns over the National Child Measurement Programme letter. GPs highlighted that addressing obesity among children is a 'difficult conversation' with several complex issues related to and sustaining that difficulty. In conclusion, referral into weight management services in the community may persistently lag if a larger and more complex tangle of barriers lie at the point of school nurse and GP decision-making. The national prevalence of, and factors associated with this hesitation to discuss weight management issues with parents and children remains largely unknown.
Collapse
|
13
|
Nobles JD, Perez A, Skelton JA, Spence ND, Ball GD. The engagement pathway: A conceptual framework of engagement-related terms in weight management. Obes Res Clin Pract 2018; 12:133-138. [PMID: 29396232 DOI: 10.1016/j.orcp.2017.12.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 12/17/2017] [Accepted: 12/23/2017] [Indexed: 01/31/2023]
Abstract
Engagement denotes the extent to which, and how, individuals participate in weight management (WM) services. Effective WM services should generate meaningful outcomes and promote high participant engagement; however, research is predominantly focused on the former. Given that engagement is a poorly understood phenomenon, and that engagement-related concepts are often used synonymously (e.g., dropout and attrition), the engagement pathway is hereby introduced. This pathway defines key concepts (e.g., recruitment, adherence, attrition) and their relationships in the enrolment, intervention, and maintenance stages of treatment. The pathway will help researchers and practitioners better understand engagement-related concepts whilst encouraging greater conceptual consistency between studies.
Collapse
Affiliation(s)
- James D Nobles
- Centre for Active Lifestyles, Leeds Beckett University, Leeds, UK.
| | - Arnaldo Perez
- Department of Pediatrics, University of Alberta, Edmonton, Canada
| | - Joseph A Skelton
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | | | - Geoff D Ball
- Department of Pediatrics, University of Alberta, Edmonton, Canada
| |
Collapse
|
14
|
Perez AJ, Kebbe M, Holt NL, Gokiert R, Chanoine JP, Legault L, Morrison KM, Sharma AM, Ball GDC. Parent Recommendations to Enhance Enrollment in Multidisciplinary Clinical Care for Pediatric Weight Management. J Pediatr 2018; 192:122-129. [PMID: 29246332 DOI: 10.1016/j.jpeds.2017.09.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 07/26/2017] [Accepted: 09/14/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To explore parents' recommendations to enhance enrollment in multidisciplinary clinical care for managing pediatric obesity. STUDY DESIGN Data for this interpretative description study were collected through individual, semistructured interviews that were audiorecorded, transcribed verbatim, and analyzed thematically. Parents (n = 79) were recruited from 4 multidisciplinary weight management clinics in Canada located in Edmonton, Hamilton, Montreal, and Vancouver. RESULTS Most interviewed parents had children with obesity (body mass index ≥95th percentile; 84.2%), were female (87.3%), had postsecondary education (69.6%), and were white (75.9%). Parents' recommendations referred to enrollment opportunities, information about obesity services, motivation for treatment, and accessibility to obesity services. Specifically, parents recommended to increase referral options and follow-up contacts with families during the enrollment process, inform referring physicians and families about the availability and characteristics of obesity services, enhance families' motivation for treatment, prevent families from getting discouraged, make services more appealing to families, and address accessibility issues (eg, offering multiple options for appointment times, providing support for transportation). CONCLUSIONS Parents' recommendations support the need for family-centered approaches to enhance enrollment; however, their feasibility, acceptability, and effectiveness remain to be tested empirically.
Collapse
Affiliation(s)
- Arnaldo J Perez
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Maryam Kebbe
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Nicholas L Holt
- Faculty of Physical Education and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Rebecca Gokiert
- Community-University Partnership, Faculty of Extension, University of Alberta, Edmonton, Alberta, Canada
| | - Jean-Pierre Chanoine
- Endocrinology and Diabetes Unit, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Laurent Legault
- Department of Pediatrics, McGill University, Montreal, Québec, Canada
| | - Katherine M Morrison
- Department of Pediatrics and Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Arya M Sharma
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Geoff D C Ball
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
| |
Collapse
|
15
|
Abstract
BACKGROUND Severe obesity (SO) in Canadian children remains poorly understood. However, based on international data, the prevalence of SO appears to be increasing and is associated with a number of psychosocial, bio-mechanical, and cardiometabolic health risks. The purpose of our national Team to Address Bariatric Care in Canadian Children (Team ABC3) is to develop and lead a series of inter-related studies to enhance the understanding and management of SO in Canadian children and adolescents (0-18 years). METHODS/DESIGN From 2015 to 2019, Team ABC3 will conduct a series of projects at the regional, provincial, and national levels using multiple methods and study designs to respond to key knowledge gaps by (i) generating evidence on the prevalence of SO and its impact on health services utilization in children using existing Canadian data sources from primary care settings, (ii) exploring contemporary definitions of SO that link with health outcomes, (iii) comparing and contrasting health risks across the continuum of SO, (iv) understanding potential barriers to and facilitators of treatment success in children with SO, and (v) examining innovative lifestyle and behavioral interventions designed to successfully manage SO in children and their families. Furthermore, to examine the impact of innovative interventions on the management SO, we will (vi) evaluate whether adding a health coach, who provides support via text, email, and/or phone, improves children's ability to adhere to a web-based weight management program and (vii) test the feasibility and impact of a community-based weight management program for pre-school children with SO and their parents that combines group-based parenting sessions with in-home visits. DISCUSSION Our research aligns with national priorities in obesity research, brings together leading scientists, clinicians, and stakeholders from across Canada, and will inform health services delivery throughout the country to provide the best care possible for children with SO and their families.
Collapse
|
16
|
Dhaliwal J, Perez AJ, Holt NL, Gokiert R, Chanoine JP, Morrison KM, Legault L, Sharma AM, Ball GD. Why do parents discontinue health services for managing paediatric obesity? A multi-centre, qualitative study. Obes Res Clin Pract 2017; 11:335-343. [DOI: 10.1016/j.orcp.2016.10.285] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 09/30/2016] [Accepted: 10/07/2016] [Indexed: 11/26/2022]
|
17
|
Ball GDC, Spence ND, Browne NE, O'Connor K, Srikameswaran S, Zelichowska J, Ho J, Gokiert R, Mâsse LC, Carson V, Morrison KM, Kuk JL, Holt NL, Kebbe M, Gehring ND, Cesar M, Virtanen H, Geller J. The readiness and motivation interview for families (RMI-Family) managing pediatric obesity: study protocol. BMC Health Serv Res 2017; 17:261. [PMID: 28399913 PMCID: PMC5387327 DOI: 10.1186/s12913-017-2201-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 03/30/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Experts recommend that clinicians assess motivational factors before initiating care for pediatric obesity. Currently, there are no well-established clinical tools available for assessing motivation in youth with obesity or their families. This represents an important gap in knowledge since motivation-related information may shed light on which patients might fail to complete treatment programs. Our study was designed to evaluate the measurement properties and utility of the Readiness and Motivational Interview for Families (RMI-Family), a structured interview that utilizes a motivational interviewing approach to (i) assess motivational factors in youth and their parents, and (ii) examine the degree to which motivation and motivation-related concordance between youth and parents are related to making changes to lifestyle habits for managing obesity in youth. METHODS From 2016 to 2020, this prospective study will include youth with obesity (body mass index [BMI] ≥97th percentile; 13-17 years old; n = 250) and their parents (n = 250). The study will be conducted at two primary-level, multidisciplinary obesity management clinics based at children's hospitals in Alberta, Canada. Participants will be recruited and enrolled after referral to these clinics, but prior to initiating clinical care. Each youth and their parent will complete the RMI-Family (~1.5 h) at baseline, and 6- and 12-months post-baseline. Individual (i.e., youth or parent) and family-level (i.e., across youth and parent) responses to interview questions will be scored, as will aspects of interview administration (e.g., fidelity to motivational interviewing tenets). The RMI-Family will also be examined for test-retest reliability. Youth data collected at each time point will include demography, anthropometry, lifestyle habits, psychosocial functioning, and health services utilization. Cross-sectional and longitudinal associations between individual and family-level interview scores on the RMI-Family and these clinical measures will be examined. DISCUSSION As a measurement tool drawing on family-centered care and motivational interviewing, the RMI-Family was designed to increase understanding of the role of motivational factors in pediatric obesity management, allowing healthcare providers and policymakers to manage pediatric obesity more effectively and efficiently. Findings will help to create an innovative, tailored model of health care delivery that uses resources judiciously and is designed to best meet families' needs.
Collapse
Affiliation(s)
- Geoff D C Ball
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
| | - Nicholas D Spence
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Nadia E Browne
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Kathleen O'Connor
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Suja Srikameswaran
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Joanna Zelichowska
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Josephine Ho
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Rebecca Gokiert
- Faculty of Extension, University of Alberta, Edmonton, AB, Canada
| | - Louise C Mâsse
- BC Children's Hospital Research Institute, School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Valerie Carson
- Faculty of Physical Education and Recreation, University of Alberta, Edmonton, AB, Canada
| | - Katherine M Morrison
- Department of Pediatrics, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Jennifer L Kuk
- Faculty of Health, School of Kinesiology and Health Science, York University, Toronto, ON, Canada
| | - Nicholas L Holt
- Faculty of Physical Education and Recreation, University of Alberta, Edmonton, AB, Canada
| | - Maryam Kebbe
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Nicole D Gehring
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Melody Cesar
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Heidi Virtanen
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Josie Geller
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
18
|
Kelleher E, Davoren MP, Harrington JM, Shiely F, Perry IJ, McHugh SM. Barriers and facilitators to initial and continued attendance at community-based lifestyle programmes among families of overweight and obese children: a systematic review. Obes Rev 2017; 18:183-194. [PMID: 27862851 PMCID: PMC5245104 DOI: 10.1111/obr.12478] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 08/04/2016] [Accepted: 09/20/2016] [Indexed: 12/13/2022]
Abstract
The success of childhood weight management programmes relies on family engagement. While attendance offers many benefits including the support to make positive lifestyle changes, the majority of families referred to treatment decline. Moreover, for those who do attend, benefits are often compromised by high programme attrition. This systematic review investigated factors influencing attendance at community-based lifestyle programmes among families of overweight or obese children. A narrative synthesis approach was used to allow for the inclusion of quantitative, qualitative and mixed-method study designs. Thirteen studies met the inclusion criteria. Results suggest that parents provided the impetus for programme initiation, and this was driven largely by a concern for their child's psychological health and wellbeing. More often than not, children went along without any real reason or interest in attending. Over the course of the programme, however, children's positive social experiences such as having fun and making friends fostered the desire to continue. The stigma surrounding excess weight and the denial of the issue amongst some parents presented barriers to enrolment and warrant further study. This study provides practical recommendations to guide future policy makers, programme delivery teams and researchers in developing strategies to boost recruitment and minimise attrition.
Collapse
Affiliation(s)
- E Kelleher
- Department of Epidemiology and Public Health, University College Cork, Cork, Ireland
| | - M P Davoren
- Department of Epidemiology and Public Health, University College Cork, Cork, Ireland
| | - J M Harrington
- Department of Epidemiology and Public Health, University College Cork, Cork, Ireland
| | - F Shiely
- Department of Epidemiology and Public Health, University College Cork, Cork, Ireland.,HRB Clinical Research Facility, Mercy University Hospital, Cork, Ireland
| | - I J Perry
- Department of Epidemiology and Public Health, University College Cork, Cork, Ireland
| | - S M McHugh
- Department of Epidemiology and Public Health, University College Cork, Cork, Ireland
| |
Collapse
|
19
|
Kwitowski M, Bean MK, Mazzeo SE. An exploration of factors influencing attrition from a pediatric weight management intervention. Obes Res Clin Pract 2016; 11:233-240. [PMID: 27544283 DOI: 10.1016/j.orcp.2016.08.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 07/25/2016] [Accepted: 08/01/2016] [Indexed: 10/19/2022]
Abstract
Pediatric obesity is a public health concern. High attrition from treatment negatively impacts outcomes, particularly among lower income and ethnic minority populations. NOURISH+ is a parent-exclusive childhood weight management treatment targeting at-risk children aged 5-11 years who are overweight or obese. The current study sought to enhance understanding of attrition among at-risk families. NOURISH+ participants completed a survey assessing barriers to treatment adherence. Among low-income, racially diverse families, practical barriers are pressing concerns. The NOURISH+ parent-exclusive approach, although empirically supported, appears inconsistent with caregivers' expectations. Minimizing practical barriers and enhancing child engagement might reduce attrition and improve outcomes.
Collapse
Affiliation(s)
- Melissa Kwitowski
- Department of Psychology, Virginia Commonwealth University, P.O. Box 842018, Richmond, VA 23284-2018, USA.
| | - Melanie K Bean
- Department of Pediatrics, Children's Hospital of Richmond at Virginia Commonwealth University, P.O. Box 980140, Richmond, VA 23298-0140, USA
| | - Suzanne E Mazzeo
- Department of Psychology, Virginia Commonwealth University, P.O. Box 842018, Richmond, VA 23284-2018, USA; Department of Pediatrics, Children's Hospital of Richmond at Virginia Commonwealth University, P.O. Box 980140, Richmond, VA 23298-0140, USA
| |
Collapse
|
20
|
Tremblay M, Perez AJ, Rasquinha AM, Avis JLS, Morrison KM, Chanoine JP, Legault L, Holt NL, Gokiert R, Sharma AM, Ball GDC. Recommendations From Parents to Improve Health Services for Managing Pediatric Obesity in Canada. Acad Pediatr 2016; 16:587-93. [PMID: 27236018 DOI: 10.1016/j.acap.2016.05.144] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 04/26/2016] [Accepted: 05/14/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Although parents are uniquely positioned to offer first-hand insights that can be used to improve health services for managing pediatric obesity, their perspective is underexplored. Our objective was to characterize parents' recommendations for enhancing tertiary-level health services for managing pediatric obesity in Canada. METHODS Semistructured, one-on-one interviews were conducted with parents of children who initiated treatment at 1 of 4 Canadian tertiary-level, multidisciplinary weight management clinics. Parent perspectives were elicited regarding the strengths and weaknesses of the health services they received as well as areas for potential improvement. Interviews were audio-recorded and transcribed verbatim. We used qualitative description as the methodological framework and manifest content analysis as the analytical strategy. RESULTS Parents (n = 65; 88% female; 72% Caucasian; 74% with at least some postsecondary education; 52% >$50,000 CDN household income) provided a range of recommendations that were organized according to health care: 1) accessibility, 2) content, and 3) delivery. The most common recommendations included increasing scheduling options (44%; n = 29), tailoring services to families' needs and circumstances (29%; n = 19), placing greater emphasis on physical activity (29%; n = 19), altering program duration (29%; n = 19), incorporating interactive elements (25%; n = 16), information provision (25%; n = 16), and providing services at sites closer to participants' homes (24%; n = 15). CONCLUSIONS Parents' recommendations to enhance health services for managing pediatric obesity concerned modifiable factors related to accessibility, content, and delivery of care. Further research is needed to evaluate whether implementing suggested recommendations improves clinically relevant outcomes including attrition, quality of care, and success in weight management.
Collapse
Affiliation(s)
- Melissa Tremblay
- Department of Educational Psychology, Faculty of Education, University of Alberta, Edmonton, Alberta, Canada
| | - Arnaldo J Perez
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | | | - Jillian L S Avis
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Katherine M Morrison
- Department of Pediatrics, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Jean-Pierre Chanoine
- Endocrinology and Diabetes Unit, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Laurent Legault
- Department of Pediatrics, McGill University, Montreal, Quebec, Canada
| | - Nicholas L Holt
- Faculty of Physical Education and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Rebecca Gokiert
- Community-University Partnership, Faculty of Extension, University of Alberta, Edmonton, Alberta, Canada
| | - Arya M Sharma
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Geoff D C Ball
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
| |
Collapse
|
21
|
Perez AJ, Avis JLS, Holt NL, Gokiert R, Chanoine JP, Legault L, Morrison KM, Sharma AM, Ball GDC. Why do families enrol in paediatric weight management? A parental perspective of reasons and facilitators. Child Care Health Dev 2016; 42:278-87. [PMID: 26728419 DOI: 10.1111/cch.12311] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 11/10/2015] [Accepted: 11/22/2015] [Indexed: 01/26/2023]
Abstract
BACKGROUND Few children with obesity who are referred for weight management end up enroled in treatment. Factors enabling enrolment are poorly understood. Our purpose was to explore reasons for and facilitators of enrolment in paediatric weight management from the parental perspective. METHODS Semi-structured interviews were conducted with parents of 10- to 17-year-olds who were referred to one of four Canadian weight management clinics and enroled in treatment. Interviews were audio-recorded and transcribed verbatim. Manifest/inductive content analysis was used to analyse the data, which included the frequency with which parents referred to reasons for and facilitators of enrolment. RESULTS In total, 65 parents were interviewed. Most had a child with a BMI ≥95th percentile (n = 59; 91%), were mothers (n = 55; 85%) and had completed some post-secondary education (n = 43; 66%). Reasons for enrolment were related to concerns about the child, recommended care and expected benefits. Most common reasons included weight concern, weight loss expectation, lifestyle improvement, health concern and need for external support. Facilitators concerned the referral initiator, treatment motivation and barrier control. Most common facilitators included the absence of major barriers, parental control over the decision to enrol, referring physicians stressing the need for specialized care and parents' ability to overcome enrolment challenges. CONCLUSIONS Healthcare providers might optimize enrolment in paediatric weight management by being proactive in referring families, discussing the advantages of the recommended care to meet treatment expectations and providing support to overcome enrolment barriers.
Collapse
Affiliation(s)
- A J Perez
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - J L S Avis
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - N L Holt
- Faculty of Physical Education and Recreation, University of Alberta, Edmonton, AB, Canada
| | - R Gokiert
- Community-University Partnership, Faculty of Extension, University of Alberta, Edmonton, AB, Canada
| | - J-P Chanoine
- Endocrinology and Diabetes Unit, British Columbia Children's Hospital, Vancouver, BC, Canada
| | - L Legault
- Department of Pediatrics, Faculty of Medicine, McGill University, Montréal, QC, Canada
| | - K M Morrison
- Department of Pediatrics and Population Health Research Institute, Faculty of Medicine, McMaster University, Hamilton, ON, Canada
| | - A M Sharma
- Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, AB, Canada
| | - G D C Ball
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| |
Collapse
|
22
|
McPherson AC, Ball GD, Maltais DB, Swift JA, Cairney J, Knibbe TJ, Krog K. A Call to Action: Setting the Research Agenda for Addressing Obesity and Weight-Related Topics in Children with Physical Disabilities. Child Obes 2016; 12:59-69. [PMID: 26716496 PMCID: PMC4753575 DOI: 10.1089/chi.2015.0119] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Pediatric obesity is a world-wide challenge. Children with physical disabilities are particularly at risk of obesity, which is worrisome because obesity can result in serious secondary conditions that decrease health status, reduce independence, and increase impact on healthcare systems. However, the determinants of obesity and the health promotion needs of children with physical disabilities are relatively unexplored compared with their typically developing peers. METHODS This white paper describes a Canadian multi-stakeholder workshop on the topic of obesity and health in children with physical disabilities and provides recommendations for future research in this understudied area. RESULTS Seventy-one knowledge gaps identified by attendees using a modified nominal group technique clustered into six themes: (1) early, sustained engagement of families; (2) rethinking determinants of obesity and health; (3) maximizing impact of research; (4) inclusive integrated interventions; (5) evidence-informed measurement and outcomes; and (6) reducing weight biases. Attendees worked together to develop research plans in more detail for three areas identified through consensus as high priority: "early, sustained engagement of families;" "rethinking determinants of obesity and health;" and "evidence informed measurement and outcomes." CONCLUSIONS Using the workshop described here as a call to action, Canadian researchers are now well positioned to work toward a greater understanding of weight-related topics in children with physical disabilities, with the aim of developing evidence-based and salient obesity prevention and treatment approaches.
Collapse
Affiliation(s)
- Amy C. McPherson
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada.,Dalla Lana School of Public Health and Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Geoff D.C. Ball
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Désirée B. Maltais
- Department of Rehabilitation, Laval University, Québec City, Québec, Canada.,Center for Interdisciplinary Research in Rehabilitation and Social Integration, Québec City, Québec, Canada
| | - Judy A. Swift
- School of Biosciences, The University of Nottingham, Nottingham, United Kingdom
| | - John Cairney
- Departments of Family Medicine, Psychiatry and Behavioral Neurosciences, and Kinesiology, Hamilton, Ontario, Canada.,CanChild Center for Studies in Childhood Disability, Hamilton, Ontario, Canada.,INCH Lab, McMaster University, Hamilton, Ontario, Canada
| | - Tara Joy Knibbe
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Kim Krog
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto. Toronto, Ontario, Canada
| | | |
Collapse
|
23
|
Maximova K, Ambler KA, Rudko JN, Chui N, Ball GDC. Ready, set, go! Motivation and lifestyle habits in parents of children referred for obesity management. Pediatr Obes 2015; 10:353-60. [PMID: 25394883 DOI: 10.1111/ijpo.272] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Revised: 07/29/2014] [Accepted: 09/26/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Parents play a fundamental role in helping children with obesity to make and maintain healthy lifestyle changes. OBJECTIVE This study aimed to characterize stages of engagement to change nutrition and physical activity habits among parents whose children with obesity were enrolled in obesity management and examine differences in parents' own nutrition and physical activity habits according to their stage of engagement. METHODS Medical records of 113 children (body mass index [BMI] ≥95th percentile) enrolled in an outpatient weight management clinic were reviewed for baseline (cross-sectional) data. Parents completed the Weight Loss Behavior-Stage of Change Scale to assess the degree of engagement in making healthy changes to their lifestyle behaviours. Latent class analysis was used to classify parents into distinct clusters by grouping individuals with similar ratings of stages of engagement regarding nutrition- and physical activity-related behaviours. RESULTS Parents' engagement in healthy lifestyle behaviours varied (more engaged [n = 43]; less engaged [n = 70]). A greater proportion of parents in the more engaged group was in action and/or maintenance stages of changing their lifestyle habits. The more engaged group was less overweight than the less engaged group (BMI = 28.5 vs. 33.3 kg m(-2); P < 0.05). Further, the more engaged group consumed fewer total calories, calories from fat, trans fat and carbohydrates vs. their less engaged peers (P < 0.05). Compared with the less engaged group, the more engaged group consumed more daily servings of vegetables and fruits (4.9 vs. 3.9, P < 0.05) and accumulated more steps per day (9130 vs. 7225; P < 0.05). The more engaged group was also more likely to meet daily recommendations for vegetable and fruit intake (48.8 vs. 24.3%; P < 0.05) and physical activity (42.9 vs. 22.9%, P < 0.05). CONCLUSIONS Parents of children with obesity varied in their degree of engagement in making healthy changes to their lifestyle behaviours, and those categorized as more engaged already demonstrated positive lifestyle behaviours. Information regarding parents' degree of engagement in healthy behaviours can inform clinical recommendations, especially when parents represent the primary agents of change in families trying to manage paediatric obesity.
Collapse
Affiliation(s)
- K Maximova
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - K A Ambler
- Pediatric Centre for Weight and Health, Stollery Children's Hospital, Alberta Health Services, Edmonton, Alberta, Canada.,Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - J N Rudko
- Pediatric Centre for Weight and Health, Stollery Children's Hospital, Alberta Health Services, Edmonton, Alberta, Canada
| | - N Chui
- Pediatric Centre for Weight and Health, Stollery Children's Hospital, Alberta Health Services, Edmonton, Alberta, Canada
| | - G D C Ball
- Pediatric Centre for Weight and Health, Stollery Children's Hospital, Alberta Health Services, Edmonton, Alberta, Canada.,Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| |
Collapse
|
24
|
Perez A, Holt N, Gokiert R, Chanoine JP, Legault L, Morrison K, Sharma A, Ball G. Why don't families initiate treatment? A qualitative multicentre study investigating parents' reasons for declining paediatric weight management. Paediatr Child Health 2015; 20:179-84. [PMID: 26038633 DOI: 10.1093/pch/20.4.179] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2015] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Many families referred to specialized health services for managing paediatric obesity do not initiate treatment; however, reasons for noninitiation are poorly understood. OBJECTIVE To understand parents' reasons for declining tertiary-level health services for paediatric weight management. METHOD Interviews were conducted with 18 parents of children (10 to 17 years of age; body mass index ≥85th percentile) who were referred for weight management, but did not initiate treatment at one of three Canadian multidisciplinary weight management clinics. A semi-structured interview guide was used to elicit parents' responses about reasons for noninitiation. Interviews were audio-recorded and transcribed verbatim. Data were managed using NVivo 9 (QSR International, Australia) and analyzed thematically. RESULTS Most parents (mean age 44.1 years; range 34 to 55 years) were female (n=16 [89%]), obese (n=12 [66%]) and had a university degree (n=13 [71%]). Parents' reasons for not initiating health services were grouped into five themes: no perceived need for paediatric weight management (eg, perceived children did not have a weight or health problem); no perceived need for further actions (eg, perceived children already had a healthy lifestyle); no intention to initiate recommended care (eg, perceived clinical program was not efficacious); participation barriers (eg, children's lack of motivation); and situational factors (eg, weather). CONCLUSION Physicians should not only discuss the need for and value of specialized care for managing paediatric obesity, but also explore parents' intention to initiate treatment and address reasons for noninitiation that are within their control.
Collapse
Affiliation(s)
- Arnaldo Perez
- Department of Pediatrics, University of Alberta, Edmonton, Alberta
| | - Nicholas Holt
- Faculty of Physical Education and Recreation, University of Alberta, Edmonton, Alberta
| | - Rebecca Gokiert
- Faculty of Extension, University of Alberta, Edmonton, Alberta
| | | | - Laurent Legault
- Endocrinology and Metabolism, McGill Unviversity, Montreal, Quebec
| | - Katherine Morrison
- Pediatrics and Population Health Research Institute, McMaster University, Hamilton, Ontario
| | - Arya Sharma
- Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, Alberta
| | - Geoff Ball
- Department of Pediatrics, University of Alberta, Edmonton, Alberta
| |
Collapse
|
25
|
Dhaliwal J, Nosworthy NMI, Holt NL, Zwaigenbaum L, Avis JLS, Rasquinha A, Ball GDC. Attrition and the management of pediatric obesity: an integrative review. Child Obes 2014; 10:461-73. [PMID: 25496035 DOI: 10.1089/chi.2014.0060] [Citation(s) in RCA: 108] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND A key challenge in managing pediatric obesity is the high degree of program attrition, which can reduce therapeutic benefits and contribute to inefficient health services delivery. Our aim was to document and characterize predictors of, and reasons for, attrition in pediatric obesity management. METHODS We searched literature published until January 2014 in five databases (CINAHL, EMBASE, MEDLINE, PsycINFO, and Scopus). Articles were included if they were English, included participants 0-18 years of age, focused on pediatric obesity management, incorporated lifestyle and behavioral changes without pharmacotherapy, provided attrition data, and reported information about predictors of, and/or reasons for, attrition from family-based interventions provided in research or clinical settings. Twenty-three articles (n=20 quantitative; n=2 qualitative; n=1 mixed methods) met our inclusion criteria. Clarity of study aims, objectives, methods, and data analysis were appraised using Bowling's checklist. RESULTS Attrition varied according to definition (minimum to maximum, 4-83%; median, 37%). There were few consistent predictors of attrition between studies, although dropout was higher among US-based families receiving public health insurance. Older children were also more likely to discontinue care, but sex and baseline weight status did not predict attrition. The most commonly reported reasons for attrition were logistical barriers and programs not meeting families' needs. CONCLUSIONS Developing and evaluating strategies designed to minimize the risk of attrition, especially among families who receive public health insurance and older boys and girls, are needed to optimize the effectiveness of pediatric obesity management.
Collapse
Affiliation(s)
- Jasmine Dhaliwal
- 1 Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta , Edmonton Clinic Health Academy, Edmonton, Alberta, Canada
| | | | | | | | | | | | | |
Collapse
|
26
|
Lupi JL, Haddad MB, Gazmararian JA, Rask KJ. Parental perceptions of family and pediatrician roles in childhood weight management. J Pediatr 2014; 165:99-103.e2. [PMID: 24721470 DOI: 10.1016/j.jpeds.2014.02.064] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Revised: 01/15/2014] [Accepted: 02/19/2014] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To characterize parental perceptions of the respective roles of families and the pediatrician in childhood weight management. STUDY DESIGN Structured in-person interviews (n = 69) were conducted with parents of children ages 3-12 years visiting a pediatric clinic. Interview topics included perceptions of weight and associated problems, child weight status and concerns, and the pediatrician's role in weight management. Interviews were coded qualitatively and analyzed thematically. RESULTS Nine major themes were developed from the findings. Parents were clear about the health consequences of excess weight but were not clear about the concept of body mass index, often relying on visual cues or symptoms to identify excess weight. Parents relied on pediatricians to identify weight problems and suggest diet and exercise plans, but few recognized them as a link to additional weight-management resources. Parents were divided on the role of the pediatrician in managing child weight and were most interested in receiving tailored nutrition information. Parents preferred family behavioral change strategies over singling out an overweight child. Although parents did not always define their child as overweight, many parents of overweight children did express concerns about their child's weight. CONCLUSIONS Parents believe that pediatricians have a central role in identifying childhood weight problems by completing screening tests such as body mass index assessments, interpreting the health implications, and communicating those implications to parents. Ensuring that parents understand the health implications of excess weight is critical given gaps in parental knowledge and confidence with healthy lifestyle changes as well as parental ambivalence toward child-directed interventions.
Collapse
Affiliation(s)
- Jenna L Lupi
- Department of Behavioral Sciences and Health Education, Emory University, Atlanta, GA
| | - Maryam B Haddad
- Laney Graduate School, Emory University, Atlanta, GA; Department of Epidemiology, Emory University, Atlanta, GA
| | | | - Kimberly J Rask
- Department of Health Policy and Management, Emory University, Atlanta, GA.
| |
Collapse
|
27
|
Avis JL, Bridger T, Buchholz A, Chanoine JP, Hadjiyannakis S, Hamilton J, Jetha MM, Legault L, Morrison KM, Wareham A, Ball GD. It's like rocket science…only more complex: challenges and experiences related to managing pediatric obesity in Canada. Expert Rev Endocrinol Metab 2014; 9:223-229. [PMID: 30736161 DOI: 10.1586/17446651.2014.897605] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Pediatric obesity is an urgent and complex public health issue. Approximately one-third of Canadian children are overweight or obese, a proportion that highlights the need for effective and accessible services to improve short- and long-term health risks. In our experience, we have encountered a number of challenges common in pediatric obesity management across our clinical and research centers. For the purpose of this review, these challenges and our real-world experiences are grouped as issues that span (i) caring for children, adolescents, and families, (ii) collaborating with colleagues and (iii) working within the health care system. Collectively, we highlight a number of lessons learned from our years of experience and detail ongoing initiatives designed to optimize health services for managing obesity for children and adolescents in Canada.
Collapse
Affiliation(s)
- Jillian Ls Avis
- a Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T5K0L4, Canada
| | - Tracey Bridger
- b Department of Pediatrics, Faculty of Medicine, Memorial University, St. John's, NL, Canada
- c Janeway Children's Health and Rehabilitation Centre, St. Johns, NL, Canada
| | - Annick Buchholz
- d The Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, ON, Canada
| | - Jean-Pierre Chanoine
- e Department of Pediatrics, Endocrinology and Diabetes Unit, Vancouver, BC, Canada
- f British Columbia's Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Stasia Hadjiyannakis
- d The Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, ON, Canada
| | - Jill Hamilton
- g Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Mary M Jetha
- a Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T5K0L4, Canada
- h Pediatric Centre for Weight and Health, Stollery Children's Hospital, Alberta Health Services, 11111 Jasper Ave, Edmonton, AB T5K0L4, Canada
| | - Laurent Legault
- i Department of Pediatrics, McGill University, Montreal, QB, Canada
| | | | - Anne Wareham
- c Janeway Children's Health and Rehabilitation Centre, St. Johns, NL, Canada
| | - Geoff Dc Ball
- a Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T5K0L4, Canada
- h Pediatric Centre for Weight and Health, Stollery Children's Hospital, Alberta Health Services, 11111 Jasper Ave, Edmonton, AB T5K0L4, Canada
| |
Collapse
|
28
|
Smith KL, Straker LM, McManus A, Fenner AA. Barriers and enablers for participation in healthy lifestyle programs by adolescents who are overweight: a qualitative study of the opinions of adolescents, their parents and community stakeholders. BMC Pediatr 2014; 14:53. [PMID: 24552207 PMCID: PMC3942615 DOI: 10.1186/1471-2431-14-53] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 02/13/2014] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Overweight or obesity during adolescence affects almost 25% of Australian youth, yet limited research exists regarding recruitment and engagement of adolescents in weight-management or healthy lifestyle interventions, or best-practice for encouraging long-term healthy behaviour change. A sound understanding of community perceptions, including views from adolescents, parents and community stakeholders, regarding barriers and enablers to entering and engaging meaningfully in an intervention is critical to improve the design of such programs. METHODS This paper reports findings from focus groups and semi-structured interviews conducted with adolescents (n?=?44), parents (n?=?12) and community stakeholders (n?=?39) in Western Australia. Three major topics were discussed to inform the design of more feasible and effective interventions: recruitment, retention in the program and maintenance of healthy change. Data were analysed using content and thematic analyses. RESULTS Data were categorised into barriers and enablers across the three main topics. For recruitment, identified barriers included: the stigma associated with overweight, difficulty defining overweight, a lack of current health services and broader social barriers. The enablers for recruitment included: strategic marketing, a positive approach and subsidising program costs. For retention, identified barriers included: location, timing, high level of commitment needed and social barriers. Enablers for retention included: making it fun and enjoyable for adolescents, involving the family, having an on-line component, recruiting good staff and making it easy for parents to attend. For maintenance, identified barriers included: the high degree of difficulty in sustaining change and limited services to support change. Enablers for maintenance included: on-going follow up, focusing on positive change, utilisation of electronic media and transition back to community services. CONCLUSIONS This study highlights significant barriers for adolescents and parents to overcome to engage meaningfully with weight-management or healthy lifestyle programs. A number of enablers were identified to promote ongoing involvement with an intervention. This insight into specific contextual opinions from the local community can be used to inform the delivery of healthy lifestyle programs for overweight adolescents, with a focus on maximising acceptability and feasibility.
Collapse
Affiliation(s)
- Kyla L Smith
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
- Curtin Health Innovation Research Institute, Curtin University, Perth, Australia
| | - Leon M Straker
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
- Curtin Health Innovation Research Institute, Curtin University, Perth, Australia
| | - Alexandra McManus
- Curtin Health Innovation Research Institute, Curtin University, Perth, Australia
| | - Ashley A Fenner
- Curtin Health Innovation Research Institute, Curtin University, Perth, Australia
- School of Psychology and Speech Pathology, Curtin University, Perth, Australia
| |
Collapse
|
29
|
Avis JLS, Ambler KA, Jetha MM, Boateng H, Ball GDC. Modest treatment effects and high program attrition: The impact of interdisciplinary, individualized care for managing paediatric obesity. Paediatr Child Health 2013; 18:e59-63. [PMID: 24497784 PMCID: PMC3907354 DOI: 10.1093/pch/18.10.e59] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND There is an urgent need to identify effective weight management interventions in real-world, clinical settings to improve the health of children with obesity. OBJECTIVES To determine the impact of individualized, interdisciplinary care on the weight status of children with obesity; to assess the relationship between clinical interactions and change in participants' weight status; and to document the degree of program attrition. METHODS A retrospective medical record review of clinical and administrative data from a paediatric weight management clinic in Edmonton, Alberta, was performed, which included data from a group of five- to 18-year-olds (body mass index [BMI] ≥85th percentile) collected from 2008 to 2012. Demographic, anthropometric and attendance data were retrieved from baseline and follow-up at three-, seven- and 11-month timepoints. The primary outcomes were participants' BMI z-score and change in BMI z-score over time. RESULTS Data from 165 individuals were included. Among those with follow-up anthropometric data, weight stabilization occurred at three (n=127) and seven months (n=84). For individuals with follow-up anthropometric data at 11 months (n=44), BMI z-score tended to decrease over time (-0.05±0.12 units; P=0.06). Program attrition increased over time (23%, 49% and 73% at three-, seven- and 11-month follow-ups, respectively). Between presentation and three-month follow-up, there was an inverse relationship between the number of clinical appointments attended and change in BMI z-score (r= -0.18; P=0.04), an association that became nonsignificant at seven and 11 months (both P>0.05). CONCLUSION An individualized, interdisciplinary weight management intervention led to weight stabilization and a modest weight reduction in children with obesity. Strategies to minimize program attrition are needed to optimize family engagement in care and success in managing paediatric obesity.
Collapse
Affiliation(s)
- Jillian LS Avis
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta
| | - Kathryn A Ambler
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta
- Pediatric Centre for Weight and Health, Stollery Children’s Hospital, Alberta Health Services, Edmonton, Alberta
| | - Mary M Jetha
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta
- Pediatric Centre for Weight and Health, Stollery Children’s Hospital, Alberta Health Services, Edmonton, Alberta
| | - Henrietta Boateng
- Pediatric Centre for Weight and Health, Stollery Children’s Hospital, Alberta Health Services, Edmonton, Alberta
| | - Geoff DC Ball
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta
- Pediatric Centre for Weight and Health, Stollery Children’s Hospital, Alberta Health Services, Edmonton, Alberta
| |
Collapse
|
30
|
Keaschuk RA, Ball GDC. Tailoring Health Services for Managing Pediatric Obesity: A Proposed, Practice-Based Framework for Working with Families. Curr Nutr Rep 2013; 2:243-50. [DOI: 10.1007/s13668-013-0055-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|