Health Care Providers' Perceived Role in Changing Environments to Promote Healthy Eating and Physical Activity: Baseline Findings From Health Care Providers Participating in the Healthy Eating, Active Communities Program

Samuels & Associates, Oakland, California, USA.
PEDIATRICS (Impact Factor: 5.47). 07/2009; 123 Suppl 5(Supplement 5):S293-300. DOI: 10.1542/peds.2008-2780H
Source: PubMed


The California Endowment's Healthy Eating, Active Communities program was designed to reduce disparities in the incidence of obesity by improving food and physical-activity environments for low-income children. It was recognized at the outset that to succeed, the program needed support from community advocates. Health care providers can be effective advocates to mobilize community members and influence policy makers.
This study was conducted to describe how health care providers address obesity prevention in clinical practice and to assess health care providers' level of readiness to advocate for policies to prevent childhood obesity.
The study included two data-collection methods, (1) a self-administered survey of health care providers (physicians, dietitians, nurses, nurse practitioners, medical assistants, and community health workers) and (2) stakeholder interviews with health care facility administrators, health department staff, and health insurance organization representatives. Two-hundred and forty-eight health care providers participated in the provider survey and the health care stakeholder interviews were conducted with 56 respondents.
The majority (65%) of health care providers usually or always discussed the importance of physical-activity, reducing soda consumption, and breastfeeding (as appropriate) during clinical pediatric visits. More than 90% of the providers perceived home or neighborhood environments and parental resistance as barriers to their efforts to prevent childhood obesity in clinical practice. More than 75% of providers reported not having engaged in any policy/advocacy activities related to obesity-prevention. Most (88%) of the stakeholders surveyed thought that health care professionals should advocate for policies to reduce obesity, especially around insurance coverage for obesity-prevention.
Providers perceived that changing the food and physical-activity environments in neighborhoods and schools was likely to be the most effective way to support their clinical obesity-prevention efforts. Health care providers need time, training, resources, and institutional support to improve their ability to communicate obesity-prevention messages in both clinical practice and as community policy advocates.

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    • "There is limited knowledge on the practical experience involved with planning and implementation of community-based obesity prevention programmes (King et al., 2011). Recent studies have covered Australia (Wilson et al., 2009, de Groot et al., 2010, de Silva-Sanigorki et al., 2010) and America (Boyle et al., 2009, Po " e et al., 2010, Dreisinger, et al., 2011), however little has been published documenting efforts in the UK. The findings from this investigation, illustrate the challenging experiences of stakeholders when implementing a large community-based obesity prevention programme in the north-east of England. "
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    ABSTRACT: Recent literature indicates the potential of community-based obesity prevention programmes in the endeavour to reduce the prevalence of obesity in developed nations. Considerable suggestion and advocacy come from theoretical standpoints and little is known on actual practical application of this type of multi-component health promotion programme. This article explores the experiences of 'implementation' by stakeholders of a large community-based obesity prevention programme, facilitated by a National Health Service Care Trust in the north-east of England, UK. Three stakeholder groups (senior health officials, public health workers and community members) who had administrated and experienced the programme since its conception in 2006 provide perspectives on the aspects of local delivery and receipt. Semi-structured interviews and focus groups were conducted with stakeholders (28 participants in total). The participants felt there were three broad aspects which shaped and constrained the delivery and receipt of the programme, namely partnership working, integration of services and quality issues. Data indicated that it had taken time to establish working partnerships between the multi-agencies involved in the community-based obesity programme. Strategic management would aid the processes of communication and collaboration between agencies and also the local community involved in the administration, delivery and participation of interventions in the programme. Secondly, the way in which the programme is justified and sustained will have to be reviewed, with the intention of using a suitable evaluative framework or tool for monitoring purposes.
    Health Promotion International 06/2014; 29(2):2014. DOI:10.1093/heapro/das072 · 1.94 Impact Factor
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    • "Some of these barriers include lack of knowledge and behaviour management (Gance-Cleveland et al., 2009; Steele et al., 2011). Difficulties in raising weight issues, such as stigma and personal fears, also limit their ability to promote healthier habits (Boyle et al., 2009; Klein et al., 2010; Steele et al., 2011). Thus, different management guidelines, practice recommendations Health Promotion International doi:10.1093/heapro/dat023 "
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    ABSTRACT: To increase the understanding of difficulties in promoting healthy habits to parents, we explore barriers in health-care provision. The aim of this study is to describe nurses' perceived barriers when discussing with parents regarding healthy food habits, physical activity and their child's body weight. A mixed method approach was chosen. Nurses (n = 76) working at 29 different Child Health Care Centers' in an area in west Sweden were included in the study. Three focus group interviews were conducted and 17 nurses were selected according to maximum variation. Data were categorized and qualitative content analysis was the chosen analysis method. In the second method, data were obtained from a questionnaire distributed to all 76 nurses. The latent content was formulated into a theme: even with encouragement and support, the nurses perceive barriers of both an external and internal nature. The results identified four main barriers: experienced barriers in the workplace-internal and external; the nurse's own fear and uncertainty; perceived obstacles in nurse-parent interactions and modern society impedes parents' ability to promote healthy habits. The nurses' perceived barriers were confirmed by the results from 62 of the nurses who completed the questionnaire. Despite education and professional support, the health professionals perceived both external and internal barriers in promoting healthy habits to parents when implementing a new method of health promotion in primary care. Further qualitative studies are needed to gain deeper understanding of the perceived barriers when promoting healthy habits to parents.
    Health Promotion International 04/2013; 29(4). DOI:10.1093/heapro/dat023 · 1.94 Impact Factor
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    • "This might seem a natural role for physicians, extending their health promotion efforts with their patients to the community. Unfortunately, although many health care providers are aware of the childhood obesity epidemic, are concerned about its health impacts, and want to work on its prevention, they continue to see themselves primarily as clinical practitioners and not as health educators or advocates in the broader community [73]. "
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    ABSTRACT: Although pediatric providers have traditionally assessed and treated childhood obesity and associated health-related conditions in the clinic setting, there is a recognized need to expand the provider role. We reviewed the literature published from 2005 to 2012 to (1) provide examples of the spectrum of roles that primary care providers can play in the successful treatment and prevention of childhood obesity in both clinic and community settings and (2) synthesize the evidence of important characteristics, factors, or strategies in successful community-based models. The review identified 96 articles that provide evidence of how primary care providers can successfully prevent and treat childhood obesity by coordinating efforts within the primary care setting and through linkages to obesity prevention and treatment resources within the community. By aligning the most promising interventions with recommendations published over the past decade by the Institute of Medicine, the American Academy of Pediatrics, and other health organizations, we present nine areas in which providers can promote the prevention and treatment of childhood obesity through efforts in clinical and community settings: weight status assessment and monitoring, healthy lifestyle promotion, treatment, clinician skill development, clinic infrastructure development, community program referrals, community health education, multisector community initiatives, and policy advocacy.
    Journal of obesity 04/2013; 2013(11):172035. DOI:10.1155/2013/172035
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