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
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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"This is similar to what Boyle, Lawrence, Schwarte, Samuels, and McCarthy (2009) found in a survey to 248 health care providers serving low-income communities in California. When the health care providers (including physicians, dietitians, nurses, nurse practitioners, medical assistants, and community health care workers) rated various barriers to obesity prevention efforts, the top two barriers came out to be " parental resistance " (91%) and " family or neighborhood environments undermine recommendations " (90%) (Boyle et al., 2009). Also, in the study by Holt et al. (2011) of primary care physicians located in Southern Appalachia, providers rated the top two barriers to obesity treatment to be lack of parent involvement (32.4% most of the time) and lack of patient motivation (21.6% most of the time). "
[Show abstract][Hide abstract]ABSTRACT: This descriptive study was to determine self-reported treatment practices of school-based health center (SBHC) providers when caring for overweight/obese children. Providers (n=33) from SBHCs in 6 states (AZ, CO, NM, MI, NY, NC) completed a baseline survey before being trained on obesity recommendations. SBHC providers reported patient/parent barriers to be more significant to treatment than clinician/setting barriers (p<0.0001). Most providers (97%) indicated childhood overweight needs treatment, yet only 36% said they initiate treatment in children who do not want to control their weight. SBHC providers also did not commonly refer overweight/obese children to specialists.
Full-text · Article · Nov 2014 · Journal of Pediatric Nursing
"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. "
[Show abstract][Hide abstract]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.
Full-text · Article · Jun 2014 · Health Promotion International
"One popular learning session discussed appropriate billing codes for obesity. As insurance companies often provide minimal reimbursement for obesity-related diagnosis codes, providers have little financial incentive to address obesity concerns with patients [11, 21]. The coding and billing learning session encouraged providers to use appropriate diagnostic codes for all patients with overweight and obesity and maximize opportunities for providing additional obesity-related care during office visits. "
[Show abstract][Hide abstract]ABSTRACT: /st>Quality improvement (QI) activities are required to maintain board certification in pediatrics. However, because of lack of training and resources, pediatricians may feel overwhelmed by the need to implement QI activities. Pediatricians also face challenges when caring for overweight and obese children.
/st>To create a virtual (online) QI learning collaborative through which pediatric practices could easily develop and implement a continuous QI process.
/st>Pediatric practices that were part of the Children's National Health Network were invited to participate, with the option to receive continuing medical education and maintenance of certification credits.
s)Practices conducted baseline and monthly chart audits, participated in educational webinars and selected monthly practice changes, using Plan-Do-Study-Act cycles. Practices reported activities monthly and periodic feedback was provided to practices about their performance.
s)Improvement in (i) body mass index (BMI) percentile documentation, (ii) appropriate nutritional and activity counseling and (iii) follow-up management for high-risk patients.
/st>Twenty-nine practices (120 providers) participated, and 24 practices completed all program activities. Monthly chart audits demonstrated continuous improvement in documentation of BMI, abnormal weight diagnosis, nutrition and activity screening and counseling, weight-related health messages and follow-up management of overweight and obese patients. Impact of QI activities on visit duration and practice efficiency was minimal.
/st>A virtual learning collaborative was successful in providing a framework for pediatricians to implement a continuous QI process and achieve practice improvements. This format can be utilized to address multiple health issues.
Full-text · Article · Feb 2014 · International Journal for Quality in Health Care