Diane O. Tyler

Family‐centered collaborative negotiation: A model for facilitating behavior change in primary care

PurposeTo describe a parent–child-based model that melds a family-centered interaction approach, Touchpoints, with brief negotiation strategies (an adaptation of motivational interviewing) to address health risks in children. An application of the model for addressing childhood overweight in the primary care setting is presented. Data SourcesSelected research, theoretical, and clinical articles; national recommendations and guidelines; and a clinical case. ConclusionsLifestyle health behaviors are learned and reinforced within the family; thus, changes to promote child health require family involvement. Interventions that engage parents and support parent–child relationships, while enhancing motivation and the abilities to change behavior, are recommended. Implications for PracticePrimary care is an appropriate setting for addressing lifestyle health behaviors. A collaborative partnership, rather than a prescriptive manner, is advocated for primary care providers when working to facilitate health-promoting behavior.

Weight loss methods used by African American and Euro‐American women

In this naturalistic study employing intensive interviews and anthropometric measures, an educationally and economically diverse community-based sample of 40 African American and 40 Euro-American women described their lifetime experiences with weight management. Twenty types of weight loss methods were identified and grouped into one of three categories: lifestyle work, head work, and professional services. The most frequently used weight loss methods were from the lifestyle work category, with the leading methods identified as exercise on own and reduce high calorie and/or increase low calorie foods. African Americans and Euro-Americans overwhelmingly used similar weight loss methods, with the only significant difference occurring in the more frequent use of commercial diet products among the African American group. Methods from the head work category were used significantly more often by women with higher social status, while heavier women more frequently sought professional services to lose weight than thinner women. The Euro-American women engaged in weight loss methods for significantly longer periods of time and were found to weigh significantly less than the African American women. These findings suggest that the shorter duration of weight loss attempts may be a major factor contributing to the larger body size in African American women.

Ensuring Quality Preventive Care: The Texas Department of Health's Put Prevention Into Practice Initiative

In the current public health arena, assurance of quality clinical preventive services to all populations will be possible only if collaborations are nurtured between public health and the private sector health care delivery systems. This article explores key preventive health programs that serve as the historical context for the evolution of the Texas Department of Health-Put Prevention Into Practice (TDH-PPIP) initiative, outlines documented barriers to implementation of preventive services in primary care, and reviews national public health programs launched to reduce these barriers. Lastly, a discussion regarding the joint responsibilities of the public health and the private sector professionals in assuring quality preventive services to all populations is initiated. Collaborative efforts, such as the TDH-PPIP, initiative improve the availability and quality of clinical preventive services and, thus, result in significant advances in the public health goal of ensuring conditions in which people can be healthy.

The impact of genetic information on policy and clinical practice.

This article discusses genetics-related policy issues that have an impact on health care systems, health care providers, and their patients: privacy, mass screening, family screening, and knowledge dissemination. Access, cost, and ethical implications are important discussant points for each of these genetic-related policy issues. Embedded in the issue of privacy are concerns of insurability, confidentiality, and discrimination. The public health policy implications related to mass screening programs include efficacy of the screening tests, availability of primary and secondary interventions, access, costs, and program evaluation. Policy issues for family screening are similar to mass screening, with added concerns about privacy and availability of adequate resources, including health care providers and counselors trained in genetics. Knowledge dissemination is critical to maintaining currency of clinical information and applications of genetic technologies and treatments. As genetic information expands, the need for knowledge dissemination will increase. The importance of advanced practice nurses’ involvement in these policy issues is discussed.

A primary care intervention to improve weight in obese children: A feasibility study

Purpose:Examine the effects of a primary care weight management program, which used a parent–child–provider collaborative negotiation intervention, among rural‐dwelling families with obese children. Data sources:Health histories, physical examinations, fasting blood samples, interviews, and questionnaires. Conclusions:Feasibility of implementing a family weight management intervention in a rural primary care setting was demonstrated. Few differences between the treatment and comparison groups were found; however, more favorable trends and outcomes occurred in those who received the intervention. Implications for practice:Positive provider–patient communication in helping families with obese children make difficult lifestyle changes should be encouraged in primary care clinics as small changes in behavior can result in reducing risk and improving health outcomes.Purpose Examine the effects of a primary care weight management program, which used a parent–child–provider collaborative negotiation intervention, among rural-dwelling families with obese children. Data sources Health histories, physical examinations, fasting blood samples, interviews, and questionnaires. Conclusions Feasibility of implementing a family weight management intervention in a rural primary care setting was demonstrated. Few differences between the treatment and comparison groups were found; however, more favorable trends and outcomes occurred in those who received the intervention. Implications for practice Positive provider–patient communication in helping families with obese children make difficult lifestyle changes should be encouraged in primary care clinics as small changes in behavior can result in reducing risk and improving health outcomes.

Utilizing "PPIP Texas style!" in a medically underserved population.

Implementation models, such as the national Put Prevention Into Practice program, have produced small to moderate changes in the delivery of preventive services in primary care. More recently, researchers concluded that guides and tools, such as the PPIP toolkit, are helpful, but are not sufficient to facilitate substantive change in clinical preventive practice. Successful implementation of clinical preventive services, according to the Texas Department of Health-PPIP (TDH-PPIP) initiative, involves creating or altering systems to produce change in service delivery for a specific setting. This article describes the ways in which the guidelines and instruments that were developed and refined through the collaborative efforts among public and private health systems were used to implement systems change and improve clinical preventive services at one community primary health care clinic in Texas. The process and empirical results of using the TDH-PPIP Implementation Model in the field are also presented, as well as a discussion of one-year evaluation data.