Jillian L.S. Avis

Working With Parents to Prevent Childhood Obesity: Protocol for a Primary Care-Based eHealth Study.

Background Parents play a central role in preventing childhood obesity. There is a need for innovative, scalable, and evidence-based interventions designed to enhance parents’ motivation to support and sustain healthy lifestyle behaviors in their children, which can facilitate obesity prevention. Objective (1) Develop an online screening, brief intervention, and referral to treatment (SBIRT) eHealth tool to enhance parents’ concern for, and motivation to, support children’s healthy lifestyle behaviors, (2) refine the SBIRT eHealth tool by assessing end-user acceptability, satisfaction, and usability through focus groups, and (3) determine feasibility and preliminary effectiveness of the refined SBIRT eHealth tool through a randomized controlled trial. Methods This is a three-phase, multi-method study that includes SBIRT eHealth tool development (Phase I), refinement (Phase II), and testing (Phase III). Phase I: Theoretical underpinnings of the SBIRT tool, entitled the Resource Information Program for Parents on Lifestyle and Education (RIPPLE), will be informed by concepts applied within existing interventions, and content will be based on literature regarding healthy lifestyle behaviors in children. The SBIRT platform will be developed in partnership between our research team and a third-party intervention development company. Phase II: Focus groups with parents, as well as health care professionals, researchers, and trainees in pediatrics (n=30), will explore intervention-related perceptions and preferences. Qualitative data from the focus groups will inform refinements to the aesthetics, content, structure, and function of the SBIRT. Phase III: Parents (n=200) of children—boys and girls, 5 to 17 years old—will be recruited from a primary care pediatric clinic while they await their children’s clinical appointment. Parents will be randomly assigned to one of five groups—four intervention groups and one control group—as they complete the SBIRT. The randomization function is built into the tool. Parents will complete the eHealth SBIRT using a tablet that will be connected to the Internet. Subsequently, parents will be contacted via email at 1-month follow-up to assess (1) change in concern for, and motivation to, support children’s dietary and physical activity behaviors (primary outcome), and (2) use of online resources and referrals to health services for obesity prevention (secondary outcome). Results This research was successfully funded and received ethics approval. Development of the SBIRT started in summer 2012, and we expect all study-related activities to be completed by fall 2016. Conclusions The proposed research is timely and applies a novel, technology-based application designed to enhance parents concern for, and motivation to, support children’s healthy lifestyle behaviors and encourage use of online resources and community services for childhood obesity prevention. Overall, this research builds on a foundation of evidence supporting the application of SBIRTs to encourage or “nudge” individuals to make healthy lifestyle choices. Findings from Phase III of this project will directly inform a cluster randomized controlled trial to study the effectiveness of our intervention across multiple primary care-based settings. Trial Registration ClinicalTrials.gov NCT02330588; http://clinicaltrials.gov/ct2/show/NCT02330588 (Archived by WebCite at http://www.webcitation.org/6WyUOeRlr).

Lessons Learned From Using Focus Groups to Refine Digital Interventions

There is growing interest in applying novel eHealth approaches for the prevention and management of various health conditions, with the ultimate goal of increasing positive patient outcomes and improving the effectiveness and efficiency of health services delivery. Coupled with the use of innovative approaches is the possibility for adverse outcomes, highlighting the need to strategically refine digital practices prior to implementation with patients. One appropriate method for modification purposes includes focus groups. Although it is a well-established method in qualitative research, there is a lack of guidance regarding the use of focus groups for digital intervention refinement. To address this gap, the purpose of our paper is to highlight several lessons our research team has learned in using focus groups to help refine digital interventions prior to use with patients.

Lifestyle Behaviors of Parents of Children in Pediatric Weight Management Are They Meeting Recommendations

Objective: Our objective was to examine the lifestyle behaviors of parents of children in pediatric weight management. Methods: Parents were recruited upon presentation of their children (body mass index [BMI] ≥85th percentile) to a pediatric weight management clinic. Parents’ demographic, anthropometric, and lifestyle habit data were collected by self-report. Parents were grouped into weight status categories based on their BMIs; lifestyle data were compared across BMI categories and to national recommendations. Results: Parents (n = 266; 84% women; BMI, mean ± SD, 31.8 ± 7.2 kg/m2) were predominantly overweight/obese (82%), and most did not meet dietary recommendations (71%). Healthy-weight parents reported more daily steps versus parents who were overweight/obese (all P < .05). Most parents (~60%) met guidelines for physical activity, sedentary activity, and sleep. Conclusion: The high prevalence of overweight and obesity combined with suboptimal dietary behaviors highlight the need to address both children’s and parents’ lifestyle habits in pediatric weight management.

It's like rocket science...only more complex: Challenges and experiences related to managing pediatric obesity in Canada

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.

Beyond Weight Loss: Experiences and Insights Related to Working Effectively with Families and Operating within the Health Care System to Manage Pediatric Obesity

Pediatric obesity is an urgent and complex public health issue. The high proportions of children who meet the definition of overweight or obesity highlight the need for effective and accessible servic

Is Waiting Room Behavior an Accurate Proxy for Families’ Actual Dietary Habits? A Comment Regarding “Junk Food Seen at Pediatric Clinic Visits: Is It a Problem?”

This letter is written with regard to the article, “Junk Food Seen at Pediatric Clinic Visits: Is It a Problem?” in which Frazier et al documented families’ consumption of food with poor nutritional value in two general pediatric clinic waiting rooms. Pediatric clinic waiting rooms are opportunistic for research purposes because families typically spend at least a few minutes in the waiting room before their appointment starts. Waiting rooms also offer an opportunity for health care professionals to promote healthy lifestyle habits (eg, healthy nutrition, injury prevention) to help prevent and manage chronic conditions, a priority well aligned with the mandate of most multidisciplinary pediatric clinics. The issue at hand is the degree to which families’ dietary eating habits can be accurately and reliably assessed in this environment. Data collection in the waiting room is a resourceand time-efficient approach, but the extent to which food consumption in this setting is a proxy for families’ actual dietary behavior is debatable, particularly because waiting rooms may be a stressful environment for parents. As noted by the authors, food with poor nutritional value may be used to reward children for good behavior or to appease children’s anxiety associated with their visit. It is plausible that families may be more inclined to consume junk foods in this specific setting. Conversely, parents may purposefully alter their behavior to reflect perceived expectations of the setting; Frazier et al noted that families may conceal foods that are not “physician approved.” Given these issues, caution should be exercised when evaluating families’ dietary intakes in clinic waiting rooms since their food choices may be affected by a number of issues, including stress and social desirability. Settings in which families are more likely to display their usual eating behaviors and investigating the degree of concordance between usual and context-specific dietary intakes of children and youth warrant further study.