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Family-centeredness of childhood obesity interventions: psychometrics & outcomes of the family-centered care assessment tool.

ABSTRACT: BACKGROUND:Incorporating family-centered care principles into childhood obesity interventions is integral for improved clinical decision making, better follow-through, and more effective communication that leads to better outcomes and greater satisfaction with services. The purpose of this study is to evaluate the psychometric properties of a modified version of the Family Centered-Care Assessment (mFCCA) tool and to assess the family-centeredness of two clinical-community childhood obesity interventions. METHODS:Connect for Health was a randomized trial testing the comparative effectiveness of two interventions that enrolled 721 children, ages 2-12?years, with a body mass index (BMI)???85th percentile. The two arms were (1) enhanced primary care; and (2) enhanced primary care plus contextually-tailored, health coaching. At the end of the one-year intervention, the mFCCA was administered. We used Rasch analyses to assess the tool's psychometrics and examined differences between the groups using multiple linear regression. RESULTS:629 parents completed the mFCCA resulting in an 87% response rate. The mean (SD) age of children was 8.0 (3.0) years. The exploratory factor analysis with 24 items all loaded onto a single factor. The Rasch modeling demonstrated good reliability as evidenced by the person separation reliability coefficient (0.99), and strong validity as evidenced by the range of item difficulty and overall model fit. The mean (SD, range) mFCCA score was 4.14 (0.85, 1-5). Compared to parents of children in the enhanced primary care arm, those whose children were in the enhanced primary care plus health coaching arm had higher mFCCA scores indicating greater perception of family-centeredness (??=?0.61?units [95% CI: 0.49, 0.73]). CONCLUSIONS:Using the mFCCA which demonstrated good psychometric properties for the assessment of family-centered care among parents of children with obesity, we found that individualized health coaching is a family-centered approach to pediatric weight management. TRIAL REGISTRATION:Clinicaltrials.gov NCT02124460.

SUBMITTER: Simione M

PROVIDER: S-EPMC7291578 | biostudies-literature | 2020 Jun

REPOSITORIES: biostudies-literature

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Family-centeredness of childhood obesity interventions: psychometrics & outcomes of the family-centered care assessment tool.

Simione Meg M Sharifi Mona M Gerber Monica W MW Marshall Richard R Avalon Earlene E Fiechtner Lauren L Horan Christine C Orav E John EJ Skelton Joseph J Taveras Elsie M EM

Health and quality of life outcomes 20200611 1

<h4>Background</h4>Incorporating family-centered care principles into childhood obesity interventions is integral for improved clinical decision making, better follow-through, and more effective communication that leads to better outcomes and greater satisfaction with services. The purpose of this study is to evaluate the psychometric properties of a modified version of the Family Centered-Care Assessment (mFCCA) tool and to assess the family-centeredness of two clinical-community childhood obes ...[more]

PMID: 32527270

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Project description:Objective:Community-based, family-centered obesity prevention/treatment initiatives have been shown to be effective in reducing body mass index (BMI) and improving healthy habits in children if implemented with high intensity and sufficient duration. Let's Go! 5-2-1-0 Program (5-2-1-0) was incorporated into family-centered, monthly physical activity classes and cooking classes over six months delivered by Young Men's Christian Association (YMCA) staff. We hypothesized that implementation of this intervention would improve 5-2-1-0 knowledge attainment, increase healthy behavior (based on 5- 2-1-0 curriculum), and improve BMI and waist circumference measurements in children. Methods:Children attending YMCA summer camps in Rochester, MN, during 2016 were recruited via study packets mailed to their families. Height, weight, and waist circumference measurements as well as the results of the Modified Healthy Habits Survey and the 5-2-1-0 Knowledge Acquisition Survey were recorded for each participating child at baseline and 6-month follow-up. The intervention group received monthly healthy habit reminder emails, and was invited to monthly evening cooking and physical activity classes for 7 sessions over a 6-month period. Results:Fifteen families in the intervention group attended classes. Of those, 13 families regularly participated in (attended at least 5 out of 7) both the monthly physical activity and cooking classes. The children in the intervention group had a significant improvement in the number of Knowledge Acquisition Survey questions answered correctly (p<0.001), while there was no improvement in the control group. As compared to children in the control group, there was no significant change in BMI or waist circumference or healthy habits in the intervention group. Conclusion:Our study findings indicate that our intervention resulted in improved knowledge about healthy habits, but did not significantly impact healthy habits or BMI. Potential reasons for this were the small sample size and the attenuated length and/or intensity of the intervention.

Project description:BackgroundA wide range of interventions has been implemented and tested to prevent obesity in children. Given parents' influence and control over children's energy-balance behaviors, including diet, physical activity, media use, and sleep, family interventions are a key strategy in this effort. The objective of this study was to profile the field of recent family-based childhood obesity prevention interventions by employing systematic review and quantitative content analysis methods to identify gaps in the knowledge base.MethodsUsing a comprehensive search strategy, we searched the PubMed, PsycIFO, and CINAHL databases to identify eligible interventions aimed at preventing childhood obesity with an active family component published between 2008 and 2015. Characteristics of study design, behavioral domains targeted, and sample demographics were extracted from eligible articles using a comprehensive codebook.ResultsMore than 90% of the 119 eligible interventions were based in the United States, Europe, or Australia. Most interventions targeted children 2-5 years of age (43%) or 6-10 years of age (35%), with few studies targeting the prenatal period (8%) or children 14-17 years of age (7%). The home (28%), primary health care (27%), and community (33%) were the most common intervention settings. Diet (90%) and physical activity (82%) were more frequently targeted in interventions than media use (55%) and sleep (20%). Only 16% of interventions targeted all four behavioral domains. In addition to studies in developing countries, racial minorities and non-traditional families were also underrepresented. Hispanic/Latino and families of low socioeconomic status were highly represented.ConclusionsThe limited number of interventions targeting diverse populations and obesity risk behaviors beyond diet and physical activity inhibit the development of comprehensive, tailored interventions. To ensure a broad evidence base, more interventions implemented in developing countries and targeting racial minorities, children at both ends of the age spectrum, and media and sleep behaviors would be beneficial. This study can help inform future decision-making around the design and funding of family-based interventions to prevent childhood obesity.

Project description:BackgroundChildhood obesity prevention interventions have engaged coalitions in study design, implementation, and/or evaluation to improve research outcomes; yet, no systematic reviews have been conducted on this topic. This mixed methods review aims to characterize the processes and dynamics of coalition engagement in community-based childhood obesity prevention interventions.MethodsData Sources: Studies extracted from Ovid MEDLINE, PubMed, and Web of Science; complementary original survey and interview data among researchers of included studies. Eligible Studies: Multisetting community-based obesity prevention interventions in high-income countries targeting children 0-12 years with anthropometric, behavioral, or environmental/policy outcomes. The Community-Based Participatory Research (CBPR) Conceptual Model was used as an overarching framework.ResultsThirteen studies met inclusion criteria. Elements of CBPR were evident across all studies with community engagement in problem identification (n = 7), design/planning (n = 11), implementation (n = 12), evaluation (n = 4), dissemination (n = 2), and sustainability (n = 10) phases. Five studies reported favorable intervention effects on anthropometric (n = 4), behavioral (n = 1), and/or policy (n = 1) outcomes; descriptive associations suggested that these studies tended to engage community members in a greater number of research phases. Researchers involved in 7 of 13 included studies completed a survey and interview. Respondents recalled the importance of group facilitation, leadership, and shared understanding to multisector coalition work. Perceived coalition impacts included community capacity building and intervention sustainability.ConclusionsThis review contributes to a deeper understanding of intervention processes and dynamics within communities engaged in childhood obesity prevention. Future research should more rigorously assess and report on coalition involvement to assess the influence of coalitions on multiple outcomes, including child weight status.

Project description:ImportanceFamily-based treatment (FBT) is recommended for childhood obesity, but even when sought, attrition is high. Extrinsic incentives, which have been effective for improving adult health, could improve FBT engagement.ObjectiveTo assess parents' preferences for FBT incentives.Design, setting, and participantsSurvey study of parents of children aged 6 to 17 years with obesity (body mass index in ≥95th percentile for age and sex). Parents' preferences for FBT incentive program attributes were assessed in a discrete choice experiment conducted using a nationally representative, web-based survey in March 2018. Attributes included (1) the monetary value of the incentive, (2) the payment structure, (3) the goal being incentivized, and (4) the person(s) being incentivized. A fractional factorial design was used to create a set of profiles representing hypothetical FBT incentives. Parents were presented with 10 pairs of profiles and asked which would most motivate them in FBT. Parents were also asked about preferences between a small, guaranteed incentive and a lottery for a large incentive. Analyses used a hierarchical Bayesian model and linear regressions.Main outcomes and measuresParents' preference for different incentive program attributes and levels.ResultsThe nationally representative survey had a 41.4% eligibility rate (n = 339) and a 89.7% completion rate (n = 304). A total of 53.3% of respondents (weighted percentage) were non-Hispanic white, 42.6% had an annual household income less than $50 000, and 28.3% had a bachelor's degree. Parents preferred higher incentives, although they were willing to accept lower-value incentives if both the parent and the child (vs the child alone) were required to meet the goal (mean difference [MD], -$108; 95% CI, -$132 to -$84), if the incentive used a gain-framed vs loss-framed payment structure (MD, -$72; 95% CI, -$85 to -$59), and if physical activity goals were incentivized over weight loss (MD, -$63; 95% CI, -$82 to -$44) or dietary monitoring (MD, -$5; 95% CI, -$1 to $28). Only 20.6% of parents preferred a lottery over a guaranteed payment. Preferences did not vary among demographic or health subgroups.Conclusions and relevanceIn this study, parent-stated preferences did not align with FBT best practices or behavioral economic theory. A randomized clinical trial could examine whether aligning incentives with preferences or best practices would maximize FBT engagement and behavior change.

Project description:BackgroundPatient-centered outcome measures for childhood obesity are limited. Identifying outcomes that patients and families consider important could be a viable avenue for better engagement of patients and interventions that are efficacious and acceptable to patients. Latino children experience high rates of obesity, and under-recognition of obesity in preschool aged children is common.MethodsWe used growth chart data to identify low-income, Latino children 2-5 years of age with obesity who decreased their adiposity (positive deviants) and a set of controls. We used qualitative interview data to identify themes around goals parents used in addressing weight. Then, we applied a modified Delphi approach across groups of caregivers and providers to identify common goals. We conducted focus groups to explore conflicts and congruency between caregivers and providers related to goals. Using the focus group data, we developed a decision tool for use between patients and providers relevant for early childhood obesity.ResultsWe identified 257 children who successfully reduced adiposity (positive deviants) from 1621 eligible growth charts. From interviews with 44 parents (21 positive deviants and 23 controls), we coded and categorized outcomes such as increased happiness, clothing size and improved activity. We recruited 81 parents, grandparents and health care providers to participate in the modified Delphi process of ranking outcomes by importance and feasibility. Focus groups (2, total n = 24) suggested potential methods for a common framework to discuss goals, including a modified growth chart. We created a decision-tool that incorporated a growth chart and a section for discussion of patient-centered goals. A final focus group (1, n = 10) provided feedback on the tool as acceptable and potentially useful.ConclusionsThe development of a patient-centered tool around achieving a healthy weight in early childhood identified common goals between providers and parents. While the tool has been developed, prospective testing of this patient-centered tool and its effects on engagement, parent motivation, and behavior change would be a useful next step.

Project description:Care transitions from the hospital to home are critical to the sustainability of our health care system. Ineffective care transitions can be caused by high incidences of post-discharge adverse events, by poor communication with patients, and/or by inadequate information transfer between providers from the hospital to home. Any one of these can lead to fragmented care, high readmission rates, increased visits to the emergency department, and ultimately poor patient outcomes. Despite the ongoing improvement efforts of health care organizations, the efficacy of person- and family-centered care transition interventions on the quality of care and on the patient experience are not known. The aim of this systematic review is to critically analyze the body of evidence regarding the effectiveness of person- and family-centered care transition interventions on the quality of care, and the experience of patients.We will conduct a systematic review using the Cochrane Handbook's guidelines and will adhere to a standardized reporting format: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A comprehensive search strategy will be conducted in the following databases: MEDLINE, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, and the Cochrane Consumers and Communication Group. Following a two-step screening process, data including the full reference, objectives, target population, description of the intervention and control intervention, outcome measures, design, length of post-intervention follow-up period, and the study results will be extracted, synthesized, and reported. Risk of bias and quality of the studies will also be assessed.This systematic review will summarize and present the evidence base for person- and family-centered care transition interventions. This review will also inform further research and will lay the groundwork for more empirical studies on person- and family-centered care transitions. Specifically, the results of this systematic review may inform the development of measures to monitor safe and effective person- and family-centered transitions from the hospital to home. These results may also be important for policy makers, decision-makers, clinicians, and patients/families who are involved in navigating the health care system.PROSPERO CRD42017067990.

Dataset Information

Family-centeredness of childhood obesity interventions: psychometrics & outcomes of the family-centered care assessment tool.

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Family-centeredness of childhood obesity interventions: psychometrics & outcomes of the family-centered care assessment tool.

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