Evaluation of a Pediatric Obesity Management Toolkit for Health Care Professionals: A Quasi-Experimental Study

Barkha P Patel, Stasia Hadjiyannakis, Laurie Clark, Annick Buchholz, Rebecca Noseworthy, Julie Bernard-Genest, Catharine M Walsh, Amy C McPherson, Jonah Strub, Michele Strom, Jill K Hamilton, Barkha P Patel, Stasia Hadjiyannakis, Laurie Clark, Annick Buchholz, Rebecca Noseworthy, Julie Bernard-Genest, Catharine M Walsh, Amy C McPherson, Jonah Strub, Michele Strom, Jill K Hamilton

Abstract

Health care professionals (HCPs) play a critical role in helping to address weight-related issues with pediatric patients, yet often feel ill-equipped to discuss/manage this complex and sensitive health issue. Using the five As ("Ask, Assess, Advise, Agree, and Assist") of Pediatric Obesity Management, we created a series of educational videos and evaluated the content, quality (acceptability, engagement), and impact of these videos on HCPs' self-efficacy, knowledge, and change in practice when addressing weight-related issues with pediatric patients and their families using questionnaires. HCPs (n = 65) participated in a baseline assessment and 4-6 month follow-up (n = 54). Knowledge and self-efficacy increased post-video for the majority of participants. At follow-up, most HCPs reported a change in their practice attributable to viewing the videos, and their self-efficacy ratings improved over time for the majority of questions asked. Most participants rated aspects of each of the videos highly. Preliminary findings suggest that an evidence-based educational toolkit of videos, based on the 5As framework, may lead to changes in self-reported behaviors among HCPs, and sustained improvements in their self-efficacy in addressing weight-related topics with children and their families. (Clinical Trial Number NCT04126291).

Keywords: healthcare professionals; obesity; pediatrics; self-efficacy; videos.

Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Figures

Figure 1
Figure 1
Consolidated Standards for Reporting of Trials (CONSORT) flow diagram.
Figure 2
Figure 2
(A–G) Post-video change in knowledge. Participant agreement (%) measured using a Likert-type scale (1 to 7, where 1 = No change (or reduction in knowledge), 2 = Almost the same, 3 = A little better, 4 = Somewhat better, 5 = Moderately better, 6 = Better, and 7 = A great deal better) is shown for each statement (n = 65).
Figure 3
Figure 3
(A–K) Post-video change in self-efficacy. Participant agreement (%) measured using a Likert-type scale (1 to 7, where 1 = No change (or reduction in self-efficacy), 2 = Almost the same, 3 = A little better, 4 = Somewhat better, 5 = Moderately better, 6 = Better, and 7 = A great deal better) is shown for each statement (n = 65).
Figure 4
Figure 4
(A–I). Impact on practice 4 to 6 months later. Participant agreement (%) measured using a Likert-type scale (1 to 7, where 1 = No change, 2 = Hardly any change, 3 = No noticeable change, 4 = Somewhat changed, but the change has not made a big difference, 5 = A noticeable change, 6 = A real and worthwhile difference in my practice, and 7 = Made all the difference in my practice) is shown for each statement (n = 54).

References

    1. Ruiz L.D., Zuelch M.L., Dimitratos S.M., Scherr R.E. Adolescent Obesity: Diet Quality, Psychosocial Health, and Cardiometabolic Risk Factors. Nutrients. 2019;12:43. doi: 10.3390/nu12010043.
    1. Campbell-Scherer D.L., Asselin J., Osunlana A.M., Fielding S., Anderson R., Rueda-Clausen C.F., Johnson J.A., Ogunleye A.A., Cave A., Manca D., et al. Implementation and evaluation of the 5As framework of obesity management in primary care: Design of the 5As Team (5AsT) randomized control trial. Implement. Sci. 2014;9:78. doi: 10.1186/1748-5908-9-78.
    1. Jelalian E., Boergers J., Alday C.S., Frank R. Survey of physician attitudes and practices related to pediatric obesity. Clin. Pediatr. 2003;42:235–245. doi: 10.1177/000992280304200307.
    1. Alexander S.C., Østbye T., Pollak K.I., Gradison M., Bastian L.A., Brouwer R.J.N. Physicians’ beliefs about discussing obesity: Results from focus groups. Am. J. Health Promot. 2007;21:498–500. doi: 10.4278/0890-1171-21.6.498.
    1. Cooke N.K., Ash S.L., Goodell L.S. Medical students’ perceived educational needs to prevent and treat childhood obesity. Educ. Health. 2017;30:156–162. doi: 10.4103/efh.EfH_57_16.
    1. Lee S., Smith M.L., Kromann L., Ory M.G. Medical Students and Childhood Obesity: Health Disparity and Implication for Education. Int. J. Environ. Res. Public Health. 2019;16:2578. doi: 10.3390/ijerph16142578.
    1. Lenders C.M., Manders A.J., Perdomo J.E., Ireland K.A., Barlow S.E. Addressing Pediatric Obesity in Ambulatory Care: Where Are We and Where Are We Going? Curr. Obes. Rep. 2016;5:214–240. doi: 10.1007/s13679-016-0210-2.
    1. Van Gerwen M., Franc Č., Rosman S., Le Vaillant M., Pelletier-Fleury N. Primary care physicians’ knowledge, attitudes, beliefs and practices regarding childhood obesity: A systematic review. Obes. Rev. 2009;10:227–236. doi: 10.1111/j.1467-789X.2008.00532.x.
    1. Mikhailovich K., Morrison P. Discussing childhood overweight and obesity with parents: A health communication dilemma. J. Child Health Care. 2007;11:311–322. doi: 10.1177/1367493507082757.
    1. Walker O., Strong M., Atchinson R., Saunders J., Abbott J. A qualitative study of primary care clinicians’ views of treating childhood obesity. BMC Fam. Pract. 2007;8:50. doi: 10.1186/1471-2296-8-50.
    1. McPherson A.C., Knibbe T.J., Oake M., Swift J.A., Browne N., Ball G.D.C., Hamilton J. “Fat is really a four-letter word”: Exploring weight-related communication best practices in children with and without disabilities and their caregivers. Child Care Health Dev. 2018;44:636–643. doi: 10.1111/cch.12575.
    1. Puhl R.M., Latner J.D. Stigma, obesity, and the health of the nation’s children. Psychol. Bull. 2007;133:557–580. doi: 10.1037/0033-2909.133.4.557.
    1. Gudzune K.A., Johnson V.R., Bramante C.T., Stanford F.C. Geographic Availability of Physicians Certified by the American Board of Obesity Medicine Relative to Obesity Prevalence. Obesity. 2019;27:1958–1966. doi: 10.1002/oby.22628.
    1. Mastrocola M.R., Roque S.S., Benning L.V., Stanford F.C. Obesity education in medical schools, residencies, and fellowships throughout the world: A systematic review. Int. J. Obes. 2020;44:269–279. doi: 10.1038/s41366-019-0453-6.
    1. Flodgren G., Deane K., Dickinson H.O., Kirk S., Alberti H., Beyer F.R., Brown J.G., Penney T.L., Summerbell C.D., Eccles M.P. Interventions to change the behaviour of health professionals and the organisation of care to promote weight reduction in overweight and obese people. Cochrane Database Syst. Rev. 2010;3:CD000984. doi: 10.1002/14651858.CD000984.pub2.
    1. Dietz W.H., Baur L., Hall K., Puhl R.M., Taveras E.M., Uauy R., Kopelman P. Management of obesity: Improvement of health-care training and systems for prevention and care. Lancet. 2015;385:2521–2533. doi: 10.1016/S0140-6736(14)61748-7.
    1. Mayer R.E. Applying the science of learning to medical education. Med. Educ. 2010;44:543–549. doi: 10.1111/j.1365-2923.2010.03624.x.
    1. Kenny K.P., Alkazme A.M., Day P.F. The effect of viewing video clips of paediatric local anaesthetic administration on the confidence of undergraduate dental students. Eur. J. Dent. Educ. 2017;22:e57–e62. doi: 10.1111/eje.12257.
    1. Thomson A.A., Brown M., Zhang S., Stern E., Hahn P.M., Reid R.L. Evaluating Acquisition of Knowledge about Infertility Using a Whiteboard Video. J. Obstet. Gynaecol. Can. 2016;38:646–650.
    1. Haywood C., Jr., Lanzkron S., Hughes M.T., Brown R., Massa M., Ratanawongsa N., Beach M.C. A video-intervention to improve clinician attitudes toward patients with sickle cell disease: The results of a randomized experiment. J. Gen. Intern. Med. 2011;26:518–523. doi: 10.1007/s11606-010-1605-5.
    1. Srivastava G., Roddy M., Langsam D., Agrawal D. An educational video improves technique in performance of pediatric lumbar punctures. Pediatr. Emerg. Care. 2012;28:12–16. doi: 10.1097/PEC.0b013e31823ed5ed.
    1. Rincon-Subtirelu M. Education as a tool to modify anti-obesity bias among Pediatric residents. Int. J. Med. Educ. 2017;8:77–78. doi: 10.5116/ijme.58b1.46e3.
    1. Whitlock E.P. Evaluating primary care behavioral counseling interventions: An evidence-based approach. Am. J. Prev. Med. 2002;22:267–284. doi: 10.1016/S0749-3797(02)00415-4.
    1. Rueda-Clausen C.F., Benterud E., Bond T., Olszowka R., Vallis M.T., Sharma A.M. Effect of implementing the 5As of obesity management framework on provider-patient interactions in primary care. Clin. Obes. 2014;4:39–44. doi: 10.1111/cob.12038.
    1. Rutherford J., Hadjiyannakis S., Clark L., Buchholz A. 5As of Pediatric Obesity Management in the 3rd National Obesity Summit. Can. J. Diabetes. 2013;37:S217–S218. doi: 10.1016/j.jcjd.2013.03.031.
    1. Bernard-Genest J., Chu L., Dettmer E., Walsh C.M., McPherson A.C., Strub J., Steinberg A., Steinegger C., Hamilton J.K. Talking about Weight With Families-Helping Health Care Professionals Start the Conversation: A Nonrandomized Controlled Trial. Clin. Pediatr. 2020;59:910–917. doi: 10.1177/0009922820922844.
    1. Campoverde Reyes K.J., Perez N.P., Czepiel K.S., Shaw A.Y., Stanford F.C. Exploring Pediatric Obesity Training, Perspectives, and Management Patterns Among Pediatric Primary Care Physicians. Obesity. 2021;29:159–170. doi: 10.1002/oby.22990.
    1. McPherson A.C., Hamilton J., Kingsnorth S., Knibbe T.J., Peters M., Swift J.A., Krog K., Chen L., Steinberg A., Ball G.D.C. Communicating with children and families about obesity and weight-related topics: A scoping review of best practices. Obes. Rev. 2017;18:164–182. doi: 10.1111/obr.12485.
    1. Hadjiyannakis S., Buchholz A., Chanoine J.-P., Jetha M.M., Gaboury L., Hamilton J., Birken C., Morrison K.M., Legault L., Bridger T., et al. The Edmonton Obesity Staging System for Pediatrics: A proposed clinical staging system for paediatric obesity. Paediatr. Child Health. 2016;21:21–26. doi: 10.1093/pch/21.1.21.
    1. Harris P.A., Taylor R., Thielke R., Payne J., Gonzalez N., Conde J.G. Research electronic data capture (REDCap)—A metadata-driven methodology and workflow process for providing translational research informatics support. J. Biomed. Inf. 2009;42:377–381. doi: 10.1016/j.jbi.2008.08.010.
    1. Bandura A. Guide for constructing self-efficacy scales. Self-Effic. Beliefs Adolesc. 2006;5:307–337.
    1. Whittemore R., Grey M., Lindemann E., Ambrosino J., Jaser S. Development of an Internet coping skills training program for teenagers with type 1 diabetes. Comput. Inf. Nurs. 2010;28:103–111. doi: 10.1097/NCN.0b013e3181cd8199.
    1. Croghan I.T., Ebbert J.O., Njeru J.W., Rajjo T.I., Lynch B.A., DeJesus R.S., Jensen M.D., Fischer K.M., Phelan S., Kaufman T.K., et al. Identifying Opportunities for Advancing Weight Management in Primary Care. J. Prim. Care Community Health. 2019;10:2150132719870879. doi: 10.1177/2150132719870879.
    1. Davis D.A., Mazmanian P.E., Fordis M., Van Harrison R.T.K.E., Thorpe K.E., Perrier L. Accuracy of physician self-assessment compared with observed measures of competence: A systematic review. JAMA. 2006;296:1094–1102. doi: 10.1001/jama.296.9.1094.
    1. Holloway A., Watson H.E. Role of self-efficacy and behaviour change. Int. J. Nurs. Pract. 2002;8:106–115.
    1. Woolfitt Z. The Effective Use of Video in Higher Education. [(accessed on 21 August 2020)];2015 Cited 28 September 2016. Available online: .

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