Interviewing staff, clinicians and parents at clinics that participated in the Healthy Eating Active Living TeleHealth Community of Practice (HEALTH COP) program, the team identified four factors that helped clinicians successfully address obesity. These included strong clinic management support, experienced physician champions, parental involvement in the design of programs and cross-communication between clinics. The research was published in the journal Quality Management in Health Care.
“We wanted to build capacity in clinics to help them prevent and manage childhood obesity,” said first author Ulfat Shaikh, pediatrician and director of Healthcare Quality at the UC Davis School of Medicine. “Now we understand how important it is to carefully select clinician champions, partner with parents on program design and make sure our counseling fits the cultural context.”
Excessive weight and obesity is a huge problem in the United States, affecting as many as 30 percent of children. It’s even more of a concern in rural areas, where poverty, culture and poor access to healthy foods can compound the issue, Shaikh said.
To address the problem, UC Davis created HEALTH COP, a virtual learning network that provides rural physicians education and peer support. Clinicians were encouraged to track each patient’s weight and BMI, discuss diet and exercise and propose simple lifestyle changes. An earlier study showed that the program improved obesity assessments, counseling and children’s nutrition and activity.
In the current study, researchers interviewed staff, physicians, nurses and parents at the seven participating rural California clinics to better understand how the program worked.
There were a number of significant barriers, such as a lack of resources and getting families to come back for follow-up visits. In addition, clinicians in busy clinics had trouble making extra time to thoroughly discuss obesity. Success often hinged on whether clinic management fully supported the program.
“A critical factor was whether clinic leadership genuinely valued these efforts,” noted Shaikh. “Did they provide resources and visibly support the program? In this case, a top-down approach really made a big difference.”
Strong commitment from physician champions also played an important role. In particular, physicians who had previous experience with obesity care were better suited to advance the program’s goals. In one case, a physician champion in a mostly Hispanic area took extra time to learn the nutritional differences between corn and white flour tortillas. Encouraging families to make the simple switch from white flour to corn, paid health dividends within the all-important cultural context.
In addition, responses from parents underscored HEALTH COP’s ability to help kids, and entire families, make significant lifestyle changes.
“The parent comments were very poignant,” said Shaikh. “Though the program was directed at children, it influenced lifestyle changes in the whole family.”
Armed with data from this study, the researchers have recommendations for similar programs: select physician champions carefully, involve parents more deeply in program design, and make sure clinic leadership is totally and genuinely on board.
Other authors on the paper were Patrick Romano and Debora Paterniti, both of UC Davis.
This study was supported by a grant from the Agency for Healthcare Research and Quality (K08HS18567).