Abstract
BackgroundThe Texas Childhood Obesity Research Demonstration study was an integrated, systems-oriented intervention that incorporated primary and secondary obesity prevention approaches targeting multiple sectors, including primary care clinics, to address childhood obesity. The primary care clinic component included the American Academy of Pediatrics’ Next Steps weight management counseling materials that support brief healthy lifestyle-focused visits. The current study describes the methodology and assesses the implementation of the Next Steps program in the participating primary care clinics, as well as the association of implementation with enrollment of children with overweight and obesity in the secondary prevention intervention.MethodsThe study used a serial cross-sectional study design to collect data from 11 primary care clinics in Houston (n = 5) and Austin (n = 6), Texas, in 2013–2014. Responses of primary care providers on 42 self-reported survey questions assessing acceptability, adoption, appropriateness, and feasibility of the program were utilized to create a mean standardized clinic implementation index score. Provider scores were aggregated to represent Next Steps implementation scores at the clinic level. A mixed effects logistic regression test was conducted to determine the association between program implementation and the enrollment of children in the secondary prevention.ResultsMean implementation index score was lower at Year 2 of implementation (2014) than Year 1 (2013) although the decrease was not significant [63.2% (12.2%) in 2013 vs. 55.3% (16.5%) in 2014]. There were no significant associations between levels of implementation of Next Steps and enrollment into TX CORD secondary prevention study.ConclusionsThe development of an index using process evaluation measures can be used to assess the implementation and evaluation of provider-based obesity prevention tools in primary care clinics.
Highlights
Over one-third of children in the United States have overweight or obesity, with more Hispanic, non-Hispanic black, and children from low socioeconomic conditions being affected than non-Hispanic white children [1, 2]
Our study examined the acceptability, adoption, appropriateness, and feasibility of the Steps program materials, which were pilot tested in primary care clinics that participated in the primary prevention component of the TX Texas Childhood Research Demonstration (CORD) study over two years of implementation
There were no significant associations between levels of implementation of Steps and enrollment into Texas Childhood Research Demonstration (TX CORD) secondary prevention study
Summary
Over one-third of children in the United States have overweight or obesity, with more Hispanic, non-Hispanic black, and children from low socioeconomic conditions being affected than non-Hispanic white children [1, 2]. At present, there is low active participation from PCPs in assessing or managing children with overweight or obesity in the primary care clinics [5], even though pediatricians can identify children with obesity [6]. Developing a similar indicator or index for weight management interventions in primary healthcare settings will help to evaluate the fidelity of the intervention and help to compare how the different primary care clinics perform. The Texas Childhood Obesity Research Demonstration study was an integrated, systems-oriented intervention that incorporated primary and secondary obesity prevention approaches targeting multiple sectors, including primary care clinics, to address childhood obesity. The current study describes the methodology and assesses the implementation of the Steps program in the participating primary care clinics, as well as the association of implementation with enrollment of children with overweight and obesity in the secondary prevention intervention
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