Primary Care, Communication, and Improving Children's Health

NCT02277899 | Completed

• 2 other identifiers: 1K23HL118152-01A1 Aim 21K23HL118152-01A1
• Study Type: observational
• Target: 100
• Locations: 1 country
• Sites: 1

Brief Summary

The purpose of this study is to determine communication content and strategies in primary care that predict improvement in weight status among overweight school-age children.

Conditions

Childhood Obesity; Overweight; Communication; Weight Loss

Keywords

childhood obesity; overweight; communication; primary care; weight management; communication methods; patient-centered communication

Outcome Measures

Primary Outcomes (1)

• Percent overweight

  The percent over the median BMI percentile for age and gender. This measure changes comparably for similar weight changes in overweight and severely-obese children. In contrast, an overweight child would have to lose substantially less weight than a severely-obese child for the same change in BMI z-score.

  From recorded well-child visit to next well-child visit, approximately 12 months later

Secondary Outcomes (1)

• BMI z-score

  From recorded well-child visit to next well-child visit, approximately 12 months later

Other Outcomes (1)

• Change in the number of "5-2-1-0" behaviors

  From recorded well-child visit to next well-child visit, approximately 12 months later

Study Arms (1)

Overweight school-age children

Overweight 6-12 year-old children. Weight status will be measured and parents complete surveys at baseline and one year later. Pediatricians will complete surveys at baseline, and after index visit. Visits will be directly video-recorded. The impact of pediatrician clinical practices and communication strategies on child's weight status will be evaluated at one year. Clinical practices (such as risk-factor screening) that occur during the 1-year interval between well-child visits also will be assessed. Specific clinical practice elements and communication strategies that will be examined include: 1. Communication regarding child's high weight status 2. Counseling regarding cardiovascular risk factor screening and assessment 3. Behavioral counseling 4. Interval follow-up to readdress weight, and 5. Patient-centeredness, scored as the ratio of patient to doctor-centered communication regarding weight topics.

Other: Communication regarding overweight status; Other: Risk-factor assessment and counseling; Other: Lifestyle behavior assessment and counseling; Other: Interval follow-up to readdress weight; Other: Patient-centered communication

Interventions

Communication regarding overweight status OTHER

Pediatrician-patient/parent communication regarding child's high weight status

Overweight school-age children

Risk-factor assessment and counseling OTHER

Counseling regarding cardiovascular risk factor assessments/results.

Overweight school-age children

Lifestyle behavior assessment and counseling OTHER

Counseling regarding diet and lifestyle changes to improve weight status.

Overweight school-age children

Interval follow-up to readdress weight OTHER

Interval follow-up to readdress weight, prior to the next well-child visit one year later. Follow-up could include ongoing care through nutrition and/or an intensive weight-management program.

Overweight school-age children

Patient-centered communication OTHER

Patient-centered communication will be scored as the ratio of patient to doctor-centered communication regarding weight topics. Means will be calculated for total and weight-communication-specific pediatrician, child, and parent-talk time, and patient, doctor, and the ratio of patient/doctor-centered communication scores. For the primary hypothesis, biomedical information-giving (for example, risk-factor communication) will be treated as patient-centered because the principal investigator's focus groups suggest that parents want this information, and prior research suggests that including biomedical-information giving improves the correlation of Roter's patient-centeredness measure with patient health status and satisfaction scores.

Overweight school-age children

Eligibility Criteria

• Age: 6 Years - 12 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17)
• Sampling Method: Non-Probability Sample

Study Population

We will recruit pediatricians (from academic, community, and private practices), children, and a consenting parent. Pediatricians and children will be selected to reflect the proportions of minority pediatricians and children in the practices. Pediatricians at the community and private practices will be eligible to participate if they provide outpatient pediatric care ≥20 hours/week. At the academic clinic, only second and third-year residents will be eligible. Eighty-five children and a consenting parent will be recruited.

You may qualify if:

• Schedule a well-child visit with a participating pediatrician
• Agree to return in one year for the follow-up well-child visit
• Overweight
• years old
• Have a working telephone and/or e-mail address
• Child/parent willing to provide assent/consent

You may not qualify if:

• Unstable illness (such as uncontrolled asthma)
• Developmental condition (such as trisomy 21)
• Planning to move/leave practice within two years

Sponsors & Collaborators

• University of Texas Southwestern Medical Center: lead
• National Heart, Lung, and Blood Institute (NHLBI): collaborator

Study Sites (1)

University of Texas Southwestern and Children's Medical Center

Dallas, Texas, 75390, United States

Location

Related Publications (5)

• Turer CB, Montano S, Lin H, Hoang K, Flores G. Pediatricians' communication about weight with overweight Latino children and their parents. Pediatrics. 2014 Nov;134(5):892-9. doi: 10.1542/peds.2014-1282. Epub 2014 Oct 13.

  PMID: 25311599 BACKGROUND

• Turer CB, Mehta M, Durante R, Wazni F, Flores G. Parental perspectives regarding primary-care weight-management strategies for school-age children. Matern Child Nutr. 2016 Apr;12(2):326-38. doi: 10.1111/mcn.12131. Epub 2014 Apr 10.

  PMID: 24720565 BACKGROUND

• Upperman C, Palmieri P, Lin H, Flores G, Turer CB. What do parents want for their children who are overweight when visiting the paediatrician? Obes Sci Pract. 2015 Oct;1(1):33-40. doi: 10.1002/osp4.5. Epub 2015 Sep 10.

  PMID: 28580163 BACKGROUND

• Turer CB, Upperman C, Merchant Z, Montano S, Flores G. Primary-Care Weight-Management Strategies: Parental Priorities and Preferences. Acad Pediatr. 2016 Apr;16(3):260-6. doi: 10.1016/j.acap.2015.09.001. Epub 2015 Sep 26.

  PMID: 26514648 BACKGROUND

• Turer CB, Barlow SE, Montano S, Flores G. Discrepancies in Communication Versus Documentation of Weight-Management Benchmarks: Analysis of Recorded Visits With Latino Children and Associated Health-Record Documentation. Glob Pediatr Health. 2017 Feb 6;4:2333794X16685190. doi: 10.1177/2333794X16685190. eCollection 2017.

  PMID: 28239625 BACKGROUND

MeSH Terms

Conditions

Pediatric Obesity; Overweight; Communication; Weight Loss

Interventions

Counseling

Condition Hierarchy (Ancestors)

Obesity; Overnutrition; Nutrition Disorders; Nutritional and Metabolic Diseases; Body Weight; Signs and Symptoms; Pathological Conditions, Signs and Symptoms; Behavior; Body Weight Changes

Intervention Hierarchy (Ancestors)

Mental Health Services; Behavioral Disciplines and Activities; Community Health Services; Health Services; Health Care Facilities Workforce and Services

Study Officials

• Christy B Turer, MD, MHS

  University of Texas Southwestern and Children's Medical Center Dallas

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: observational
• Observational Model: COHORT
• Time Perspective: PROSPECTIVE
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: October 27, 2014
• First Posted: October 29, 2014
• Study Start: October 14, 2014
• Primary Completion: August 5, 2016
• Study Completion: August 10, 2017
• Last Updated: May 19, 2020

Record last verified: 2020-05

Locations

US (1)