Childhood Healthy Behaviors Intervention in a Pediatric Primary Care Setting: Impact on Provider Practice
The high prevalence of childhood overweight and obesity in the U.S., and the known association of health consequences as a result of obesity are of concern from a public health perspective. Health inequities exist for African American youth who are at increased risk of obesity compared to other groups. Overweight and obesity and in children are largely preventable and require targeted efforts to address and reverse the present high rates of these conditions. The Childhood Healthy Behaviors Intervention (CHBI) introduced an evidence-based practice initiative that included parental completion of a 10-item Healthy Habits Questionnaire (HHQ) to assess dietary and exercise behaviors, BMI assessment by the primary care provider, and healthy behaviors goal-setting with the provider and parent based on the 5-2-1-0 behavioral goals. Purpose: To improve the consistency of healthcare providers' delivery of healthy behaviors messages targeted at prevention and treatment of childhood overweight and obesity, and to improve consistency of documentation of weight classification. Design: The project design was a non-experimental mixed methods design. The quantitative design was a one-group pre-test-post-test with independent samples; descriptive qualitative data were collected from providers with focused interviews after completion of the intervention timeframe.Methods: Charts reviews of well visits for children 2 through 9 years in independent pre-test (n=267) and post-test samples (n-253) were completed for classification of overweight or obesity based on BMI as indicated by the correct ICD-9 diagnostic code and demographic data on the sample population. A systematic random sample of 50 pre- and 50 post-intervention records from the above sample were reviewed for change in practice in documentation of healthy habits assessment and counseling during preventive/well visits. HHQ surveys (n=428) collected from the pilot and intervention phases were analyzed for frequency of dietary and activity behavior responses. Focused interviews (n=12) were conducted to elicit provider satisfaction responses to open-ended questions regarding impressions of the intervention and were analyzed for content and themes.Results: Providers demonstrated a large change in assessment of health habits and goal-setting of healthy behaviors, improvement in the recognition of overweight and obesity with correct diagnostic coding for BMI, and satisfaction with the time needed to perform the intervention with an improved patient habit assessment. Demographic data and HHQ survey data provided important information about the sample population to inform future practice. Conclusion: The CHBI improved the consistency of provider clinical practice in the delivery of healthy behaviors assessment and counseling targeted at the prevention and treatment of childhood overweight and obesity.
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