Executive Summary: Introduction of a Conversation Starter Tool to Improve Health Habits in Young Children

 

 

 

 

Executive Summary: Introduction of a Conversation Starter Tool to Improve Health Habits in Young Children

 

 

 

Rachel Knafel, MSN, RN, FNP-BC

 

Purdue University

 

 

 

Executive Summary: Introduction of a Conversation Starter Tool to Improve Health Habits in Young Children

 

Obesity rates in adults and children in the United States (US) continue to climb (Center for Disease Control and Prevention [CDC], 2021a; CDC, 2021c). Overweight in children is defined as a body mass index (BMI) at or above the 85th percentile, while BMI at or above the 95th percentile is considered obese (CDC, 2018). Currently, one in three children in the US is considered overweight or obese (American Academy of Pediatrics [AAP], 2020b). Children with obesity are more likely to suffer from hypertension, hyperlipidemia, insulin resistance, type 2 diabetes, asthma, sleep apnea, joint pain, fatty liver disease, cholelithiasis, gastro-esophageal reflux, orthopedic problems, and psychiatric disorders (Barlow, 2007; CDC, 2021b). Implementing individual and familial measures during early childhood development is essential, as treatment of obesity tends to become more difficult as the patient matures (Gortmaker et al., 2015; Wang et al., 2012). Unfortunately, many parents underestimate their child’s weight status, which may affect a parent’s motivation regarding changes that can be made in the home (Baughcum et al., 2000; Hackie & Bowles, 2007; Hernandez et al., 2017; Hidalgo-Mendez et al., 2019; Lydecker & Grilo, 2016; Mejia De Grubb et al., 2017; Pasch et al., 2016).

Problem Statement and Significance

A review of relevant literature reveals a significant public health issue, recommendations for treatment, and gaps in identifying effective, generalizable implementation strategies at the primary care level. The AAP has described the role of providers in the prevention and treatment of childhood obesity, citing the importance of becoming familiar with behavior modification techniques and general promotion of parenting interventions (Daniels & Hassink, 2015). For this study, a conversation starter tool was designed to assist providers in identifying health habits needed for improvement, educating parents on rationales for improvement, and assisting parents in setting a specific goal to implement a health habit needed for improvement. The purpose of this study was to determine whether the introduction of the conversation starter tool improved health habits in four-to eight-year-old children over four-to-six weeks. A secondary aim of this study was to determine whether the accuracy of parental perception of children’s weight status improved when providers were made aware of the parent’s perception before the visit.

Methodology

A pre-test, post-test quasi-experimental study was conducted between May and August 2021 to evaluate the effectiveness of a provider-initiated conversation starter tool in improving health habit adherence in four-to eight-year-old children. The tool included a questionnaire and an educational handout, called “Healthy Habits for Kids.” The questionnaire, available in English and Spanish, was utilized to gather demographic information, parental perception of children’s weight status, and current health habit adherence (Figure 1). The handout, also available in English and Spanish, was developed to address the health habits identified in the questionnaire (Figure 2). Because not all parents are concerned about their child’s weight status, the handout was created to identify a myriad of health benefits that may be motivating to parents. These health benefits include improved school performance, health, behavior, memory, mental health, focus, self-esteem, and flexibility, as well as a decreased risk of heart disease, obesity, diabetes, stress, behavior issues, anger, and school problems (AAP, 2013; AAP, 2020a; AAP, 2020c; AAP, 2020d; Hassink, 2014; Lobelo et al.,  2020; “Media Use in School-Aged Children and Adolescents,” 2016; Rethy, 2020).

Participants included in the study were parents of four-to eight-year-old children who presented to the clinic for a well-child exam. Patients were assigned to control or intervention based on which pediatrician they saw. The control group contained 45 participants, and the intervention group contained 46 participants. The control arm received the questionnaire and standard care. Standard care included distributing a “95210” handout, which encouraged nine hours of sleep per night, five servings of fruits and vegetables, two hour

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