Pediatric Obesity Prevention in Primary Care: Employing Brief Action Planning with Obesigenic Behavior Screening
Challenges for primary care providers to implement recommendations for lifestyle screening and counseling about weight status and obesigenic behaviors include time constraints, perceived family resistance, and lack of provider self-efficacy. A practice-based intervention designed to address barriers and to increase patient health behavior action planning was implemented. It used a brief screen for obesigenic behaviors, Family Nutrition Physical Activity (FNPA), as a menu for change when applying Brief Action Planning (BAP), a quick motivational interviewing-informed (MI) support technique, during health supervision visits (HSVs).
Pediatric and family medicine practices paired by specialty and socioeconomic demographics were randomized into intervention and control practices. Intervention practices received 4.5 hours of training in BAP and the FNPA for 3 months followed by 3 months of implementation targeting children ages 4-17 years during HSVs. Meanwhile, control group practices provided usual care. Provider level outcomes included action plan documentation, weight status discussion, self-efficacy of health behavior discussions pre-/post-intervention, and satisfaction with the intervention. Patient level outcomes included success with action plans at 1 month, perceived patient-centeredness of encounter, and satisfaction with the intervention. Outcomes were measured by chart abstraction, provider surveys and confidence ratings on self-efficacy (11-items), and patient surveys 1-month post visit.
Twelve practices were randomized to intervention and control groups (19 and 18 providers respectively). No differences in demographics or prior exposure to MI/BAP existed between groups. No differences in demographics or weight status existed between the participating 210 intervention and 220 control group patients. More intervention encounters had action plans (72% vs. 3.6%, p<0.05) and weight status discussions documented in the chart (52% vs. 38%, p<0.05) compared to control encounters. At baseline, control and intervention providers were similar in all aspects of the self-efficacy evaluation. Increases were demonstrated in provider confidence to assess readiness, counsel families on diet, and patients on physical activity (all p<0.05). Provider satisfaction with assessment and quality of the tool was high (3.8 and 3.9 of 5-point rating). Intervention patients were more likely to have partial or complete success with their goals (96.6% vs. 84.8%, p<0.05), perceive the visit as patient-centered (3.67 vs. 3.41 of 4-point rating, p<0.05) and rate ease of intervention as high (3.6 to 3.92 of 4-point rating). The sustainability of behavior changes and impact on the trajectory of patient weight gain are currently being assessed.
Use of the FNPA tool paired with BAP improved documentation of health behavior action plans and weight status discussions during HSVs. More intervention patients were successful in meeting their plans at 1 month. This practice-based approach can effectively increase provider confidence in effectiveness in influencing patient health behaviors. Further study of this intervention’s sustainability and impact on growth trajectories of pediatric patients is warranted.