Structured Physical Activity and Dietary Education Program for Obese Adolescents: An Evaluation of a Quality Improvement Project at a Rural Primary Care Clinic

Structured Physical Activity and Dietary Education Program for Obese Adolescents: An Evaluation of a Quality Improvement Project at a Rural Primary Care Clinic by Andrietta Wright Barnett MS, South University, 2011 BS, Medical University of South Carolina, 2008 Project Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Nursing Practice Walden University June 2017 Abstract Childhood obesity is a worldwide epidemic. In the United States, approximately 17% of adolescents are obese; and 13% of the general population is overweight. Obese adolescents are at threefold risk for developing chronic health conditions in adulthood, including type II diabetes, hypertension, and heart disease. The purpose of this project was to evaluate the results of a quality improvement program to reduce adolescent obesity as measured by BMI 5% over 18 months in a rural health primary care clinic. The health belief model and theory of planned behavior guided the project as adolescents need to first understand the risks associated with obesity and the benefits derived from a healthier lifestyle Then, they can be prepared to engage in regular exercise and good eating behaviors. A convenience sample of 100 adolescents was randomly assigned to an intervention group with structured physical activity regimen and dietary education classes and a standard care group with normal counseling. Two separate one-sided t tests with 90% confidence intervals were used to analyze the data. Also, run charts were constructed to assess the effectiveness of the program. The result of the t test revealed the weight for the intervention group at 18 months (M = 42.85, SD = 0.79) was significantly lower than it was for those in the non-intervention group (M = 45.06, SD = 0.59), t(36) = -9.79, p < 0.01. Furthermore, the run charts demonstrate the average BMI for those in the interventional group steadily decreased over 18 months while the non-intervention group steadily increased. Positive social change was achieved at the organization level as adolescent obesity was reduced with the evidence-based interventions. This project serves as a potential model for replication in other rural health primary care clinics.Childhood obesity is a worldwide epidemic. In the United States, approximately 17% of adolescents are obese; and 13% of the general population is overweight. Obese adolescents are at threefold risk for developing chronic health conditions in adulthood, including type II diabetes, hypertension, and heart disease. The purpose of this project was to evaluate the results of a quality improvement program to reduce adolescent obesity as measured by BMI 5% over 18 months in a rural health primary care clinic. The health belief model and theory of planned behavior guided the project as adolescents need to first understand the risks associated with obesity and the benefits derived from a healthier lifestyle Then, they can be prepared to engage in regular exercise and good eating behaviors. A convenience sample of 100 adolescents was randomly assigned to an intervention group with structured physical activity regimen and dietary education classes and a standard care group with normal counseling. Two separate one-sided t tests with 90% confidence intervals were used to analyze the data. Also, run charts were constructed to assess the effectiveness of the program. The result of the t test revealed the weight for the intervention group at 18 months (M = 42.85, SD = 0.79) was significantly lower than it was for those in the non-intervention group (M = 45.06, SD = 0.59), t(36) = -9.79, p < 0.01. Furthermore, the run charts demonstrate the average BMI for those in the interventional group steadily decreased over 18 months while the non-intervention group steadily increased. Positive social change was achieved at the organization level as adolescent obesity was reduced with the evidence-based interventions. This project serves as a potential model for replication in other rural health primary care clinics. Structured Physical Activity and Dietary Education Program for Obese Adolescents: An Evaluation of a Quality Improvement Project at a Rural Primary Care Clinic by Andrietta Wright Barnett MS, South University, 2011 BS, Medical University of South Carolina, 2008 Project Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Nursing Practice Walden University June 2017 Dedication This project is dedicated to the sisterhood, friendship, and memory of Dr. Sheila O’Banner. Dr. O’Banner and her husband funded several research projects related to obesity in children and healthy eating habits in rural communities. Her strength and faith in God allowed Dr. O’Banner to develop multiple walking trails and community gardens in Colleton County with microscopic funding. I remembered her last words to me was to develop my research project in a rural community. Her memory lives on through my project and all the goals she set for reducing obesity in the countryside. Dr. O’Banner’s dedication to reducing obesity in children had given me strength when I became tired while working on my project. Acknowledgments Many thanks to Dr. Oliver Harden who served as my preceptor during my doctoral practicum. I am thankful and appreciative of the multitudes of research ideas, insights, and guidance shown to me during my internship experience. The many hours spent assisting me with research will never be forgotten I am grateful to all the Walden faculty for supporting me throughout the program. Special appreciation to my family and friends for your support and encouraging words during my studies.