Primary Care, Communication, and Improving Children's Health
Condition: Childhood Obesity; Overweight; Communication; Weight Loss
MeSH terms: Overweight; Pediatric Obesity; Weight Loss
Study type: Observational

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.
    

Detailed description: 
      We will test whether 1) pediatrician-patient communication regarding overweight status,
      behavior/risk-factor counseling, and the frequency and time to next follow-up visit, compared
      with either no communication or incomplete communication (communicating only high weight
      status without behavior/risk-factor counseling or a follow-up visit) will predict improvement
      in weight status at one year follow-up, and 2) during pediatrician-patient communication
      regarding weight and weight management, higher patient-centeredness will predict improvement
      in weight status at one year follow-up. The communication content identified will generate
      new information about the most effective content and style of pediatrician-patient
      communication that predict weight-status improvement. Because we prospectively will examine
      clinical practice elements in the one-year interval between well-child visits, acknowledging
      that communication regarding high weight status may initiate assessment of risk factors for
      heart disease (such as high cholesterol and blood sugar), more frequent follow-up visits, or
      prompt a nutrition referral, we will generate novel information about the most effective
      clinical practices and follow-up interval and frequency that predict weight-status
      improvement in overweight children. We also will examine if the content and style of
      communication are related to improvements in diet and lifestyle behaviors at one-year
      follow-up.
    

Intervention name(s): Communication regarding overweight status; Risk-factor assessment and counseling; Lifestyle behavior assessment and counseling; Interval follow-up to readdress weight; Patient-centered communication
Intervention type(s): Other; Other; Other; Other; Other
Intervention description(s): Pediatrician-patient/parent communication regarding child's high weight status; Counseling regarding cardiovascular risk factor assessments/results.; Counseling regarding diet and lifestyle changes to improve weight status.; 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.; 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.
Observational model: Cohort
Time perspective: Prospective
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.
      
Keywords: childhood obesity; overweight; communication; primary care; weight management; communication methods; patient-centered communication