Primary Care, Communication, and Improving Children's Health

Study Overview
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Brief Summary
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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
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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.

Official Title
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Primary Care, Communication, and Improving Children's Health

Conditions
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Childhood Obesity, Overweight, Communication, Weight Loss

Intervention / Treatment
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* Other: Communication regarding overweight status
* Other: Risk-factor assessment and counseling
* Other: Lifestyle behavior assessment and counseling
* Other: Interval follow-up to readdress weight
* Other: Patient-centered communication


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Schedule a well-child visit with a participating pediatrician Agree to return in one year for the follow-up well-child visit Overweight 6-12 years old Have a working telephone and/or e-mail address Child/parent willing to provide assent/consent Exclusion Criteria: Unstable illness (such as uncontrolled asthma) Developmental condition (such as trisomy 21) Planning to move/leave practice within two years

Ages Eligible for Study
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Minimum Age: 6 Years
Maximum Age: 12 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Overweight school-age children<br>Overweight 6-12 year-old children. Weight status will be measured and parents complete surveys at baseline and one year later. Pediatricians will complete surveys at baseline, and after index visit. Visits will be directly video-recorded. The impact of pediatrician clinical practices and communication strategies on child's weight status will be evaluated at one year. Clinical practices (such as risk-factor screening) that occur during the 1-year interval between well-child visits also will be assessed. Specific clinical practice elements and communication strategies that will be examined include: Communication regarding child's high weight status Counseling regarding cardiovascular risk factor screening and assessment Behavioral counseling Interval follow-up to readdress weight, and Patient-centeredness, scored as the ratio of patient to doctor-centered communication regarding weight topics. | Other: Communication regarding overweight status<br>* Pediatrician-patient/parent communication regarding child's high weight status<br>Other: Risk-factor assessment and counseling<br>* Counseling regarding cardiovascular risk factor assessments/results.<br>Other: Lifestyle behavior assessment and counseling<br>* Counseling regarding diet and lifestyle changes to improve weight status.<br>Other: Interval follow-up to readdress weight<br>* 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.<br>Other: Patient-centered communication<br>* 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.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Percent overweight | The percent over the median BMI percentile for age and gender. This measure changes comparably for similar weight changes in overweight and severely-obese children. In contrast, an overweight child would have to lose substantially less weight than a severely-obese child for the same change in BMI z-score. | From recorded well-child visit to next well-child visit, approximately 12 months later | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| BMI z-score | Change in BMI z-score of 0.25-0.5 has been associated with reductions in cardiovascular-disease risk factors. Using both percent overweight and BMI z-score measures will allow examination of the relationship between relative weight changes and cardiovascular-disease risk-factor improvement. | From recorded well-child visit to next well-child visit, approximately 12 months later | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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primary care, childhood obesity, overweight, communication, weight management, communication methods, patient-centered communication