Progress of Pilot Study: Child/Adolescent Overweight and Obesity Prevention Program in a FQHC

Description of Activity
This is an update of my Service Learning Experience (SLE), which also happens to be my DNP Capstone Project. For those who may not have read my previous posts, my project is the implementation of a child/adolescent overweight and obesity prevention program based on expert recommendations at a federally qualified health center (FQHC) in Southwestern Texas. This past January 2012 was the first month of a 3-month program. During this month, the registered dietician (RD) and I enrolled eligible participants to the program that were either referred by the providers for overweight, obesity, or weight management or siblings of these children/teens recruited by the RD. Consents were signed and pre-intervention data were obtained. Pre-intervention data covers the following information:

• Baseline weight and BMI
• Children/Teens and parent characteristics
• Eating habits, physical activity levels, sedentary behaviors
• Identifying a priority goal or behavior/habit to change 
• Identifying perceived levels of Willingness/Importance and Confidence
• Identifying perceived barriers, benefits, and solutions to change habits/behaviors
• Previous experiences with MD, RN, RD visits pertaining to overweight/obesity care

During this process, we've identified areas that need revision to improve efficiency and efficacy of the process. I've revised some forms to make it simpler and more straight-forward for the participants; therefore, yielding more meaningful data. I am presently tallying the data and identifying missing data  I plan to retrieve from the participants on their second month visit with the RD. I constantly communicated with the RD during this month, reviewing with her the process, providing feed-back, and obtaining her feed-back, as well. I also try to consistently communicate with my mentor (Special Projects Officer of the health center) through e-mail.

This February, the RD will continue to follow-up with the participants and evaluate their progress in terms of their set/identified goals and to review their perceived levels of willingness/importance and confidence to change, identified barriers, benefits, and solutions. I am also consistently reviewing the goals/objectives of the project with the RD so that we can continually keep our focus in improving patient outcomes and her practice. 

Observations

Although I only have a very small sample size (n = 26), this first month experience represents or depicts what is known about childhood overweight and obesity: vulnerable populations, eating habits, sedentary behaviors, and physical activity levels, parental characteristics. Almost all children we've enrolled, except for two are of Hispanic/Latin American descent and all but one have at least an overweight/obese parent. Although it is beyond the scope of this project to identify the psychological/emotional impact of being overweight and obesity on children/teens, I've observed its link to poor self-esteem. There's one teen who attempted to commit suicide, one who wants to quit school, one who keeps to herself because of always being teased, and so on. Most of the participants identified being more physically active as their priority goal. Children/teens who reside in unsafe neighborhoods tend to stay inside the house instead of playing outside. Most of the children/teens come from low-income families, some with single parents, and a few mothers articulated lack of support from their spouses in efforts to live healthier lifestyles. Families are verbalizing their awareness of the implications of being overweight/obese to health and future quality of life.

From the RD's perspective, she is the only RD for the entire health center that covers 4 clinical sites. She covers adult and pediatric referrals and oftentimes need to make the phone call herself to set appointments with the patients. She had requested for extra support from other personnel to make these phone calls but has not been successful. 

Future Plans and Learning Points

For the entire month of February, I plan to obtain some missing data when participants meet with the RD during the second visit. I also need to ensure that the RD completes viewing the 4-part Motivational Interviewing videos from the Let's Go! website. I need to complete data analysis of pre-intervention data and start writing my final report. March will be the third and last visit of the participants with the RD. At this time, post-intervention data will be obtained, certificates of program completion and tokens of appreciation (e.g. basketballs, volleyballs, soccer balls, skipping ropes, hoola hoops) will be handed out once evaluation surveys are completed. I also plan to meet with the RD and my mentor this February for a mid-project evaluation.

I've learned during the first month visit how important it is to make the families feel that the health professional/RD is truly present to help them through this ordeal using Motivational Interviewing as a means to assist families improve their self-efficacy. I've also realized the importance of being the leader of this project at every step of the way. It can't be delegated nor can I be complacent at any point. I need to be flexible and pro-active, be able to foresee/anticipate potential issues, and intervene or make appropriate changes on time. Constant communication with the team is also one of the most critical elements of the project. It really is so much convenient to stay home and relax, but this project is a commitment to serve a vulnerable and disadvantaged population. Getting out of my comfort zone to see this project unfold gives me a sense of gratitude to do a project that can greatly benefit children and their families in the community. But above all, I see this as a means to be faithful to the deeper calling of service to others.