Introduction
Method
Study setting
The Texas childhood research demonstration (TX CORD) study
Primary care clinic component of the TX CORD primary prevention study
Measures
Description of the next steps program
Process evaluation survey
Provider characteristics
Acceptability of using the next steps program materials
Adoption of the next steps program materials
Appropriateness of the next steps program materials
Feasibility of the next steps program materials
Study design and sample
Statistical analysis
Development of the implementation index
Examination of implementation index score
Examination of association of implementation index levels with the enrollment of children with overweight and obesity in the TX CORD secondary prevention study
Results
Provider characteristics
Year 1 of implementation (2013), 30 (%) | Year 2 of implementation (2014), 34 (%) | P value | |
---|---|---|---|
Female | 25 (83.3) | 26 (76.5) | 0.496 |
At least 40 years of age | 16 (53.3) | 18 (52.9) | 0.983 |
Race/ethnicity | |||
Non-Hispanic white | 12 (40.0) | 9 (26.5) | 0.418 |
Non-Hispanic black | 5 (16.7) | 6 (17.7) | |
Hispanic | 4 (13.3) | 10 (29.4) | |
Others | 8 (26.7) | 9 (26.5) | |
At least 6 years of employment in the current position | 17 (56.7) | 19 (55.9) | 0.950 |
At least 6 years of experience in the medical field | 25 (83.3) | 26 (76.5) | 0.348 |
At least 6 years of experience working with pediatric patients after completing medical training | 25 (83.3) | 26 (76.5) | 0.496 |
More than 10 hours of prior training on how to manage childhood overweight or obesity | 14 (46.7) | 16 (47.1) | 0.560 |
Next steps process evaluation data
Year 1 of implementation (2013) | Year 2 of implementation (2014) | |
---|---|---|
Acceptability, mean (SD) | ||
Ease of learning to use the Next Steps materials | ||
I learned to use it quickly | 2.8 (1.0) | 2.6 (1.2) |
I easily remember how to use it | 2.6 (1.0) | 2.5 (1.2) |
The training I received was adequate | 2.8 (0.8) | 2.6 (1.1) |
Satisfaction with Next Steps materials | ||
With overweight or obese kids, I am likely to use Next Steps during well child visits | 2.8 (1.2) | 2.2 (1.3) |
With overweight or obese kids, I am likely to use Next Steps during acute care visits | 1.7 (1.1) | 1.5 (1.1) |
With overweight or obese kids, I am likely to use Next Steps during obesity-specific visits | 3.2 (1.1) | 2.8 (1.2) |
I am likely to use Next Steps with non- overweight/obese kids | 1.8 (0.9) | 1.7 (1.0) |
Patients/families refer to the Next Steps poster | 2.0 (0.9) | 1.7 (1.0) |
I refer to the Next Steps poster when I talk with patients/families | 2.2 (1.0) | 1.8 (1.0) |
Mean score (SD) of the acceptability items at clinic provider level | 2.5 (0.6) | 19.4 (7.9) |
Adoption, mean (SD) | ||
Frequency of use of Next Steps materials for counseling with patients who are overweight or obese? | 1.7 (1.4) | 1.4 (1.4) |
How often do you use each of the following with patients who are overweight or obese? | ||
Next Steps poster | 1.4 (1.3) | 0.9 (1.2) |
Next Steps flip chart | 1.7 (1.4) | 1.2 (1.4) |
Next Steps activity books for home | 0.9 (1.1) | 0.6 (1.2) |
List of community resources that support a healthy lifestyle | 1.8 (1.3) | 1.9 (1.7) |
Mean score (SD) of the adoption items at clinic provider level | 1.5 (1.0) | 1.2 (1.1) |
Appropriateness, mean (SD) | ||
When I talk with patients and families about obesity, the Next Steps | ||
Materials overall helps me be more effective | 2.8 (0.9) | 2.8 (1.1) |
Poster helps me be more effective | 2.3 (0.9) | 2.4 (1.0) |
Flip chart helps me be more effective | 2.7 (1.0) | 2.6 (1.1) |
Patient activity book helps me be more effective | 2.2 (1.0) | 2.2 (0.9) |
Materials fits into my patient/office flow | 2.3 (1.0) | 2.2 (1.1) |
Mean score (SD) of the appropriateness items at clinic provider level | 2.4 (0.7) | 2.4 (0.9) |
Appropriateness, mean (SD) | ||
Applicability of the themed visits, n (%) | ||
Category A: Setting the foundation | ||
Understanding health (set a foundation for good health) was applicable | 17 (56.7) | 22 (64.7) |
Category B: Introduce concepts that are important to cover early for success | ||
Understanding healthy food was applicable | 20 (66.7) | 24 (70.6) |
Home environment was applicable | 17 (56.7) | 20 (58.8) |
Eating and your emotions was applicable | 16 (53.3) | 23 (67.7) |
Portion sizes was applicable | 20 (66.7) | 25 (73.5) |
Healthy drinks was applicable | 21 (70.0) | 24 (70.6) |
Category C: Focus on other important concepts | ||
Physical activity was applicable | 18 (60.0) | 23 (67.7) |
Feeling good about yourself was applicable | 15 (50.0) | 20 (58.8) |
Reading food labels was applicable | 16 (53.3) | 21 (61.8) |
Screen time and sleep was applicable | 20 (66.7) | 24 (70.6) |
Meal patterns and snacks was applicable | 18 (60.0) | 24 (70.6) |
Holidays/Special occasions was applicable | 14 (46.7) | 23 (67.7) |
Eating away from home was applicable | 17 (56.7) | 22 (64.7) |
Parenting was applicable | 17 (56.7) | 18 (52.9) |
Community partners was applicable | 10 (33.3) | 21 (61.8) |
Healthy family was applicable | 17 (56.7) | 22 (64.7) |
Bullying and teasing was applicable | 14 (46.7) | 19 (55.9) |
Goal setting was applicable | 18 (60.0) | 21 (61.8) |
Unintentional disruptions was applicable | 10 (33.3) | 17 (50.0) |
Mean score (SD) of the appropriateness items at clinic provider level | 0.7 (0.4) | 0.7 (0.4) |
Feasibility, mean (SD) | ||
Access to the following materials provided by the CORD team, n (%) | ||
Next Steps poster was accessible | 25 (83.3) | 26 (76.5) |
Next Steps flip chart was accessible | 25 (83.3) | 28 (82.4) |
Next Steps activity books for home was accessible | 23 (76.7) | 20 (58.8) |
List of community resources that support a healthy lifestyle was accessible | 24 (80.0) | 24 (70.6) |
Mean score (SD) of the feasibility items at clinic provider level | 0.9 (0.3) | 0.7 (0.3) |
Implementation index score
Implementation index levels and TX CORD secondary prevention enrollment
Clinics | Children with overweight and obesity seen (n = 6198) | Referred (n = 1957) | Enrolled (n = 533) | % referred (out of total seen) | % enrolled (out of total seen) | % enrolled (out of total referred) |
---|---|---|---|---|---|---|
Clinic I | 1364 | 116 | 26 | 8.5% | 1.9% | 22.4% |
Clinic C | 436 | 82 | 15 | 18.8% | 3.4% | 18.3% |
Clinic J | 263 | 56 | 27 | 21.3% | 10.3% | 48.2% |
Clinic D | 677 | 171 | 61 | 25.3% | 9.0% | 35.7% |
Clinic B | 91 | 28 | 14 | 30.8% | 15.4% | 50.0% |
Clinic F | 540 | 194 | 34 | 35.9% | 6.3% | 17.5% |
Clinic H | 712 | 272 | 62 | 38.2% | 8.7% | 22.8% |
Clinic K | 716 | 293 | 77 | 40.9% | 10.8% | 26.3% |
Clinic E | 513 | 254 | 91 | 49.5% | 17.7% | 35.8% |
Clinic G | 684 | 356 | 74 | 52.0% | 10.8% | 20.8% |
Clinic A | 202 | 135 | 52 | 66.8% | 25.7% | 38.5% |
Enrollment Year 1 (2013) | Enrollment Year 2 (2014) | |
---|---|---|
OR (95% CI) | OR (95% CI) | |
Implementation index (reference: relatively low implementation) | ||
Medium implementation | 1.32 (0.71–2.47) | 0.96 (0.53–1.76) |
Relatively high implementation | 1.62 (0.71–3.72) | 0.61 (0.29–1.29) |
Underlying constructs | ||
Acceptability | 1.04 (1.00–1.08) | 1.00 (0.98–1.02) |
Adoption | 1.01 (1.00–1.02) | 0.99 (0.97–1.00) |
Appropriateness | 1.01 (0.99–1.03) | 1.00 (0.98–1.01) |
Feasibility | 1.00 (0.99–1.02) | 0.99 (0.98–0.99) |