Background: Obesity among children and youth is a public health crisis. At CCI Health and Wellness (CCI) 50% of the pediatric patient populations 6-16 years is obese (>95th percentile). In an effort to promote health and reduce obesity rates, we sought and received funding from the Office of Minority Health to implement a comprehensive nutrition invention in the context of pediatric primary care. Prior to the implementation of this intervention CCI did not offer nutritional services and patients had to travel outside of the community to a nearby academic medical center for services; for some this posed a financial burden and was not feasible. Our intervention, ActOut! includes three primary components: the integration of a culturally congruent family nutrition counseling; a system for prescribing park visits and a culturally tailored group nutrition education program. Primary outcomes we are examining included: fruit, vegetable, whole grain and sugar sweetened beverage consumption, as well as physical activity and patient BMI. In addition, we are exploring processes including: staff and patient acceptability of the intervention and fidelity across sites was examined.
Methods: Patients between the ages of 6 and 16 with a BMI above the 85% percentile were referred to the intervention by their provider. Data was collected for intervention and controls at baseline and follow-up, using data collection forms embedded in the electronic medical record. Data reports were provided to external evaluators who conducted univariate and bivariate analyses. Process evaluation methods included key informant and participant interviews as well as document review and observation. Qualitative data was transcribed and coded thematically using an inductive approach. Key themes were reported back to program planners who used the findings to inform program processes.
Results: To date there are 100 youth enrolled in ActOut!. Of those enrolled, 82% report Hispanic ethnicity. The gender split among participants is fairly even with 44% reporting male gender and 50% reporting female gender (6% missing data). To date we have not seen significant changes in BMI, however, we have seen changes in self-reported health behavior. ActOut! participants report increases in fruit (12%) and vegetable (10.8%) intake as well as increases in the number of days in which they are physically (33.3%). Finally, 32.2% of participants report a decrease in screen time and 33% report a decrease in soda consumption. With respect to process outcomes, the intervention has been highly acceptable among both participants and health center staff.
Conclusions: An intentional focus on promoting healthful behaviors through family nutrition counseling can both shift patient health behavior and provider capacity for supporting patients. Program processes, meanwhile indicate engaging diverse care team members in decision-making related to intervention processes, as well as early 1:1s are important strategies for facilitating buy-in.