Promoting Healthy Families Through Enhanced Primary Care

描述（由申请人提供）：初级保健一直是儿童肥胖预防中未充分利用的资源。在家庭在控制环境和行为模式方面仍起主要作用的幼儿中，促进健康的生活方式是关键。然而，由于难以有效地收集儿童/家庭行为的数据，缺乏护理点临床医生对有效咨询的支持，以及需要家庭加强计划改变，在良好的儿童保育期间进行肥胖预防咨询是具有挑战性的。我们建议进行一项可行性研究，以创新的以家庭为中心的初级保健干预措施，以满足农村低收入社区的这些需求。家庭准备改变将指导咨询和访问后计划的访问后加强。本项目将个人数据助理（PDA）技术、基于社区实践的研究网络（PBRN）和一个在办公系统变革方面经验丰富的研究团队结合起来，设计并试点测试了一个解决肥胖风险的初级保健办公室系统，我们将通过四个具体目标将这项工作扩展到儿童肥胖预防。

DESCRIPTION (provided by applicant): Primary care has been an under-utilized resource for childhood obesity prevention. Promotion of healthy lifestyles in younger children when families still play a major role in controlling their environment and modeling behaviors is key. However, obesity prevention counseling during well child care is challenging due to difficulties in efficiently gathering data on child/family behaviors, lack of point of care clinician supports for effective counseling, and the need for family reinforcement of planned changes. We propose a feasibility study of an innovative family-focused intervention for primary care to meet these needs in rural, low-income...communities. Family readiness to change will guide the counseling and post-visit planned post visit reinforcement. This project brings together personal data assistant (PDA) technology, a community Practice Based Research Network (PBRN), and a research team experienced in office system change, to design and pilot test a primary care office system to address obesity risk, we will extend that work to obesity prevention in children through four specific aims. 1) Using hand held PDAs, we will develop an obesity risk screening and counseling system well child visits (WCV) for ages 4 -10. PDA summarized screening results will prompt the clinician to provide brief counseling messages tailored to each child's obesity risk behaviors and family readiness to change behavior. 2) We will evaluate the specific content and quality of clinician obesity counseling provided at the WCV through parent surveys before and after implementation of the PDA screening and counseling program. 3) To support action by families post visit, we will develop a post-visit intervention package of newsletters and materials also tailored to child/family obesity risk behaviors and parental readiness to change. 4) We will evaluate the impact of this post visit intervention program in a 6 month trial focused on children identified with BMI >85%. Families will be randomized to receive either a series of 4 mailed supports versus a single generic-content mailing. We will determine the respective impact of these two levels of post-visit support on stage of change, parental action on key obesity risk behaviors, child behaviors, and stabilization of BMI z scores after 6 months.