From Assessing To Connecting: A Formative Research Study For Pediatric Patients With Physical Activity And Nutrition Needs

Approximately 1 in 5 children in the US have obesity, and children who do not meet federal physical activity and nutrition guidelines have a 70% higher prevalence compared to their peers who do meet the guidelines. Routine healthy lifestyle screening questions have been used at well-child visits at our institution for over a decade to identify kids who are at risk, yet physicians and nurse practitioners often lack effective tools to connect their patients and families to community resources to help them meet the physical activity and nutrition guidelines. PURPOSE: Our study aims to build a framework for a pediatric primary care referral system that promotes connections to healthy lifestyle services in the community. METHODS: Our study used formative research and qualitative methodology, guided by a theoretical framework that applies the Sociotechnical Systems theory to the process for connecting patients to resources. Data were collected through in-depth interviews with members of the primary care clinic (PCC) team (n = 17), a focus group with parents and guardians (n = 9), community stakeholders (n = 15), and the bioinformatics team at our pediatric institution (n = 5). A follow-up survey was also sent out to the PCC (n = 34). Data were analyzed with Dedoose using a hybrid inductive and deductive coding approach. RESULTS: Parents and the PCC team shared their insights for important considerations in the design of this system, and bioinformatics and community organizations provided input for system functionality and process. Themes from the analysis indicate the system must be trusted, sustainable, and tailored to individual needs and circumstances. The assessment must be time efficient, the resources must be comprehensive and high quality, and the referral must consider location and transportation to be successful. CONCLUSION: There was overall excitement across participant types, indicating that this system could be a valuable tool for connecting patients and families to physical activity and nutrition resources in the community. Participants did not all agree on a single unified process, but having options would be important for each aspect of the system, and would maximize the acceptability for all participants. Funding is from a pilot grant supported by our local CTSA (University of Kansas Clinical Translational Science Institute), which is funded by National Institutes of Health