Lessons Learned From Using Focus Groups to Refine Digital Interventions.

There is growing interest in applying novel eHealth approaches for the prevention and management of various health conditions, with the ultimate goal of increasing positive patient outcomes and improving the effectiveness and efficiency of health services delivery. Coupled with the use of innovative approaches is the possibility for adverse outcomes, highlighting the need to strategically refine digital practices prior to implementation with patients. One appropriate method for modification purposes includes focus groups. Although it is a well-established method in qualitative research, there is a lack of guidance regarding the use of focus groups for digital intervention refinement. To address this gap, the purpose of our paper is to highlight several lessons our research team has learned in using focus groups to help refine digital interventions prior to use with patients.

Working With Parents to Prevent Childhood Obesity: Protocol for a Primary Care-Based eHealth Study.

BACKGROUND: Parents play a central role in preventing childhood obesity. There is a need for innovative, scalable, and evidence-based interventions designed to enhance parents' motivation to support and sustain healthy lifestyle behaviors in their children, which can facilitate obesity prevention. OBJECTIVE: (1) Develop an online screening, brief intervention, and referral to treatment (SBIRT) eHealth tool to enhance parents' concern for, and motivation to, support children's healthy lifestyle behaviors, (2) refine the SBIRT eHealth tool by assessing end-user acceptability, satisfaction, and usability through focus groups, and (3) determine feasibility and preliminary effectiveness of the refined SBIRT eHealth tool through a randomized controlled trial. METHODS: This is a three-phase, multi-method study that includes SBIRT eHealth tool development (Phase I), refinement (Phase II), and testing (Phase III). Phase I: Theoretical underpinnings of the SBIRT tool, entitled the Resource Information Program for Parents on Lifestyle and Education (RIPPLE), will be informed by concepts applied within existing interventions, and content will be based on literature regarding healthy lifestyle behaviors in children. The SBIRT platform will be developed in partnership between our research team and a third-party intervention development company. Phase II: Focus groups with parents, as well as health care professionals, researchers, and trainees in pediatrics (n=30), will explore intervention-related perceptions and preferences. Qualitative data from the focus groups will inform refinements to the aesthetics, content, structure, and function of the SBIRT. Phase III: Parents (n=200) of children-boys and girls, 5 to 17 years old-will be recruited from a primary care pediatric clinic while they await their children's clinical appointment. Parents will be randomly assigned to one of five groups-four intervention groups and one control group-as they complete the SBIRT. The randomization function is built into the tool. Parents will complete the eHealth SBIRT using a tablet that will be connected to the Internet. Subsequently, parents will be contacted via email at 1-month follow-up to assess (1) change in concern for, and motivation to, support children's dietary and physical activity behaviors (primary outcome), and (2) use of online resources and referrals to health services for obesity prevention (secondary outcome). RESULTS: This research was successfully funded and received ethics approval. Development of the SBIRT started in summer 2012, and we expect all study-related activities to be completed by fall 2016. CONCLUSIONS: The proposed research is timely and applies a novel, technology-based application designed to enhance parents concern for, and motivation to, support children's healthy lifestyle behaviors and encourage use of online resources and community services for childhood obesity prevention. Overall, this research builds on a foundation of evidence supporting the application of SBIRTs to encourage or "nudge" individuals to make healthy lifestyle choices. Findings from Phase III of this project will directly inform a cluster randomized controlled trial to study the effectiveness of our intervention across multiple primary care-based settings. TRIAL REGISTRATION: ClinicalTrials.gov NCT02330588; http://clinicaltrials.gov/ct2/show/NCT02330588 (Archived by WebCite at http://www.webcitation.org/6WyUOeRlr).

It's like rocket science only more complex: challenges and experiences related to managing pediatric obesity in Canada.

Pediatric obesity is an urgent and complex public health issue. Approximately one-third of Canadian children are overweight or obese, a proportion that highlights the need for effective and accessible services to improve short- and long-term health risks. In our experience, we have encountered a number of challenges common in pediatric obesity management across our clinical and research centers. For the purpose of this review, these challenges and our real-world experiences are grouped as issues that span (i) caring for children, adolescents, and families, (ii) collaborating with colleagues and (iii) working within the health care system. Collectively, we highlight a number of lessons learned from our years of experience and detail ongoing initiatives designed to optimize health services for managing obesity for children and adolescents in Canada.

Modest treatment effects and high program attrition: The impact of interdisciplinary, individualized care for managing paediatric obesity.

BACKGROUND: There is an urgent need to identify effective weight management interventions in real-world, clinical settings to improve the health of children with obesity. OBJECTIVES: To determine the impact of individualized, interdisciplinary care on the weight status of children with obesity; to assess the relationship between clinical interactions and change in participants' weight status; and to document the degree of program attrition. METHODS: A retrospective medical record review of clinical and administrative data from a paediatric weight management clinic in Edmonton, Alberta, was performed, which included data from a group of five- to 18-year-olds (body mass index [BMI] ≥85th percentile) collected from 2008 to 2012. Demographic, anthropometric and attendance data were retrieved from baseline and follow-up at three-, seven- and 11-month timepoints. The primary outcomes were participants' BMI z-score and change in BMI z-score over time. RESULTS: Data from 165 individuals were included. Among those with follow-up anthropometric data, weight stabilization occurred at three (n=127) and seven months (n=84). For individuals with follow-up anthropometric data at 11 months (n=44), BMI z-score tended to decrease over time (-0.05±0.12 units; P=0.06). Program attrition increased over time (23%, 49% and 73% at three-, seven- and 11-month follow-ups, respectively). Between presentation and three-month follow-up, there was an inverse relationship between the number of clinical appointments attended and change in BMI z-score (r= -0.18; P=0.04), an association that became nonsignificant at seven and 11 months (both P>0.05). CONCLUSION: An individualized, interdisciplinary weight management intervention led to weight stabilization and a modest weight reduction in children with obesity. Strategies to minimize program attrition are needed to optimize family engagement in care and success in managing paediatric obesity.

HISTORIQUE: Il est urgent de trouver des interventions efficaces de gestion du poids en milieu clinique pour améliorer la santé des enfants obèses. OBJECTIFS: Déterminer les effets de soins personnalisés et interdisciplinaires sur le poids d'enfants obèses, évaluer le lien entre les interactions cliniques et les modifications au poids des participants et établir le taux d'abandon du programme. MÉTHODOLOGIE: Les chercheurs ont procédé à une analyse rétrospective des dossiers médicaux et des données administratives d'une clinique pédiatrique de gestion du poids d'Edmonton, en Alberta, qui incluait les données d'un groupe de jeunes de cinq à 18 ans (indice de masse corporelle [IMC] ≥85e percentile) colligées entre 2008 et 2012. Ils ont extrait les données démographiques, anthropométriques et de participation initiales, puis aux suivis de trois, sept et 11 mois. Les résultats primaires étaient l'écart réduit de l'IMC et le changement à cet écart au fil du temps. RÉSULTATS: Les données de 165 personnes ont été incluses dans l'étude. Parmi les personnes qui possédaient des données anthropométriques de suivi, on a observé une stabilisation du poids au bout de trois (n=127) et sept mois (n=84). Chez les personnes qui possédaient des données anthropométriques au suivi de 11 mois (n=44), l'écart réduit de l'IMC avait tendance à diminuer au fil du temps (−0,05±0,12 unités; P=0,06). L'abandon du programme a augmenté dans le temps (23 %, 49 % et 73 % au suivi de trois, sept et 11 mois, respectivement). Entre la présentation et le suivi de trois mois, le lien entre le nombre de rendez-vous cliniques auquel les patients avaient assisté était inversement proportionnel à la modification de l'écart réduit de l'IMC (r= −0,18; P=0,04), une association qui n'était plus significative au suivi de sept et 11 mois (tous deux P>0,05). CONCLUSION: Une intervention personnalisée et interdisciplinaire a suscité la stabilisation du poids et une légère perte de poids chez des enfants obèses. Des stratégies pour réduire au minimum l'abandon du programme s'imposent pour optimiser la participation familiale aux soins et réussir à gérer l'obésité en pédiatrie.