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Bridging the healthcare access gap and addressing COVID-19 vaccine hesitancy among rural-dwelling Black American adults residing in the Deep South require involvement of faith-based leaders in the community. This study explored perceived barriers and resources to meeting community needs, including vaccination, during the COVID-19 pandemic as reported by 17 Black American church leaders in the rural West Alabama Black Belt geographic region in May 2022. The main themes that emerged included (1) attending to community impact of COVID-19 illness and death; (2) maximizing health literacy and diminishing vaccine hesitancy through engaging in preventive health practices and sharing public health information; (3) addressing challenges created or exacerbated by COVID-19, including reduction in in-person attendance (particularly among adolescents and young adults), limited access to and literacy with technology, and political perceptions influencing engagement in preventive health behaviors; (4) maximizing technological solutions to increase attendance in the church; and (5) engaging in solution-focused and innovative initiatives to meet the identified needs in the congregation and community. Church leaders in West Alabama rural areas facing economic, health, and technological disparities identified "silver linings" as well as challenges created or exacerbated during the pandemic. As the need for COVID-19 vaccination and booster vaccination continues, Black American church leaders play pivotal roles in meeting rural community needs.
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BACKGROUND: Prostate cancer incidence is highest for Black men of the African diaspora in the United States and Caribbean. Recent changes in recommendations for prostate cancer screening have been shown to decrease overall prostate cancer incidence and increase the likelihood of late stage disease. However, it is unclear how trends in prostate cancer characteristics among high risk Black men differ by geographic region during the changes in screening recommendations. METHODS: In this study, we used population-based prostate cancer registry data to describe age-adjusted prostate cancer incidence trends from 2008 to 2015 among Black men from six geographic regions. We obtained data on incident Black prostate cancer patients from six cancer registries (in the United States: Florida, Alabama, Pennsylvania, and New York; and in the Caribbean: Guadeloupe and Martinique). After age standardization, we used descriptive analyses to compare the demographics and tumor characteristics by cancer registry site. The Joinpoint regression program was used to compare the trends in incidence by site. RESULTS: A total of 59,246 men were analyzed. We found the highest incidence rates (per 100,000) for prostate cancer in the Caribbean countries (181.99 in Martinique and 176.62 in Guadeloupe) and New York state (178.74). Incidence trends decreased significantly over time at all sites except Martinique, which also showed significantly increasing rates of late stage (III/IV) and Gleason score 7+ tumors. CONCLUSIONS: We observed significant differences in prostate cancer incidence trends among Black men after major changes prostate screening recommendations. Future studies will examine the factors that differentially influence prostate cancer trends among the African diaspora.
Subject(s)
Prostatic Neoplasms , Male , Humans , United States/epidemiology , Prostatic Neoplasms/epidemiology , Prostatic Neoplasms/pathology , Incidence , Early Detection of Cancer , Prostate-Specific Antigen , Caribbean Region/epidemiologyABSTRACT
Current literature supports the creation and implementation of nurse residency programs to support new graduate nurses. The lack of this important postlicensure resource poses a problem for new graduate nurses who are seeking additional assistance and guidance during the transition to professional practice. This qualitative study revealed the factors, barriers, and benefits that influenced the decision-making process of nurse leaders in the implementation of nurse residency programs.
Subject(s)
Hospital Administrators , Internship and Residency , Humans , Qualitative Research , LeadershipABSTRACT
BACKGROUND: Coronary artery disease (CAD) remains the leading cause of death in the U.S. Atherosclerotic changes leading to CAD begin in early childhood. Universal lipid screenings remain low nationwide despite the 2011 National Heart, Lung, and Blood Institute's (NHLBI) Expert Panel Guidelines. LOCAL PROBLEM: The aim of this quality improvement project was to examine the benefit of an educational intervention on the implementation of universal lipid screening guidelines within a federally qualified health center tasked with providing care to a high-risk population. INTERVENTION: An educational intervention was offered detailing the 2011 NHLBI guidelines. A total of seven medical providers participated in the intervention. METHOD: Following the intervention, a pre- and post- knowledge survey was given to assess improvement in knowledge. A retrospective chart review was performed to evaluate application to practice. RESULTS: The number of lipid screenings improved from 7.8% (n = 384) pre-intervention to 39.2% (n = 74) post intervention. There was a statistically significant increase in screenings post-intervention t (456) = 7.842, p = .000, two-tailed). CONCLUSION: More studies are needed to adequately identify the impact of universal screening guidelines on the health of both children and adults alike. PRACTICE IMPLICATIONS: Universal lipid screenings remain promising in early identification of CAD in the pediatric population. Interventions related to expanding the knowledge of healthcare providers, patients, and families are key to decreasing CAD morbidity and mortality.
Subject(s)
Mass Screening , Quality Improvement , Child , Humans , Lipids , Retrospective Studies , Risk FactorsABSTRACT
Through each era, the southeastern United States was and continues to be an epicenter for industrial companies to establish factories and plants. Though this development attracts economic gain for the companies and surrounding areas, low-income and predominantly Black communities bear the brunt of the environmental consequences while frequently remaining stagnant economically. This qualitative, community-based participatory research study grew out of a larger study designed to recruit lay community advisors from communities labeled as hard to reach in research. We focus on Holt, Alabama, an unincorporated community in the southeastern United States region. The primary goal of this research inquiry is to thematically analyze community interviews stemming from a topic of research, practice, and policy interest to community members: the effects of industrial pollution on Holt citizens' daily lives. Content analysis of focus-group transcripts revealed four emergent themes, including: (1) how the pollution affects their water, soil, and air quality; (2) illness related to pollution; (3) community engagement and empowerment; and (4) suggestions regarding what government officials could do to address this area of need. Building upon the prior research regarding environmental justice, human flourishing, and the definition of nurturing environments, suggestions are made regarding the creation, implementation, and maintenance of project advisory councils focused on issues of environmental justice. Community advocacy and empowerment as well as community and scientific partnerships are imperative to alleviate problems associated with environmental justice.
Subject(s)
Air Pollution , Social Justice , Community-Based Participatory Research , Environmental Justice , Environmental Pollution , HumansABSTRACT
Understanding the views of cancer survivors on their experience is important for informing community-based interventions. We studied, for the first time, the views of cancer survivors residing in Saint Lucia on their overall care experience. We used interview data from a cohort of adult cancer survivors from Saint Lucia between 2019 and 2020. We performed a thematic analysis to derive themes from codes. Forty-four survivors provided responses to at least one of the three questions. The majority of survivors were black, female and diagnosed with breast cancer. Survivors were interviewed on average five years after diagnosis. Four common themes emerged; "Availability of support groups", "Importance of support from family and friends", "Access to finances" and "Health education and patient navigation". Travel overseas for health services was common among survivors. Survivors expressed emotional distress during travel due to isolation from family and local providers. This is typical among island populations and is distinct from existing patient frameworks. Survivors also suggested that networking amongst providers and interventions assisted families of cancer survivors. Although tertiary care services are limited, we showed that survivors deeply value and depend on their inter-personal relationships during care. Interventions aimed at strengthening the inter-personal environment of survivors are warranted.
Subject(s)
Cancer Survivors , Neoplasms , Adult , Female , Health Resources , Humans , Neoplasms/therapy , Saint Lucia , Self-Help Groups , Social Support , SurvivorsABSTRACT
BACKGROUND: Few studies have examined the real-time and dynamic relationship between lifestyle behaviors and treatment-related symptoms. OBJECTIVE: The aim of this study was to examine the associations of daily physical activity and sedentary behavior with symptom burden, pain interference, and fatigue among patients who were undergoing active cancer treatment. METHODS: A total of 22 (mean age = 57 years; 73% women; 55% Black) cancer patients were recruited from a local hospital and reported a daily diary of physical activity, sedentary behavior, symptom burden, pain interference, and fatigue over 10 days. Adjusted mixed-effects models were used to examine all associations. RESULTS: Body mass index moderated the relationship between physical activity and symptom burden (γ = 0.06, P < .01) and physical activity and fatigue (γ = 0.09, P < .05). On days where physical activity was higher than average, symptom burden and fatigue scores were lower among patients who had lower body mass index values. Also, age moderated the relationship between sedentary behavior and symptom burden (γ = -0.04, P < .05); on days where patients sat more, symptom burden was lower among patients who were younger than the average age. CONCLUSIONS: Overall, these data indicate that treatment-related symptoms vary daily within cancer patients and that physical activity may alleviate treatment-related symptoms for leaner patients. Larger samples and objective assessments of physical activity and sedentary behavior are needed to validate our results. IMPLICATIONS FOR PRACTICE: Oncology nurses may be in the best position to promote physical activity during treatment as a strategy to manage symptom burden.
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Neoplasms , Sedentary Behavior , Exercise , Fatigue/etiology , Female , Humans , Life Style , Male , Middle Aged , Neoplasms/complications , Neoplasms/therapyABSTRACT
BACKGROUND: The magnitude for potential burnout is enormous. The Centers for Disease Control and Prevention, Center for Addiction and Mental Health, and Substance Abuse and Mental Health Services Administration reported diagnoses of psychiatric and substance use disorders are at an all-time high for physicians, psychiatrists, nurses, social workers, and psychologists. OBJECTIVE: Reduce the potential for burnout among outpatient mental health clinicians and staff. METHOD: Develop an agency wellness protocol utilizing evidence-based interventions to reduce the potential for clinician and staff burnout. RESULTS: Survey data indicated low to moderate levels of burnout and depersonalization. Staff and clinician recommendations provided during feedback sessions were incorporated with evidence-based interventions to establish a wellness protocol. CONCLUSION: Implementing evidence-based interventions in a wellness protocol may reduce the potential for clinician and staff burnout.
Subject(s)
Burnout, Professional , Mental Health , Burnout, Professional/prevention & control , Burnout, Professional/psychology , Health Personnel/psychology , Humans , Surveys and QuestionnairesABSTRACT
Objective: Cancer mortality inequity among persons of African Ancestry is remarkable. Yet, Black inclusion in cancer biology research is sorely lacking and warrants urgent attention. Epidemiologic research linking African Ancestry and the African Diaspora to disease susceptibility and outcomes is critical for understanding the significant and troubling health disparities among Blacks. Therefore, in a cohort of diverse Blacks, this study examined differences in genetic ancestry informative markers (AIMs) in the DNA repair pathway and the cancer related biomarker 4-(Methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL).Methods: Participants completed a questionnaire and provided bio-specimens. AIMs in or around DNA repair pathway genes were analyzed to assess differences in minor allele frequency (MAF) across the 3 ethnic subgroups. NNAL concentration in urine was measured among current smokers.Results: To date the cohort includes 852 participants, 88.3% being Black. Of the 752 Blacks, 51.3% were US-born, 27.8% were Caribbean-born, and 19.6% were Africa-born. Current and former smokers represented 14.9% and 10.0%, respectively. US-born Blacks were more likely to be smokers and poor metabolizers of NNAL. Two-way hierarchical clustering revealed MAF of AIMs differed across the 3 ethnic subgroups.Conclusion: Our findings are consistent with the emerging literature demonstrating Black heterogeneity underscoring African Ancestry genetic subgroup differences - specifically relevant to cancer. Further investigations, with data harmonization and sharing, are urgently needed to begin to map African Ancestry cancer biomarkers as well as race, and race by place\region comparative biomarkers to inform cancer prevention and treatment in the era of precision medicine.
Subject(s)
Ethnicity , Neoplasms , Human Migration , Humans , Neoplasms/genetics , Neoplasms/prevention & control , Philadelphia , SmokersABSTRACT
OBJECTIVE: Assess the relationship between educating caregivers about high-reliability principles and reporting of potential adverse safety events. BACKGROUND: Persuading caregivers to report potential safety events is challenging. Learning high-reliability principles may help caregivers identify and report potential safety problems. METHODS: Event reports submitted by caregivers 6 months before and after high-reliability training were examined for event types, event significance, and shift when events occurred. χ Tests assessed relationships between variables. RESULTS: The number and type of caregiver event reports before and after training were not significantly different; however, clinical process error reports significantly decreased (χ = 9.251, P = .003). There was a significant difference in reports submitted by day and night shifts (χ = 5.942, P = .02). CONCLUSIONS: Trends suggest staff report actual, rather than potential, events regardless of training. Further research is needed to determine what motivates caregivers to report safety concerns.
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Medical Errors/statistics & numerical data , Medical Staff, Hospital/education , Medical Staff, Hospital/psychology , Humans , Motivation , Patient Safety , Program Evaluation , Retrospective Studies , Risk ManagementABSTRACT
In 2011, the Veterans Health Administration mandated that Veterans Affairs (VA) Medical Centers develop and implement a policy that allowed registered nurses (RNs) and advanced practice registered nurses (APRNs) to pronounce the death of residents who die in Veterans Affairs community living centers, previously known as nursing homes, provided that there is a written do-not-resuscitate order in their medical record. The purpose of this quality improvement project was to determine the extent to which the implementation of the RN/APRN death pronouncement policy affected death pronouncement time for residents who die after 5 PM and before 7:30 AM, on weekends and holidays. This project is significant because the previous physician-only death pronouncement policy was found to cause unnecessary delays in death pronouncement. A chart review of the medical records of all veterans' deaths pronounced by physicians 3 years before the implementation of the policy and 4 years after the RN/APRN policy was reviewed and implemented. The data analysis was conducted using descriptive analysis. A significant difference was found in the results (P < .05). The maximum for prepolicy deaths was 125 minutes. The maximum for postpolicy deaths was 7 minutes. The results supported the assumption that RN/APRN pronounced death without delay.
Subject(s)
Advanced Practice Nursing/standards , Nurse's Role , Nursing Homes , Resuscitation Orders , Veterans , Hospice and Palliative Care Nursing , Humans , Quality Improvement , United States , United States Department of Veterans Affairs/standards , VirginiaABSTRACT
BACKGROUND: Accurate blood pressure measurements (BPM) are important, as clinicians are tasked daily with using such measurements to make clinical diagnoses and patient care judgments. Research studies and controlled trials hold such measurements to a higher standard than everyday clinical practice. OBJECTIVE: The aim of this study was to evaluate difference in BPM outcomes of individuals in a clinic setting when clinicians collect BPM as usual vs BPM after 5- (USPSTF recommendation) and 10- minute (study unique intervention) timed rest interval. METHODS: A repeated-measures design was used to examine individual BPMs at the intervals of baseline, after a 5-minute rest interval post-baseline, and after a 10-minute rest interval post-baseline. Results Pairwise comparisons indicated that baseline SBP was the highest when compared to SBP measured at both 5- and 10-minutes post-baseline. SBP measured at 5-minutes was also significantly higher compared to SBP collected at 10-minutes post-baseline (psâ¯<â¯.05). For DBP, the repeated-measures ANOVA indicated that there was no significant difference across BPMs, F(2,198)â¯=â¯1.25, pâ¯=â¯.29. CONCLUSIONS: Results from this study revealed that implementing a 5-minute rest interval before BPMs are taken in a clinic setting produces a "clinically observable" reduction in the overall mean systolic BPs as seen at both 5- and 10-minute BPM intervals. It is important for all healthcare clinicians to recognize the importance of accurate BPM and the need to encourage better regulated BPM standard in everyday practice.
Subject(s)
Blood Pressure Determination/methods , Blood Pressure Determination/psychology , Nursing Staff, Hospital/psychology , Nursing Staff, Hospital/statistics & numerical data , Primary Health Care/methods , Primary Health Care/statistics & numerical data , Social Responsibility , Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Time Factors , Young AdultABSTRACT
BACKGROUND AND OBJECTIVES: This study describes the adaptation and validation of Sörensen et al. (2017)'s preparation for future care (PFC) scale with diverse samples including rural dwelling African Americans and certified nursing assistants (CNAs), and subsequent psychometric development. RESEARCH DESIGN AND METHODS: Responses to the five-subscale PFC survey from 33 rural African American men across 12 months and cognitive interviews with a subset of 12 of these men are described. Psychometric refinement included descriptive qualitative analyses of consultations with experienced lay research advisors (N = 4 and N = 7) regarding potential changes to the PFC and a confirmatory factor analysis of the resultant scale (N = 138). RESULTS: Cognitive interviews with rural African American men revealed difficulty understanding Eurocentric questions. Emergent themes included emotional avoidance of planning, considerations of nursing homes and possible care providers, and coping strategies. In two consultation meetings, trained lay research advisors recommended language modifications to the original questions and response options. Factor analyzing the resultant scale revealed support for the original subscale constructs (acceptable fit: χ2 = 205.03, df = 124, p < .001; root mean square error of approximation = .069 [.052-.085]; comparative fit index = .93; Tucker-Lewis index = .91). DISCUSSION AND IMPLICATIONS: PFC and engagement in advance care planning is uncommon among African Americans, possibly due to distrust of and lack of cultural competency among health care professionals. The resulting tool and response options may be used as an interview guide/survey with African Americans to gain understanding about their preparation for future health care needs.
Subject(s)
Advance Care Planning , Black or African American , Cultural Competency , Patient Care Planning , Rural Population , Adult , Black or African American/psychology , Aged , Alabama , Early Detection of Cancer/psychology , Health Knowledge, Attitudes, Practice/ethnology , Humans , Interviews as Topic , Male , Middle Aged , Prostatic Neoplasms/diagnosis , Prostatic Neoplasms/prevention & control , Psychometrics , Surveys and QuestionnairesABSTRACT
PURPOSE: Prostate cancer (PCa) is the second leading cause of cancer death in U.S. men [American Cancer Society (ACS)], most often affecting men age 50 and older. The study provides information about factors that influence rural AA men in their decision to undergo screening for PCa with a specific focus on PCa knowledge among AA men and their health care advocates. METHODS: A longitudinal quantitative study included AA males and their health care advocates. Participants were from three Alabama rural counties. Measures included demographics, PCa knowledge, decisional conflict, and health literacy scales. RESULTS: Thirty-three men with a mean age of 54.61 and 35 health care advocates were included in the study. PROCASE Knowledge Index measure results indicate a lack of PCa knowledge among both male primary participants and their advocates. The knowledge of AA men in the study was somewhat low, with individuals correctly answering approximately six questions out of ten at multiple time points (baseline total M = 6.42, SD = 1.52). Decisional conflict responses at 12 months (38.64) were lower than at baseline (M = 62.88) and at 6 months (M = 58.33), p < .005. CONCLUSION: Health care advocates of the 33 male participants were usually women, spouses, or significant others, supporting the vital role women play in men's health specifically in rural underserved communities. Low overall PCa knowledge, including their risk for PCa, among these participants indicates a need for PCa and screening educational interventions and dialogue that include males and their significant others.
Subject(s)
Decision Making , Health Knowledge, Attitudes, Practice , Mass Screening/methods , Prostatic Neoplasms/diagnosis , Adult , Black or African American , Aged , Early Detection of Cancer , Humans , Male , Middle Aged , Pilot ProjectsABSTRACT
INTRODUCTION: African-American men have higher rates of prostate cancer and more advanced cancer when diagnosed than men of other ethnicities. PURPOSE: To explore the perspectives and shared experiences of rural African-American men when it comes to interactions with healthcare providers, shared decision-making, and information on prostate cancer and screening. METHODS: A convenience sample of African-American men in four rural counties in the southeastern United States agreed to participate. Semi-structured interviews of 43 men were conducted in patients' homes, classrooms, offices, and local churches. Lincoln and Guba's (1985) naturalistic approach was used. RESULTS: Analysis of the rich, in-depth narratives gleaned from these African-American men revealed three themes: 1) limitations in knowledge of prostate cancer, 2) poor patient/provider communication, and 3) deficient health literacy skills. CONCLUSIONS: Participants' perspectives about limited knowledge regarding PCa, variation in provider-patient communication and the finding of low health literacy skills expand knowledge, inform clinical practice, and provide evidence for further investigation to better provider communication and patient education concerning PCa and decision making in this population.
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IN BRIEF This article describes a study to gain insight into the utility and perceived feasibility of the American Diabetes Association's Diabetes Risk Test (DRT) implemented by nurse practitioners (NPs) in the retail clinic setting. The DRT is intended for those without a known risk for diabetes. Researchers invited 1,097 NPs working in the retail clinics of a nationwide company to participate voluntarily in an online questionnaire. Of the 248 NPs who sent in complete responses, 114 (46%) indicated that they used the DRT in the clinic. Overall mean responses from these NPs indicated that they perceive the DRT as a feasible tool in the retail clinic setting. Use of the DRT or similar risk assessment tools in the retail clinic setting can aid in the identification of people at risk for type 2 diabetes.
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PURPOSE/OBJECTIVES: To explore differences in cancer risk knowledge and colorectal cancer (CRC) knowledge among adults in Alabama. â©. RESEARCH APPROACH: Telephone interviews were conducted using an 80-item questionnaire that included 14 demographic questions and 26 general questions regarding healthcare quality, sources of health-related information, and cancer fears and risk factors. Also included were 40 questions dealing with CRC perceptions and experiences (asked only of respondents aged 50 years or older).â©. SETTING: A standard random-digit-dialed statewide telephone survey, targeting adult residents of Alabama. Interviews were conducted during about seven weeks in 2012. â©. PARTICIPANTS: 1,024 participants, including 615 who were aged 50 years or older. Most of the participants identified as Caucasian.â©. METHODOLOGIC APPROACH: A secondary data analysis using data from a CRC screening survey of Alabama residents conducted in 2012 by the University of South Alabama polling group via telephone.â©. FINDINGS: Knowledge of general cancer risk factors predicted disagreement with the statement, "There is nothing you can do to avoid getting cancer," and disagreement with the statement, "Only people with signs or symptoms should be screened for CRC." Binary logistic regression showed that those higher in CRC risk knowledge were more likely to have been screened for CRC. â©. CONCLUSIONS: Knowledge of general cancer risk factors may increase self-efficacy. In addition, individuals with increased knowledge of colorectal cancer risk factors were more likely to participate in CRC screening. â©. INTERPRETATION: Nurses play an instrumental role in addressing CRC, a preventable and treatable cancer. An opportunity exists for nurses and other healthcare providers to develop culturally appropriate educational interventions to increase knowledge related to CRC, risk factors, and screening, particularly among those who are at increased risk. This education needs to occur in clinical practice and within the community.
Subject(s)
Colorectal Neoplasms , Health Knowledge, Attitudes, Practice , Alabama , Colorectal Neoplasms/diagnosis , Colorectal Neoplasms/epidemiology , Early Detection of Cancer , Female , Humans , Male , Middle Aged , Risk FactorsABSTRACT
Obstacles that prevent rural African Americans (AAs) from regularly engaging in cancer screening were explored, and a theoretical approach was formulated utilizing social networks as a culturally sensitive form of health promotion. Disparities in cancer morbidity and mortality continue to exist between AAs and Caucasians in the United States. Often rural dwellers are further disadvantaged because of a potential lack of medical and financial resources and low health literacy. Social networks provide an existing framework where health concerns are discussed and health interventions in cancer screening can strengthen or encourage relevant health behaviors in rural AAs and other disadvantaged populations.
Subject(s)
Black or African American/statistics & numerical data , Community Networks/organization & administration , Health Promotion/organization & administration , Mass Screening/organization & administration , Neoplasms/prevention & control , Rural Population/statistics & numerical data , Black or African American/psychology , Female , Health Services Accessibility/organization & administration , Humans , Male , Neoplasms/ethnologyABSTRACT
Pertussis, also known as whooping cough, is a vaccine-preventable disease most commonly affecting infants and young children. This article describes a project to develop an evidence-based protocol for implementing prenatal vaccination and cocooning in a major medical center in Georgia.
Subject(s)
Pertussis Vaccine/therapeutic use , Whooping Cough/pathology , Whooping Cough/prevention & control , Humans , Infant, Newborn , Mass Vaccination/standards , United States , Whooping Cough/therapyABSTRACT
The purpose of this article is to discuss the importance of addressing obesity, a national epidemic. Furthermore, the paper focuses on the utilization of a clinical practice protocol for identifying patients who are obese or at risk for obesity in the primary care setting. The practice protocol includes guidelines for assessment, documentation, and a consistent educational intervention for the identified priority population. The rapidly increasing incidence of obesity in our primary care practices supports the need for evidence-based approaches to ensure consistent assessment and documentation, thereby increasing the potential for weight management and obesity reduction.