A pilot project to increase health literacy among youth from seasonal farmworker families in rural eastern North Carolina: a qualitative exploration of implementation and impact.

OBJECTIVE: There are substantial health inequalities for seasonal agricultural workers and their families in the United States. One identified inequality is in health literacy. The authors explored the implementation and impact of connecting youth from seasonal farmworker families who participated in a leadership and college pipeline program with Internet access by providing a tablet with a paid cellular data plan and university library-based health literacy training. METHODS: With the support of a National Network of Libraries of Medicine Health Information Outreach Award, we conducted a qualitative, utilization-focused evaluation by conducting semi-structured interviews from December 2017 through February 2018 with middle and high school age participants in the program (n=10). After parental consent and youth assent, we recorded interviews with participants at program activity locations or in their homes. We then utilized inductive thematic analysis with 2 primary coders. RESULTS: We identified four themes: (1) having access to the Internet can be transformative, (2) access resulted in increased knowledge of and interest in one's own and others' health, (3) "Google" is the norm, and (4) participant training increased self-efficacy to determine credible sources and resources. CONCLUSION: Providing Internet access and iPads was possible to implement and resulted in increased utilization of health information. The combination of Internet access with training on information literacy was a key factor in achieving these positive outcomes. The findings suggest the importance of ensuring equitable access to the Internet in efforts to improve educational and health outcomes for seasonal farmworkers and their families.

Tipping point: factors influencing a patient's decision to proceed with bariatric surgery.

BACKGROUND: Despite the fact that bariatric surgery is the most effective intervention for morbid obesity, only a fraction of obese patients, even after undergoing evaluation for surgery, decide to undergo the surgery. Opting out by patients is fairly common yet little is known about factors that lead a patient to decide to undergo surgery. OBJECTIVE: The purpose of this qualitative study was to identify factors that "tipped the scales" in the patient's experience leading to a decision to move ahead with surgery. SETTING: The study was carried out in the bariatric surgical clinic of a southeastern regional medical center. METHODS: This qualitative descriptive study utilized semistructured interviews with patients (n = 24) at the time of their "decision visit" to determine the factors related to their positive decision to move forward. A modification of Colaizzi's procedural steps of analysis was used to extract, organize, and analyze data for central themes. RESULTS: Two main factors leading participants to decide to move ahead with bariatric surgery were their own worsening health issues and low energy levels that limited their activities. Participants also noted additional factors that impacted their "tipping point" such as financial considerations and family influences. CONCLUSIONS: The decision to move ahead with bariatric surgery is influenced by many factors to which this research provides additional insight. Further research is warranted to fully understand this phenomenon and develop appropriate outreach and educational approaches.

Following Bariatric Surgery: an Exploration of the Couples' Experience.

BACKGROUND: Bariatric surgery is the most effective intervention for morbid obesity, resulting in substantial weight loss and the resolution of co-morbid conditions. It is not clear what impact bariatric surgery and the subsequent life-style changes have on patients' couple relationships. The purpose of this phenomenological study was to examine the lived experience of couples after one member of the couple underwent bariatric surgery. METHODS: This study utilized a phenomenological approach of semi-structured interviews of the couples jointly (n = 10 couples). Colaizzi's method of analysis for phenomenological studies was utilized to elucidate the central themes and distill the essence of the participants' experience. RESULTS: All of the couples felt their post-operative success was due to a joint effort on both members of the couples' part. The participant couples described the following five emerging thematic experiences: (a) changes in physical health, (b) changes in emotional health, (c) changes in eating habits, (d) greater intimacy in the relationship, and (e) the joint journey. CONCLUSIONS: This research provides greater insight into the experience of the couple than has been previously reported. The use of qualitative research techniques offer new approaches to examine the biopsychosocial outcomes and needs of bariatric surgery patients. Further research is warranted in order to develop culturally appropriate interventions to improve the patient's surgical and biopsychosocial outcomes.

Barriers to transition of obese patients from hospital to community.

OBJECTIVES: To identify barriers encountered by case managers in hospitals, home care agencies, and nursing homes in the transition of the obese patient from the hospital to the community. STUDY DESIGN: Exploratory descriptive design was used. Hospital case managers, nursing home administrators, and Medicare-certified home healthcare agency administrators were surveyed to identify barriers. METHODS: Hospital case managers in each licensed acute care hospital, directors of licensed nursing homes, and administrators of the Medicarecertified home healthcare agencies in 1 southern state were surveyed. The survey instrument was designed by the investigators based on variables identified in the literature or encountered within their practice. Instruments consisted of items related to the respondent's experience with barriers such as patient size, degree of patient independence, patient care requirements, staffing levels, and the need for assistive equipment, as well as items used to collect basic demographic information. RESULTS: Both hospital case managers and nursing home directors reported as major barriers the equipment, the size of the patient, patient independence, and finances. Home care agency directors reported that the presence or absence of a competent caregiver was the major factor in the decision to accept or not accept an obese patient. CONCLUSIONS: Transition of the obese patient presents major challenges. Further exploration is needed to identify the extent of problems and make policy recommendations toward a solution.

For comparison: experience with a children's obesity camp.

BACKGROUND: The alarming rise in childhood obesity has resulted in a number of bariatric surgical initiatives. To interpret the outcomes, a comparison with a nonoperative approach is prudent. METHODS: In 2003, 2004, and 2005, we measured the outcomes produced by an isolated summer camp in North Carolina for 74, 99, and 89 obese children and adolescents with a mean age of 12.7 +/- 2.3, 13.0 +/- 1.9, and 13.2 +/- 1.8 years and initial body mass index (BMI) of 33.1 +/- 5.7, 33.4 +/- 6.4, and 32.9 +/- 7.0 kg/m2, respectively. The camp featured a 1700/d caloric diet, daily aerobic and resistance weight training exercise, nutrition classes, and weekly sessions with a psychologist. The changes in weight, BMI, body shape measurements, and fitness level were assessed. The average length of stay was 4.3, 4.2, and 4.4 weeks, respectively, in 2003, 2004, and 2005. RESULTS: The BMI, body shape, and weight change measures significantly improved during each of the summers. The campers lost 1.6, 2.0, and 1.8 kg/wk during each of the 3 years. Their waist measurements decreased by 9.1 +/- 5.12 cm, 9.9 +/- 5.6 cm, and 8.1 +/- 5.8 cm. Significant improvements occurred in the timed sprints, .5-mile (0.8-km) run, and vertical jump. Of those campers staying for two summers, 4.4% continued to reduce their BMI despite growth, 56.5% maintained their BMI at less than the initial baseline measurement, and 39.1% increased their BMI to greater than the baseline. The co-morbidities also improved. One camper, aged 15 years, weighing 211 kg, progressed from being able to walk 3 steps to managing the 100-yard (91-m) dash in 42 seconds after losing 35 kg in 8 weeks. CONCLUSION: Diets, exercise, and behavioral modification are useful approaches in severely obese children that can, in some, produce significant albeit expensive long-term results. Recidivism is a problem. Surgical outcomes must compare favorably with these outcomes.