Predicting childhood obesity prevention behaviors using social cognitive theory.

Four commonly suggested public health strategies to combat childhood obesity are limiting television viewing, encouraging daily physical activity, increasing fruit and vegetable intake, and increasing water consumption. This study examined the extent to which selected social cognitive theory constructs can predict these four behaviors in upper elementary children. A 52-item valid and reliable scale was administered to 159 fifth graders. Minutes of physical activity was predicted by self-efficacy to exercise and number of times taught at school (R2 = 0.072). Hours of TV watching were predicted by number of times taught about healthy eating at school and self-control through goal setting (R2 = 0.055). Glasses of water consumed were predicted by expectations for drinking water (R2 = 0.091). Servings of fruits and vegetables consumed were predicted by self-efficacy of eating fruits and vegetables (R2 = 0.137). Social cognitive theory offers a practically useful framework for designing primary prevention interventions to reduce childhood obesity.

The North Carolina experience with the diabetes health disparities collaboratives.

BACKGROUND: The Bureau of Primary Health Care (BPHC) adopted a collaborative approach that used the Chronic Care Model and quality improvement methods. The North Carolina Diabetes Prevention and Control Branch has partnered with the 12 participating community health centers since early 2000. METHODS: Team leaders of the first four centers that participated in the collaboratives were interviewed. Information obtained included previous diabetes efforts, benefits of the collaborative, success factors, and barriers to sustainability. CASE STUDY: In one of two case studies, a nonprofit community health center made Chronic Care Model-based changes to the organization of health care, clinical information systems, and delivery system design. RESULTS: Centers tracked used the electronic registry to establish a baseline, trend key process and outcome measures, and raise the standard of care. Success factors included senior leadership support, physician champions, multidisciplinary teams, and priority of collaborative activities. Barriers included staff turnover and low priority in strategic planning. Glycohemoglobin (A1C) values from aggregated reports demonstrated improvement. DISCUSSION: Useful strategies for future collaboratives may include providing provider-specific data, imparting vision to new team members, ensuring that leadership provides collaborative structure and resources, and pairing veteran and new participating sites.