Pediatric Obesity Community Programs: Barriers & Facilitators Toward Sustainability

Pediatric Obesity Community Programs: Barriers & Facilitators Toward Sustainability Eli K. Po’e • Sabina B. Gesell • T. LynneCaples • Juan Escarfuller • Shari L. Barkin (2010). Journal of Community Health 35: 348-354. doi: 10.1007/s/10900-010-9262-5

Background and Purpose Childhood obesity is a major problem; this generation may be the first that has a shorter lifespan that its parents. In the United States alone, 25% of children are currently overweight or obese and the numbers are continuing to rise. In order to prevent childhood obesity, effective community-based programs and additional resources must be established. The purpose of this study is to identify common barriers and facilitators affecting community organizations in offering obesity-related services. The identification of inhibitors and promoters to education and prevention is imperative in order to create sustainable community programs aimed to prevent to reduce obesity. (Po’e et al, 2010)

Research Method • This study was an exploratory, cross-sectional, qualitative research study dependent on grounded theory. • Grounded theory is when the hypothesis, or theory, is based on the empirical data gathered in the study. • Inclusion Criteria • The community organizations had to be currently active in the Davidson County of Nashville, TN. • The community organizations also had to have self-identified programs targeted towards pediatric obesity as well as services provided to children and youth based on healthy lifestyle behaviors. • Data was collected from December 2007 to February 2008. (Po’e et al, 2010)

Data Gathering Process • Systematic, in-depth, face-to-face, semi-structured interviews were utilized. • Interviews were conducted with key personnel (i.e. directors, executive directors, managers) serving as representatives of the community organization. • One interview was conducted for each organizationand was conducted by the same interviewer. • The interviews took place at the location of the organization. • Interviews consisted of nine open-ended questions with the interviewer prompting participant to elaborate on response. • Prior to participation in the interview, an informed consent was signed by the organization. (Po’e et al, 2010)

Subjects and Populations • 80 community organizations met the inclusion criteria previously discussed. • 30 of these 80 organizations were randomly selected for the interview. • However, five organizations could not arrange a time to meet and one organization withdrew. • Therefore, 24 community organizations completed the interview. • The subjects (community organizations) could be divided into three main categories: community outreach programs, after-school programs, and clinic-based programs. • The description of the population is identical to the inclusion criteria with the exception of the location. The implications of this study could be generalized to other locations in the United States. (Po’e et al, 2010)

Data Analysis • Inductive and deductive analysis was used to extract words and concepts as well as generate themes and subthemes. • I.e. If a question was “How long is your program?” a theme would be program duration with a subtheme as annually. • Reviewers then independently tallied the subtheme frequency. • The qualitative data of the study also included specific quotes recorded during the interview from interviewees. (Po’eet al, 2010)

Results Facilitators to Perceived Success and Percent of Organizations that Reported Them • Revising and Enhancing Programs (73%) • Changing the population being targeted to include more people • Adding more programs available • Community Involvement (62.5%) • Engaging volunteers who want to help the community but don’t know how • Creating Partnerships (54.2%) • With other organizations (such as hospitals and farmers) (Po’eet al, 2010)

Results Barriers to Perceived Success and Percent of Organizations that Reported Them • Not Enough Funding (44%) • Not enough money to start/maintain programs • Centers are forced to find ways to alter programs to spend less or through out programs • Inconsistent/lack of Participation (42%) • Participation is completely voluntary • Cannot force individuals to participate • Insufficient Staffing (21%) • Staff members who are available are stretched thin to try to cover roles and needs in the community (Po’e et al, 2010)

Support Staff (27%) • Design programs and run them • Partnerships (50%) • Allow for greater quantity/quality of programs • Funding (42%) • Centers need constant funding to provide classes and programs Results Sustainability and the Percent of Organizations that Reported Them (Po’e et al, 2010)

Results: Table 1 Major themes & subthemes No. (%) of organizations that indicated this subtheme at least once Major theme: barriers 10.5 (43.8%) 10 (41.7%) 5 (20.8%) Major theme: facilitators 17.5 (73.0%) 15 (62.5%) 13 (54.2%) Major theme: sustainability 12 (50.0%) 10 (41.7%) 6.5 (27.1%) • Major theme: barriers • Funding/money • Lack of participation • Lack of support staff • Major theme: facilitators • Programmatic enhancements • Community involvement • Partnerships • Major theme: sustainability • Partnerships • Funding • Support staff (Po’e, et al, 2010, Table 1)

Study Conclusion • Our youth are in danger. Being overweight or obese is a problem in 25% of the pediatrics population in America today. In order to target this population for health promotion education, it is necessary to identify what facilitates the success of programs available to the youth. It is also important to determine the barriers these programs face. • Through this study, it was shown that barriers include insufficient or lack of funding, lack of participation, and insufficient staffing. Facilitators included partnerships, involvement of the community, and revision/enhancement of programs. • Funding, the support staff, and partnerships were identified as the factors that sustain the programs that were interviewed. (Po’eet al, 2010)

Nursing Implications • So what does this information mean to the world of nursing? • Obesity is a quickly spreading epidemic that will inevitably affect our patients in some way. • Healthcare institutions are part of the coalitions that need to join together to help fight pediatric obesity. • We need to switch the role of healthcare from only treating the disease to also treating the root of the problem. Prevention is key!

Nursing Implications • So what can we do? • This study found that resources directed at reducing pediatric obesity were much more sustainable if they partnered with other resources • Healthcare institutions need to work together with families, schools, and other community resources to help fight the obesity epidemic (Po’e et al, 2010)

Nursing Implications • The nurse’s role • Continuing the message of promoting techniques to both treat and prevent obesity (diet, healthy lifestyle, etc.) • Referring children and families to other resources (Boys and Girls Club, Girl Scouts, Sports teams, etc.) • Partnering with other organizations to collaborate on fighting obesity • Living as role models

Unresolved Issues • Obesity is still a rapidly growing problem in the United States and this definitely includes the pediatric population • The way the trend is going, this generation of children may be the first to live a shorter life than their parents did • Much research on the issue is still needed • Healthcare needs to focus less on treating the complications of obesity and more on preventing it in the first place (Po’e et al, 2010)

Reference Po'e, E. K., Gesell, S. B., Caples, T. L., Escarfuller, J., & Barkin, S. L. (2010). Pediatric obesity community programs: Barriers & facilitators toward sustainability. Journal of Community Health, (35) 348-354. doi: 10.1007/ s10900-010-9262-5

Pediatric Obesity Community Programs: Barriers & Facilitators Toward Sustainability