- Patient-provider communication and education tools are helpful in nudging parents to identify and understand their child’s health needs when issues would otherwise go unacknowledged, shows a study published in the Journal of the American Board of Family Medicine.
Communication tools such as pictorial and instructional flash cards can help parents of overweight or obese children identify these health concerns, researchers noted. This is something that is difficult to facilitate in the primary care visit.
Parents, pediatric patients, and their providers often face four challenges barring them from properly addressing weight concerns:
- Clinicians don’t spend enough time talking about body mass index (BMI)
- Parents have skewed perceptions about their child’s weight and BMI
- Parents are accepting of a poor BMI diagnosis
- Parents, patients, and clinicians have a difficult time in shared decision-making and goal-setting following BMI discussions
Pennsylvania-based researchers sought to overcome these barriers using Fitwits, a communication tool developed by healthcare professionals, parents, and children between 2007 and 2009.
“Seventeen flashcards populated with ‘Fitwits’ and ‘Nitwits’ food and snack-based characters frame key expert-recommended elements: BMI discussion, use of the term obesity, exercise, nutrition, portion sizes, and behavioral management suggestions,” the researchers described.
The flash cards, which providers use during wellness visits to facilitate conversations about weight and BMI, prompt discussions about daily activity, reduction of fast food and sugary beverage intake, and healthy BMI categories. Through these discussions, providers are supposed to help parents understand that their child is overweight or obese and then facilitate shared goal-setting.
The researchers introduced the tool to 53 clinicians and 140 patients, regardless of BMI, in a primary care office. Overall, 53 percent of participating child patients were obese or overweight.
The team measured Fitwits effectiveness by administering a baseline survey prior to the clinician conducting the appointment and one following the Fitwits discussion. Specifically, the survey sought to determine parent perceptions of patient BMI and weight issues.
The baseline survey showed that half of patients correctly perceived their child’s weight status. After patient-provider conversations, about 60 percent of parents correctly identified their child’s weight status.
These differences were more pronounced for children with an overweight or obese BMI category. At baseline, 34 percent of parents knew their child was overweight and 4 percent knew their child was obese. At follow-up, those numbers increased to 52 percent and 24 percent, respectively.
Ideally, more parents of overweight or obese children would have had accurate perceptions of child BMI after the intervention, the researchers said. However, cultural discussions around weight and BMI may still skew parent perceptions.
“Continuing underrecognition or acknowledgment of overweight/obese children and some healthy children was noted,” the team reported. “This highlights the difficulties of educating parents to identify BMI status in the new ‘normal’ environment of heavier children, even with a dedicated intervention.”
“Choosing an incorrect BMI category could represent one or more belief or cultural or social factors, including low acceptance by parents of their child's BMI status on a chart compared with the parent's strong notion of a child as underweight, healthy, or, at most, overweight,” the researchers continued.
Despite the room for improvement, the researchers called the Fitwits intervention a success, helping to improve patient-provider communication and patient education. Prior to the intervention, providers struggled with communicating issues surrounding child weight clearly but sensitively.
The Fitwits tool served as a catalyst for these conversations and helped providers frame weight discussions around sensitivity and patient responsibility.
“Providers agree on health-supporting, culturally attuned, and motivating discussions,” the researchers said. “Our physicians were trained and accustomed to using the flashcard term obesity, defined as ‘too much weight for height.’”
The communication tool was also effective because it engaged all key stakeholders, resulting in shared decision-making and goal-setting. This helped drive patient satisfaction during care encounters.
“In studies that included agreement on a corrective plan, families lauded weight-related discussions that partner the child, parent, and physician; set specific goals over successive visits; and provide simplified and correct nutrition information,” the researchers wrote.
Overall, these results highlight the importance of better patient-provider communication in improving shared decision-making and goal-setting. When clinicians meaningfully communicate with parents and pediatric patients, they can work together to identify and understand health concerns and work as a team to create an action plan.