Date Available

11-13-2023

Year of Publication

2023

Degree Name

Master of Science in Nutrition and Food Systems (MSNFS)

Document Type

Master's Thesis

College

Agriculture

Department/School/Program

Dietetics and Human Nutrition

First Advisor

Dr. Alison Gustafson

Abstract

Rural children experience increased rates of obesity and reduced access to specialized weight management facilities, which makes receiving the recommended frequency of care difficult. Clinical-community partnerships, recommended by the American Academy of Pediatrics (AAP) to expand access, have been shown to be a feasible strategy of care delivery. Examination of literature and stakeholder interviews were used to inform the development of a collaborative pediatric weight management program in a rural, Appalachian community. Screening articles as well as intervention articles were reviewed. Outcomes of screening articles reviewed included BMI measures (3), screening practices (7), and referral practices (4). Common outcomes of intervention articles included BMI (24), parent BMI (7), diet (17), physical activity (16), quality of life (9), and sleep/sleep quality (7). Key results from these outcomes varied in each article. Clinical referral was seen in 23 studies and family-centeredness was seen in 25 of the 32 intervention articles reviewed. The majority of intervention studies that reported improved outcomes included both clinical referral and family-centered interventions. Interview guides were developed using the Consolidated Framework for Implementation Research (CFIR). Structured stakeholder interviews were conducted among implementation partners (n=4), community partners (n=1), and individuals (parents/caregivers) (n=1). Interviews were transcribed and a thematic analysis was conducted. Themes that emerged during thematic analysis included Barriers, Facilitators, Need for Intervention, Incentives, Receptivity, Setting Characteristics, and Implementation Considerations. Barrier sub-themes included transportation, childcare, adherence, time, and financial barriers. Facilitators sub-theme included complementary programs and processes. Incentives were grouped into monetary and non-monetary incentives sub-themes. Receptivity included community and organizational receptivity sub-themes. Setting characteristics included community and organizational setting characteristics sub-themes. Community site considerations (spaciousness, access, and familiarity); overlapping financial and adherence barriers; provision of program-specific incentives; and positive program framing to improve receptivity and participation were notable characteristics examined among themes and should be considered in future program development. Preliminary research, establishing factors that may influence implementation within the specified community, is of great importance to ensure efficacy; thus, the findings of this study will present critical information for program development and delivery.

Digital Object Identifier (DOI)

https://doi.org/10.13023/etd.2023.421

Funding Information

Centers for Disease Control and Prevention High Obesity Program

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