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Article Title

Weight-Related Messages in Well-Child Visits: What Do Teens Desire?

Publication Date

8-15-2016

Keywords

well-child visit, qualitative data

Abstract

Background/Aims: With the United States’ prevalence of childhood obesity at approximately 17%, well-child visits are a critical time to discuss well-being, physical activity and other concerns. Discussion of healthy weight is a key component of these pediatric visits. Appropriate delivery of weight-related messages to adolescents and their families is critical. Accusatory messages may distance adolescents from health care, whereas nondirect approaches could suggest unhealthy weight is nonproblematic. Feedback on weight-related messages during the well-child visit may improve health care delivery in this setting.

Methods: Opinions on weight, weight-related messaging, blood pressure and lipid testing knowledge were collected through focus groups with adolescents 14–18 years old. Eligible adolescents had a body mass index > 85th percentile and/or a diagnosis of high blood pressure or high cholesterol. A framework matrix method was used for data analysis.

Results: Four focus groups, stratified by gender, were held (16 participants [9 male]; mean age 15.7 ± 1.05 years). Teens expressed that a relationship based on provider trust, built over time, with personal and parental responsibility, are important aspects of the well-child “team.” Adolescents voiced strong desire for parental inclusion in health-related discussions. Ideal parental involvement was described as supportive and encouraging to provider recommendations. Teens expressed a lack of knowledge and awareness, along with misconceptions, about health consequences due to unhealthy weight, blood pressure and cholesterol. Providers were described as a resource to discuss weight-related topics; teens expected and welcomed weight-related conversations. Adolescents appreciated casual conversations based on activities and interests, although a serious approach was considered helpful to encourage meaningful changes. Discussions about blood pressure, cholesterol and diabetes were categorized as “scary” and “overwhelming.”

Conclusion: Our data suggest a provider-adolescent relationship built on trust, team work, support and encouragement creates a positive atmosphere for weight-related messages for teens during a well-child visit. Adolescents described long-standing patient-provider histories, suggesting a pediatric medical home concept may be critical in positive discussions of weight. Next steps include analyzing similar parent and provider focus group data and incorporating focus group concepts into a patient-centered, brief, educational intervention for providers focusing on weight-related messages during the well-child visit.

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