Andrew Sussman, PhD, MCRP Alberta Kong, MD, MPH Jose Canaca, MD Rachel Mittleman, MEd
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Using a Community-Based Participatory Process in Creating a School-Based Health Center Obesity Intervention for Multi-ethnic Teens Andrew Sussman, PhD, MCRP Alberta Kong, MD, MPH Jose Canaca, MD Rachel Mittleman, MEd Sally Davis, PhD Nina Wallerstein, DrPH 1st Annual UNM National Health Disparities Conference May 24, 2011
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Using a Community-Based Participatory Process in Creating a School-Based Health Center Obesity Intervention for Multi-ethnic Teens. Andrew Sussman, PhD, MCRP Alberta Kong, MD, MPH Jose Canaca, MD Rachel Mittleman, MEd Sally Davis, PhD Nina Wallerstein, DrPH. - PowerPoint PPT Presentation
Transcript of Andrew Sussman, PhD, MCRP Alberta Kong, MD, MPH Jose Canaca, MD Rachel Mittleman, MEd
Using a Community-Based Participatory Process in Creating a
School-Based Health Center Obesity Intervention for Multi-ethnic Teens
Andrew Sussman, PhD, MCRPAlberta Kong, MD, MPH
Jose Canaca, MDRachel Mittleman, MEd
Sally Davis, PhDNina Wallerstein, DrPH
1st Annual UNM National Health Disparities Conference May 24, 2011
Background
Overweight (BMI 85th-95th percentile) and obesity (BMI ≥95th percentile) disproportionately affect certain racial and ethnic populations.
Nationally, Hispanic boys and non-Hispanic Black girls experience significantly higher BMI rates than their non-Hispanic White counterparts.
In New Mexico, American Indian youth have the highest rate of obesity (17.8%), double that of White youth (8.7%); Black (13.5%) and Hispanic (12.8%) youth also have high rates, about one -third higher than White youth.
Background Promising strategies for intervention with
teens include: Targeting locations (e.g., school) where
adolescents spend the majority of their time Motivational interviewing Use of media
Intervention is based on the Transtheoretical Model or Stages of Change Progress through a series of stages
Adolescents Committed to Improvement of Nutrition and Physical Activity
(ACTION)
Phase 1: Use an adaptive community-based participatory research approach to develop a school-based health center intervention for overweight teens Create DVD and clinician tool kit
Phase 2: Feasibility testing of the school-based health center intervention against standard care for weight loss
R21 HL092533 NIH/NHLBI
Methods (Phase 1: Formative Research)
Create strategies for DVD and provider toolkit.
Semi-structured interviews with OW/OB teens (N=7) and with parents (N=8) of OW/OB teens from two participating high schools
ACTION Advisory Council meetings: 7 OW/OB teens and 5 parents of OW/OB teens
Feedback from 2 school-based health center providers and program manager
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Parent and Student Interviews
Purpose—formative data collection to help guide intervention development Served as basis for ACTION Advisory Council Creation of DVD and provider toolkit
Method—semi-structured qualitative interviews with purposefully selected adolescent and parents
Parent and Student Interviews: Demographics
Students Parents
Participating SchoolsIntervention 2 3
Control 5 5Sex
Female 4 6Age (mean) 16 45.1Ethnicity
Hispanic 3 3Native American 1 1African American 2 2
Non Hispanic White 1 1Other 0 1
Employment StatusFull time 0 4Part time 3 2
Not Employed 4 2
Parent and Student Interviews
Interview Domains: Teen/Parent views on:
Typical daily routines (focus on nutrition and physical activity)
Use of media (cell phones, music, computers, TV/movies, etc.)
Perspectives on health and obesity (barriers and facilitators to being healthy; change motivators)
Intervention Development (DVD content, group vs. individual, etc.)
Parent and Student Results
Parent themes: Difficult to motivate kids Kids not worried about obesity and
consequences Emphasize importance of parents as
role models Schools as “unhealthy” environments—
food, lack of PE and health classes
Parent and Student Results
Adolescent themes:
Less concerned about long term problems Adolescents busy—school, activities and
work Define health more as “functional” (what
can I do) than illness status Receptive to working with SBHC provider;
need social network support
1) Translation of Themes to DVD
Challenge of motivation Teens: tap into
internal motivation
“Functional” health
status
2) Translation of Themes to DVD
Inadequate exposure to health/nutritional information (no PE or health classes)
Navigating unhealthy environments
3) Translation of Themes to DVD
Adolescents busy (school, activities and work)
Feasible, accessible options needed
DVD—Style and Content
Hire a Pro: Chris Schueler (Christopher Productions)
Make it “HOT, HIP and COOL”
“Kids like us”, “problems like ours” (sources of internal motivation)
DVD not meant as full solution but catalyst
Provider Toolkit Content Weight loss guidelines Motivational interviewing Parent publication:
supporting teens, stocking the refrigerator, cheaper food choices, recipes
Displays for clinic
Session tools: weight history assessment diet/physical activity assessment goal setting MyPyramid.gov activity/food journal label reading portion tips breakfast fast food eating at school drinks snacks local physical activity resources
Conclusions
Conducting formative assessment research using an adaptive participatory process was an effective way to develop culturally appropriate and tailored intervention materials in multiethnic school settings.
Our experience demonstrates the importance of partnership formation in the creation of contextually sensitive interventions.
Questions?
