Evidence Based Practice Article for Community



Evidence Based Practice Article for Community

Stacey L. Klein

Ferris State University

Abstract

For this assignment a review of a scholarly article is completed for ADPIE project. After reviewing the article Engaging Parents in Child Obesity Prevention: Support preferences of the parents (Wolfenden et al., 2010) it is determined the outcomes measured would be beneficial to ADPIE as well as the specific Community ADPIE project. By including parents in the process and supporting their role in a child’s dietary choice and health status with education and encouragement significant gains could be made in the fight against childhood obesity.

Evidence Based Practice Article for Community

Evidence Based Practice Article for Community Evaluation

In this country statistically 17% of elementary kids are obese ("Over Weight", 2010, para. 1). According to Jane Borr, Holland Hospital’s manager of school nursing at Holland Public Schools (HPS) the rate at HPS soars to 18-20% (J. Borr, personal communication, November 17, 2010). It is a national epidemic leading to type 2 diabetes, hyper-lipidemia, high blood pressure, kidney problems and a myriad of other health problems once reserved to adults ("Over Weight", 2010, para. 2). In Australia a random phone survey was conducted in the Hunter New England region of New South Wales. This area is culturally and socio-economically diverse much like Holland, Michigan. This study titled “Engaging Parents in Child Obesity Prevention: Support preferences of the parents” (Wolfenden et al., 2010) examines a key resource in the fight to prevent this ugly disease. “Parents and home family environments are among the strongest influences on children’s diet, physically activity and weight status and are an important intervention targets in efforts to curb the growing burden of disease associated with childhood obesity.” (Wolfenden et al., 2010, p. 1)

We know once a child reaches middle school his peers become as important if not more so than parents when it comes to making decisions.

Peer pressure is only one way that peers influence each other. Peers model behavior for each other, structure opportunities in which adolescents can engage in these behaviors, and set norms that, during this stage in life, young people are particularly inclined to follow. All four types of influence (peer pressure, modeling, structuring opportunities, and setting and enforcing group norms) occur simultaneously in the daily lives of teens, delivering both complementary and conflicting messages (Smith, 2004, p. 1).

Parents need to take the opportunity while kids are still listening to instill good habits when it comes to nutrition and exercise. But what happens when parents don’t know the best nutritional decisions to make, or work full time, or have trouble making ends meet financially? According to Maslow (Simmons, Irwin, & Drinnen, 1987), the first level of needs are physiological needs. “These are biological needs. They consist of needs for oxygen, food, water, and a relatively constant body temperature. They are the strongest needs because if a person were deprived of all needs, the physiological ones would come first in the person's search for satisfaction.” Basically families struggling to make ends meet financially won’t have the self actualization to seek better ways of feeding their families for health because they are struggling with the very basics needs. Maslow believed one must meet all the needs at the first level on the hierarchy before one can even think about meeting the second level needs and so on. (Simmons, Irwin, & Drinnen, 1987, p. 1) While these families are probably secure in the first level of Maslow’s hierarchy, they are more concerned with putting food on the table rather than making healthy choices. Kari Mathews-Ricks, an educator in a rural area of North Carolina where the socioeconomic status is much like HPS, states “a lot of these kids eat free and reduced breakfast and lunch and may not have another full meal until the next day at school. Imagine going home on a Friday knowing there might not be much to eat until Monday morning.”(K. A. Mathews-Ricks, personal communication, November 30, 2010)

Intervention

Helping parents engage in practices that are likely to prevent childhood obesity is a considerable challenge for health care professionals, policy makers and researchers, the aim of this study is to determine who was likely to use services designed to help parents prevent overweight and obesity and what types of services they prefer (Wolfenden et al., 2010, p. 1).

At the elementary level parents are huge influences in kid’s lives (Wolfenden et al., 2010). If health care providers and schools can provide support and teaching so parents are able to make good choices for diet and exercise, and model these choices no matter their socioeconomic status, then obesity in kids should begin to decrease. In the study it was determined most parents preferred personalized mailed print materials, (85%) tailored specifically to each family with education on healthy choices in nutrition, as well as physical activity. Specialist appointments (61%) would also be very well received, which is interesting in the fact most families also said time and travel would be difficult. Another popular choice was interactive email (58%) (Wolfenden et al., 2010, p. 1).

Researchers measured success based on how closely the perceived service use related to studies done on adult program use. The study, while limited “by the reliance on parent reports of perceived service use” (Wolfenden et al., 2010, p. 3), seems to be a good indicator of what types of services would be successful. The researchers found preferences stated in the adult program correspond closely with actual use of resources.

Even if the actual usage of resources is lower, a reoccurring theme in the fight to reduce childhood obesity seems to be parental involvement. Schools can’t do it alone; they need support from parents and caregivers at home. By supporting the preferences of the parent, the key influencers of kids, families are more likely to take to heart what health care providers and schools are trying to teach. By validating parents concerns and opinions health care providers and schools are able to encourage parents to join the health care team.

Usability for ADPIE

This outcome measure is definitely usable for ADPIE. Funding is severely limited in schools it would make sense to spend a little to find out what parents are looking for in the way of resources and then use the funds to support these resources. In this study “these services were also more likely to be used by parents who are less active, or are not consuming adequate servings of fruits and vegetables.” (Wolfenden et al., 2010, p. 3) This would indicate a way to reach the highest risk children. It seems silly to spend money on education classes for parents if they can’t come because of work. If parents feel emails and individualized mailings would be the biggest benefit it would follow to spend the limited resources in those things.

Obviously this would just be a jumping off point in the quest to reduce childhood obesity. Phone surveys would serve to gather information to make sure schools are utilizing their limited funding appropriately, to get the biggest bang for their buck.

Resources

A huge benefit of this outcome measure is the fact it would be relatively easy to implement. Phone surveys could be done by volunteers in the school district, and by asking each parent if they are willing to complete the survey no special permissions would be needed. After the survey is complete data could be tabulated and then further research would be needed to study promising services.

Once surveys are complete additional funding would be necessary to implement parents’ choices. Specialist appointments would need to be a first step. Evaluation of current practices and needs would need to be completed in order to make personalized mailings a reality. In practice the interactive email would probably be the most cost effective way to include the greatest number of families. (Wolfenden et al., 2010)

Usability by Community ADPIE Group

For the same reasons these outcome interventions could be used in ADPIE in general the study would be a great jumping off point for this project. Holland Hospital’s manager of school nursing at HPS Jane Borr states,

Our biggest barriers seem to be getting parent/s to accept the fact that their child is headed down a very bad road with nutrition and health. Most of the time the parent has the same issues. They have so many other "issues" that seem to outweigh the health issue. Especially if they "feel OK" today. They can't seem to comprehend that in 10 years they will probably have major health issues. They are worrying about jobs, food, paying cable and cell phone bills. The kids live in apartments or areas where it's not safe to walk to the park to play or even play outside in the neighborhood. The parent doesn't have time or deem it important to take them outside to play. They just buy them videos and a bag of chips to have after school. Most kids I talk to don't remember what they had for supper last night because they do not sit down to a meal. It's take- out in the car or grab and go sit in front of the TV. If I had a lot of money to do a program, I would add an hour on to the end of the school day. We would have physical fitness, classes in nutrition, self esteem, and taking care of your body (J. Borr, personal communication, November 17, 2010).

By enlisting these parents to help with this problem and validating their preferred method of learning HPS could have a valuable asset to start making change in the health status of their students.

Parents not only help mold and shape specific behaviors in children but also influence their attitudes and beliefs about food and eating practices. Understanding the impact of these more global parental influences and trying to intervene at this level may provide additional strategies to help curb childhood obesity. (Rhee, 2008, p. 228)

Education alone will not be enough to make lasting change in pediatric obesity especially when cultural norms dictate behavior such as food preparation and body image. However, the reoccurring theme throughout available literature is parents must be involved. One way to do this is to listen to their concerns and opinions in the education arena. Then utilize available funds to help parents understand the very real problem of childhood obesity and ways to combat it, while still honoring their culture.

Conclusion

Childhood obesity is an epidemic in the United States and there is no easy fix for this problem. There are many reasons contributing to childhood obesity and thankfully most of them can be changed. Kids can’t change their genetic makeup or their socioeconomic status but they can change diet, exercise and their environment, and parents are a huge factor in this. Health care providers and schools have limited funds make change, so officials need to use what funds are available wisely. By taking the time to find out what services parents feel would be most beneficial for information and support health care providers and schools can enlist their help to combat this ever increasing problem.

References

American Heart Association, (2010). Over Weight in Children. Retrieved from healthy/overweight-in-children_ucm_304054_Article.jsp

Rhee, K. (2008, January). Childhood Overweight and the Relationship between Parent Behaviors, Parenting style, and Family Functioning. ANNALS, AAPSS, 615, 226-230. doi: 10.1177/002716207311669

Simmons, J. A., Irwin, D. B., & Drinnen, B. A. (1987). Psychology-The Search for Understanding. Retrieved from

Smith, A. M. (2004). The Power of Peers. Retrieved from

Wolfenden, L., Bell, C., Wiggers, J., Butler, M., James, E., & Chipperfield, K. (2010). Engaging parents in child obesity prevention: Support preferences of parents. Journal of Paediatrics and Child Health. doi: 10.1111/j.1440-1754.2010.01776.x

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