Well-child visits (WCVs) in primary care clinics provide a sustainable model for intervention delivery, especially since parents and caregivers value and trust feedback from pediatricians. Primary care providers are on the front lines of obesity prevention, yet clinical preventive care has had limited success in preventing childhood obesity. Nearly all children attend WCVs, yet obesity rates among preschool-age children (ages 2–5 years) have escalated and remain high. WCVs can be enhanced with patient-reported outcomes measures to engage parents as well as referrals to community services, but research has not investigated the comparative effectiveness of these approaches to standard-of-care WCVs. Multilevel approaches have been supported for school-age children, but evidence is insufficient to provide direction for preschool-age children. The goal of this research is to respond to this gap by comparing two enhancements to WCVs designed to promote family-centered counseling for the prevention of obesity in a high-risk population of rural, low-income preschool-age children in the Geisinger Health System.
The study responds to PCORI’s focus on high-cost and high-need patients, as rural children experience higher rates of obesity and are nearly twice as likely to experience severe obesity compared with their nonrural peers. A cluster-randomized controlled trial is proposed to compare effectiveness of the two enhanced interventions versus the standard WCV on obesity prevention among preschool-age children. Comparators include the standard-of-care WCV, the patient-reported outcomes (PRO) WCV, and the PRO WCV + Food Care, which represent clinic, patient–clinic, and patient–clinic–community models, respectively. The WCV is consistent with clinical guidelines and the standard annual clinical visit for children in the United States. The PRO WCV, patient–clinic model enhances the ability of clinical providers to quickly assess children’s risk of obesity and provide family-centered, behaviorally anchored counseling, and it has shown effectiveness in preventing obesity among preschool-age children. PRO WCV + Food Care uses the patient–clinic–community model to evaluate the additive effect of referring families to community-based programs that successfully improve food security and obesity prevention.
We hypothesize that the PRO WCV and PRO WCV + Food Care comparators will offer advantages over the standard WCV comparator because the former targets those parenting practice, nutrition (i.e., sugar-sweetened beverage intake), physical activity, screen time, and sleep behaviors that lead to differences in child body mass index. Our overarching goal is to inform standard of clinical care for obesity prevention among preschool-age children in rural, low-income families who are at high risk for obesity, by comparing care delivery models to determine the value of connecting families, clinicians, and community-based services; these models show excellent potential for dissemination.
Other Health Services Interventions
Training and Education Interventions