| Childhood obesity continues to be a major public health issue, and pediatric primary care providers could help address this epidemic. However, multiple factors may impact a provider's ability to address obesity, including practice level procedures and resources, individual attitudes and beliefs, and physician-patient communication skills. The purpose of this research project was to explore barriers and facilitators to childhood obesity counseling by primary care providers. In the first aim, a practice level environmental assessment tool was compared to chart reviews at eight practices and observations at four practices to assess the tool's ability to characterize and rank practice level support for body mass index (BMI) documentation, BMI communication, and practice level resources for healthy eating and physical activity. The assessment tool had good within-practice reliability (kappa=0.63) and good agreement with chart and observation data (percent agreement = 87-100; 50-100), respectively. The second aim used baseline survey data of providers' (N=123) attitudes, beliefs, and counseling frequency to determine the association between self-efficacy, outcome expectations, practice level support, and counseling frequency. Providers were confident/very confident (88.6%) in their ability to counsel about healthy eating, physical activity, and weight and agreed/strongly agreed (73.3%) that their counseling would result in actual changes. Providers with higher self-efficacy and outcome expectations were more likely (odds ratio=2.4; 2.2) to report providing obesity counseling. Practice level support was not associated with reported counseling frequency. For aim 3, focus groups were held with male caregivers to explore concerns and preferences when communicating with primary care providers about childhood obesity. The qualitative findings revealed that these fathers were involved in their children's healthcare and found doctors to be a helpful partner to keep their children healthy, yet they generally felt "left out" during appointments. The quality of the relationship with their children's doctor influenced how receptive fathers were to discussing their children's weight, diet, and physical activity behaviors. Fathers made suggestions to help improve communication between doctors and fathers, such as conveying a sense of respect, giving concrete examples on "how" to eat more healthfully and increase physical activity. |
