Strategies to Recruit a Diverse Low-Income Population to Child Weight Management Programs From Primary Care Practices
IMPLEMENTATION EVALUATION — Volume 14 — December 21, 2017
PEER REVIEWED
Figure 1. Resources: Patient resources include accessible programs and reduced language and cultural barriers. Office resources include material for brief counseling, EHR alerts, EHR guidance for obesity evaluation, and a simple referral process. The health care systems to which the practices belong modify EHRs to include discussions and counseling on body weight and extraction of de-identified EHR data for the researchers. Activities: Patients communicate with bilingual research staff. Training for providers and their staffs address each practice’s priorities. The research staff provides health care practices with ongoing support and information on patient participation and outcome. The health care systems extract de-identified data. Outputs: The resources and activities described above generate data on the volume and characteristics of the clinical population, the referred patients, and the enrolled patients. Other outputs are how referrals vary by office and the providers’ qualitative assessment of program material, training, and support. Data indicate recruitment strengths and weaknesses. Short-term outcomes: In addition to the improved health of enrolled patients, findings lead to design and implementation of improved recruitment strategies for future programs as well as increased provider satisfaction: Long-term outcomes. Dissemination of improved recruitment strategies positions primary care practices as effective referral sites for many children. As the proportion of children with obesity using weight management programs increases, obesity prevalence in children and ultimately in adults decreases.
Figure 1. Framework to optimize recruitment of patients for the Texas Childhood Obesity Research Demonstration (TX CORD) study, Texas, 2012–2014.
Figure 2. Prevalence of overweight and obesity among patients with a body mass index at or above the 85th percentile (N = 7,845) seen in Texas Childhood Obesity Research Demonstration (TX CORD) study practices, by racial/ethnic groups. Data are from NHANES 2011–2012 (2) and from participating TX CORD practices, 2012–2014. Abbreviations: NHANES, National Health and Nutrition Examination Survey.
| Age Category | Percentile by Data Source | Hispanic, % | Non-Hispanic Black, % | Non-Hispanic White, % |
|---|---|---|---|---|
| Early childhood (aged 2–5 y) | NHANES ≥85th | 29.8 | 21.9 | 20.9 |
| TX CORD ≥85th | 27.2 | 19.4 | 20.7 | |
| NHANES ≥95th | 16.7 | 11.3 | 3.5 | |
| TX CORD ≥ 95th | 13.2 | 8.3 | 9.7 | |
| Middle childhood (aged 6–12 y) | NHANES ≥ 85th | 46.2 | 38.1 | 29.4 |
| TX CORD ≥ 85th | 44.8 | 37.5 | 35.9 | |
| NHANES ≥ 95th | 26.1 | 23.8 | 13.1 | |
| TX CORD ≥ 95th | 27.5 | 20.9 | 18.9 |
Figure 3. Outcome of patients with a body mass index at or above the 85th percentile (N = 2,030) referred to the Texas Childhood Obesity Research Demonstration (TX CORD) study. Among patients referred to the study, eligibility and interest varied by age group.
| Outcome | Age Group, % | ||
|---|---|---|---|
| 2–5 y, n = 822 | 6–8 y, n = 567 | 9–12 y, n = 641 | |
| Not interested/not responsive | 52.2 | 42.7 | 34.0 |
| Enrolled | 19.5 | 31.9 | 32.4 |
| Did not meet research criteria | 19.0 | 17.6 | 23.6 |
| No transportation | 5.2 | 4.4 | 3.9 |
| Did not meet medical criteria | 4.0 | 3.2 | 4.2 |
| Unknown | 0.1 | 0.2 | 1.9 |
Figure 4. Percentage of patients in 12 primary care practices with a body mass index at or above the 85th percentile referred (N = 2,030) and enrolled (N = 549) in the Texas Childhood Obesity Demonstration (TX CORD) study, by primary care practice. Asterisks indicate that electronic health records for that office were modified to include a referral process for overweight or obesity. Numbers in parentheses are the total number of eligible patients in each practice.
| Practice | No. Eligible Patients | % Eligible Patients Referred | Eligible Patients Enrolled |
|---|---|---|---|
| 1 | 202 | 66.8 | 25.7 |
| 2* | 684 | 52.0 | 10.8 |
| 3 | 513 | 49.5 | 17.7 |
| 4 | 96 | 44.8 | 16.7 |
| 5* | 716 | 40.9 | 10.8 |
| 6* | 712 | 38.2 | 8.7 |
| 7* | 540 | 35.9 | 6.3 |
| 8 | 91 | 30.8 | 15.4 |
| 9 | 677 | 25.3 | 9.0 |
| 10 | 263 | 21.3 | 10.3 |
| 11 | 436 | 18.8 | 3.4 |
| 12* | 1,364 | 8.5 | 1.9 |
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