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Title: Strategies to recruit a diverse low-income population to child weight management programs from primary care practices

Author
item BARLOW, SARAH - Texas Children'S Hospital
item BUTTE, NANCY - Children'S Nutrition Research Center (CNRC)
item HOELSCHER, DEANNA - University Of Texas Health Science Center
item SALAHUDDIN, MELIHA - University Of Texas Health Science Center
item PONT, STEPHEN - University Of Texas At Austin

Submitted to: Preventing Chronic Disease
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 10/20/2017
Publication Date: 12/1/2017
Citation: Barlow, S.E., Butte, N.F., Hoelscher, D.M., Salahuddin, M., Pont, S.J. 2017. Strategies to recruit a diverse low-income population to child weight management programs from primary care practices. Preventing Chronic Disease. 14:E138. https://doi.org/10.5888/pcd14.170301.
DOI: https://doi.org/10.5888/pcd14.170301

Interpretive Summary: Recruitment of low-income, ethnically diverse children into weight management programs has been challenging for health care providers. Recruitment strategies were developed to recruit eligible patients from 12 primary care practices participating in the Texas Childhood Obesity Research Demonstration (TX CORD). To support health care practices, electronic health records (EHRs) and print materials were provided to facilitate obesity recognition, screening, and study referral. Brief training for providers and their office staffs covered screening patients for obesity, empathetic communication, obesity billing coding, and use of counseling materials. Overall, 27% of the children referred by their primary care providers were enrolled into the weight management program. Children who were older, Hispanic and more severely obese were more likely to enroll. Referral rates varied widely among the 12 primary care practices. Engagement and recruitment strategies for enrolling children with obesity into weight management programs should be strengthened. Factors associated with referral and enrollment, better systems for EHR tools, and data on provider and office adherence to study protocols should be examined.

Technical Abstract: Primary care practices can be used to engage children and families in weight management programs. The Texas Childhood Obesity Research Demonstration (TX CORD) study targeted patients at 12 primary care practices in diverse and low-income areas of Houston, Texas, and Austin, Texas for recruitment to a trial of weight management programs. This article describes recruitment strategies developed to benefit both families and health care practices and the modification of electronic health records (EHRs) to reflect recruitment outcomes. Our approach was to facilitate family participation, materials and programs were provided in English and Spanish, and programs were conducted in convenient locations. To support health care practices, EHRs and print materials were provided to facilitate obesity recognition, screening, and study referral. We provided brief training for providers and their office staffs that covered screening patients for obesity, empathetic communication, obesity billing coding, and use of counseling materials. We collected EHR data from 2012 through 2014, including demographics, weight, and height, for all patients aged 2 to 12 years who were seen in the 12 provider practices during the study's recruitment phase. The data of patients with a body mass index (BMI) at or above the 85th percentile were compared with the same data for patients who were referred to the study and patients who enrolled in the study. We also examined reasons that patients referred to the study declined to participate. Overall, 26% of 7,845 patients with a BMI at or above the 85th percentile were referred to the study, and 27% of referred patients enrolled. Enrollment among patients with a BMI at or above the 85th percentile was associated with being Hispanic and with more severe obesity than with patients of other races/ethnicities or less severe obesity, respectively. Among families of children aged 2 to 5 years who were referred, 20% enrolled, compared with 30% of families of older children (>5 y to 12 y). Referral rates varied widely among the 12 primary care practices, and referral rates were not associated with EHR modifications. Engagement and recruitment strategies for enrolling families in primary care practice in weight management programs should be strengthened. Further study of factors associated with referral and enrollment, better systems for EHR tools, and data on provider and office adherence to study protocols should be examined. EHRs can track referral and enrollment to capture outcomes of recruitment efforts.