Benchmark – Capstone Project Change Proposal

Table of Contents

1. Background………………………………………………………………………….…….3

2. Problem statement…………………………………………………………………………3

3. Purpose of the change proposal……………………………………………………………6

4. PICOT……………………………………………………………………………………..6

5. Literature search strategy employed…………………………………………………..…10

6. Evaluation of the literature……………………………………………………………….10

7. Applicable change or nursing theory utilized……………………………………………14

8. Proposed implementation plan with outcome measures…………………………………15

9. Identification of potential barriers to plan implementation: Overcoming barriers………16

10. References………………………………………………………………………………..18

1. Background

The increasing rate of obesity among children and adolescents in the last three decades is posing a major health concern that should be urgently addressed. Despite the latest national reports in the country that suggest a positive decline in the childhood obesity prevalence patterns, the country still grapples with about 12 million children suffering from obesity. Considering the immediate and long-term health impacts of obesity, a lot of resources and efforts have been spent by government agencies and advocacy groups to address this epidemic. However, these efforts have only yielded limited or short-term gains. As a result, the adverse impacts of childhood obesity continue to capture the interests and attention of public, and policy makers. Childhood obesity not only pose serious health problems, but it also increases the economic costs for treating children. Therefore, there is need to develop effective strategies to regulate the worrying increase in the population of overweight and obese children.

2. Problem Statement

Childhood obesity is a big health problem that needs a lot of attention to be solved. The rate of obesity among children is increasing and is likely to increase further in the future because of the changes in children’s lifestyles. Due to the development of technology, the nature of children’s recreational activities has changed. In the past, most children’s recreational activities were outdoor games. However, technology has caused the development of activities such as video games and films which make children spend most of their time indoors doing minimal physical activities. An increase in the obesity prevalence rate brings about an increase in the numerous health issues related to weight. Therefore, the children may continue to have deteriorated health. Therefore, this problem needs a lot of attention not only by the parents but also the government, healthcare professionals and the communities. Studying this topic is significant because it helps to point out the extent of the problem and determine some steps that can be taken to reduce obesity among children.

Childhood Obesity

Childhood obesity is a relatively common condition among the United States’ population. This condition is characterized by excessive amounts of weight, which affects the health and well-being of children (Kelsey et al., 2014). As methods to determine the exact amount of body fat percentage are limited, there body mass index (BMI) is used as the measure to determine whether children are overweight or obese. The BMI represents the ratio of weight to height. According to the Center for Disease Control and Prevention (CDC), a person is considered to be obese if their BMI is greater than or equal to the 95th percentile (Centers for Disease Control and Prevention, 2013). While obesity is a problem that affects all population demographics, childhood obesity has some additional effects because of the vulnerability of the affected population.

Childhood Obesity in America

Obesity is one of the popular health issues that affects children in the U.S. it is estimated that one in every three children in America is above the recommended weight. The prevalence of obesity among children in America has tripled during the last three decades (Cunningham, Kramer & Narayan, 2014). The American Heart Association rates childhood obesity as the number one health concerns that parents should be worried about. This problem is rated worse than smoking and alcohol consumption.

According to CDC’s obesity statistics results, the rate of obesity among children increases with age. Between 2011 and 2014, the rate of childhood obesity among children between 2 and 5 years old decreased significantly. The prevalence of obesity among this age group is currently 8.9%. Childhood obesity among children from 6 to 11 years old affects 17.5% of children in America. The older children are at the highest risk with a 20.5% prevalence rate among the children between 11 and 19 years (Centers for Disease Control and Prevention, 2013).

Studies have shown that childhood obesity is more prevalent among the minority communities. For instance, the prevalence of obesity is higher among the Hispanic and African-American communities compared to the Caucasian communities (Van Grouw & Volpe, 2013). The prevalence of childhood obesity is also likely to be higher among the lower socio-economic groups.

Impact of Childhood Obesity

Obesity has health, social, emotional, and psychological impacts on the affected children. Obesity has caused the development of some health concerns in children that were previously just found among the adults. For instance, health issues such as Type 2 Diabetes, high blood pressure, cardiovascular diseases, and elevated blood cholesterol are currently very common among the children’s population (Ogden et al., 2014). These are health issues that were common among the adult population and almost non-existent among the children.

Obesity also has some negative psychological impacts among the children such a negative body image, low-self-esteem, anxiety issues, and depression (Reilly & Kelly, 2011). The commonly desirable body standard in the society is that of a slim person. Therefore, children with excess body weight tend to go through psychological issues trying to meet the society’s standards of the acceptable body image.

These children may also go through social and emotional distress because of the higher chance of them being bullied by their peers in school. Studies have shown that children who are obese tend to undergo discrimination even in their home environment. The bullying, discrimination, and stereotyping may lead them to be emotionally distressed, which can lead to psychological problems that affect them even much later in their lives.

3. Purpose of the Change Proposal

The primary objective of this change proposal is to develop more effective interventions of reducing and managing childhood obesity in the United States. This objective is important especially at a time when obesity is becoming a very prevalent disorder in the country. Another purpose of this proposal is to educate and inform the target American audience on ways of addressing childhood obesity. Finally, the proposal seeks to influence the policy-making process by providing insights into nationwide strategies of childhood obesity control

4. PICOT Statement

P-I–C-O-T Statement

P- Patients who suffer from obesity (BMI of more than 30)

I- Undertaking nutritional education, diet, and exercise

C- Comparison to not taking nutritional education, diet, and exercise

O- Improved health outcomes in terms of overall weight loss

T – A year’s time limit

PICOT Statement: Patients, who suffer from obesity (BMI of more than 30) undertaking nutritional education, diet and exercise in comparison to not taking nutritional education, diet, and exercise, can have improved health outcomes in terms of overall weight loss in a year’s time limit.

PICOT Overview

Childhood obesity poses serious health problems in the US as the number of overweight and obese population increases at a rapid pace every year. The effects of this problem have arrested the attention of policymakers, societal members, and government agencies. This has resulted in ranking childhood obesity as a national health concern. The adverse impacts of this disease go beyond the health realms to include economic burden on both personal and national budgets. While there are numerous risk factors and various evidence-based interventions to address this challenge, no single approach is consistently efficacious in curbing the disease. Consequently, it is imperative that efficacious initiatives and policies be developed to address the never-ending problem of childhood obesity. Multidisciplinary approaches are often broad and cut across all dimensions of personal health problems. Instead of placing emphasis solely on biomedical models, health care professionals should also seek to promote behavior change among obesity patients and their family members. A PICOT statement can be utilized as an effective tool to seek interventions of addressing childhood obesity.

PICOT Statement

Population

In the US, obesity prevalence is highest among children aged from 6 to 11 years (Cheung et al. 2016). The disease has tripled among this age group from 4.2 percent to 15.3 percent from 1963 to 2012. In the last three decades, increased cases of obesity prevalence have been noted among children of all ages, although the differences in obesity prevalence have been recorded in terms of age, race, ethnicity, and gender (Cheung et al. 2016). In this respect, children from socioeconomically disadvantaged families and some racial and ethnic minorities experience the higher median score on obesity than the dominant white population. Higher obesity rates are often recorded among blacks and Hispanics compared to whites. For instance, a survey on girls in the Southwest revealed that the yearly cases of obesity stood at 4.5 percent among Blacks, 2 percent among Hispanics, and 0.7 percent among white girls aged from 13 to 17 years (Cheung et al. 2016). For low-income earners, American Indians rank highest at 6.3 percent, followed closely by Hispanics at 5.5 percent.

Intervention

Evidence-based interventions that seek to reduce childhood obesity incidences in the country should target two major areas: prevention and treatment. High-quality RCT has been proven as one of the most effective preventative intervention, especially in schools (Reilly, 2006). Such interventions involve making changes on the school curriculum by introducing and improving physical education, changing school meal provisions, and reducing the television viewing hours. Schools should also engage in promotional campaigns that encourage walking form home to school (Ickes, McMullen, Haider & Sharma, 2014). This intervention has been successful in most cases involving girls in the sense that the risks of becoming obese are significantly lowered. Treatment interventions should be limited to motivated families and communities, in which the child and parents perceive obesity as a problem. From a theoretical perspective, treatments should be continued for longer periods such as months to years. Diets should be modified, especially with the use of regimen such as traffic light diet. Television viewing habits should also be reduced (Ickes et al. 2014). Furthermore, treatment should be aimed at encouraging families to self-monitor their lifestyle. Finally, more time should be offered for consulting with family members.

Comparison

Being a member of a multidisciplinary team, the nurse practitioner performs the task of offering standardized care and advocacy support for healthy community environments. In addition, the nurse helps to ensures that there is proper coverage, access to, and incentives for regular obesity prevention, screening, diagnosis and treatment (Vine et al. 2013). There is also need to promote active living and healthy eating at work. Finally, focus should be on promoting healthy living during weight gain. There is also need to expand the role of health care providers, in childhood obesity prevention.

Outcome

When a nurse is involved as one of the primary members in the multidisciplinary team approach, the child should be guaranteed of better continuity of care. The outcomes of interventions should include reduced obesity risks and curriculum adjustments for sustainable change to make it cost-effective (Ross et al. 2010). The curriculum modifications should be generalizable. One of the leading causes of failure of previous interventions is that they targeted modifications at the micro levels. This means that targeting individual children, families, or schools make it harder to have positive outcomes or impacts on the many other influences on weight status that affect the environment at the macro levels. Obesity control efforts that are successful should require a more macro-environmental strategy in addition to the micro level behavioral adjustments.

Time

Obesity treatment and management should be a process that takes months to years. This is because the focus should not just be on the individual level, but also on the general behavioral patterns of a person’s family, friends, and society at large (Ross et al. 2010). Therefore, interventions should be multidisciplinary and aim at changing the behavior of the patient by promoting long term positive outcomes. Precautions to monitor blood pressure can be done every two weeks or on a monthly basis. Medications such as sibutramine can be utilized for periods of up to one year. However, its use should be discontinued in patients whose weight loss stabilizes at less than five percent of their initial body weight.

5. Literature search strategy employed

The main search strategy that was employed for the development of this literature review is the database search method. This method was utilized to identify the potentially relevant scholarly articles within the childhood obesity literature. Examples of these databases included the Cochrane and Medline databases. Search terminologies related to childhood obesity were used to identify relevant scholarly works. Thereafter, an article review was undertaken to examine the degree of relevance of each article to the research topic.

6. Evaluation of the Literature

The prevalence of childhood obesity in the United States has increased at such a rapid rate that this has been considered a serious healthcare issue. This issue has attracted the attention of policy makers, government agencies, and the community. Due to the extent of the problem, a large number of researchers have investigated a number of factors relating to childhood obesity. One of the factors that have been investigated is the impact of changing the attitudes of the patients towards obesity and lifestyle factors that cause a risk factor. In this study, the main factor being investigated is the impact of education on exercise and diet on patients who have a BMI of more than 30. The following is a summary of a review of the literature used to determine the impact of educating patients on exercise and diet changes.

Comparison of Research Questions

Most of the literature analyzed for this study focuses on the intervention strategies for childhood obesity. Cheung et al. seeks to understand the extent of the childhood obesity in America. The research asks about the incidence of childhood obesity in America in a bid to demonstrate the extent of the problem.

Ickes et al. (2014) research question compares the intervention strategies used in the American schools and international ones. The main aim of this study is to determine the gaps in the intervention used in American schools that has caused the increased childhood obesity. On the other hand, Reilly (2006) research investigates the interventions strategies for childhood obesity in United States schools that have been applied overtime. The research question for this study is to investigate the effectiveness of each of the strategies that have been applied.

McGrath (2017) directly investigates the effectiveness of having an obesity education awareness program for the families of children suffering from childhood obesity. The research asks whether educating patients and family on the importance of maintaining ideal weight and providing awareness on obesity can help reduce the incidence of childhood obesity. Ross et al. (2010) investigates the recommended interventions for childhood obesity. The research question for this study seeks to understand some of the most effective interventions strategies to help reduce obesity among children in the United States.

On the other hand, Vine et al. (2013) seeks to understand the role that primary care providers can play in improving the issue of childhood obesity. The research asks whether primary care providers have the capability to make a positive difference through patient education to help reduce the incidence of childhood obesity. Taveras et al. (2014) compares the effectiveness of various interventions for childhood obesity. The question for this study is whether various interventions applied in primary care have the same impact on the reduction of childhood obesity. Lastly, Janicke et al. (2014) investigates the effectiveness of family lifestyle interventions in the reduction of obesity. The question of this study asks whether changing lifestyle factors such as diet and exercise can help to reduce obesity in children.

Comparison of Sample Populations

All the researches that have been included in this study were meta-analyses or reviews of literature except Taveras et al. (2015) which included a randomized control trial. This study included a sample of 649 children between 6 and 12 years. The other studies were analyses of other researches that have been done in the past on obesity. Janicke et al. (2014) analysed 20 studies whose sample sizes amount to 1,671 participants. On the other hand, Ross et al. (2010) performed a review of 73 studies. The research does not indicate the number of participants represented by the analyzed studies. McGrath (2017) conducted a literature analysis of 7 articles. There is a variation between the sample sizes of the analyzed articles ranging from 12 participants to 9000 participants. Ickes et al. (2014) conducted a systematic analysis including 12 studies whose samples sizes range between 10 and 20 participants. In general the studies that have been included in this research have generally small sample sizes. Most of the studies are literature reviews with a very low number of studies included in the analysis. None of these studies is longitudinal in nature and the samples are very small. Therefore, there is a high chance that the studies are limited in terms of the choice of methods. The following is an analysis of the limitations of each of the studies.

Comparison of the Limitations of the Studies

The limitations of the studies included in this research are mainly in the choice of methodology, specifically the samples and analysis methods used by the respective researchers. The main limitation of Ickes et al. is that the review of research was done in a narrative format. The study fails to utilize quantitative methods to enhance the accuracy of the results. Qualitative data analysis has a significant risk of inaccuracy. The study by McGrath (2017) is limited by the very small sample size. The review analyses less than 10 studies, which makes the chances of inaccuracy to be very high. Additionally, the author has used only qualitative techniques of data analysis, thus, increasing chances of inaccuracy. On the other hand, Cheung et al. (2016) is limited by the use of convenience data. The studies used in this study were not primarily meant to study the research question of the researcher. Therefore, there is a high chance of inaccuracy in the results collected. Reilly (2006) fails to clearly define the methodology used by the researcher. Therefore, it is hard to ascertain the true strengths and limitations of the study. Ross et al. (2013) is also limited by inconsistencies in the research methodology. The study included research from more than 100 studies but there are some studies that were not specific to the research question. The researchers made the closest connection to determine the results of the study. In general, these studies have a significant chance of inaccuracy and lack of reliability because of the limitations of the methodologies employed by the researchers.

The studies that have been analyzed for this research demonstrate consistent results with regards to the effective intervention strategies for childhood obesity. From the studies it is clear that childhood obesity is an extensive problem in the United States. The best interventions to this problem include changes in the family lifestyle of the families. Lifestyle changes include the increase of physical activity and the change of the diets. Intervention within the primary care setting has also been found to be an effective form of intervention for childhood obesity. The primary care professionals can help parents to reduce the extent of obesity in the American children by implementing education strategies. These studies confirm the hypothesis that education on lifestyles changes to the patients and their families can help to reduce the incidence of childhood obesity in the United States. Therefore, they can be used to confirm the PICOT statement of this study which argues that “Patients, who suffer from obesity (BMI of more than 30) undertaking nutritional education, diet and exercise in comparison to not taking nutritional education, diet, and exercise, can have improved health outcomes in terms of overall weight loss in a year’s time limit”.

7. Applicable Change/Nursing Theory Utilized

Two theories that can help to explain and develop interventions related to childhood obesity include the health belief model and the theory of planned behavior. The theory of planned behavior helps to clarify many of the issues that are related to negative behavioral patterns (Sothern, Gordon & Von Almen, 2016). The theory postulates that the environmental attributes are fully mediated by perceived behavioral control. This framework moderates the relationship of intention to behavior from perceived behavioral control. In case perceived behavioral control is high, then the intention will convert to behavior. On the contrary, if the perceived behavioral control is low, then it is less likely that the intention will convert to behavior.

Unlike the theory of planned behavior, the health belief model is based on the idea that people are motivated to change when the perceived severity and susceptibility is high. In this respect, people are most likely to embark on recommended positive behavior such as proper dietary practices if they feel that the possibility of getting childhood obesity is high, and that childhood obesity is so severe (Sothern, Gordon & Von Almen, 2016).  In such a situation, they will be motivated to embark on behavioral change, a situation referred to as ‘readiness to act’.

The theory that makes more sense in implementing EBP project for childhood obesity is the theory of planned behavior. The health belief model was originally designed with concern for public health issues (Sothern, Gordon & Von Almen, 2016). This model has not been received well in the pediatric community since children and adolescents basically perceive themselves as immortal and may not use rationalism. The theory of planned behavior can inform message strategies that seek to address parental issues over infant and toddler feeding practices. This is because toddlers’ appetites may fluctuate from day to day depending on many factors such as their activity levels, whether or not they are in a growth spurt. Therefore, parents can regulate their dietary behaviors.

8. Proposed Implementation Plan with Measurable Outcomes

The solution to childhood obesity is the implementation of initiatives to prevent unhealthy weight gain and to manage the weight for children who already have excess weight. There needs to be education initiatives that will encourage parents to promote a healthy lifestyle for their children. Children need to have healthy diets and engage in physical activity as often as possible. A healthy lifestyle can be promoted both in the school and the home environment. At school there should be rules and regulations that promote healthy lifestyles such as compulsory participation in sports and regulated sale of unhealthy food options (Hanks, Just & Wansink, 2013). At home, the parents should be able to control the types of foods and food portions that their children have. They should also promote participation in physical activity to promote metabolism and avoid gaining of unhealthy weight.

In the medical setting, there is not much that can be done to improve the issue of childhood obesity. There are no medications currently approved for use in childhood obesity in America. In fact, the American Association of Pediatrics discourages use of medication to control children’s weight. However, healthcare professionals can participate in education of parents to promote healthier lifestyles (Bleich et al., 2013).

9. Identification of Potential Barriers to Planned Implementation

Potential Barriers

Efforts that seek to prevent and respond to childhood obesity problem must take into account potential barriers and limitations for them to be successful. For instance, there are numerous potential barriers that hamper adolescents from accessing these programs and services (Smith et al. 2014). Adolescents can be difficult to recruit to healthy lifestyle initiatives for different reasons. For some, the fear of humiliation or bullying makes it harder to seek help. For others, the promotion of a healthy lifestyle is not enticing if they are overly concerned about their weight. In most situations, adolescents do not want to admit that they are overweight.

Another potential barrier is the challenge experienced in the retention of program participants. This is especially true for families who find it hard to remain engaged with the program (Smith et al. 2014). For most families, this requires a commitment in terms of time engagement. Another program-specific factor of start and finish times can be viewed as a barrier that makes it tougher for families to remain engaged in the long-run. Some participants are conflicted in their view for the most appropriate start time, since others seek to include children and adolescents immediately after schooling hours or days (Smith et al. 2014). For some parents, if these programs cannot be implemented full time, they have to be addressed during working part time hours.

Overcoming the Barriers

There is need to focus on making the programs more enjoyable and rewarding for both children and adolescents. This would improve the possibility that their families would remain in such programs (Smith et al. 2014). It is also important to get parents involved since they are the ones who are in control of the food and can regulate their children’s use of video games and television. Program staff members are also key enablers for maintaining families’ levels of engagement in the programs (Smith et al. 2014). Therefore, there is need to establish a good relationship between facilities and participants as one of the most crucial parts of the program.

For adolescents who are hesitant to join activities geared towards reducing or preventing childhood obesity, there is need for a wide-reaching and personalized communication campaign to reach adolescents and parents (Smith et al. 2014). Emphasis should be placed on the message. Face-to-face selling goes a long way in promoting behavior change communication. In particular, use of communication channels such as brochures, newsletters, and email communication can work effectively (Smith et al. 2014). Finally, participants should receive a generalized feedback regarding the entire program and has been achieved.