Knierim Shanna Doucette, Moore Susan L, Raghunath Silvia Gutiérrez, Yun Lourdes, Boles Richard E, Davidson Arthur J
Ambulatory Care Services, Denver Health, 601 Broadway Street, Mail Code 1914, Denver, CO, 80203, USA.
Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA.
Matern Child Health J. 2018 Nov;22(11):1589-1597. doi: 10.1007/s10995-018-2553-7.
Objective This qualitative study explored parent and patient navigator perspectives of home visitation as part of a childhood obesity program in a low-income, largely Latino population. Methods Three patient navigators and 25 parents who participated in a home-based, childhood obesity program participated in focus groups or interviews. Emergent themes were identified through content analysis of qualitative data. Results Three overall themes were identified. Patient navigators and parents perceived: (1) enabling characteristics of home-based program delivery which facilitated family participation and/or behavior change (i.e., convenience, increased accountability, inclusion of household members, delivery in a familiar, intimate setting, and individualized pace and content); (2) logistic and cultural challenges to home-based delivery which reduced family participation and program reach (i.e., difficulties scheduling visits, discomfort with visitors in the home, and confusion about the patient navigator's role); and (3) remediable home-based delivery challenges which could be ameliorated by additional study staff (e.g., supervision of children, safety concerns) or through organized group sessions. Both patient navigators and participating parents discussed an interest in group classes with separate, supervised child-targeted programming and opportunities to engage with other families for social support. Conclusions for Practice A home visitation program delivering a pediatric obesity prevention curriculum in Denver was convenient and held families accountable, but posed scheduling difficulties and raised safety concerns. Conducting home visits in pairs, adding obesity prevention curriculum to existing home visiting programs, or pairing the convenience of home visits with group classes may be future strategies to explore.
目的 本定性研究探讨了在一个低收入、主要为拉丁裔人群的儿童肥胖项目中，家长和患者导航员对家访的看法。方法 三名患者导航员和25名参与家庭式儿童肥胖项目的家长参加了焦点小组或访谈。通过对定性数据的内容分析确定了新出现的主题。结果 确定了三个总体主题。患者导航员和家长认为：（1）家庭式项目实施的有利特征，促进了家庭参与和/或行为改变（即便利性、更高的责任感、家庭成员的参与、在熟悉、私密的环境中实施、个性化的节奏和内容）；（2）家庭式实施的后勤和文化挑战，降低了家庭参与度和项目覆盖范围（即安排家访困难、对家中访客感到不适、对患者导航员角色的困惑）；（3）可补救的家庭式实施挑战，可通过增加研究人员（如监督儿童、安全问题）或通过有组织的小组会议加以改善。患者导航员和参与的家长都讨论了对小组课程的兴趣，这些课程有针对儿童的单独、有监督的编程，以及与其他家庭互动以获得社会支持的机会。实践结论 在丹佛实施的一项提供儿科肥胖预防课程的家访项目很方便，让家庭承担责任，但存在安排困难并引发了安全问题。两人一组进行家访、在现有的家访项目中增加肥胖预防课程，或将家访的便利性与小组课程相结合，可能是未来需要探索的策略。
