Lori Pbert, PhD Kristin Schneider, PhD, Stravoula Osganian, MD, ScD, Susan Druker, MA, Robert Magner, MPH, George Reed, PhD, Lauren Gellar, PhD, Mary
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1 Lori Pbert, PhD Kristin Schneider, PhD, Stravoula Osganian, MD, ScD, Susan Druker, MA, Robert Magner, MPH, George Reed, PhD, Lauren Gellar, PhD, Mary Ann Gapinski, RN, MSN, NCSN, Anne Sheetz, RN, BSN, MPH NIH/NHLBI R21HD ClinicalTrials.gov ID# NCT
2 UMMS, Division of Preventive and Behavioral Medicine Children s Hospital Boston MA Dept Public Health/School Health Unit School Health Settings: School Nurses Administrators
3 Systematic review for USPSTF (Whitlock et al, 2010) found moderate/high intensity interventions can weight, BUT GAPS: targeted younger children conducted in specialty health care settings with limited reach (accessibility, cost) and public health impact
4 Part Time Full Time Primary health professional in school setting Accessible and continuous care Professional organization (NASN) cites role of school nurse is to assist regarding diet, physical activity and weight and provide obesity treatment
5 Pair-matched cluster RCT (6 high-schools, n=84 OW/OB teens) Counseling Intervention (LGFG) ; SCT Information and Contact Control 2-month follow-up (100% retention) 6-month follow-up (100% retention)
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10 Identified their adolescent health concerns/priorities: OW/OB among teens Fit their mission and responsibilities Engaged administrators to support nurse in this role
11 School Health Unit/School nurses Experience caring for OW/OB teens Understand work flow, feasibility in school setting Current practice/style Skills and credibility to deliver healthrelated counseling UMMS researchers and nutritionists Empirical evidence, treatment recommendations (CDC) Theoretical frameworks Intervention design expertise Evaluation skills JOINT INTERVENTION DESIGN WORKING GROUP: LGFG Pilot testing work out kinks Focus groups with OW/OB teens, their parents, school nurses, school staff and administrators
12 Knowledge Scope of problem Recommendations (diet, PA, SB) Theoretical framework, counseling approach Motivation Compatibility with mission, job responsibilities Evidence underlying protocol Skills/confidence Protocol review and demonstration Practice with feedback Implementation tips from the field (barriers and tested strategies), brainstorm
13 School Administration Fit mission (education/health of students) Did not interfere with academic classes See as school nurse role/job School Nurse Compatible with role/mission Confident in ability to conduct intervention Intervention protocol and materials clear, easy to use (high fidelity) Teen comfort/acceptability reinforced delivery OW/OB Teens High acceptability- very comfortable talking with nurse re: weight Perceived helpfulness Non-interference with academic classes facilitated session adherence Easily access nurse without parental involvement, transportation or cost
14 BARRIER School Sustaining institutional support Lack of PA opportunities School Nurse Time/conflict with other duties Ongoing delivery OW/OB Adolescent Participation Lack of social support for weight loss efforts SOLUTIONS/RESEARCH DIRECTIONS Reinforce benefits (improved health academics), address concerns Engage school staff to support efforts After school exercise program LGFG-E Resources to protect time for intervention delivery (e.g., floating nurse) Group format, maximize nurse time LGFG-G Incorporate into performance evaluation Process to let students know of program Identify and address barriers to participation Group format LGFG-G Social networking technology LGFG-G
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17 Counseling Intervention 1:1 Sessions SCT Constructs Fostering Behavior Change Weight -Related Behavior Changes Decreased BMI/Weight Instruction and Guidance Dietary, PA and SB ecommendations Strategies for self control Social Support Encouragement from school nurse Social Modeling Strategies used by other teens in Student Booklet Self-Efficacy Knowledge Behavioral Capability Self-Control Outcome Expectations Improved dietary quality Increased PA Decreased sedentary behavior
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