Researchers develop 'conversation cards' to broach subject of pediatric weight management

Medical researchers at the University of Alberta have created a deck of cards with conversation starters about sensitive and informational topics related to weight, that parents can use to guide their discussions when talking about their child's weight management with health professionals.

Researchers in the Faculty of Medicine & Dentistry at the University of Alberta created these 'conversation cards' based on their findings in a recently published paper in the peer-reviewed journal Patient Education and Counseling.

Their study revealed that a family-based approach, where are key players in developing an action plan with their child's health-care professional, is key to building rapport, trust and success for everyone involved.

In their study the researchers carried out interviews with various health-care professionals and parents of children with weight-management problems. The study showed that parents are less apt to work with health-care professionals in certain scenarios. Parents took offence to the use of the term obese, health-care professionals who seem disrespectful or apathetic, and health-care professionals who determine goals and action plans for the child without consulting the parents. All of these dynamics can negatively affect the willingness of the parents to be engaged, follow medical advice or return for follow-up appointments, the study noted.

Health-care professionals acknowledged they were sometimes overly eager to help and found it difficult to step back and let the families be more involved in the decision-making process, said the paper.

"What we found is relationships are fundamental to maintaining that contact, in supporting families to make healthy changes," says pediatric medical researcher Geoff Ball, the principal investigator who worked alongside co-investigators Mandi Newton and Arya Sharma, as well as medical graduate student Carla Farnesi, on the research study.

"It's not always easy to navigate that relationship but when it is done well, clinicians feel rewarded and families perceive value in that interaction…If we want to be effective at addressing these issues, language and rapport are central."

To address these issues in clinical practice, the researchers developed these 'conversation cards', which will be piloted in January 2012 at the Alberta Health Services Pediatric Centre for Weight and Health. Each deck has 45 statements focusing on various key areas such as nutrition, activity and family issues – for example, 'My kids hate vegetables,' 'I like it when medical terms are explained to me,' 'My partner doesn't understand me very well,' and 'Healthy foods are expensive.' There are some blank cards where parents can write their own statements.

The cards will be given to parents while they are in the waiting room.

"We want to use the cards to get to the most important issues the families are dealing with that day," says Ball, who is also the director of Alberta Health Services's Pediatric Centre for Weight and Health. "One of the things that these cards do is reduce the power differential between the medical expert and the parents. If parents feel more empowered by initiating the direction of the discussion, we think we can set the stage for a more supportive and positive conversation."

Ball said an obesity researcher he knows in Vancouver told him about the idea of using cards to initiate discussions with medical professionals. The concept started in the U.K. where a similar set of cards was developed for adults with type 2 diabetes.

Building a working relationship with parents is a central concern for the AHS' Pediatric Centre for Weight and Health. The centre gets about 200 referrals a year for children with weight-management problems, but only about half of the parents follow up on their referrals by contacting the centre.

Other interesting findings from the U of A study noted parents sometimes find it challenging to make time for follow-up appointments and would be interested in having physicians conduct follow-ups via email, text messaging or phone calls. Ball said if communicating with families via these mediums can be done in a safe and secure way, it would be another tool to use to promote patient-centred care.

Researchers interviewed 12 health-care professionals who work in the area of pediatric weight management and eight parents whose children are getting assistance in this area. Interviews were conducted either through focus groups or one-on-one interviews using vignettes where a mock example was given of a parent's interactions with various regarding her child with issues.

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