Table 2.
Characteristics of studies included in review (n = 24).
| Title | Year | Setting | Topic covered | Aims or objectives of study | Study design | Outcomes assessed and key measures | Brief overview of key results |
|---|---|---|---|---|---|---|---|
| The Doctor Will “Friend” You Now: A Qualitative Study on Adolescents' Preferences for Weight Management App Features (San Giovanni et al., 2021) | 2021 | Pediatric clinic; Academic medical center | Obesity | Explore adolescent preferences about a technology-based weight management intervention | Qualitative research | Exploratory outcomes (qualitative) | The use of technology applications was promoted by familiarity, ease of use, and accessibility. Preferred features included nutrition education, recording of physical activity, self-monitoring, and social connection. Barriers included problems with app features, speed, excess information, layout/user design, and privacy concerns. |
| Provider Practice and Perceptions of Pediatric Obesity in Appalachian Kentucky (Thornberry et al., 2019) | 2019 | Other: non-specified primary care | Obesity | Explore current practices for managing pediatric obesity | Survey research | Exploratory outcomes (quantitative) | Adherence to expert recommendations for managing pediatric obesity were mixed: 67 % of providers reported always or almost always using BMI percentiles; 61 % reported never using waist circumference to assess obesity; 53 % reported almost always discussing physical activity. |
| Translation of clinical practice guidelines for childhood obesity prevention in primary care mobilizes a rural Midwest community (Gibson, 2016) | 2014 | Rural health clinic | Obesity | To assess effectiveness of using the 5210 program to improve childhood obesity | Non-randomized experimental study | Intervention outcomes; Process outcomes | Documentation of BMI increased from 27 to 98 %; educational counseling increased from 9 to 87 %; accurate diagnosis of obesity increased from 0 to 32 %. Providers reported that intervention was appropriate at acute and well child visits and that they focused on messaging around eating more fruits and vegetables; watching less television; drinking more water/fewer sugar-based beverages |
| Promoting Weight Maintenance among Overweight and Obese Hispanic Children in a Rural Practice (Parra-Medina et al., 2015) | 2015 | Rural health clinic | Obesity | To evaluate an obesity management intervention for Hispanic children and their parents | Randomized controlled trial | Intervention outcomes | Greater proportion of children in standard care group in increased waist circumference and weight gain compared to intervention group. Controlling for demographic factors, odds of weight gain was reduced by 75 % for children in intervention group. |
| Organizing for Quality Improvement in Health Care: An Example From Childhood Obesity Prevention (Shaikh et al., 2015) | 2015 | Pediatric clinic; Family practice; Other: Indian Health Service Clinic | Obesity | To evaluate how a telehealth community of practice QI intervention addressed rural clinic's challenges related to translating evidence to practice for preventing and managing obesity | Qualitative research | Process outcomes; Exploratory outcomes (qualitative) | Barriers included staffing capacity and resources, lack of time, lack of patient follow-up, cultural concerns in addressing BMI, and concerns around social determinants of health. Facilitators reported were the use of clinic champions, efforts to align the intervention with established practices, clear and consistent communication, and alignment of intervention with local/community resources. |
| Collaborative practice improvement for childhood obesity in rural clinics: the Healthy Eating Active Living Telehealth Community of Practice (HEALTH COP) (Shaikh et al., 2014) | 2014 | Pediatric clinic; Family practice | Obesity | Assess a virtual quality improvement project focused on adherence to clinical guidelines to treat childhood obesity | Non-randomized experimental study | Intervention outcomes | Significant increase in documentation of BMI percentile and weight category by clinicians. Clinicians covered an average of 0.8 more related educational topics per visit compared to pre-intervention. Parents’ report of use of family-centered care did not differ pre and post-intervention. |
| Evaluation of a primary care intervention on body mass index: the Maine Youth Overweight Collaborative (Gortmaker et al., 2015) | 2015 | Other: non-specified primary care clinics | Obesity | Assess impact of primary care intervention to change BMI z-score trajectories for overweight and obese pediatric patients | Non-randomized experimental study | Intervention outcomes | A decrease in growth of BMI z-score for subjects with obesity in intervention and control sites was observed as well as a significant decline in rate of increase of BMI z-score for patients with overweight and healthy weight. However here was no evidence of an overall intervention effect. |
| Implementing the obesity care model at a community health center in Hawaii to address childhood obesity (Okihiro et al., 2013) | 2013 | FQHC/CHC | Obesity | Assess a quality improvement project to improve obesity management in pediatric primary care | Mixed methods | Intervention outcomes; Exploratory outcomes (qualitative) | Integration of nutrition and behavioral health services within pediatric practices was achieved. During project period BMI was assessed at 100 % of well-child visits. Participants reported improved collaboration between staff and improved awareness of pediatric obesity. |
| Perceived barriers, resources, and training needs of rural primary care providers relevant to the management of childhood obesity (Findholt et al., 2013) | 2013 | Pediatric clinic; Family practice; Rural health clinic | Obesity | To explore perceived barriers, resources, and training needs of rural primary care providers to assess, treat, and prevent pediatric obesity | Qualitative research | Exploratory outcomes (qualitative) | Practice barriers included time constraints, lack of reimbursement, few opportunities to detect obesity Clinician barriers included limited knowledge. Family-patient barriers included family lifestyle and lack of parent motivation to change; low family income and lack of health insurance; sensitivity of the issue Community barriers included lack of pediatric sub-specialists, few community resources. Sociocultural barriers included sociocultural influences; high prevalence of childhood obesity Resources needed were hospital dietitians (underutilized) handouts/patient-facing materials; clinic and/or community-based programming; interest in learning about recommended best practices for assessment/monitoring, how to motivate parents. |
| Impact of a primary care intervention on physician practice and patient and family behavior: keep ME Healthy---the Maine Youth Overweight Collaborative (Polacsek et al., 2009) | 2009 | Pediatric clinic; Family practice | Obesity | To evaluate a clinical decision support and family-centered intervention on pediatric overweight and obesity | Non-randomized experimental study | Intervention outcomes | In pre-post assessment: significantly higher rate of BMI assessment, BMI percentile, weight classification, and use of intervention screening tool; Parents reported discussion of all intervention behaviors; reports of counseling were higher in intervention group compared to control |
| Pediatric obesity management in rural clinics in California and the role of telehealth in distance education (Shaikh et al., 2011) | 2011 | FQHC/CHC; Rural health clinic | Obesity | Assess needs of health care providers to address pediatric obesity through telehealth |
Survey research | Exploratory outcomes (quantitative) | On a five-point scale, most providers rated their self-efficacy in being able to address pediatric obesity as either a 2 or 3. Commonly reported barriers were lack of local weight management programs, low patient motivation, and little family involvement. The majority of participants already used telehealth services and were interested in participating in continuing education on pediatric obesity via telehealth. |
| Treating pediatric obesity in the primary care setting to prevent chronic disease: perceptions and knowledge of providers and staff (Silberberg et al., 2012) | 2012 | Pediatric clinic; Family practice; FQHC/CHC | Obesity | Assess primary care provider's and staff's perceptions and knowledge toward pediatric obesity treatment and dietitian services | Survey research | Exploratory outcomes (quantitative) | Participating providers reported high levels of comfort addressing pediatric obesity, but reported very low levels of perceived effectiveness to impact pediatric obesity. For example almost 80 % felt comfortable or very comfortable raising the issue of a child being overweight but only 60 % felt that would be effective to impact weight. |
| Child overweight interventions in rural primary care practice: a survey of primary care providers in southern Appalachia (Wu et al., 2007) | 2007 | Pediatric clinic; Family practice; Academic medical center | Obesity | Explore primary care practitioners’ current practices to address childhood overweight and obesity in southern Appalachia | Survey research | Exploratory outcomes (quantitative) | Participating primary care providers had positive attitudes towards overweight treatment; low self-assessment of skills in behavioral management strategies; low readiness to address overweight in children. |
| Motivational Interviewing Screening Tool to Address Pediatric Obesity (Hyde and McPeters, 2022) | 2022 | Pediatric clinic; Rural health clinic | Obesity | Assess impact of motivational interviewing survey tool to address obesity among patients ages 10 to 18 |
Non-randomized experimental study | Intervention outcomes; Process outcomes | 90 % of patients received motivational interviewing survey tool during well-child visit during project period. Over 50 % of patients classified as overweight/obese. |
| Sustainability of key Maine youth overweight collaborative improvements: A follow-up study (Polacsek et al., 2014) | 2014 | Pediatric clinic; Family practice | Obesity | Evaluate intervention effects on provider knowledge, beliefs, practices, patient experience, and office systems | Non-randomized experimental study | Intervention outcomes | There was a significant increase in recording BMI percentile in charts from 2012 vs 2009, no change in recording of weight or blood pressure. Parent surveys indicate increase in counseling about sugar sweetened beverages and decrease in nutrition counseling. Clinician surveys report sustainment of knowledge, beliefs, practices. |
| The Health Care Provider’s Experience With Fathers of Overweight and Obese Children: A Qualitative Analysis (Anti et al., 2016) | 2016 | Pediatric clinic; Family practice | Obesity | To examine the healthcare providers’ experiences working with fathers of overweight and obese children | Qualitative research | Exploratory outcomes (qualitative) | Providers reported fathers have less of a role or presence in child’s health compared to mother and are resistant to accepting child’s weight as an issue |
| Improving Human Papillomavirus Vaccine Use in an Integrated Health System: Impact of a Provider and Staff Intervention (McLean et al., 2017) | 2017 | Pediatric clinic; Family practice | HPV vaccination | Test a multicomponent intervention to improve HPV vaccination in a regional healthcare system | Non-randomized experimental study | Intervention outcomes | HPV vaccination coverage increased from 41 to 59 % in intervention departments and only 32 to 45 % in control departments; however changes in series completion was not significantly different between intervention and control departments. |
| Human Papillomavirus Immunization in Rural Primary Care (Gunn et al., 2020) | 2020 | Pediatric clinic; Family practice | HPV vaccination | Identify organizational and clinic factors that support HPV vaccine delivery | Mixed methods | Exploratory outcomes (qualitative); Exploratory outcomes (quantitative) | Up-to-date vaccination rates ranged from 13 to 28 % for “low-performing clinics” and 50–70 % for “high-performing” clinics. Qualitative themes that emerged to distinguish higher performing clinics included: staffing and vaccine protocols, presence of a vaccine champion, utilizing all opportunities to vaccinate and patient communication and education. |
| HPV vaccine attitudes and practices among primary care providers in Appalachian Pennsylvania (Huey et al., 2009) | 2009 | Pediatric clinic; Family practice; Other: Gynecology practices | HPV vaccination | To understand primary care providers HPV vaccine-related practices and recommendations | Survey research | Exploratory outcomes (quantitative) | In first survey; 80 % of clinicians were currently offering the vaccine; concerns about the vaccine included: cost and insurance, newness of the vaccine, worries that age was too young, not knowing who should administer vaccine. In second survey 94 % reported recommending to all patients and barriers to vaccination included cost of the vaccine (especially for women ages 18–26), belief that recommended age is too low and that vaccine may report sexual activity |
| Effect of provider prompts on adolescent immunization rates: a randomized trial (Szilagyi et al., 2015) | 2015 | Pediatric clinic; Family practice | HPV vaccination | Assess impact of an electronic-health record based intervention on adolescent immunization rates | Randomized controlled trial | Intervention outcomes | No intervention effect was observed on increasing rates of HPV vaccination (any dose in the series). |
| Implementation Challenges and Opportunities Related to HPV Vaccination Quality Improvement in Primary Care Clinics in a Rural State (Askelson et al., 2019) | 2019 | Pediatric clinic; Family practice | HPV vaccination | Understand selection and implementation of evidence-based interventions to support HPV vaccination | Survey research | Exploratory outcomes (quantitative) | External actors (e.g., payors) are often involved in decision making about implementation of EBIs. Clinics use resources like the state health department, Vaccines for Children staff to support implementation efforts. |
| Evidence-Based Practice Model to Increase Human Papillomavirus Vaccine Uptake: A Stepwise Approach (Beck et al., 2021) | 2021 | Other: Primary care/walk-in | HPV vaccination | Assess a stepwise evidence-based practice model to improve HPV vaccination uptake | Non-randomized experimental study | Intervention outcomes | 100 % of parents approached consented to vaccination. A total of 24 HPV vaccines were administered during the six-week intervention period, compared to 4 HPV vaccines in the six-week comparison period. |
| Sun protection counseling for children: primary care practice patterns and effect of an intervention on clinicians (Dietrich et al., 2000) | 2000 | Pediatric clinic; Family practice | Skin cancer | Describe implementation of SunSafe intervention in pediatric practices | Mixed methods | Intervention outcomes; Exploratory outcomes (qualitative); Exploratory outcomes (quantitative) | Intervention clinics increased their provision of educational materials in their waiting rooms and at summer well child visits and distributed more samples of sunscreen compared to control clinics. Pediatricians, compared to other types of providers, were more likely to address sun protection at visits and provide materials like educational pamphlets and sunscreen samples. |
| Prescription for health: changing primary care practice to foster healthy behaviors (Cifuentes et al., 2005) | 2005 | Pediatric clinic; Family practice; Other: Internal medicine | Multiple behaviors: Obesity; Smoking/vaping/ tobacco use | Describe lessons learned from a practice-based network project that addressed behavior change in the following areas: smoking, unhealthy diet, physical inactivity, and risky alcohol use | Other: Observations; progress reports; meeting notes | Process outcomes | Four key lessons learned: health behavior counseling can be done by frontline staff in primary care practices; this counseling may require substantial practice redesign; refined of existing models and frameworks can guide these efforts; co-evolution, rather than traditional collaboration, can help create synergy across projects |