Table 3.
Illustrative quotes from stakeholders.
| Intervention characteristics | |
| Design quality and packaging | |
| 1. A formal curriculum with illustrative examples of healthy behavior change | |
| 1a | “We eliminated [soda]completely because [the dietitian] had sugar in little bottles. The portions of sugar in bottles, how much sugar sodas have, how they harm us.”—Parent Adviser |
| 1b | “Not just pointing pictures at the book but having the physical food there and the key was, portion control, so seeing what a plate looked like.”—Patient Adviser |
| 1c | “I think the cooking demonstrations, also have to be about the recipes that would fit into what people are used to in terms of their heritage.”—Pediatrician |
| Adaptability | |
| 2. A patient-centered program with a tailored approach | |
| 2a | “Do this, do this, do this. Go home and eat this. Don't eat that.” They think that's what our program is going to be. It's not…Its behavior change model, which is “What do you think you can do?”—Local YMCA program director |
| 2b | “[What] I think is a key element to be successful, because if the patient[s] do not feel comfortable with the providers they…will go to listen to you or they [don't make] many changes.”—Behavioral Health Professional |
| 2c | “We've really had to learn a lot in this first session of, like, we sort of had the child sitting with their parent, and as we're facilitating the first hour, what we found was that the parents were doing all the talking…”—Local YMCA program director |
| Relative advantage | |
| 3.3. A family-centered program where all members of the family are involved in behavior change | |
| 3a | “Certainly, one of the things that was abundantly clear to me …that you cannot just do a program to change youth obesity with just the children. That's just never going to work. It can't work because …it's a family issue.”—Local YMCA program director |
| 3b | “…one thing that is very, very helpful is pay attention to the interest of the family and support [and] connect the families with family partners or community support.”—Behavioral health professional |
| 3c | “So, I think that there needs to be more focus on the parents and educating them because they're coming from a family, you know, they're in the same situation. So, some parenting skills, limit setting, cooking, shopping, and menu planning.”—Dietitian |
| 4. Group visits to help build a support system for participants | |
| 4a | “I think that group visits work better than individual visits …because of the support system…They don't feel like…they're the only ones. They have… other kids with them that are going through the same things.”—Community Health Worker |
| 4b | “I think the special sauce is the relationships that they build with each other- and then sort of they feel responsible to each other, right?”—Local YMCA Program Director |
| 4c | “I would've definitely wanted, being in a group setting. Especially [with] kids…around my own age; so, you can relate to them a lot…”—Patient Adviser |
| Characteristics of individuals | |
| Other personal attributes | |
| 5. The inclusion of high-quality core personnel such as a community health worker, a physician, a behavioral health clinician and a dietitian | |
| 5a | “I would say, number one, having someone who really knows the community and knows the culture of our patients…. Because if you can't understand our culture and our community, then whoever tries to teach is not going to get any parent to do anything.”—Community Health Worker |
| 5b | “Be compassionate with people because some of the patients, especially the parents sometimes they come with long faces because of different issues.”—Dietitian |
| Outer setting | |
| Cosmopolitanism | |
| 6. Partnerships of clinic and community organizations | |
| 6a | “Neither one of us can do this work alone… clinical needs us, and we need clinical. Whether the partnership is around a referral source, or if it's …collaborative programming. I think we need each other”—Local YMCA Program Director |
| 6b | “I think, to make it work better especially in my community, either the schools after school when you find a place like the nurse's office where the doctor can travel to, the different neighborhoods in the community, to access more people.”—Patient Adviser |
| 6c | “I think with this new wave of quality improvement, and controlling costs…that might be the next phase where we…establish firmer relationships with effective community resources of the YMCA.”—Internal Medicine Physician /Chief Medical Officer |
| External policies and incentives | |
| 7. Sustained funding for the program with insurance reimbursement | |
| 7a | “I think it's very important that health insurance be providing reimbursement… it would create a priority, for different organizations to provide these services. If they can't find the funding, they won't be able to put more into it.”—Patient Adviser |
| 7b | “It's going to be critically important, obviously, to manage chronic diseases as inexpensively as possible, and certainly it is cheaper to have a community health worker touch base with a family than it is to have a nurse or to have, you know, the provider… ACO models are probably going to incorporate more aggressive case management and we'll probably utilize … community health workers down the road. And so, I think that insurers will pay attention that because I think they're an inexpensive way to kind of in a culturally appropriate, linguistically appropriate way, to have health-related education to people who have chronic diseases.”—Pediatrician |
| 7c | “I think it is important, and making sure it's evidence-based, which I think goes part and parcel with the cost …efficiency and quality equation, but then, going that step further to say, “Let's not look at it as a one-year, how much did you save,” but in the long run”—Medicaid Official |
| Patient needs and resources | |
| 8. Identifying and developing solutions to patient barriers | |
| Transportation | |
| 8a | “It's tough I think for them to get here, for families to actually come get into the clinic…They might take the bus, which is just a lot for them….They might not have the money to get here”—Dietitian |
| Childcare | |
| 8b | “With the families having a lot of children, and lack of babysitters, they're coming here and having to bring them all…”—Community health worker |
| Time constraints | |
| 8c | “The only problem with the weight clinic, for me, personally, was just—it was very time-consuming for the patients…”—Community Health Worker |
| Tertiary care centers are often where programs are occurring | |
| 8d | “So that access for those programs are an issue, and when you have a disease that has, you know, has a 40 percent prevalence rate in our community, there is no way that those patients can all be seen at tertiary care centers. It's just not possible.”—Pediatrician |
| Cost | |
| 8e | “but I think you should do something like that, or to help with obesity, or free groups to do exercise, or for people that don't have resources like me.”—Parent Adviser |
| Language | |
| 8f | “In a perfect world, we would have in-person interpreters for all these visits.” Pediatrician |