Date of Graduation

Fall 12-12-2019

Document Type

Project

Degree Name

Doctor of Nursing Practice (DNP)

College/School

School of Nursing and Health Professions

Department/Program

Nursing

Program

Family Nurse Practitioner

First Advisor

Dr. Alexa Curtis

Second Advisor

Dr. Jo Ann Loomis

Abstract

Abstract

Purpose: Childhood obesity is a significant health problem associated with increased adult morbidity and mortality. Rural areas like Central Valley California demonstrate disproportionate rates of obesity. Children in rural and underserved populations are at a higher risk of developing obesity. Data suggest that obesity is often under-addressed during routine health care visits. Primary care practitioners are the first point of health care contact and have a unique opportunity to prevent and address obesity through health monitoring and education.

In response to escalating rates of obesity, clinical recommendations have been established for primary care providers including the use of patient-centered approaches to motivate families on behavior change. The use of Motivational Interviewing (MI) encourages the patient to recognize their readiness for change, assess the benefits of embracing healthy behavior, and evaluate their confidence and perceived ability to make the change. Recommended behavioral changes to address childhood obesity include encouraging consumption of nourishing foods rich in whole grains, low fat or fat-free foods, fruits and vegetables, lean meat and other protein sources, and daily physical activity of 60 minutes or more for ages 6 to 18 with emphasis on aerobic, muscle, and bone strengthening.

This DNP student developed a health promotion project that focused on educating Family Nurse Practitioner (FNP) students from the University of San Francisco (USF) and San Jose State University (SJSU) on best practices for addressing childhood obesity in the primary care setting. A prevention strategy was designed to use MI to address childhood obesity within the context of a routine pediatric health screening.

Method: An in-service was conducted for the FNP students including (a) MI techniques and Change Talk interactive scenario to elicit change in behavior, physical activity, and diet; (b) BMI screening guidelines; (c) 5-2-1-0 rule educational tool; (d) the Choose My Plate educational tools; and (e) the Healthy Eating and Activity Together (HEAT) educational tool. Interventions were implemented at Reedley and Orange Cove High Schools in Kings Canyon Unified School District in Fresno County during the sports physical assessment program. Measures: Evaluation metrics included a pre/post-test questionnaire to measure student FNP (n=15) knowledge and confidence after delivery of the MI education to students from Reedley and Orange Cove High Schools. The survey evaluated the knowledge of MI techniques, childhood obesity prevention readiness, confidence in the use of MI, and potential barriers to participating in the prevention strategies. Results: Project outcomes showed an increased mean of 4.13 (SD 1.06) in knowledge, while confidence increased from mean of 2.6 (SD .06) to 4.13 (SD 0.64) in MI techniques, childhood obesity screening guidelines, and BMI screening. Conclusions: Outcomes indicate that an education program can increase student FNP’s knowledge and confidence in using the MI techniques to address childhood obesity in the primary care setting.

Keywords: Motivational Interviewing, Childhood Obesity, Central California

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