Developing School-based BMI Screening & Parent Notification Programs: Findings from Focus Groups with Parents of Elementary School Students

November 7, 2006 American Public Health Association Meeting

Boston, MA

Martha Y. Kubik, PhD, RNUniversity of Minnesota, School of Nursing

Mary Story, PhD, RDUniversity of Minnesota, School of Public Health

Gayle Rieland, MS, RN, LSNISD #191

Problem: Childhood Obesity

Prevalence among children & youth 2-19 years of age

17 % overweight 17% @ risk of overweight

NHANES 2003-2004 (Ogden et al, JAMA, 2006)

School-based strategy to decrease obesity prevalence

Conduct annual assessments of student’s height, weight & BMI & make information available to parents

Recommendation: Institute of Medicine, 2004

School-based BMI Screening Programs

PRO Individual

Primary prevention Secondary prevention

Family Promote healthy lifestyle

practices Population

Surveillance Policy & Practice Budget appropriation

CON Individual

Weight stigmatization Body image dissatisfaction

& disordered eating Family

Victim blaming Lack of effective

interventions Population

Cost Oversight

Study Purpose

To determine the opinions & beliefs of parents of elementary school-aged students regarding school-based height, weight & BMI screening

To develop a parent notification program sensitive to parent needs and convey supportive messages about weight & healthy weight control

Study Design: Focus Group

Sample Recruitment: Schools:

One suburban school district in upper Midwest

2 elementary schools participated in BMI screening pilot study

Parent recruitment: October 2004 – January 2005 School’s newsletter & website Participant incentives:

Free meal $50

Questioning Format: Semi-structured format

School-based ht/wt/BMI screening

Preferred BMI notification method

Message content Health information needs

Analysis: Thematic approach Review by 2 research staff

Study Sample

Focus Groups 10 groups

5 to 9 participants per group

Participants 71 parents

90% Female 96% Caucasian Mean age: 39 (range: 27 to 49) 50% college degree 41% worked full time; 42% worked part time

Results: Thematic Summary Provide advance notice health screening is

offered, what screening encompasses & option to decline participation

Confirm measurement done in private, respectful & standardized manner & steps will be taken to minimize weight-related teasing among children

Notify all parents of results by mail

Results: Thematic Summary

Along with BMI information, provide family-oriented healthy eating & physical activity recommendations

Share aggregate school-level data describing overweight prevalence with school, community & state decision-makers

Results: Qualitative Summary

GENERAL OPINIONS ABOUT HEALTH SCREENING: “If they’re going to be doing this [height/weight screening], instead of just collecting data or some poll or whatever they’re doing, they need to inform the parents so parents are aware of what’s going on with their children, if they are at risk [of obesity] or not.”

CONCERNS ABOUT SCREENING: “It’s a matter of the kids confidentiality. These kids need to be respected and given the privacy they need. I’m not saying pull out the heavy kids. Treat them all the same and have it [screening] be a private matter.”

BMI REPORTING: “I think if you’re going to take the time to screen them you should add the BMI, because that puts it in context and takes away the ‘you’re fat,’ ‘you’re short,’ ‘you’re whatever.’

Results: Qualitative Summary

MESSAGE CONTENT: “And it shouldn’t be just focused on the kid. Maybe it could be a wake up call to the parents too. Gosh, my child’s a little bit heavier. Maybe I am too. Just to change the lifestyle of the whole household.”

USES OF BMI PREVALENCE DATA: “I think having it published is helpful. It’s going to get the school board members, the legislators all aware that … whoa, look at this. What are we doing? What do we need to change?”

Study Strengths &Limitations Strengths:

One of the first to examine parents opinions/beliefs about school-based BMI screening & parent notification programs

Standardized data collection procedures Most parents worked outside home 50% college educated; 50% less than college

Limitations: Convenience sample Self-reported views Generalizability

Participants primarily Caucasian & female from one suburban school district in upper Midwest

Parents of elementary school students

Conclusions Parents generally supportive of school-based

BMI screening & notification programs

Program support likely to be enhanced by: Assurance of student privacy during measurement Institution of a dissemination plan that informs

parents and school community

Next steps … Will school-based BMI screening & parent notification

programs be an effective obesity prevention tool? Hypothesis merits testing Need for program evaluation