Information provision, informational value, and relational support: assessing perceptions of pediatric family-centered communication as predictors of weight-related outcomes in preschool children
The Centers for Disease Control and Prevention currently estimate that one of every eight preschool age children in the U.S. are overweight or obese, and those preschoolers are five times more likely to become overweight adults compared with those in a healthy weight range (CDC, Vital Signs, 2013; Ogden, Carrol, Kit, & Flegal, 2014). Pediatric well-child visits are arguably one of the most opportune times to address weight-related problems and obesogenic behavioral patterns at both the family and individual levels (Tyler & Horner, 2008). Parents of 24-48 month olds completed two surveys one year apart, (n=291 in the longitudinal sample). Children were weighed and measured at both time points. Survey measures assessed parental perceptions of communication with their regular pediatric health care providers, including the provision of recommendations for weight-related behaviors, the value associated with that advice in terms of influence on behavior and decision-making, and satisfaction with the quality and quantity of the information provided. Using questions adapted from the Primary Care Assessment Survey (PCAS) and the Health Care Climate Questionnaire (HCCQ) parents reported how much relational support they received from their providers, including assessments of provider-parent communication, interpersonal treatment, trust, satisfaction with care, autonomy support, knowledge of the patient/family, and overall satisfaction with care. Parents also reported child food consumption (both obesogenic and anti-obesogenic foods), daily minutes of physical activity, and daily minutes of TV viewing. Hierarchical multivariate regression analyses indicated that the provision of weight-related recommendations specific to a type of weight-related behavior did not significantly predict the enactment of those behaviors one year later, in the presence of other informational and relational variables. Parental perception that their health care provider discussed the risks and consequences of being overweight predicted decreased obesogenic food consumption, but increased TV viewing behavior. Parental satisfaction with the quality of information provided predicted an increase in child physical activity. Satisfaction with information quantity, however, predicted decreased amounts of activity. The influence provider advice had on parental decisions about child behavior predicted decreased amounts of TV viewing and decreased child BMI percentile. Contrary to the hypothesis, better parent assessments of the provider-parent relationship at Time 1 predicted increased consumption of obesogenic foods and Child BMI percentile one year later. None of these factors predicted child changes in the consumption of fruits and vegetables. Overall, the results of this study present the possibility that focusing too much on simply providing information to families, or on developing/maintaining provider-parent relationships, may not result in positive weight-related outcomes for child patients, and may under some circumstances have a negative impact on changes in child weight and weight-related behaviors. Additional research should be undertaken to determine how parents judge informational value and influence, and how pediatric health care providers can tailor their communication strategies to increase the perceived value of their messages.
Childhood obesity, Child Body Mass Index (BMI), Child weight, Weight-related behavior, Family-centered care, Family-centered communication, Pediatric communication, Provider-parent communication, Pediatric information sharing, Relationship-centered care, Primary Care Assessment Survey (PCAS), Health Care Climate Questionnaire (HCCQ), Physical activity, TV viewing, Fruit and vegetable consumption, Obesogenic food consumption, Provider-parent relationship
University of Illinois - Urbana-Champaign
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University of Illinois at Urbana-Champaign