masthead

CONTENTS OF THIS ISSUE

Spring 2019 Issue

Volume 11 | Number 2

Print page  
PRINT PAGE

Original Manuscript

Project HAPPY: A Navigator’s Perspective

Kathleen Winger, OMS III
Tami Hendriksz, DO, FACOP, FAAP

Abstract

Objective
Project HAPPY (Healthy Attitudes Produce Positive Youth) is a school-based, family-centered pilot program designed to address the concerns of childhood obesity and related sequelae in a diverse community. This study explores the sustainability of newly established attitudes in a family-based setting, evaluates effects of healthy food alternatives and barrier recognition, evaluates the impact and perceptions of parents’ behavior on children’s behavior and explores the impact of creating a social support system within the community for continued healthy behaviors.

Methods
This was a program evaluation conducted at Elsa Widenmann Elementary School in Vallejo, California. Study participants included seven students enrolled at Elsa Widenmann between Kindergarten and sixth grade, along with members of their families. All participants took part in a six-week “Wellness” Education Program with established lessons focused on making healthy dietary and lifestyle choices and promoting a more positive mindset towards these choices. Each family was assigned to a navigator, a first-year medical student from Touro University California College of Osteopathic Medicine, with whom they worked for the duration of the program. The navigators served to guide each family through the curriculum and provided support by taking into account the individual family’s culture, dynamics and needs.

Results & Conclusion
The Project HAPPY pilot study served  to bolster both parents’ and children’s knowledge and self-efficacy regarding healthy eating and exercise habits. Navigators gained confidence in their ability to counsel families in their health, connect different topics in regard to preventative health and understand the structures that shape clinical interactions. The success of this pilot study allowed for funding of a full-scale (12-week) Project HAPPY cohort which will more formally examine the impact on the families as well as the medical students involved. 

Manuscript
There have been a number of programs designed and developed to address the pediatric obesity epidemic. Nearly one out of every five children today meets the criteria for obesity in the United States.1 The long term health consequences associated with childhood obesity are extensive and include diabetes, high cholesterol, hypertension, heart disease and obstructive sleep apnea. The feelings of isolation and alienation that these children often experience can lead to depression, suicidal ideation and uncontrolled eating behaviors.2-7 Current research has demonstrated that obesity prevention and treatment programs can be successful when targeted at younger (<12 years old) age groups and continued for a minimum of six weeks. Meeting with groups of children at one time (as opposed to individual pediatric office visits) can help to expand the social network for the children involved, decrease some of the stigma attached to pediatric obesity and help to vitalize pediatric obesity prevention and treatment. Further, involving the children’s family at young ages is key to success; this helps to create a sustainable environment that promotes a healthy lifestyle even after completion of the program.8-11  As introduced in a prior edition of the American College of Osteopathic Pediatricians eJournal, Project HAPPY (Healthy Attitudes Produces Positive Youth) is a community-based, family-centered pediatric obesity prevention program for Solano County residents that was designed to follow those best practices described above.12  This manuscript represents the reflections and experiences of one of the medical students who helped to lead that pilot study. 

Project HAPPY explores the established concept of sustainability of newly established attitudes in a family-based setting, evaluates effects of healthy food alternatives and barrier recognition, evaluates the impact and perceptions of parents’ behavior on children’s behavior and explores the impact of creating a social support system within the community for continued healthy behaviors.13,14 In addition to the community impact, it also provides first year medical students at Touro University California the opportunity to assume a professional role as family navigator and develop communication and patient education skills as they guide families in their decisions to make healthy dietary and lifestyle choices.

This was a program evaluation conducted at Elsa Widenmann Elementary School in Vallejo, California. Study participants included seven students enrolled at Elsa Widenmann between Kindergarten and sixth grade, along with members of their families. The Touro University California Institutional Review Board approved this program and informed consent was obtained by having all participants sign forms that detailed the program along with its benefits and risks. All participants took part in a six-week “Wellness” Education Program with established lessons focused on making healthy dietary and lifestyle choices and promoting a more positive mindset towards these choices. Each family was assigned to a navigator, a first-year medical student from Touro University California College of Osteopathic Medicine, with whom they worked for the duration of the program. The navigators served to guide each family through the curriculum and provided support by taking into account the individual family’s culture, dynamics, and needs.

In addition to providing health education to the participants, the study served as a service-based learning experience for navigators. From the medical student perspective, the opportunity to counsel families regarding their health allowed first year medical students to increase their confidence in their ability to provide patient education while gaining empathy toward patients and their families. As this was the pilot program, navigators had the unique opportunity to collaborate in the creation of the curriculum, thereby gaining a deeper understanding of the current literature supporting the guidance provided to families and the confidence gained from helping to build the program on a solid evidence-based platform. Establishing a rapport with families allowed insight into barriers the community may face (such as the local food deserts and limited free-time busy working families have),while ultimately supporting the ability of future healthcare providers to operate within the structural competency paradigm. Engaging with the community in a long-term professional regard served as a positive reminder for why students entered medical school and helped reduce feelings of burnout.

The Project HAPPY pilot study served  to bolster both parents’ and children’s knowledge and self-efficacy regarding healthy eating and exercise habits. Navigators gained confidence in their ability to counsel families in their health, connect different topics in regard to preventative health and understand the structures that shape clinical interactions. The success of this pilot study allowed for funding of a full-scale (12-week) Project HAPPY cohort which has been designed to more formally examine the impact of participation in Project HAPPY on the families as well as the medical students involved. In this way, the anecdotal gains that were observed and experienced by the medical student navigators involved in the pilot study can be validated and highlighted. Project HAPPY has the potential to be a program that helps address the pediatric obesity epidemic while also decreasing burnout and increasing empathy in future physicians. Future studies will continue to look at both the community members who participate in the program as well as the medical student volunteers.

Acknowledgments – We would like to acknowledge all of the medical students and Vallejo community members who have participated in Project HAPPY and helped to make it the valuable and impactful program that it is today.

References

  1. Childhood Obesity Facts. (2018, 1 29). Retrieved 10 15, 2018, from Centers for Disease Control and Prevention: https://www.cdc.gov/healthyschools/obesity/facts.htm
  2. Narang I, Mathew JL. Childhood obesity and obstructive sleep apnea. J Nutr Metab. 2012; doi: 10.1155/2012/134202.
  3. Pollock NK. Childhood obesity, bone development, and cardiometabolic risk factors. Mol Cell Endocrinol. 2015;410:52-63. doi: 10.1016/j.mce.2015.03.016.
  4. Africa JA, Newton KP, Schwimmer JB. Lifestyle interventions including nutrition, exercise, and supplements for nonalcoholic fatty liver disease in children. Dig Dis Sci. 2016;61(5):1375–1386.
  5. Morrison KM, Shin S, Tarnopolsky M, et al. Association of depression and health related quality of life with body composition in children and youth with obesity. Journal of Affective Disorders 2015;172:18–23.
  6. Halfon N, Kandyce L, Slusser W. Associations between obesity and comorbid mental health, developmental, and physical health conditions in a nationally representative sample of US children aged 10 to 17. Academic Pediatrics. 2013;13.1:6–13.
  7. Beck AR. Psychosocial aspects of obesity. NASN Sch Nurse. 2016;31(1):23–27.
  8. Gordon-Larsen P, The NS, Adair LS. Longitudinal trends in obesity in the United States from adolescence to the third decade of life. Obesity. 2010;18(9):1801-–804.
  9. David M. Janicke, Ric G. Steele, Laurie A. Gayes, Crystal S. Lim, Lisa M. Clifford, Elizabeth M. Schneider, Julia K. Carmody, Sarah Westen.  Systematic Review and Meta-Analysis of Comprehensive Behavioral Family Lifestyle Interventions Addressing Pediatric Obesity, Journal of Pediatric Psychology, Volume 39, Issue 8, 1 September 2014, Pages 809–825, https://doi.org/10.1093/jpepsy/jsu023
  10. Ann M. Davis, Marina C. Daldalian, Carlene A. Mayfield, Kelsey Dean, William R. Black, Marilyn L. Sampilo, Martha Gonzalez-Mijares, and Richard Suminski.Outcomes from an Urban Pediatric Obesity Program Targeting Minority Youth: The Healthy Hawks Program Childhood Obesity 2013 9:6, 492-500
  11. Sung‐Chan, P. , Sung, Y. W., Zhao, X. and Brownson, R. C. (2013), Family‐based models. Obes Rev, 14: 265-278. doi:10.1111/obr.12000
  12. Shenoi S, Yu K, Winger K, and Hendriksz T.  Project HAPPY (Healthy Attitudes Produce Positive Youth): A Pilot Study.  eJournal of the American College of Osteopathic Pediatricians.  2018 Fall (10, 3).
  13. Hendy, Helen M., Keith E. Williams, and Thomas S. Camise. Kid's Choice Program improves weight management behaviors and weight status in school children. Appetite. 2011. 56(2): 484-494.
  14. Gatto, N.M., et al.  LA Sprouts Randomized Controlled Nutrition, Cooking and Gardening Programme Reduces Obesity and Metabolic Risk in Hispanic/Latino Youth. Pediatric Obesity. 2017. 12(1): 28–37., doi:10.1111/ijpo.12102.

Back to top

Mission

The mission of the ACOP eJournal  is to serve as a mentor. The journal will strive to act as a teaching portal for those students, fellows and attending physicians who strive for, and have a thirst for, a scholarly existence.

Contribute to YOUR eJournal

Click Here
to submit a manuscript
for consideration


 

YOUR eJOURNAL IS NOW AVAILABLE ON YOUR SMARTPHONE AND TABLET!

 

member app


Get the
FREE ACOP
Membership App

FREE download
available from:

 


JOIN ACOP TODAY!

CLICK HERE


ACOP Pediatric Trac at OMED 18

ACOP Pediatric Track at OMED '19
October 24-28, 2019
Baltimore, Maryland

CLICK HERE
to view the
Mobile Meeting Guide

CLICK HERE
to Register