Decreasing Obesity Rate in Children

Summary, Conclusions, and Recommendations

This DPI project is concerned with the exploration of the impact of the educational intervention aimed at decreasing BMI by reducing caloric intake and enhancing physical activity among Hispanic elementary-school children with obesity. The prevalence of this disorder and its comorbidity among US children is still alarming as approximately 20% of American children and adolescents are obese (Hales et al., 2017). Although the overall increase in the rate of affected children is insignificant, some populations are at a higher risk of obesity development. Hispanic children are vulnerable due to certain socioeconomic and cultural factors (Ogden et al., 2014). Parents have a considerable effect on their children’s dietary intake and physical activity as families are some of the primary platforms for the development of eating habits and lifestyles (Liu et al., 2018). Therefore, it is critical to make sure that parents have the necessary skills and knowledge to contribute to the creation of proper dietary and physical activity patterns. Although some studies have addressed the issue and examined the effectiveness of educational interventions, the outcomes of an educational program for Hispanic elementary-school children are still unidentified.

The Parent Training (PT) Program developed by Slusser et al. (2012) was modified to meet the needs of the Hispanic elementary-school children residing in Charlotte, NC. Although the PT Program has proved to reduce children’s BMI, it involved younger children with obesity and was characterized by a one-year duration. This DPI project aimed at exploring the effects of a one-month educational project on children’s BMI through shaping their physical activity and dietary intake. It was important to obtain quantitative data to create an intervention that could be employed state- or even nationwide. The developed educational program can be an affordable project that will be provided to Hispanic parents of school-aged children in the clinical setting.

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INTRODUCTION
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Summary of the Project

The purpose of this DPI project was to examine the effects of an educational intervention provided to parents on their elementary-school Hispanic children’s BMI through shaping their dietary behaviors and physical activity. The clinical question for this project was: For parents of elementary school-aged Hispanic children from low-income families, will Parent Training Program, compared to no session be effective in controlling and decreasing the BMI in one month? In order to address this clinical question, a quantitative quasi-experimental project was implemented. This project involved the analysis of dependent variables including children’s BMI and their physical activity. The target populations’ BMI was calculated by their parents and reported before the start of the educational intervention and after its termination. The measurement of children’s physical activity was conducted with the help of Physical Activity Questionnaires (PAQ) designed for children. The independent variables were the intervention.

The overall number of participants was 40 parents of Hispanic elementary-school children. The participants had two or three sessions of the PT Program each week during one month. Each educational session was devoted to a specific topic associated with obesity, its treatment, healthy eating and lifestyle, as well as shaping behaviors. Before the start of the intervention, the parents completed PAQs and BMI reports. Self-reporting was chosen as a data collection method because it was validated by many studies related to eating behaviors and lifestyle changes (Olfert et al., 2018). The analysis of the collected data was conducted with the help of SPSS, which enhanced the validity of the findings.

This chapter includes the discussion of the results of the project and the implications for practice and research. The findings are analyzed and put into the context of the existing interventions aimed at reducing children’s BMI. Conclusions concerning the impact of the intervention on children’s dietary intake and physical activity are drawn. Theoretical and practical implications of this DPI project are discussed in detail. Several recommendations regarding the implementation of the project are also provided in this chapter.

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SUMMARY OF THE PROJECT
Reminds the reader of the clinical question(s) and the main issues being evaluated.
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Summary of Findings and Conclusion

This DPI project was instrumental in identifying the outcomes of the PT Program provided to parents of Hispanic elementary-school children. Although Kim et al. (2016) found that educational interventions shorter than five weeks can hardly be effective, specific improvements regarding children’s BMI and physical activity were apparent. The statistically significant reduction of children’s BMI and an increase in their physical activity were detected. These findings are consistent with the results of several studies aimed at evaluating the effectiveness of similar interventions (Knol et al., 2016; Clarke et al., 2015). This DPI project proves that both BMI and children’s physical activity are affected by the program, which is in conflict with the findings of Bagherniya et al. (2017) who identified no correlation between a similar educational intervention and children’s physical activity patterns. This project also provided evidence to support the assumption that parental involvement is one of the most influential factors affecting the outcomes of the interventions targeting obese children. It is possible to conclude that this intervention can potentially have a considerable positive effect on public health linked to a specific population with a particular health concern.

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Summary of Findings and Conclusions
This section is organized by clinical question(s), and it conveys the specific findings of the project. It presents all conclusions made based on the data analysis and findings of the project. It relates the findings back to the literature, significant chapters in Chapter 1, and advancing scientific knowledge in Chapter 1.
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Organized by the same section titles as Chapter 4, clinical question(s) or by themes. 2 Remind the reader of the clinical question again.
Significant themes/ findings are compared and contrasted, evaluated and discussed in light of the existing body of knowledge. Identify themes associated with your findings when you obtain results.
Significance of every finding is analyzed and related to the significance section and advancing scientific knowledge section of Chapter 1. Discuss the information you provided in the Significance of Project section and relate your project results.
The conclusion summarizes the findings, refers back to Chapter 1, and ties the project together.
The findings are bounded by the DPI project parameters described in Chapters 1 and 3. Make sure you relate your findings to the information you provided in Chapters 1 and 3.
The findings are supported by the data and theory, and directlyrelate to the clinical question(s).
No unrelated or speculative information is presented in this section. Currently, the information you provided is speculative.
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Implications

The suggested intervention proved to be effective in the target population, which makes it possible to utilize the program in various settings. The project has several theoretical and practical implications that have to be mentioned. This educational intervention is designed for the clinical setting, so its implications are mainly related to this area. The major stakeholders include children, parents, medical staff, and healthcare facilities’ administrations.

Theoretical implications. This DPI project has well-pronounced theoretical implications. The social cognitive theory was an appropriate theoretical underpinning of the program aimed at shaping people’s behaviors as parents gained certain knowledge and skills, which led to the shift in their children’s physical activity and dietary patterns. The SCT has been widely used in studies aimed at changing people’s behavior, as well as attitudes towards certain phenomena, lifestyles, and activities (Knol et al., 2016; Bagherniya et al., 2017; Lee et al., 2017). It has been acknowledged that the focus on behaviors and attitudes is beneficial when addressing obesity (Lee et al., 2017). However, this project also unveiled an important weakness of the theoretical paradigm mentioned above. Although the SCT can be utilized in such studies, it is important to pay specific attention to motivating participants to remain active throughout the entire project, which was also mentioned by Bagherniya et al. (2017). Self-reporting can be regarded as an efficient tool to be utilized in the studies involving parents as the participants reveal their interest in real data rather than distorted information. The weakness of the instruments chosen for this DPI project was its reliance on purposive sampling that can undermine the generalizability of the findings.

Practical implications. The practical implications of this DPI project are manifold and can have a positive effect on nursing practice. One of the primary benefits of this intervention is its affordability and applicability for various healthcare facilities. The nursing staff can also be properly prepared to implement the project due to the availability of resources since the PT Program has already been described in several studies including this project (Slusser et al., 2012; Lee et al., 2015). In addition, healthcare facilities will be able to improve the quality of the services they provide through the delivery of educational intervention that results in positive outcomes of public health.

This project can also be utilized in the educational setting as schools may offer the program evaluated in this project for their overweight students or those diagnosed with obesity. As mentioned above, school-based interventions targeting students’ lifestyle and dietary intake have proved to be more effective than those based in clinical, home, or other settings (Weihrauch-Blüher et al., 2018). Students and their parents are accustomed to their school environment and often find school-based programs more convenient, which has a positive effect on their motivation, engagement, and compliance (Weihrauch-Blüher et al., 2018). Therefore, educational facilities could benefit from the implementation of the PT program that can be modified to address the specific needs of the population. School nurses will play the central role in the application process, so they will need the corresponding training.

Future implications. Further steps in the area may involve the focus on generalizability and people’s attitudes. First, it is necessary to implement a project that will involve a considerable sample. The intervention can also be conducted in different states to ensure that it can be effective irrespective of local peculiarities of the population. Furthermore, it can be beneficial to identify stakeholder’s views on the program, its weaknesses and outcomes.

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Implications
This section should describe what could happen because of this DPI project results. It also tells the reader what the research implies theoretically, practically, and for the future.
2 You are off to a good start. Once you have results, revisit this area and add some additional insight.
Provides a retrospective examination of the theoretical framework presented in Chapter 2 in light of the practice improvement project’s findings. 2
Critically evaluates the strengths and weaknesses of the project, and the degree to which the conclusions are credible given the methodology, project design, and data. 1 Apply your implications to your methodology, design, and data once you obtain data.
Delineates applications of new insights derived from the practice improvement project to solve real and significant problems. 2
Section is written in a way that is well structured, has a logical flow, uses correct paragraph structure, uses correct sentence structure, uses correct punctuation, and uses correct APA format. 2
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Recommendations

It is possible to provide several recommendations regarding the implementation of this project. Some of the major areas to focus on include the sample size, long-term effects, and stakeholders’ perspectives. Nurses and the administration of healthcare facilities should implement the offered PT program described that is affordable and easy-to-conduct. These steps can improve the analyzed intervention and address children’s obesity, which can have a lasting effect and persist in these children’s adulthood.

Recommendations for future projects. Future studies aimed at reducing obesity in children can employ a similar methodology but concentrate on enhancing the generalizability of the findings. Researchers should make sure that the interventions they develop can be utilized in various settings and address the needs of diverse populations. can explore the effects of the intervention by including a larger sample. It can be sufficient to include several hundreds of parents to obtain valid data unveiling the short-term effects of a program for a specific geographic location (Braden et al., 2015). In order to enhance the validity of this project, it is necessary to implement the intervention in diverse states and communities.

The offered program can also be applicable in other countries, although some slight modifications can be needed. Researchers in the UK, as well as other European countries, may be first to develop school-based interventions grounded on the PT program evaluated during this project. Later, other nationalities will also benefit from the use of the educational program. Clearly, these projects will be shaped to address the cultural peculiarities of school-aged children living in those states. It is also important to consider certain features of the educational settings of the countries with the focus on the role played by school nurses, curriculum, and resources.

Furthermore, it is essential to conduct a longitudinal study to examine the long-term effects of the educational intervention. Weihrauch-Blüher et al. (2018) note that projects targeting children’s dietary habits and physical activity tend to have short-term effects. Therefore, it is important to make sure that this intervention shapes parents’ and children’s behaviors affecting children’s health patterns. If children whose parents have participated in the project fail to maintain healthy lifestyles in their adolescence and adulthood, the project can be regarded as only partially effective.

The identification of stakeholders’ attitudes towards some aspects of the intervention will help in designing an effective educational intervention. Clarke et al. (2015) stress that parental involvement and their motivation play a substantial role in the success of the project. Therefore, it is critical to explore the reasons behind parents’ willingness to participate, commitment to the goals of the project, and their expectations regarding the outcomes of the intervention.

It is also important to pay attention to the medical staff’s perspectives, so a qualitative study involving the involved nursing professionals will be instrumental in identifying the program’s weaknesses. De Craemer et al. (2013) emphasize that the staff’s views can help in identifying ways to improve the training process to make parents more engaged. Nursing practitioners can also report any barriers to the successful implementation of the project.

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Recommendations for Future PROJECTS
This section should contain a minimum of four to six recommendations for future DPI projects, as well as a full explanation for why each recommendation is being made. The recommended project methodology/design should also be provided.
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Contains a minimum of four to six recommendations for future projects. 3
Identifies and discusses the areas that need further examination, or addresses gaps or new patient or system needs the project found. 2
Suggests “next steps” in forwarding this line of evidence and clinical implications. 2
Recommendations relate back to the project significance and advancing scientific knowledge sections in Chapter 1. 2
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Recommendations for practice. Nursing professionals can be regarded as the primary change agents who can benefit from implementing this project. The program is affordable and is rather short, so parents are likely to remain motivated, which will positively affect their children’s health outcomes. Nurses are often reluctant to implement and initiate any changes due to the lack of knowledge, experience, as well as the need to be involved in complex projects (Laws et al., 2015). This DPI project is an illustration of the way nurses can implement change and improve children’s health. The administration of healthcare facilities will also benefit from reading about this project findings. The affordability of programs is one of the most analyzed aspects that influences the decision regarding their implementation (Epstein et al., 2014). Medical centers can improve the quality of the provided services by offering certain populations to participate in the project. In this way, the healthcare system will address one of the most serious public health concerns affecting American children.

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Recommendations for Future Practice
This section should contain two to five recommendations for future practice based on the results and findings of the project, as well as a full explanation for why each recommendation is being made.
2 Be specific about how the project can impact future practice.
Contains two to five recommendations for future practice. 1 Identify 2-5 ways practice can be improved by the findings associated with your project and the information you gathered when developing the project.
Discusses who will benefit from reading and implementing the results of the project. 2 Will anyone else benefit from reading your project? Consider disciplines other than nurses. What about children of obese parents?
Discusses ideas based on the results that practitioners can implement in the work or educational setting. 1 How can others implement your intervention?
Unrelated or speculative information unsupported by data is clearly identified as such.
Recommendations relate back to the project significance section in Chapter 1. Remind the reader of the foundation you set in Chapter 1. How do your recommendations relate?
Section is written in a way that is well structured, has a logical flow, uses correct paragraph structure, uses correct sentence structure, uses correct punctuation, and uses correct APA format. 2
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References

Bagherniya, M., Taghipour, A., Sharma, M., Sahebkar, A., Contento, I. R., Keshavarz, S. A.,… Safarian, M. (2017). Obesity intervention programs among adolescents using social cognitive theory: A systematic literature review. Health Education Research, 33(1), 26-39. Web.

Braden, A., Strong, D., Crow, S., & Boutelle, K. (2015). Parent changes in diet, physical activity, and behavior in family-based treatment for childhood obesity. Clinical Pediatrics, 54(5), 494-497. Web.

Clarke, J. L., Griffin, T. L., Lancashire, E. R., Adab, P., Parry, J. M., & Pallan, M. J. (2015). Parent and child perceptions of school-based obesity prevention in England: A qualitative study. BMC Public Health, 15, 1224-1229. Web.

Epstein, L. H., Paluch, R. A., Wrotniak, B. H., Daniel, T.O., Kilanowski, C., Wilfley, D., & Finkelstein, E. (2014). Cost-effectiveness of family-based group treatment for child and parental obesity. Childhood Obesity, 10(2), 114-121. Web.

Hales, C. M., Carroll, M. D., Fryar, C. D., & Ogden, C. L. (2017). Prevalence of obesity among adults and youth: United States, 2015-2016. National Center for Health Statistics Data Brief, 288. Web.

Kim, H. S., Park, J., Park, K. Y., Lee, M. N., & Ham, O. K. (2016). Parent involvement intervention in developing weight management skills for both parents and overweight/obese children. Asian Nursing Research, 10(1), 11-17. Web.

Knol, L. L., Myers, H. H., Black, S., Robinson, D., Awololo, Y., Clark, D.,… Higginbotham, J. C. (2016). Development and feasibility of a childhood obesity prevention program for rural families: Application of the social cognitive theory. American Journal of Health Education, 47(4), 204-214. Web.

Lee, R., Leung, C., Chen, H., Louie, L., Brown, M., Chen, J. L.,… Lee, P. (2017). The impact of a school-based weight management program involving parents via mHealth for overweight and obese children and adolescents with intellectual disability: A randomized controlled trial. International Journal of Environmental Research and Public Health, 14(10), 1178-1196. Web.

Lee, S., Wong, J., Shanita, S., Ismail, M., Deurenberg, P., & Poh, B. (2015). Daily physical activity and screen time, but not other sedentary activities, are associated with measures of obesity during childhood. International Journal of Environmental Research and Public Health, 12(1), 146-161. Web.

Liu, Y., Ma, Y., Jiang, N., Song, S., Fan, Q., & Wen, D. (2018). Interaction between parental education and household wealth on children’s obesity risk. International Journal of Environmental Research and Public Health, 15(8), 1754-1764. Web.

Ogden, C. L., Carroll, M. D., Kit, B. K., & Flegal, K. M. (2014). Prevalence of childhood and adult obesity in the United States, 2011-2012. JAMA, 311(8), 806-814. Web.

Olfert, M., Barr, M., Charlier, C., Famodu, O., Zhou, W., Mathews, A.,… Colby, S. (2018). Self-reported vs. measured height, weight, and BMI in young adults. International Journal of Environmental Research and Public Health, 15(10), 2216-2226. Web.

Slusser, W., Frankel, F., Robison, K., Fischer, H., Cumberland, W. G., & Neumann, C. (2012). Pediatric overweight prevention through a parent training program for 2–4 year-old Latino children. Childhood Obesity, 8(1), 52–59. Web.

Weihrauch-Blüher, S., Kromeyer-Hauschild, K., Graf, C., Widhalm, K., Korsten-Reck, U., Jödicke, B., … Wiegand, S. (2018). Current guidelines for obesity prevention in childhood and adolescence. Obesity Facts, 11(3), 263-276. Web.

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