By Lindsay Tiffany, Communications Specialist, NACCHO

The following post is part of a series of interviews with local health department (LHD) staff who will present at the 2015 NACCHO Annual conference. This post offers a preview of the session “Pediatrician Perception of the LiveWell Greenville “At the Doctor” Toolkit in Improving Patient Communication Regarding Healthy Lifestyle Behaviors,” which will explore a successful collaboration between a healthy living coalition and pediatric care providers aimed at lowering rates of overweight and obesity in children. NACCHO Voice spoke with speakers Sally Wills, MPH, Executive Director, LiveWell Greenville; Melissa Fair, MPH, Evaluation Coordinator, LiveWell Greenville; Alicia Powers, PhD, Associate Professor of Health Sciences, Furman University, and Principal Investigator, Evaluation Director, LiveWell Greenville; and Rhonda Felder, PhD, MPT, Program Evaluator, LiveWell Greenville.

• Thanks so much for speaking with me. To start, please describe both LiveWell Greenville and the At the Doctor Toolkit.

Sally Wills: LiveWell Greenville is a community coalition made up of over 150 partners in Greenville, SC. We focus on healthy eating and active living and try to impact those areas by creating policy, systems, and environmental (PSE) change in five settings: healthcare, schools, after-school programs, at the workplace, and faith communities. Our partners have been together since 2010 working toward PSE changes to help make the healthy choice the easy choice.

The At the Doctor Toolkit was developed with pediatricians. It came about when pediatric professionals started to notice a change in a child’s BMI, particularly in the upward direction toward overweight and obese, and wanted some resources at their disposal to immediately help address some of the behaviors related to overweight and obesity.

LiveWell Greenville investigated a variety of different resources that are out there and came up with a toolkit out of Maine, which was the 5-2-1-0. It stands for five fruits and vegetables per day; two hours or less of screen time per day; at least one hour of physical activity per day; and zero calories from sugar-sweetened beverages. In addition to that, we developed based on feedback from parents and healthcare providers a second set of guidance about the types of foods parents should be feeding their kids at different ages. Those pieces come together to represent the physical toolkit.

The toolkit was distributed in combination with motivational interviewing training for each of those providers—it wasn’t just a matter of handing a few brochures to a parent or child and saying, “Here, go change.” It was developed with the mindset that through motivational interviewing, providers could really get at the root causes the child might be dealing with and then work with the child and parent to figure out the behaviors they could work on. That conversation was noted in the child’s chart so that when he or she came back for a visit, the provider could follow up and identify progress.

Melissa Fair: Rhonda and I have done a lot of research [into similar toolkits] and ours was probably the first comprehensive approach, which incorporated not only physician educational materials and patient and family educational materials but also motivational interviewing training and a technique to communicate with the family. It’s a well-rounded package.

• How did you approach your collaboration with healthcare practitioners to facilitate community health promotion efforts?

Alicia Powers: One of the keys to our partnership is we had a champion pediatrician who provided a key link between the pediatric providers here in Greenville and LiveWell Greenville. She was integral in making sure the toolkit was developed appropriately for pediatric care providers’ use. It wasn’t something we developed and were trying to push onto them. Our champion pediatrician was the one who went into these pediatric offices and gave them the resources and the toolkit with the motivational interviewing skills and pushed for consistent BMI screenings. She was probably the most important component of our partnership.

Wills: We had several pediatric practices involved as well as the Greenville County Medical Society, several hospital representatives, and the health department. The Piedmont Health Foundation was one of the key partners that brought everybody together in the very beginning. This group of partners within LiveWell Greenville is what we refer to as the At the Doctor Workgroup.

Powers: Another key to our success is that all of our pediatric providers are under one healthcare system.

• What was the impact of the “At the Doctor” toolkit?

Rhonda Felder: We were really excited with our feedback. We fielded an evaluation survey to see what pediatric care providers thought of the toolkit and how they were using it. We received a 48% response rate (i.e., 73 practitioners). In addition to Likert scale questions, we also gave them space to write comments and many people did, which really shaped our next steps. What we discovered was that (1) providers were really excited about having a BMI tool; (2) the toolkit reminded them to check BMIs if they weren’t already doing so; and (3) the toolkit provided them with a standardized way to do it. They expressed that the motivational interviewing would be useful but didn’t understand well how to use it. Because of that feedback, we implemented additional motivational interviewing training in 2013.

A few other comments we received were that care providers need more resources for older kids and we were able to shape the toolkit based on their feedback. Another interesting thing was that respondents asked for recreational opportunities and family activities to recommend to their patients. One of the things that LiveWell Greenville developed was a LiveWell Near You map to help families locate parks and recreation sites, walking trails, elementary school playgrounds, and more that were open.

Powers: We did not collect data from the medical records to track BMIs. We do collect youth BMI data in the county through the school system. So we’ll be able to track BMIs over time eventually but we’re not able right now to tie those outcomes directly to At the Doctor. Because we have so many efforts going on through the LiveWell Greenville coalition, from the evaluation perspective we try to evaluate specific programs and then have some higher-level metrics. We look at how collectively we’re impacting the health of the county.

• How can public health professionals replicate the success of your toolkit?

Felder: The most important thing was having that champion, our pediatric partner, who was essential to getting us into the care providers’ offices and helping us sell them the idea of the toolkit. I know how busy pediatric care providers can be. When the information comes from one of your own, it’s more impactful. I think if LiveWell had gone to the offices directly, it would not have worked as well.

Wills: The physician perspective on how we should develop the training was as crucial as the fact that she provided the training. She knew how that information would be received. We were ready to give her the resources she needed to make that happen.

Felder: Using existing resources that we know work was key. You don’t have to recreate the wheel. We maximized our time by using the existing 5-2-1-0 resources out of Maine, with permission of course.

Interested in more interviews with NACCHO Annual 2015 presenters? See more here.

To learn more about the outstanding learning opportunities at NACCHO Annual 2015, July 7–9 in Kansas City, MO, visit http://www.nacchoannual.org.