Conversation Cards for Adolescents^©: a patient-centered communication and behavior change tool for adolescents with obesity and health care providers

ABSTRACT

Background: Health care providers (HCPs) report barriers to effective communication with adolescents with obesity when discussing lifestyle behavior change and may benefit from tailored health communication tools to use during consultations with this uniquely challenging group of patients. Our purpose was to describe the content, design, production, dissemination, and application of Conversation Cards for Adolescents^© (CCAs), a patient-centered, bilingual (English and French) tool intended to facilitate adolescent-HCP communication as well as lifestyle and behavior changes among adolescents with obesity.

Methods: Our multiple mixed-methods, cross-language, and patient-oriented research included three interrelated steps and was conducted in 2018–19 with 19 adolescents with obesity, 3 HCPs, and profit and non-profit organizations. These included data prioritization activities (Step 1), semi-structured telephone interviews (Step 2), and production and dissemination in collaboration with Obesity Canada (Step 3).

Results: In Step 1, adolescents prioritized 153 barriers, enablers, and recommendations related to the adoption of healthy lifestyle behaviors among adolescents with obesity. In Step 2, adolescents, HCPs, and researchers co-designed CCAs, which resulted in creating a hard copy deck of 45 cards organized into seven suits that were equally distributed across three categories (barriers, enablers, recommendations). In Step 3, 500 English and 200 French copies of CCAs were refined, produced and disseminated online.

Conclusions: Our research generated a practical, patient-centered, bilingual tool for HCPs that was designed to optimize clinical communication and tailored messaging for lifestyle behavior change among adolescents with obesity.

KEYWORDS:

• Adolescent
• health Services
• life Style
• obesity
• Bilingualism

Acknowledgements

The authors wish to thank all adolescents, their parents, and HCPs for participating in this study. They also wish to thank Ms. Charmaine Mohipp (Centre for Healthy Active Living, Children’s Hospital of Eastern Ontario, Ottawa, ON) for helping with research ethics documentation and participant recruitment. MK was funded by a Canadian Institutes of Health Research Frederick Banting and Charles Best Canada Graduate Scholarships-Doctoral. SDS was supported by a Canada Research Chair (Tier 2) in Knowledge Translation in Children’s Health. GDCB was supported by an Alberta Health Services Chair in Obesity Research. MK and GDCB conceptualized and designed the study. MK collected and analyzed the data, drafted the initial manuscript, and reviewed and revised subsequent versions. AP and CR assisted with data analysis. AB was the Ottawa-site study lead and provided methodological feedback on the interview process. TLFM, SDS, and MPD provided expertise in knowledge syntheses and qualitative inquiry, including feedback on interview guides. MK, TLFM, MPD, and GDCB contributed to acquisition of grant funding. All authors read, edited, and approved the final manuscript. MK and GDCB accept direct responsibility for the manuscript.

Disclosure of interest

M Kebbe and GDC Ball worked in partnership with Obesity Canada to distribute Conversation Cards for Adolescents^© through their online store of educational tools and resources. No honorarium or other form of payment was given to anyone involved in the preparation of this study. All other authors declare that they have no competing interests.

Notes on contributors

Dr. Maryam Kebbe is Postdoctoral Fellow in the Department of Pediatrics, Faculty of Medicine & Dentistry, at the University of Alberta and lead in the development and evaluation of Conversation Cards for Adolescents©. Dr. Kebbe’s work in clinical and health services research focuses on improving the efficiency and effectiveness of healthcare professionals and the health care system through changes to practice and policy to ultimately improve Canadians’ health and well-being. Particularly, she has led and contributed to studies related to disease prevention and management, patient engagement, patient access to care, parenting, health communication and collaboration, and family motivation in the context of adult, childhood, and adolescent obesity. Dr. Kebbe has expertise across methodologies, including knowledge synthesis, mixed-methods research (qualitative and quantitative inquiry), cross-language and patient-oriented research, and clinical trials.

Dr. Arnaldo Perez is currently appointed as Educational Methodologist in the Department of Dentistry, Faculty of Medicine & Dentistry, at the University of Alberta. Dr. Perez’ research involvements range from dental education to engagement, attrition, and retention in treatment for pediatric weight management with particular emphasis on conceptual and theoretical frameworks.

Dr. Annick Buchholz is Clinical Psychologist and lead in outcomes management and research at the Centre for Healthy and Active Living (CHAL). Dr. Buchholz co-leads the development and evaluation of the prevention program 'BodySense', a program aimed at promoting healthy body image in athletes. Dr. Buchholz is also a co-investigator on the Research on Eating Disorders and Adolescents Lifestyle (REAL) study, a longitudinal study examining shared risk factors between eating disorders and obesity in a sample of Canadian youth from the Ottawa region. More recently. Dr. Buchholz has been co-leading the newly formed Pediatric Research on Eating Disorders and Obesity (PREDO) unit, the first collaboration of its kind in Canada, unifying researchers and clinicians from the Eating Disorders Program (EDP), the Centre for Healthy Active Living (CHAL), the Healthy Active Living and Obesity Research Unit (HALO). The overarching goal of this endeavor is to build a strong program that informs prevention, policy, research, and treatment regarding the joint risk factors associated with eating disorders and obesity. Finally, Dr. Buchholz is a co-investigator with CANPWR, the Canadian Pediatric Weight Management Registry for pediatric obesity.

Dr. Tara-Leigh F McHugh is Associate Professor in the Faculty of Kinesiology, Sport, and Recreation at the University of Alberta. Dr. McHugh’s research is focused on enhancing the sport, physical activity, and body image experiences of youth. Through qualitative and collaborative research approaches Dr. MChugh’s research provides an in-depth exploration of the psychosocial aspects of such experiences. Dr. McHugh has extensive experience working with Indigenous youth, and her commitment to community-based approaches and the sustained engagement of local Indigenous experts has supported the success of her nationally funded program of research.

Dr. Shannon D Scott is Professor in the Faculty of Nursing at the University of Alberta and Canada Research Chair for Knowledge Translation in Child Health. Dr. Scott’s ECHO (translating Evidence in Child Health to improve Outcomes) research program focuses on knowledge translation in pediatric health settings to improve outcomes for children, their families, and the health care system. In her research program, Dr. Scott explores the reasons why research is used or not and what facilitates and hinders this process, with a particular focus on elements of the context or work environment.

Dr. Caroline Richard is Assistant Professor in the Faculty of Agricultural, Life & Environmental Sciences at the University of Alberta and Canada Research Chair in Nutritional Immunology. Dr. Richard’s overall research program aims to study the role of nutrition on immune function in the context of chronic diseases including obesity, metabolic syndrome, and type 2 diabetes. More specifically, how specific dietary interventions can improve immune dysfunction related to chronic diseases. Dr. Richard uses two approaches to answer research questions: control feeding studies in humans and mechanistic animal models. Dr. Richard has developed a variety of expertise during her career related to the cardiometabolic health including on common cardiovascular risk factors, the intravascular lipid metabolism and inflammation. The impact of targeted nutritional intervention on the overall cardiometabolic health and understanding the relationship between the cardiovascular system and the immune system is a pivotal component of her research. The other area of Dr. Richard’s research program centers on the effect of nutrition on maternal and infant health. In particular, how dietary interventions (during pregnancy and lactation) impact the development of the immune system in offspring (programing effect).

Dr. Michele Dyson is currently appointed as Assistant Professor for the Alberta Research Centre for Health Evidence in the Division of Pediatric Emergency Medicine in the Faculty of Medicine & Dentistry. Dr. Dyson has methodological expertise in knowledge synthesis, mixed-methods research, clinical trials, and implementation research.

Dr. Geoff Ball is Professor in the Department of Pediatrics at the University of Alberta and Alberta Health Services Chair in Obesity Research. Dr. Ball leads a national program of clinical and health services research focused on the management and prevention of obesity in children and their families. Dr. Ball's research applies several methodological approaches, including clinical trials, qualitative inquiry, epidemiology, and literature reviews that are designed to generate, translate, apply, and disseminate new knowledge that can optimize obesity prevention and management for children and families.

Additional information

Funding

This research was supported by an operating grant from the Health Outcomes Improvement Fund, Maternal Newborn Child Youth Strategic Clinical Network, Alberta Health Services (RES0033207). These funders did not play a role the design of the study and collection, analysis, and interpretation of data and in writing the manuscript.