• Poster
  • October 1, 2012

Attrition and Retention in Pediatric Weight Management: A Multicenter Survey

Presented at Annual Leadership Conference, 2012

Sarah E. Hampl, MD, Medical Director, Weight Management, Children’s Mercy Hospitals and Clinics, Kansas City, MO
Erinn T. Rhodes, MD, MPH, Director, Type 2 Diabetes Program, Director of Endocrinology Healthcare Research and Quality, Boston Children’s Hospital, Boston, MA
 

The work presented in this poster was completed as a component of FOCUS on a Fitter Future II, the Children’s Hospital Association’s childhood obesity FOCUS Group.

Learning Objectives:

  1. Understand parental views on attrition from pediatric weight management programs 
  2. Understand parental-program staff communication upon discontinuation of treatment
  3. Identify steps to improve retention in pediatric weight management programs 

Introduction/Background:
Attrition from tertiary care pediatric weight management clinics and programs averages >50%, and threatens these programs’ sustainability. The FFF II retention subcommittee found that parental views on reasons for attrition was an understudied area. Thus, the subcommittee sought to assess parental views on attrition and suggestions for program improvement.

Initiative Description:
The subcommittee developed a telephone survey for parents of children who had attended less than 25% of program visits or who had not returned after an initial clinic visit. The survey assessed views of potential causes of attrition, including the domains of transportation, program characteristics, scheduling, finances, barriers to implementation of healthy lifestyles, mismatched expectations, communication with providers, parent and child physical/emotional health, and motivation. The survey also elicited parental suggestions on methods to increase retention and other program improvements. The survey was translated into Spanish and formatted in a manner to enable electronic transmission to a central coordinating center (Rainbow Babies and Children’s). The survey was then fielded from 13 FFF II hospitals. Additional information collected included child demographics and BMI at clinic/program initiation.

Innovation:
The study sought insight into reasons for program attrition from parents, who are key drivers of family-based change and instrumental in children’s success in weight management. The study was conducted among 13 sites, making it one of the few known multi-center studies from pediatric weight management programs.

Results/Outcomes or Potential Results/Outcomes:
147 parents were interviewed, 87% were mothers and children were significantly obese and ethnically diverse. Scheduling, barriers to implementation and transportation problems were identified as having a moderate or high influence on the decision not to return for at least 50% of respondents. Patient/family motivation and mismatched expectations were next most often reported. Parents of commercially insured, Caucasian patients most often reported mismatched expectations as moderately to highly influential. Parents of patients referred by a physician (vs. self-referred) more often reported that transportation was influential, and parents of patients seen in clinics (vs. programs) more often reported finances as influential.

Lessons Learned:
Our subcommittee worked out many of the logistics of conducting a multi-center study which will benefit us in our future endeavors together. Possible clinic/program changes in response to this study’s findings could include scheduling alternative times for visits, offering more treatment alternatives, breaking recommendations down into manageable goals and considering transportation and financial needs of families more carefully. Additionally, the area of mismatched parent/staff expectations warrants further study.

Future of Initiative/Next Steps:
The FFF III retention subcommittee is developing a survey to assess parent and child/teen treatment expectations at program initiation and self-reported progress in the expectation domains during the treatment process. Congruency of expectations and progress in these domains, and associations of expectation congruency with attrition and child/teen BMI will be assessed.