The Implementation of Support Calls in a Pilot Childhood Obesity Intervention

Low health literacy in parents has been linked to increased obesity risk for their children. When providing information to patients with low health literacy, teach-back (TB) and teach-to-goal (TTG) methods are recommended, but no studies have examined the degree to which TB/TTG strategies can be implemented with fidelity in community-based programs. A study was conducted to determine if type of delivery staff (community or research) is related to implementation fidelity; the degree to which TB/TTG methods are necessary for parent/caregiver understanding of childhood obesity learning objectives; and if baseline parent/caregiver health literacy level is related to support call response. Ninety-four families with overweight/obese children aged 8-12 years were enrolled in a pilot childhood obesity intervention that included 6 bi-weekly parent/caregiver support calls integrating TB/TTG methods into a 5 A's approach. Research partners (n=2) delivered all calls in Wave 1. During Waves 2 and 3, community staff (n=5) delivered a majority of calls with training and support from research staff. ). Average completion rate across calls was 62% and did not differ according to participant health literacy level. Community partners were more likely than research partners to complete calls with participants (68% versus 57%), but this trend was not significant. Both research and community partners adhered to call scripts with high fidelity (97% versus 98%). A significant main effect of health literacy level on TB/TTG performance was found for Call 1 and Call 3 during Wave 1 and for Call 1 during Waves 2 and 3 of iChoose (p<0.05, 0.01, and 0.05). An interaction effect of health literacy level and question number was found for Call 3 during Wave 1 only (p<0.05). For all calls in which TB/TTG performance differed significantly by health literacy level, participants with adequate health literacy were found to have better performance. Following the program, participants expressed they felt satisfied and comfortable with follow-up calls (9.1 (2.0) and 9.5 (1.2) on a 10-point scale), while agreeing that calls helped improve their eating and PA habits (8.1 (2.6) and 7.5 (2.7)) and helped them learn class material better (8.1 (2.7)). Trained community partners were able to deliver the same support call content with similarly high fidelity, completion, and acceptability. Although participant baseline health literacy level had less impact on the need for TB/TTG and on program perception than we anticipated, our findings open up different possibilities to utilize these strategies while using precious resources more efficiently.