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Participation Results

During Study 3, pre and post questionnaires were administered before and after the screening to get a handle on reactions to the CARDIAC Project. Pre and post questionnaires were sent to parents and their 5th grade children. A separate “Post CARDIAC Survey” was included in the post questionnaires asking questions about the screening process, satisfaction with the screening, and rationale for participation and non-participation. The information below is derived from those particular questionnaires.                                                                

Most Common Reasons for Participating in CARDIAC
Parents
             
  • Concern about the child’s weight and lack of exercise.
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  • Family history of high cholesterol and diabetes.
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  • Parents felt comforted with their child’s school involvement with the project.
    •          
  • Provided an opportunity to learn about their child’s health.
    •          
  • Materials helped parents understand that children can have problems with cholesterol.
    •        
Children
             
  • Wanted to know if they were healthy.
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  • Wanted to know their cholesterol levels.
    •          
  • Wanted to learn more about their health.
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  • Thought CARDIAC would be fun. Parents wanted them to participate.
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Most Common Reasons for NOT Participating in CARDIAC
Parents
             
  • Were not familiar with the CARDIAC program.
    •          
  • Their child was concerned about the fingerstick.
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  • Their child was absent on Screening day.
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  • Chose to have cholesterol testing done at physician’s office.
    •        
Children
             
  • Afraid of needles and/or didn’t want to get fingerstick.
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  • The information about CARDIAC was lost or not given to parents.
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  • "Just didn’t want to".
    •        

Child and Parent FLP Completion Rates by CARDIAC Condition                                                                                                                                                                                                                                    

CARDIAC Year Counties # of Children Recommended for FLP # (%)Children Completing FLP # Parents Completing FLP # of Parents/Childb
7 Standard 376 26 (6.9%) 18 0.048
7 Tailoreda 353 33 (9.3%) 20 0.057
8 Standard 377 37 (9.8%) 14 0.037
8 Tailored 308 49 (15.9%) 50 0.162

a=Baseline year; Tailored counties adhered to Standard procedure. b=Because the true number of parents available for each recommended child is unknown, rates are calculated as the number of parents who complete the FLP/recommended child.
  1. FLP completion rates were not significantly different for children or parents across Standard and Tailored counties at baseline (year 7)
    2.  
  2. In year 8, children and parents in the Tailored condition had significantly higher completion rates than children and parents in the Standard condition (ps < .01 and .001, respectively). The Group X Time interaction was significant for parents (p < .001), but not children.

 

Year 7&8 participation rate graph (without Monroe and Pleasants)                                                                                                                  

Year Tailored Standard Traditional
7 (2004-2005) 60.15 60.95 50.85
8 (2005-2006) 63.88 62.39 45.76

Due to the observed influence of school size and the potential for other school-level variables to impact participation, child participation in CARDIAC screening was also analyzed at the level of the school. The figure below represents the Traditional (Non-NHLBI Counties), Standard, and Tailored child participation rates at the school level whiles controlling for school size.

Tailored school participation increased 3.73% from Year 7 to Year 8, while the Standard schools experienced a 1.44% increase. Although this difference was not statistically significant by analysis, there is a clear trend toward greater increases in participation for the Tailored schools; statistical power to detect differences at the school level was limited.

The potency of the Standard procedures for CARDIAC Screening recruitment appears to be best explained by two factors:

     
  • The inclusion of beliefs-based information in the CARDIAC Introduction materials (Talking Points and Teaching Poster), and
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  • The personal contact with the individuals being recruited (i.e., children). Although the Tailored materials contained an enhanced version of the beliefs-based information, this information was delivered in a less potent format (i.e., in print rather than in person), and the materials were thus responsible for more modest increases in participation.

 

Differences between CARDIAC Participants and Non-Participants

(Information from Post Health Belief Questionnaires Study 3)

Children who participated in CARDIAC and their parents were more likely to read the Tailored brochures about CARDIAC than non-participants and their parents. Children who participated in CARDIAC were more likely to have a regular health care provider than non-participants. Parents of CARDIAC participants were more likely to have insurance than parents of non-participants. Participating children were more likely to report that most of their friends participated in CARDIAC than non-participating children Participating children were more likely to want to know their cholesterol levels than non-participating children. Within the Tailored group only, parents of CARDIAC participants reported significantly higher BMIs than parents of non-participants (30.28 vs. 25.64). This finding suggests that the tailored materials are effective in encouraging parents who have weight problems to sign their children up for the CARDIAC Project.

Parents of children who participated in CARDIAC and were recommended for an FLP, reported making the following changes when interviewed by phone (Study 4):                                                                                                                                                                                     

Diet Exercise Health Care
Child 43% 39% 12%
Parent 22% 23% 4%
Other Family Members 45% 25% 8%
No Change 31% 46% 82%

POST CARDIAC Differences

(Information from Post CARDIAC Questionnaires; Study 3)

     
  • After CARDIAC, both parents of participating and non-participating children agreed that every parent should know their child’s cholesterol level.
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  • Parents of participants intended to get their child’s cholesterol checked over the next 6 months.
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  • Parents of participating and non-participating children perceived fewer barriers to having their own cholesterol checked.
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  • Participating children showed an intention to eat healthier after CARDIAC while non-participating children did not.

 

FLP Barriers and Facilitators

(Information from Follow-up Phone Calls with participating and non-participating parents; Study 4)

Barriers to the FLP 

  • Parents perceived several barriers to their children getting the Follow Blood Test, (multiple responses were listed for each participant):  
    • 63%: Time
    • 26%: Competing Activities
    • 14%: Didn’t feel it was necessary
    • 14%: Fear of needles/pain
    • 11%: Important others were against it (either pediatricians didn’t feel it was necessary or the other parents didn’t feel it was needed)
    • 6%: Lack of transportation
    • 6%: Distrust of Labs/MD/others

Facilitators to the FLP

  • Parents reported several factors contributing to their participation in the FLP:
    • 80%: Concern about child’s health
    • 43%: Family history of health problem
    • 11%: Important others recommended it
    • 8%: Materials about program
    • 6%: Test was free
      •