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FLP Barriers and Facilitators

Results

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

Barriers to the FLP   

  • Parents perceived several barriers to their child completing the Follow Up 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 parent didn’t feel it was needed)
  • 6%: Lack of transportation
  • 6%: Distrust of Labs/MD/ others

Facilitators to the FLP

  • Parents reported several factors contributed 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

   

CARDIAC Participation

Predicting CARDIAC Participation using the Theory of Planned Behavior

(Information from Health Beliefs Questionnaires; Study 3) 

Factors that predicted participation in CARDIAC Screening were:

  • Parents who identified fewer barriers to taking care of their child’s health.
  • Parents who reported a greater intention to participate in health screenings themselves.
  • Children who had a more positive attitude toward controlling cholesterol and avoiding heart disease.

Participation in CARDIAC Screening

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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 analyzed at the level of the school. The figure above represents the Traditional (Non-research Counties), Standard, and Tailored child participation rates at the school level while controlling for school size.

Tailored school participation increased 3.73% from the 2004-5 school year to 2005-6 school year, while the Standard schools experienced a 1.44% increase. Although this difference was not statistically significant by analysis, there is a 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
    •        
  • 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.
    •      

Changes in Families

Results

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

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

 

 

Child and Parent

Participation in CARDIAC Diagnosis*                                                

CARDIAC Year Counties # of Children Recommended for FLP # (%)Children Completing FLP # Parents Completing FLP # of Parents/Childb
2004-2005 Standard 376 26 (6.9%) 18 0.048
2004-2005 Tailoreda 353 33 (9.3%) 20 0.057
2005-2006 Standard 377 37 (9.8%) 14 0.037
2005-2006 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.
    *=Traditional CARDIAC is not included because FLPs were offered in the school.

     
  1. FLP completion rates were not significantly different for children or parents across Standard and Tailored counties at baseline (2004-2005)
    2.    
  2. During the 2005-2006 school year, 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.
    3.  

Environmental Factors

  • Strong support for CARDIAC by teachers and principals resulted in higher participation in CARDIAC.
  • Smaller schools had higher participation rates than larger schools.

 

Gender Differences

Results                          

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Girls’ participation in CARDIAC was consistently higher than that of boys.

                                                                                                                                                                  

Overall Participation in CARDIAC
  Male Female
2004 - 2005 46.7 53.3
2005 - 2006 47.2 52.8


  undefined
                                                                                                                                                                                                           

Standard and Tailored Participation in CARDIAC
  Male Female
Standard Counties (2004-2005) 46.2 53.8
Tailored Counties (2004- 2005) 47.3 52.7
Standard Counties (2005-2006) 45.6 54.4
Tailored Counties (2005-2006) 48.8 51.2

 
 
  undefined   

 

Sources of Health Information

Results

 

Where do WV Residents get Health Information?

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Barriers and Facilitators to Participation in Health Screenings                                   

Facilitators to Participating in Health Screenings
(Identified from Interviews and Health Beliefs Questionnaires; Study 1 and 2)
Parents
             
  • Appreciate school-based health programs and value school nurses
    •          
  • Put their children’s health needs ahead of their own
    •          
  • Trust local health care providers
    •          
  • Are sensitive to health problems in their families and in the community
    •          
  • Believe that programs are more credible when local individual's are involved
    •          
  • Value experts/specialists opinions are valued
    •          
  • Believe adults should know their cholesterol levels
    •        
Children
             
  • Believe in prevention
    •          
  • Are curious about their health
    •          
  • Are concerned about the health problems in their families and want to learn ways to stay healthy
    •          
  • Want to participate in health screenings if their friends are participating
    •        

                                                                                                                                                                                                                   

Barriers to Participating in Health Screenings
          (Identified from Interviews and Health Beliefs Questionnaires; Study 1 and 2)
Cost Screenings and follow-up testing may be too expensive 
Families may not be able afford to spend their limited resources on health		 "I don’t know if that’s [screening] necessary or if people really want to know because the result may mean a stress test and further cost down the road… People may view that as prohibitive." - Adult
Privacy Parents and children can be afraid their medical information will be shared with others and have negative consequences "Yeah, it’s [being weighed] difficult for a lot of kids. It might offend them or something." - Child
"I know I wouldn’t want to be weighed in front of everyone" – Adult
Knowledge Parents may not know children can have cholesterol problems, and may be unaware of the relationships between cholesterol and heart disease, weight, and exercise "Being that young, parents are not concerned [about cholesterol]… they are not aware that kids have problems." – Adult
Concern about outcomes of testing Adults feel screenings bring "bad news" and do not want to take medication.
Children fear they may be embarrassed or may be forced to make changes in diet, etc.		 "They [children] might be afraid that they have high cholesterol and be disgraced for the rest of their lives."- Child
 "If they [adults] don’t know anything about, they don’t have to deal with it." - Adult
General approach to medical care Some adults are not prevention-oriented, do not want to know if they have a health problem and avoid going to the doctor.
Some children believe that they do not have to be concerned with health until they are older.		 "People basically don’t come running to the doctor for minor issues and in some instances they don’t necessarily go for major issues. Part of that is just culture and part of that is just the fact that there had been a lack of availability." - Adult
"I forget about cholesterol. I just forget about it, but I’m healthy." - Child
Fear Adults and children fear needles and contamination from needles "I was afraid because I had one [blood test] before from my doctor and the person who did it, it was the first time they were doing it, and they jerked and it like took three times." - Child

 

 

Participation Differences

Differences between CARDIAC Participants and Non-Participants

  (Information from 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.
    •  

 

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.
    •    
  • Parents of participants intended to get their child’s cholesterol checked over the next 6 months.
    •    
  • Parents of participating and non-participating children perceived fewer barriers to having their own cholesterol checked.
    •    
  • Participating children showed an intention to eat healthier after CARDIAC while non-participating children did not.
    •  

 

POST CARDIAC Differences related to the Theory of Planned Behavior

  • Parents of children who participated in CARDIAC demonstrated:
  • An increase in perceived behavioral control over their own health
  • Fewer perceived barriers to their own health
  • Increased perceived ability to participate in health screenings

Reasons for participating

Reasons for participating or not participating in CARDIAC

  (Information from Health Beliefs Questionnaires; Study 3)                                                                                                        

Most Common Reasons for Participating in CARDIAC
Parents
               
  • Concern about the child’s weight and lack of exercise.
    •            
  • Family history of high cholesterol and diabetes.
    •            
  • 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.
    •            
  • Wanted to know their cholesterol levels.
    •            
  • Wanted to learn more about their health.
    •            
  • Thought CARDIAC would be fun.
    •            
  • Parents wanted them to participate.
    •          


                                                                                                       

Most Common Reasons for NOT Participating in CARDIAC
Parents
               
  • Were not familiar with the CARDIAC program.
    •            
  • Their child was concerned about the fingerstick.
    •            
  • Their child was absent on Screening day.
    •            
  • Chose to have cholesterol testing done at physician’s office.
    •          
Children
               
  • Afraid of needles and/or didn’t want to get fingerstick.
    •            
  • The information about CARDIAC was lost or not given to parents.
    •            
  • "Just didn’t want to".
    •