Designing a healthy lifestyle assessment and resource referral system within pediatric primary care settings

BACKGROUND: Approximately 1 in 5 US children have obesity. Primary care-based screening for healthy lifestyle behaviors is one way to identify children at risk of having obesity and related consequences; however, providers often lack tools to connect patients and families to obesity prevention. Our study sought to identify essential elements of an electronic health record-based screening and community referral system to help pediatric patients meet physical activity and nutrition guidelines. 
METHODS: Our mixed-methods study was conducted at a large, academic pediatric medical center in a Midwestern, US city. Qualitative data included in-depth interviews with health care workers (n = 17), focus groups with community organizations (n = 15), parents and guardians of pediatric patients (n = 9), and a bioinformatics team (n = 5). Data informed a subsequent survey with health care providers (n = 40). Multiple data collection methods and participant types triangulated findings. 
RESULTS: Participants indicated that a screening-referral system would need to be trusted, sustainable, and tailored. Screening should be anchored in a nonjudgmental conversation, streamlined and time efficient, and offer options that cater to individual circumstances and needs. Referrals to community resources would need to be sourced from a comprehensive and high-quality database, tailored to individuals' preferences, and kept up to date. 
CONCLUSIONS: Overall, participants believed a system to facilitate community referrals for physical activity and nutrition would be valuable, and suggested ways to maximize acceptability. Our study explored a way to link pediatric patients to community resources to better meet physical activity and nutrition recommendations and guides future innovations to improve obesity-related lifestyle risk factors.