St. Mary Medical Center, Saint Louis University team up for population health

December 1, 2014


For five years, St. Mary Medical Center in Langhorne, Pa., and the Saint Louis University College for Public Health and Social Justice have collaborated on a program called KidShape 2.0 aimed at reducing childhood obesity by engaging a child's whole family in healthy lifestyle changes.

Starting this fall, they'll also work together to roll it out to two other Trinity Health hospitals: Holy Cross Hospital in Silver Spring, Md., and Mercy Medical Center – Sioux City in Iowa. Collaborators from St. Mary Medical Center and the university say the partnership, which draws on the university's public health expertise and the hospital's real-world experience working with patients, children and families, has led to benefits for those enrolled in the program and the institutions involved.

St. Mary Medical Center has an annual, renewable contract with Saint Louis University College for Public Health and Social Justice. It relates to support from the university on the KidShape 2.0 program, and the relationship extends to other community benefit programs at the hospital and support with analyzing community health data in the region as well. The parties didn't disclose the fees paid to the university.

Data driven
The partnership provides a means to collaborate on data collection and on tools to measure the effectiveness of KidShape 2.0's curriculum, and offers opportunities for graduate students of public health to use their skills as they gain experience working on a program to improve the health of a population. For patients, better data collection and analysis has led to improvements in the program's lessons in ways the data indicate will best motivate behavioral change.

Jeffrey Mayer, a Saint Louis University assistant professor of behavioral science and health education, said of the work to improve the childhood obesity prevention program, "I could not do it alone, and neither could they."

Dietitian Shara Aaron, left, who works with the KidShape 2.0 program, teaches children how to make healthy kale pesto at Silver Lake Nature Center in Bucks County, Pa. St. Mary Medical Center's KidShape 2.0 programs are offered at different locations in the county to provide easy access for families.

The collaboration began when Barbara Adons, a nurse and director of community health services at St. Mary Medical Center, and Mayer met in 2009 at a CHA community benefit meeting in New Orleans. St. Mary Medical Center adopted the KidShape program in 2005 after analyzing several childhood obesity prevention or reduction programs. KidShape, first developed at the Center for Human Nutrition at the University of California Los Angeles, was evaluated at 13 sites in Southern California with more than 400 overweight children who took part in the program; it showed increases in fruit and vegetable consumption and physical activity and improved self-esteem. KidShape participants also showed decreases in sedentary activity, consumption of fats and sweets and BMI reduction.

However, St. Mary Medical Center wanted to improve its own program, which came to be known as KidShape 2.0 at the medical center. Adons and others worked with Mayer and a handful of graduate students over the years to set goals and then refine the program. Mayer and students also helped with more detailed planning for the eight-week program, creating a logic model of the program, in which the curriculum was charted to show what lessons would be taught each week, what activities supported those lessons, what outcomes were expected and what would be measured to see if the outcomes were reached, Mayer said.

As part of the process, the researchers focused on reliable and valid ways to measure the program's outcomes. For instance, while many childhood obesity prevention programs involve the whole family because parents grocery shop, cook and often set rules around healthy behaviors in the family, KidShape organizers at St. Mary Medical Center wanted to gauge if family involvement led to rule changes at home related to diet and exercise. Mayer and public health students helped the hospital formulate survey questions to see if a family had changed behaviors related to their health. The researchers assessed areas such as whether families had increased limits on children's screen time, limited children's unhealthy snacks in favor of healthier choices or had family dinners together more often.

Beyond that, they expanded survey questions that showed whether a family was taking steps toward healthier behavior, such as asking about the type of food in the kitchen cabinets after the educational program to see if unhealthy foods had been replaced with nutritious alternatives. And the written survey inquires about whether family members spend more time reading nutrition labels on foods they consume than they had before the program, organizers said.

While KidShape 2.0 organizers and the Saint Louis University researchers conducted pre-and post-program surveys and recorded height, weight and BMI before and after the program, the collaboration also led them to begin surveying parents and children separately, so they could better gauge what each population thought about the program and what changes it prompted. Before those changes to the surveys, "we didn't know whose voice we were hearing," said Joann Dorr, nurse and manager of the Families Living Well programs at the medical center, including the KidShape 2.0 program. The separate surveys help the hospital determine what students learned, what parents learned and who had changed behaviors, said Dorr.

Real-world experience
The collaboration has been an excellent learning opportunity for Saint Louis University public health students, Mayer said, as they formulate surveys and analyze data with a goal of improving a program. A master's student, who is now a doctoral candidate, went to St. Mary and did a three month internship related to KidShape. Four other students have assisted with the work.

Adons said universities can be an underutilized resource, "They do all this research, and it doesn't always trickle down to the front lines," she said. The collaboration has resulted in more detailed data about the program and its outcomes. "We've been able to demonstrate the impact," Adons said. That has been important in helping to secure grants and funding for the program.

Next up, Mayer said, will be work to assess the implementation of the program at the hospitals in Maryland and Iowa. As staff there are trained to teach KidShape 2.0, Mayer and his students will measure staff knowledge of the program's curriculum and their ability to replicate the program in the new settings.


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