Transforming evidence-based obesity guidelines into clinical practice

Background: A system-level community obesity prevention project was implemented by public health nurses (PHNs) from four counties that partnered together with ten clinical sites in a obesity-prevention collaborative in the Midwest. The project aimed to increase implementation of the Institute for Clinical Systems Improvement Prevention and Management of Obesity Guideline in ten collaborating partner healthcare settings. The objectives of this study were to investigate perceptions of administrators and providers at partner settings regarding the impact of the project, and to evaluate the reliability of the Omaha System as a tool for documenting system level interventions and outcomes.

Methods: Participants in the mixed methods study (n=40) were administrators (n=10) and clinicians (n=30) from partner settings. Measures: Omaha System Problem Rating Scale for Outcomes knowledge, behavior, and status (KBS) scores for the Health care supervision problem. Procedures and analysis: Key informant interviews (qualitative analysis), pre- and post-intervention KBS scores (quantitative analysis, percentage agreement).

Results: Partner interviews indicated that the community obesity prevention intervention was effective in creating sustainable system-level changes within healthcare sites. Keys to success were inspiring staff-led strategic changes in practice to promote use of guidelines, integrating documentation prompts within clinical records, providing educational resources for weight management conversations, and training partners in motivational interviewing. PHN-observed and partner-reported KBS ratings were consistent across agencies, with preliminary findings showing 77% agreement overall.

Conclusions: System-level PHN interventions were successful in supporting, improving, and sustaining obesity prevention practice. The Omaha System provided reliable data to show system-level outcomes.