Qualitative Research Concerning Expert Committee Recommendations on Pediatric Obesity Management
Linda Barselow, Chanelle Carley, Kathleen Helton, and Julia McGraw 
Nursing Research N302
March 5, 2012
Alisha Betka 

Qualitative Research Concerning Expert Committee Recommendations on Pediatric Obesity Management
	The purpose of this paper is to summarize and evaluate a research study related to an issue of interest to the authors of this paper.  The purpose of the research was to determine whether pediatricians would benefit from the use of health information technology.  This would include  “pop-ups” and other decision innovations used to alert physicians on identifying obesity in clients, which would then link them to Expert Committee Recommendations on Childhood Obesity Management in clinical practice (McDonald, et al., 2011).   The conceptual framework for this study was to determine how familiar pediatricians were with Expert Committee Recommendations, the barriers concerning its use, and what could be done to improve its utilization, through computer technology.
	The hypothesis stated that electronic alerts for obese clients in their computerized charts would remind pediatricians of current guidelines and facilitate appropriate actions.  Thus, helping eliminate emotional concerns and standardize the treatment of obesity (McDonald, et al., 2011).  The design of the research is a homogenous sampling of primary care pediatric physicians from two multi-site group practices in the greater Boston area.  Recruitment was through e-mail and postal service to pediatricians.  The pediatricians that chose to volunteer for the study were interviewed by telephone.  They were given a variety of open-ended questions regarding perspectives and current approaches on obesity screening and management, familiarity with and current use of the Expert Committee Recommendations, use of health information technology, and suggestions for potential health information technology innovations (McDonald et al., 2011).  
The process described is phenomenological research, “capturing the “lived experience” of study participants” (Burns & Grove, 2009 p. 54).  The subjects serve a diverse clientele.  The study was approved by the Harvard Pilgrim Health Care Human Studies Committee.  Basic confidentiality information was given at the beginning of the telephone interviews to obtain verbal consents. The study included thirty-two pediatricians.  All interviews were recorded and transcribed. (McDonald et al., 2011).   Participants were given one hundred dollars after their interviews were finalized.  The study found that many pediatricians used the Expert Committee Recommendation inconsistently.  The study also found that some pediatricians were using the Expert Committee Recommendation, but not aware that they were actually using it, while others were completely unaware of its’ existence.  Data analysis of the qualitative text involves transcripts being read using a constant comparison process of new data and recurring themes.  A spreadsheet was used to keep track of interpretations of information.  
Validity was discussed with regard to limitations.  The sample size and qualitative methods were not preformed to give an exact percentage concerning the pediatricians’ views (McDonald, et al., 2011).  Themes reported were reoccurring from a diverse population, adding to the validity.  The authors of the article acknowledge that although the subjects were from public and private practices serving diverse neighborhoods, there may be differences that could be not measured.   Subjects were voluntary and may not have agreed with all of the ways to manage pediatric obesity, although the interviews provided specific and thoughtful reflections concerning health information technology interventions (McDonald, et al., 2011).
Introduction
	This research is significant to nursing because it deals with technology that will standardize health care for obese children.  The study involved current approaches to obesity screening and management, how to guide the approach, exploring improvements, and the emotions involved in confronting obesity.  The study also mentioned, the importance of understanding the social context of a family and gaining confidence in obesity management.        
Review of Literature
	The guidelines concerning the management of pediatric obesity have been available to physicians for over ten years.  Limited time, skills, and resources were the main barriers for pediatricians not using the guidelines (McDonald et al., 2011).  Health information technology makes information and resources readily available to physicians, which has shown an increase in obesity counseling and could make great improvements in other areas as well.   This study looks at pediatricians’ thoughts concerning the use and efficiency of health information technology, for its best use possible.  Many pediatricians use computerized growth charts, laboratory results, print visit summaries, and structured templates on a regular basis  (McDonald, et al, 2011).  
Laboratory screening was an area where most subjects deviated from Expert Committee Recommendations, since they felt they were unnecessary.   Some pediatricians felt the tests do more harm than good.  Since, the results could be within normal ranges, the family may believe interventions are unnecessary and allow health problems to worsen.  This could also cause a loss of authority for the physician.  Results for the use of “pop-ups” were generally favored concerning standardized care.  Some negative thoughts that reoccurred in the study concerning “pop-ups” included redundancy, annoyance, and distractions.  Educational materials that were highly requested included information on local resources, programs, and activities related to client age, sex, neighborhood and body mass index, as well as, automatically generating an appropriate group of laboratory tests, a calculator that converts to the metric system, and a to link to Expert Committee Recommendations (McDonald, et al., 2011).  
Conclusion
Reoccurring themes that evolved in the study were pediatricians’ preferences to center their obesity treatment using their own clinical experience and their client relationship rather than going to the expert guidelines for appropriate care (McDonald, et al., 2011).  Pediatricians stated a willingness to try a standardized approach to obesity counseling, if high demand features were incorporated into the health information technology, without creating monotony with the alerts (McDonald, et al., 2011).  This article presents concepts and information applicable to the general public and professionals, such as nurses.   The authors of the article state that additional research is needed before an accurate conclusion can be made concerning the alerts in health information technology effecting physician behavior and client outcomes (McDonald, et al., 2011).           

Reference
Burns, N. & Grove, S. K.  (2009).  The practice of nursing research appraisal, synthesis, and generation of evidence.  Sixth Edition.  Missouri: Elsevier.
McDonald, J., Goldman, R. E., O’Brien, A., Ayash, C., Mitchell, K., Marshall, R., Simon, S. R., & Taveras, E. M.  (2011).  Health information technology to guide pediatric obesity management.  Clinical Pediatrics, 50(6), 543-549.  doi: 10.1177/0009922810395131