[Document title] | 2018

PICO TEMPLATE for NUR4164 Assignment

1. The definition of the problem and development of the question:

Provide your relevant clinical idea in this section

Childhood obesity is a major health epidemic in the United States. Obesity can cause a
wide array of long term health issues. It is important as a health care provider to promote health
and wellness to families. Children in the United states are no longer required to take the
presidential fitness test. If school-based programs are more effective then home-based programs,
school-based programs need to be implemented back into schools. If home-based exercise
programs are more effective, parents and children need education on successful exercise
programs to use at home. Overall, the aim is to decrease childhood obesity and increase physical
activity of school aged children.

2. Construct the statements in the PICO template box:

PICO TEMPLATE BOX
Question Components Statements
P – Patient or Population or School age children
Problem
Description of characteristics
and/or demographics or
disease profile

I – Intervention School based exercise program

Description of action,
implementation method
and/or exposure

C – Comparison Family based exercise program

Description of alternative
treatment approach, placebo
and/or control mechanism
O – Outcome Determine which is more successful in reducing childhood
obesity

CDC Reference: https://www.cdc.gov/healthyweight/children/index.html

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Description of what you want

to accomplish, resolve,
improve and/or relieve
The PICO Question that you have formulated for the provided clinical idea:

In school age children what is the effect of a school-based exercise program versus family based
exercise interventions in reducing childhood obesity?

3. A PICO question is considered to be a foreground question. It can also be broken down

into different categories related to clinical practice management. Identify and complete
the box for the question type that best describes what you propose to study.
Question Type Applicable Question
Research Design
Diagnosis Controlled trial, In ________ (P) are/is ___________ (I)
Systematic compared with __________(C) more accurate in
Review/Meta- diagnosis ______ (O))?
analysis of RCT
Therapy/Treatment Double blind In school age children (P), what is the effect of a
controlled trial, school-based exercise program_(I) on childhood
RCT, Systematic obesity(O) compared with a family-based
Review/Meta- exercise program (C)
analysis of RCT
Prevention RCT, Cohort For ______ (P) does the use of __________ (I)
study, Case control reduce the future risk of _________ (O)
compared with ___________(C)?
Prognosis Cohort study, Case Does _______ (I) influence _______ (O) _ in
control, Case patients who have _______ (P)?
series/Case report
Etiology/Harm RCT, Cohort Are _______ (P) who have _______ (I) at
study, Case control (increased/decreased) risk for/ of _________ (O)
compared with _______ (P) with/without
______(C)?
Cost analysis Economic analysis For ________ (P) who have _______ (I) will the
______ (O) be cost effective?

4. Provide a listing of the search terms that you would use to identify credible resources for
each part of your PICO component.
PICO component Clinical Question Search Strategy

CDC Reference: https://www.cdc.gov/healthyweight/children/index.html

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P School age children Age 5-18, school age,

adolescents
I School exercise program School exercise, presidential
fitness test
C Home exercise program Exercise, family exercise
O Obesity Childhood obesity
Type of Question Therapy / Treatment
Type of Study Systematic Review

Database(s) to be used for this assignment is (are):

EBSCO

5. List any inclusion criteria that you may want to use to help narrow the search process to
lead to a more effective search.
Criteria Limitation
Patient age 5-18 years old
Language English
Gender
Publication 2014-2018
dates
Other School age, exercise, childhood obesity

6. For the selected database, please provide a print-out page of the first page of the search
indicating the number of articles and pertinent limiting criteria.

Search Attempts Search Terms Filters # of findings

Parameters
1 2014-2018 Childhood obesity, Full text, peer 2
school, exercise reviewed
2 2014-2018 Childhood obesity, Full text, peer 62
exercise reviewed
3 2014-2018 School Exercise and Full text, peer 13
obesity reviewed

CDC Reference: https://www.cdc.gov/healthyweight/children/index.html

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1.

2.

CDC Reference: https://www.cdc.gov/healthyweight/children/index.html

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3.

7. Use this table to identify the levels of evidence for the articles you are using for this
assignment.
Levels of
Evidence
I Systematic review or meta-analysis of RCTs
II RCT
III Controlled trial without randomization
IV Case-control or cohort study
V Systematic review of qualitative or descriptive studies
VI Qualitative or descriptive study
VII Opinion or consensus

Ash, T., Agaronov, A., Young, T., Aftosmes-Tobio, A., & Davison, K. (2017). Family-based

childhood obesity prevention interventions: a systematic review and quantitative content

analysis. International Journal of Behavioral Nutrition & Physical Activity, 14(1), 1–12.

https://doi-org.db20.linccweb.org/10.1186/s12966-017-0571-2

Level of evidence: V

This article was a review on studies completed to see if family-based interventions are effective

in preventing childhood obesity. The family-based exercise programs were more successful.

CDC Reference: https://www.cdc.gov/healthyweight/children/index.html

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However, it is noted in this review that there were barriers in educating parents and the studies

had age limitations, mainly focusing on ages 2-10. The reviews of the listed studies do support

the idea that a family-based exercise program is more effective in fighting childhood obesity than

a school-based exercise program.

Bryant, M., Burton, W., Cundill, B., Farrin, A. J., Nixon, J., Stevens, J., . . . Brown, J. (2017).

Effectiveness of an implementation optimisation intervention aimed at increasing parent

engagement in HENRY, a childhood obesity prevention programme - the Optimising

Family Engagement in HENRY (OFTEN) trial: Study protocol for a randomised

controlled trial. Trials,18(1). doi:10.1186/s13063-016-1732-3

Level of Evidence: II

This article creates and tests a home intervention program for childhood obesity. The goal of the

study states that in order “To reverse trends in obesity, there is a clear need to engage parents in

shaping healthy weight-related behaviours in their children”. The test engages parents and

educates them on exercise programs to complete at home as well as nutritional information to

help prevent childhood obesity. The study states that there was difficulty in maintaining parent

engagement and the study could be difficult to replicate due to demographics and parent

engagement issues.

Elinder, L. S., Patterson, E., Nyberg, G., & Norman, Å. (2018). A Healthy School Start Plus for

prevention of childhood overweight and obesity in disadvantaged areas through parental

support in the school setting - study protocol for a parallel group cluster randomised

trial. BMC Public Health, 18(1), 1–13. https://doi-

org.db20.linccweb.org/10.1186/s12889-018-5354-4

CDC Reference: https://www.cdc.gov/healthyweight/children/index.html

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Level of evidence: IV

This study compares home based programs effectiveness on childhood obesity versus school-

based programs. The result of the research here was also stated, “the key to obesity prevention

may be the home environment where parents shape the food, meal, and physical activity

environment”. This article also brings to light that most kids are less active at home on the

weekends, so therefore there would be a greater impact on obesity if a home-based exercise

program was implemented.

Hesketh, K., & Campbell, K. (2014). Obesity prevention interventions for early childhood: An

updated systematic review of the literature. Childhood Obesity Prevention, 396-407.

doi:10.1093/acprof:oso/9780199572915.003.0034

Level of Evidence: V

This is a systematic review of multiple approaches to address childhood obesity. This compares

home based programs to school based physical activity interventions. This review discusses

evidence-based practice studies and compares both school and family-based programs stating

“Family-based intervention programs are considered as one of the most successful methods for

obesity treatment or prevention.” (Hesketh & Campbell, 2014).

Based on your research, discuss the answer to your PICO question:

Based on the multiple articles and research studies related to childhood obesity and

interventions at home or at school, the most effective intervention to prevent childhood obesity

in school aged children is to have a home-based exercise program. Studies have shown that

intervention at school paired with intervention or exercise at home is the most effective

CDC Reference: https://www.cdc.gov/healthyweight/children/index.html

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approach. Children that are supported and encouraged at home with an exercise program are

more likely to have a lower BMI then those who only exercise at school. Familial support

improves overall commitment to the exercise program and leads to other healthy interventions

such as an improved diet or meal plan. Families should be encouraged to exercise regularly with

their children. Nurses should educate families on the importance of physical activity and the

negative impact childhood obesity can have on overall health. An extensive review of recent

relevant studies supports that idea that family-based exercise programs are more effective then

school-based programs.

CDC Reference: https://www.cdc.gov/healthyweight/children/index.html

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Fact Sheet – Childhood Obesity

 Family-based intervention programs are considered as one

of the most successful methods for obesity treatment or
prevention (Hesketh & Campbell, 2014).
 Familial support improves overall commitment to the
exercise program and leads to other healthy interventions
such as an improved diet or meal plan
 Kids are less active at home on the weekends, so therefore
there would be a greater impact on obesity if a home-based
exercise program was implemented versus a school-based
program.
 According to the Centers for Disease Control (2018), Obesity
prevalence was 13.9% among 2- to 5-year-olds, 18.4%
among 6- to 11-year-olds, and 20.6% among 12- to 19-year-
olds.
Parents can help!
 Encourage healthy eating habits
 Limit sugar-sweetened beverages
 Encourage physical activity
 The CDC (2018) recommends 60
minutes of moderate physical
activity daily.

CDC Reference: https://www.cdc.gov/healthyweight/children/index.html