标题：Educating Health Care Professionals in Advocacy for Childhood Obesity Prevention in Their Communities: Integrating Public Health and Primary Care in the Be Our Voice Project
摘要：Objectives. We assessed the perceived need for and the effectiveness of the Be Our Voice advocacy training. In this training, health care professionals learned public health strategies to advocate for environmental systems changes to prevent childhood obesity in their communities. Methods. We assessed 13 trainings across 8 pilot sites. We conducted 2 rounds of surveys with participants—pre-training (n = 287, 84% response rate) and immediately post-training (n = 254, 75% response rate)—and semi-structured interviews with participants after training (n = 25). Results. We uncovered essential and promising elements of the training. Primary care providers found the Be Our Voice training effective at building their comfort with and motivation for engaging in public health advocacy; they reported achieving learning objectives, and they had positive responses to the training overall and to specific sessions. They articulated the need for the training and plans for advocacy in their communities. Conclusions. The Be Our Voice training provides an opportunity to integrate primary care providers into public health, community-based advocacy. It may be a model for future educational offerings for health care professionals in graduate and postgraduate training and in practice. The effort to reverse the epidemic of childhood obesity in the United States provides a key opportunity to integrate public health and primary care by educating clinicians to be public health advocates in their communities. Obesity rates among the nation's children have tripled in the past 30 years. 1 As of 2008, over 30% of children aged 2 to 19 years had body mass indexes at or above the 85th percentile for their age. 2 Public health strategies for community-level prevention and environmental change hold particular promise for positively affecting the environments in which children live, learn, and play, and ultimately, for reversing the obesity epidemic. 3,4 Integrating the clinical expertise of primary care providers with such public health approaches may further accelerate obesity prevention in communities. Through the approach of community-oriented primary care, there is longstanding precedent for efforts to bring together primary care and public health at the community level. 5–8 Health care professionals (HCPs) have daily exposure to the childhood obesity epidemic via the patients they treat, and they are trusted leaders in and resources for their communities. 9 Their scientific and clinical knowledge of the epidemic coupled with this trusted community role positions HCPs to participate in community-based advocacy outside of their clinics. 10 Expert committees and professional organizations have called on HCPs to collaborate with the public health community and to engage in community-based advocacy, and research has demonstrated that many clinicians are interested in advocacy. 11–13 Tobacco control, often cited by those engaged in reversing the obesity epidemic, is the most visible of several public health advances that benefitted from the active engagement of HCPs. 14 For example, HCPs have been important participants in public health campaigns on issues including promotion of child safety seats and bicycle helmets. 15–17 Despite this potential role for HCPs as advocates, substantial barriers hinder clinicians becoming engaged in public health advocacy. Many medical schools include advocacy training in their curricula, and certain medical specialties, including pediatrics, require advocacy training as a part of residency training. 18,19 However, although some curricular programs are beginning to be tested, standard curricula do not yet exist to guide these requirements, and there is insufficient attention to advocacy in continuing medical education. 20,21 Additional barriers include clinical service delivery often being the sole determinant of payment, the time required to be involved in advocacy outside the clinic, and limitations in most clinicians’ knowledge of how to connect to their communities in public health advocacy. 4,10,22,23 In response to this opportunity, the National Initiative for Children's Healthcare Quality, in partnership with the American Academy of Pediatrics (AAP), the California Medical Association Foundation, and the Robert Wood Johnson Foundation Center to Prevent Childhood Obesity—the “National Partners”—created the Be Our Voice project with support from the Robert Wood Johnson Foundation. The project provides training and follow-up support to primary care providers to participate in community-based public health advocacy for childhood obesity prevention in their communities. This study examined the perceived need for this training and initial responses to it among HCPs in 8 pilot Be Our Voice communities.
