RESUMEN
Interviewing 67 primarily middle-class parents and children in a southern U.S. city, we learned that families know a great deal about the dangers of excess sugar consumption. However, in the private spaces of family life, families let down their guard and enjoy sugary treats, often treating them as symbolic markers of love and comfort. Theoretical concepts emerging from the dramaturgical perspective of Erving Goffman (1959) and from contemporary symbolic interactionists illuminate how sugar consumption is simultaneously shunned and celebrated in private family life. Moving beyond previous research, we track the ways sugary products facilitate love, sanity, and privacy to make daily family life bearable for both parents and children. We call the rhetorical and physical practices that enable excusable sugar indulgence Health Performance Strategies. Our findings on how families engage in these health performance strategies have broader implications for many other efforts to govern the health habits of families.
RESUMEN
BACKGROUND: Primary care is the ideal place to implement behaviour change interventions for weight management. However, most primary care physicians are not managing patient weight as a standard of care due to lack of knowledge, skills and reimbursement. Generating more physicians who are familiar and comfortable with providing weight management is essential in leveraging a global change. In our university free clinic, medical students provide healthy lifestyle counselling using shared decision making to each patient at every clinic visit. OBJECTIVE: Improve the efficacy of behaviour change interventions via increased patient responsiveness and adherence. METHODS: The needs assessment demonstrated a subpar patient response rate to check-ins regarding behavioural change goals. In the first and second interventions, check-in message structure and contact schedule were varied to maximize patient responsiveness and goal achievement. RESULTS: In the needs assessment, 58% of patients responded to follow-ups and 58% of patients accomplished their goal. The first intervention cycle resulted in an improvement of responsiveness to 70% and accomplishment of goals to 59%. The second intervention cycle resulted in an improvement of responsiveness to 78% and accomplishment of goals to 74%. CONCLUSIONS: Messages that were frequent, unique, succinct and delivered within 4 weeks after the clinic visit resulted in the highest response rate and goal attainment. Other primary care clinics can use these interventions to increase patient completion of implemented behaviour changes for a healthier lifestyle.
