British Columbian Healthcare Providers' Perspectives on Facilitators and Barriers to Adhering to Pediatric Diabetes Treatment Guidelines.

OBJECTIVES: There are few studies exploring why adherence to clinical practice guidelines for the treatment of childhood type 1 diabetes is suboptimal. Our objective was to describe healthcare providers' perspectives on the facilitators of and barriers to adhering to pediatric diabetes treatment guidelines. METHODS: We fielded an electronic survey to 260 pediatric diabetes healthcare providers (physicians, nurses, dietitians) in British Columbia, Canada, followed by qualitative interviews with a purposeful sample (N=15) of physicians and allied healthcare providers. Descriptive statistics and directed content analysis were used. RESULTS: We received 95 of 260 survey responses(37%). Of the 260 healthcare providers who received the survey, 116 were known to be working in a pediatric diabetes centre, and 71 of 116 (61%) responded. Almost all providers were aware of (92%) and familiar with (77%) the Canadian Diabetes Association clinical practice guidelines, and most were in agreement with the recommendations. Patient-level factors, such as poor adherence and patient/family preferences for higher glycemic targets, as well as inadequate resources (i.e. funding, mental health support), were identified as significant barriers. Qualitative interviews identified 3 key themes: 1) working collectively provincially; 2) supporting emotional and mental health and 3) frequent interactions with patients. A provincial health delivery and communication model, as well as mental health support integrated into routine patient care, were recommended. CONCLUSIONS: The results of this study can guide resource allocation toward key priorities, such as increased investment in mental health support for children with diabetes. The next steps include collecting patient and family perspectives on improving guideline adherence.

Sustainable childhood obesity prevention through community engagement (SCOPE) program: evaluation of the implementation phase.

Childhood obesity rates are steadily rising. Sustainable Childhood Obesity Prevention Through Community Engagement (SCOPE) is a community-based participatory action research (PAR) program aimed at preventing childhood obesity. This study aimed to describe community perspectives on, and elicit feedback about, SCOPE's first phase of implementation in two pilot cities in British Columbia, Canada. A case study was implemented using interviews and questionnaires to obtain feedback about SCOPE from two groups: SCOPE coordinators and stakeholders (i.e., individuals and organizations that were a member of the community and engaged with SCOPE coordinators). Participants were recruited via email and (or) by telephone. Coordinators completed a telephone interview. Stakeholders completed a questionnaire and (or) a telephone interview. Thematic analysis was conducted. Participants included 2 coordinators and 15 stakeholders. Participants similarly interpreted SCOPE as a program focused on raising awareness about childhood obesity prevention, while engaging multiple community sectors. Overall, participants valued the program's role in facilitating networking and partnership development, providing evidence-based resources, technical expertise, and contributing funding. Participants felt that SCOPE is sustainable. However, participants felt that barriers to achieving healthy weights among children included those related to the built environment, and social, behavioral, and economic obstacles. Perspectives on factors that facilitated and acted as barriers to SCOPE's first phase of implementation were obtained from the SCOPE communities and may be used to enhance the sustainability of SCOPE and its applicability to other BC communities.

Prematurity stereotyping and mothers' interactions with their premature and full-term infants during the first year.

OBJECTIVE: To longitudinally assess stability and correlates of prematurity stereotyping and perceptions of infant vulnerability in mothers of premature (N = 56) and full-term (N = 59) infants. METHOD: At 5, 9, and 12 months, mothers rated videotapes of unfamiliar infants with a full-term label (FTL) or a preterm label (PL), interacted with their own infant, and completed other questionnaires. A subgroup of infants were administered a developmental assessment at 32 months. RESULTS: Mothers rated PL infants more negatively than FTL infants at each age. Individual differences in stereotyping were not stable. Mothers who negatively rated infants labeled with the same birth status of their own infants exhibited more negative interactive behaviors with their infants. Mothers who viewed their own infant as more vulnerable and who showed more prematurity stereotyping at 5 months had infants with lower 32-month mental scores. CONCLUSIONS: The results suggest an association between early maternal cognitions and both contemporaneous maternal behavior and later child developmental outcomes.