Moving the needle on health inequities: principles and tactics for effective cross-sector population health networks.

PURPOSE OF REVIEW: To summarize elements of cross-sector population health networks to support systems and policy change to achieve equitable access to health services and healthy development opportunities for young children and families, allowing everyone to have a fair and just opportunity to be as healthy as possible. RECENT FINDINGS: The principles and tactics of Equity and Inclusion, Readiness, Joint Planning, Governance, and Data can guide cross-sector networks in effectively supporting communities in addressing health inequities. These principles are not linear or siloed, but rather, they overlap and reinforce each other. The principles require equity and the participation of community members to be central in all aspects of cross-sector network work. SUMMARY: By building strong relationships among community partners, cross-sector population health networks can ensure the network is not a short-term, transactional one-time project, but rather, a sustained collaboration through enduring processes and infrastructure. Networks can gain a fuller understanding of the needs and assets of a community through engagement and leadership by community members than they could gather from data and surveys alone. This approach to serving a community by making members equal partners in the effort helps to place equity at the center of a network's focus, as does embedding equity-related decision-making tools and processes into daily operations of the network. If cross-sector networks build resilient, inclusive structures and procedures, they can utilize them to quickly pivot and adjust to emerging needs or respond to crisis.

Feasibility of Using a Commercial Fitness Tracker as an Adjunct to Family-Based Weight Management Treatment: Pilot Randomized Trial.

BACKGROUND: Fitness trackers can engage users through automated self-monitoring of physical activity. Studies evaluating the utility of fitness trackers are limited among adolescents, who are often difficult to engage in weight management treatment and are heavy technology users. OBJECTIVE: We conducted a pilot randomized trial to describe the impact of providing adolescents and caregivers with fitness trackers as an adjunct to treatment in a tertiary care weight management clinic on adolescent fitness tracker satisfaction, fitness tracker utilization patterns, and physical activity levels. METHODS: Adolescents were randomized to 1 of 2 groups (adolescent or dyad) at their initial weight management clinic visit. Adolescents received a fitness tracker and counseling around activity data in addition to standard treatment. A caregiver of adolescents in the dyad group also received a fitness tracker. Satisfaction with the fitness tracker, fitness tracker utilization patterns, and physical activity patterns were evaluated over 3 months. RESULTS: A total of 88 adolescents were enrolled, with 69% (61/88) being female, 36% (32/88) black, 23% (20/88) Hispanic, and 63% (55/88) with severe obesity. Most adolescents reported that the fitness tracker was helping them meet their healthy lifestyle goals (69%) and be more motivated to achieve a healthy weight (66%). Despite this, 68% discontinued use of the fitness tracker by the end of the study. There were no significant differences between the adolescent and the dyad group in outcomes, but adolescents in the dyad group were 12.2 times more likely to discontinue using their fitness tracker if their caregiver also discontinued use of their fitness tracker (95% CI 2.4-61.6). Compared with adolescents who discontinued use of the fitness tracker during the study, adolescents who continued to use the fitness tracker recorded a higher number of daily steps in months 2 and 3 of the study (mean 5760 vs 4148 in month 2, P=.005, and mean 5942 vs 3487 in month 3, P=.002). CONCLUSIONS: Despite high levels of satisfaction with the fitness trackers, fitness tracker discontinuation rates were high, especially among adolescents whose caregivers also discontinued use of their fitness tracker. More studies are needed to determine how to sustain the use of fitness trackers among adolescents with obesity and engage caregivers in adolescent weight management interventions.