1. Mahsa Parviz, BS1 and Jennifer K. Cheng, MD, MPH1
STEPS to Health: Development of a student health coaching program for pediatric obesity management in an academic teaching hospital
Mahsa Parviz, BS1 and Jennifer K. Cheng, MD, MPH1
1Division of General Pediatrics, Department of Medicine, Boston Children’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
INTRODUCTION
Boston Children’s Hospital Primary Care Center (CHPCC) is the single largest provider of pediatric primary care in Boston, annually serving over 14,000 children from predominantly low-income, racial/ethnically diverse backgrounds.
45% of children seen for well care are overweight or obese.
In this opportune setting, we developed STEPS to Health, a health coaching program in collaboration with Harvard Medical School to train pre-medical Harvard undergraduate students to serve as health coaches in a team-based, patient-centered care model and help families of obese and overweight children adopt more healthful behaviors.
In this model, 6 pre-medical Harvard undergraduates are trained to work as integral members of the care team (including clinical assistants, nurses, physicians, social workers, patient navigators, dieticians, and others) to engage and activate families, help them implement healthier lifestyle behaviors, negotiate barriers, utilize existing resources, and stay connected to the health care team.
The development of this program bridges medical training gaps, presents pre-medical students with the opportunity to engage in clinical volunteering, provides patients and their families with various options for personalized obesity intervention and is implemented at minimal cost to the hospital.
Made it up 12 flights of stairs at Boston Children’s Hospital!
METHODS
The trained student health coach conducts semi-structured interviews with the patient and family to determine what families would want from the STEPS to Health program. Interviews are audio-taped, transcribed verbatim and the descriptive data is analyzed. The health coach connects the family to the appropriate existing resources during the intake visit if requested.
Eligible Patients:
2-21 years old and seen for well care
≥ 85th percentile for BMI
Exclusion Criteria:
Non-English speaking
Severe comorbid conditions
Table 1. STEPS to Health semi-structured interview guide  # 
Question  1
If you had a health coach, what would you want them to help you with?  2
Which is your top concern?  3 
How do you think your doctor could best help you with ___(top concern)___?  4 
How do you think your health coach could best help you with ___(top concern)___?  5 
What do you think of having health coaches help families do things like eating a healthier diet or sticking with an exercise program?  6 
How could a health coach help families make better food choices?  7 
How would you want a health coach to connect with you (in-person during the clinic visit, by phone, , web portal, in person at the gym, etc.)?  8
How often would you want them to connect with you? 
RESULTS
Of the 42 patients who participated, there were 21 males and 21 females. The cohort of patients seen by STEPS to Health coaches who consented to participating in this study consisted of 21 Black, 13 Hispanic, 3 Caucasian, 3 Other and 2 Asian. Average patient age was years (SD 4.42) and the median was Health coaches have connected 33 patients to biweekly group health and physical activity sessions held in-clinic. 20 patients were referred to physical activity in their area (e.g. youth soccer in Brockton, MA).
50% of study subjects reported “help with healthier eating habits” as their top concern. A majority of families expressed interest in the assistance of a health coach with maintaining a consistent dieting regimen.
36% of families want “help finding physical activity” from their health coach. All but two patients interviewed were interested in the concept of having a health coach.
24% of families wanted their doctor to “give dietary advice” when asked how their doctor could help with their top concern, and 12% of families “do not believe the doctor would be able to help."
57% of families reported as the most convenient method of contact and 55% wanted to be contacted once a week.
STEPS to Health Patient Demographics
CONCLUSIONS
Cycle 1 of STEPS to Health has proven to be successful. Future directions for cycle 2 include recruitment of more undergraduate health coaches, particularly those that are bilingual/Spanish-speaking, for project expansion and increasing the number of patients served. Geographical expansion may begin by collaborating with academic teaching hospitals across the nation. Additional studies are required to gauge feasibility and identify barriers to implementing the STEPS to Health model on a national level.
n=42
Average BMI percentile= 95.20% (SD=4.29)
Median BMI percentile= 96.91%