September 07, 2019
By Edan Stanley
Anne K Scheer, PhD, Southern Illinois University School of Medicine, offers a preview of her upcoming session at PCMH Congress 2019, as well as details her experiences working on the ground floor of patient-centered, pediatric research.
Please introduce yourself and tell me about your background.
My name is Anne Scheer. I'm an assistant professor in the Department of Population Science and Policy at Southern Illinois University School of Medicine (SIU). My background is in sociology and I am a childhood sociologist by training.
My research interests include nutritional health (children's perspectives on health, food literacy, childhood obesity, and the culture of food) and education (school discipline, trauma-informed schooling, and educational disparities). I use qualitative methods to explore children's own views and voices on different topics. For example, I conduct interviews, focus groups, and participant observation. I also conduct document analyses, depending on the topic.
Previously, I have worked in schools to explore children's views on punitive school discipline. Since I transitioned to SIU School of Medicine, I started looking into the problem of childhood obesity. Specifically, I am focusing on rural children's perspectives on health, well‑being, and nutrition.
You're presenting at PCMH Congress this weekend. Can you give a brief overview of what your session, “How PCMH/PCSP Can Identify Population Health Needs and Guide Focused Care Planning to Improve Outcomes” will entail?
Our session will focus on reviewing our pilot study on obtaining patient perspectives and effects on plans of care, outcomes, and patients’ ability to meet health care objectives. Jill Leonard*, my co-presenter will be able to provide a stronger perspective on the Patient‑Centered Medical Home dimension portion of our presentation but we are a unique, and essentially, a very unusual team. It was Jill who provided me with the contacts to get into the small, rural district where I'm currently conducting my research.
My component in the study is to do the research that is designed to explore children's own views on health, well‑being, and nutrition. The goal, or the motivation for this research, was to make sure that programs or interventions that are in place here and elsewhere to address overweight and obese children are in line with what is going on the children's lives: Are existing programs addressing what is actually going on? Are they designed in a way that actually works for the kids and the families? Do they take into consideration the daily lives, routines, and lived experiences of the kids and the families?
For my research, I conducted interviews with 45 students in two fifth grade classrooms in a small, rural district and used other data-collection strategies specifically designed to explore children’s own perspectives, to better understand their views on nutritional health. The district is comprised of four schools, Kindergarten through 2nd grade, 3rd through 5th grade, 6 through 8, and 9 through 12. I work in the intermediate school and spend a lot of time with the children in the cafeteria, talking to them, eating lunch with them, and observing what they're doing, what food means to them, and how they use food.
The district itself has no grocery store in the entire area that the district covers. Families have to drive 20 to 30 miles east or west to get to the nearest grocery stores with fresh produce.
One particular area that I looked into was the social role of food. For example, food as a type of currency to acquire social capital through food‑sharing. I observed students bringing food, chips, or cookies—things the kids know to be unhealthy, but that are still very popular among most kids. They will bring those foods to share with others. That, at least in the moment, allows them to acquire a status boost, if you will.
*Editorial Note: Look for an upcoming video interview with PCMH expert and quality improvement nurse, Jill Leonard, RN, from Southern Illinois University School of Medicine.
What kind of challenges do you anticipate throughout your research or in the pilot study?
A part of our research that is going to be challenging, but challenging in a very positive way, is to translate these findings into the clinical field. The dominant research paradigm is a quantitative paradigm. Most people around here are used to things with large data sets that are numerical. To actually have a narrative, such as what is produced through qualitative research, is rare in this context. That will be Jill’s and my job, to find ways to translate the information that we collect through this research in a way that is not just meaningful for the kids and families with whom we work, but also meaningful for those people in the clinical field that are in charge of either adapting existing programs or creating new programs.
Will you and Ms Leonard be involved with guidance in implementation of these programs or changes?
Not at this point, no. The starting point for us—where Jill and my passion overlapped—is the idea that, before we do anything, or before we continue to do anything, we need to figure what's actually going on: Do the kids think of health the same way that we think of health? What does healthy and unhealthy eating mean to them? What matters to them? What factors influence their decisions to engage in healthy versus unhealthy behaviors?
We want to help answer these questions so we can make sure that whatever programs we engage in, either by creating them or by improving existing ones, truly address what's going on. A lot of the time, ideas sound good on paper, and they can sound convincing in theory, but they don't necessarily work in practice for a variety of reasons.
For example, we can bring fresh fruits and vegetables to children and their families, but that may not be at all what they're looking for – it may not be what is keeping them from eating well. Families may not know how to prepare certain foods in ways that taste good to them. Depending on circumstances, they may not even have the means to prepare or store those foods.
These are things we are trying to figure out. We hope that our work can help better understand what being healthy means to children and what the key factors are that are keeping them from being as healthy as they can be. These insights are crucial before we move to the stages of working with an existing program or creating a new one that better captures the lives of the people we are trying to help.
What do you anticipate some of the challenges of implementing the different strategies to be?
Producing measurable outcomes that continue to secure provider/clinician buy‑in. As I stated before, it's a very quantitative world. However, what people eat, why they become and stay overweight or obese are highly complex topics that are related to many different aspects of people's lives that it not only takes a long time to effect change, it can also be challenging to define and measure success.
At the population level, obviously, it would be wonderful if we could, at some point, say something like: “Over the past 20 years, we have significantly decreased the rates of childhood overweight and obesity in our state.” However, we are very mindful that childhood overweight and obesity are tied to so many factors that make this a very ambitious goal. What we are hoping to achieve is to define and show success in a way that creates meaningful change for children’s nutritional health and well-being and, at the same time, secures ongoing buy‑in and support by those in charge of creating, administering, and overseeing related programs.
What do you hope the key takeaways for attendees from your session should be?
An increased awareness of how important it is to include perspectives of those we try to help, whatever field it is. In this case, it's nutritional health and well‑being, but that would go for any other field that medicine touches: What is going on in our patients’ lives and what factors in our patients’ lives may help or hinder improved health outcomes? I hope attendees of our session will go home with an increased appreciation and drive to take into consideration the perspectives and realities of people that we work with, of our patients—for program design, implementation, and evaluation.