Date of Award

8-2026

Document Type

Dissertation

Degree Name

Doctor of Nursing Practice

Degree Discipline

Nursing Practice

Abstract

Background: Childhood obesity is a significant public health concern associated with metabolic, cardiovascular, and psychosocial complications. Despite the availability of evidence-based pediatric obesity management guidelines, adherence to these guidelines remains inconsistent in primary care settings. Purpose: This evidence-based quality improvement project aimed to determine whether provider education on the 2023 American Academy of Pediatrics (AAP) Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity, combined with implementation of an electronic health record (EHR) clinical decision support prompt, improved provider knowledge and adherence to guideline-recommended obesity management practices. Method: A pre-post quasi-experimental study was conducted in a privately owned pediatric primary care clinic in Northwest Houston, Texas. The intervention consisted of a provider education session and implementation of an EHR prompt that activated when a patient’s body mass index was at or above the 95th percentile. Provider knowledge was assessed using a survey administered before and after the education session. Adherence was evaluated through retrospective chart reviews comparing pre-intervention and post-intervention outcomes for pediatric patients with obesity. Results: Provider knowledge improved following the educational intervention: mean knowledge scores increased from 7.33 to 9.00, with a mean difference of 1.67 points and a large effect size (Cohen’s d = 1.29). Provider adherence for patients aged 10 years or older increased from 7.7% (3 of 39 patients) pre-intervention to 12.5% (4 of 32 patients) post-intervention. Adherence for patients younger than 10 years remained 0.0% during both periods. Although overall adherence increased following implementation, Fisher’s exact test indicated no statistically significant association between time period and adherence (p = .701). Cohen’s h was 0.119, indicating a small magnitude of difference. Conclusion: The education session improved provider knowledge and, combined with EHR clinical decision support, was associated with a very small increase in adherence to evidence-based pediatric obesity management guidelines. Although statistically significant improvements in adherence were not observed during the implementation period, the intervention demonstrated feasibility within a pediatric primary care setting and showed potential to support guideline-concordant obesity management. Continued implementation and ongoing monitoring may further improve adherence and support sustainable practice changes.

Keywords: American Academy of Pediatrics, childhood obesity management, clinical decision support, clinical practice guidelines, electronic health record prompt, evidence-based practice, guideline adherence, nutrition referral, obesity management,obesity screening, pediatric obesity, primary care, provider education, quality improvement

Committee Chair/Advisor

Chloe Gaines

Committee Member

Sharisse Hebert

Committee Member

Shannon Chopp

Committee Member

Lora Torres

Rights

© 2021 Prairie View A & M University

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

Date of Digitization

8/18/2026

Contributing Institution

J B Coleman Library

City of Publication

prairie View

MIME Type

Application/PDF

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