title: The Massachusetts BMI letter: a qualitative study of responses from parents of obese children.
abstract: OBJECTIVE
  Massachusetts (MA) public schools conduct mandated body-mass index (BMI) screening and until recently, communicated results in a letter to parents/caregivers, to encourage primary care visits and provide aggregate data to the state Department of Public Health. This study assessed the letter's readability and qualitatively explored parents' responses to it.
  
  
  METHODS
  Readability of the BMI letter was calculated. Audio-taped 1-h focus groups were conducted with parents/caregivers of 8- to 14-year-old obese (≥95th BMI-for-age percentile) children. A semi-structured interview guide was used to elicit responses. Qualitative content analysis was conducted on transcripts to identify emergent themes.
  
  
  RESULTS
  Readability analysis showed higher grade levels than recommended. Eight focus groups consisting of two to six parents each were conducted (n=29); 83% were female, mean age 41±9years, and 65% self-identified as Hispanic/Latino. Key themes identified included usefulness of the BMI letter, concerns about utility of BMI for screening, concerns about impacting self-esteem, and failure to understand the letter.
  
  
  CONCLUSIONS
  The MA BMI letter may not have been achieving its desired goal with some parents.
  
  
  CONCLUSIONS
  Emergent themes from this study could be used to test effectiveness of similar BMI letters nationwide and develop strategies to improve communication to parents.
authors.affiliation: Center for Science in the Public Interest, DC, USA.
authors.forename: Lindsay J
authors.initials: LJ
authors.lastname: Moyer
authors.affiliation: Department of Nutrition, University of Massachusetts Amherst, Amherst, USA. Electronic address: ecarbone@nutrition.umass.edu.
authors.forename: Elena T
authors.initials: ET
authors.lastname: Carbone
authors.affiliation: Department of Nutrition, University of Massachusetts Amherst, Amherst, USA.
authors.forename: Jean A
authors.initials: JA
authors.lastname: Anliker
authors.affiliation: Department of Medicine, Baystate Medical Center, Springfield, USA; Clinical and Translational Science Institute, Tufts University School of Medicine, Boston, USA.
authors.forename: Sarah L
authors.initials: SL
authors.lastname: Goff
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015992:Body Mass Index; D002648:Child; D032882:Comprehension; D005260:Female; D017144:Focus Groups; D006801:Humans; D008297:Male; D008404:Massachusetts; D008875:Middle Aged; D009765:Obesity / Q000517:prevention & control*; D010290:Parents; D036301:Qualitative Research; D011932:Reading; D013637:Tape Recording; D055815:Young Adult
keywords: BMI; Body mass index screening; Health literacy; Patient–provider communication; Weight communication