BACKGROUND: Since 2010, nurses in Massachusetts public schools have conducted state-mandated Body Mass Index (BMI) screening of first, fourth, seventh, and tenth graders and communicated results in a letter to parents/caregivers. The objective of this study was to explore parents’ responses to the BMI letter and their experiences with weight-related language used by health professionals. These two areas were examined in the context of parents’ health literacy skills and readability of the letter. METHODS: Readability of the letter was calculated using five common formulas. One-hour focus groups were conducted using a semi-structured interview guide with a convenience sample of parents/caregivers of 8- to 14-year-old obese children participating in a weight management program. Parents were asked to share reactions to 10 weight terms in random order. Parents also completed a written version of the Newest Vital Sign (NVS) health literacy assessment. Focus group data were transcribed verbatim, and content analyses conducted to identify emergent themes. Descriptive statistics were calculated for NVS scores. RESULTS: Reading-level estimates of the BMI letter ranged from fifth to seventh grade. Twenty-nine individuals participated in eight focus groups (83% female, mean age 41 yrs+9 yrs, 59% self-identified as Hispanic/Latino). NVS scores for 12 participants (41%) indicated a possibility (n=7) or high likelihood (n=5) of limited health literacy. “Emotions” emerged as a major theme. Parents expressed concern, guilt, fear, anger, rationalization, skepticism, and acceptance regarding the letter and weight-related terms. Parents had mixed reactions to the letter: finding the information helpful, voicing concern about privacy and self-esteem, and displaying confusion when interpreting the weight status. A majority (67%) of parents who expressed confusion about the letter or weight terminology received an NVS score indicating a possibility or high likelihood of limited health literacy. Among the weight terms, parents preferred weight, weight problem, and unhealthy weight more than obese or extremely obese. CONCLUSIONS: This is the first known study to evaluate how parents respond to and comprehend the Massachusetts BMI letter. Emergent themes could be used to inform quantitative assessment of communication challenges associated with the letter. This study has implications for respectfully and effectively communicating BMI results nationwide.

As people age there is an overwhelming desire to remain in the familiar surroundings of the family home, what is called Aging in Place. But inevitable changes that occur in their lives force the aging adults and their families to consider a move to some form of institutional living. Living at a distance from one another, the adult child attempts to maintain peace of mind concerning the well-being of their aging parents but finds it to be a difficult task. I propose to address this problem by first proposing that technology can help minimize the anxieties experienced by the adult child concerning their aging parents well being by appropriately presenting information on the aging parents daily life. This technological design concept does not require that the aging parent input, or for that matter, do anything other than live their lives as they normally live them. Further, this technology provides this information in a manner that is continuously available to the adult child for either opportunistic or planned perusal. As a single instance of the technological design concept proposed above, the Digital Family Portrait embeds well-being related information into an item commonly found in homes, the picture in a picture frame. The Digital Family Portrait was first tested in a wizard-of-oz field trial, then redesigned based on the outcome of this initial field trial coupled with the results of two lab-based studies and a further informal evaluation. The redesigned Digital Family Portrait was built and installed in the home of an adult child while the sensors to drive it were installed in an aging parents home. A field trial of this installation lasting for one year was conducted. The result of this field trial was to find that the Digital Family Portrait was an acceptable means of resolving certain peace of mind issues for the adult child while not raising privacy. It was found to be used in a socially acceptable manner by the adult child while the aging parent to reported feeling less lonely.