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CONversation Cards© were created to enhance communication between parents and healthcare professionals working in pediatric weight management. They are conversation starters designed to help parents identify the biggest challenges they face when addressing issues related to their children’s weight and health. Once parents identify their challenges, healthcare professionals can align their counseling and interventions with the issues that are most important to families.

Conversation Cards

Clinicians have reported difficulties to effectively communicate with families regarding obesity, observations that indicate a need to improve how obesity is addressed in the healthcare setting. To enhance their day-to-day practice, clinicians have expressed a desire for clinical tools to help them support families managing obesity. Being able to identify their most pressing lifestyle concerns and priorities, clinicians can help families to set and meet lifestyle-related goals.

We developed CONversation Cards© (CCs) and Conversation Cards for Adolescents© (CCAs) that can serve as a priority-setting activity for parents and adolescents, respectively. These are tangible tools for clinicians to individualize treatment and set realistic goals. CCs and CCAs can help to optimize communication between families and clinicians, moving beyond a didactic or simple conversation about healthy behaviors.

CONversation Cards©

CONversation Cards© were created to enhance communication between parents and healthcare professionals working in pediatric weight management. They are conversation starters designed to help parents identify the biggest challenges they face when addressing issues related to their children’s weight and health. Once parents identify their challenges, healthcare professionals can align their counseling and interventions with the issues that are most important to families. Statements in CCs are distributed across 6 themes (communication, interpersonal relationships, nutrition, parenting, physical activity, and weight management).

How to use the cards:

  1. When a family arrives for their appointment, they should be given the cards to review while they wait to be called to see the clinician.
  2. Upon meeting with the clinician, the family passes on their chosen cards documented on the CCs Chart Note.
  3. Take a moment to review the number of cards selected and note the themes. Some questions to ask yourself, “Did they select a high number of cards?”, “Are the cards all from the same theme?”, “Which ones do we feel are a priority to address first?”
  4. Depending on the chosen cards, the issue might relate to an element of the family-clinician relationship which may simply require adjustment by the clinician. For example, if a family has selected the card, “Medical terminology confuses me”, the clinician may want to check-in with the family more often and verify their understanding or offer definitions for key terms.
  5. The cards are meant to guide the discussion and are not meant to limit the focus of the appointment. When meeting with a family, clinicians should acknowledge the fact that they may not be able to address all the cards, but will definitely keep them in mind moving forward.

 Conversation Cards for Adolescents© (CCAs)

Conversation Cards for Adolescents© (CCAs) were created to enhance communication and goal-setting between adolescents and healthcare professionals working in weight management. They are conversation starters designed to help adolescents identify the challenges and facilitators they experience when addressing issues related to their weight and health. Once adolescents identify their priorities – by choosing a card (or cards) from the deck – health care professionals can tailor their counseling and intervention with the issues that are most important to them. Statements in CCs are distributed across 7 themes (nutrition, physical activity, sedentariness, sleep, mental well-being, relationships, and clinical factors) and 3 categories (barriers, enablers, potential enablers). CCAs are available in Canada’s two official languages, English and French.

How to use the cards:

  1. When adolescents arrive for their appointment, they should ideally be given the cards to review independently from parents while they wait to be called to see the clinician.
  2. Adolescents are to document their chosen cards (3–5) on the CCAs Chart Note. Upon meeting with the clinician, adolescents can share their top priorities with the clinician.
  3. Take a moment to review the number of cards selected and note the themes and categories. Some questions to ask yourself, “Did they select a high number of cards?”, “Are the cards all from the same theme or category?”, “Which ones do we feel are a priority to address first?”
  4. Consider meeting with the adolescent alone to discuss their priorities if that is their preference.
  5. The cards are meant to guide the discussion and are not meant to limit the focus of the appointment. When meeting with an adolescent, clinicians should acknowledge the fact that they may not be able to address all the cards, but will definitely keep them in mind moving forward.

References:

Note: Subscriptions may be required to view the articles below. 

Kebbe M, Byrne JLS, Damanhoury S, Ball GDC. Following suit: using Conversation Cards for priority setting in pediatric weight management. Journal of Nutrition Education and Behavior. 2017 July–August 49(7): 588-592.e1

doi: 10.1016/j.jneb.2017.03.020.

PMID: 28479009

Ball GD, Farnesi BC, Newton AS, Holt NL, Geller J, Sharma AM, Johnson ST, Matteson CL, Finegood DT. Join the conversation! The development and preliminary application of conversation cards in pediatric weight management. Journal of Nutrition Education and Behavior. 2013 Sep-Oct;45(5):476-8.

doi: 10.1016/j.jneb.2013.02.002.

PMID: 23602164

Farnesi BC, Ball GD, Newton AS. Family-health professional relations in pediatric weight management: an integrative review. Pediatric Obesity. 2012 Jun;7(3):175-86.

doi: 10.1111/j.2047-6310.2012.00029.x.

PMID: 22492659

Farnesi BC, Newton AS, Holt NL, Sharma AM, Ball GD. Exploring collaboration between clinicians and parents to optimize pediatric weight management. Patient Education and Counseling. 2012 Apr;87(1):10-7.

doi: 10.1016/j.pec.2011.08.011.

PMID: 21925825

Frequently Asked Questions:

Can I remove cards from the deck or only use certain sections of the deck?

While you can adjust the deck to your needs, the cards were developed to reflect the diversity of issues experienced by teens in weight management. The number of cards represents a range of issues, many of which are inter-related. Our research with the original deck of CONversation Cards© designed for families revealed that all cards in the deck were chosen by families, suggesting that the complete deck of cards for teens might be most useful and relevant.

How can I help a teen that has selected cards beyond my area of comfort of expertise?

Given the range of issues included, it would be surprising if you felt confident and competent in all areas. Along with validating teens’ experiences, as with other topics that emerge in your clinical interactions that are beyond your expertise, it is completely reasonable to seek support and information from a colleague(s) to assist you or to refer your patient to a clinician or service so they can receive the support they seek.

What if teens aren’t comfortable selecting some cards in the presence of their parents?

As with any clinical appointments with teens, it is important for them to know your role and how you can best support them. Sometimes, this may include meeting with them individually, without their parents; however, when teens are ready, willing, and able to make healthy lifestyle and behavioural changes, the support of their parents or other important adults in their lives is often very important in helping them to make and maintain healthful changes.

What if teens select cards that do not align with their parents’ priorities?

Conversation Cards for Adolescents were created for and with teens, so it is expected that their priorities may differ from those of their parents. Ideally, areas of focus that both teens and parents can work on as a family may lead to the greatest likelihood of success. In the event that agreement can’t be achieved, your skill and experience as a clinician are important to help reconcile differences of opinion, along with identifying ways for parents to support their teens even when they disagree about their priorities.

What if teens select too many cards, how am I supposed to address them all?

If teens select too many cards, it can be helpful to ask them to look over the selected cards again and choose their top 3. Explain to them that this helps you to personalize your counseling; it also helps them to avoid feeling overwhelmed by a large number of issues that may be difficult to address in a short period of time.

References:

1. Kebbe M, Perez A, Buchholz A, McHugh TLF, Scott SD, Richard C, Dyson MP, Ball GDC. Recommendations from adolescents with obesity to facilitate healthy lifestyle changes: a multi-centre, qualitative study International Journal of Public Health, 2019 (Submitted).

2. Kebbe M, Perez A, Buchholz A, Scott SD, McHugh TLF, Dyson MP, Ball GDC. Health care providers’ delivery of health services for obesity management in adolescents: a multi-centre, qualitative study. BMC Health Serv Res. 2020; 20: 850. Published online 2020 Sep 10. doi: 10.1186/s12913-020-05702-8.

3. Kebbe M, Perez A, Buchholz A, Scott SD, McHugh TLF, Richard C, Dyson MP, Ball GDC. Adolescents’ involvement in decision-making for pediatric weight management: A multi-centre qualitative study on perspectives of adolescents and health care providers. Patient Education and Counseling, 2019; 102 (6):1194-1202.

4. Kebbe, M., Perez, A., Buchholz, A., McHugh, T.-L. F., Scott, S. D., Richard, C., Mohipp, C., Dyson, M. P., & Ball, G. D. C. (2018). Barriers and enablers for adopting lifestyle behavior changes in adolescents with obesity: A multi-centre, qualitative study. PLoS ONE, 13(12), Article e0209219.

5. Kebbe M, Damanhoury S, Browne N, Dyson M, McHugh TL, Ball GDC. Barriers to and enablers of healthy lifestyle behaviors of adolescents with obesity: a scoping review and stakeholder consultation. Obesity Reviews, 2017; 12: 1439-1453. DOI: 10.1111/obr.12602.

6. Kebbe M, Byrne J, Damanhoury S, Ball GDC. Following suit: using Conversation Cards for priority-setting in pediatric weight management. J Nutr Educ Behav . Jul-Aug 2017;49(7):588-592.e1. doi: 10.1016/j.jneb.2017.03.020. Epub 2017 May 3.

Contact:
There cards were developed by Drs. Maryam Kebbe (kebbe@ualberta.ca ) and Geoff Ball (gdball@ualberta.ca ) at the University of Alberta in partnership with teens from the Stollery Children’s Hospital (Edmonton, AB, Canada) and Children’s Hospital of Eastern Ontario (Ottawa, ON, Canada).