A qualitative exploration into parental recognition of overweight and obesity in pre-adolescents: a process of discovery

Australian parents' experiences when discussing their child's overweight and obesity with the Maternal and Child Health nurse: A qualitative study

AIMS AND OBJECTIVES

To explore parents' experiences when discussing child overweight issues with the Maternal and Child Health nurse.

BACKGROUND

Community-based child and family health nurses are in a unique position to discuss child overweight and obesity with parents. However, studies of parents' experiences in this context are lacking.

METHOD

Ten mothers of children identified as overweight or obese from regional Victoria, Australia, were interviewed in 2017. Data were analysed using an inductive qualitative thematic approach. The COREQ guidelines were used to ensure study rigour.

RESULTS

In summary, the analysis revealed experiences of Maternal and Child Health nurses "brushing over" the topic, with a lack of information provided about how to tackle the problem at home. The interpersonal relationship aspect of continuity of care was described as facilitating awareness of the child's overweight, although mothers expressed confusion about what constituted a "healthy weight range." While some mothers perceived the nurse's role was to offer evidence-based information and support, others saw the family doctor as the appropriate health professional to address the problem.

CONCLUSION

The findings of this study indicate that parents are often left unsure how to manage their child's weight despite the child being identified as overweight or obese by their Maternal and Child Health nurse.

RELEVANCE TO CLINICAL PRACTICE

Discussions about overweight and obesity may be facilitated by continuity of care where established relationships serve as a facilitator for effective communication. The findings further indicate a need for more structured support of Maternal and Child Health nurses working with parents of young children identified as overweight or obese, including ongoing education, skill development and improved understanding of parental health literacy and its links to childhood obesity.

Is children's weight a public health or a private family issue? A qualitative analysis of online discussion about National Child Measurement Programme feedback in England

Background

The National Child Measurement Programme (NCMP) is a child weight monitoring system in England, taking place in the first and final years of primary school. Many local authorities consider it important to inform parents if their child is overweight, and do so by letter alongside the offer of support and advice. Such letters have been met with mixed reactions from parents, but research seeking to better understand parents’ responses is often limited by reliance on survey data and low participation rates. This study aimed to collect a broad variety of perspectives on the programme by analyzing views expressed in parent-to-parent discussions posted online.

Methods

UK-based online parenting fora were used to identify discussion threads based around the NCMP between 2010 and 2017. Thirty-one discussion threads from two parent fora were identified. Thematic analysis was used to identify themes in these data.

Results

The primary themes identified related to (1) the legitimacy of feedback and judgement from health professionals, (2) the relative importance of collecting population level data above individual preferences, and (3) risks versus benefits of having conversations with children about weight. Most threads adopted an ‘argument, counter-argument’ format, providing two sides to each issue raised. Information and opinions consistent with public health messages were frequently provided, such as how data are used, that feedback is intended to be helpful, and the importance of collecting national data. There was little evidence of individual parents shifting their views in response to others’ arguments.

Conclusions

This study provides novel insight into peer-to-peer debates about the NCMP, including the arguments parents find convincing and acceptable for and against a national programme to weigh children and provide feedback to parents about their weight. Online fora were used as an opportunity to express criticism or distress, but also to seek advice from peers regarding concerns about whether or not to opt-out. Thus, both general issues related to the legitimacy of population screening and outcomes for individual children were of concern to parents.

Comparing Low-income Mothers' and Fathers' Concern for Young Children's Weight

PURPOSE

The objectives of this study were to compare the relationship of mother and father (1) perceived child weight and child body mass index (BMI) z-score, (2) concern for child's current weight and child BMI z-score, and (3) concern for child's future weight and child BMI z-score.

DESIGN AND METHODS

This cross-sectional study included low-income mothers (n=30) and fathers (n=30) with a young child (3 to 10years old) from the same household. Each parent completed select items from the Child Feeding Questionnaire (CFQ) with a trained interviewer. Child BMI z-score was calculated.

RESULTS

There was a significant, positive relationship between fathers' perceived child weight and child BMI z-score (p=0.006) and between fathers' concern for a child's future weight and child BMI z-score (p=0.001) but not among mothers.

CONCLUSIONS

Cohabitating low-income parents of young children may have conflicting appraisals of their child's BMI z-score and concerns for their child's future weight, and low-income fathers may be more accurate and concerned about their children's weight.

PRACTICE IMPLICATIONS

Based on findings from this study, healthcare providers including physicians and nurses should attempt to include fathers in discussions regarding their child's weight for obesity prevention, especially in low-income families.

Mothers' conceptions about excess weight in infancy and the nutritional status of their children

OBJECTIVE

To analyze maternal conceptions about excess weight in infancy and the nutritional status of their preschool-aged children.

METHODS

A mixed, exploratory study was performed using semi-structured interviews. Two study groups were defined: a group of 16 mothers of children with excess weight and a group of 15 mothers of eutrophic children. The interviews were submitted to content analysis using CHIC software (Classification Hiérarchique Implicative et Cohésitive¯).

RESULTS

The mothers of children with excess weight tended to conceive thin children as malnourished, while those of normal weight children emphasized the influence of family and genetics as determinants of a child's nutritional status. Although there was a certain consensus among the mothers that an unhealthy diet contributes to the risk of a child developing excess weight, the concept of genetics as a determinant of a child's nutritional status was also present in the dialogue from the mothers of both groups. This result indicates a lack of clarity regarding the influence of eating behavior and family lifestyle on weight gain and the formation of a child's eating habits. Both groups indicated that the mother has a decisive role in the eating habits of her child; however, the mothers of children with excess weight did not seem to take ownership of this concept when addressing the care of their own children.

CONCLUSION

Differences in conceptions, including taking ownership of care, may contribute to the development of excess weight in preschool-aged children.

The Health Care Provider's Experience With Fathers of Overweight and Obese Children: A Qualitative Analysis

PURPOSE

The purpose of this study was to explore the experience of health care providers (HCPs) in the outpatient setting as they work with fathers of children who are overweight and obese.

METHOD

Interpretative phenomenological analysis was used for data collection and analysis. Seven HCPs were interviewed about their experiences.

RESULTS

Two major themes emerged from the experiences of these HCPs: "dad in the back seat" and "paternal resistance."

DISCUSSION

The theme of "dad in the back seat" captured the HCPs' experiences and perceptions of parental roles and related stereotypes with respect to fathers' lack of presence in the health-care setting, family roles that relegate fathers to the back seat in dealing with this issue, and the tendency of fathers to take a passive role and defer to mothers in the management of their child's weight. "Paternal resistance" reflected the perceived tendency of the father to resist the acceptance of his child's weight as a problem and to resist change and even undermine family efforts to make healthier choices.

CONCLUSION

HCPs' experiences of fathers as having a minimal role in the management of their child's overweight and obesity may lead them to neglect fathers as agents of change with regard to this important issue.