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Schwartzkoff E, Burrows T, Bailey A, Sneddon E, Duncanson K. What are health professionals' perceptions of conducting routine growth assessments and lifestyle interventions? A qualitative study involving allied health professionals, nurses and doctors in rural and regional New South Wales. Aust J Prim Health 2023; 29:596-605. [PMID: 37380151 DOI: 10.1071/py22251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 05/10/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND Allied health professionals, nurses and doctors within the New South Wales (NSW) public health system provide trusted health information to a large proportion of families across the state. This means they are well positioned to opportunistically assess and discuss child weight status with families. Prior to 2016, weight status was not routinely addressed in most NSW public health settings, however recent policy changes promote quarterly growth assessments for all children aged under 16years who attend these facilities. The Ministry of Health recommend health professionals use the 5 As framework, a consultation approach to encourage behaviour change, to identify and manage children with overweight or obesity. This study aimed to explore allied health professionals', nurses' and doctors' perceptions of conducting routine growth assessments and providing lifestyle support to families in a local health district in rural and regional NSW, Australia. METHODS This descriptive, qualitative study involved online focus groups and semi-structured interviews with health professionals. Audio recordings were transcribed and coded for thematic analysis, with rounds of data consolidation between research team members. RESULTS Allied health professionals, nurses and doctors who work in a variety of settings within a local health district of NSW participated in one of four focus groups (n =18 participants) or semi-structured interviews (n =4). The predominant themes related to: (1) health professionals' professional identity and their perceived scope of practice; (2) interpersonal qualities of health professionals; (3) the service delivery ecosystem in which health professionals worked. Diversity in attitudes and beliefs about routine growth assessments were not necessarily specific to discipline or setting. CONCLUSIONS Allied health professionals, nurses and doctors recognise the complexities involved in conducting routine growth assessments and providing lifestyle support to families. The 5 As framework used in NSW public health facilities to encourage behaviour change may not allow clinicians to address these complexities in a patient centred way. The findings of this research will be used to inform future strategies aimed at embedding preventive health discussions into routine clinical practice, and to support health professionals to identify and manage children with overweight or obesity.
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Affiliation(s)
- Emma Schwartzkoff
- Health Promotion, Mid North Coast Local Health District, Port Macquarie, NSW 2444, Australia; and School of Health Sciences (Nutrition and Dietetics), University of Newcastle, Callaghan, NSW 2308, Australia
| | - Tracy Burrows
- School of Health Sciences (Nutrition and Dietetics), University of Newcastle, Callaghan, NSW 2308, Australia
| | - Andrew Bailey
- Research and Knowledge Translation, Mid North Coast Local Health District, Port Macquarie, NSW 2444, Australia
| | - Eloise Sneddon
- Health Promotion, Mid North Coast Local Health District, Port Macquarie, NSW 2444, Australia
| | - Kerith Duncanson
- Heath Education and Training Institute (NSW Health), St Leonards, NSW 2067, Australia; and School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia
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Eli K, Neovius C, Nordin K, Brissman M, Ek A. Parents' experiences following conversations about their young child's weight in the primary health care setting: a study within the STOP project. BMC Public Health 2022; 22:1540. [PMID: 35962359 PMCID: PMC9375316 DOI: 10.1186/s12889-022-13803-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 07/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In primary healthcare, conversations between clinicians and parents about young children's overweight are key to providing support and initiating weight management. However, given the sensitivity of this topic, these conversations are difficult for both clinicians and parents and are sometimes delayed or avoided. To understand the emotional impact of these conversations, this study aims to shed light on parents' experiences following conversations with primary care nurses about their child's overweight. METHODS Participants were recruited through a childhood obesity randomized controlled trial (RCT) conducted in Sweden. Telephone-based semi-structured interviews were conducted with 17 parents (mean age 40; the majority were women (n = 12/17), had a university degree (n = 14/17) and were born in Sweden (n = 13/16)). Their children were between 3 and 7 years old (mean age 4.8 years) with overweight (n = 7) or obesity (n = 10). The interviews were recorded, transcribed, and analyzed using thematic analysis. RESULTS Two main themes were developed. Theme 1, 'Receiving the overweight/obesity diagnosis', explores parents' reactions to the conversation with the primary care nurse. Depending on how the nurse presented the topic, conversations either fostered an alliance between the parent and the nurse, encouraging parents to reflect and develop insights about the child's and the family's needs (subtheme Conversations that empower), or felt limited, uncomfortable, or belittling (subtheme Conversations that provoke resistance). Theme 2, 'Parenting a child with a formal diagnosis of obesity', explores challenges parents faced following the weight conversations, including managing their own feelings and concerns (subtheme Fear of transferring weight anxiety), dealing with others' reactions (subtheme Involve family and manage surroundings) and asking for and receiving support from health care professionals (subtheme Obtain support from health care professionals). CONCLUSIONS While conversations with primary care nurses about children's weight were often emotional, most parents felt these conversations were ultimately helpful, as they encouraged them to enact positive lifestyle changes. Importantly, when nurses initiated conversations in a responsive, non-blaming way, inviting parents to reflect on their situation, parents felt more supported and empowered. These findings convey the importance of providing communication skills training to pediatric healthcare professionals, with particular focus on childhood overweight and obesity. TRIAL REGISTRATION NUMBER ClinicalTrials.gov NCT03800823 ; 11 Jan 2019.
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Affiliation(s)
- Karin Eli
- Unit for Biocultural Variation and Obesity, School of Anthropology and Museum Ethnography, University of Oxford, Oxford, UK.,Warwick Medical School, University of Warwick, Coventry, UK
| | - Catharina Neovius
- Regional Unit for the Well-Baby Clinics, Sachsska Children's Hospital, Stockholm, Sweden
| | - Karin Nordin
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Markus Brissman
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.,Occupational Therapy & Physiotherapy, Allied Health Professionals Function, Karolinska, University Hospital, Stockholm, Sweden
| | - Anna Ek
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
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Nowicka P, Ek A, Grafström E, Johansson T, Nordin K, Neuman N, Reijs Richards H, Eli K. How Do Interpersonal Relationships Affect Children's Weight Management? A Qualitative Analysis of Parents' Long-Term Perceptions after Obesity Treatment. Child Obes 2022; 18:274-280. [PMID: 34767728 DOI: 10.1089/chi.2021.0156] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: Childhood obesity interventions are particularly effective during the preschool age, but little is known about parents' long-term perceptions of weight management. This study explores how parents perceive the influence of interpersonal relationships on their children's eating and physical activity 4 years after participating in a randomized controlled trial. Bronfenbrenner's ecological systems theory frames this study, with the child's environment conceptualized as interlocking microsystems that affect weight management. Methods: Interviews were conducted with 33 parents (85% mothers, 48% with university degree) of 33 children [mean age 9.3 (standard deviation 0.7), 46% girls] from Stockholm, Sweden. Interviews were analyzed using thematic analysis, focusing on parents' perceptions of interpersonal relationships: family, relatives, other children, preschool/school staff, and health care practitioners. Results: Two main themes were developed: (1) Discouragement, with the subthemes Conflicting rules and Social comparison, and (2) Support and understanding, with the subthemes Teamwork and Shared responsibility and continuity of care. Parents perceived children's weight management as a continuous orchestration of different influences across social spheres. Years after obesity treatment, parents struggled to maintain the child's healthy routines outside the home. However, when siblings, grandparents, teachers, and friends' parents acted supportively, routines were easier to maintain. Conclusions: The findings suggest that each microsystem in a child's environment has important influence on weight management, such that, as children grow older, children's lifestyles cannot be managed by parents alone. To facilitate weight management, more people in the child's environment should be involved early in the treatment process, and continued professional support should be offered to parents.
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Affiliation(s)
- Paulina Nowicka
- Department of Food Studies, Nutrition, and Dietetics, Uppsala University, Uppsala, Sweden.,Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Anna Ek
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Emeli Grafström
- Department of Food Studies, Nutrition, and Dietetics, Uppsala University, Uppsala, Sweden
| | - Tora Johansson
- Department of Food Studies, Nutrition, and Dietetics, Uppsala University, Uppsala, Sweden
| | - Karin Nordin
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Nicklas Neuman
- Department of Food Studies, Nutrition, and Dietetics, Uppsala University, Uppsala, Sweden
| | - Hannah Reijs Richards
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Karin Eli
- Department of Food Studies, Nutrition, and Dietetics, Uppsala University, Uppsala, Sweden.,Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom.,School of Anthropology and Museum Ethnography, University of Oxford, Oxford, United Kingdom
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Castor C, Derwig M, Borg SJ, Ollhage ME, Tiberg I. A challenging balancing act to engage children and their families in a healthy lifestyle - Nurses' experiences of child-centred health dialogue in child health services in Sweden. J Clin Nurs 2021; 30:819-829. [PMID: 33377556 DOI: 10.1111/jocn.15622] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 10/26/2020] [Accepted: 12/10/2020] [Indexed: 01/03/2023]
Abstract
AIMS AND OBJECTIVES To describe nurses' experiences of a child-centred family guided intervention of obesity tested within the child health services targeting children identified with overweight and their caregivers. BACKGROUND Interventions aiming to support families towards a healthier lifestyle can lead to decreased risk of overweight evolving into obesity in a child. At the same time, nurses have found dialogues on weight challenging and may therefore avoid them. DESIGN Qualitative descriptive inductive design following content analysis applying to the COREQ guidelines. METHODS Content analysis was used to analyse 13 individual semi-structured interviews with nurses in the child health service in Sweden after completed training in CCHD, including how to facilitate the dialogue with the use of illustrations. RESULTS The theme Health dialogue about weight is a challenging balancing act facilitated by a supportive intervention emerged through eight subcategories in three main categories. Nurses experienced that CCHD with children identified with overweight and their caregivers provoked an emotional response both for themselves and for the caregivers of the child. The training in child-centred health dialogues promoted the nurses' work with structure and professionalism, as the nurses carefully took tentative steps to engage the family for a healthy lifestyle. CONCLUSIONS Emotional and practical challenges in performing CCHD still remained among nurses after customised training, which might comprise the child's rights to be involved in his or her own care when the child was identified as overweight. However, training for nurses, including lectures and tutorials, was found to increase the quality and professionalism of performing CCHD by providing structure, tools and tutorial support. RELEVANCE TO CLINICAL PRACTICE Customised training and illustrations can support nurses when performing a structured intervention such as child-centred health dialogues.
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Affiliation(s)
- Charlotte Castor
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Mariette Derwig
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | | | | | - Iren Tiberg
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
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Davidson K, Vidgen H, Denney-Wilson E, Daniels L. Who is responsible for assessing children's weight status? - a qualitative study of health professionals in regional Australia. BMC Public Health 2019; 19:1196. [PMID: 31470830 PMCID: PMC6716851 DOI: 10.1186/s12889-019-7539-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 08/22/2019] [Indexed: 11/24/2022] Open
Abstract
Background Currently in Australia there is a lack of clarity regarding routine assessment of primary school aged children’s weight status despite it being the first step in the identification of overweight and obesity. The National Health and Medical Research Council Obesity Guidelines recommend primary health care professionals include routine weight status assessment in consultations with children yet research suggests this rarely occurs in practice. This study aimed to determine the views of primary health care professionals regarding routine weight status assessment in primary school aged children and to establish the barriers to assessing children’s weight status. Methods Using the case study of a regional town, Rockhampton, purposeful sampling was used to represent the key primary health care settings and professional groups. Interviews were conducted with 31 health professionals. Data were collected and analysed guided by two frameworks, the Capability, Opportunity, Motivation and Behaviour and Theoretical Domains Frameworks. Results Eight themes emerged from data and these were relevant to the three levels of influence on the routine weight status of assessment, system, setting and individual. System level themes related to having a formalised program for the undertaking of routine weight status assessment in primary school aged children, increasing the population’s awareness about the importance of the weight status check and limited public health services available for management of childhood overweight and obesity. Setting level theme regarded the location where routine weight status in primary school aged children could be undertaken. Four themes at the individual level of influence on the routine weight status assessment related to the primary health professionals’ roles, barriers to assessing children’s weight status, methods of weight status assessment and starting a weight related conversations with families. Conclusion The Government, primary health care services, professional organisations and associations as well as health professionals must commit to long-term implementation of the Obesity Guidelines. Immediate action to improve the undertaking of routine weight status assessment in children must be taken by each health service and health professional. Strategies should aim to positively affect motivation to assess children’s weight status as it is the central component in creating change in practice.
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Affiliation(s)
- Kamila Davidson
- School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology, Kelvin Grove Campus, O Block, A Wing, Victoria Park Road, Kelvin Grove, Brisbane, Queensland, 4059, Australia.
| | - Helen Vidgen
- School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology, Kelvin Grove Campus, O Block, A Wing, Victoria Park Road, Kelvin Grove, Brisbane, Queensland, 4059, Australia
| | - Elizabeth Denney-Wilson
- Sydney Nursing School, The Universtiy of Sydney, 88 Mallett St, Sydney, New South Wales, 2050, Australia
| | - Lynne Daniels
- School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology, Kelvin Grove Campus, O Block, A Wing, Victoria Park Road, Kelvin Grove, Brisbane, Queensland, 4059, Australia
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