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Pallan M, Mason F, Parretti HM, Adab P, Abbott S, Jolly K. Supporting healthcare professionals to address child weight with parents: a qualitative study. Br J Gen Pract 2024; 74:e417-e425. [PMID: 38575182 PMCID: PMC11005922 DOI: 10.3399/bjgp.2023.0238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 10/06/2023] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Primary care and community healthcare professionals (HCPs) are well placed to discuss child excess weight with parents and support them to make changes. However, HCPs have concerns about addressing this issue. There is a need to understand the factors that influence HCPs in initiating these conversations to inform strategies to support them. AIM To explore with HCPs, working in primary care and community settings, their experiences of having conversations about child weight with parents, and the factors that create barriers or facilitate them to have these conversations. DESIGN AND SETTING A qualitative study with GPs, primary care nurses (PNs), and school nurses (SNs) in England. METHOD GPs and PNs were recruited to participate in semi-structured interviews. SNs from a community healthcare NHS trust were recruited to participate in focus groups. Vignettes were used to stimulate discussion. Data were analysed guided by the Framework approach. RESULTS Thirteen GPs, seven PNs, and 20 SNs participated. The following three themes were identified regarding barriers to HCPs having conversations about child excess weight: structural and organisational; HCP related; and parent or family related. The themes identified for the factors that facilitate these conversations were: structural changes (for example, dedicated appointments, access to weight assessment data, joined-up working across agencies); HCP approaches (for example, providing appropriate dietary and physical activity advice); and HCP knowledge and skills (for example, enhancing HCPs' general and weight management-related skills and knowledge of child weight management services). CONCLUSION A range of barriers exist to HCPs addressing child excess weight with parents in primary care and community settings. Actions to effect structural changes and support HCPs in developing relevant knowledge and skills are required to overcome these barriers.
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Affiliation(s)
- Miranda Pallan
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham
| | - Frances Mason
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham
| | - Helen M Parretti
- Norwich Medical School, Faculty of Medicine and Health, University of East Anglia, Norwich
| | - Peymané Adab
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham
| | - Sally Abbott
- Research Centre for Healthcare and Communities, Institute for Health and Wellbeing, Coventry University, Coventry; Department of Dietetics, University Hospitals Coventry and Warwickshire NHS Trust, Coventry
| | - Kate Jolly
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham
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Grey E, Griffin T, Jolly K, Pallan M, Parretti H, Retzer A, Gillison F. Extended brief interventions for weight management and obesity prevention in children: A rapid evidence review. Obes Rev 2023; 24:e13633. [PMID: 37604189 DOI: 10.1111/obr.13633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 07/25/2023] [Accepted: 07/30/2023] [Indexed: 08/23/2023]
Abstract
Uptake of child weight management (CWM) support is typically low, and services are not available in all areas. Extended brief interventions (EBIs) have been proposed as an affordable way to provide enhanced support, at a level between one-off brief advice and intensive CWM programs. This rapid systematic review sought to synthesize evidence on the efficacy of EBIs for weight management and obesity prevention in children (2-18 years). Embase and Web of Science were searched from January 2012 to January 2022. Nineteen studies, reporting on 17 separate EBIs, were included. The quality of studies was variable, and the EBIs were heterogeneous. The majority of EBIs (n = 14) were based on motivational interviewing. Five of the included studies reported significant improvements in parent or child determinants of health behavior change. However, robust measures of behavioral determinants were rarely used. No studies reported significant positive effects on child weight. No clear patterns in outcomes were identified. There is currently insufficient evidence for EBIs to be adopted as part of CWM services. To improve the evidence base, EBIs that are currently being implemented by local health services, should be evaluated to establish the most effective content, how it should be delivered, and by whom.
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Affiliation(s)
- Elisabeth Grey
- NIHR Applied Research Collaboration West, Bristol Medical School, University of Bristol, Bristol, UK
- Department for Health, University of Bath, Bath, UK
| | | | - Kate Jolly
- Institute of Applied Health Research and NIHR Applied Research Collaboration West Midlands, University of Birmingham, Birmingham, UK
| | - Miranda Pallan
- Institute of Applied Health Research and NIHR Applied Research Collaboration West Midlands, University of Birmingham, Birmingham, UK
| | - Helen Parretti
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Ameeta Retzer
- Institute of Applied Health Research and NIHR Applied Research Collaboration West Midlands, University of Birmingham, Birmingham, UK
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Cheng ER, Moore C, Parks L, Taveras EM, Wiehe SE, Carroll AE. Human-centered designed communication tools for obesity prevention in early life. Prev Med Rep 2023; 35:102333. [PMID: 37564121 PMCID: PMC10410241 DOI: 10.1016/j.pmedr.2023.102333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 07/17/2023] [Accepted: 07/18/2023] [Indexed: 08/12/2023] Open
Abstract
Objective How we communicate about obesity is critical as treatment paradigms shift upstream. We previously identified parental perceptions, concerns, beliefs, and communication preferences about early life obesity risk. We engaged parents of children 0 to 24 months of age and pediatricians from Indianapolis, Indiana, USA in the co-design of messages and tools that can be used to facilitate parent/provider conversations about early life obesity prevention. Methods From April to June 2021, we conducted a series of co-design workshops with parents of children ages 0 to 24 months and pediatricians to identify their preferences for communicating obesity prevention in the setting of a pediatric well visit. Human-centered design techniques, including affinity diagraming and model building, were used to inform key elements of a communication model and communication strategy messages. These elements were combined and refined to create prototype tools that were subsequently refined using stakeholder feedback. Results Parent participants included 11 mothers and 2 fathers: 8 white, 4 black, and 1 Asian; median age 33 years with 38% reporting annual household incomes less than $50,000. Pediatricians included 7 female and 6 male providers; 69% white. Through an iterative process of co-design, we created an exam room poster that addresses common misconceptions about infant feeding, sleep and exercise, and a behavior change plan to foster parent/provider collaboration focused on achieving children's healthy weight. Conclusions Our hands-on, collaborative approach may ultimately improve uptake, acceptability and usability of early life obesity interventions by ensuring that parents remain at the center of prevention efforts.
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Affiliation(s)
- Erika R. Cheng
- Indiana University School of Medicine, Department of Pediatrics, Division of Children’s Health Services Research, 410 W. 10 St., Suite 2000, Indianapolis, IN 46220, United States
| | - Courtney Moore
- Indiana Clinical & Translational Sciences Institute (CTSI), Research Jam, 410 W. 10 St., Suite 1000, Indianapolis, IN 46220, United States
| | - Lisa Parks
- Indiana Clinical & Translational Sciences Institute (CTSI), Research Jam, 410 W. 10 St., Suite 1000, Indianapolis, IN 46220, United States
| | - Elsie M. Taveras
- Kraft Center for Community Health, Massachusetts General Hospital, 125 Nashua St., Boston, MA 02114, United States
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 665 Huntington Ave., Boston, MA 02115, United States
| | - Sarah E. Wiehe
- Indiana University School of Medicine, Department of Pediatrics, Division of Children’s Health Services Research, 410 W. 10 St., Suite 2000, Indianapolis, IN 46220, United States
- Indiana Clinical & Translational Sciences Institute (CTSI), Research Jam, 410 W. 10 St., Suite 1000, Indianapolis, IN 46220, United States
| | - Aaron E. Carroll
- Indiana University School of Medicine, Department of Pediatrics, Center for Pediatric and Adolescent Comparative and Effectiveness Research, 410 W. 10th St., Suite 2000, Indianapolis, IN, United States
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Rossiter C, Cheng H, Denney-Wilson E. Primary healthcare professionals' role in monitoring infant growth: A scoping review. J Child Health Care 2023:13674935231165897. [PMID: 36963017 DOI: 10.1177/13674935231165897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/26/2023]
Abstract
Excessive weight gain in infancy is an established risk for childhood obesity. Primary healthcare professionals have regular contact with infants and are well placed to monitor their growth. This review explores primary healthcare professionals' practice in monitoring growth for infants from birth to 2 years, addressing assessment methods, practitioner confidence and interventions for unhealthy weight gain. Reviewers searched four databases for studies of primary healthcare professionals working in high-income countries that reported on practice monitoring infant growth. Thirty-six eligible studies documented health professionals' practice with infants. While most clinicians regularly weighed and measured infants, some did not record measurements comprehensively. Growth monitoring occurred regularly during well-child visits but was less common during unscheduled visits. Some participants were less proficient at interpreting growth trajectories or lacked confidence in detecting excessive weight gain and in communicating concerns to parents. Few interventions addressed unhealthy growth among infants. Primary healthcare professionals require support to monitor growth trajectories effectively, to communicate appropriately with parents and to engage them in developing healthy behaviours early. Strategies are also required to monitor infants not regularly attending primary health care.
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Affiliation(s)
- Chris Rossiter
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, 522555The University of Sydney, New South Wales, Australia
| | - Heilok Cheng
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, 522555The University of Sydney, New South Wales, Australia
- Sydney Institute for Women, Children and their Families, Sydney Local Health District, Sydney, New South Wales, Australia
- Centre of Research Excellence in Translating Early Prevention of Obesity in Childhood (EPOCH-Translate CRE), Australia
| | - Elizabeth Denney-Wilson
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, 522555The University of Sydney, New South Wales, Australia
- Sydney Institute for Women, Children and their Families, Sydney Local Health District, Sydney, New South Wales, Australia
- Centre of Research Excellence in Translating Early Prevention of Obesity in Childhood (EPOCH-Translate CRE), Australia
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Skantze C, Almqvist-Tangen G, Karlsson S. School nurses' experience of communicating growth data and weight development to parents of children 8 and 10 years of age. BMC Public Health 2023; 23:21. [PMID: 36600248 PMCID: PMC9814472 DOI: 10.1186/s12889-022-14941-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 12/23/2022] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION The prevalence of overweight and obesity among children has risen sharply during recent decades. School nurses are key health professionals in interventions targeting the early onset of overweight and obesity during childhood. Understanding how school nurses experience communication with parents concerning their child´s growth and weight development are essential. The aim of the study is to describe school nurses' experience of communicating growth data and weight development to parents of school children ages 8 and 10 years. METHOD The design of the study is a descriptive, qualitative design with purposive and snowball sampling. Sixteen interviews with school nurses were conducted and analysed with qualitative content analysis. RESULT The analysis resulted in three main categories including subcategories. In Challenges in the professional role, the school nurses expressed a lack of knowledge, skills and tools in communication, described a perception of parental responsibility and stated using several different approaches in communicating growth data and weight development to parents. In Sustainable communication with parents, the school nurses described the value of creating a dialogue, a supportive approach to the parents, and the building of a relation between them and the parents as essential. In Barriers in communicating the child´s weight, the school nurses described the experience of stigma concerning the subject of overweight and obesity, increased concern when they detected underweight as well as an ambivalence towards measuring weight. CONCLUSION The study highlights an educational challenge concerning the need for training, skills, and strategies for communication with parents. A variety of ways in school nurses' communication with parents were identified in the present study and this shows an inconsistency in how School health services was offered and a need for the development of evidence-based procedures for communicating growth data and weight development to parents.
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Affiliation(s)
- Caroline Skantze
- grid.73638.390000 0000 9852 2034School of Health and Welfare, Halmstad University, PO Box 823, 30118 Halmstad, Sweden
| | - Gerd Almqvist-Tangen
- grid.8761.80000 0000 9919 9582Department of Paediatrics, University of Gothenburg, 40530 Gothenburg, Sweden
| | - Staffan Karlsson
- grid.73638.390000 0000 9852 2034School of Health and Welfare, Halmstad University, PO Box 823, 30118 Halmstad, Sweden ,grid.73638.390000 0000 9852 2034Faculty of Health Sciences, Halmstad University and Kristianstads University, 29188 Kristianstad, Sweden
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Carroll C, Sworn K, Booth A, Pardo‐Hernandez H. Stakeholder views of services for children and adolescents with obesity: Mega-ethnography of qualitative syntheses. Obesity (Silver Spring) 2022; 30:2167-2184. [PMID: 36321275 PMCID: PMC9828799 DOI: 10.1002/oby.23558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 07/21/2022] [Accepted: 07/21/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The efficacy of services for children and adolescents with obesity is well researched, but this review describes what actually matters to stakeholders (children, caregivers, and professionals) in relation to such services. METHODS A mega-ethnography, an innovative review-of-reviews approach that uses conceptual findings as primary data, was performed. Twelve bibliographic databases (2010-2020) were searched for reviews that considered the values and preferences of stakeholders concerning services or interventions (diet, exercise, lifestyle) that targeted children and adolescents with obesity. RESULTS From 485 citations, 17 relevant reviews were identified. The synthesis found that the perceived need to address obesity is determined by subjective norms of weight and interactions with health professionals. Children's and caregivers' participation in obesity management services is shaped by their response to content, acceptability, and perceived benefits and demands. Whether they continue with and complete an intervention are determined by its perceived success, beyond just weight loss, including behavior change, enhanced self-esteem, and the provision of timely and relevant support. CONCLUSIONS Obesity management services must be promoted in a sensitive manner and must be tailored, be varied, and make positive use of family and schools if children and caregivers are to seek and actively engage with them.
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Affiliation(s)
| | - Katie Sworn
- School of Health and Related ResearchUniversity of SheffieldSheffieldUK
| | - Andrew Booth
- School of Health and Related ResearchUniversity of SheffieldSheffieldUK
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Cheng ER, Moore C, Parks L, Taveras EM, Wiehe SE, Carroll AE. Communicating Risk for Obesity in Early Life: Engaging Parents Using Human-Centered Design Methodologies. Front Pediatr 2022; 10:915231. [PMID: 35837240 PMCID: PMC9273946 DOI: 10.3389/fped.2022.915231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 06/01/2022] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Pediatricians are well positioned to discuss early life obesity risk, but optimal methods of communication should account for parent preferences. To help inform communication strategies focused on early life obesity prevention, we employed human-centered design methodologies to identify parental perceptions, concerns, beliefs, and communication preferences about early life obesity risk. METHODS We conducted a series of virtual human-centered design research sessions with 31 parents of infants <24 months old. Parents were recruited with a human intelligence task posted on Amazon's Mechanical Turk, via social media postings on Facebook and Reddit, and from local community organizations. Human-centered design techniques included individual short-answer activities derived from personas and empathy maps as well as group discussion. RESULTS Parents welcomed a conversation about infant weight and obesity risk, but concerns about health were expressed in relation to the future. Tone, context, and collaboration emerged as important for obesity prevention discussions. Framing the conversation around healthy changes for the entire family to prevent adverse impacts of excess weight may be more effective than focusing on weight loss. CONCLUSIONS Our human-centered design approach provides a model for developing and refining messages and materials aimed at increasing parent/provider communication about early life obesity prevention. Motivating families to engage in obesity prevention may require pediatricians and other health professionals to frame the conversation within the context of other developmental milestones, involve the entire family, and provide practical strategies for behavioral change.
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Affiliation(s)
- Erika R Cheng
- Department of Pediatrics, Division of Children's Health Services Research, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Courtney Moore
- Indiana Clinical and Translational Sciences Institute (CTSI), Research Jam, Indianapolis, IN, United States
| | - Lisa Parks
- Indiana Clinical and Translational Sciences Institute (CTSI), Research Jam, Indianapolis, IN, United States
| | - Elsie M Taveras
- Kraft Center for Community Health, Massachusetts General Hospital, Boston, MA, United States.,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Sarah E Wiehe
- Department of Pediatrics, Division of Children's Health Services Research, Indiana University School of Medicine, Indianapolis, IN, United States.,Indiana Clinical and Translational Sciences Institute (CTSI), Research Jam, Indianapolis, IN, United States
| | - Aaron E Carroll
- Department of Pediatrics, Center for Pediatric and Adolescent Comparative and Effectiveness Research, Indiana University School of Medicine, Indianapolis, IN, United States
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Clarke R, Heath G, Nagakumar P, Pattison H, Farrow C. "He's not fat, he just has asthma": a qualitative study exploring weight management in families living with pediatric asthma. J Asthma 2021; 59:1750-1757. [PMID: 34470559 DOI: 10.1080/02770903.2021.1975739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Children and young people living with asthma have an increased risk of overweight/obesity, leading to increased severity of asthma symptoms. Weight management has been recommended to improve asthma symptoms, however, there is limited understanding of how this is experienced or how children and young people with asthma and their families wish to be supported. The aim of this study was to explore parents and children/young people's views and experiences of managing weight while living with asthma, and to identify acceptable strategies for support.Methods: A qualitative methodological approach was taken to facilitate rich understanding of families' insights into weight management while living with asthma. In-depth interviews were conducted with nine families living with pediatric asthma (n = 9 parents, 9 young people). Data were analyzed using a Framework approach.Results: Findings indicated that family engagement with weight management behaviors was primarily influenced by perceptions of risk regarding asthma outcomes and beliefs about asthma control. Families also reported weight management engagement to be influenced by perceptions of the food environment, perceptions of the exercise environment (e.g. weather, anticipated social outcomes) and the availability of weight management support. Participants sought tailored support which gave consideration to the asthma-obesity interaction. It was suggested that this would help reduce perceptions of weight stigma in consultations, thereby supporting behavioral changes.Conclusions: Individualized weight management plans that consider families concerns about asthma-related risk are needed to manage weight in children and young people living with asthma.
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Affiliation(s)
- Rebecca Clarke
- School of Psychology, College of Health & Life Sciences, Aston University, Birmingham, UK
| | - Gemma Heath
- School of Psychology, College of Health & Life Sciences, Aston University, Birmingham, UK
| | - Prasad Nagakumar
- Department of Paediatric Respiratory Medicine and Cystic Fibrosis, Birmingham Women's and Children's Hospital, Birmingham, UK
| | - Helen Pattison
- School of Psychology, College of Health & Life Sciences, Aston University, Birmingham, UK
| | - Claire Farrow
- School of Psychology, College of Health & Life Sciences, Aston University, Birmingham, UK
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Rashid A. Yonder: Condoms in prisons, childhood obesity, healthcare disinvestment, and long-haul truck drivers. Br J Gen Pract 2021; 71:277. [PMID: 34045258 PMCID: PMC8163459 DOI: 10.3399/bjgp21x716081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Affiliation(s)
- Ahmed Rashid
- GP and Clinical Associate Professor, UCL Medical School, UCL, London. @Dr_A_Rashid
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