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Mihalache L, Popa AD, Gherasim A, Nita O, Graur M, Rosu OM, Arhire LI. Assessing Weight Stigma: Validating Attitudes and Beliefs Questionnaires Among Future Healthcare Professionals. Cureus 2024; 16:e66345. [PMID: 39113816 PMCID: PMC11304508 DOI: 10.7759/cureus.66345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2024] [Indexed: 08/10/2024] Open
Abstract
Background This study aimed to establish the reliability and validity of the Anti-Fat Attitudes (AFA) questionnaire and the Beliefs About Obese Persons (BAOP) scale. Methodology A convenience sample of 257 students from three distinct sections of the University of Medicine and Pharmacy "Grigore T. Popa" Iasi (Medical Faculty, Nutrition and Dietetics, and Nursing) participated in an observational study. Construction validity was tested with exploratory factor analysis. The students completed a form containing sociodemographic data, the AFA questionnaire, and the BAOP scale. Weight and height were self-reported and used to determine the body mass index. Results The value of the Cronbach alpha coefficient for the AFA questionnaire indicated adequate internal consistency (0.862). The exploratory factor analysis identified the following three factors corresponding to the original questionnaire: Dislike, Fear of Fat, and Willpower. We validated a single-factor structure of the BAOP scale, which had adequate internal consistency (0.781). There were statistically significant differences (AFA: p = 0.02; BAOP: p = 0.03) between the scores of the students from Nutrition and Dietetics, Nursing, and General Medicine. Conclusions This study demonstrated that the AFA questionnaire and the BAOP scale could be used to evaluate weight stigma in healthcare students, providing a useful tool to assess the effects of weight stigma awareness interventions in this population.
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Affiliation(s)
- Laura Mihalache
- Internal Medicine II, University of Medicine and Pharmacy "Grigore T. Popa" Iasi, Iasi, ROU
| | - Alina Delia Popa
- Internal Medicine II/Nursing, University of Medicine and Pharmacy "Grigore T. Popa" Iasi, Iasi, ROU
| | - Andreea Gherasim
- Internal Medicine II, University of Medicine and Pharmacy "Grigore T. Popa" Iasi, Iasi, ROU
| | - Otilia Nita
- Internal Medicine II, University of Medicine and Pharmacy "Grigore T. Popa" Iasi, Iasi, ROU
| | - Mariana Graur
- Internal Medicine, University "Ștefan cel Mare" of Suceava, Suceava, ROU
| | - Oana Madalina Rosu
- Internal Medicine II, University of Medicine and Pharmacy "Grigore T. Popa" Iasi, Iasi, ROU
| | - Lidia Iuliana Arhire
- Internal Medicine II, University of Medicine and Pharmacy "Grigore T. Popa" Iasi, Iasi, ROU
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Gao G, Liu Y, Dong Z, He J, Wang C, Chen X, Chen W. Investigation of obesity and its related factors among Chinese medical staff: a cross-sectional pilot study. Eat Weight Disord 2024; 29:15. [PMID: 38372804 PMCID: PMC10876749 DOI: 10.1007/s40519-024-01643-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 01/30/2024] [Indexed: 02/20/2024] Open
Abstract
BACKGROUND Many studies have covered the prevalence of obesity in different populations. However, studies on the prevalence and predictors of obesity among medical staff are lacking. The aim of our study is to investigate the prevalence of obesity among medical staff and to identify the related predictors. METHODS Using a snowballing recruitment strategy in the form of an electronic questionnaire, a cross-sectional survey was conducted among 1201 medical staff from cooperative hospitals between January and March 2022. We designed a questionnaire to investigate the participants' demographic, lifestyle, diet, physical activity, and work status. RESULTS The overall prevalence of obesity was 8.5%, with males (13.7%) having a greater incidence than females (5.7%) (p < 0.001). Multiple logistic regression analyses showed that alcohol drinking (OR, 2.34; 95% CI 1.23-4.42, p = 0.01), sugar-sweetened beverages consumed > 3/week (OR, 2.50; 95% CI 1.02-6.15, p = 0.046), and working a night shift > 1/week (OR, 2.17; 95% CI 1.02-4.61, p = 0.043) were independent predictive factors for obesity in men. For women, having midnight snack having midnight snack (OR, 2.93;95% CI 1.24-6.96, p = 0.015), good sleep quality (OR, 4.47; 95% CI 1.10-21.70, p = 0.038), and working a night shift > 1/week (OR, 3.62; 95% CI 1.73-7.57, p = 0.001) were independently associated with obesity. CONCLUSIONS Obesity presented a low prevalence among medical staff. Alcohol drinking, drinking sugar-sweetened beverages > 3/week, and night shift > 1/week predicted a higher risk of obesity in males. In females, having midnight snack, good sleep quality, and night shift > 1/week were independently associated with obesity. LEVEL OF EVIDENCE V, descriptive study.
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Affiliation(s)
- Guie Gao
- Department of Operating Room, The First Affiliated Hospital of Jinan University; School of Nursing, Jinan University, No. 601, Huangpu Avenue West, Guangzhou, China
- Department of Nursing, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Yuping Liu
- Department of Nursing, The First Affiliated Hospital of Jinan University, Guangzhou, China
- Department of Surgery Clinic, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Zhiyong Dong
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, No. 613 Huangpu Avenue West, Guangzhou, China
| | - Jinai He
- Department of Nursing, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Cunchuan Wang
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, No. 613 Huangpu Avenue West, Guangzhou, China
| | - Xiaomei Chen
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, No. 613 Huangpu Avenue West, Guangzhou, China.
| | - Wenhui Chen
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, No. 613 Huangpu Avenue West, Guangzhou, China.
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Winter VR, Trout K, Harrop E, O'Neill E, Puhl R, Bartlett-Esquilant G. Women's refusal to be weighed during healthcare visits: Links to body image. Body Image 2023; 46:41-47. [PMID: 37209579 DOI: 10.1016/j.bodyim.2023.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 04/19/2023] [Accepted: 04/23/2023] [Indexed: 05/22/2023]
Abstract
The purpose of this mixed methods study was to assess the relationship between body image and refusal to be weighed by a healthcare provider among women in the United States, including examination of their reasons for refusal. Between January 15 to February 1, 2021, an online mixed-methods cross-sectional survey assessing body image and healthcare behaviors was administered to adult cis-gender women. Of the 384 respondents, 32.3 % reported refusing to be weighed by a healthcare provider. After controlling for SES, race, age, and BMI in multivariate logistical regression, the odds of refusing to be weighed were 40 % lower for every unit increase in body image score (positive body appreciation). The most common reasons for refusing to be weighed were having a negative impact on emotions, self-esteem, or mental health (52.4 %). Higher body appreciation decreased the odds of refusing to be weighed among women. Reasons for refusing to be weighed ranged from shame and embarrassment to lack of provider trust, personal autonomy, and concerns about discrimination. Identifying interventions and alternatives such as telehealth to provide healthcare services that are weight-inclusive may mediate these negative experiences.
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Affiliation(s)
- Virginia Ramseyer Winter
- University of Missouri School of Social Work, Center for Body Image Research & Policy, 705 Clark Hall, Columbia, MO 65211, United States.
| | - Kate Trout
- University of Missouri School of Health Professions, Department of Health Sciences, 329 Clark Hall, Columbia, MO 65211, United States
| | - Erin Harrop
- University of Denver, Graduate School of Social Work, Craig Hall, 2148 South High Street, Denver, CO 80208, United States
| | - Elizabeth O'Neill
- Washburn University Department of Social Work, Benton Hall Room 412B, 1700 SW College Avenue, Topeka, KS 66621, United States
| | - Rebecca Puhl
- University of Connecticut Department of Human Development & Family Sciences and Rudd Center for Food Policy & Health, 348 Mansfield Road, Unit 1058 Storrs, CT 06269-1058, United States
| | - Gillian Bartlett-Esquilant
- University of Missouri School of Medicine, Department of Community and Family Medicine, 7 Hospital Drive Suite MA306N Medical Sciences Building, Columbia, MO 65211, United States
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GÖLBAŞI E, BORLU A. PREJUDICES OF PRIMARY SCHOOL TEACHERS AGAINST OBESITY AND RELATED FACTORS. KAHRAMANMARAŞ SÜTÇÜ İMAM ÜNIVERSITESI TIP FAKÜLTESI DERGISI 2022. [DOI: 10.17517/ksutfd.1132897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Abstract
Amaç: Günümüzün önemli bir sağlık sorunu olan çocukluk çağı obezitesiyle mücadalede etkin rol oynayabilecek öğretmenlerin obezite önyargı durumlarının ortaya konulması önemlidir. Bu çalışmada Kırşehir il merkezindeki ilkokul öğretmenlerinin obezite önyargı durumları ve obez öğrencilere karşı yaklaşımlarının belirlenmesi amaçlandı.
Gereç ve Yöntemler: Tanımlayıcı kesitsel tipteki bu çalışmaya 200 ilkokul öğretmeni dahil edildi. Veriler anket formu aracılığıyla yüz yüze toplandı. Öğretmenlerin obezite önyargı durumları “GAMS-27 Obezite Önyargı Ölçeği” (OÖÖ) kullanılarak değerlendirildi. OÖÖ ölçeğinden alınan puanın artması obezlere karşı önyargının artması anlamına gelmektedir. Tanımlayıcı bulgular sayı ve yüzdelerle ifade edildi. Karşılaştırmalı analizlerde Pearson ki-kare, t testi ve tek yönlü ANOVA testi, post hoc analizlerde Duncan testi kullanıldı. p
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Analysis of the Lifestyle of Spanish Undergraduate Nursing Students and Comparison with Students of Other Degrees. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095765. [PMID: 35565155 PMCID: PMC9103797 DOI: 10.3390/ijerph19095765] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/03/2022] [Accepted: 05/07/2022] [Indexed: 02/06/2023]
Abstract
Background: Nursing students are exposed to concepts of healthy lifestyles while they are attending university. Objective: The aim of this study was to analyze whether nursing students have a healthier lifestyle than non-nursing students and to determine whether their behaviour is consistent with their beliefs. Methods: A cross-sectional study, with 293 university students was performed by using a validated questionnaire to measure beliefs and behaviour regarding health. Results: The lifestyle pattern of the nursing students evaluated was characterised by a high percentage of nurses with low levels of physical activity, poor balanced diet and smoking habits. The comparative analysis showed no significant differences between nursing students and students from other degrees. Conclusions: Students have a positive attitude and knowledge about healthy lifestyle, but do not transfer it to their own lives. Nurses’ lifestyle can unintentionally affect the behaviour of other people through their own behaviour and beliefs because they serve as a model for a healthy lifestyle. These findings support that nurse educators have an active role as promoter of health by using lessons to modify the behaviour of their students.
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Klobodu SS, Mensah PA, Willis M, Bailey D. Weight Bias Among Nutrition and Dietetics Students in a Ghanaian Public University. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2022; 54:406-411. [PMID: 35351356 DOI: 10.1016/j.jneb.2022.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 01/15/2022] [Accepted: 01/23/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES To measure the internal consistency reliability of 3 weight bias scales among nutrition and dietetics students enrolled at a public university in Ghana and to use the Fat Phobia Scale (FPS) to determine the prevalence of weight bias and the differences in gender and body mass index. DESIGN Online survey gathered self-reported height, weight, and demographic data. Explicit weight bias was assessed using validated FPS, Beliefs About Obese People, and Attitudes Toward Obese Persons scales. PARTICIPANTS Sample of 172 students. MAIN OUTCOME MEASURES Prevalence of weight bias. ANALYSIS Cronbach α reliability test was used to measure the internal consistency of scales. The prevalence of weight bias was expressed as a percentage. Independent t tests and analysis of variance were used to explore differences in gender and weight categories. RESULTS The reliability scores for FPS, Beliefs About Obese People, and Attitudes Toward Obese Persons scales were 0.92, 0.51, and 0.38, respectively. About 53% of participants expressed weight bias. A significant difference was observed for weight bias between overweight and obese participants, with participants with obesity showing greater weight bias (P = 0.03). CONCLUSION AND IMPLICATIONS Fat Phobia Scale (most reliable) identified more than half of the students had a negative attitude toward obesity. Weight bias training within this population may improve attitudes toward obesity.
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Affiliation(s)
- Seth Selorm Klobodu
- Department of Nutrition and Food Science, California State University, Chico, CA.
| | - Peace Akua Mensah
- Department of Nutrition and Food Science, University of Ghana, Legon, Ghana
| | - Mariah Willis
- Psychology Department, California State University, Chico, CA
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Rose A, Cooley A, Yap TL, Alderden J, Sabol VK, Lin JRA, Brooks K, Kennerly SM. Increasing Nursing Documentation Efficiency With Wearable Sensors for Pressure Injury Prevention. Crit Care Nurse 2022; 42:14-22. [PMID: 35362082 DOI: 10.4037/ccn2022116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Documentation presents an overwhelming burden to bedside clinical nurses. Nurses must manually enter several hundred data points into electronic health record flow sheets, taking time from direct patient care and introducing opportunity for documentation errors. LOCAL PROBLEM A patient record audit revealed a significant gap in documented patient repositioning events. This quality improvement initiative evaluated automated repositioning documentation via a wearable sensor system. METHODS A pretest-posttest design was used to examine retrospectively collected manual documentation and prospectively collected sensor documentation of patient repositioning events in a 148-bed rural community hospital. Repositioning documentation manually entered into electronic health records during the baseline period (January 1 to February 28, 2018) was compared with automatic, sensor-based repositioning documentation during the implementation period (corresponding months in 2019 and 2020 to eliminate seasonality). RESULTS A convenience sample of 105 patient records was reviewed. The mean documented patient repositioning interval was 6.6 hours in the baseline period and 2.4 hours in the implementation period. The improvement was most pronounced in patients with obesity, whose mean repositioning interval improved from 9.4 hours to 2.5 hours. Documentation compliance (actual vs expected repositioning documentation) was 31% with manual documentation and 82% with automatic sensor-based documentation. CONCLUSIONS Repositioning was documented more than 2.5 times as frequently with sensor technology as with manual data entry. Body position and reasons for delayed repositioning events were documented more completely with sensor technology. Automated documentation may improve the accuracy of electronic health records and reduce the documentation burden for nurses.
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Affiliation(s)
- Angelia Rose
- Angelia Rose is a nurse practitioner specializing in wound care at Hunt Regional Medical Center, Greenville, Texas
| | - Annemari Cooley
- Annemari Cooley is senior director of clinical development with Smith+Nephew Advanced Wound Management division, Fort Worth, Texas
| | - Tracey L Yap
- Tracey L. Yap is an associate professor in the Duke University School of Nursing and a senior fellow in the Duke University Center for the Study of Aging and Human Development, Durham, North Carolina
| | - Jenny Alderden
- Jenny Alderden is a critical care nurse specialist and an associate professor at Boise State University, Boise, Idaho
| | - Valerie K Sabol
- Valerie K. Sabol is a professor and Chair, Division of Healthcare in Adult Populations, Duke University School of Nursing
| | - Jiunn-Ru Angela Lin
- Jiunn-Ru (Angela) Lin is a data analyst and a statistician with Smith+Nephew Advanced Wound Management division
| | - Katie Brooks
- Katie Brooks is a Doctor of Nursing Practice student at Duke University School of Nursing
| | - Susan M Kennerly
- Susan M. Kennerly is a professor in the Department of Nursing Science at East Carolina University School of Nursing, Greenville, North Carolina
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Empathy as a Factor Conditioning Attitudes towards the Elderly among Physiotherapists-Results from Poland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19073994. [PMID: 35409677 PMCID: PMC8998115 DOI: 10.3390/ijerph19073994] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 03/17/2022] [Accepted: 03/24/2022] [Indexed: 01/02/2023]
Abstract
Attitudes of healthcare workers towards the elderly significantly affect the quality of care dedicated to this group of patients. The purpose of this study was to assess the approach of Polish physiotherapists to the elderly and to analyze the factors influencing these attitudes. The study was based on a cross-sectional Internet-based survey that was conducted in the period from May to September 2021. It was completed by 252 subjects: 189 women and 63 men. The study was based on the involvement of physiotherapists with the right to practice their profession in accordance with the law in force in Poland. The tools used in the study were The Kogan Attitudes towards the Elderly (KAOP) score and The Jefferson Empathy Scale (JSE). To model the KOAP score as a function of the predictors, Bayesian linear regression was used. The average KOAP score in the sample was M (SD) = 100.7 (17.46), with the central 50% of the observations ranging from 81 to 113 points. We observed one statistically credible relationship: relevance of contacts with elderly people was positively and moderately related to KOAP. Additionally, we observed that the JSE scale was positively, but very weakly, associated with KOAP. Empathy and own experience of health care providers may protect against negative attitudes towards the elderly, meaning empathy in healthcare professionals is crucial.
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Clements JN, Akins KB. A cross-sectional study of student pharmacists' attitudes and self-awareness towards obesity and weight. CURRENTS IN PHARMACY TEACHING & LEARNING 2021; 13:1654-1658. [PMID: 34895675 DOI: 10.1016/j.cptl.2021.09.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 07/07/2021] [Accepted: 09/15/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Neutral attitudes towards people with obesity is a necessity among student pharmacists entering the workforce and caring for this patient population. The purpose of the study was to investigate the perception towards people with obesity among student pharmacists. METHODS A cross-sectional study using a self-administered questionnaire was sent to 237 student pharmacists. The questionnaire consisted of four demographic questions, the 14-item Fat Phobia Scale (FPS), and the 20-item Attitudes Towards Obese Persons Scale (ATOPS). Statistical analysis was completed to determine any differences between gender, age, and current status in pharmacy school. RESULTS Eighty-four student pharmacists completed the questionnaire (35.4% response rate). Most participants were female (84.5%) and > 25 years of age (61.9%). Scores indicated an average level of fat phobia with no difference between males and females (mean score 2.8 ± 0.23 and 2.8 ± 0.29, respectively; P = .92). For attitude, the mean scores were - 0.93 ± 0.42 for males and - 0.75 ± 0.59 for females, indicating a neutral attitude towards obesity and no difference between groups (P = .35). There was no difference in age (younger vs. ≥ 25 years of age) in the FPS (P = .06) or ATOPS (P = .36). There was no difference in mean scores of FPS and ATOPS based on current year in pharmacy school (P = .69 and P = .97, respectively). CONCLUSIONS Student pharmacists had an average level of fat phobia and neutral attitude towards people with obesity regardless of gender, age, and year in pharmacy school.
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Affiliation(s)
- Jennifer N Clements
- Department of Nursing Administration, Spartanburg Regional Healthcare System, 101 East Wood Street, Spartanburg, SC 29303, United States; Department of Pharmacy Practice, Presbyterian College School of Pharmacy, 307 North Broad Street, Clinton, SC 29325, United States.
| | - Kendall B Akins
- DrugCo Discount Pharmacy and University of North Carolina Eshelman School of Pharmacy, 107 Smith Church Road, Roanoke Rapid, NC 27870, United States; Presbyterian College School of Pharmacy, 307 North Broad Street, Clinton, SC 29325, United States.
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Sobczak K, Leoniuk K. Attitudes of Medical Professionals Towards Discrimination of Patients with Obesity. Risk Manag Healthc Policy 2021; 14:4169-4175. [PMID: 34675711 PMCID: PMC8504468 DOI: 10.2147/rmhp.s317808] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 09/16/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Many studies show that discriminatory practices are common in healthcare institutions, also in the form of medical staff’s inappropriate behaviour. Weight stigma may not only become a source of unpleasant experience for the patients but also cause them to withdraw from the treatment, which may further exacerbate their condition. Patients and Methods In a nationwide study, we asked 184 medical professionals, about their experiences and opinions on the discrimination of patients with obesity. The study was conducted in 2020, with the use of CAWI method, based on an original survey created for this study. Results Most of the medical professionals (68.5%) estimated that the problem of worse attitudes towards patients suffering from obesity is a common phenomenon. About 48.4% witnessed medical staff’s discriminatory behaviours. The most frequent forms of inappropriate behaviours pertained to interpersonal relations – mocking the appearance (96.6%), looks of disgust and repulsion (96.2%), lack of reaction to offensive remarks (92.0%) or scaring a patient with the necessity to lose weight (57.7%). The participants of the study pointed to limited access to dedicated medical equipment (62.4%) as a discriminatory systemic limitation. Conclusion Discrimination of patients with obesity is a social issue, which also occurs within the health care system. Limited access to medical resources, gaps in knowledge of obesity and an insufficient level of soft skills in health care professionals are the key deficiencies, which hinder effective treatment.
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Affiliation(s)
- Krzysztof Sobczak
- Department of Sociology of Medicine and Social Pathology, Medical University of Gdansk, Gdansk, Poland
| | - Katarzyna Leoniuk
- Department of Sociology of Medicine and Social Pathology, Medical University of Gdansk, Gdansk, Poland
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Ak ES, Türkmen A, Özbaş A, Fındık ÜY. Examination of Attitudes of Nurses Working in Surgical Services Toward Obesity and Obese Patients. Bariatr Surg Pract Patient Care 2021. [DOI: 10.1089/bari.2020.0072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ezgi Seyhan Ak
- Florence Nightingale Faculty of Nursing, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Açelya Türkmen
- Florence Nightingale Faculty of Nursing, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ayfer Özbaş
- Florence Nightingale Faculty of Nursing, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ümmü Yıldız Fındık
- Faculty of Health Sciences, Nursing Department, Trakya University, Edirne, Turkey
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Smith CJ, McNaughton DA, Meyer SB. Implications for clients when nurses view weight as main cause of Type 2 diabetes in primary care. Aust J Prim Health 2021; 27:404-408. [PMID: 34229828 DOI: 10.1071/py20245] [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: 10/26/2020] [Accepted: 04/28/2021] [Indexed: 11/23/2022]
Abstract
Type 2 diabetes (T2D) is often seen as primarily caused by weight, and its amelioration associated with individual behaviour change, which has the potential for negative consequences for people living with the disease. The aims of this study were to explore how weight was framed by diabetes resource nurses and to determine the implications of that framing for nurse practice in a primary care setting in Australia. The research was a qualitative empirical case study using semistructured interviews with nurses focusing on meanings and interpretations. The findings were interpreted using a constructivist epistemology of both inductive and deductive inference. The study found that nurses viewed overweight and obesity as unhealthy and the primary causes of T2D, and that weight was frequently discussed in the health care encounter. Nurses emphasised individual responsibility through behaviour change to manage T2D, downplaying other known causes such as age and family history and important social inequalities. Studies show that nurses have negative attitudes towards overweight and obese patients. The implications of this research are that the nurses' views could potentially negatively affect clients' management of T2D, which has the potential for poor health outcomes.
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Affiliation(s)
- Cynthia J Smith
- School of Health and Human Services, Camosun College, 4461 Interurban Road, Victoria, BC V9E2C1, Canada; and Corresponding author.
| | - Darlene A McNaughton
- Anthropology - Faculty of Humanities, Arts, Social Sciences and Education, School of Humanities, Arts, and Social Sciences, University of New England, Madgwick Drive, Armidale, NSW 2351, Australia
| | - Samantha B Meyer
- University of Waterloo, 200 University Avenue, Waterloo, ON N2L3G1, Canada
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Hadjittofi M, Gleeson K, Arber A. The experience of disgust by nursing and midwifery students: An interpretative phenomenological approach study. Nurs Inq 2021; 29:e12427. [PMID: 34143918 DOI: 10.1111/nin.12427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 05/05/2021] [Accepted: 05/06/2021] [Indexed: 11/29/2022]
Abstract
Although disgust is recognized as a common and prominent emotion in healthcare, little is known about how healthcare professionals understand, experience and conceptualize disgust. The aim of the study was to gain an in-depth understanding of how nursing and midwifery students experience, understand and cope with disgust in their clinical work. Interviews were transcribed verbatim and analysed using interpretative phenomenological analysis (IPA). Six participants (all women: two nursing students, four midwifery students) from a university in the South of England were interviewed. Four superordinate themes with eight subthemes were identified. Overall, findings suggest that participants experience both moral and physical disgust; however, they find it difficult to talk about and use other terms to describe their experience. Findings are discussed through the lens of social identity theory, to understand the relevance of professional identity and how this might further maintain the disgust taboo. The strategies participants have developed in order to cope with disgust are explored and understood within the current healthcare climate. Future research should focus on ways of addressing the experience of disgust by healthcare professionals in order to improve the quality of care provided, especially in the climate of the COVID-19 crisis.
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Affiliation(s)
| | - Kate Gleeson
- School of Psychology, University of Surrey, Guildford, UK
| | - Anne Arber
- School of Health Sciences, University of Surrey, Guildford, UK
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Usta E, Bayram S, Altınbaş Akkaş Ö. Perceptions of nursing students about individuals with obesity problems: Belief, attitude, phobia. Perspect Psychiatr Care 2021; 57:777-785. [PMID: 32892386 DOI: 10.1111/ppc.12613] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 08/19/2020] [Accepted: 08/21/2020] [Indexed: 11/27/2022] Open
Abstract
PURPOSE This study aimed to determine the beliefs, attitudes, and phobias of nursing students about obese individuals. DESIGN AND METHOD This descriptive and cross-sectional study involved 658 students from the nursing department of a Turkish university. Data collection tools were the Fat Phobia Scale (FPS), Turkish Attitudes toward the Obese Persons Scale (T-ATOP), and Turkish Beliefs about Obese Persons Scale (T-BAOP). FINDINGS Students had moderate levels of fat phobia and attitudes towards obese individuals and they believed obesity is controlled by individuals. PRACTICAL IMPLICATIONS Fat phobic attitudes of nursing students should be prevented and positive beliefs and attitudes should be developed.
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Affiliation(s)
- Esra Usta
- Vocational School of Health Services, Düzce University, Düzce, Turkey
| | - Serap Bayram
- Vocational School of Health Services, Düzce University, Düzce, Turkey
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Christenson A, Torgerson J, Hemmingsson E. Attitudes and beliefs in Swedish midwives and obstetricians towards obesity and gestational weight management. BMC Pregnancy Childbirth 2020; 20:755. [PMID: 33272237 PMCID: PMC7712607 DOI: 10.1186/s12884-020-03438-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 11/18/2020] [Indexed: 02/08/2023] Open
Abstract
Background Gestational weight interventions are important in maternity care to counteract adverse pregnancy events. However, qualitative findings indicate potential obstacles in the implementation of interventions due to the sensitivity of the subject and existing obesity stigma. Pregnant women have reported disrespectful or unhelpful communication, while some midwives seem to avoid the topic, as not to upset women. This descriptive study aimed to provide knowledge about maternity care providers’ beliefs about obesity, and their attitudes towards gestational weight management. Method A web survey was emailed to Swedish maternity care clinics. Existing questionnaires, “Beliefs About Obese People” (BAOP), “Perceived weight bias in health care” and “Attitudes toward obese patients” was used, supplemented with questions formulated for this study. An open free-text question allowed participants to provide a deeper and more nuanced picture of the topic. Results 274 respondents (75% midwives and 25% obstetricians) participated. One third of respondents found obesity to be a more sensitive topic than smoking or alcohol habits, and 17% of midwives agreed to the statement: “I sometimes avoid talking about weight so as not to make the pregnant woman worried or ashamed”. Having had training in motivational interviewing seemed positively associated with midwives’ inclination to talk about body weight, especially with women with obesity (p = .001), whereas years of working experience were not associated. Having received obesity education increased confidence in providing adequate information, but still only 46% felt they had enough knowledge to provide diet and exercise advice to pregnant women with obesity. Qualitative data revealed great empathy for women with obesity, and a wish to have more obesity education and access to other professionals. Conclusion Swedish maternity care staff displayed empathy for women with obesity and found gestational weight interventions important, but almost one fifth of midwives sometimes avoid the subject of body weight for fear of upsetting women. Education about obesity facts, training in person-centered communication, i.e. motivational interviewing, and access to dieticians may facilitate gestational weight management implementation. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-020-03438-1.
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Affiliation(s)
- Anne Christenson
- Center for Obesity, Academic Specialist Center, Stockholm Health Services, Stockholm, Sweden. .,Division of clinical epidemiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Jarl Torgerson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Erik Hemmingsson
- The Swedish School of Sports and Health Sciences, Åstrand Laboratory of Work Physiology, Stockholm, Sweden
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Tapking C, Benner L, Hackbusch M, Schüler S, Tran D, Ottawa GB, Krug K, Müller-Stich BP, Fischer L, Nickel F. Influence of Body Mass Index and Gender on Stigmatization of Obesity. Obes Surg 2020; 30:4926-4934. [PMID: 32772227 PMCID: PMC7719108 DOI: 10.1007/s11695-020-04895-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 07/24/2020] [Accepted: 07/28/2020] [Indexed: 11/01/2022]
Abstract
BACKGROUND Stigmatization and discrimination of people with obesity due to their weight are a common problem that may lead to additional weight gain. This study evaluated the influence of different parameters on the stigmatization of obesity. MATERIAL AND METHODS Participants of six groups (general population, patients with obesity, medical students, physicians, nurses in training and nurses; n = 490) answered the short-form fat phobia scale (FPS) between August 2016 and July 2017. The influence of body mass index (BMI), gender and other factors on total scores and single adjective pairs was analyzed. RESULTS A total of 490 participants were evaluated. The total mean FPS rating was 3.5 ± 0.6. FPS was significantly lower (more positive) in participants with obesity (3.2 ± 0.7) compared with participants without obesity (3.5 ± 0.5, p < 0.001). Individuals with obesity and diabetes rated the FPS significantly lower (more positive), whereas age and gender did not have a significant influence. Participants with obesity linked obesity more often with good self-control (p < 0.001), being shapely (p = 0.002), industrious (p < 0.001), attractive (p < 0.001), active (p < 0.001), self-sacrificing (p < 0.001) and having more willpower (p < 0.001) than the participants without obesity. Females rated more positive in shapely versus shapeless (p = 0.038) and attractive versus non-attractive (p < 0.001) than males. CONCLUSIONS The present study shows that stigmatization of obesity is present in medical professionals as well as the general population. People affected by obesity characterized other people with obesity more positively (e.g. attractive or active), whereas people without obesity linked negative characteristics with obesity. Gender had an influence only on single items of FPS but did not affect overall stigmatization of obesity.
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Affiliation(s)
- Christian Tapking
- Department of General, Visceral and Transplant Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Trauma Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwig-Guttmann-Strasse 13, 67071 Ludwigshafen on the Rhine, Germany
| | - Laura Benner
- Institute of Medical Biometry and Informatics, University of Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
| | - Matthes Hackbusch
- Institute of Medical Biometry and Informatics, University of Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
| | - Svenja Schüler
- Institute of Medical Biometry and Informatics, University of Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
| | - Danny Tran
- School of Medicine, University of Texas Medical Branch, Galveston, TX USA
| | - Gregor B. Ottawa
- Coordination Centre of Clinical Trials, University Hospital of Heidelberg, Im Neuenheimer Feld 110, Heidelberg, Germany
| | - Katja Krug
- Department of General Practice and Health Services Research, University Hospital of Heidelberg, Vossstr. 2, 69115 Heidelberg, Germany
| | - Beat P. Müller-Stich
- Department of General, Visceral and Transplant Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
| | - Lars Fischer
- Department of Surgery, Hospital Mittelbaden, Balger Strasse 50, 76532 Baden-Baden, Germany
| | - Felix Nickel
- Department of General, Visceral and Transplant Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
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Rodríguez-Gázquez MDLA, Ruiz-Iglesias A, González-López JR. Changes in anti-fat attitudes among undergraduate nursing students. NURSE EDUCATION TODAY 2020; 95:104584. [PMID: 33011617 DOI: 10.1016/j.nedt.2020.104584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 07/14/2020] [Accepted: 08/25/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND The number of people with obesity has been increasing significantly in recent decades. Nursing students play a role in the care of obese patients, but the presence of a stigma regarding this patient group reduces the quality of care due to a climate of mistrust and lack of expectations. OBJECTIVES To analyse if the anti-fat attitudes of nursing students at the Faculty of Nursing, Physiotherapy and Podiatry at Universidad de Sevilla (Spain) change during their degree training. DESIGN A cross-sectional study was carried out. SETTINGS Undergraduate nursing institution in Spain. PARTICIPANTS 578 nursing students enrolled at the Faculty in all academic years, from the first through the fourth. METHODS Following ethical approval, each participant took part in an individual self-report via the Anti-Fat Attitudes (AFA) Questionnaire, in its validated Spanish version. RESULTS The mean standardised AFA total was 2.29.; by domains: 1.29 in Dislike, 2.87 in Fear of fat, and 3.73 in Willpower. Analysis of variance tests showed significant differences in the AFA total score and domains by sex and academic year. Multiple linear regression analysis demonstrated that the highest prejudices were shown by enrolled participants in their first year, particularly when the AFA total score was considered. CONCLUSIONS Nursing students at the Faculty do not have many prejudices towards obese people. Anti-obesity attitudes among nursing students decrease as the students progress in their degree, implying that the specific training received (degree curriculum) also enables students to develop their non-technical skills.
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Affiliation(s)
| | - Ana Ruiz-Iglesias
- Department of Nursing, Faculty of Nursing, Physiotherapy and Podiatry, Universidad de Sevilla, Seville, Spain, C/ Avenzoar, nº 6, 41009 Seville, Spain.
| | - José Rafael González-López
- Department of Nursing, Faculty of Nursing, Physiotherapy and Podiatry, Universidad de Sevilla, Seville, Spain, C/ Avenzoar, nº 6, 41009 Seville, Spain.
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Oliver TL, Qi BB, Shenkman R, Diewald L, Smeltzer SC. Weight Sensitivity Training Among Undergraduate Nursing Students. J Nurs Educ 2020; 59:453-456. [DOI: 10.3928/01484834-20200723-06] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 02/26/2020] [Indexed: 11/20/2022]
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Hauff C, Fruh SM, Sims BM, Williams SG, Herf C, Golden A, Graves RJ, Minchew LA, Hall HR. Nurse practitioner students' observations of preceptor engagement in obesity management and weight bias: A mixed-methods approach. J Am Assoc Nurse Pract 2020; 32:520-529. [PMID: 32590444 PMCID: PMC7451910 DOI: 10.1097/jxx.0000000000000440] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Obesity is considered a growing epidemic in the United States. Nurse practitioners (NPs) have the opportunity to serve as leaders in addressing concerns related to disease management, particularly obesity. Currently, we lack an awareness of how NP students are learning obesity management from their preceptors. PURPOSE Thus, the current study sought to explore how NP students perceive preceptors' behaviors when managing patients with obesity. METHODOLOGICAL ORIENTATION This study used a mixed-methods design. Participants were asked to report how often they observed their preceptors engage in different strategies when interacting with patients with obesity (e.g., calculate body mass index, identify goals). Students were then asked to respond to the statement: "share observations you made of how patients with obesity were treated in this environment." Students completed 2 clinical rotations during this period and, thus, were asked to answer the questions twice to capture experiences at both clinical sites. SAMPLE Researchers surveyed 225 NP students completing clinical rotations in 3 settings (Family Practice, Pediatrics, and Obstetrics/Gynecology). CONCLUSIONS Quantitative results revealed significant differences in the frequency of observed obesity management behaviors by all preceptors. Qualitative results revealed that NP students most often observed preceptors displaying interpersonal warmth without weight bias when working with patients with obesity. Contrary to current literature, this sample of NP students observed their preceptors engaging in positive interactions with individuals with obesity. IMPLICATIONS FOR PRACTICE Educators must continue to teach students to engage in unbiased behavior toward patients. It is critical to continue to improve obesity management content offered in NP programs.
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Affiliation(s)
- Caitlyn Hauff
- Department of Health, Kinesiology, & Sport, College of Education and Professional Studies, University of South Alabama, Mobile, Alabama
| | - Sharon M. Fruh
- College of Nursing, University of South Alabama, Mobile, Alabama
| | - Brook M. Sims
- Combined-Integrated Clinical and Counseling Psychology Program, University of South Alabama, Mobile, Alabama
| | - Susan G. Williams
- College of Nursing at Baldwin County Campus, University of South Alabama, Fairhope, Alabama
| | - Cindy Herf
- College of Nursing at Baldwin County Campus, University of South Alabama, Fairhope, Alabama
| | | | | | - Leigh A. Minchew
- College of Nursing, University of South Alabama, Mobile, Alabama
| | - Heather R. Hall
- College of Nursing, University of South Alabama, Mobile, Alabama
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Gormley N, Melby V. Nursing students' attitudes towards obese people, knowledge of obesity risk, and self-disclosure of own health behaviours: An exploratory survey. NURSE EDUCATION TODAY 2020; 84:104232. [PMID: 31683140 DOI: 10.1016/j.nedt.2019.104232] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 06/03/2019] [Accepted: 09/22/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND The rates of people being overweight and obese are recognised as global public health concerns. Negative attitudes towards obese and overweight people are prevalent among health care professionals. Nurses and nursing students have a significant role in health promotion of people who are obese or overweight and can assist people in achieving healthy lifestyles. However, evidence suggests that nurses and nursing students fail to engage in healthy lifestyles themselves and display negative attitudes towards obese and overweight people. Such negative behaviours put nurses and nursing students in a precarious position when advising overweight and obese people to adopt healthy lifestyles. OBJECTIVES This study aimed to ascertain nursing students' obesity risk knowledge, their attitudes towards obese and overweight people, and their own health promoting lifestyle behaviours. DESIGN A descriptive correlational study was used. SETTING One university in the United Kingdom. PARTICIPANTS A total of 210 nursing students enrolled on a university degree course in Adult or Mental Health Nursing in years 1, 2 and 3. METHODS Data were collected using three valid and reliable questionnaires: Obesity Risk Knowledge Scale, Attitudes Towards Obese Persons Scale and the Health Promoting Lifestyle Profile. Dependent variables were correlated with independent variables on field of study, year of study, and gender. RESULTS Results showed that nursing students engage in unhealthy lifestyle behaviours and fail to meet government recommended levels for physical activity. Nursing students had poor knowledge on obesity risk and displayed neutral attitudes towards overweight and obese people. CONCLUSIONS Educational providers of nursing courses should embrace the need for nursing students to interrogate and enhance their own healthy lifestyle behaviours as an integral component of the pre-registration education course. This may strengthen the credibility and suitability of nursing students as future nurses in health promoting activities of patients who are overweight and obese.
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Affiliation(s)
| | - Vidar Melby
- School of Nursing and Institute of Nursing and Health Research, Ulster University, Derry BT48 7JL, UK.
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Elboim-Gabyzon M, Attar K, Peleg S. Weight Stigmatization among Physical Therapy Students and Registered Physical Therapists. Obes Facts 2020; 13:104-116. [PMID: 32074613 PMCID: PMC7250323 DOI: 10.1159/000504809] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 11/14/2019] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Weight stigmatization is reflected in anti-fat attitudes and stereotypical perceptions of people who are overweight; it has been demonstrated to be prevalent in many segments of society across multiple countries. Studies examining the prevalence of weight stigmatization use different research tools, which can hinder inter-study comparisons. There is also evidence indicating weight stigmatization among registered physical therapists, although its magnitude differs between studies. Limited information exists regarding the attitudes and beliefs of physical therapy (PT) students toward individuals with obesity. Examining weight stigmatization among PT students is particularly important for developing appropriate educational interventions that may influence the professional lives of future physical therapists. OBJECTIVE This study aims to characterize and compare the stigmatizing attitudes and beliefs of PT students and certified physical therapists regarding people with obesity in Israel. Its secondary objective is to translate three weight stigmatization questionnaires into Hebrew and determine their psychometric properties. METHODS A cross-sectional, anonymous, and computerized self-report survey was completed by 285 certified physical therapists (average age 39.6 ± 10.1 years) and 115 PT students (average age 26.4 ± 4.9 years). The study used three validated weight stigma questionnaires employed in earlier studies to determine different aspects of weight stigmatization: the Fat Phobia Scale (short form; FPS), Anti-Fat Attitudes (AFA) questionnaire, and Beliefs about Obese People (BAOP). These questionnaires were translated into Hebrew and their psychometric properties ascertained. RESULTS Similar to the original English versions, the translated versions of the three questionnaires demonstrated good internal consistency (Cronbach's α values of FPS = 0.77; AFA = 0.75; BOAP = 0.59). The three questionnaires showed a low correlation. No significant difference was noted in the FPS and AFA scores between groups, reflecting that both demonstrated average weight stigmatization (FBS in both groups: average score of 3.6 out of 5; AFA therapists: 3.3 ± 1.2, students: 3.0 ± 1.2 out of 9). However, significant between-group differences were observed for BOAP, which examines beliefs regarding individuals' control over their weight (therapists: 16.4 ± 5.6, students: 18.0 ± 5.7 out of 48; p < 0.01). CONCLUSION Student and certified physical therapists demonstrate average levels of weight stigmatization, as reflected in the FPS and AFA scores. Nevertheless, compared to certified physical therapists, physical therapist students believe more strongly that obesity cannot be controlled by the individual. The students' beliefs could affect their clinical judgment and behavior as health care professionals in the future. Therefore, anti-fat attitudes and stereotypical perceptions should be addressed and remediated early using educational interventions during the study period.
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Affiliation(s)
- Michal Elboim-Gabyzon
- Faculty of Social Welfare and Health Sciences, Physical Therapy Department, University of Haifa, Haifa, Israel,
| | - Karin Attar
- Faculty of Social Welfare and Health Sciences, Physical Therapy Department, University of Haifa, Haifa, Israel
| | - Smadar Peleg
- Physical Therapy Department, Zefat Academic College, Zefat, Israel
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Fan M, Hong J, Cheung PN, Tang S, Zhang J, Hu S, Jiang S, Chen X, Yu S, Gao L, Wang C, Chen W, Yang W. Knowledge and Attitudes Towards Obesity and Bariatric Surgery in Chinese Nurses. Obes Surg 2019; 30:618-629. [PMID: 31758470 DOI: 10.1007/s11695-019-04173-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Abstract
Background
Obesity has become a global epidemic. Surgical treatment of obesity and metabolic disorders in China is increasing rapidly, but it is still a new discipline even to health professionals. As an important member of the multidisciplinary team, the knowledge and attitudes of nurses provide crucial health care to the patients and support to surgeons.
Objectives
To study the Chinese nurses’ knowledge of obesity and metabolic disorders, and attitudes towards bariatric surgery and to improve their capability of work in this new discipline.
Methods
This is a multicenter study, with the questionnaire distributed to cooperative hospitals in the form of an electronic questionnaire by the First Affiliated Hospital of Jinan University in April 2018. A questionnaire was designed to investigate nurses’ demographic, knowledge, and attitude towards obesity, weight loss, and bariatric surgery.
Results
A total of 5311 questionnaires were received, with an effective rate of 91.8% (4878 questionnaires); 65.2% of nurses had a normal BMI. Nurses generally had a high knowledge of obesity and related cardiovascular diseases (98.6%) and type 2 diabetes mellitus (90.2%). However, there was a lack of knowledge in other related aspects, for example its relations to carcinoma (49.5%), gastroesophageal reflux disease (40.1%), and psychological disorders (49.1%), which are controversial issues in bariatric surgery. It was found that education (p < 0.05) had an important influence to nurses’ knowledge about the comorbidities of obesity. Female nurses had a higher tendency to choose weight loss than males, but male nurses did physical exercise more frequently than females (p < 0.05). Their acceptance of safety (25.1%) and efficacy (22.9%) of bariatric surgery is low, with concerns predominantly about postoperative complications and adverse effects. Surgical nurses had a more optimistic attitude towards surgery (p < 0.05).
Conclusions
Chinese nurses have poor knowledge of obesity-related metabolic disorders and also have poor acceptance of surgical treatment modalities. Our findings suggest that it is crucial to enhance the continuing education of Chinese nurses for obesity, metabolic disorders, and bariatric surgery.
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Ward P, McPhail D. Fat Shame and Blame in Reproductive Care: Implications for Ethical Health Care Interactions. ACTA ACUST UNITED AC 2019. [DOI: 10.1080/23293691.2019.1653581] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Pamela Ward
- Centre for Nursing Studies, Memorial University, St. John’s, NL, Canada
- Memorial University of Newfoundland, St. John’s, NL, Canada
| | - Deborah McPhail
- Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
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Robstad N, Westergren T, Siebler F, Söderhamn U, Fegran L. Intensive care nurses' implicit and explicit attitudes and their behavioural intentions towards obese intensive care patients. J Adv Nurs 2019; 75:3631-3642. [PMID: 31566770 DOI: 10.1111/jan.14205] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 08/09/2019] [Accepted: 08/13/2019] [Indexed: 11/27/2022]
Abstract
AIMS To examine qualified intensive care nurses' implicit and explicit attitudes towards obese intensive care patients and whether their attitudes are associated with their behavioural intentions towards these patients. BACKGROUND Obese intensive care patients may experience more stress than do normal-weight patients. Intensive care nurses' attitudes and the way they address their care are thus vital. Despite a range of studies revealing that health professionals hold anti-fat attitudes towards obese patients, there is a lack of knowledge about intensive care nurses' implicit and explicit attitudes and if such attitudes are associated with behavioural intention. DESIGN A cross-sectional survey. METHODS From November 2017 - January 2018, a web-based survey was conducted with 159 qualified intensive care nurses (84.3% women, mean age 45.52 years) recruited through 16 intensive care units and Facebook. The survey consisted of implicit attitude tests, explicit bias scales, the Anti-fat Attitude questionnaire, vignettes measuring behavioural intention, and demographic questions. RESULTS Intensive care nurses reported implicit preferences for thin over thick people and found obese individuals slightly 'worse' and 'lazy', comprising less willpower than thin individuals. Attitudes were not associated with behavioural intention. CONCLUSION This study provides new knowledge about qualified intensive care nurses' anti-fat attitudes and behavioural intention towards obese intensive care patients. These findings should be acknowledged by policymakers, clinical healthcare providers and educators to secure optimal care for these patients. IMPACT STATEMENT These results should be used in nursing attitude change programmes, in intensive care units, and among nursing educators, focusing on increasing nurses' knowledge of the complexities of obesity. Further research on obese intensive care patients' healthcare experiences and the impact that healthcare providers' anti-fat attitudes and behaviours has on patients' perceived care quality is needed.
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Affiliation(s)
- Nastasja Robstad
- Department of Health and Nursing Sciences, Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
| | - Thomas Westergren
- Department of Health and Nursing Sciences, Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
| | - Frank Siebler
- Department of Psychology, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway
| | - Ulrika Söderhamn
- Department of Health and Nursing Sciences, Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
| | - Liv Fegran
- Department of Health and Nursing Sciences, Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
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Yılmaz HÖ, Yabancı Ayhan N. Is there prejudice against obese persons among health professionals? A sample of student nurses and registered nurses. Perspect Psychiatr Care 2019; 55:262-268. [PMID: 30701561 DOI: 10.1111/ppc.12359] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 12/27/2018] [Accepted: 01/15/2019] [Indexed: 11/28/2022] Open
Abstract
PURPOSE The aim of this study was to assess whether there is prejudice toward obese persons among student nurses and registered nurses. DESIGN AND METHOD A total of 379 participants were included (190 student nurses, 189 registered nurses). The Fat Phobia Scale and Belief About Obese Persons Scale were used to determine the prejudice. FINDINGS Registered nurses were found to have more negative prejudices toward obese persons than those of student nurses. These prejudices were determined to be influenced by the nurses' body mass index and having an obese person in the family. PRACTICAL IMPLICATIONS Both groups had negative prejudices toward obese persons, there was a higher level of prejudice among the registered nurses. These prejudices can have a negative impact on healthcare practices.
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Affiliation(s)
- Hacı Ömer Yılmaz
- Department of Nutrition and Dietetics, Faculty of Health Science, Gümüşhane University, Gümüşhane, Turkey
| | - Nurcan Yabancı Ayhan
- Department of Nutrition and Dietetics, Faculty of Health Science, Ankara University, Ankara, Turkey
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Yildiz M, Yalcinoz Baysal H. Prejudice against obesity in university students studying in health-related departments. Perspect Psychiatr Care 2019; 55:170-174. [PMID: 30033627 DOI: 10.1111/ppc.12314] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 06/19/2016] [Accepted: 07/03/2018] [Indexed: 12/12/2022] Open
Abstract
PURPOSE This study was conducted to determine the degree of obesity prejudice exhibited and felt by students attending health-related departments. DESIGN AND METHOD The sample included 729 students studying in health-related departments at a university in Turkey who volunteered to take part in the study. FINDINGS The average Obesity Prejudice Scale (OPS) score of the students was 75.54±10.43, thus indicating that they tend toward prejudice. PRACTICAL IMPLICATIONS According to the results of the study, university students who will be future nurses and other healthcare professionals, tend toward obesity prejudice, negatively impacting health care.
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Affiliation(s)
- Metin Yildiz
- Institute of Health Sciences, Ataturk University, Erzurum, Turkey
| | - Hasret Yalcinoz Baysal
- Faculty of Nursing, Public Health Nursing Department, Ataturk University, Erzurum, Turkey
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Affiliation(s)
- Cat Pausé
- College of Humanities and Social Sciences, Massey University, Palmerston North, New Zealand
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Goad E, Gleeson K, Jackson S. Personal factors associated with the attitudes of nurses towards patients with obesity: a literature review. Clin Obes 2018; 8:444-451. [PMID: 30222911 DOI: 10.1111/cob.12275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 05/16/2018] [Accepted: 05/25/2018] [Indexed: 11/28/2022]
Abstract
This literature review explores the association between body mass index and self-esteem in nurses, alongside their attitudes towards patients who have obesity. These variables have either previously been linked to weight bias, or with prejudice more generally, but findings in this context are inconclusive. Searches were conducted through Psychology Cross Search, PubMed, Web of Science, Proquest Allied Health Professionals and Google Scholar. Ten studies met the inclusion criteria and were tabulated and critiqued using appropriate appraisal tools. The literature covered a time span of over 30 years with the type and quality of study methodologies varying. Research was rarely underpinned by theory. As such, no consensus was reached in drawing together the findings but the direction of future research needed to address these issues is discussed. Further research should focus on developing the literature using an appropriate theoretical underpinning in order to better understand the research that has begun further afield.
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Affiliation(s)
- E Goad
- Department of Psychology, University of Surrey, Guildford, UK
| | - K Gleeson
- Department of Psychology, University of Surrey, Guildford, UK
| | - S Jackson
- Faculty of Health and Medical Sciences, University of the West of England, Bristol, UK
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Barra M, Singh Hernandez SS. Too big to be seen: Weight-based discrimination among nursing students. Nurs Forum 2018; 53:529-534. [PMID: 29968365 DOI: 10.1111/nuf.12282] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
An educational intervention was conducted to determine the efficacy of an obesity sensitivity program to determine nursing students' attitudes toward obese clients. As part of the clinical curriculum, nursing students (N = 103) received weekly obesity sensitivity education on weight-based discrimination. Students' completed a preproject and postproject attitudes toward obese persons scale (Barra, 2015) to evaluate discriminatory beliefs and actions. All clinical groups had a significant positive change in their own weight prejudices postobesity education intervention. Chi-square analysis was utilized as a measure of association between pre- and postobesity education with clinical application concerning obesity size, body odor, appearance, and lifestyle, along with provider fear of a back injury. Promoting nursing student awareness of obese client bias can dissipate negative stigmas to promote a therapeutic patient-provider relationship.
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Affiliation(s)
- Maryanne Barra
- Department of Nursing, Seton Hall University, College of Nursing, South Orange, New Jersey
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Gayer GG, Weiss J, Clearfield M. Fundamentals for an Osteopathic Obesity Designed Study: The Effects of Education on Osteopathic Medical Students' Attitudes Regarding Obesity. J Osteopath Med 2018; 117:495-502. [PMID: 28759091 DOI: 10.7556/jaoa.2017.099] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Context Obesity is a major health concern in the United States, and its prevalence continues to rise. Although it is a common health issue, many people, including health care professionals, are biased against people with obesity. Objective To determine whether a comprehensive obesity curriculum presented to students in medical school can positively influence their attitudes toward obesity. Methods The study was designed around a comprehensive educational obesity curriculum at Touro University College of Osteopathic Medicine-CA, involving the classes of 2013 through 2018. A survey to assess student attitudes toward obesity was distributed to first-year students before the curriculum, directly after completion, and each year after until graduation (graduating classes of 2015 through 2018). Second- and third-year medical students in 2011 (graduating classes of 2014 and 2013), who did not complete the curriculum, were given an examination to establish baseline values and served as the control group. The obesity curriculum consisted of lectures delivered during the first and second year of medical school and case study simulations during the third year. Knowledge gained from the curriculum was assessed with a multiple-choice examination, and bias was assessed using the Fat Phobia Scale. Results A total of 718 first- through fourth-year students were included. Students who completed the first year of the obesity curriculum (n=528) showed significantly greater medical knowledge regarding obesity-related epidemiology, pathogenesis, biochemistry, pathophysiology, and metabolic factors; nutrition, diet, physical activity, self-control, and behavior modification; pharmacologic and nonpharmacologic interventions; and associated chronic disorders, based on their multiple-choice examination scores compared with the control group. The examination scores indicated significant increases in medical knowledge compared with the precurriculum cohort after the curriculum (OMS I students: 130 [72.4%]; 133 [92.6%]; 133 [91.1%]; 132 [89.0%]; vs control: 105 [47.2%]; 134 [52.6%], respectively [P<.01]). In all 4 years observed, there was a significant reduction in bias among first-year medical students after obesity curriculum (before: 3.65, 3.76, 3.57, 3.61, and after: 3.47, 3.38, 3.34, 3.37, respectively) (P<.05). The reduction in bias was also significantly sustained throughout the fourth year. Conclusion A comprehensive obesity curriculum throughout medical school resulted in an improvement in students' attitudes toward and knowledge of obesity.
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Hunter J, Rawlings-Anderson K, Lindsay T, Bowden T, Aitken LM. RETRACTED: Exploring student nurses' attitudes towards those who are obese and whether these attitudes change following a simulated activity. NURSE EDUCATION TODAY 2018; 65:225-231. [PMID: 29604606 DOI: 10.1016/j.nedt.2018.03.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 02/09/2018] [Accepted: 03/15/2018] [Indexed: 06/08/2023]
Abstract
This article has been retracted: please see Elsevier Policy on Article Withdrawal (http://www.elsevier.com/locate/withdrawalpolicy). This article has been retracted at the request of the Editor-in-Chief and authors as there was a major error in reporting the results of the "Nurses' attitudes towards obesity and obese patients scale" (NATOOPS). In some places, it was reported that the higher NATOOPS scores indicated a more positive attitude. However, in the original scale, a higher score indicates a more negative attitude. The authors apologize for any inconvenience caused.
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Affiliation(s)
- Janet Hunter
- Nursing Division, School of Health Sciences, City, University of London, United Kingdom.
| | | | - Tracy Lindsay
- Nursing Division, School of Health Sciences, City, University of London, United Kingdom
| | - Tracey Bowden
- Nursing Division, School of Health Sciences, City, University of London, United Kingdom
| | - Leanne M Aitken
- Nursing Division, School of Health Sciences, City, University of London, United Kingdom
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A tool to measure the attitudes and beliefs of nursing students towards childhood overweight/obesity. Collegian 2018. [DOI: 10.1016/j.colegn.2017.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Lobchuk M, Hoplock L, Halas G, West C, Dika C, Schroeder W, Ashcroft T, Clouston KC, Lemoine J. Heart health whispering: A randomized, controlled pilot study to promote nursing student perspective-taking on carers' health risk behaviors. BMC Nurs 2018; 17:21. [PMID: 29849504 PMCID: PMC5968556 DOI: 10.1186/s12912-018-0291-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 05/18/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lifestyle counseling is described as a "major breakthrough" in the control of chronic diseases. Counseling can be challenging to nurses due their lack of motivation to counsel, hesitancy to appear non-judgmental, lack of empathy, and lack of time. Nurses voice their need for more training in counseling communication skills. Our main objective was to engage in ongoing development and testing of a promising Heart Health Whispering perspective-taking intervention on nursing students' clinical empathy, perceptual understanding, and client readiness to alter health risk behaviors. METHODS In this randomized controlled pilot study, the full intervention (perspective-taking instructions, practice, and video-feedback) and partial intervention (video-feedback only) comprised 24 and 18 nursing students, respectively. Quantitative data were collected with a 10-item pre- and post-intervention clinical empathy tool, a one-item 'readiness to change' health risk behavior tool plus similarity ratings on students' empathic accuracy were calculated. Data were analyzed using Independent Samples t Tests and mixed model ANCOVA models. Students' and actors' evaluative responses toward the intervention phases were collected by handwritten notes, and analyzed using content analysis and constant comparison techniques. RESULTS The main finding was that students in the full intervention group reported greater clinical empathy in the post versus baseline condition. Students underestimated their clinical empathy in comparison to carers' reports in the post-condition. In both intervention groups, carers reported more readiness to change in the post-condition. Carers identified favorable and unfavorable perceptions and outcomes of approaches taken by students. Students desired immediate and direct feedback after the video-dialogue and -tagging exercise. CONCLUSIONS Heart Health Whispering is a promising intervention to help educators in basic and continuing education to bolster nurse confidence in empathic conversations on health risk behaviors. This intervention incorporates commonly used strategies to teach empathic communication along with a novel video-analysis application of a perspective-taking task. Student and carer actor comments highlighted the value in opportunities for students to engage in self-evaluation and practicing the empathic process of taking the client's perspective on health risk behaviors.
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Affiliation(s)
- Michelle Lobchuk
- Rady Faculty of Health Sciences, College of Nursing, University of Manitoba, Room 315 – 89 Curry Place, Winnipeg, MB R3T 2N2 Canada
| | - Lisa Hoplock
- Rady Faculty of Health Sciences, College of Nursing, University of Manitoba, Room 315 – 89 Curry Place, Winnipeg, MB R3T 2N2 Canada
| | - Gayle Halas
- Max Rady Faculty of Health Sciences, College of Medicine, University of Manitoba, P228-770, Bannatyne Avenue, Winnipeg, MB R3E 0W3 Canada
| | - Christina West
- Rady Faculty of Health Sciences, College of Nursing, University of Manitoba, Room 315 – 89 Curry Place, Winnipeg, MB R3T 2N2 Canada
| | - Cheryl Dika
- Rady Faculty of Health Sciences, College of Nursing, University of Manitoba, Room 315 – 89 Curry Place, Winnipeg, MB R3T 2N2 Canada
| | - Wilma Schroeder
- Red River College, Nursing, 2055 Notre Dame Avenue, Winnipeg, MB R3H 0J9 Canada
| | - Terri Ashcroft
- Rady Faculty of Health Sciences, College of Nursing, University of Manitoba, Room 315 – 89 Curry Place, Winnipeg, MB R3T 2N2 Canada
| | - Kathleen Chambers Clouston
- Department of Surgery, Section of General Surgery, University of Manitoba, 770 Bannatyne Avenue, Winnipeg, MB R3E 0W3 Canada
| | - Jocelyne Lemoine
- Rady Faculty of Health Sciences, College of Nursing, University of Manitoba, Room 315 – 89 Curry Place, Winnipeg, MB R3T 2N2 Canada
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Obara AA, Alvarenga MDS. [Transcultural adaptation of the Antifat Attitudes Test to Brazilian Portuguese]. CIENCIA & SAUDE COLETIVA 2018; 23:1507-1520. [PMID: 29768605 DOI: 10.1590/1413-81232018235.17252016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Accepted: 08/03/2016] [Indexed: 11/22/2022] Open
Abstract
Obese individuals are often blamed for their own condition and the targets of discrimination and prejudice. The scope of this study is to describe the cross-cultural adaptation to Brazilian Portuguese and the validation of the Antifat Attitudes Test - specifically developed for evaluation of negative attitudes toward the obese individual. The scale has 34 statements distributed in three subscales - Social/Character Disparagement (15 items), Physical/Romantic Unattractiveness (10 items) and Weight Control/Blame (9 items). The method involved the translation of the scale; evaluation of the conceptual, operational and item equivalence; evaluation of the semantic equivalence using the paired t test, the Pearson correlation coefficient and the intraclass correlation coefficient (ICC); internal consistency evaluation (Cronbach's alpha) and test-retest reliability (ICC) and Confirmatory Factor Analysis - after application in 340 college students in the area of health. The results showed good global internal consistency and reliability (α 0.85; CCI 0.83), and factor analysis showed that the original subscales can be kept in the adaptation, and therefore the scale adapted to the Brazilian-Portuguese version is valid and useful in studies to explore negative attitudes toward obese individuals.
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Affiliation(s)
- Angélica Almeida Obara
- Faculdade de Saúde Pública, Universidade de São Paulo. Av. Dr. Arnaldo 715, Cerqueira César. 03178-200 São Paulo SP Brasil.
| | - Marle Dos Santos Alvarenga
- Faculdade de Saúde Pública, Universidade de São Paulo. Av. Dr. Arnaldo 715, Cerqueira César. 03178-200 São Paulo SP Brasil.
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Bucher Della Torre S, Courvoisier DS, Saldarriaga A, Martin XE, Farpour-Lambert NJ. Knowledge, attitudes, representations and declared practices of nurses and physicians about obesity in a university hospital: training is essential. Clin Obes 2018; 8:122-130. [PMID: 29327430 DOI: 10.1111/cob.12238] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 11/08/2017] [Accepted: 11/23/2017] [Indexed: 11/26/2022]
Abstract
In the context of a worldwide obesity epidemic, healthcare providers play a key role in obesity management. Knowledge of current guidelines and attitudes to prevent stigmatization are especially important. This study aimed to assess knowledge, attitudes, beliefs, perception of opportunity for intervention, declared practices and need for training and material of nurses and physicians about obesity in a Swiss University Hospital. A total of 834 physicians and nurses filled an online survey. The questionnaire was based on literature, exploratory interviews and expert committee review. It was pre-tested with 15 physicians and nurses. Participants declared a low level of negative attitudes towards individuals living with obesity. However, the results highlighted a lack of knowledge to diagnose obesity in adults and children, as well as confidence and training to care of patients with obesity. One-third of providers did not know how to calculate body mass index. Half of providers felt it was part of their role to take care of patients with obesity, even if 55% of them had the feeling that they did not have adequate training. Nurses and physicians working in a university hospital showed a low level of negative attitudes but a lack of knowledge and skills on obesity management. Training should be improved in this population to insure adequate and coherent messages and equal access to evidence-based treatment for patients living with obesity.
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Affiliation(s)
- S Bucher Della Torre
- Department of Nutrition and Dietetics, School of Health Sciences - Geneva, HES-SO University of Applied Sciences and Arts Western Switzerland, Geneva, Switzerland
| | - D S Courvoisier
- Quality of Care Unit, University Hospitals of Geneva, Geneva, Switzerland
| | - A Saldarriaga
- Department of Public Education, Geneva Child and Youth Health Service, Geneva, Switzerland
| | - X E Martin
- Health and Movement Consultation, Unit of Pediatric Cardiology, Service of Pediatric Specialties, Department of Child and Adolescent, University Hospitals of Geneva, Switzerland
| | - N J Farpour-Lambert
- Obesity Prevention and Care Program, Service of Therapeutic Education for Chronic Diseases, Department of Community Medicine, Primary Care and Emergency, University Hospitals of Geneva, Geneva, Switzerland
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Jumbe S, Meyrick J. Contrasting Views of the Post-bariatric Surgery Experience between Patients and their Practitioners: a Qualitative Study. Obes Surg 2018. [DOI: 10.1007/s11695-018-3185-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Robstad N, Söderhamn U, Fegran L. Intensive care nurses’ experiences of caring for obese intensive care patients: A hermeneutic study. J Clin Nurs 2017. [DOI: 10.1111/jocn.13937] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Nastasja Robstad
- Department of Health and Nursing Sciences; Faculty of Health and Sport Sciences; University of Agder; Kristiansand Norway
| | - Ulrika Söderhamn
- Department of Health and Nursing Sciences; Faculty of Health and Sport Sciences; University of Agder; Kristiansand Norway
| | - Liv Fegran
- Department of Health and Nursing Sciences; Faculty of Health and Sport Sciences; University of Agder; Kristiansand Norway
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Altun Uğraş G, Yüksel S, Erer MTI, Kettaş E, Randa S. Are Nurses Willing to Provide Care to Obese Surgical Patients? Bariatr Surg Pract Patient Care 2017. [DOI: 10.1089/bari.2017.0009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Gülay Altun Uğraş
- Department of Surgical Nursing, Health School, Mersin University, Mersin, Turkey
| | - Serpil Yüksel
- Department of Surgical Nursing, Division of Nursing, Faculty of Health Science, Necmettin Erbakan University, Konya, Turkey
| | | | - Elife Kettaş
- Medical Faculty, Mersin University, Mersin, Turkey
| | - Serap Randa
- Medical Faculty, Mersin University, Mersin, Turkey
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Cain B, Buck K, Fuller-Tyszkiewicz M, Krug I. Australian Healthcare Professionals' Knowledge of and Attitudes toward Binge Eating Disorder. Front Psychol 2017; 8:1291. [PMID: 28824484 PMCID: PMC5545598 DOI: 10.3389/fpsyg.2017.01291] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 07/14/2017] [Indexed: 01/08/2023] Open
Abstract
Objective: This study aimed to investigate Australian healthcare practitioners’ knowledge and attitudes toward binge eating disorder (BED). Method: Participants were 175 healthcare professionals, who were randomized to one of two conditions that assessed diagnostic and treatment knowledge of either comorbid BED and obesity or only obesity via case vignette, as well as weight bias toward obese patients. Results: Results suggested that participants demonstrated a reluctance to diagnose comorbid BED and obesity, that their knowledge of physical complications associated with BED was limited, and that they indicated a narrow range of evidence-based treatment options. When compared with levels of weight bias expressed by healthcare professionals in previous international studies, Australian clinicians were significantly less biased, however, still largely endorsed ‘negative’ attitudes toward obesity. Conclusion: Findings suggest that future clinical training in eating disorders should therefore focus not only on diagnostic criteria, physical complications and treatment options, but also on practitioner attitudes toward eating and weight.
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Affiliation(s)
- Belinda Cain
- Melbourne School of Psychological Sciences, The University of Melbourne, MelbourneVIC, Australia
| | - Kimberly Buck
- Melbourne School of Psychological Sciences, The University of Melbourne, MelbourneVIC, Australia
| | - Matthew Fuller-Tyszkiewicz
- School of Psychology, Deakin University, BurwoodVIC, Australia.,Centre for Social and Early Emotional Development, Deakin University, BurwoodVIC, Australia
| | - Isabel Krug
- Melbourne School of Psychological Sciences, The University of Melbourne, MelbourneVIC, Australia
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Tanneberger A, Ciupitu-Plath C. Nurses' Weight Bias in Caring for Obese Patients: Do Weight Controllability Beliefs Influence the Provision of Care to Obese Patients? Clin Nurs Res 2017; 27:414-432. [PMID: 28052689 DOI: 10.1177/1054773816687443] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Given the pervasive stigma faced by obese individuals in family, work, and health care settings, the present study aimed to explore whether nurses' weight controllability beliefs influence their perception of how care is provided to obese patients. To this end, 73 nurses from an acute care hospital completed the Weight Control/Blame Subscale of the Antifat Attitudes Test and reported on their perception of discrimination in, and available resources for, the provision of care to obese patients. Nurses endorsing stronger beliefs that weight lies under individual control were more likely to report discrimination of obese patients in clinical practice. Weight bias, higher care intensity, and lack of necessary resources were the main reasons reported for perceived weight discrimination. Our results support theories placing internal attribution of overweight and conflict over resources at the origin of weight stigma and call for appropriate interventions to improve nurses' work environment and reduce their weight bias.
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Kolko RP, Kass AE, Hayes JF, Levine MD, Garbutt JM, Proctor EK, Wilfley DE. Provider Training to Screen and Initiate Evidence-Based Pediatric Obesity Treatment in Routine Practice Settings: A Randomized Pilot Trial. J Pediatr Health Care 2017; 31:16-28. [PMID: 26873293 PMCID: PMC4980292 DOI: 10.1016/j.pedhc.2016.01.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 01/04/2016] [Accepted: 01/04/2016] [Indexed: 11/26/2022]
Abstract
INTRODUCTION This randomized pilot trial evaluated two training modalities for first-line, evidence-based pediatric obesity services (screening and goal setting) among nursing students. METHOD Participants (N = 63) were randomized to live interactive training or Web-facilitated self-study training. Pretraining, post-training, and 1-month follow-up assessments evaluated training feasibility, acceptability, and impact (knowledge and skill via simulation). Moderator (previous experience) and predictor (content engagement) analyses were conducted. RESULTS Nearly all participants (98%) completed assessments. Both types of training were acceptable, with higher ratings for live training and participants with previous experience (ps < .05). Knowledge and skill improved from pretraining to post-training and follow-up in both conditions (ps < .001). Live training demonstrated greater content engagement (p < .01). CONCLUSIONS The training package was feasible, acceptable, and efficacious among nursing students. Given that live training had higher acceptability and engagement and online training offers greater scalability, integrating interactive live training components within Web-based training may optimize outcomes, which may enhance practitioners' delivery of pediatric obesity services.
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Affiliation(s)
- Rachel P. Kolko
- Department of Psychiatry, University of Pittsburgh
- Department of Psychology, Washington University in St. Louis
| | - Andrea E. Kass
- Department of Psychology, Washington University in St. Louis
- Department of Medicine, The University of Chicago
| | | | | | - Jane M. Garbutt
- Department of Medicine, Washington University School of Medicine
- Department of Pediatrics, Washington University School of Medicine
| | | | - Denise E. Wilfley
- Department of Psychology, Washington University in St. Louis
- Department of Psychiatry, Washington University School of Medicine
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Lee JA, Pausé CJ. Stigma in Practice: Barriers to Health for Fat Women. Front Psychol 2016; 7:2063. [PMID: 28090202 PMCID: PMC5201160 DOI: 10.3389/fpsyg.2016.02063] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 12/20/2016] [Indexed: 01/19/2023] Open
Abstract
In this paper, we explore barriers to health for fat people. By shifting the focus from what fat people do or do not do, neoliberal principles are replaced by a focus instead on structural and institutional policies, attitudes, and practices. This includes the impact of stigma on the health treatment and health-seeking behavior of fat people. For example, we consider the role that provider anti-fat attitudes and confirmation bias play in the failure to provide evidenced-based healthcare to fat patients. This is an autoethnographic paper, which provides the opportunity to read research from the perspective of fat scholars, framed by questions such as: can fat people have health? Is health itself a state of being, a set of behaviors, a commodity, a performance; perhaps the new social contract? As a co-written autoethnographic paper, one aspect of the evidence provided is the recorded experiences of the two fat authors. This includes writing from notes, journals, compiled and repeated experiences with medical professionals, family, and the community. Framed by feminist standpoint and supported by literature drawn from Fat Studies, Public Health, Obesity Research, and other interdisciplinary fields, this is a valuable opportunity to present an extended account of fat discrimination and the impact of the stigma fat people face through the medical profession and other sectors of the community, written by fat individuals. The paper concludes by considering the health pathways available to fat people. Special attention is paid to whether Bacon and Aphramor's Health at Every Size paradigm provides a path to health for fat individuals.
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Affiliation(s)
- Jennifer A. Lee
- College of Arts, Victoria UniversityMelbourne, VIC, Australia
| | - Cat J. Pausé
- College of Humanities and Social Sciences, Institute of Education, Massey UniversityPalmerston North, New Zealand
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Lobchuk M, Halas G, West C, Harder N, Tursunova Z, Ramraj C. Development of a novel empathy-related video-feedback intervention to improve empathic accuracy of nursing students: A pilot study. NURSE EDUCATION TODAY 2016; 46:86-93. [PMID: 27614549 DOI: 10.1016/j.nedt.2016.08.034] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 08/15/2016] [Accepted: 08/29/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Stressed family carers engage in health-risk behaviours that can lead to chronic illness. Innovative strategies are required to bolster empathic dialogue skills that impact nursing student confidence and sensitivity in meeting carers' wellness needs. PURPOSE To report on the development and evaluation of a promising empathy-related video-feedback intervention and its impact on student empathic accuracy on carer health risk behaviours. DESIGN A pilot quasi-experimental design study with eight pairs of 3rd year undergraduate nursing students and carers. METHODS Students participated in perspective-taking instructional and practice sessions, and a 10-minute video-recorded dialogue with carers followed by a video-tagging task. Quantitative and qualitative approaches helped us to evaluate the recruitment protocol, capture participant responses to the intervention and study tools, and develop a tool to assess student empathic accuracy. MAIN RESULTS The instructional and practice sessions increased student self-awareness of biases and interest in learning empathy by video-tagging feedback. Carers felt that students were 'non-judgmental', inquisitive, and helped them to 'gain new insights' that fostered ownership to change their health-risk behaviour. There was substantial Fleiss Kappa agreement among four raters across five dyads and 67 tagged instances. CONCLUSION In general, students and carers evaluated the intervention favourably. The results suggest areas of improvement to the recruitment protocol, perspective-taking instructions, video-tagging task, and empathic accuracy tool.
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Affiliation(s)
- Michelle Lobchuk
- University of Manitoba, Rady Faculty of Health Sciences, College of Nursing, 89 Curry Place, Winnipeg, Manitoba R3T 2N2, Canada.
| | - Gayle Halas
- University of Manitoba, Rady Faculty of Health Sciences, College of Medicine, P228-770 Bannatyne Avenue, Winnipeg, Manitoba R3E 0W3, Canada.
| | - Christina West
- University of Manitoba, Rady Faculty of Health Sciences, College of Nursing, 89 Curry Place, Winnipeg, Manitoba R3T 2N2, Canada.
| | - Nicole Harder
- University of Manitoba, Rady Faculty of Health Sciences, College of Nursing, 89 Curry Place, Winnipeg, Manitoba R3T 2N2, Canada.
| | - Zulfiya Tursunova
- University of Manitoba, Rady Faculty of Health Sciences, College of Nursing, 89 Curry Place, Winnipeg, Manitoba R3T 2N2, Canada.
| | - Chantal Ramraj
- University of Manitoba, Rady Faculty of Health Sciences, College of Nursing, 89 Curry Place, Winnipeg, Manitoba R3T 2N2, Canada.
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Garcia JT, Amankwah EK, Hernandez RG. Assessment of Weight Bias Among Pediatric Nurses and Clinical Support Staff Toward Obese Patients and Their Caregivers. J Pediatr Nurs 2016; 31:e244-51. [PMID: 26948091 DOI: 10.1016/j.pedn.2016.02.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 01/25/2016] [Accepted: 02/08/2016] [Indexed: 11/25/2022]
Abstract
The increasing burden of obesity is prevalent in the pediatric populations. Pediatric nurses are spending increasing amounts of time and effort caring for obese patients however no prior studies have explored how nurses perceive obese patients. The purpose of this study is to identify weight bias in pediatric nurses (RNs) and clinical support staff (CSS) working in a pediatric hospital setting. A convenience sample of RNs and CSS from an urban, pediatric hospital were surveyed using the Nurses' Attitudes toward Obesity and Obese Patients Scale (NATOOPS), which consists of 6 patient-care factors with an additional factor added to assess bias towards the patient's caregiver. Mean factor scores ≥50 indicated bias. Data were summarized using descriptive statistics and means were compared using independent t tests. Multivariate logistic regression models were used to determine the association between putative risk factors and weight bias. RNs and CSS (N=308) demonstrated weight bias toward obese patient characteristics (mean=61.9) and perceived controllability of obesity (mean=65.8). CSS felt negatively about their supportive roles in caring for obese patients (mean=52.5). Respondent weight status and professional title resulted in variability of biased attitudes. Race, employment status, number of obese patients cared for daily, and department were predictive of biased attitudes. Weight biased attitudes toward obese pediatric patients and their caregivers were found among RNs and CSS. Future qualitative research will assist in the understanding the factors that cause nurse weight bias.
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Affiliation(s)
- Janelle T Garcia
- All Children's Hospital, Johns Hopkins Medicine, St. Petersburg, FL.
| | | | - Raquel G Hernandez
- All Children's Hospital, Johns Hopkins Medicine, St. Petersburg, FL; Johns Hopkins University School of Medicine, Department of Pediatrics, Baltimore, MD
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Murphy AL, Gardner DM. A scoping review of weight bias by community pharmacists towards people with obesity and mental illness. Can Pharm J (Ott) 2016; 149:226-35. [PMID: 27540405 DOI: 10.1177/1715163516651242] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Community pharmacists are accessible health care professionals who are increasingly offering weight management programs. People living with serious mental illness have markedly higher rates of obesity and associated illness outcomes than the general population, providing pharmacists who are interested in offering weight management services with an identifiable patient subgroup with increased health needs. Issues with stigma within obesity and mental illness care are prevalent and can lead to inequities and reduced quality of care. METHODS We conducted a scoping review to map and characterize the available information from published and grey literature sources regarding community pharmacists and weight bias towards obese people with lived experience of mental illness. A staged approach to the scoping review was used. RESULTS Six articles and 6 websites were abstracted after we removed duplicates and applied our inclusion and exclusion criteria. The published studies that we found indicated that pharmacists and pharmacy students do demonstrate implicit and explicit weight bias. CONCLUSIONS Very limited research is available regarding weight bias in pharmacists and stigma towards people with obesity, and we found no information on these phenomena relating to people with lived experience of mental illness. Investigations are needed to characterize the extent and nature of anti-fat bias and attitudes by pharmacists and the consequences of these attitudes for patient care.
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Affiliation(s)
- Andrea L Murphy
- College of Pharmacy (Murphy, Gardner), Dalhousie University, Halifax, Nova Scotia
| | - David M Gardner
- College of Pharmacy (Murphy, Gardner), Dalhousie University, Halifax, Nova Scotia
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McIntosh T, Hunter DJ, Royce S. Barriers to physical activity in obese adults: A rapid evidence assessment. J Res Nurs 2016. [DOI: 10.1177/1744987116647762] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Rising rates of obesity are becoming a major problem in the Western world, with multiple implications for individuals’ health and also health service resources. Physical activity can positively influence weight loss and weight loss maintenance; however, levels are low among obese individuals. The aim of this study was to identify the barriers faced by obese individuals which prevent them from engaging with physical activity. A rapid evidence assessment was undertaken based on the framework provided by Bettany-Saltikov. Studies were identified from an electronic database search using key words, reference list search and manual searching of current journal issues. Identified studies were screened for relevance, appraised for quality and relevant data were extracted in order to identify themes for analysis. Seventeen studies were included in the review, of which twelve were quantitative, five qualitative and one mixed methods. Several barriers were identified relating to three main themes: physical, psychological and external barriers. Due to the variety of barriers faced by obese individuals it is important to treat each person as an individual and identify the barriers perceived by them, in order to provide targeted support to overcome these barriers.
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Affiliation(s)
- Toni McIntosh
- Student Nurse (at time of writing), School of Health, Nursing and Midwifery, University of the West of Scotland, UK
| | - David J Hunter
- Lecturer in Adult Health, School of Health, Nursing and Midwifery, University of the West of Scotland, UK
| | - Sue Royce
- Lecturer in Adult Health, School of Health, Nursing and Midwifery, University of the West of Scotland, UK
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Nicholls W, Pilsbury L, Blake M, Devonport TJ. The attitudes of student nurses towards obese patients: A questionnaire study exploring the association between perceived causal factors and advice giving. NURSE EDUCATION TODAY 2016; 37:33-37. [PMID: 26608388 DOI: 10.1016/j.nedt.2015.11.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 10/09/2015] [Accepted: 11/06/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND Nurses acting in primary care roles are central in addressing obesity as a public health priority. Nurses with a lower Body Mass Index have been shown to have negative attitudes towards obesity. Additionally, where the patient is perceived as being responsible for their excess weight, a negative attitude may also be held. The extent to which negative attitudes may influence the advice provided by nurses to obese patients is unknown. OBJECTIVES The present paper sought to examine whether the level of advice offered to obese patients by student nurses is associated with (i) the perceived causal factors of obesity, (ii) attitudes towards obesity and (iii) body mass index of the nurse. METHOD Participants were 92 student nurses from a university in the Midlands, UK. Participants received one of four patient vignettes; three were affected by obesity, with reference to either a behavioural, social, or medical cause; and the fourth was normal weight. Student nurses elected advice they would offer from five staged options (from no active involvement in advising the patient, through to discussing dietary advice). Attitudes towards obesity and social desirability were measured using validated questionnaires. RESULTS No association was found between the level of advice offered and either the causal factor of obesity, the student nurses' attitude towards obesity, or the nurses' Body Mass Index. Most students endorsed the highest level of advice-a patient centred discussion. CONCLUSION Findings show that advice giving by student nurses was not associated with perceived cause of obesity, or attitude, but is in line with the current Nursing and Midwifery Council (2015) recommendations. That is, most students endorsed a patient centred discussion. This suggests that professional training guidelines for the non-judgemental treatment of obese patients are not only being recognised, but implemented.
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Affiliation(s)
- Wendy Nicholls
- Institute of Psychology, University of Wolverhampton, Mary Seacole Building, Nursery Street, Wolverhampton, WV1 1AD, United Kingdom.
| | - Linda Pilsbury
- Institute of Psychology, University of Wolverhampton, Mary Seacole Building, Nursery Street, Wolverhampton, WV1 1AD, United Kingdom.
| | - Marcia Blake
- Institute of Sport, University of Wolverhampton, Gorway Road, Walsall, WS1 3BD, United Kingdom.
| | - Tracey J Devonport
- Institute of Sport, University of Wolverhampton, Gorway Road, Walsall, WS1 3BD, United Kingdom.
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Buchmann M, Wermeling M, Lucius-Hoene G, Himmel W. Experiences of food abstinence in patients with type 2 diabetes: a qualitative study. BMJ Open 2016; 6:e008907. [PMID: 26739724 PMCID: PMC4716189 DOI: 10.1136/bmjopen-2015-008907] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 10/23/2015] [Accepted: 10/23/2015] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE People with type 2 diabetes often report pressure to abstain from many of life's pleasures. We tried to reconstruct these patients' sense of pressure to better understand how people with diabetes make sense of, and integrate, these feelings into their life. DESIGN, SETTING AND PARTICIPANTS A secondary analysis of narrative interviews with 14 patients with type 2 diabetes who are part of a website project. MAIN OUTCOME MEASURES Grounded theory-based analysis of narrative interviews, consisting of open, axial and selective coding. RESULTS People with type 2 diabetes felt obliged to give up many pleasures and live a life of abstinence. They perceived a pressure to display a modest culinary lifestyle via improved laboratory test results and weight. Their verbal efforts to reassure and distance themselves from excessiveness indicate a high moral pressure. With regard to the question of how to abstain, food and behaviour were classified into healthy and unhealthy. Personal rules sometimes led to surprising experiences of freedom. CONCLUSIONS People with diabetes have internalised that their behaviour is a barrier to successful treatment. They experience an intensive pressure to show abstinence and feel misjudged when their efforts have no visible effect. Taking into account this moral pressure, and listening to patients' personal efforts and strategies to establish healthy behaviours, might help to build a trusting relationship with healthcare providers.
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Affiliation(s)
- Maike Buchmann
- Department of General Practice, University Medical Center, Göttingen, Germany
| | - Matthias Wermeling
- Department of General Practice, University Medical Center, Göttingen, Germany
| | - Gabriele Lucius-Hoene
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg, Germany
| | - Wolfgang Himmel
- Department of General Practice, University Medical Center, Göttingen, Germany
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Evidence-Based Management of Infertility in Women With Polycystic Ovary Syndrome. J Obstet Gynecol Neonatal Nurs 2016; 45:111-22. [DOI: 10.1016/j.jogn.2015.10.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2015] [Indexed: 01/13/2023] Open
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