Enabling overweight children to improve their food and exercise habits--school nurses' counselling in multilingual settings

"A constant battle against sedentary lifestyle and screen time": Swedish school nurses' views on school children's physical activity and its promotion - a grounded theory study

School nurses are in a key position to promote children's physical activity. They engage all children in health dialogues and use different approaches to inform children about physical activity and motivate them to change their physical activity level. In a school context, it is important to explore and problematize school nurses' views of children's physical activity and the influence of these views on their professional practice in the school health service. Identifying and problematizing school nurses' views of physical activity would enable them to create improved guidelines and equivalent ways of working in the future. Therefore, this study aims to discursively explore Swedish school nurses' views on school children's physical activity and its promotion and elucidate them through a discursive framework based on sensitizing concepts. This study uses a qualitative research design with a constructivist grounded theory approach. Semi-structured interviews were conducted with 24 school nurses. The analysis resulted in a core category describing how school nurses use intertwined views to lead children from sedentarity to physical activity. Furthermore, the school nurses' practices were identified in three categories: fostering everyday movement as a tool for health, battling children's sedentarity under difficult conditions, and promoting everyday movement and compensating for unequal access. The results indicate that school nurses lack common and clear guidelines for their mission to promote physical activity to children, which may lead to inequality in access to physical activity for children and young people.

Exploring primary school years interactions around child weight: A qualitative meta-synthesis of school staff, parent, and child views and experiences

Interactions about children's weight and weight-related behaviors occur from an early stage in school settings between various stakeholders and are often intended to facilitate weight-related behavioral change in children and/or families. This meta-synthesis (PROSPERO - CRD42019133231) aimed to investigate stakeholder reported experiences and challenges of these encounters. Studies were eligible if they included school stakeholders (teaching or nonteaching staff, parents, caregivers, or children), explored communication topics related to child obesity (weight, diet or activity), were conducted within an early school setting (primary school stage or international equivalent), and used qualitative methods. Database searches conducted March-July 2019 (updated November 2020) identified 40 studies (2324 participants) from seven countries. Included studies were assessed for quality using the Critical Appraisal Skills Programme. Using inductive thematic analysis, we identified four core themes across this database: (1) "conversation characteristics and consequences," (2) "missing components," (3) "avoiding stigma," and (4) "school responsibilities." Overall, stakeholders recognized that schools are well-positioned to provide positive influential messages about childhood obesity and reported that discussions on this topic do occur in early school settings but that stakeholders find them difficult, complex, and lack the necessary skills to deliver the nonjudgmental, consistent, and tailored support that they desire.

Reflections on a complex intervention targeting healthy eating in young children

In this article, the author offers her experiences of conducting a public health nursing intervention based on the use of the Medical Research Council framework for complex interventions. This article provides examples aimed at helping and inspiring others who might be interested in conducting a complex intervention study. The intervention focused on counseling about food and feeding practices provided by public health nurses in a sample of child health centers in Norway 2015-2018. Aspects of food and nutrition are central to public health nurses' counseling at the child health center, and they experience challenges when counseling on these themes. This article offers an approach to handling the complexity of public health nursing interventions on counseling among families. The topics presented on planning and performing an intervention and the related challenges might have relevance for public health nursing in several countries.

Adjusting and doing the same: school nurses' descriptions of promoting participation in health visits with children of foreign origin

Background

School nurses in the school health services are assigned to promote health and participation among children when conducting health visits. Still, for children of foreign origin this promotion of participation might be hampered by challenges related to cultural diversity and language barriers. Therefore, knowledge needs to be developed regarding how these children’s participation can be promoted, to support them in sharing and describing matters important for their health. The aim was to investigate school nurses’ descriptions of promoting participation for children of foreign origin in health visits.

Methods

A content analysis of 673 Swedish school nurses’ answers to eight open-ended questions regarding promotion of participation for children of foreign origin was conducted. The open-ended questions were part of a larger web-based cross-sectional survey distributed to school nurses in Sweden.

Results

The results show that school nurses use three main approaches during the health visit: adjusting according to the child’s proficiency in Swedish and/or cultural or national background, adjusting according to the child’s individual needs, and doing the same for all children regardless of their origin. Yet, adjustments according to the child’s proficiency in Swedish and/or cultural or national background were the most common.

Conclusions

By combining the approaches of adjusting, a child-centered care that contributes to children’s participation in health visits and equity in health could be provided.

The use of a communication tool about diet at the child health centre: A cluster randomized controlled trial

Aim

To investigate the effect of a communication tool about diet used in public health nurse consultations with parents compared with standard consultations concerning the 2-year-old child's diet.

Design

A cluster randomized controlled trial.

Methods

Ten municipalities were selected randomly and matched in pairs. In each pair, the control or intervention group was randomly allocated. Parents were recruited to participate from January 2015 to January 2017. In intervention clusters, a communication tool about diet was used to help the parents (N = 140) to focus on a healthy diet for their child. In the control clusters, parents (N = 110) attended standard consultations. The participants completed semi-quantitative food frequency questionnaires at baseline and end point.

Results

No effect of the intervention was seen on the child's daily intake of vegetables or saturated fat, or body mass index. Significantly fewer parents desired more information about food for toddlers in the intervention than in the control group.

The Sociocultural Factors Underlying Latina Mothers' Infant Feeding Practices

In this study, we examined the sociocultural factors underlying infant feeding practices. We conducted four focus groups with 19 Latina mothers of children 0 to 2 years of age enrolled in Early Head Start programs in the United States over a 1-year period. We found these mothers considered both science- and family-based feeding recommendations. However, advice from family was often inconsistent with science- and nutrition-based recommended feeding practices. In the interest of showing respect and preserving harmonious relationships, some mothers accepted family advice instead of recommended practices while others employed strategies to follow recommended practices without offending. Nutrition educators need to consider the intersection of macro, organizational, and community factors with micro-level processes in shaping the implementation of recommended feeding practices within family systems. Nutrition interventions for Latino families should capitalize on Latina mothers’ strategies for navigating multiple information sources while preserving cultural values and family relationships.

Nurses' use of pliable and directed strategies when encountering children in child and school healthcare

Nurses in Swedish child and school healthcare need to balance their assignment of promoting children's health and development based on the national health-monitoring programme with their responsibility to consider each child's needs. In this balancing act, they encounter children through directed and pliable strategies to fulfil their professional obligations. The aim of this study was to analyse the extent to which nurses use different strategies when encountering children during their recurrent health visits throughout childhood. A quantitative descriptive content analysis was used to code 30 video recordings displaying nurses' encounters with children (3-16 years of age). A constructed observation protocol was used to identify the codes. The results show that nurses use pliable strategies (58%) and directed strategies (42%) in encounters with children. The action they use the most within the pliable strategy is encouraging (51%), while in the directed strategy, the action they use most is instructing (56%). That they primarily use these opposing actions can be understood as trying to synthesize their twofold assignment. However, they seem to act pliably to be able to fulfil their public function as dictated by the national health-monitoring programme, rather than to meet each child's needs.

Adolescents' evaluations of the quality of lifestyle counselling in school-based health care

BACKGROUND

Adolescents need effective lifestyle counselling precisely because health problems are so common. Good-quality lifestyle counselling can prevent the problems from becoming worse and decrease the costs of health care. Nurse practitioners in schools are well positioned to promote adolescent health.

AIM

This study describes adolescents' evaluations of the quality of lifestyle counselling and factors related to it in school-based health care.

METHODS

The data were collected from seventh- to ninth-grade adolescents (n = 846) using the Counselling Quality Instrument, from two junior high schools in northern Finland. The study employed a web-based survey. Response rate was 67% (n = 563). The data were analysed via descriptive statistics.

RESULTS

Most adolescents (84%) reported that the counselling resources related to school-based health care are quite good. Most of them reported that nutrition (70%) and physical activity (63%) related to lifestyle counselling are sufficient. Approximately half of adolescents (51%) considered the counselling related to substance abuse as being sufficient. Most (80%) felt that the level of interaction during counselling is good. Overall, the majority of adolescents reported that goal-oriented lifestyle counselling (67%) and adolescent-centred counselling (69%) are good. Finally, most adolescents (72%) reported that they have benefitted from lifestyle counselling. Gender and health status were significantly related to resources, interaction and benefits of lifestyle counselling. Girls evaluated that counselling were more adolescent-centred than boys. Adolescents with very good health status evaluated content of lifestyle counselling better than adolescents with poorer health status.

CONCLUSION

The adolescents evaluated the quality of lifestyle counselling in school-based health care as mainly being good. School nurses should pay particular attention when providing counselling to boys and those who are in poorer health.

Nursing: promoting the health of overweight children and adolescents in the school context

The study aimed to analyze the nursing interventions related to the competencies of health promotion of overweight children and adolescents in the school context, in light of the Galway Consensus through an integrative review. Articles published between 1988 and June, 2013 were found in the databases CINAHL, SCOPUS, MEDLINE/PubMed, Cochrane, LILACS and SciELO. A total of 139 publications were obtained from indexed descriptors. Ten articles were selected after reading. The most evident competencies for health promotion were: catalyzing change, needs assessment and impact assessment. The highlights were activities of health education and partnerships with other health professionals and the families of students. It was found that the skills of health promotion developed by nurses can contribute to the adoption of healthy habits by overweight children and adolescents.

School nurses' experiences with motivational interviewing for preventing childhood obesity

Motivational interviewing is a counseling method used to bring about behavior change; its application by school nurses for preventing obesity in children is still new. This study, based on in-depth interviews with 12 school nurses, shows how school nurses adapted motivational interviewing and integrated it into their daily practice along with other methods they knew from the past. Three dilemmas for school nurses were revealed: when the child was severely overweight and the parents did not perceive this as a problem, when the child and the parents were at different stages of motivation to change, and when applying an individualized approach such as motivational interviewing for preventing a complex societal problem, in this instance obesity. The study raises an important issue to consider, with implications for school nursing and obesity prevention: motivational interviewing as either a counseling method or a prevention strategy.

Changes in community readiness among key school stakeholders after Ready for Recess

School community readiness (CR) for health promotion efforts may be critical to the effectiveness of school-based interventions aimed at promoting youth physical activity and reducing childhood obesity. The purpose of this study was to: (i) identify key informants who scored highest on school CR at baseline and (ii) determine the effects of Ready for Recess on changes in CR among school key informants from baseline to post-intervention. Key informants (N = 98) across 17 schools participated in CR interviews. Interview questions focused on school CR for physical activity and childhood obesity efforts across six dimensions. At baseline, principals scored higher than teachers in overall readiness and knowledge of the issue and higher than recess staff and nurses in leadership. Leadership readiness decreased across key informants at post-intervention and principals demonstrated greater decreases when compared with recess staff. Baseline disparities between principals and other key informants suggest principals may have overestimated the readiness of staff implementing the intervention. Declines among principals indicate that they may not have been prepared to deliver adequate support to successfully implement the intervention. These results illuminate the importance of assessing/improving school readiness prior to interventions. The CR model may provide an opportunity to improve school-based physical activity interventions.