Abstract
BackgroundNurses in child health care (CHC) centers in Sweden play a key role in the early detection and management of childhood overweight/obesity, through meeting families early, regularly and over many years. However, research focusing on CHC nurses’ perceptions of their role in childhood overweight/obesity management is scarce. As part of the EU-funded project “Science and Technology in childhood Obesity Policy” (STOP), this study examines CHC nurses’ perceptions of speaking to parents about children’s overweight/obesity and of their role in referring children to treatment for overweight/obesity.MethodsAll registered CHC nurses in Stockholm County (n = 442) received an email invitation letter explaining the study. Individual face-to-face visits (n = 15) in selected centers, and phone calls (n = 24) to nurses working in these centres were also conducted. In total, 17 CHC nurses (all female, average work experience 6.7 years (SD ± 4.9 years)) from 10 municipalities (including four of the top five municipalities with the highest prevalence of overweight and obesity) in Stockholm County were interviewed. The interviews were conducted by phone, transcribed and analyzed using thematic analysis.ResultsTwo main themes were developed through the analysis: 1) The relationship between the nurse and the parent and 2) Glitch in the system. Under the first theme, nurses reported that weight-related discussions were facilitated by building and maintaining trust with parents. However, nurses also said they were reluctant to address children’s weights if this could compromise parents’ trust. Under the second theme, nurses highlighted several organizational barriers to addressing a child’s weight with parents, including insufficient cooperation with other healthcare providers and limited time for visits. Nurses also identified lack of sufficient knowledge about what to offer the family and lack of confidence in their communication skills as additional barriers.ConclusionsWe found that pediatric nurses perceive relational and organizational factors as barriers to address childhood obesity with parents. To improve care, it is necessary to provide nurses with continuing education about obesity and communication skills and organizational support to improve communication within the healthcare system.Trial registrationClinicalTrials.gov NCT03800823; 11 Jan 2019, prospectively registered.
Highlights
Nurses in child health care (CHC) centers in Sweden play a key role in the early detection and management of childhood overweight/obesity, through meeting families early, regularly and over many years
Two out of the 10 CHC centers represented areas with lower prevalence
This suggests that public health initiatives should focus on reducing the stigmatization of overweight and obesity on the societal level; this could be done through a combination of a social marketing campaign aimed at reaching the wider public, and gatekeeper education aimed at schools and primary care
Summary
Nurses in child health care (CHC) centers in Sweden play a key role in the early detection and management of childhood overweight/obesity, through meeting families early, regularly and over many years. As part of the EU-funded project “Science and Technology in childhood Obesity Policy” (STOP), this study examines CHC nurses’ perceptions of speaking to parents about children’s overweight/obesity and of their role in referring children to treatment for overweight/obesity. In the clinical encounter, healthcare providers may be as reluctant as parents to acknowledge verbally a child’s overweight or obesity. Healthcare providers feel uncomfortable when initiating discussions about child overweight because of worries about offending parents [4] and awareness of the prevailing societal stigma attached to excess bodyweight [5]. Healthcare providers’ reluctance to discuss overweight and obesity may lead children to miss opportunities for treatment; as one study found, healthcare professionals and parents often prefer to wait until the other party raises the issue, thereby leading to stalemate [6]. Because communication between parents and healthcare professionals is key to the management of children’s overweight/obesity, it is important to understand why healthcare professionals may be reluctant to speak about overweight and obesity among young children
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