Design and psychometric testing of instruments to measure qualified intensive care nurses’ attitudes toward obese intensive care patients

Abstract

The purpose of this pilot study was to design and test research instruments to measure qualified intensive care nurses' implicit and explicit attitudes and behavioral intentions toward obese intensive care patients. In previous studies researchers have demonstrated that some health professionals hold negative attitudes toward obese patients; however, little is known about qualified intensive care nurses' attitudes toward these patients. Our cross-sectional pilot study involved Implicit Association Tests, the Anti-fat Attitude questionnaire, an explicit bias scale comprising ratings of explicit beliefs and feelings, assessment of behavioral intentions based on vignettes, and demographic questions. Thirty qualified intensive care nurses from a general intensive care unit in Norway (80% female; age range 31-62 years) completed the study. Nurses reported implicit and explicit preferences for thin over thick patients and found obese patients lazier than normal-weight patients. Measures of behavioral intentions and anti-fat attitudes were reliable. Generally, the nurses intended to help obese patients immediately. Nevertheless, explicit anti-fat attitudes (rho = −0.49) as well as implicit anti-obese stereotypes (rho = −0.40) were negatively correlated with such intentions. Data supported satisfactory face validity, and convergent and discriminant validity within and between implicit and explicit attitudes and stereotypes.The set of research instruments were reliable, valid, and suitable tools to measure qualified intensive care nurses' implicit and explicit attitudes; however, the present findings need to be replicated in a larger-scale study. K E Y W O R D S attitude, implicit, intensive care, nurse, obesity

Intensive care nurses’ implicit and explicit attitudes and their behavioural intentions towards obese intensive care patients

“…According to Crandall (), there are no reasons to have antipathy towards obese individuals if the person is not responsible for his/her own weight. The AFA subscales ‘willpower’ and ‘dislike’ were positively correlated in our study, supporting Crandall's theory () and other previous work (Magallares & Morales, ; Robstad, Siebler, et al, ). Furthermore, the qualified ICU nurses scored lower on the ‘Dislike’ scale than on ‘Willpower’, of which both correlated significantly with the bad/good scale.…”

“…In that study, 54% of nurses preferred to provide health care to normal‐weight patients rather than to obese patients (Akman et al, ). In a previous study by Robstad, Söderhamn, et al (), some ICU nurses questioned whether obese ICU patients were entitled to the same treatment and care owing to their heavy weight, which could threaten nurses’ health. In fact, physical challenges associated with obese ICU patients’ weight may influence nurses’ willingness to care for these patients (Shea & Gagnon, ); hence, it is not only negative attitudes that may influence nurses’ behaviour towards obese patients.…”

“…We used the AFA, which was developed by Crandall () and consists of 13 statements measuring prejudice against obese people. The questionnaire has satisfactory reliability (Crandall, ; Robstad, Siebler, et al, ). The questionnaire is divided into three subscales measuring ‘dislike of fat people’ (seven questions), ‘fear of fat’ (three questions), and ‘willpower’ (three questions measuring beliefs about the controllability of weight) (Crandall, , p. 884).…”

“…Vignettes are designed so they can reveal a picture of, for example, participants’ behaviours or decisions without experimenting with real persons or patients (Evans et al, , p. 161). Four vignettes designed in a previous study, which were brief, written stories designed as real‐life scenarios that could happen at an ICU with two questions, were incorporated in this study (Robstad, Siebler, et al, ). The questions were presented on a 7‐point semantic scale from 1‐7 ( very likely to very unlikely ).…”

“…There is an indication that nurses and other healthcare professionals hold negative attitudes towards obese patients (Brown, ; Puhl & Brownell, ; Puhl & Heuer, ). Some nurses hold stereotypical views that obese patients are lazy (Brown, ; Robstad, Siebler, Söderhamn, Westergren, & Fegran, ; Robstad, Söderhamn, et al, ; Schwartz, Chambliss, Brownell, Blair, & Billington, ), that obesity is self‐inflicted (Robstad, Söderhamn, et al, ), and that obese persons not are as good as others (Ward‐Smith & Peterson, ). Crandall et al () stated that those who believe that obesity is a controllable condition have a higher anti‐fat bias than do those who think it is an uncontrollable situation.…”