Implementing guidelines for preventing, identifying and treating adolescent overweight and obesity—School nurses’ perceptions of the challenges involved
Abstract:Having a proper strategy for implementation, and ensuring that necessary clinical structures and resources are available, is crucial. Including school nurses in developing and implementing such strategies is vital for success in implementing national guidelines.
“…Usually because the response back is very negative. You do not want to lose their trust in the condition they have come to see you about (GP) (Walker et al, 2007).In addition, the issue of body mass index (BMI) not being an exact measure was highlighted, particularly in cases where children presented with more developed muscles: ‘we don't measure whether this is muscles or fat … both boys and girls can often be quite solid … and we don't take that into account’(Helseth et al, 2017). The appropriateness of using BMI as an indicator of overweight was thus discussed, with some GPs choosing to use growth charts rather than BMI: If they are on the 50th percentile for their height but the 100th percentile for their weight, most parents realise there is a problem so I tend to do that rather than give a number.…”
Background
Healthcare professionals are ideally placed to discuss weight management with children and families to treat and prevent childhood obesity. The aim of this review was to collect and synthesize primary research evidence relating to health professional's views and experiences of discussing weight with children and their families.
Methods
Systematic searches were conducted using the following databases: MEDLINE (OVID), Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE (OVID), PsycINFO (OVID) and Healthcare Management Information Consortium (HMIC). Twenty‐six full text qualitative studies published in English Language journals since inception to October 2019 were included. Papers were quality assessed and synthesized using an inductive thematic analysis approach.
Results
Data analysis generated five themes: sensitivity of the issue, family–professional relationships, whole systems approach, professional competency and sociocultural context.
Conclusion
Supporting behaviour change through discussion of healthy weight with children and families is an important part of the health professional's role. Tailored information for professionals, including resources and training, facilitates them to confidently talk to children and families about weight prioritized within interventions. The success of such interventions requires commitment from a range of professionals to ensure healthy weight is tackled through a whole system approach.
“…Usually because the response back is very negative. You do not want to lose their trust in the condition they have come to see you about (GP) (Walker et al, 2007).In addition, the issue of body mass index (BMI) not being an exact measure was highlighted, particularly in cases where children presented with more developed muscles: ‘we don't measure whether this is muscles or fat … both boys and girls can often be quite solid … and we don't take that into account’(Helseth et al, 2017). The appropriateness of using BMI as an indicator of overweight was thus discussed, with some GPs choosing to use growth charts rather than BMI: If they are on the 50th percentile for their height but the 100th percentile for their weight, most parents realise there is a problem so I tend to do that rather than give a number.…”
Background
Healthcare professionals are ideally placed to discuss weight management with children and families to treat and prevent childhood obesity. The aim of this review was to collect and synthesize primary research evidence relating to health professional's views and experiences of discussing weight with children and their families.
Methods
Systematic searches were conducted using the following databases: MEDLINE (OVID), Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE (OVID), PsycINFO (OVID) and Healthcare Management Information Consortium (HMIC). Twenty‐six full text qualitative studies published in English Language journals since inception to October 2019 were included. Papers were quality assessed and synthesized using an inductive thematic analysis approach.
Results
Data analysis generated five themes: sensitivity of the issue, family–professional relationships, whole systems approach, professional competency and sociocultural context.
Conclusion
Supporting behaviour change through discussion of healthy weight with children and families is an important part of the health professional's role. Tailored information for professionals, including resources and training, facilitates them to confidently talk to children and families about weight prioritized within interventions. The success of such interventions requires commitment from a range of professionals to ensure healthy weight is tackled through a whole system approach.
“…Our study reflects a small set of health professionals’ views on the continued challenge of raising the issue of children’s weight, as well as how to manage that conversation between parents, children and health professionals [ 30 – 33 ]. Interventions which promote conversations between health professionals, children and families have shown some success [ 34 – 37 ]; suggesting improved confidence and skills among health professionals.…”
ObjectiveThe Eat Well Move More (EWMM) family and child weight management service is a 12-week intervention integrating healthy eating and physical activity education and activities for families and children aged 4–16. EWMM service providers identified low uptake 12 months prior to the evaluation. The aims of this study were to describe referral practices and pathways into the service to identify potential reasons for low referral and uptake rates.ResultsWe conducted interviews and focus groups with general practitioners (GPs) (n = 4), school nurses, and nursing assistants (n = 12). Data were analysed using thematic analysis. School nurses highlighted three main barriers to making a referral: parent engagement, child autonomy, and concerns over the National Child Measurement Programme letter. GPs highlighted that addressing obesity among children is a ‘difficult conversation’ with several complex issues related to and sustaining that difficulty. In conclusion, referral into weight management services in the community may persistently lag if a larger and more complex tangle of barriers lie at the point of school nurse and GP decision-making. The national prevalence of, and factors associated with this hesitation to discuss weight management issues with parents and children remains largely unknown.
“…The National Association of School Nurses (NASN) identifies the school nurse as having the expertise and skills needed for childhood obesity prevention and reduction efforts (NASN, 2018). However, many school nurses cite limited resources and time restraints as a barrier to implementation (Helseth, Riiser, Fagerlund, Misvaer, & Glavin, 2017; Schroeder & Smaldone, 2017). Peer mentorship functions as a solution to overcome these barriers.…”
Sugar-sweetened beverages (SSBs) are a large source of added sugar in teenagers’ diets, comprising 20–25% of daily calories. Despite efforts, teens in rural and southern states continue to have the high SSB consumption rates. Using Teen Advisory Councils (TAC), students designed and delivered school-specific interventions at five Tennessee schools. Using repeated measures models with Bonferroni correction, data were collected on SSBs and water consumption at baseline and 30 days postintervention. The 573 participants ranged from 13 to 19 years; mean age 15.97 years ( SD = 1.4). Daily SSB servings decreased from a mean of 2.37 ( SD = 2.06) to 1.87 ( SD = 1.89; p = .024). Weekly SSB behaviors decreased 10%. Daily water consumption increased 19.5% to 4.46 ( SD = 2.97) servings ( p = .03). Student-led efforts supported behavioral changes. TACs were effective at changing lifestyle behaviors. Community-driven solutions may result in manageable changes to sustain behaviors.
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