A challenging balancing act to engage children and their families in a healthy lifestyle – Nurses' experiences of child‐centred health dialogue in child health services in Sweden

Abstract

Aims and objectives To describe nurses' experiences of a child‐centred family guided intervention of obesity tested within the child health services targeting children identified with overweight and their caregivers. Background Interventions aiming to support families towards a healthier lifestyle can lead to decreased risk of overweight evolving into obesity in a child. At the same time, nurses have found dialogues on weight challenging and may therefore avoid them. Design Qualitative descriptive inductive design following content analysis applying to the COREQ guidelines. Methods Content analysis was used to analyse 13 individual semi‐structured interviews with nurses in the child health service in Sweden after completed training in CCHD, including how to facilitate the dialogue with the use of illustrations. Results The theme Health dialogue about weight is a challenging balancing act facilitated by a supportive intervention emerged through eight subcategories in three main categories. Nurses experienced that CCHD with children identified with overweight and their caregivers provoked an emotional response both for themselves and for the caregivers of the child. The training in child‐centred health dialogues promoted the nurses' work with structure and professionalism, as the nurses carefully took tentative steps to engage the family for a healthy lifestyle. Conclusions Emotional and practical challenges in performing CCHD still remained among nurses after customised training, which might comprise the child's rights to be involved in his or her own care when the child was identified as overweight. However, training for nurses, including lectures and tutorials, was found to increase the quality and professionalism of performing CCHD by providing structure, tools and tutorial support. Relevance to clinical practice Customised training and illustrations can support nurses when performing a structured intervention such as child‐centred health dialogues.

A child‐centered health dialogue for the prevention of obesity in child health services in Sweden – A randomized controlled trial including an economic evaluation

“…Another explanation might be that caregivers experienced an emotional response when the BMI growth chart was used to identify overweight and did not accept additional care 13,37,42 . Several studies showed that health professionals felt uncomfortable introducing the topic of overweight and found health dialogues with families about overweight challenging 23,37,39 . Likewise, in our study nurses in both groups answered that they felt uncomfortable communicating about overweight.…”

“…In our study, a larger proportion of nurses in the intervention group believed they had adequate knowledge of child overweight and felt competent in the communication method. A qualitative study describing nurses' experiences of CCHD showed that CCHD encouraged nurses to mention their concern about the child's health in relation to their weight, which is an important step in the prevention of child obesity 36,37,39 . Nurses trained in CCHD felt that they had been provided with a toolbox that facilitated a more professional way of performing a dialogue with caregivers and children with overweight 39 …”

“…Likewise, in our study nurses in both groups answered that they felt uncomfortable communicating about overweight. The qualitative study of nurses' experiences of CCHD, however, found that the tutorial sessions did increase their self‐esteem in starting the conversation about weight and lifestyle already in early childhood and demonstrated the need for continuous training with room for reflection 37,39 . A qualitative interview study exploring caregivers' experiences of CCHD when overweight is identified is ongoing.…”

“…Nurses allocated to intervention care received an extra interactive 1‐day training in small groups in October–November 2016. The training, described elsewhere, 39 focused on how to promote child participation and how to apply a family‐therapeutic solution‐focused approach 30,34 . The training was followed by four tutorial sessions of one hour, once every two months.…”

“…The training, described elsewhere, 39 focused on how to promote child participation and how to apply a family-therapeutic solutionfocused approach. 30,34 The training was followed by four tutorial sessions of one hour, once every two months.…”