A qualitative study of primary care clinicians' views of treating childhood obesity

Walker, O P Luke; Strong, Mark; Atchinson, Rebecca; Saunders, Joanna; Abbott, Jo

doi:10.1186/1471-2296-8-50

Cited by 116 publications

(160 citation statements)

References 18 publications

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“…The professional–parent relationship may be further complicated by some HCP beliefs that a lack of willpower contributes to obesity (Ljungkrona‐Falk, Brekke, & Nyholm, 2014), often attributing childhood obesity to family characteristics (e.g., lack of motivation to change, concern about weight, and cultural factors (Bonde, Bentsen, & Hindhede, 2014; Fisher & Kral, 2008; Isma, Bramhagen, Ahlstrom, Östman, & Dykes, 2012; Trigwell, Watson, Murphy, Stratton, & Cable, 2014; Turner et al ., 2016)). If HCPs anticipate a negative reaction from parents, they may prioritize relationships over addressing children's weight (Chadwick et al ., 2008; Regber, Mårild, & Hanse, 2013; Walker, Strong, Atchinson, Saunders, & Abbott, 2007). …”

Section: Introductionmentioning

confidence: 99%

Barriers and facilitators to health care professionals discussing child weight with parents: A meta‐synthesis of qualitative studies

Bradbury

Chisholm

Watson

et al. 2018

British J Health Psychol

135

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IntroductionChildhood obesity is one of the most serious global public health challenges. However, obesity and its consequences are largely preventable. As parents play an important role in their children's weight‐related behaviours, good communication between parents and health care professionals (HCPs) is essential. This systematic review provides a meta‐synthesis of qualitative studies exploring the barriers and facilitators experienced by HCPs when discussing child weight with parents.MethodsSearches were conducted using the following databases: MEDLINE (OVID), Psych INFO (OVID), EMBASE (OVID), Web of Knowledge and CINAHL. Thirteen full‐text qualitative studies published in English language journals since 1985 were included. Included studies collected data from HCPs (e.g., nurses, doctors, dieticians, psychologists, and clinical managers) concerning their experiences of discussing child weight‐related issues with parents. An inductive thematic analysis was employed to synthesize findings.FindingsEmerging subthemes were categorized using a socio‐ecological framework into intra/interpersonal factors, organizational factors, and societal factors. Perceived barriers and facilitators most commonly related to intra/interpersonal level factors, that is, relating to staff factors, parental factors, or professional–parent interactions. HCPs also attributed a number of barriers, but not facilitators, at the organizational and societal levels.ConclusionThe findings of this review may help to inform the development of future weight‐related communication interventions. Whilst intra/interpersonal interventions may go some way to improving health care practice, it is crucial that all stakeholders consider the wider organizational and societal context in which these interactions take place. Statement of contribution What is already known on the subject? Childhood obesity is one of the United Kingdom's most serious current public health challenges.Health care professionals are in a prime position to identify child weight issues during routine consultations.However, they often feel unable or unequipped to raise the topic and provide information on child weight management. What does this study add? To our knowledge, this is the first review to synthesize barriers and facilitators to discussing child weight.This review interprets key barriers and facilitators in the context of the socio‐ecological model.Supports the development of interventions matched to the appropriate level of the socio‐economic model.

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Section: Introductionmentioning

confidence: 99%

Barriers and facilitators to health care professionals discussing child weight with parents: A meta‐synthesis of qualitative studies

Bradbury

Chisholm

Watson

et al. 2018

British J Health Psychol

135

View full text Add to dashboard Cite

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“…However, research among primary care practitioners has identified a degree of ambivalence as to whether primary care has the resources or expertise to deal with this problem. 4,5 This pilot randomised controlled trial (RCT) examined the clinical efficacy of a nurse-led PCC compared with a consultant-led secondary care service at BRHC. The feasibility for a fully powered trial was assessed using a number of outcomes, including: (a) the clinical suitability of patients referred to receive PCC-based care; (b) the willingness of families to be randomised to PCCs; and (c) the degree to which families randomised to PCCs engaged with the service.…”

Section: Introductionmentioning

confidence: 99%

Evaluating the transferability of a hospital-based childhood obesity clinic to primary care: a randomised controlled trial

Banks¹,

Sharp²,

Hunt³

et al. 2012

Br J Gen Pract

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Research Abstract BackgroundThe Care Of Childhood Obesity (COCO) clinic at the Bristol Royal Hospital for Children (BRHC) uses a multidisciplinary approach comprising a consultant, dietitian, and exercise specialist. The clinic has demonstrated efficacy in managing children's weight but similar clinics are scarce in the UK. AimThis pilot randomised controlled trial (RCT) aimed to examine the feasibility of undertaking a fully powered RCT and to gauge whether the COCO model could be effective as a nurse-led clinic in primary care settings. Design and settingPatients were randomised to a hospital-based childhood obesity clinic or a nurse-led clinic in a primary care setting in south-west England. MethodChildren aged 5-16 years with a body mass index (BMI) ≥98th centile were referred by GPs to the consultant in charge of the COCO clinic at BRHC. Referred children were clinically screened for suitability and invited into the study. Consenting families were randomised to BRHC or a primary care clinic (PCC) and offered five appointments over 12 months. Clinical effectiveness was measured by change in body mass index standard deviation score (BMI SDS) at 12 months. Other measures included: treatment adherence, quality of life (QOL), and satisfaction. Feasibility was examined by assessing referral, screening, and recruitment data. ResultsA total 152 patients were referred by GPs: 31 (20%) were screened out; 45 (30%) declined to participate. Seventy-six (50%) patients were randomised and 68 provided baseline data (PCC = 42; BRHC = 26); 52 provided outcome data (PCC = 29; BRHC = 23). Mean change in BMI SDS was PCC -0.17 (95% confidence interval [CI] = -0.27 to -0.07); BRHC -0.15 (95% CI = -0.26 to -0.05). QOL, adherence, and satisfaction data indicated similar positive patterns in both trial arms. ConclusionScreening and recruitment data indicate that primary care is a clinically appropriate setting and acceptable to families. The primary clinical outcome measure (reduction in BMI SDS), along with secondary outcome measures, indicate that primary care has the potential to be effective in providing weight management for children, using the COCO model.

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“…To date, there have been a few qualitative studies examining barriers to weight loss from the perspectives of health professionals (9)(10)(11) , parents (4,12,13) and children (13,14) . A survey of American health professionals identified lack of parental involvement, lack of patient motivation and lack of support services as key barriers to the management of childhood obesity (9) .…”

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confidence: 99%

Lessons learned from a family-focused weight management intervention for obese and overweight children

Twiddy

Wilson

Bryant

et al. 2012

Public Health Nutr.

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Objective: Treatment for childhood obesity is characterised by high attrition rates and failure to achieve weight maintenance. It is therefore important to develop more effective programmes. The aim of the present qualitative study was to explore the views of parents, children and health trainers to identify issues which can inform the development of more effective programmes. Design: A qualitative study combining in-depth interviews and focus groups. Participants were selected purposively from current and past attendees. Setting: WATCH-IT, a UK-based community child weight management programme. Subjects: Twenty-three families who had previously attended (or were currently attending) WATCH-IT were interviewed. Focus groups with ten trainers explored their views of the intervention. Results: Parents and children had different goals for involvement, with parents focusing on psychological benefits, while children concentrated on goals relating to weight loss and physical fitness. Parents were found to struggle to provide consistent support to their children and this was exacerbated by family dynamics. The child's commitment to lose weight, support from their family and a good relationship between the child and their trainer were viewed as important keys to successful weight management. Conclusions: The study will guide the design of existing and future programmes by providing insights into issues that challenge successful engagement. It highlights the possible value of exploring the therapeutic relationship between trainers and participants. Keywords Obesity management Children InterventionChildhood obesity is rising almost universally (1,2) . Given the significant long-term health consequences of childhood obesity it is important to consider how best to manage children who are already overweight or obese. The most recent Cochrane review of interventions for childhood obesity examined the results of sixty-four randomised controlled trials and concluded that programmes that involved the whole family and included aspects around nutrition, behaviour modification and physical activity were more effective than those targeting the obese child alone (3) . Although lifestyle interventions can reduce the level of obesity in children and adolescents, attrition rates for interventions were often high (3) . Evidence also suggests that, while children might lose weight following a lifestyle intervention, they often remain in the obese category (4) . It is therefore important to understand those factors associated with success on weight management programmes.Psychological theory can be used to understand how the beliefs of young people, family members and health trainers may influence young people's weight management behaviours. Bandura's Social Cognitive Theory (5) (SCT) proposes that behaviour is a function of aspects of the person and the environment, and that the primary drivers of behaviour change include skills (e.g. ability to exercise more or control calorie intake), self-efficacy (belief in one's ability to perf...

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A qualitative study of primary care clinicians' views of treating childhood obesity

Cited by 116 publications

References 18 publications

Barriers and facilitators to health care professionals discussing child weight with parents: A meta‐synthesis of qualitative studies

Barriers and facilitators to health care professionals discussing child weight with parents: A meta‐synthesis of qualitative studies

Evaluating the transferability of a hospital-based childhood obesity clinic to primary care: a randomised controlled trial

Lessons learned from a family-focused weight management intervention for obese and overweight children

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