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

Abstract

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.

Experience of nurses measuring preschool body mass index for the Health target: Raising Healthy Kids

“…This is consistent with research indicating that increased knowledge and competence facilitated communication, while lack of confidence was a barrier. 11 Nurses in this study were mainly aged .50 years (57%) and 54% had $16 years registered nurse experience so they were an experienced group of nurses. 16 so that nurses may have to contact families after the check to say that the initial assessment was wrong and referral was required.…”

“…Communication was also highlighted in the recent review on barriers and facilitators to this challenging discussion. 11 Communication in this study had two distinct aspects: the art of communication and providing reinforced messages. The art of communication included the interpersonal skills involved in ensuring the check was a positive experience for families, particularly if referral was indicated.…”

“…The art of communication included the interpersonal skills involved in ensuring the check was a positive experience for families, particularly if referral was indicated. Bradbury et al 11 noted that some health professionals reported avoiding talking to families about obesity due to previously experienced negative responses. Avoidance of the topic was rarely mentioned in this study, perhaps due to mandated reporting.…”

“…Lack of consistent messages from health professionals was commonly mentioned by nurses as a barrier to communication, which is consistent with international literature. 11,18 The benefit of all health professionals in contact with a family delivering the same message was stressed by nurses. Nurses felt undermined when other health professionals did not mention that a child was overweight or obese.…”

“…The addition of a BMI screen into health checks increases the possible complexity of discussion associated with checks, as obesity is a challenging issue to discuss with parents. 11 A recent review of qualitative studies exploring the barriers and facilitators to discussing weight with families identified intra-and inter-personal factors as important, such as health professionals' knowledge and competence, which facilitated communication when present, and was a barrier if absent. 11 Fear of parental response to perceived criticism of their lifestyle, lack of time in consultations, cultural beliefs around healthy weight and lack of clear protocols for referral were also barriers to discussion.…”