Promoting Healthy Weight for All Young Children: A Mixed Methods Study of Child and Family Health Nurses’ Perceptions of Barriers and How to Overcome Them.

Abstract

Background: Childhood obesity is a global health concern. Early intervention to help parents adopt best practice for infant feeding and physical activity is critical for maintaining healthy weight. Australian governments provide universal free primary healthcare from child and family health nurses (CFHNs) to support families with children aged up to five years and to provide evidence-based advice to parents. This paper aims to examine factors influencing the child obesity prevention practices of CFHNs and to identify opportunities to support them in promoting healthy infant growth.Methods: This mixed methods study used a survey (n = 90) and semi-structured interviews (n = 20) with CFHNs working in two local health districts in Sydney, Australia. Survey data were analysed descriptively; interview transcripts were coded and analysed iteratively. Survey and interview questions examined how CFHNs addressed healthy infant feeding practices, healthy eating, active play and limiting sedentary behaviour during routine consultations; factors influencing such practices; and how CFHNs could be best supported.Results: CFHNs frequently advised parents on breastfeeding, introducing solid foods, and techniques for settling infants. They spent less time providing advice on evidence-based formula feeding practices or encouraging physical activity in young children. Although nurses frequently weighed and measured children, they did not always use growth charts to identify those at risk of becoming overweight or obese. Nurses identified several barriers to promoting healthy weight gain in infants and young children, including limited parental recognition of overweight in their children or motivation to change diet or lifestyle; socioeconomic factors (such as the cost of healthy food); and beliefs and attitudes about infant weight and the importance of breastfeeding and physical activity amongst parents and family members.Conclusions: CFHNs require further education and support for their role in promoting optimal child growth and development, especially training in behaviour change techniques to increase parents’ understanding of healthy infant weight gain. Parent information resources should be accessible and address cultural diversity. Resources should highlight the health effects of childhood overweight and obesity and emphasise the benefits of breastfeeding, appropriate formula feeding, suitable first foods, responsiveness to infant feeding cues, active play and limiting screen time.

Influence of the Implementation of Strengths-based Nursing and Healthcare on Early Childhood Nurses’ Competencies: A Mixed-Method Study.

“…They had occupied their actual posts for more than 15 years and worked part time. The characteristics of our sample were similar to those of other international ECN samples in the literature (7,32,33). In accordance with another study, except for age and time at their actual post, these characteristics had no in uence on the frequency of action (34).…”

Barriers and facilitators to implementing practices for prevention of childhood obesity in primary care: A mixed methods systematic review

“…Deficits in knowledge to support breastfeeding women, 55,56,58–61 BMI thresholds for classification of overweight and obesity, 28,31,33,35,42,50,54 risk factors for excess weight gain in infants, 25,30,35,39 and recommendations for diet, physical activity and screen time for children 24,31–33,35,39,50,72,73 were identified. Perceived lack of skills in raising the topic of weight and related behaviors was frequently reported 25,30,34,39,40,43,50–52,64,68,73 . PCPs felt it was particularly difficult to discuss weight related topics with parents who were regarded as having overweight 27,31,40,50,73 …”

“…Implementation was hindered when PCPs perceived a lack of support for the PCP's role, lack of strong leadership and poor inter‐disciplinary cooperation 23,25,27,35,50,52,59,60,63,73,74 . All PCP groups reported there was insufficient time to sensitively discuss weight related topics 23–25,27,31–36,39,41,42,50,52,55,63–66,72–74 . Some PCPs expressed concerns about allocation of funding and resources to support the implementation of protocols 23,63,74 .…”

“…Parents are resistant to advice, lack interest, not motivated 1,2,5–8,10,11,13,14,16,18,20–22,30,33–35,37,38,40,42,48,50 …”

“…Deficits in knowledge about childhood obesity 6,7,13,21,22,25,29,30,32 Lack of familiarity with guideline content 7,18,[21][22][23]30,31,48 Lack of skills (counseling, communication) 7,13,18,19,[21][22][23]37 Lack of obesity prevention training 2,7,11,13,18,[21][22][23]29,31 Psychological capability Uncertainty about identifying infants at risk of developing obesity 7,13,14,16,21,29,30,34,37,38,46 Disagreement with guideline content/usefulness 1,8,9,13,…”