Public health nurse referrals for paediatric weight management: A nested mixed‐methods study

Abstract

Aims and objectives To (a) characterise and determine proportions of referred and enrolled children and (b) explore public health nurses’ (PHNs) experiences, perspectives and recommendations regarding a new nurse‐led referral pathway for paediatric weight management. Background Children with obesity and their families in Canada access specialised services for obesity management through physician referral. Since this requirement can prevent timely access to health services, we established and tested a referral pathway whereby PHNs directly refer children to specialised care for obesity management. Design Nested mixed‐methods study reported using GRAMMS. Method Our research study included children (2–17 years of age; body mass index ≥85th percentile) referred by a PHN to the Pediatric Centre for Weight and Health (PCWH; Stollery Children's Hospital, Edmonton, Alberta, Canada) from April 2017–September 2018. We summarised referral and enrolment data using descriptive statistics and conducted one‐on‐one, semi‐structured telephone interviews with PHNs; interviews were audio‐recorded, transcribed verbatim, managed using NVivo 12 and analysed by two independent reviewers using content analysis. Results Our sample included 79 referred children (4.4 ± 1.8 years old; 3.4 ± 1.3 BMI z‐score; 52.7% male), of which 47 (59.5%) enrolled in care. PHNs’ (n = 11) experiences, perspectives and recommendations regarding the new referral pathway were grouped into four categories: (a) practicality of the referral pathway (e.g., simple and straightforward), (b) utility of the referral pathway (e.g., economic and timesaving), (c) uptake of the referral pathway (e.g., physician's influence) and (d) recommendations to improve the referral pathway (e.g., having electronic access to the referral form). Conclusions A PHN‐specific referral pathway led most children and families to enrol in paediatric weight management and overall was perceived as acceptable and appropriate among PHNs. Relevance to clinical practice Our results highlight the valuable role that PHNs can play in directly referring children to specialised services for weight management. This pathway has the potential to reduce wait times and enhance treatment enrolment.

Management of overweight and obesity in children and adolescents by nurses: a mixed-method study

“…Thus, they contributed to a better communication between professionals and to the continuity of care to this group (36) .…”

“…To solve this problem of dialogue between parents and professionals, nurses in Canada who were referring obese children and adolescents to a reference center in the treatment of this morbidity requested that a counter-referral be sent with updates, informing about the situation of these young people and their families. Thus, they contributed to a better communication between professionals and to the continuity of care to this group 36 .…”

“…The adoption of these measures may result in a reduction in waiting lines for medical appointments by young people and their family members. A study conducted in Canada states that actions carried out directly by nurses to children and adolescents with obesity reduce waiting times, as they do not need to go through the doctor (36) . Moreover, from these strategies, there may be a strengthening of PHC as a coordinator of health care for secondary and tertiary care of the health system.…”

“…They claim not to have received enough information about healthy eating practices by professionals 17 . Other studies have identified that nurses, when referring overweight children or adolescents to the nutritionist, do not have a dialogue with this professional 19 , 36 as well as no longer follow up these young people after referral 20 , 38 . These results corroborate the findings of our study.…”