The difficult conversation: a qualitative evaluation of the ‘Eat Well Move More’ family weight management service

Johnson, Ronald W.; Oyebode, Oyinlola; Walker, Sadie; Knowles, Elizabeth; Robertson, Wendy

doi:10.1186/s13104-018-3428-0

Cited by 10 publications

(9 citation statements)

References 33 publications

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“…This was echoed by parents interviewed in Perez, Yaskina, et al (2018) who indicated a lack of receptiveness towards enrolling in paediatric weight management due to a lack of clarity around the services offered. Similar to recommendations by PHNs in our study, healthcare professionals in another qualitative evaluation on family weight management services mentioned the need to receive updates on families' enrolment status from the respective clinic (Johnson, Oyebode, Walker, Knowles, & Robertson, 2018). Receiving updates may prompt PHNs to decide on next steps to take with families in future consultations.…”

Section: Discussionsupporting

confidence: 71%

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

Nguyen

Kebbe

Peng

et al. 2020

Journal of Clinical Nursing

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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.

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Section: Discussionsupporting

confidence: 71%

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

Nguyen

Kebbe

Peng

et al. 2020

Journal of Clinical Nursing

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“…Crucially however, such strategies need to be coupled with an exploration of the unique structural, contextual and cultural factors driving these ethnic group patterns in child weight status locally, particularly through qualitative investigation. In addition, general barriers to GPs and nurses referring families to obesity services need to be explored and addressed [56]. Qualitative approaches would also provide opportunities for parents’ and children’s voices to inform the design of targeted messages or services, creating more “culturally competent” modes of design and delivery and providing detailed understandings of the target communities [57].…”

Section: Discussionmentioning

confidence: 99%

Understanding local ethnic inequalities in childhood BMI through cross-sectional analysis of routinely collected local data

et al. 2019

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BackgroundLocal-level analysis of ethnic inequalities in health is lacking, prohibiting a comprehensive understanding of the health needs of local populations and the design of effective health services. Knowledge of ethnic disparities in child weight status is particularly limited by overlooking both the heterogeneity within ethnic groupings; and the complex ecological contexts in which obesity arises. This study aimed to establish whether there was variation in childhood BMI across ethnic groups in Coventry, and the influence of individual, school and neighbourhood contexts, using routinely collected local data.MethodsNational Child Measurement Programme data were compiled for the period 2007/8–2014/15 and combined with routinely collected local data reflecting school performance and demographics, and school and neighbourhood physical environments. Multi-level modelling using Monte Carlo Markov Chain methods was used to account for the clustering of children within schools and neighbourhoods. Ethnic group differences in BMI z-score (zBMI) were explored at 4–5 years and 10–11 years for girls and boys alongside individual, school and neighbourhood covariates.ResultsAt age 4–5 years (n = 28,407), ethnic group differences were similar for boys and girls, with children from South Asian, White other, Chinese and ‘any other’ ethnic groups having a significantly lower zBMI, and Black African children having a higher zBMI, versus White British (WB) children. Patterns differed considerably at age 10–11 years (n = 25,763) with marked sex differences. Boys from White other, Bangladeshi and Black African groups had a significantly higher zBMI than WB boys. For girls, only children from Black ethnic groups showed a significantly higher zBMI. Area-level deprivation was the only important school or neighbourhood covariate, but its inclusion did not explain ethnic group differences in child zBMI.ConclusionThis analysis contributes to the existing literature by identifying nuanced patterns of ethnic disparities in childhood adiposity in Coventry, supporting the targeting of early obesity prevention for children from Black African groups, as well as girls from Black Caribbean and Black other ethnic backgrounds; and boys from Bangladeshi and White other ethnic backgrounds. It also demonstrates the utility of exploring routinely collected local data sets in building a comprehensive understanding of local population needs.

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“…With the rising prevalence of paediatric obesity, healthcare professionals are increasingly discussing weight-based health with young patients and their families. These consultations can be perceived as a challenge, with some general practitioners reluctant to have the ‘difficult conversation’ with parents and children [ 42 , 43 ]. 86.7% of school nurses in Missouri also believed counselling families about weight loss was difficult, but not inconvenient (51.9%) [ 44 ].…”

Section: The Views and Experiences Of Healthcare Professionals In The Paediatric Settingmentioning

confidence: 99%

“…Johnson et al found that school nurses in Solihull, England, felt introducing the subject of obesity as particularly problematic, either in person or via written correspondence [ 42 ]. In England, letters are sent to parents after a national measurement programme is conducted in primary schools.…”

Section: The Views and Experiences Of Healthcare Professionals In The Paediatric Settingmentioning

confidence: 99%

“…These letters detail the child’s body mass index and related health risks [ 45 ]. School nurses had faced backlash from some parents upon the receipt of these letters, which then acted as a barrier to further meaningful weight-related discussions and referral to lifestyle interventions [ 42 ].…”

Section: The Views and Experiences Of Healthcare Professionals In The Paediatric Settingmentioning

confidence: 99%

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The Use of Effective Language and Communication in the Management of Obesity: the Challenge for Healthcare Professionals

2021

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Purpose of Review Initial conversations about weight with patients are important to set the tone for future dialogue and management of obesity. There is often reluctance in raising the topic of overweight or obesity in consultations. We aimed to evaluate literature to discover the perceived barriers to optimal discussion about weight status and preferred weight-based terminology for adults, adolescents and parents of younger children. Recent Findings Fear of offending patients, insufficient training and lack of knowledge of referral pathways were identified as factors hindering healthcare professionals’ ability to discuss weight with patients. Neutral terms, such as ‘weight’, were preferred by patients, with ‘fat’ and ‘obese’ viewed as undesirable and stigmatising words. Summary There is a need for greater support and provision of specific training, including education on communicating weight status, for those involved in the management of obesity. More research is necessary to assess the impact of interventions to improve initial discussions with patients about weight.

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The difficult conversation: a qualitative evaluation of the ‘Eat Well Move More’ family weight management service

Cited by 10 publications

References 33 publications

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

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

Understanding local ethnic inequalities in childhood BMI through cross-sectional analysis of routinely collected local data

The Use of Effective Language and Communication in the Management of Obesity: the Challenge for Healthcare Professionals

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