Understanding Parents’ Perceptions of School-Based BMI Screening and BMI Report Cards Using Perceptual Mapping: Implications for School Nurses

Abstract

Half of U.S. states measure students' body mass index (BMI), with many communicating that information to parents through a "BMI report card" or notification letter. School nurses are usually responsible for implementing these programs and communicating results to parents. The purpose of this study was to understand parents' perceptions of BMI screening programs to help inform school nurses about messages that are most helpful to use in report cards to motivate parents to follow-up with a health-care provider or to make behavioral changes for their child. Using a cluster analysis and perceptual mapping methods, a commercial marketing technique that creates three-dimensional graphic maps, we identified four unique clusters of parents based on their core attitudes and beliefs related to BMI screenings and report cards. Based on vector modeling techniques, key message strategies were developed that can be used by school nurses to enhance parent response to a BMI report card.

Parents' Perceptions of and Responses to School‐Based Body Mass Index Screening Programs—A Systematic Review

“…In addition, a majority of studies (N = 11) had predominately white, non‐Hispanic samples, and all had predominantly female caregiver participants. Three studies specifically recruited a larger proportion of racial/ethnic minority participants, 26,27,29 and 3 other studies specifically made racial/ethnic comparisons 28,30,31 . Studies described participant socioeconomic status (SES) in varied ways.…”

“…Seven studies included parents who received a state‐mandated notification letter after their child was screened 25,31,33‐37 . Three studies included both parents who did and did not receive a letter, 26,28,38 and 3 studies included feedback from parents who were asked questions about a hypothetical letter without seeing a visual representation 11,29,39 . Other studies provided an example letter to parents 27,30 .…”

“…Additionally, parents reported that BMI notification could motivate change to healthier behaviors 28 . Fewer studies (N = 4) assessed parent beliefs that screening could be misleading because it does not account for muscle mass, 28,29 and, in other studies (N = 2), some parents reported that notification was not surprising because they already knew their child's weight status 25,40 …”

“…Parents perceived these conversations as distressing for children identified as “overweight” or at risk 25‐27,31,34‐37 . Two of the 7 studies reviewed reported specific characteristics and beliefs of parents who were more likely to discuss the letter with their child: parents of children outside of “normal” weight status; older parents; ethnic‐minority parents; and parents who trusted the BMI screening program and school nurse 29,31 . A minority of parents believed that responsibility for BMI screening did not belong with their child's school: “The school can only do so much.…”

Is fatigue a cue to obtain iron supplements in Odisha, India? A mixed methods investigation

“…Perceptual mapping is often used in commercial marketing [40][41][42] but it has recently gained momentum in health behaviour communication. [43][44][45][46][47] In the current study, we expand on the public health application of perceptual mapping by using this technique to understand how women understand fatigue in relation to items associated with the acquisition of iron tablets. We follow the perceptual mapping activity with a card sorting exercise to understand if cognitive (ie, perceived importance to health) and affective (ie, dislike) perceptions could inform the results of the perceptual maps.…”