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Barriers to and facilitators of nurse-parent interaction intended to promote healthy weight gain and prevent childhood obesity at Swedish child health centers
Nordic School of Public Health NHV, Gothenburg, Sweden & Department of Public Health and Community Medicine, Public Health Epidemiology Unit, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Department of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Nordic School of Public Health NHV, Gothenburg, Sweden & Department of Psychology, University of Gothenburg, Gothenburg, Sweden.
2013 (English)In: BMC Nursing, ISSN 1472-6955, E-ISSN 1472-6955, Vol. 12, 27Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Overweight and obesity in preschool children have increased worldwide in the past two to three decades. Child Health Centers provide a key setting for monitoring growth in preschool children and preventing childhood obesity.

METHODS: We conducted semi-structured interviews with 15 nurses working at Child Health Centers in southwest Sweden in 2011 and 2012. All interviews were tape recorded and transcribed verbatim and imported to QSR N'Vivo 9 software. Data were analyzed deductively according to predefined themes using content analysis.

RESULTS: Findings resulted in 332 codes, 16 subthemes and six main themes. The subthemes identified and described barriers and facilitators for the prevention of childhood obesity at Child Health Centers. Main themes included assessment of child's weight status, the initiative, a sensitive topic, parental responses, actions and lifestyle patterns. Although a body mass index (BMI) chart facilitated greater recognition of a child's deviant weight status than the traditional weight-for-height chart, nurses used it inconsistently. Obesity was a sensitive topic. For the most part, nurses initiated discussions of a child's overweight or obesity.

CONCLUSION: CHCs in Sweden provide a favorable opportunity to prevent childhood obesity because of a systematic organization, which by default conducts growth measurements at all health visits. The BMI chart yields greater recognition of overweight and obesity in children and facilitates prevention of obesity. In addition, visualization and explanation of the BMI chart helps nurses as they communicate with parents about a child's weight status. On the other hand, inconsistent use and lack of quality assurance regarding the recommended BMI chart was a barrier to prevention, possibly delaying identification of overweight or obesity. Other barriers included emotional difficulties in raising the issue of obesity because it was perceived as a sensitive topic. Some parents deliberately wanted overweight children, which was another specific barrier. Concerned parents who took the initiative or responded positively to the information about obesity facilitated prevention activities.

Place, publisher, year, edition, pages
London: BioMed Central, 2013. Vol. 12, 27
Keyword [en]
Child, Preschool, Obesity, Health promotion, Prevention, Child health centers
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:hh:diva-29116DOI: 10.1186/1472-6955-12-27PubMedID: 24308289OAI: oai:DiVA.org:hh-29116DiVA: diva2:845052
Available from: 2015-08-10 Created: 2015-08-10 Last updated: 2017-12-04Bibliographically approved
In thesis
1. Barriers and Facilitators of Health Promotion and Obesity Prevention in Early Childhood: A Focus on Parents, Results from the IDEFICS Study
Open this publication in new window or tab >>Barriers and Facilitators of Health Promotion and Obesity Prevention in Early Childhood: A Focus on Parents, Results from the IDEFICS Study
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Childhood obesity has increased dramatically during the past thirty years. Parents are key persons in their children’s lives and their efforts to create healthy lifestyles are very important. However, social and economic determinants of health also affect parents’ opportunities to promote a healthy lifestyle.

Aims: To explore barriers and facilitators in promoting healthy lifestyles and preventing childhood obesity, focusing on parental roles.

Methods and main findings: Three studies originated from the Identification and Prevention of Dietary- and Lifestyle-induced health Effects in Children and InfantS (IDEFICS) study of determinants for two to nine-year-old children’s health in eight European countries. The fourth study was a qualitative interview study conducted in southwest Sweden.

Paper I: In focus group discussions (20 focus groups with children and 36 with parents), parents described lack of time, financial constraints, availability and food marketing techniques as barriers for promoting healthy eating. School policies about food varied; only Sweden and Estonia provided free school lunches. Children described great variation in the availability of unhealthy foods and beverages in their homes.

Paper II: Objectively measured Body Mass Index (BMI) of children (n=16 220) were compared to parents’ perception of and concern for their children’s health and weight status. In all weight categories and all countries, a substantial proportion of parents failed to accurately judge their child’s weight status. In general, parents considered their children to be healthy, irrespective of their weight status. Parents of children with overweight or obesity systematically underestimated their children’s weight status across eight European countries. Accurate parental weight perception in Europe differed according to geographic region.

Paper III: Swedish IDEFICS participants (n=1825) were compared with an age- and sex-matched referent population (n=1825), using registers from Statistics Sweden and the Swedish Medical Birth Register. Longitudinal child growth data (n=3650) were collected from child health centers and school health services. Families with low income, less education, foreign background or single parenthood were underrepresented in the IDEFICS study. BMI at inclusion had no selection effect but, at eight years of age, the obesity prevalence was significantly greater among referents.

Paper IV: A qualitative content analysis was used to interpret the findings from interviews with nurses (n=15) working at child health centers in the southwest of Sweden. The BMI Chart to identify overweight and obesity in children facilitated greater recognition but nurses used it inconsistently, a barrier to prevention. Other barriers were obesity considered a sensitive issue and that some parents wanted overweight children.

Conclusion: Parents may not perceive their child’s growth trajectory from overweight to obesity, and the preschool years may pass without effort to change lifestyle. Therefore, objective measurement and information of children’s BMI weight status by healthcare professionals is of great importance. To reach all parents and avoid selection bias, health surveys or health promoting activities must be tailored. Health promoting activities at the family level as well as the societal level should start early in children’s lives to prevent childhood obesity.

Place, publisher, year, edition, pages
Göteborg: Department of Public Health and Community Medicine, Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, 2014. 75 p.
Keyword
parents, children, obesity, weight perception, registers, prevention, health promotion
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:hh:diva-29130 (URN)978-91-628-8926-5 (ISBN)
Public defence
2014-02-28, Aulan, Nordic School of Public Health NHV, Nya Varvet, Fredrik Bloms väg 25, Göteborg, 13:00 (Swedish)
Opponent
Supervisors
Projects
IDEFICS (EU-project)
Available from: 2015-08-11 Created: 2015-08-10 Last updated: 2015-08-11Bibliographically approved

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