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Moberg M, Golsäter M, Norman Å. Parents' Thoughts Regarding Their Normal-Weight Children's Food and Physical Activity as Expressed During Health Conversations With the School Nurse: A Qualitative Analysis Informing Health-Promoting Practices. J Sch Nurs 2023; 39:385-395. [PMID: 34184918 PMCID: PMC10486157 DOI: 10.1177/10598405211025440] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Parents are key to promoting children's healthy growth and development. However, school nurses need knowledge about how to best support parents' health-promoting activities. This study aimed to explore parents' thoughts regarding their normal-weight 6-year-old children's food and physical activity behaviors as expressed during health conversations with the school nurse. Qualitative content analysis of audio-recorded conversations (n = 30) showed that parents think of their children's behaviors in terms of: (a) children's personality in relation to food and physical activity; (b) recognizing children's food and physical activity behaviors; (c) parenting in relation to food and physical activity; (d) interaction with children in situations around food and physical activity; and (e) contextual circumstances to promote children's healthy food and physical activity behaviors. The study contributes with novel knowledge regarding clinical work in health promotion, with suggestions for how school nurses can engage parents in promoting and sustaining healthy food and physical activity behaviors.
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Affiliation(s)
- Marianna Moberg
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Marie Golsäter
- CHILD, School of Health and Welfare, Jönköping University, Jönköping, Sweden
- Futurum—Academy for Health and Care, Region Jönköping County, Jönköping, Sweden and Linköping University, Linköping, Sweden
| | - Åsa Norman
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Elinder LS, Wiklund CA, Norman Å, Stattin NS, Andermo S, Patterson E, Hemmingsson E, Cook C, Raposo S, Kwak L. IMplementation and evaluation of the school-based family support PRogram a Healthy School Start to promote child health and prevent OVErweight and obesity (IMPROVE) - study protocol for a cluster-randomized trial. BMC Public Health 2021; 21:1630. [PMID: 34488691 PMCID: PMC8419825 DOI: 10.1186/s12889-021-11663-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 08/25/2021] [Indexed: 11/22/2022] Open
Abstract
Background IMPROVE aims to conduct a hybrid type 3 evaluation design to test the effectiveness of bundled implementation strategies on intervention fidelity of the Healthy School Start (HSS) program, while simultaneously monitoring effects on health outcomes of children and parents. The HSS is a 4-component family support program for children starting school (5–7 years of age) promoting healthy dietary habits and physical activity in the home environment to prevent childhood obesity and parents’ risk of developing type 2 diabetes. Methods IMPROVE is a cluster-randomized controlled trial with two arms to evaluate and compare the effects of two different bundles of implementation strategies on intervention fidelity expressed as adherence and responsiveness at 12 and 24 months (primary outcomes). Thirty schools in two municipalities will participate in the study reaching about 1400 families per school year. In stakeholder workshops, key implementation determinants were identified according to the domains of the Consolidated Framework for Implementation Research. Through a consensus process with stakeholders, two bundles of implementation strategies were tailored to address context-specific determinants. Schools randomly assigned to group 1 will receive bundle 1 (Basic) and group 2 will receive bundle 1 + 2 (Enhanced). Bundle 2 consists of external facilitation, fidelity monitoring and feedback strategies. Secondary outcomes will include change in acceptability, appropriateness, feasibility, and organisational readiness as perceived by school staff. In addition, child weight status and diet, and parents’ feeding practices and risk of type 2 diabetes will be monitored. Linear and ordinal regression analysis will be used to test the effect on the primary and secondary outcomes, taking clustering and covariates into consideration where needed. Process evaluation will be conducted through key stakeholder interviews to investigate experiences of the program and perceptions on sustainability. Discussion This systematic approach to investigating the effectiveness of two different bundles of implementation strategies tailored to context-specific determinants on the fidelity of the HSS intervention will provide new insight into feasible implementation strategies and external support needed for the HSS to be effective and sustainable. Results will help inform how to bridge the gap between the research on school-based health programs and routine practice in schools. Trial registration Registered prospectively at ClinicalTrials.gov ID: NCT04984421, registered July 30, 2021 Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11663-2.
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Affiliation(s)
- Liselotte Schäfer Elinder
- Department of Global Public Health, Karolinska Institutet, SE-171 77, Stockholm, Sweden. .,Centre for Epidemiology and Community Medicine, Region Stockholm, SE-104 31, Stockholm, Sweden.
| | - Camilla A Wiklund
- Department of Global Public Health, Karolinska Institutet, SE-171 77, Stockholm, Sweden
| | - Åsa Norman
- Department of Global Public Health, Karolinska Institutet, SE-171 77, Stockholm, Sweden.,Department of Clinical Neurosciences, Karolinska Institutet, SE-171 65, Solna, Sweden
| | - Nouha Saleh Stattin
- Academic Primary Healthcare Centre, Region Stockholm, SE-113 65, Stockholm, Sweden.,Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, SE-141 83, Huddinge, Sweden
| | - Susanne Andermo
- Department of Global Public Health, Karolinska Institutet, SE-171 77, Stockholm, Sweden.,Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, SE-141 83, Huddinge, Sweden
| | - Emma Patterson
- Department of Global Public Health, Karolinska Institutet, SE-171 77, Stockholm, Sweden
| | - Erik Hemmingsson
- Department of Physical Activity and Health, Swedish School of Sport and Health Sciences, SE-114 68, Stockholm, Sweden
| | - Clayton Cook
- Department of Organizational Leadership and Policy Development, University of Minnesota, Minneapolis, MN, 55, USA
| | - Sara Raposo
- Department of Global Public Health, Karolinska Institutet, SE-171 77, Stockholm, Sweden.,Centre for Epidemiology and Community Medicine, Region Stockholm, SE-104 31, Stockholm, Sweden
| | - Lydia Kwak
- Institute for Environmental Medicine, Karolinska Institutet, SE-171 77, Stockholm, Sweden
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NASA Mission X Program for Healthy Eating and Active Living among Taiwanese Elementary School Students. J Pediatr Nurs 2019; 49:e8-e14. [PMID: 31307856 DOI: 10.1016/j.pedn.2019.06.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 06/26/2019] [Accepted: 06/27/2019] [Indexed: 12/31/2022]
Abstract
PURPOSE This study assessed the effects of an intervention program adapted from the NASA Mission X (MX) program on children's Healthy Eating Active Living (HEAL) knowledge and behaviors and anthropometry. METHODS This clustered randomized control trial recruited 8 elementary schools in remote rural areas of Northern Taiwan. The intervention was the 8-week MX program. All the 3rd and 4th graders were invited to the study (n = 245). Children's weight, height, HEAL knowledge and behaviors were measured pre- and post-intervention. RESULTS The intervention group had significantly more improvements than control group in physical activity knowledge score (+0.91 vs. +0.25, p = 0.002), diet knowledge score (+0.62 vs. +0.17, p = 0.044), and score of interests in NASA and space exploration (+0.34 vs. -0.07, p < 0.0001). BMI increased from 18.4 to 18.6 (p < 0.05) for the control group but did not change for the intervention group. The changes in BMI between groups did not differ significantly. CONCLUSION AND PRACTICE IMPLICATIONS This randomized controlled trial showed that the NASA MX program was feasible and acceptable among children in Taiwan, and improved children's HEAL knowledge. (ClinicalTrials.gov registration: NCT03355131).
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Davidson K, Vidgen H, Denney-Wilson E, Daniels L. Who is responsible for assessing children's weight status? - a qualitative study of health professionals in regional Australia. BMC Public Health 2019; 19:1196. [PMID: 31470830 PMCID: PMC6716851 DOI: 10.1186/s12889-019-7539-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 08/22/2019] [Indexed: 11/24/2022] Open
Abstract
Background Currently in Australia there is a lack of clarity regarding routine assessment of primary school aged children’s weight status despite it being the first step in the identification of overweight and obesity. The National Health and Medical Research Council Obesity Guidelines recommend primary health care professionals include routine weight status assessment in consultations with children yet research suggests this rarely occurs in practice. This study aimed to determine the views of primary health care professionals regarding routine weight status assessment in primary school aged children and to establish the barriers to assessing children’s weight status. Methods Using the case study of a regional town, Rockhampton, purposeful sampling was used to represent the key primary health care settings and professional groups. Interviews were conducted with 31 health professionals. Data were collected and analysed guided by two frameworks, the Capability, Opportunity, Motivation and Behaviour and Theoretical Domains Frameworks. Results Eight themes emerged from data and these were relevant to the three levels of influence on the routine weight status of assessment, system, setting and individual. System level themes related to having a formalised program for the undertaking of routine weight status assessment in primary school aged children, increasing the population’s awareness about the importance of the weight status check and limited public health services available for management of childhood overweight and obesity. Setting level theme regarded the location where routine weight status in primary school aged children could be undertaken. Four themes at the individual level of influence on the routine weight status assessment related to the primary health professionals’ roles, barriers to assessing children’s weight status, methods of weight status assessment and starting a weight related conversations with families. Conclusion The Government, primary health care services, professional organisations and associations as well as health professionals must commit to long-term implementation of the Obesity Guidelines. Immediate action to improve the undertaking of routine weight status assessment in children must be taken by each health service and health professional. Strategies should aim to positively affect motivation to assess children’s weight status as it is the central component in creating change in practice.
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Affiliation(s)
- Kamila Davidson
- School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology, Kelvin Grove Campus, O Block, A Wing, Victoria Park Road, Kelvin Grove, Brisbane, Queensland, 4059, Australia.
| | - Helen Vidgen
- School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology, Kelvin Grove Campus, O Block, A Wing, Victoria Park Road, Kelvin Grove, Brisbane, Queensland, 4059, Australia
| | - Elizabeth Denney-Wilson
- Sydney Nursing School, The Universtiy of Sydney, 88 Mallett St, Sydney, New South Wales, 2050, Australia
| | - Lynne Daniels
- School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology, Kelvin Grove Campus, O Block, A Wing, Victoria Park Road, Kelvin Grove, Brisbane, Queensland, 4059, Australia
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Francis E, Hoke AM, Kraschnewski JL. Body Mass Index Screening and Follow-Up: A Cross-Sectional Questionnaire Study of Pennsylvania School Nurses. Interact J Med Res 2018; 7:e11619. [PMID: 30578174 PMCID: PMC6320393 DOI: 10.2196/11619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 10/10/2018] [Accepted: 10/27/2018] [Indexed: 11/17/2022] Open
Abstract
Background Childhood overweight and obesity health concerns can affect a student’s academic performance, so it is important to identify resources for school nurses that would help to improve self-efficacy, knowledge, and confidence when approaching parents with sensitive weight-related information and influence overall obesity prevention efforts in the school setting. Objective The purpose of this study was to conduct a Pennsylvania (PA) state-wide 29-item survey addressing school nursing barriers and practices, supplementing information already known in this area. Although the survey covered a range of topics, the focus was body mass index (BMI) screening and its related practice within the schools. Methods We conducted a state-wide Web-based survey of school nurses in PA to understand current areas of care, find ways to address child health through school BMI screenings and follow up, and identify current educational gaps to assist school nurses with providing whole child care within the realm of weight management. Chi-square test of independence was conducted to determine the relationship between BMI screening follow up and interest in a BMI toolkit. Results Nurse participants (N=210), with a 42% (210/500) response rate, represented 208 school districts across PA. Participants were asked about their current process for notifying parents of BMI screening results. The majority (116/210, 55.2%) send a letter home in the mail, while others (62/210, 29.5%) send a letter home with students. A small number (8/210, 3.8%) said they did not notify parents altogether, and some (39/210, 18.6%) notify parents electronically. More than one-third (75/210, 35.7%) of nurses reported receiving BMI screening inquiries from parents; however, under half (35/75, 46.7%) of those respondents indicated they follow up with parents whose child screens overweight or obese. Overall, the vast majority (182/210, 86.7%) do not follow up with parents whose child screens overweight or obese. The majority (150/210, 71.4%) of the nurses responded they would benefit from a toolkit with resources to assist with communication with parents and children about BMI screenings. A significant association between respondent follow up and interest in a BMI toolkit was observed (P=.01). Conclusions Schools must start recognizing the role school nurses play to monitor and promote children’s health. This goal might include involving them in school-based preventive programs, empowering them to lead initiatives that support whole child health and ensuring opportunities for professional development of interest to them. Nonetheless, the first step in facilitating obesity prevention methods within schools is to provide school nurses with meaningful tools that help facilitate conversations with parents, guardians, and caregivers regarding their child’s weight status and health through a BMI screening toolkit.
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Affiliation(s)
- Erica Francis
- Department of Pediatrics, Penn State University, Hershey, PA, United States
| | - Alicia Marie Hoke
- Department of Pediatrics, Penn State University, Hershey, PA, United States
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Kowalski AE, Hartung SQ. Are Body Mass Index Screening Programs in Schools Enough? Body Mass Index Notification, Follow-up, and School Nurse Role. NASN Sch Nurse 2018; 34:223-227. [PMID: 30501472 DOI: 10.1177/1942602x18814771] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Childhood and adolescent obesity are epidemic in the United States. Because of this crisis, schools in our nation have been challenged to develop strategies to decrease the number of overweight and obese youth, with many states passing legislation requiring body mass index (BMI) monitoring by the school. This may be done as a screening or surveillance program depending on the state, with some states requiring notification to parents. As school nurses are often the only health professional in the school, they are typically the employee tasked with leading the BMI screening programs. School nurses, both in states requiring and in states without requirements for BMI screening programs, must be knowledgeable about evidence-based programs and strategies that have promise in reversing the obesity epidemic. Indeed, school nurses are in a position to be an active participant in the fight against the obesity and overweight crisis.
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Schroeder K, Smaldone A. What Barriers and Facilitators Do School Nurses Experience When Implementing an Obesity Intervention? J Sch Nurs 2017; 33:456-466. [PMID: 29108499 PMCID: PMC6080249 DOI: 10.1177/1059840517694967] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
A recent evaluation of a school nurse-led obesity intervention demonstrated a 5% implementation rate. The purpose of this study was to explore school nurses' perceived barriers to and facilitators of the intervention in order to understand reasons for the low implementation rate. Methods included semi-structured individual interviews with school nurses. Data were analyzed using content analysis and heat mapping. Nineteen nurses participated and eight themes were identified. Parental and administrative gatekeeping, heavy nurse workload, obesogenic environments, and concerns about obesity stigma were barriers to implementation. Teamwork with parents and school staff was a key facilitator of implementation. Nurses also noted the importance of cultural considerations and highlighted the need to tailor the intervention to the unique needs of their school environment and student population. These findings suggest that for school nurses to play a key role in school-based obesity interventions, barriers must be identified and addressed prior to program implementation.
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Affiliation(s)
- Krista Schroeder
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA
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Helseth S, Riiser K, Holmberg Fagerlund B, Misvaer N, Glavin K. Implementing guidelines for preventing, identifying and treating adolescent overweight and obesity-School nurses’ perceptions of the challenges involved. J Clin Nurs 2017; 26:4716-4725. [DOI: 10.1111/jocn.13823] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2017] [Indexed: 01/12/2023]
Affiliation(s)
- Sølvi Helseth
- Department of Nursing and Health Promotion; Faculty of Health; Oslo and Akershus University College of Applied Sciences; Oslo Norway
| | - Kirsti Riiser
- Department of Physiotherapy; Faculty of Health; Oslo and Akershus University College of Applied Sciences; Oslo Norway
| | - Bettina Holmberg Fagerlund
- Department of Nursing and Health Promotion; Faculty of Health; Oslo and Akershus University College of Applied Sciences; Oslo Norway
| | - Nina Misvaer
- Department of Nursing and Health Promotion; Faculty of Health; Oslo and Akershus University College of Applied Sciences; Oslo Norway
| | - Kari Glavin
- Department of Nursing and Health Promotion; Faculty of Health; Oslo and Akershus University College of Applied Sciences; Oslo Norway
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O’Donnell JE, Foskett-Tharby R, Gill PS. General practice views of managing childhood obesity in primary care: a qualitative analysis. JRSM Open 2017; 8:2054270417693966. [PMID: 28620503 PMCID: PMC5464385 DOI: 10.1177/2054270417693966] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To explore general practice staff views of managing childhood obesity in primary care. DESIGN A qualitative study to elicit the views of clinical and non-clinical general practice staff on managing childhood obesity. SETTING Interviews were conducted at 30 general practices across England. These practices were interviewed as part of the Quality and Outcomes Framework Pilot Study. PARTICIPANTS A total of 52 staff from 30 practices took part in a semi-structured interview. MAIN OUTCOME MEASURES Key themes were identified through thematic analysis of transcripts using an inductive approach. RESULTS Three themes were identified: lack of contact with well children, sensitivity of the issue, and the potential impact of general practice. Identifying overweight children was challenging because well children rarely attended the practice. Interviewees felt ill equipped to solve the issue because they lacked influence over the environmental, economic and lifestyle factors underpinning obesity. They described little evidence to support general practice intervention and seemed unaware of other services. Raising the issue was described as sensitive. CONCLUSION General practice staff were unconvinced that they could have a significant role in managing childhood obesity on a large scale. Participants believed schools have more contact with children and should coordinate the identification and management of overweight children. Future policy could recommend a minor role for general practice involving opportunistically identifying overweight children and signposting to obesity services.
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Affiliation(s)
- Jennifer E O’Donnell
- National Collaborating Centre for Indicator Development (Institute of Applied Health Research) University of Birmingham, Edgbaston B15 2TT UK
| | - Rachel Foskett-Tharby
- National Collaborating Centre for Indicator Development (Institute of Applied Health Research) University of Birmingham, Edgbaston B15 2TT UK
| | - Paramjit S Gill
- National Collaborating Centre for Indicator Development (Institute of Applied Health Research) University of Birmingham, Edgbaston B15 2TT UK
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