Journal of Human Nutrition and Dietetics
DIETETIC AND PROFESSIONAL PRACTICE Dietitians’ perceptions of communicating with preadolescent, overweight children in the consultation setting: the potential for e-resources C. Raaff,1 C. Glazebrook1 & H. Wharrad2 1
Division of Psychiatry and Applied Psychology, School of Medicine, Institute of Mental Health, University of Nottingham, Nottingham, UK Division of Nursing, School of Health Sciences, Queen’s Medical Centre, University of Nottingham, Nottingham, UK
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Keywords dietitian, face-to-face communication, interactive e-resources, overweight, patient involvement, preadolescent children. Correspondence C. Glazebrook, Institute of Mental Health, University of Nottingham Innovation Park, Triumph Road, Nottingham NG7 2TU, UK. Tel.: +44 (0)115 8230420 Fax: +44 (0)115 8230433 E-mail:
[email protected] How to cite this article Raaff C., Glazebrook C. & Wharrad H. (2014) Dietitians’ perceptions of communicating with preadolescent, overweight children in the consultation setting: the potential for e-resources. J Hum Nutr Diet. 28, 300–312 doi: 10.1111/jhn.12247 This is an open access article under the terms of the Creative Commons AttributionNonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
Abstract Background: There are calls to enhance existing child weight management interventions and to develop new treatment approaches. The potential for interactive electronic resources (e-resources) to support child–dietitian communication has yet to be explored. Towards developing such a tool, the present study aimed to understand dietetic attitudes and approaches to communicating with preadolescent overweight children in individual consultations to support behaviour change. Methods: A purposive sample of 18 dietitians, providing weight management advice to overweight 7–11-year-old children, took part in the study. Individual semi-structured telephone interviews were conducted. Data were transcribed and then analysed using inductive thematic analysis. Content analysis was used to interpret dietetic attitude towards e-resources. Results: Six overarching themes were identified describing dietitians’ views: the complexity of treating childhood obesity, the strategic balance of dietetic communication focus between child and parent, the child’s capacity to communicate affecting their contribution, dietetic approaches to verbal child communication and the features of resources that can support them, as well as dietetic expectations for resources. Independent inter-rater agreement for the themes was 76.9% and 73.1%, respectively. The majority of dietitians (n = 13) supported the concept of introducing an interactive multimedia eresource into child weight management consultations. Conclusions: Most dietitians sought to engage the preadolescent child in the consultation, using dietetic visual aids to complement verbal strategies and to serve as scaffolding for the conversation. There is scope for interactive e-resources to enhance communication, provided that they are flexibly tailored to meet the needs of the dietitian and the overweight child.
Introduction The widespread problem of childhood obesity across the world has been recognised for some time (Reilly & Dorosty, 1999; James, 2004). Despite the considerable effort being put into managing and treating this problem in the UK (Aicken et al., 2008), further research is needed to enhance existing interventions and to develop other approaches for treating overweight and obese children 300
(Epstein & Wrotniak, 2010). The National Institute for Health and Care Excellence (NICE, 2013) has recommended qualitative research into the views and experiences of health professionals delivering child weight management interventions, as well as those of their clients. A number of recent studies have produced some valuable data in this field, such as the finding that preadolescent children want the opportunity to participate more in their dietary treatment (Dixey et al., 2001;
ª 2014 The Authors. Journal of Human Nutrition and Dietetics published by John Wiley & Sons Ltd on behalf of The British Dietetic Association Ltd.
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Murtagh et al., 2006). However, most have investigated parent and child perspectives (Edmunds, 2005; Stewart et al., 2008; Hester et al., 2010; Turner et al., 2012). Studies that have explored the insights of health professionals have tended to include general practitioners, practice nurses and school nurses, but not dietitians (Walker et al., 2007; Turner et al., 2009; Visram et al., 2013). There have also been calls to innovate weight management interventions. Staniford et al. (2011) suggested introducing technology-based strategies to tailor treatment according to factors, such as the child’s age and readiness to change, in addition to the regular support of weight management clinicians that families in other studies (Murtagh et al., 2006; Stewart et al., 2008) also reported as invaluable. Although the concept of tailoring information through computer-based solutions is not new (Dijkstra & De Vries, 1999), using technology to enhance face-to-face consultations with dietitians may offer a fresh perspective. A recent systematic review (Raaff et al., 2014) identified 14 interventions that had used multimedia technology within a clinical service to improve health outcomes amongst 7–11-year-old children. None had adequately investigated the potential for such technologies to enhance health professionals’ communication with preadolescent children. However, there is a case for using appropriately designed resources to provide scaffolding for conversations with young children (Gauvain & Cole, 1997), thereby improving their capacity to communicate in a consultation. The present study was undertaken to inform the development of a dietetic interactive e-resource for weight management appointments with 7–11-year-old children. Accordingly, the study aimed to explore dietetic views, attitudes and approaches to weight management appointments with preadolescent children. In addition, the study sought to gauge dietetic opinion on the use of interactive e-resources to support child–dietitian communication. Materials and methods Design This cross-sectional, qualitative study used semi-structured telephone interviews to explore dietetic views on communicating with children about weight management. The target sample size was 20 participants. Recruitment Purposive sampling intended to recruit dietitians and dietetic assistants (with experience of providing weight management advice to overweight 7–11-year-olds) through two British Dietetic Association (BDA) specialist interest groups in the UK: DOM UK (Dietitians in Obesity
Dietetic communication with the overweight child
Management) and the Paediatric Group. An e-flier invited interest from member and nonmember dietitian and dietetic assistant colleagues. Potential participants were asked to read an online information sheet and to submit a consent form via the SurveyMonkey website. Alternatively, those interested in taking part were able to contact the researcher to receive the information sheet and consent form by post or e-mail. After submission of consent forms, the researcher contacted the participants to arrange a telephone interview. Participants No dietetic assistants responded to the study invitation. Almost all of the 18 dietitians who took part in the study were female and worked in the National Health Service (NHS). Most (n = 14) practised in England, across 13 geographical English counties, with others from Wales, Northern Ireland and the Republic of Ireland. Participant characteristics are summarised in Table 1. Seven were fulltime paediatric dietitians; the remainder provided dietetic treatment to children on a part-time basis. A range of different child weight management services were represented by the participants. Some dietitians treated overweight children within general paediatric consultations; half (n = 9) were commissioned to provide a specialist child weight management service either as the sole dietitian or in partnership with other dietitians, or as part of a multidisciplinary team (n = 4). Nondietitian team members varied from health promotion advisors and dietetic assistants, school nurses, physiotherapists, and occupational therapists, to a consultant paediatrician, and a physical activity advisor.The time allocated for dietitians to spend with each overweight child varied considerably (Table 1). All but one dietitian offered individual appointments. Statistical analysis Each interview lasted a mean (SD) of 31.24 (7.51) min. The recording equipment failed during one interview, resulting in an inaudible data file. In this case, the data were summarised within 4 h of the interview, from the researcher’s memory and detailed interview notes, and separated from the main data set, being used only to comment on emerging themes. The remaining 17 interviews were transcribed verbatim by the researcher. A code was assigned to each participant to preserve confidentiality and anonymity. Participant identifiers were stored separately and all data were stored in password-protected files. Data were analysed using inductive theme analysis (Braun & Clarke, 2006). This process involved identifying interesting features and patterns in the transcripts. Significant topics, as well as recurring views or concepts, were
ª 2014 The Authors. Journal of Human Nutrition and Dietetics published by John Wiley & Sons Ltd on behalf of The British Dietetic Association Ltd.
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Dietetic communication with the overweight child Table 1 Participant characteristics: dietetic experience and practice
Characteristic
Range/measure
Number of dietitians
Paediatric employment1 (h/week)
≤7.5 h
3
7.6–15 h 1 15.1–22.5 h 3 22.6–30 h 2 30.1–37.5 h 9 Range (h): 2.00–37.50 Mean (h): 25.90 SD: 13.34 ≤2 years 6
Experience2 (years)
>2–5 years 5 >5–10 years 2 >10–15 years 4 >15–20 years 1 Range (years): 0.25–16.00 Mean (years): 6.25 SD: 5.35 0–2 children 9
Patient contact3 (children/week)
Initial consultations4 (min/appointment)
Review consultations5 (min/appointment)
3–5 children 6 6–7 children 0 8–10 children 3* Range (children):
