SUPPORT (SUpporting health Professionals to help Parents address OveRweighT in children) Study

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The SUPPORT study identified how local health systems can support healthcare professionals to have healthier weight conversations with parents of primary school-age children.

This study was conducted in collaboration with and funded by Public Health England.

Background

Healthcare Professionals (HCPs) working in community settings have a role in supporting adults and children with excess weight to change their eating and physical activity behaviours. Previous research suggests that healthcare professionals are reluctant to have conversations with parents about their children achieving a healthier weight. They perceive several barriers to having these conversations, which include: lack of time, confidence and knowledge; fear of damaging their existing patient-professional relationship; difficulty in raising the issue when the parent is consulting for another reason; and lack of information on the weight category that the child falls into.

Academic research team

 

Support Study Team

Professor Peymané Adab

Professor Peymané Adab

Professor of Chronic Disease Epidemiology & Public Health

Institute of Applied Health Research

Peymané is a public health physician and Professor of Chronic Disease Epidemiology & Public Health in the Institute of Applied Health, University of Birmingham.  She is also Lead of the PHRESH consortium, part of the NIHR School for Public Health Research.

Her research interests are in chronic disease epidemiology and behavioural medicine. This includes a portfolio of work ...

Telephone
+44 (0)121 414 3777
Email
p.adab@bham.ac.uk

Professor Kate Jolly

Professor Kate Jolly

Professor of Public Health and Primary Care
Deputy Director of the Institute of Applied Health Research

Institute of Applied Health Research

Kate Jolly is a Professor of Public Health and Primary Care.

Her main research interests are on the prevention and management of important non-communicable diseases, such as cardiovascular and respiratory conditions; behaviour change to reduce obesity and increase physical activity and maternal and child health.

 

Telephone
+44 (0)121 414 7552/PA: Anne Walker +44 (0)121 414 7578
Email
c.b.jolly@bham.ac.uk

Dr Miranda Pallan

Dr Miranda Pallan

Reader in Public Health & Epidemiology

Institute of Applied Health Research

Miranda’s research mainly focuses on the health of children and adolescents. She has undertaken research into the epidemiology, prevention and management of overweight and obesity in children, and is also expanding her research to include general health and wellbeing in childhood and adolescence. Her research seeks to improve health in childhood, and in the longer term to reduce adult ill ...

Telephone
+44 (0) 121 414 7990
Email
m.j.pallan@bham.ac.uk

External researchers

Dr Helen Parretti

 

What was the study?

We asked GPs, Primary Care Nurses and School Nurses who work in ethnically diverse areas or areas of high social and economic disadvantage to take part in interviews or focus groups. We explored their experiences of having these conversations with parents. We asked about the difficulties they have encountered, the perceived challenges, the factors that help them to have these conversations, the potential role of routinely collected information on children’s weight and height, the need for and access to training and skills development, and their views on how they can best be supported to have these conversations. We asked participants to consider certain clinical scenarios to further explore these areas.

What did the study find?

In total, 40 HCPs from the East and West Midlands participated in this study (13 GPs, 7 Primary care Practice Nurses, and 20 School Nurses). While primary care practitioners and school nurses all recognise that tackling childhood obesity is part of their remit, they express some confusion about their particular role addressing the issue.

HCPs perceive several barriers, which relate to initiating opportunistic conversations with parents about their child’s weight. Prominent barriers were: restricted time and capacity; not being commissioned to undertake this activity; limited (and limited knowledge of) available services for onward referral and signposting; HCPs’ fear (mainly relating to the anticipated parental reaction); cultural issues (cultural beliefs relating to weight and language barriers); and challenging family social situations.

HCPs perceived that there were several facilitators to having these conversations with parents. The most prominent facilitators were: effective communication and developing a rapport with a parent; raising the issue of child weight by linking it to the presenting complaint; supporting behaviour change in families and providing advice on diet and physical activity; making additional dedicated appointments to discuss the issue; awareness of childhood obesity and its health consequences; knowledge of childhood obesity care pathways; use of objective measures of childhood obesity to start conversations with parents (including NCMP data); awareness of cultural beliefs; and joined up systems (including closer links with schools and access to child health data).

Several areas were identified where HCPs could be better supported in having healthier weight conversations with parents. These included: supporting the use of BMI centiles to assess excess weight in children; supporting a joined up approach that enables HCPs to view notes added by others caring for the child such as health visitors, paediatricians, dietitians; increasing awareness of and access to NCMP data; and supporting HCPs to signpost and refer to services, and provide appropriate resources to families. Clarification of the roles of different HCP groups in childhood obesity prevention and management was also identified as important. The value of training to support HCPs in this area was recognised and participants identified key general skills that they found helpful when having healthier child weight conversations with parents. However, they identified several barriers to attending specific training courses (time and funding). Despite this, HCPs expressed an interest in CPD activities that enabled colleagues to share their learning in this area.

Potential areas for future action

To overcome the barriers identified across all three HCP groups, support structures should be introduced to enable these HCPs to: dedicate time to having healthier weight conversations with parents; access data relating to child weight; provide resources which are appropriate for a culturally diverse population; and have clarity around local care pathways for child obesity including up to date information on local services across public, private and voluntary sectors. Further consultation with key stakeholders and professional bodies is required to explore potential support structures. The key discussion areas are:

Advice about healthier diets, physical activity and weight management

Increase awareness of resources available to order or access online. Develop a resource pack (which may include collating resources that are already available) in a range of formats (e.g. print, online) for HCPs to give to families (or signpost to) to supplement brief advice. The content of the materials should address cultural diversity within the population.

Signposting, referral and care pathways

Develop a process to keep HCPs informed of available local healthy weight services and resources provided by public, voluntary and third sectors, and embed updated care pathways into the local healthcare system so that HCPs can easily refer and signpost families during consultations.

Role of HCP

National government, professional bodies and NHS to work together to further define and communicate the remit of General Practitioners, Primary Care Practice Nurses and School Nurses in child obesity prevention and management, including follow up arising from the NCMP. Ensure HCPs’ remit is reflected in their commissioning/contracting structures. HCPs who are undertaking interventions to address child excess weight need dedicated appointments with families. Enable communication between primary care and schools to support families with child weight management.

NCMP & data

a)          Explore the content of the NCMP feedback letter with parents to identify upsetting elements to inform further adaptation of the letter. Ensure Local Authorities include content on where and how to seek further information and help within the NCMP letter.

b)          Explore the feasibility of sending a copy of the NCMP feedback letter to all GPs.

c)          Enable the health care system to allow GPs and Practice Nurses to access NCMP data.

d)          Enable a joined-up data sharing system where HCPs can access longitudinal data on child weight (from birth and including NCMP data) and previous referrals/access to services from all agencies across all sectors.

Enhancement of core training

Work with Health Education England, professional bodies and universities to further enhance GP and nurse postgraduate/speciality training by adding or strengthening elements relating to: child obesity (and communication with parents); lifestyle medicine; opportunistic health promotion intervention; cultural awareness (including the impact of different cultures on the acceptance of excess weight in children); BMI centiles (the use and interpretation of, advantages and limitations, to ensure that healthcare professionals have an accurate understanding of the validity, strengths and limitations of these measures); and evidence on how excess weight affects a range of common conditions in children (enabling HCPs to link to presenting complaints).

CPD opportunities

Work with professional bodies to create multi-agency continuing professional development opportunities to facilitate sharing of experiences of supporting families of children with excess weight across different HCP groups.

Evaluation

Ensure that future actions to address the above areas have an accompanying comprehensive programme of evaluation.

What impact will the study have?

Policy implications

The areas identified for potential action through this study align closely with current policy. The Government’s Childhood Obesity Plan prioritises enabling HCPs to support families to achieve a healthier weight. This study has identified several ways in which HCPs may be supported to be able to offer this help to families through: improved structures and systems relating to data, NCMP, weight management services and care pathways; clarity on the HCP role and a recognition if this within commissioning and contracting structures; additions to postgraduate professional training and CPD opportunities; and provision of resource packs. Consultation with key stakeholders is required to develop the areas identified into recommendations for action within the health care system in England so that primary care and community healthcare professionals are better supported to conduct healthier weight conversations with parents of primary school age children.

Enhancing the current professional training is also in line with the NHS Long Term Plan and the Healthier Weight Competency framework. These recommend the inclusion of lifestyle medicine education within professional training, which will help to achieve the aim of ensuring that there is a greater emphasis on nutrition training. Recommendations relating to the NCMP data (enhancing awareness, understanding and access to) is in line with previous research and the Governments’ Green Paper ‘Advancing our health: prevention in the 2020s’, which commits to exploring how NCMP data may be linked to digital child health records, a policy further supported by the Digital Health Child Health Strategy.

Reports and publications

Contact

Telephone: +44 (0)121 414 7990