School of Nursing, Midwifery and Physiotherapy, The University of Nottingham, Queen's Medical Centre, B Floor, South Block, Nottingham, NG7 2HA, UK.
BMC Fam Pract. 2011 Jun 23;12:54. doi: 10.1186/1471-2296-12-54.
There is a strong rationale for intervening in early childhood to prevent obesity. Over a quarter of infants gain weight more rapidly than desirable during the first six months of life putting them at greater risk of obesity in childhood. However, little is known about UK healthcare professionals' (HCPs) approach to primary prevention. This study explored obesity-related knowledge of UK HCPs and the beliefs and current practice of general practitioners (GPs) and practice nurses in relation to identifying infants at risk of developing childhood obesity.
Survey of UK HCPs (GPs, practice nurses, health visitors, nursery, community and children's nurses). HCPs (n = 116) rated their confidence in providing infant feeding advice and completed the Obesity Risk Knowledge Scale (ORK-10).Semi-structured interviews with a sub-set of 12 GPs and 6 practice nurses were audio recorded, taped and transcribed verbatim. Thematic analysis was applied using an interpretative, inductive approach.
GPs were less confident about giving advice about infant feeding than health visitors (p = 0.001) and nursery nurses (p = 0.009) but more knowledgeable about the health risks of obesity (p < 0.001) than nurses (p = 0.009). HCPs who were consulted more often about feeding were less knowledgeable about the risks associated with obesity (r = -0.34, n = 114, p < 0.001). There was no relationship between HCPs' ratings of confidence in their advice and their knowledge of the obesity risk.Six main themes emerged from the interviews: 1) Attribution of childhood obesity to family environment, 2) Infant feeding advice as the health visitor's role, 3) Professional reliance on anecdotal or experiential knowledge about infant feeding, 4) Difficulties with recognition of, or lack of concern for, infants "at risk" of becoming obese, 5) Prioritising relationship with parent over best practice in infant feeding and 6) Lack of shared understanding for dealing with early years' obesity.
Intervention is needed to improve health visitors and nursery nurses' knowledge of obesity risk and GPs and practice nurses' capacity to identify and manage infants' at risk of developing childhood obesity. GPs value strategies that maintain relationships with vulnerable families and interventions to improve their advice-giving around infant feeding need to take account of this. Further research is needed to determine optimal ways of intervening with infants at risk of obesity in primary care.
在儿童早期进行干预以预防肥胖是有充分理由的。超过四分之一的婴儿在生命的头六个月体重增长过快，使他们在儿童时期肥胖的风险更大。然而，人们对英国医疗保健专业人员（HCPs）的初级预防方法知之甚少。本研究探讨了英国 HCPs 的肥胖相关知识，以及全科医生（GPs）和执业护士在识别有发展为儿童肥胖风险的婴儿方面的信念和当前做法。
对英国 HCPs（全科医生、执业护士、健康访视员、托儿所、社区和儿童护士）进行调查。HCPs（n=116）对提供婴儿喂养建议的信心进行了评分，并完成了肥胖风险知识量表（ORK-10）。对 12 名全科医生和 6 名执业护士进行了半结构化访谈，录音、录音并逐字转录。使用解释性、归纳性方法进行主题分析。
全科医生在婴儿喂养建议方面的信心低于健康访视员（p=0.001）和托儿所护士（p=0.009），但对肥胖健康风险的了解程度高于护士（p<0.001）。经常被咨询喂养问题的 HCPs 对肥胖相关风险的了解程度较低（r=-0.34，n=114，p<0.001）。HCPs 对自己建议的信心评分与其肥胖风险知识之间没有关系。访谈中出现了六个主要主题：1）将儿童肥胖归因于家庭环境，2）婴儿喂养建议是健康访视员的角色，3）专业人员依赖于关于婴儿喂养的轶事或经验知识，4）难以识别或不关心“有风险”成为肥胖的婴儿，5）优先考虑与父母的关系而不是婴儿喂养的最佳实践，6）缺乏处理幼儿肥胖问题的共识。
需要干预措施来提高健康访视员和托儿所护士对肥胖风险的认识，以及全科医生和执业护士识别和管理有发展为儿童肥胖风险的婴儿的能力。全科医生重视与弱势家庭保持关系的策略，并且需要考虑到这一点，以改善他们在婴儿喂养方面的建议。需要进一步研究确定在初级保健中干预有肥胖风险的婴儿的最佳方法。
