Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
Veterinary Medicine, Utrecht University, Utrecht, The Netherlands.
BMC Fam Pract. 2020 Jan 28;21(1):18. doi: 10.1186/s12875-020-1088-3.
Overweight in children is a rising problem leading to serious consequences later in life. The Dutch guideline 'Obesity' for general practitioners recommends discussing obesity in children regardless of the reason of consultation and provides diagnostic and therapeutic tools. However, limited literature indicates that general practitioners experience barriers to discuss this topic. The aim of this study was to determine current perceived barriers of general practitioners in discussing overweight during a regular consultation in children aged 4 to 12 years and to what extent they discuss the topic. Furthermore, we attempt to get more insight in the specific needs and ideas for improvement among GPs.
A semi-structured in-depth interview study was conducted. Dutch general practitioners with a broad range of demographic characteristics were invited to participate. The transcripts were analysed using a modified version of the constant comparative method. Using this method, we identified perceived barriers of general practitioners.
Ten general practitioners were included in the study. Four major themes were identified in the interviews: absence of physical or mental complaints related to overweight, internal barriers of the general practitioners, the child's family background and logistics. Major barriers appeared to be a low consultation rate of these children, the sensitivity of the topic (e.g. fear for children's or parents' reactions and/or disturbance of the relation, influence on the self-esteem of the child, resistance in the parents), the absence of a long-standing relation between general practitioner and child or parent, the background of the child and lack of time or prioritizing.
Dutch general practitioners indicate to experience barriers and need tools for how to discuss children's overweight during regular consultations within the limited time available. The low consultation rate among children aged 4 to 12 years due to lack of physical complaints is mentioned as a new and important barrier. Therefore, the prior focus might be raising awareness among parents concerning overweight in children aged 4 to 12 years and, thereby, stressing the potential supporting role of primary care professionals in tackling the overweight of their child.
儿童超重是一个日益严重的问题，会导致日后严重后果。荷兰全科医生的“肥胖症”指南建议无论咨询原因如何，都要讨论儿童肥胖问题，并提供诊断和治疗工具。然而，有限的文献表明，全科医生在讨论这个话题时存在障碍。本研究旨在确定全科医生在讨论 4 至 12 岁儿童超重问题时目前面临的障碍，并确定他们讨论该话题的程度。此外，我们试图更深入地了解全科医生的具体需求和改进意见。
采用半结构式深入访谈研究。邀请具有广泛人口统计学特征的荷兰全科医生参与。使用改进的常规定量比较方法分析转录本。使用这种方法，我们确定了全科医生的感知障碍。
研究共纳入 10 名全科医生。访谈中确定了四个主要主题：与超重相关的身体或精神投诉缺失、全科医生的内在障碍、儿童的家庭背景和后勤。主要障碍似乎是这些儿童的就诊率低、该话题的敏感性（例如担心儿童或父母的反应和/或关系干扰、对儿童自尊心的影响、父母的阻力）、全科医生与儿童或父母之间缺乏长期关系、儿童背景以及缺乏时间或优先事项。
荷兰全科医生表示，在有限的时间内，他们在常规就诊中讨论儿童超重问题时会遇到障碍，并需要相关工具。由于缺乏身体投诉，4 至 12 岁儿童的就诊率较低，这被认为是一个新的重要障碍。因此，目前的重点可能是提高家长对 4 至 12 岁儿童超重问题的认识，并强调初级保健专业人员在解决其子女超重问题方面的潜在支持作用。
