Sophia Children's Hospital, Department of Pediatrics, Division of Pediatric Endocrinology and Obesity Center CGG, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Institute, Amsterdam, The Netherlands.
BMC Health Serv Res. 2024 Sep 27;24(1):1133. doi: 10.1186/s12913-024-11532-9.
Both the causes and consequences of childhood obesity can be complex. To provide healthcare that is suitably tailored to the specific needs of children with obesity integrated care is required. The objective of this study was to explore the perceived barriers and facilitators of healthcare professionals (HCPs) in providing integrated care for children with obesity, to support them in tailoring the healthcare approach.
In this qualitative study, semi-structured in-depth interviews were conducted with 18 healthcare professionals with experience in childhood obesity care; pediatricians, youth healthcare nurses and a youth healthcare physician. A two-phased thematic content analysis was performed: an inductive analysis with open and selective coding and a deductive analysis with axial coding using the patient-centered care model by Stewart.
Overall, the healthcare professionals defined the etiology of obesity as complex, and experienced the integrated care as complicated. The results fit into the four theme-structure of the patient-centered care model, with the integrated care system as an additional fifth theme. The main barriers were perceived within the sub-themes of illness and healthcare experiences, and sensitivity over talking about weight-related issues. The main facilitators were perceived within the sub-themes of conducting a biomedical, psychosocial and lifestyle assessment, tailoring the approach to families' situation and investing in a family-professional relationship. Weight stigma appeared to be an underlying barrier for healthcare professionals that impacted, both explicitly and implicitly, upon all themes.
Healthcare professionals providing integrated care for children with obesity, experience this type of care as complicated and comprising many barriers and facilitators regarding the four themes of the patient-centered care model and the fifth theme of the integrated care system. This paper demonstrates the patient-centered care model could prove helpful structuring a tailored approach within integrated care. This approach supports healthcare professionals in adopting a broad perspective towards individual and environmental factors and investing in the relationship, with respect to the sensitivity and complexity of childhood obesity.
儿童肥胖的原因和后果可能都很复杂。为了提供适合儿童肥胖具体需求的医疗服务，需要综合护理。本研究的目的是探讨医疗保健专业人员（HCP）在为肥胖儿童提供综合护理方面的感知障碍和促进因素，以支持他们定制医疗方法。
在这项定性研究中，对 18 名具有儿童肥胖护理经验的医疗保健专业人员（儿科医生、青年保健护士和青年保健医生）进行了半结构化深入访谈。采用两步式主题内容分析法进行分析：一是采用斯图尔特（Stewart）的以患者为中心的护理模式进行的归纳分析，包括开放式和选择性编码；二是采用演绎分析，包括轴向编码。
总体而言，医疗保健专业人员将肥胖的病因定义为复杂的，并将综合护理视为复杂的。结果符合以患者为中心的护理模式的四个主题结构，综合护理系统是一个额外的第五个主题。主要障碍存在于疾病和医疗保健体验的子主题中，以及对体重相关问题的敏感性。主要促进因素存在于进行生物医学、心理社会和生活方式评估、根据家庭情况调整方法以及投资于家庭-专业关系的子主题中。体重耻辱感似乎是医疗保健专业人员的一个潜在障碍，它直接或间接地影响了以患者为中心的护理模式的所有主题。
为肥胖儿童提供综合护理的医疗保健专业人员认为这种护理很复杂，包括以患者为中心的护理模式的四个主题和综合护理系统的第五个主题在内，存在许多障碍和促进因素。本文表明，以患者为中心的护理模式在综合护理中可能有助于构建量身定制的方法。这种方法支持医疗保健专业人员对个人和环境因素采取广泛的观点，并在尊重儿童肥胖的敏感性和复杂性的基础上投资于关系。
