Bonde, Ane

Hindhede, Anette Lykke

EARLY DETECTION AND PREVENTION OF CHILDHOOD OBESITY BY SCHOOL NURSES  AH Bonde, MC Larsen & AL Hindhede  Steno Health Promotion Center, Steno Diabetes Center, Gentofte Background Increasing prevalence of overweight among children constitutes a significant public health challenge and the evidence on effective interventions is scarce.  Following several years of child growth monitoring, a Danish municipality has introduced an obesity prevention intervention where the school nurses offer counselling sessions to children and their parents. The intended target groups, detected by BMI screening, are overweight but not obese children, and children at risk of overweight. Obese children should be referred to a specialized centre.   Objective The objective of the study was to investigate how the intervention theory was translated into practice by the school nurses.  Methods The “Realistic evaluation” framework was employed to design the study. The hypothesis of the causal change mechanism, also called the “intervention theory”, was put forward as shown in Figure 1. A mixed methods approach was chosen for data collection.  Registration forms were collected from 44 nurses, involving 253 children identified during the one year pilot period of the intervention.  In addition to this, a convenience sample of nine nurses participated in semi-structured interviews about the counselling sessions.   Results Less than half of the 253 identified children (42%) were from the   intended target group of overweight children and children at risk of overweight. The others (58%) were obese and thus not in the target group of this            intervention. (Table 1).  There are several explanations for this, the most important being (i) unclear written material about the target groups and (ii) obese children or parents who would not accept the intervention at the specialized centre.  154 children had at the time of the study participated in one, two or three intervention sessions. The children participated alone in almost a third of the sessions (29%) although the intended intervention was a “family     intervention”. (Table 2). Explanations for the lack of parental participation included parents not being available and children not wanting their parents to be involved.   Telephone contact replaced face to face counselling in some cases to   address the availability issue.    Conclusion This study revealed deviations in practice from the intervention theory, in terms of identifying the target group and delivery of the intervention as a face to face counselling session for children and their parents. No. of children Number Percent Under the 90 percentile (in risk of overweight) 10 5% 90-99 percentile (overweight) 76 37% Over the 99 percentile (obese) 120 58% Sum 206 100% Missing 47   Table 1. Classification of the detected children by BMI according to Nysom 2001* *) Nysom et al. (2001). International Journal of Obesity, Vol. 25, 177-84.  Table 2. Counselling sessions with parents & child present and with child alone *) Grade 0 = preschool. Grade 1-9 =  Compulsory school in Denmark, children age 6-16. Ane Høstgaard Bonde (ahbo@steno.dk) & Anette Lykke Hindhede (atlh@steno.dk), Steno Health Promotion Center, Steno Diabetes Center, Gentofte, Denmark  No. of sessions Grade 0-1* Grade 2-5 Grade 6-9 Total Parent(s) & child present 31 41 13 85 Child alone 6 21 7 34 Sum 37 62 20 119 Percent child alone 16% 34% 35% 29% Figure 1. The intervention theory with 4 steps in the hypothesis of the           causal change mechanism  

Early detection and prevention of childhood obesity by school nurses

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Early detection and prevention of childhood obesity by school nurses

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