Practitioner survey and qualitative interviews

Obesity prevention in early life: An opportunity to better support the role of Maternal and Child Health Nurses in Australia.
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Increasingly children are becoming overweight at a young age, with 25% of 2-4 years old in Australia overweight or obese. These children tend to remain overweight as adults. Early childhood is a critical time in which many risk factors for overweight and obesity emerge, and when habits are formed, providing an opportunity for establishing and promoting behaviours that will affect weight gain and health across the life course. Maternal and child health (MCH) nurses are well placed to address obesity prevention in early life, because of their regular contact with parents and their role in monitoring child growth and development. Little is known however, regarding the extent to which MCH nurses promote obesity prevention practices and how such practices could be better supported.
About the Study 
56 MCH nurses (response rate 85%) from two local government areas in Melbourne were surveyed. 16 of whom also participated in a qualitative interview. Both the survey and interviews aimed to examine the extent to which MCH nurses addressed healthy infant feeding practices, healthy eating, active play and limiting sedentary behavior during routine consultations with parents of young children 0-5 years. Key factors influencing such practices and how they could be best supported were also investigated. All data were collected from September to December 2013.
Key Findings 
This study shows that MCH nurses are well placed to address obesity prevention in early life because:
  • growth and child development is central to their role;
  • infant feeding and growth is high on both their and parents agendas  
  • they have a trusted and well established relationship with parents conducive to promoting family lifestyle change

Key gaps in practice identified included:

  • Around a quarter (22%) reported never or rarely using growth charts to identify infants and children at risk of overweight and obesity.
  • They often feel reluctant to raise overweight with parents because of the fear of negative reactions and uncertainty about the best intervention strategies
  • Less than half reported routinely promoting active play 
  • Only 30% routinely discussed limiting screen time such as TV viewing 
  • Just over a third (37%) reported routinely providing advice on best practice formula feeding  
  • Overall they tended to focus on ‘what to feed’ rather than parental practices around ‘how to feed’.  
MCH nurses welcomed the opportunity to learn more about how to raise sensitive issues with parents and to learn more about how to empower parents to make lifestyle changes of benefit to the whole family.
Implications for Practice
This study suggests that while MCH nurses are well placed to address obesity prevention early in life, they need additional support in this role. Key strategies to achieve this could include:
  1. Increasing MCH nurse skills in behaviour change counselling so they are more confident to approach parents about sensitive topics without fear of offending, and have conversations that will empower parents to make lifestyle changes that will benefit the whole family. 
  2. Use service delivery prompts such as growth and BMI charts, parent education materials and recording systems to help MCH nurses in creating a legitimate opening to discuss lifestyle behaviours with parents.
  3. Align advice on healthy eating, active play and screen time with child growth and development which is considered central to the MCH nurse role. 
  4. Positively frame obesity prevention messages such as screen time limits to promote parental receptiveness. 
  5. Promote continuity of care with parents, helping strengthen the MCH nurse-parent relationship, a key foundation for promoting behaviour change.
Implications for Policy
Promoting healthy lifestyle behaviours in families fits well with key strategic directions for MCH services in Victoria and with NSW Kids and Families initiative. In particular, the strategic policy direction of intervening early and preventing problems from escalating. Focusing on healthy eating habits and active play in infants may prevent problems that need to be addressed in future consultations such as fussy eating or not meeting developmental milestones. It also fits well with the strategic focus on building the capacity and confidence of the MCH workforce.
Implications for Research
This study is based on a relatively small sample of nurses from two local government areas in Melbourne. Further research is required to examine the generalisability of the findings and to explore effective approaches to supporting MCH nurse practice in the prevention of childhood obesity.
Promoting healthy weight gain fits well with the MCH nurse role, and nurses routinely undertake growth monitoring and the provision of infant feeding advice relevant to obesity prevention. A major public health opportunity remains however in assisting nurses to more effectively promote aspects of infant feeding including best practice formula feeding and parental feeding behaviours as well as promoting active play and limiting sedentary behaviour. Because parental receptiveness and maintaining rapport with parents is the key driver of nurse obesity prevention practices, improving behaviour change counseling skills will be critical to nurses raising weight related concerns with parents and addressing sensitive topics such as limiting screen time. At the service level, the use of tools such as BMI charts and integrating topics such as parental feeding behaviours, active play and screen time into parent education materials will help create legitimate openings to raise such topics with parents. With this additional support, MCH nurses are well placed to play an important role in obesity prevention in early life. 
This study is part of a broader program of research focusing on obesity prevention in disadvantaged families with young children. For more information, click here.
The summary is based on findings published in BMC Nursing, 2015, 14:26:
This summary has been prepared by Dr Rachel Laws1,5, A/Prof Karen Campbell, 1,5, Ms Paige van der Pligt1, Prof Kylie Ball, 1,5, Prof John Lynch2,5, Ms Georgina Russell3,5, A /Prof Rachael Taylor4,5 and A/Prof Elizabeth Denney- Wilson3,5
1Centre for Physical Activity and Nutrition Research, Deakin University, 2School of Population Health, University of Adelaide, 3Faculty of Health, University of Technology, Sydney, 4University of Otago, 5Centre for Obesity Management and Prevention Research Excellence in Primary Health Care (COMPaRE-PHC)
The research reported in this paper is a project of the Australian Primary Health Care Research Institute, which is supported by a grant from the Australian Government Department of Health and Ageing. The information and opinions contained in it do not necessarily reflect the views or policy of the Australian Primary Health Care Research Institute or the Australian Government Department of Health and Ageing.  KB is supported by a National Health & Medical Research Council Principal Research Fellowship, ID 1042442. JL is supported by a NHMRC Australia Fellowship 570120. RT is supported by a KPS Fellowship. PV is supported by an NHMRC Postgraduate Research Scholarship 

Please contact Associate Professor Elizabeth Denney-Wilson, Stream 1 leader: