The challenge of preventing and treating obesity in low-income, preschool children - Perceptions of WIC health care professionals
The challenge of preventing and treating obesity in low-income, preschool children - Perceptions of WIC health care professionals
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DOI：
10.1001/archpedi.156.7.662
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发表时间：
2002-07-01
影响因子：
--
通讯作者：
Whitaker, RC
中科院分区：
文献类型：
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作者：
Chamberlin, LA;Sherman, SN;Whitaker, RC
背景：肥胖已成为低收入学龄前儿童普遍关注的营养问题，也是妇女、婴儿和儿童特别补充营养计划(WIC)的主要目标人群。WIC的营养咨询工作以儿童肥胖为目标，但需要新的方法来解决客户和卫生保健专业人员对肥胖的不同看法。目的：为了开发这些新方法，我们调查了WIC卫生保健专业人员对预防和管理儿童肥胖症存在的挑战的看法。设计：一项定性研究，使用从焦点小组的录音带和个人访谈转录的数据。我们独立阅读每个成绩单和编码主题，然后通过作者的小组会议选出共同的主题。背景：肯塔基州WIC。参与者：在参与的19名卫生保健专业人员中，除1名白人女性外，所有人都曾在WIC提供营养咨询。第一个领域集中在WIC卫生保健专业人员如何看待他们咨询的母亲的生活经历、态度和行为。他们认为，母亲(1)专注于在日常生活压力下生存；(2)使用食物来应对这些压力，并将其作为育儿的工具；(3)难以对孩子的食物设定限制；(4)缺乏关于儿童正常发育和饮食行为的知识；(5)没有致力于持续的行为改变；(6)不认为超重的孩子超重。第二个领域描述了WIC卫生保健专业人员对咨询互动的看法。他们觉得(7)当谈论体重时，他们可能会冒犯母亲，(8)咨询是按协议进行的，(9)他们的营养建议经常与母亲的亲戚、朋友或初级保健医生的建议相冲突。最后一个领域描述了WIC卫生保健专业人员为解决儿童肥胖问题提出的程序性建议：(10)促进更多以客户为中心的咨询方法，(11)建立小的、得到母亲认可的行为改变目标，以及(12)与初级保健医生合作，创建更统一的肥胖咨询方法。结论：为了更好地应对儿童肥胖问题，WIC应该考虑以下几点：(1)提供咨询技能方面的培训，教育父母关于儿童发展和育儿的知识，并引发客户的社会背景和个人目标，(2)将WIC访问的时间分配和规划重点从营养风险评估转移到咨询上，以及(3)与初级卫生保健提供者和社区机构发展合作，以影响儿童肥胖。
Background: Obesity has become a common nutritional concern among low-income, preschool children, a primary target population of the Special Supplemental Nutrition Program for Women, infants, and Children (WIC). Nutrition counseling efforts in WIC target childhood obesity, but new approaches are needed that address the different perceptions about obesity that are held by clients and health care professionals.Objective: To develop these new approaches, we examined WIC health care professionals' perceptions about the challenges that exist in preventing and managing childhood obesity.Design: A qualitative study using data transcribed from audiotapes of focus groups and individual interviews. We independently read each transcript and coded themes; then, the common themes were selected through group meetings of the authors.Setting: Kentucky WIC.Participants: of the 19 health care professionals participating, all had provided nutrition counseling in WIC and all but one were white women.Results: Twelve major themes clustered into 3 domains. The first domain centered on how WIC health care professionals perceived the life experiences, attitudes, and behaviors of the mothers they counseled. They perceived that mothers (1) were focused on surviving their daily, life stresses; (2) used food to cope with these stresses and as a tool in parenting; (3) had difficulty setting limits with their children around food; (4) lacked knowledge about normal child development and eating behavior; (5) were not committed to sustained behavioral change; and (6) did not believe their overweight children were overweight. The second domain described WIC health care professionals' perceptions of counseling interactions. They felt that (7) they might offend mothers when talking about weight, (8) counseling was driven by protocols, and (9) their nutritional advice often conflicted with the advice from the mothers' relatives, friends, or primary care physicians. The last domain described programmatic suggestions WIC health care professionals offered to address childhood obesity: These included (10) promoting a more client-centered approach to counseling, (11) establishing behavioral change goals that were small and endorsed by the mother, and (12) working with primary care physicians to create a more uniform approach to counseling on obesity.Conclusions: To become more responsive to the problem of childhood obesity, WIC should consider the following: (1) providing staff training in counseling skills that educate parents on child development and child-rearing and that elicit the client's social context and personal goals, (2) shifting time allocation and programmatic emphasis in the WIC visits away from nutritional risk assessment and toward counseling, and (3) developing collaborations with primary health care providers and community agencies that impact childhood obesity.