Why don't families initiate treatment? A qualitative multicentre study investigating parents' reasons for declining paediatric weight management
Why don't families initiate treatment? A qualitative multicentre study investigating parents' reasons for declining paediatric weight management
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DOI：
10.1093/pch/20.4.179
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发表时间：
2015-05-01
影响因子：
1.9
通讯作者：
Ball, Geoff
中科院分区：
文献类型：
--
作者：
Perez, Arnaldo;Holt, Nicholas;Ball, Geoff
目的：了解父母拒绝接受儿童体重管理专科健康服务的原因。方法：对18名儿童(10~17岁；体重指数=85百分位数)的父母进行访谈，他们被转诊为体重管理，但没有在加拿大三家多学科体重管理诊所之一开始治疗。半结构化面试指南被用来征求父母对不入会原因的反应。采访被录音并逐字转录。结果：大多数父母(年龄34~55岁，平均44.1岁)为女性(n=16[89%])、肥胖(n=12[66%])和大学学历(n=13[71%])。父母不开始提供保健服务的原因分为五个主题：不认为需要儿科体重管理(例如，儿童没有体重或健康问题)；不认为需要采取进一步行动(例如，儿童已经有了健康的生活方式)；不打算开始推荐护理(例如，认为临床计划无效)；参与障碍(例如，儿童缺乏动力)；和情境因素(如天气)。结论：医生不仅应该讨论管理儿童肥胖的专门护理的必要性和价值，而且应该探索父母启动治疗的意图，并解决他们可以控制的不开始治疗的原因。
Background: Many families referred to specialized health services for managing paediatric obesity do not initiate treatment; however, reasons for noninitiation are poorly understood.Objective: To understand parents' reasons for declining tertiarylevel health services for paediatric weight management.Method: Interviews were conducted with 18 parents of children (10 to 17 years of age; body mass index >= 85th percentile) who were referred for weight management, but did not initiate treatment at one of three Canadian multidisciplinary weight management clinics. A semi-structured interview guide was used to elicit parents' responses about reasons for noninitiation. Interviews were audio-recorded and transcribed verbatim. Data were managed using NVivo 9 (QSR International, Australia) and analyzed thematically.Results: Most parents (mean age 44.1 years; range 34 to 55 years) were female (n=16 [89%]), obese (n=12 [66%]) and had a university degree (n=13 [71%]). Parents' reasons for not initiating health services were grouped into five themes: no perceived need for paediatric weight management (eg, perceived children did not have a weight or health problem); no perceived need for further actions (eg, perceived children already had a healthy lifestyle); no intention to initiate recommended care (eg, perceived clinical program was not efficacious); participation barriers (eg, children's lack of motivation); and situational factors (eg, weather).Conclusion: Physicians should not only discuss the need for and value of specialized care for managing paediatric obesity, but also explore parents' intention to initiate treatment and address reasons for noninitiation that are within their control.