Introduction
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To explore HCPs’ perceptions and attitudes towards childhood obesity
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To explore which factors HCPs perceive to be important in the development of childhood obesity
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To explore HCPs’ perceptions of their role in childhood obesity prevention and management
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To explore HCPs’ perceptions of barriers and facilitators in childhood obesity prevention and management
Methods
Study design
Setting
Recruitment and sampling
Data collection
Data analysis
Results
Participants
Characteristic | Number of participants (Total = 21) |
---|---|
Age range | |
20–29 | 8 |
30–39 | 6 |
40–49 | 5 |
50–59 | 2 |
Gender | |
Female | 16 |
Male | 5 |
Profession | |
Dentist | 2 |
Assistant Obstetrician | 1 |
Technical Nurse | 7 |
Licensed Nutritionist | 1 |
Licensed Nurse | 5 |
Family Doctor | 1 |
Obstetrician | 3 |
Surgeon | 1 |
Time qualified (years) | |
< 1 | 4 |
1–5 | 5 |
6–10 | 5 |
11–15 | 3 |
16–20 | 2 |
21–25 | 1 |
26–30 | 0 |
31–35 | 1 |
Findings
Category 1: HCPs’ perceptions and attitudes towards childhood obesity | ||
1a | Level of concern regarding childhood obesity | • Childhood obesity is not a major concern in Iquitos • Undernutrition is a greater priority than obesity |
1b | Perceived consequences of childhood obesity | • Long-term medical implications • Psychological consequences, particularly in adolescents |
Category 2: Factors which HCPs perceive to be important in the development of childhood obesity | ||
2a | Parental factors | • Parents have the most influence • Positive views of excess weight prevail |
2b | Contextual factors | • Availability of technology, affordable healthy foods and outdoor space • Perceived association with socioeconomic status |
Category 3: HCPs’ perceptions of their role in childhood obesity prevention and management | ||
3a | Educating parents about childhood obesity | • Addressing parental misconceptions • Supporting the family as a whole |
3b | Regular monitoring of child growth | • Key to recognising overweight or obese children • Enable interventions to be initiated |
Category 4: Barriers and facilitators in childhood obesity prevention and management | ||
4a | Barriers and facilitators in healthcare | • Barrier – Lack of parental cooperation • Facilitator – Utilising home visits |
4b | Barriers and facilitators in schools | • Barrier – Lack of interest from teachers and parents • Facilitator – Platform for education and government policies |
HCPs’ perceptions and attitudes towards childhood obesity
Level of concern regarding childhood obesity
“I don't think [childhood obesity] is increasing here in Iquitos, there may be cases of obesity in children, but it's not extreme” (P9 – Surgeon)
“What you see most is child undernutrition, it's more relevant. Yes, there are obese children, but the greatest percentage are undernourished” (P13 – Licensed Nurse)
“In other countries, such as the United States, there is a greater index of obesity compared to Loreto. I could highlight the undernutrition in Loreto compared to other countries. There is very little obesity here” (P14 – Licensed Nurse)
“I think other places attach more importance to childhood obesity than here in Loreto. Here, […] they are definitely putting childhood obesity aside” (P20 – Licensed Nutritionist)
Perceived consequences of childhood obesity
“If we don’t recognise the problem of obesity in children, in the future this will become an adult who will suffer from metabolic diseases such as diabetes mellitus, hypertension and dyslipidaemia” (P9 – Surgeon)
“When you reach puberty, you realize that you are fat. Then come the social factors, the bullying. [Others] aggravate them because they’re fat, and that's when they first realise that they’re obese and start to become aware” (P6 – Family Doctor)
Factors which HCPs perceive to be important in the development of childhood obesity
Parental factors
“[Childhood obesity] depends a lot on the parents because they are the ones who live with them 24 hours a day and I think we should address them first so that they can help the child too” (P13 – Licensed Nurse)
“[Responsibility is] mostly the parents’, because they must guide and educate their children properly so that later they do not suffer from disease” (P18 – Technical Nurse)
“Here at the facility, we see that the mother brings in a bottle of sugary drink, instead of bringing something healthy” (P4 – Technical Nurse)
“[Parents] say that they feed their children [certain foods] because their children want to eat that, for example, if the child says they want to eat chocolate, then they’ll give them chocolate” (P7 – Obstetrician)
“Another important factor [in childhood obesity] is the lack of awareness in parents because they just want to give [children] food but they don’t care if they are receiving the right nutrients for their body” (P7 – Obstetrician)
“A lot of the time, parents think wrongly of their kids that the fatter they are, the healthier they are” (P14 –Licensed Nurse).
“It is a challenge [to understand obesity] for us as professionals, as well as for the families, because mothers think that an obese child is healthy, when in fact it’s not” (P5 – Licensed Nurse)
“We thought [obesity] was inherited, right? If the parent is fat, then [the child is] fat too. But now, over time, studies show that weight gain in children is pathological” (P2 – Assistant Obstetrician)
“In our city, you observe […] mothers who care about their children's nutrition and enrol their children in different holiday courses such as football, volleyball, basketball, etc. to always keep them active” (P10 – Licensed Nurse)
Contextual factors
“Childhood obesity here is not so common mainly because we don't have the most advanced technology yet [...] here, children are not totally focused on technology, you rarely see children with their tablets, phones or TVs, they prefer to go out and play in the streets” (P10 – Licensed Nurse)
“Here in our region, carbohydrates are the most consumed, we don't consume fruits or vegetables. Sometimes because of the cost, it’s a little bit inaccessible” (P2 – Assistant Obstetrician)
“Parents don’t have the financial freedom to buy the right foods” (P18 – Technical Nurse)
“One of the advantages we have in Iquitos is that we don’t live in an environment with as much risk or danger as the big cities on the coast. Here, the children still go out to play, […] they have more free spaces than other cities” (P9 – Surgeon)
“Economic aspects prevent you from eating healthy fruits or vegetables as they are expensive in this region” (P6 – Family Doctor)
“Financial accessibility to have video games […] makes children today remain more inactive” (P9 – Surgeon)
“People who have a little more money […] buy junk food to please the child” (P16 – Technical Nurse)
“I think [childhood obesity is common] in the middle class because it also occurs in the class that has more wealth” (P13 – Licensed Nurse)
“[Obesity occurs] from the middle class and up and the lower group is where we attend patients with child undernutrition” (P1 – Dentist)
“The common thing you see is that the father of the family doesn’t have a job. If they don’t have a job, how are they going to feed the child” (P17 – Obstetrician)
“There are football, basketball and volleyball clubs. […] Within the city here we have higher, middle and lower social classes. The first two spheres allow their children to play there during holidays and within the school period” (P19 – Licensed Nurse)
“People here prefer to buy fast food because healthy food is expensive, they can’t buy fruits and vegetables, so they prefer to buy cheaper food although it isn’t healthy” (P7 – Obstetrician)
HCPs’ perceptions of their role in childhood obesity prevention and management
Educating parents about childhood obesity
“[Encouraging healthy lifestyles in children] basically consists of educating the parents, doesn't it? Making parents aware of good nutrition for their children” (P14 – Licensed Nurse)
“We are here to support them, whether it is the parent or the family […] because that is our job, to support” (P15 – Technical Nurse)
“We advise the family, the parents, that it’s important to understand that their child is obese. It doesn’t mean that they are healthy, because there is a culture of this misconception that a fat child is a healthy child, and that is not true” (P9 – Surgeon)
“Few children consume [healthy foods]. Parents don't teach them at home. Children learn from their environment, from home. We'll generally give them some ideas, some advice, but [unhealthy behaviours are] definitely from the home” (P21 – Obstetrician)
“We are here to guide the patient whether they understand or not, we are there every day to fight for the health of the whole family” (P15 – Technical Nurse)
“Unfortunately, parents aren’t interested, they aren’t educated. Or they already have the knowledge but for an adult to erase that is very difficult, it is already deeply embedded. That's why you always have to educate the little ones so, as they grow up, they will keep that knowledge” (P13 – Licensed Nurse)
Regular monitoring of child growth
“We, as workers, must be monitoring children whether they are obese or not […] it is our priority to keep the child healthy” (P15 – Technical Nurse)
“Healthcare personnel are already dedicated to observing the weight and height of children […] Depending on their body mass they’re referred to the specialists, if they are obese, they’re automatically referred to the nutritionist so that the child can lose weight appropriately” (P15 – Technical Nurse)
Barriers and facilitators in childhood obesity prevention and management
Barriers and facilitators in healthcare
“There are some parents who do follow [advice], for example, five out of ten. The rest I think throw in the towel, they give up […] so they don't come back to their appointments” (P20 – Licensed Nutritionist)
“I do everything possible so that the patient understands me. I practically have to scare them, because here we have to scare the parents and maybe then they’ll become aware that [obesity] can happen” (P20 – Licensed Nutritionist)
“There are mothers who only come once to the consultation and leave immediately then return after a few weeks when their child's health has already become complicated” (P10 – Licensed Nurse)
“We do home visits because the barrier was coming to the [child health] appointments” (P6 – Family Doctor)
“Our main role is to spread information to prevent illnesses, that is why we do home visits” (P8 – Technical Nurse)
“We have to do our job which is to follow-up on what [patients] are achieving, if they are succeeding or lack support, that is why home visits are made” (P5 – Licensed Nurse)
Barriers and facilitators in schools
“Last year, we worked directly with the school and were able to train teachers and parents. The best intervention has been at the school” (P21 – Obstetrician)
“Don’t forget that schools are the second home of our children. They spend half of their life in school. So, if we have an enhancing effect between families and schools […] we could advance a lot” (P9 – Surgeon)
“I think that if we, as healthcare professionals, don't go to the educational institutions they forget [about obesity] so we have to constantly advocate to strengthen the link with them” (P11 – Dentist)
“[Schools] always call parents in to talk about how they can have a healthy lifestyle with their children […] but the parents don't go, only a minority attend, […] so even though education is provided, I think more education should be given” (P13 – Licensed Nurse)
“The ministry of health implemented a policy regarding healthy kiosks where school kiosks were required to sell healthy food such as fruit and salads, not the sweets that have typically been sold there” (P9 – Surgeon)
“The government is currently focusing on chronic childhood undernutrition […] the only thing being worked on [for childhood obesity] are the healthy lunches but not anything else” (P14 – Licensed Nurse)