Before school check nurses' experiences of motivational interviewing during the weight-related referral process : an interpretive phenomenological study
Thesis DisciplineHealth Sciences
Degree GrantorUniversity of Canterbury
Degree NameMaster of Health Sciences
The alarming rate at which high weight is increasing has caused a global reaction to try and reduce the number of children who present with high body mass index. In New Zealand (NZ), the numbers are at critical level with 11% of children deemed as above healthy weight (Ministry of Health, 2018a). In response to the worrying statistics, the NZ government announced a childhood weight reduction plan to combat this issue. This includes targeted interventions, increased support for at risk children, and education around food choices and exercise, to name a few. One of the initiatives introduced as part of this plan is the Raising Healthy Kids target. This health target aimed to identify (by the end of 2017) 95% of high weight children (≥98th BMI%) through the Before School Check programme and offer a referral to a health professional for clinical evaluation and family-based nutrition, physical activity and lifestyle interventions (Ministry of Health, 2018b). A crucial part of the referral process involved effective conversations with whānau to ensure uptake into these healthy lifestyle programmes occur. Although not explicitly funded for this, motivational interviewing (MI) was recommended as an effective evidenced-based form of patient-centred communication to assist with ensuring these referrals occurred.
The Before School Check for childhood high weight health initiative is problematic. While registered nurses have received some training in MI, their willingness, confidence, and effectiveness in using this technique is unknown. At present, there is uncertainty the nurses are applying motivational interviewing techniques, or any behaviour change talk skills effectively or at all. Therefore, this study sought to investigate the nurses’ experience of weight-related conversations with whānau, and the level of understanding and application of motivational interviewing. This was achieved by using a questionnaire focussed on competencies in conjunction with recorded interviews concentrated on process-orientated accounts of the referral process. The methods used for this research were descriptive statistics for the survey and thematic analysis for the interviews. The study found nurses perceived weight-related conversations with whānau as challenging when parents were unaccepting of the weight issue. To fulfil referral obligations, nurses used familiar directive communication techniques to refer whānau back to their general practitioner (GP) because this was considered the preferred option when the conversation was difficult to navigate, and parents were more accepting of the GP referral. Considering the recent Healthy Kids policy and the barriers identified in this research, effective client-centred communication training such as motivational interviewing is needed. This is to ensure nurses have the skills and the confidence to converse on highly sensitive topics such as children’s weight problems so that the whānau can be referred onto treatment programmes. Further research is warranted to gain a better understanding of the experience on a larger scale and to ascertain the specific communication techniques used.