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- Enö Persson, Johanna, et al.
(författare)
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Experiences of nurses and coordinators in a childhood obesity prevention trial based on motivational interviewing within Swedish child health services
- 2022
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Ingår i: International Journal of Qualitative Studies on Health and Well-being. - : Taylor & Francis. - 1748-2623 .- 1748-2631. ; 17:1
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To explore the experiences of nurses and coordinators in the PRIMROSE childhood obesity prevention trial, and to understand the factors that might help to improve the outcome of future primary prevention of obesity.Methods: Using a qualitative approach, data were obtained by interviewing nine intervention nurses and three regional study coordinators. All participants were female. The interviews were transcribed and analysed using content analysis.Results: Two themes emerged: The nurses experienced that it was rewarding to participate in the trial, but challenging to combine the intervention with regular work; and The study coordinators experienced that they were in a difficult position handling the conflicting needs of the research group and the nurses' commitment to usual child health care services. The importance of support, encouragement, briefer and simpler intervention, and adaptation of the training in motivational interviewing to the setting was emphasized. Stress and lack of time were major barriers to deliver the intervention as intended.Conclusions: Although the PRIMROSE intervention was developed in collaboration with representatives from the child health services, and additional research funding was provided to compensate for time spent working with the trial, nurses experienced stress and time constraints.
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| 2. |
- Enö Persson, Johanna
(författare)
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Family-based prevention of childhood obesity : long-term outcomes, challenges and implications for future research
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Childhood obesity is considered to be one of the most serious health challenges of the 21st century. There have been indications that the prevalence has reached a plateau in high-income countries, yet the prevalence is increasing in poorer parts of the world. The same tendencies are seen within richer countries, with higher prevalence in more disadvantaged groups. Despite many ambitious attempts, an effective solution has not yet been found. Family-based early prevention interventions targeting the whole population has been called for, as well as more studies aiming at understanding factors that predispose for childhood obesity or moderate the outcomes of interventions. The cluster-randomized PRIMROSE trial had the aim of primary prevention of childhood obesity. It was based on Motivational Interviewing (MI) and cognitive behavioral principles, and delivered to parents within Swedish child health care services. Aims: The overall aim of this thesis was to investigate the long-term results of the PRIMROSE trial in terms of intervention nurses’ MI proficiency and children’s weight status at follow-up, and to gain further understanding of the results by exploring the experiences of nurses and study coordinators who had worked in the trial, as well as investigating parental risk factors for children’s weight status. Methods: In Study I the MI proficiency level among nurses who had participated in the PRIMROSE trial was explored after the nurses had received the full training package of workshop and supervision. Proficiency at follow-up and potential predictors were also analyzed. In Study II the effect of the PRIMROSE intervention in terms of children’s weight status was investigated, as well as potential moderators of the effect. Study III had a qualitative approach and intervention nurses and study coordinators who had worked in the trial were interviewed. In Study IV we explored parental self-efficacy, health behaviors and weight status as potential risk factors for children’s weight status. Results: The nurses’ proficiency levels after completing the training was generally low, and the results did not change at follow-up. There were no long-term effects of the PRIMROSE intervention on children’s weight status, and no significant moderators. The analyses of potential predictors of children’s weight status yielded no significant results except for strong associations between parents and children’s anthropometry. The interviews with the nurses and study coordinators revealed two overarching themes: “The nurses felt it was rewarding to participate in the trial, but challenging to combine working with the intervention with regular work at the child health care center”; and “The study coordinators felt they were in a difficult position handling the conflicting needs of the research group and the nurses’ commitment to usual child health care services”. The importance of support, encouragement and clear communication was emphasized, as was adaptation of the training in MI to the setting and target group. Stress and lack of time seem to have been major barriers to delivering the intervention as it was intended. Conclusions: The results of the PRIMROSE trial are in line with previous prevention trials targeting individuals’ diet and PA, indicating that we need to shift our focus. Tackling obesity demands a system approach including upstream interventions also targeting the policy level. In addition, the multifactorial etiology of childhood obesity points to the importance of multifactorial solutions, and there’s a need for more high-quality research aiming to increase our knowledge about modifiable predisposing factors and moderators. In addition, the often reported challenges in regards to practitioners’ stress levels and difficulties combining regular work duties with working in clinical trials indicates the importance of organizational support.
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| 3. |
- Enö Persson, Johanna, et al.
(författare)
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Prevention of Childhood Obesity in Child Health Services : Follow-Up of the PRIMROSE Trial
- 2018
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Ingår i: Childhood Obesity. - : Mary Ann Liebert Inc. - 2153-2168 .- 2153-2176. ; 14:2, s. 99-105
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Tidskriftsartikel (refereegranskat)abstract
- Background: Childhood obesity is an urgent public health concern, and there's a need for long-term, high-quality, primary prevention trials targeting parents of young children. The aim of the current study was to evaluate the long-term effect of a parental support program based on motivational interviewing (MI). Methods: A cluster randomized controlled trial was carried out in eight Swedish counties. Participating families (N = 1355) were enrolled when the child was 9 months old, and participated in nine sessions during ∼39 months. The aim was to pomote healthy food and physical activity (PA) habits using MI and principles from cognitive behavioral therapy. Nurses in Swedish child health services delivered the intervention, and the control group received usual healthcare. The current study was a 1-year follow-up of effects on children's weight-related measures. Regression analyses were conducted using generalized estimating equations, including analyses to investigate potential parental moderators of the effect. Results: There were no statistically significant intervention effects at follow-up [BMI difference = -0.13, p = 0.29, overweight relative risk (RR) = 0.96, p = 0.78, obesity RR = 0.57, p = 0.20]. Maternal waist circumference and unhealthy eating and paternal PA moderated the effect, but effects were small and failed to reach statistical significance after correction for multiple comparisons. Conclusions: A parent-focused primary prevention intervention based on MI delivered within child health services did not result in effects at 1-year follow-up. The results were in line with those obtained at post-assessment and indicated no late onset of effect. Further studies exploring individual and contextual factors influencing the outcome are called for.
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| 4. |
- Ghaderi, Ata, et al.
(författare)
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A Randomized Controlled Trial of the Effectiveness of Virtually Delivered Body Project (vBP) Groups to Prevent Eating Disorders
- 2020
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Ingår i: Journal of Consulting and Clinical Psychology. - : American Psychological Association (APA). - 0022-006X .- 1939-2117. ; 88:7, s. 643-656
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To investigate the effectiveness of Body Project groups delivered virtually (vBP) by peer educators for prevention of eating disorders. Method: In a randomized controlled trial vBP groups (N = 149) were compared with a placebo (expressive writing, EW: N = 148) over 24-month follow-up and to a waitlist control condition (N = 146) over 6-month follow-up among females (15-20 years old) with body image concerns. The primary outcome was incidence of eating disorder onset over 2-year follow-up measured by blinded diagnostic interviews. Waitlist participants were offered the vBP after 6 months. Results: The incidence of eating disorders onset over 24 months follow up were 3 in vBP (2.0%) and 13 in EW (8.8%), a significant difference; Hazard Ratio (Experiment B) = 0.26, 95% confidence interval (CI) [0.075, 0.92], p = .037. Incidence of eating disorder onset in vBP participants was 77% less than in EW participants. The vBP participants generally showed significantly greater reduction in eating disorder symptoms, clinical impairment, body dissatisfaction, and internalization of thin ideal compared with the waitlist participants at postintervention and 6-month follow-up, and in eating disorder symptoms, restraint, body dissatisfaction, and internalization of thin ideal compared with the EW participants at postintervention, and 6-, 12-, 18-, or 24-months follow-up. EW participants reported significantly greater reduction in clinical impairment and body dissatisfaction at postintervention compared with the waitlist participants. Conclusions: The present reduction in the incidence of eating disorders is notable given that the intervention was implemented virtually, rather than in-person. The vBP might be a viable option for future evaluation of scalable prevention of eating disorders.
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