Nursing Phone Call Program for Obesity Control Among Paediatric Patients Proposal

Introduction

Obesity is a serious health problem rooted in economic, social, or physiological changes. Paediatric obesity is a growing epidemic in many countries that requires serious attention because it is a burden not only for children but for their parents and caregivers. The number of obese or overweight children aged 5-19 has increased from 4% in 1975, and about 18% in 2016, and nearly half of these children live in Asia (World Health Organization, 2018).

Fatty or high sugar food consumption, no physical exercises, sleep disorders, and poor parental behaviours promote the development of obesity in children (Crespo et al., 2018; Xu & Xue, 2016). Being a type of nutritional disorder, obesity contributes to the risk of heart diseases, diabetes, hypertension, osteoarthritis, and cancer (Centre for Health Protection, 2019). This health problem has to be controlled among paediatric patients, and the role of caregivers and parents must be underlined. There are many ways to prevent childhood obesity, and specific nursing interventions may be developed in non-hospital settings.

Background of Study

Literature Review and Knowledge Gap

Childhood obesity is on the list of urgent public health problems in Hong Kong. The development of childhood obesity is predetermined by a variety of reasons (World Health Organization, 2018). Eating habits, the level of knowledge in parents, and the necessity to identify its symptoms at early stages should be considered (Centre for Health Protection, 2019; Crespo et al., 2018; Xu & Xue, 2016). Wang, Gao, and Lau (2017) investigated behaviour-related factors and family involvement to prove a healthy lifestyle as a significant contribution to children’s positive health outcomes.

New methods to prevent obesity in children are developed worldwide, improving education and ecological awareness of the population (Cloutier, Wiley, Wang, Grant, & Gorin, 2015). In many cases, prevention of obesity is recommended for school-goers and children who are able to make independent decisions and understand the possible outcomes of their behaviours (Schroeder et al., 2015). However, additional help and participation of experts improve the results and include large samples.

Obesity in children may be prevented by the participation of professional nurses and other healthcare workers. The role of nurses in weight control among paediatric patients cannot be ignored as it is a chance to educate and control patients (Bourgeois, Brauer, Simpson, Kim, & Haines, 2016; Fruh, 2017). The rounding process is proved to be effective for families to recognise their opinions and strengthen their practices in obesity control (Berwitt & Grossman, 2015). Intra/interpersonal level factors define the quality of communication that may be developed between healthcare workers and obese paediatric patients (Bradbury et al., 2018).

However, the relationship between the quality of life and childhood obesity is strong, and nurses must use their knowledge to support patients (Pakpour et al., 2019). Not many investigations are offered to support the idea of nurse phone calls as predictors of obesity, and this knowledge gap should be used in the study to prove its urgency and appropriateness.

Significance of the Study

In this research proposal, a nurse phone call program for obesity control among paediatric patients is introduced, along with the literature review, methodology, data collection and analysis, ethical considerations, and the study significance. Childhood obesity is a serious problem around the globe, and the more locations are involved in its discussion, the better results are expected. Phone calls organised by nurses do not require much time and financial efforts, and if this solution is effective for children, families should use it to control and prevent obesity.

Aim, Objectives, and Research Questions

The aim of this study will be to investigate the role and effectiveness of nurse phone calls and communication with parents in the intention to control weight and predict obesity in paediatric patients. There are two supplementary objectives for a researcher to be achieved along with two research questions:

1. To identify the effectiveness of parent-nurse cooperation in controlling the child’s weight (How effective is the role of parents in controlling the child’s weight?);
2. To evaluate the effectiveness of nurse phone calls on the prediction of obesity problems in paediatric patients (What are the outcomes of nurse-parent cooperation for a child?).

Methodology

Study Design

In this project, the decision to follow a quantitative research design will be made. The study will be supported by a randomised control trial that is characterised by the participation of two groups of people. Participants will be divided into an experimental group (who undergo an intervention) and a control group (who do not receive the intervention). In this case, an intervention regularly includes phone calls of nurses to families with obese or overweight children that should regularly occur during the next two years.

Description of Groups and Interventions

Sample size calculations are based on similar projects where the problem of childhood obesity was discussed through the prism of different interventions. Cloutier et al. (2015) initiated the trial in regards to the chosen budget. Sixty participants with a 20% drop rate were proved to be sufficient, along with a power of 80% and an alpha of 0.05 (Cloutier et al., 2015). This intervention will include 60 families where a parent will support communication with a professional nurse at different stages of the program. There is a possibility to divide all the participants into two equal groups (30 families in each group). An intervention will include a nurse who will call parents regularly during the next 16 months to inform them about healthy lifestyles, control weight changes, and give some recommendations.

Sampling Method, Inclusion Criteria, and Exclusion Criteria

The location of the study is Hong Kong and its paediatric private outpatient clinic. Thousands of families plan their visits to paediatricians regularly to predict health-related problems, including weight changes. Intervention with follow-up care for families with obese or overweight children aged 1-5 years will be developed in one of the outpatient clinics of Hong Kong. Simple randomisation through records with a random number generator will be performed to assign each participant who enters a study to an experimental or control group.

To be included in the project, a participant should meet the following criteria:

1. Age is between 1 and 5 years;
2. Breastfeeding is over at the moment of the study;
3. BMI is lower than the 85th percentile (the child is not obese or overweight);
4. Communication with parents via phones is possible.

There are also situations when participants are not appropriate for the study because of different reasons:

1. Children have some chronic diseases or other mental/physical health problems;
2. Children do not have parents;
3. Children are already obese or overweight at the moment of the study beginning);
4. Children are older than six years.

Data Collection Procedures

The study will be approved by an appropriate research ethics committee and eligible participants. Voluntary participation is expected when patients of local private clinics learn the details of their contributions. The pre-trial stage will include patients’ information, BMI, and awareness of the major obesity-related issues. During these first four months, a research team will gather information on the topic (literature review) and choose participants who meet the inclusion criteria.

A questionnaire is the research instrument to be used to collect data from patients. As soon as all personal data and informed consent are gathered and the participants are divided into two groups, the intervention will begin. The intervention stage will last for about 16 months to promote phone communication between a nurse and a parent about obesity control, and prevention has to be developed. The final four months are used for gathering post-intervention results by means of questionnaires. This post-intervention step will show BMI changes and the effectiveness of parents’ knowledge to prevent obesity in children.

Measurements

1. Patient information form (gender, age, height, weight, and nutritional habits);
2. Body mass index (this measure helps to check the child’s weight and determine obesity, if any);
3. Knowledge data form (20 “True-False-I Do not Know” items are divided into 4 sections – obesity symptoms, causes, risk factors, and preventive measures).

Data Analysis

Statistical analysis of the data will be organised using the Statistical Package for Social Science (SPSS). Inferential tests like Chi-square (main characteristics) and independent samples t-test will be appropriate for the study to prove its statistical significance with a p-value of <0.05. The two-way repeated-measures ANOVA will help to evaluate the level of knowledge among parents. What families know about obesity before the intervention, what they know after the intervention, and how they can apply their knowledge to real-life will be statistically explained at the end of the study.

Ethical Considerations

Approval from a local research ethics committee and the Hospital Authority is required. When participants receive information sheets and learn all the aspects of the study, they have to give informed consent and their written permission to use personal data of their children (actual participants of the study). Information about families will stay anonymous and confidential during and after the intervention. Fake names or numbers will be used to describe a particular situation, if any. No conflict of interest is expected in the study under analysis.

Budgetary Estimation

In this study, budgetary estimations have to be clarified to avoid unpredictable problems and control changes:

Schedule of Study

The study will be divided into three main sections: pre-intervention, intervention, and post-intervention. Each stage has its goals and time periods, and the research team should follow the plan and complete its functions. The following table contains several important notes about the work to be done:

References

Berwitt, A., & Grossman, M. (2015). A qualitative analysis of pediatric patient attitudes regarding family-centered rounds. Hospital Pediatrics, 5(7), 357-362. Web.

Bourgeois, N., Brauer, P., Simpson, J. R., Kim, S., & Haines, J. (2016). Interventions for prevention of childhood obesity in primary care: A qualitative study. CMAJ Open, 4(2), 194-199. Web.

Bradbury, D., Chisholm, A., Watson, P. M., Bundy, C., Bradbury, N., & Birtwistle, S. (2018). Barriers and facilitators to health care professionals discussing child weight with parents: A meta‐synthesis of qualitative studies. British Journal of Health Psychology, 23(3), 701-722. Web.

Centre for Health Protection. (2019). Obesity. Web.

Cloutier, M. M., Wiley, J., Wang, Z., Grant, A., & Gorin, A. A. (2015). The early childhood obesity prevention program (ECHO): An ecologically-based intervention delivered by home visitors for newborns and their mothers. BMC Public Health, 15(1). Web.

Crespo, N. C., Talavera, G. A., Campbell, N. R., Shadron, L. M., Behar, A. I., Slymen, D., … Elder, J. P. (2018). A randomized controlled trial to prevent obesity among Latino paediatric patients. Pediatric Obesity. Web.

Fruh, S. M. (2017). Obesity: Risk factors, complications, and strategies for sustainable long-term weight management. Journal of the American Association of Nurse Practitioners, 29(1), 3-14. Web.

Pakpour, A. H., Chen, C. Y., Lin, C. Y., Strong, C., Tsai, M. C., & Lin, Y. C. (2019). The relationship between children’s overweight and quality of life: A comparison of Sizing Me Up, PedsQL and Kid-KINDL. International Journal of Clinical and Health Psychology, 19(1), 49-56. Web.

Schroeder, N., Rushovich, B., Bartlett, E., Sharma, S., Gittelsohn, J., & Caballero, B. (2015). Early obesity prevention: A randomized trial of a practice-based intervention in 0-24 month infants. Journal of Obesity, 2015. Web.

World Health Organization. (2018). Obesity and overweight. Web.

Xu, S., & Xue, Y. (2016). Pediatric obesity: Causes, symptoms, prevention and treatment. Experimental and Therapeutic Medicine, 11(1), 15-20. Web.