Developing a communication toolbox for primary care practitioners to raise the issue of weight with parents of preschool children: a qualitative study

Background One in five British children are overweight or obese when entering primary school but most parents fail to recognise child overweight. Health-care professionals are expected to manage childhood overweight, but initiating conversations with parents is difficult. The aim of this study was to inform the development of a visual and language toolbox to support health-care professionals in initiating sensitive conversations about weight with parents of overweight preschool children. Methods Three focus group discussions were conducted with health-care professionals (total n=29) recruited from general practices in London and Bristol, UK, and 15 semi-structured interviews were undertaken with parents of preschool children (<5 years). Focus groups and interviews explored: barriers preventing conversations between health-care professionals and parents about children's overweight; the potential for existing visual body image scales to help parents put their child's weight in context; and preferred language for use in conversations about child weight. Interviews and focus groups were audio recorded, transcribed verbatim, and analysed using thematic analysis in a deductive top down approach based on predetermined themes explored in the focus groups and interviews. Findings Health-care professionals perceived parents as being unconcerned about child overweight; parents were apprehensive about health-care professionals criticising their parenting skills. Some health-care professionals did not consider child overweight to be their responsibility. General practitioners were reluctant to discuss weight with parents because of shortage of time, fear of damaging patient–practitioner relationships, and insufficient training; nurses were more willing. Both health-care professionals and parents were positive about the potential for body image scales to facilitate conversations, generally preferring scales based on three-dimensional body scans over artists' drawings. Parents thought that language used by health-care professionals needed to be clear and impactful, but not stigmatising—eg, overweight, very overweight (but not fat, heavy, or obese). Interpretation The findings suggest that a visual and language toolbox would be well received by parents and health-care professionals. Anatomically accurate preschool body image scales are needed for use in consultations. Practice nurses may be better placed than general practitioners to initiate conversations with parents. Health-care professionals should consider parents' conceptions of health and blame when conducting consultations, to encourage parental recognition of preschool overweight, with the ultimate aim of facilitating appropriate behaviour change. Funding This study is funded by a Cancer Research UK/Bupa Foundation Innovation award. The funders had no role in the writing of the abstract or the decision to submit it for publication.