school-based obesity prevention: opinions, beliefs & current practices of licensed school...
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School-based obesity prevention: Opinions, beliefs & current practices of licensed school nurses. Findings from the Minnesota School Nurse Survey
School of Nursing Annual Spring Research Day
April 21, 2006
Martha Y. Kubik, PhD RN School of Nursing, University of Minnesota
Mary Story PhD, RD School of Public Health, University of Minnesota
Problem: Childhood Obesity
Institute of Medicine (2004) Critical public health threat National public health priority
Prevalence of @risk of overweight & overweight among 2-19 year olds (NHANES: 2003-2004)*
All: 34% (17%) Non-Hispanic Whites: 33% (16%) Non-Hispanic Blacks: 35% (20%) Mexican Americans: 37% (19%)
* Ogden et al, JAMA, 2006( ) = % > 95th %
Schools
In US, 95% children & youth enrolled in school
Considerable time spent at school 6 hours/day 5 days/week 36 weeks/year 13 years
Primary location to reach ALL children & youth
School Nurses: Primary Providers of School Health Services
Nationwide, 45,000 school nurses provide care to more than 53 million school children
Opportunity to intervene at multiple levels of prevention 1 prevention:
Promote healthy lifestyle practices for ALL 2 prevention:
Case finding & referral for targeted programs
Well-positioned to assume a lead role in school-based obesity prevention
Are school nurses ready & prepared to assume role?
Study Overview: Minnesota School Nurse Survey
Purpose: To determine current roles and responsibilities
of MN school nurses in delivering school-based services that target the prevention & treatment of overweight among students
To assess school nurses’ knowledge, beliefs & attitudes about school-based preventive health services targeting obesity prevention that include both individual & population level strategies
Study Overview:Minnesota School Nurse Survey
Sample: School Nurse Organization of Minnesota (SNOM)
Licensed school nurses Active members
Data Collection: Mailed self-administered survey
64 items 10-15 minutes to complete $1 bill incentive
Fall 2005 Response rate: 80% (221/275)
Study Overview:Minnesota School Nurse Survey
Sample Characteristics: Mean age: 50 (SD 7.3); range: 25-66 Gender: 97% female Race/Ethnicity: 99% Caucasian Education:
65% bachelor’s degrees 31% master’s degrees
Median Yrs Current Position: 6 (range: 0.08-30) Median Total Yrs School Nursing: 9 (range: 1-40) Median Total Yrs Nursing Experience: 25 (range: 2-
41.5)
School Nursing Practice
1. Assessment of non-acute health conditions (MOST COMMON)
2. Case management of students with chronic health needs3. Assessment of acute health conditions4. Supervision of ancillary staff5. Medication administration6. Immunization monitoring7. Hearing & vision screening8. Skilled care9. Health education in group setting10. Paperwork11. Height & weight screening (LEAST
COMMON)
Health Screening
Screened Parents NotifiedIf not normal All No
Vision 99% 84% 15% ---
Hearing 96% 82% 17% ---
Height & Weight
37% 41% 15% 35%
BMI 3% 17% 33% 17%
BMI % 3% 57% 14% ---
77% provided on an annual basis
Obesity Prevention:Student-level intervention
NEVER RARELY SOMETIME
SOFTEN
Contact parent about a child-related weight concern?
10% 57% 31% 2%
Provide consultation to teachers about a student-related weight concern?
18% 40% 39% 2%
Check BP of an overweight child?
34% 43% 20% 3%
Check BMI of a child you think might be overweight?
62% 25% 10% 2%
Use BMI% to assess a child’s weight status?
59% 23% 12% 5%
Obesity Prevention:School-level intervention
NEVERRAREL
Y SOME-TIMES
OFTEN
Provide consultation to school administrators about health-related school policy?
11% 19% 43% 27%
Participate as a member of a school health council?
39% 17% 23% 20%
Monitor school nutrition practices, like food used in fundraising & as rewards for students?
39% 29% 26% 6%
Assess the nutrient quality of food & drinks sold to students at school from a la carte, vending machines, school stores & fundraising?
38% 24% 29% 8%
Monitor school physical activity practices, like student access to space & equipment for play before/after school?
49% 29% 17% 4%
Obesity Prevention:School Health Services & Nursing
Strongly Disagree/ Disagree
Uncertain
Strongly Agree/Agree
School health services should not be used for obesity prevention efforts.
73% 16% 7%
School administrators will support obesity prevention efforts at school.
10% 45% 42%
School nurses have adequate time to oversee & monitor obesity prevention efforts at school.
86% 7% 5%
School nurses are prepared to oversee & monitor obesity prevention efforts at school. 44% 26% 28%
Overall Findings:Nursing & School-based Obesity Prevention
Most reported limited involvement in delivering school-based services that target the prevention & treatment of overweight among students
Student level: > 50% never or rarely reported contact or counseling with parents or teachers about student-related weight concerns, checking BP or BMI in overweight child or using BMI% as an assessment tool
School level: > 65% never or rarely monitored school nutrition and physical activity practices or assessed nutrient quality of food & beverages sold to students at school
Overall Findings:Nursing & School-based Obesity Prevention
Most (73%) believed school health services should be used for obesity prevention.
Subset of schools nurses currently providing student & school-level interventions sometimes
Need for time & preparation to oversee & monitor obesity prevention efforts at school.
Clarification & development of role & responsibilities Support from school & nursing leaders
Research:Strengths & Limitations
Strengths: First survey to assess school nursing & obesity
prevention Statewide sample of licensed school nurses 80% response rate
Limitations: Self-report Response Bias Generalizeable beyond MN LSNs?
Conclusions:School Nursing & Childhood Obesity
Well-positioned to assume a key role in school-based obesity prevention efforts
Local State National
Require support to develop, integrate & sustain role Time Education & training Administrative
School Nursing
Further research Formative Intervention