School nurses' perceived barriers to discussing weight with children and their families: a qualitative approach

Previous studies have documented the presence of specific barriers to school nurses' communications with families about weight-related health. The purpose of the present study was to contribute to the literature by further analyzing, using focus group methodology, school nurses' perceived barriers to addressing weight-related health issues with children and their families.

Twenty-two school nurses from urban and rural school districts in the Midwestern United States participated in 7 focus groups during the spring semester of 2008. Sessions were recorded and transcribed in their entirety. Study authors reviewed the focus group content and identified themes of perceived barriers. NVivo 8 was used to code and evaluate themes.

Consistent with the extant literature, nurses identified a lack of knowledge and resources, personal weight challenges, lack of institutional support, and lack of time as barriers to weight-related communications with families. However, in addition to these previously identified barriers, nurses also identified family characteristics, child motivation, fear of reactions, and difficulty establishing relationships with children as barriers that impeded their communication with families about weight-related health.

As expected, the use of focus group methodology yielded evidence of barriers to communication that had not been previously identified in the literature, as well as those that had been well documented. Consistent with a socioecological view of pediatric healthcare, results suggest a number of systems that could be targeted to improve nurses' weight-related communications with families.