Motivational Interviewing by School Nurses: Spirit, Techniques, and Dilemmas in the Prevention of Child Obesity: Oral presentation

Title: Motivational Interviewing by School Nurses: Spirit, Techniques, and Dilemmas in the Prevention of Child Obesity
Introduction: School nurses play a central role in school-based, preventive health services in Denmark (National Board of Health, 2011), and they may play an important role in obesity prevention as well (Kubik et al., 2008). The City of Copenhagen has monitored the growth of school children for many years and has observed an increasing prevalence of overweight and obesity (Pearson et al., 2010). In response to this, The Child and Youth Department of Copenhagen chose a prevention strategy targeting children with a high risk of obesity with an intervention conducted by school nurses using motivational interviewing.Motivational interviewing is a counselling method to bring about behavioural change (Miller and Rollnick 1995). Effect has been documented for a range of problem behaviours related to lifestyle diseases in adults (Rubak et al. 2005; Söderlund et al. 2011). The use of motivational interviewing by school nurses for the prevention of child obesity in a family intervention is still new, and evidence on the potentials and problems is scarce (Resnicow, Davis and Rollnick, 2006; Morrison-Sandberg et al., 2011). Thus, the objective of this study is to investigate the experiences, practices and perceptions of school nurses when applying motivational interviewing to overweight children and their parents.
Theoretical/analytical framework: The study is based on the theory of motivational interviewing presented by its originators, Miller and Rollnick, in three conceptual papers (Miller & Rollnick, 1995; Emmons & Rollnick, 2001; Miller & Rose, 2009). The specific description of motivational interviewing varies slightly among the papers; however, a constant feature is that the techniques of the method are subordinated the spirit: “Motivational interviewing without this underlying spirit is no longer motivational interviewing” (Miller & Rose, 2009:535). From the three papers, we derived the keywords that characterize the spirit and the techniques of motivational interviewing to be used as a framework in the analysis.
Methodology/methods: The study was planned and carried out according to recommended stages of qualitative research interviewing (Kvale & Brinkmann, 2009). We conducted semi-structured, in-depth interviews with a purposive sample of twelve school nurses from twelve schools. The nurses were asked to bring three to four child records as cases for stimulated recall during the interview. The interviews lasted approximately one and a half hour and were audio recorded and transcribed verbatim. The interview material was coded and analysed in two steps: First, openly for what data told about motivational interviewing. Next, specifically according to the keywords of the motivational interviewing spirit and techniques.
Key results: The study showed that the motivational interviewing spirit and techniques are integrated, inseparable, and adapted by the school nurses. An example is to use the BMI-curve as a tool to inform about the overweight, and to use it with the spirit of motivational interviewing for evoking the child’s own concern, as illustrated in the following quote: “I show the BMI-curve and the dot where the child is placed on the curve. The goal is to make the child talk. Often they have noticed the overweight themselves and are concerned”. The study revealed three dilemmas with motivational interviewing for obesity prevention in children: when the parents did not perceive the child’s overweight as a problem, when the child and the parents were at different stages of motivation to change, and when an applying individualizing approach as motivational interviewing to a complex societal problem such as obesity. In the last case, with the risk of increasing social inequality in health, which is inherent in individualized prevention strategies.
Conclusion: Motivational interviewing as a counselling method with its techniques and underlying spirit was adapted by the school nurses and integrated in their practice. Three dilemmas were revealed with motivational interviewing for obesity prevention in children, which call for attention by researchers, managers, and practitioners of school health services.
Implications:Motivational interviewing spirit and techniques seem to be adaptable and useful for school nurses in counselling children and parents. However, further research and development should address the issues of adjusting the method to counselling families and children of different ages. When used for child obesity prevention, motivational interviewing was connected with dilemmas which should not be left to the individual nurse but be handled in practice by the school health service management. It is suggested to distinguish carefully between obesity prevention and obesity treatment. Further, it should be considered to use motivational interviewing for obesity treatment only. For obesity prevention it is suggested to prioritize carefully between a school-based strategy and a strategy of targeting individual high risk children. The role of the school health nurse in obesity treatment and obesity prevention should be analysed to assess where her efforts may have greatest impact – at individual child level or at school level.
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