The aim of the current study was to examine self-efficacy and perceived barriers of Dutch HCPs in regard to talking about weight and lifestyle when treating children with overweight or obesity and their parents, and assess interdisciplinary differences. On average, HCPs rated their self-efficacy fairly good (mean SE 7.2). However, 1 in 15 (6.9%) rates their self-efficacy ≤ 5, almost all HCPs (94.6%) perceive at least one barrier and 1 in 10 (9.6%) avoids talking about weight and lifestyle due to barriers. Moreover, HCPs from all 7 professions, overall 1 in 7 (14.2%), reported that they felt incapable of addressing weight and lifestyle when treating children with overweight or obesity. Underlying barriers that were reported included both internal and external factors.
In our study, interdisciplinary differences were found: Pediatricians had the highest SE ratings and lowest number of PBs, in contrast to GPs with the lowest SE ratings and highest numbers of PBs. In addition, large intra-disciplinary differences were found, e.g. pediatricians rated their SE on average a 8.1, however still 1 in 8 (12.9%) pediatricians perceived to many barriers to address weight and lifestyle when treating children with overweight or obesity. In recent Canadian studies similar large interindividual differences within groups of pediatricians were reported (16, 17). It is important to know that the role of pediatricians in the Netherlands is different in comparison to other countries. Pediatricians in other countries also provide primary health care (18, 19), while in the Netherlands they are medical specialists and provide only secondary or tertiary care. The work of a pediatrician in other countries is more comparable to our GPs and YHCPs. These differences in tasks could lead to interdisciplinary differences in self-efficacy and perceived barriers, hampering direct comparisons between countries and healthcare systems. Moreover, the observation that SE ratings are relatively high, might not relate to their competence, but instead could also reflect unconscious incompetence. However, a recurring finding is that there is a rather high chance that a child with overweight or obesity comes across one or more professionals that do not feel secure about their capabilities in talking about weight and lifestyle and avoids the topic when discussing a patient’s health (6, 9).
In the current study both external (i.e. task attributes and complexity, and the organization of health care), as well as internal determinants of self-efficacy (i.e. individual knowledge, skills and personality) were reported to form a barrier for optimal obesity care for children (13). Interestingly, in our study we found that HCPs who almost always discuss weight and lifestyle reported more often external barriers, whereas HPCs that perceive too many barriers to discuss this topic reported more often internal barriers and rated their self-efficacy significantly lower. Furthermore, many HCPs perceived more problems in talking about weight and lifestyle in cases when parents had overweight or obesity, and/or when they expected that the child and/or parent would react negatively. This relates to stigmatization of people with obesity that is present among the general public as well as among HCPs (20, 21) and asks for education in communication strategies to address this sensitive topic (22), thereby improving HCP’s perceived self-efficacy and reducing barriers (2, 14, 15, 23, 24). Furthermore, the majority of doctors (GPs, YHCPs and pediatricians) reported that insufficient time is a barrier to talk about weight and lifestyle. This is a commonly reported barrier in other studies as well, and asks also for health delivery system changes (2, 14, 15, 23, 24). Next to education, an improved and sustainable financial and infrastructural framework is necessary to reduce the obesity stigma, improve obesity care for children, and positively impact HCP’s perceived self-efficacy and barriers (6, 9, 20, 21).
The current study has some limitations. First, the sample sizes per subgroup of professionals were limited. Especially, the GPs and pediatricians were underrepresented. Moreover, within one subgroup, colleagues from the same discipline though possibly from different levels of care (i.e. mental health professionals working in either primary, secondary or tertiary care) were grouped. Therefore discipline-specific results should be interpreted with caution. Second, there is a high chance of selection bias, i.e. some professionals might have been more inclined to fill in the questionnaire than others. Third, it is possible that professionals gave socially desirable answers. Fourth, we asked HCPs to report perceived capabilities and have not evaluated correlated behavior or practical skills.
The study also has strong points. First, the inclusion of 7 different groups of professionals, covering all levels of obesity care within both the medical and social domain. In addition, it is the first study that investigated self-efficacy and perceived barriers in the Dutch healthcare setting, among HCPs in regard to talking about weight and lifestyle when treating children with overweight or obesity.
To conclude, Dutch HCPs that work in obesity care for children rate their self-efficacy on average fairly good. However, still a child with overweight or obesity has a high chance of coming across an HCP that feels incapable to address weight and lifestyle in a conversation (1 in 7, 14.2%, for each time facing a new HCP). Accordingly, for a subgroup of HPCs major improvements in the health delivery system, including educational, infrastructural and financial factors, are necessary to overcome both internal and external barriers that were reported to potentially result in avoidance to discuss weight and lifestyle when treating children with overweight or obesity. To optimally target such improvements, the relation between SE ratings, knowledge and skills, i.e. the quality of care, needs to be evaluated. Moreover, future research is necessary to study why some HCPs perceive barriers yet feel capable to address the topic, whereas others avoid the topic when appropriate, despite a similar number of perceived barriers.