1.1. Selection and description of included articles
The literature search generated a total of 8,842 references: 1,755 in PubMed, 3,478 in Embase.com, 532 in PsycInfo, 70 in IBSS, 1,755 in Scopus and 1,252 in Web of Science [see Additional File 1]. After removing duplicate references, 5,376 references remained. The flow chart for the search and selection procedure is presented in Figure 1.
The 11 included articles are listed in Table 1. Two articles focused only on child factors (25, 26), whereas the others also focused on parent and family factors as part of the assessment (27-35). Seven articles incorporated the broader healthcare process, including the assessment and the referral and treatment or weight management (26, 29, 30, 32-35).
Table 1. Description of included articles
Author
|
Year of publication
|
Title
|
Study type
|
Target population
|
Targeted professionals
|
Setting
|
Barlow et al. (28)
|
2014
|
Assessment of the obese child or adolescent
|
Literature review
|
Children or adolescent
|
Primary care providers
|
Not specified
|
Bauer et al.
(29)
|
2011
|
Assessment and management of obesity in childhood and adolescence
|
Literature review
|
2–18 years
|
Primary care providers
|
Not specified
|
Chung & Rhie (26)
|
2021
|
Severe obesity in children and adolescents: metabolic effect, assessment and treatment
|
Literature review
|
Children and adolescents
|
Medical and health professionals
|
Paediatric setting
|
Johansen et al.
(32)
|
2015
|
Danish clinical guidelines for examination and treatment of overweight and obese children and adolescents in a paediatric setting
|
Clinical guideline
|
Children and adolescents
|
Paediatricians, clinical dieticians, nurses, psychologists, social workers, physiotherapists
|
Paediatric setting
|
Jull et al.
(30)
|
2011
|
Clinical guidelines for weight management in New Zealand adults, children and young people
|
Clinical guideline
|
2–18 years
|
Primary healthcare providers
|
Primary care setting
|
Krebs et al.
(25)
|
2007
|
Assessment of Child and Adolescent Overweight and Obesity
|
Literature review
|
Children and adolescents
|
Physicians and other healthcare professionals/clinicians
|
Not specified
|
Phan et al.
(31)
|
2018
|
Impact of Psychosocial Risk on Outcomes among Families Seeking Treatment for Obesity
|
Prospective study
|
4–12 years
|
Not specified
|
Weight management clinic
|
Raatz & Gross (33)
|
2021
|
Clinical assessment and treatment of early onset severe obesity
|
Literature review
|
0–5 years
|
Not specified
|
Clinical setting
|
Schumann et al. (34)
|
2002
|
Preventing paediatric obesity: assessment and management in the primary care setting
|
Literature review
|
Children and adolescents
|
Primary care providers
|
Primary care
|
Styne et al. (35)
|
2017
|
Paediatric obesity – assessment, treatment, and prevention: endocrine society clinical practice guideline
|
Clinical guideline
|
Children and adolescents
|
Paediatricians
|
Paediatric setting
|
Varkula et al.
(27)
|
2009
|
Assessment of overweight children and adolescents
|
Book chapter
|
Children and adolescents
|
Mental health professionals
|
Speciality clinic
|
1.2 What to include in a psychosocial and lifestyle assessment
Factors that could potentially contribute to the development and maintenance of childhood obesity are presented in Table 2. Assessment factors have been classified as child, family, parental and lifestyle factors and structured into psychological and social aspects. An extensive table with the original description of the factors has been included as supplementary information [see Additional File 2]. Although all articles described biomedical factors (e.g. anthropometric methods) as part of the assessment, these factors were not included in the present study (25-35). In general, the articles devoted greater attention to biomedical factors than to psychosocial factors.
Table 2 Assessment categories, aspects and factors from the included studies
Author
|
|
|
|
Barlow et al
|
Baur et al.
|
Chung & Rhie
|
Johansen et al.
|
Jull et al.
|
Krebs et al.
|
Phan et al.
|
Raatz & Gross
|
Schumann et al.
|
Styne et al.
|
Varkula et al.
|
Year
|
|
|
|
2014
|
2011
|
2021
|
2015
|
2011
|
2007
|
2018
|
2021
|
2002
|
2017
|
2009
|
Category
|
Factors
|
Aspect
|
Subfactor
|
|
|
|
|
|
|
|
|
|
|
|
Psychosocial
|
Child
|
Psychological
|
Depression
|
X
|
x
|
x
|
x
|
x
|
x
|
x
|
|
x
|
x
|
xx
|
|
|
Disordered eating
|
X
|
x
|
x
|
x
|
|
x
|
|
|
x
|
x
|
x
|
|
|
Anxiety
|
X
|
|
x
|
x
|
|
x
|
|
|
x
|
x
|
|
|
|
Self-esteem
|
X
|
x
|
|
x
|
|
x
|
|
|
x
|
|
x
|
|
|
Body image
|
X
|
|
|
x
|
|
x
|
|
|
x
|
|
x
|
|
|
Adverse events
|
|
|
|
|
x
|
xx
|
x
|
|
|
|
x
|
|
|
Weight management
|
|
x
|
|
|
x
|
|
|
|
xx
|
|
x
|
|
|
Consequences of weight
|
|
|
|
|
x
|
|
|
|
x
|
|
x
|
|
|
History of weight
|
|
x
|
|
|
|
|
|
|
|
|
x
|
|
|
Other
|
|
|
|
x
|
|
|
|
x
|
|
x
|
x
|
|
|
Social
|
Bullying
|
x
|
x
|
|
x
|
x
|
|
|
|
|
x
|
x
|
|
|
Education
|
|
|
|
x
|
|
x
|
|
|
x
|
x
|
x
|
|
|
Social interaction
|
|
|
|
|
|
x
|
x
|
|
x
|
|
xxx
|
|
|
Loneliness
|
|
|
|
x
|
x
|
|
|
|
|
x
|
|
|
|
Other
|
|
|
x
|
|
|
|
|
|
|
x
|
|
|
Family
|
Social
|
Functioning
|
x
|
x
|
|
x
|
|
|
xx
|
x
|
x
|
x
|
x
|
|
|
Culture
|
x
|
x
|
|
x
|
x
|
|
|
|
|
|
|
|
|
Social support
|
|
|
|
|
|
|
x
|
x
|
x
|
|
x
|
|
|
Family perception
|
|
|
|
|
|
|
x
|
|
x
|
x
|
|
|
|
Parenting style
|
x
|
|
|
|
|
|
x
|
|
x
|
|
|
|
|
Relationships
|
|
x
|
|
|
|
|
x
|
|
|
|
x
|
|
|
Rules
|
|
x
|
|
|
|
|
|
|
|
|
x
|
|
|
Other
|
x
|
|
|
|
|
|
|
|
|
|
x
|
|
Parent
|
Psychological
|
Mental well-being
|
|
x
|
|
|
|
|
xx
|
|
|
x
|
x
|
|
|
Other
|
|
|
|
|
|
|
x
|
|
|
|
|
|
|
Social
|
Financial situation
|
x
|
x
|
|
|
|
|
xx
|
xx
|
xx
|
|
|
Lifestyle
|
Nutrition
|
Food intake
|
Drinks
|
xx
|
x
|
x
|
x
|
X
|
xx
|
|
|
|
x
|
|
|
|
Fast food
|
|
x
|
x
|
x
|
xx
|
x
|
|
|
|
x
|
|
|
|
Portion size
|
x
|
|
x
|
x
|
|
x
|
|
|
|
x
|
x
|
|
|
Snacks
|
x
|
x
|
x
|
x
|
|
x
|
|
|
|
|
x
|
|
|
Fruit & vegetables
|
x
|
|
|
x
|
|
x
|
|
|
|
x
|
|
|
|
General diet
|
|
|
|
|
|
|
|
x
|
x
|
|
x
|
|
|
Breakfast
|
|
x
|
|
|
|
x
|
|
|
|
|
|
|
|
Appetite
|
|
|
x
|
x
|
|
|
|
|
|
|
|
|
|
Psychological
|
Readiness to change
|
x
|
|
|
|
x
|
x
|
|
|
x
|
|
x
|
|
|
Self-efficacy
|
x
|
|
|
|
|
x
|
x
|
|
|
|
x
|
|
|
Other
|
x
|
|
|
|
|
|
|
|
x
|
|
x
|
|
|
Social
|
Routine
|
x
|
x
|
|
|
|
|
|
|
|
|
xx
|
|
|
Eating outside the home
|
x
|
|
|
|
|
x
|
|
|
|
|
x
|
|
|
Frequency
|
x
|
|
|
|
|
x
|
|
|
|
x
|
|
|
|
Location of meal
|
x
|
|
|
|
|
|
|
|
|
|
x
|
|
|
Other
|
x
|
x
|
|
|
|
|
|
x
|
|
|
xx
|
|
Physical activity
|
Physical activity
|
Usual amount of time
|
|
|
|
|
x
|
x
|
|
x
|
x
|
x
|
x
|
|
|
Sports
|
x
|
x
|
|
x
|
|
x
|
|
|
x
|
|
|
|
|
Unstructured PA
|
xx
|
x
|
|
x
|
|
x
|
|
|
|
|
|
|
|
Transportation
|
x
|
x
|
|
x
|
|
x
|
|
|
|
|
|
|
|
Routine PA
|
x
|
|
|
|
|
x
|
|
|
x
|
|
|
|
|
Other
|
xxx
|
x
|
|
|
|
|
|
|
|
|
|
|
|
Sedentary behaviour
|
Access to screen
|
x
|
x
|
x
|
|
|
x
|
|
|
x
|
x
|
|
|
|
Screen time
|
x
|
x
|
|
x
|
|
|
|
|
x
|
x
|
|
|
|
Usual amount of time
|
|
|
|
|
x
|
x
|
|
x
|
x
|
|
x
|
|
|
Other
|
|
x
|
|
|
|
|
|
|
x
|
|
|
|
|
Psychological
|
Self-efficacy
|
x
|
|
|
|
|
x
|
x
|
|
|
|
x
|
|
|
Readiness to change
|
x
|
|
|
|
x
|
x
|
|
|
x
|
|
|
|
|
Enjoyment
|
x
|
|
|
|
|
|
|
|
|
|
xx
|
|
|
Other
|
|
|
|
|
|
|
|
|
|
|
xx
|
|
|
Social
|
Family activities
|
x
|
x
|
|
|
|
x
|
|
|
|
|
|
|
Access
|
x
|
|
|
|
|
x
|
|
|
|
|
|
|
Support
|
x
|
|
|
|
|
x
|
|
|
|
|
|
|
Other
|
|
|
|
|
|
x
|
|
|
|
|
|
|
Sleep
|
Sleep behaviour
|
Disorders
|
x
|
x
|
x
|
x
|
x
|
x
|
|
|
|
|
|
|
|
Disturbances
|
|
x
|
|
x
|
xx
|
x
|
|
|
|
|
|
|
|
Routine
|
|
x
|
|
x
|
x
|
|
|
|
|
|
x
|
|
|
Amount of sleep
|
|
|
x
|
|
|
|
|
x
|
|
|
|
|
|
Social
|
Hygiene
|
|
|
|
|
x
|
|
|
|
|
|
|
Number of times mentioned in an article: ‘x’: once; ‘xx’: twice; ‘xxx’: three or more times.
1.2.1 Psychosocial assessment
The extent to which psychosocial factors were described in the articles varied from elaborate descriptions, including assessment techniques and examples of questions for both children and parents (27), to a table containing brief descriptions of psychosocial problems (25).
1.2.1a Factors related to the child
Psychological factors of the child included weight-related depression and anxiety, eating disorders, self-esteem and body image, which are specific to the assessment of childhood obesity, as opposed to more generic assessments (25-30, 32, 34, 35). Additionally, three articles included the identification of adverse events, such as major family events and a history of abuse or neglect (25, 27, 31).
In nine articles, social concerns (e.g. bullying, loneliness or problems with social interaction) were identified as social factors of the child (25, 27-32, 34, 35). Five articles noted to the importance of considering education (e.g. school avoidance and school performance) (25, 27, 32, 34, 35).
1.2.1b Factors related to the family
One major aspect of social factors of the family identified in most assessments is the importance of determining family functioning in terms of environment, structure, composition or other aspects (27-29, 31-35). Four assessments included ethnicity and cultural factors, albeit to varying extents (28-30, 32). For example, one assessment in the form of a clinical guideline was specifically intended for minority populations (i.e. Maori, Pacific and South Asian populations) (30).
1.2.1c Factors related to the parents
Four articles reported psychological factors of the parents that related to mental well-being. These articles differed in the extent to which the factors were described in relation to childhood obesity. Factors reported included adverse events, mental health concerns and eating disorders (27, 29, 31, 35). The social factor of the parents that was most prominently identified as being important to take into account was financial situation (28, 29, 31, 33, 34). Six articles did not consider social parental factors (25-27, 30, 32, 35).
1.2.2 Lifestyle assessment
Ten articles included the assessment of nutrition and physical activity as part of the lifestyle assessment (25-30, 32-35). The majority of the lifestyle assessments focused on the current lifestyle behaviour, and one article also focused on the adoption of desired healthy lifestyle behaviours by the entire family (nutrition education and physical activity) in addition to current lifestyle behaviour (25).
The specificity and extent of nutritional and physical activity assessment varied, as did the extent of resources provided to professionals. For example, one nutritional assessment offered a structured assessment to ensure the inclusion of relevant information concerning details of eating habits, including intake of sugar-sweetened beverages, milk and juices, fruits and vegetables, snacks and fast food, as well as appetite and portion size (32). Physical activity assessments included details on time spent in a variety of activities or organised sports, transportation to and from school, time spent in sedentary behaviour and screen time per day.
The focus on the psychological and social aspects of nutrition and physical activity varied, and these aspects were not considered in a literature review and a clinical guideline for the examination and treatment of children and adolescents with obesity (26, 32). Psychological aspects of nutrition and physical activity were mentioned in six assessments and in relation to readiness to change and the level of confidence in the ability to make changes (self-efficacy) (25, 27, 28, 30, 31, 34).
The majority of the assessments mentioned sleep behaviour as potentially contributing to excessive weight gain during childhood (25-30, 32, 33, 36). Most of the articles did not describe sleep patterns as part of lifestyle factors, but often as part of the biomedical assessment. For example, some assessments included the identification of various sleep-related problems, including disordered sleep, obstructive sleep apnoea syndrome and disruptive snoring (25, 26, 28-30, 36).
1.3 How to conduct a psychosocial and lifestyle assessment
The included articles focused on what to include in a psychosocial and lifestyle assessment. Eight of these articles also paid attention to how to conduct the assessment of psychosocial and lifestyle factors (25, 27-31, 35). These findings were divided into the three most prominent themes: (a) talking about psychosocial factors, lifestyle and weight; (b) the professional-patient relationship; and (c) attitudes of healthcare professionals.
1.3.1 Talking about psychosocial factors, lifestyle and weight
As noted by Barlow et al. and Varkula et al., it is important to communicate sensitively and introduce the topic carefully (e.g. by asking whether a patient or parent has any concern about the child’s weight) (27, 28), as children and parents might feel ashamed and defensive about obesity (28). They further advised HCPs to use the terms preferred by parents (27, 28). According to Jull, HCPs should avoid jargon and explain any health terms clearly, in addition to reflecting on their own communication preferences (e.g. the words and tone used; body language) (30).
Four articles paid explicit attention to behaviour change techniques (e.g. goal setting, stimulus control and self-monitoring) and conversational techniques (e.g. motivational interviewing) that should be applied (25, 29, 31, 35). According to Johansen et al., open-ended questions and reflective listening techniques could help direct communication towards changes in behaviour (29).
1.3.2. The professional-patient relationship
The importance of the professional-patient relationship was explicitly mentioned in articles by Jull et al. and Varkula et al. (27, 30). According to these two articles, early rapport building and a non-judgmental demeanour are of the utmost importance to the ideal assessment and management of childhood obesity. The authors stressed the vital importance of involving the family and engaging with children and families, building enhancing and collaborative relationships, and showing genuine respect (27, 30).
1.3.3 Attitudes of healthcare professionals
As noted in studies by Barlow et al., Baur et al. and Jull et al., ideal assessment and management calls for HCPs to adopt an emphatic, supportive, non-judgmental and collaborative attitude (28-30).
2. Focus groups
2.1 Study characteristics
An overview of the self-reported general characteristics of the focus-group participants is presented as supplementary information [see Additional File 3]. In all, 28 professionals participated in the study, one of who participated in two focus groups. Four other professionals cancelled their participation due to personal circumstances. The mean age of the participants was approximately 45 years, and 25 (89%) of the participants were female.
The participants represented a total of 35 functions, as several participants combined multiple functions. The focus groups included professionals working 15 different positions at a variety of levels in the healthcare system, ranging from community care to secondary care: integrated (or general) care advisors (n=8; 27.6%), YHC nurses (n=6; 17.1%), CPs (n=5; 14.3%), YHC doctor (n=3; 8.6%), paediatricians (n=2; 5,7%), project leaders of the local integrated care approach (n=2; 5.7%), managers of the local integrated care approach (n=2; 5.7%), specialised YHC nurses (n=2; 5.7%), professor of nutrition and health (n=1; 2.9%), social worker (n=1; 2.9%), dietician (n=1; 2.9%), researcher (n=1; 2.9%) and trainer and developer of national education for CPs (n=1; 2.9%). An overview of the distribution of positions is provided as supplementary information [see Additional File 3].
The participants represented a total of 29 different organisations, most within the municipal health services (n=12; 41.4%). Other organisations included a municipality (n=3; 10.3%), ‘Youth on a Healthier Weight’ (JOGG) (n=3; 10.3%), a hospital (n=2; 6.9%), the Netherlands Youth Institute (n=2; 6.9%), the Dutch Centre for Youth Healthcare (n=2; 6.9%), a dietician practice (n=1; 3.5%), a university (n=1; 3.5%), a primary school (n=1; 3.5%) and a professional association (n=1; 3.5%). One participant (3.5%) was self-employed. An overview of the organisations represented is provided as supplementary information [see Additional File 3].
2.2 What to include in a psychosocial and lifestyle assessment
Relevant factors that should be taken into account as part of the assessment have been classified as child, family, parental and lifestyle factors and structured into psychological and social aspects.
2.2.1 Psychosocial assessment
2.2.1a Child factors
Factors that participants identified as important to consider focused largely on the well-being of the child, stress and relaxation. The participants also emphasised the importance of discussing the strengths and capabilities of the child and family. Depending on the child’s age (predominantly with children aged 12 years and older), factors such as peer pressure, gaming behaviour and gaming in combination with sleeping were regarded as relevant.
When children go to secondary school, they often have money and go along with the group. Those who can’t afford to buy snacks between meals are in an awkward position, because the rest of the group is going, and they like these things as well. (Focus group 2, R5)
2.2.1b Family factors
Participants emphasised the need to consider various aspects of family functioning, including the family situation and composition (e.g. separated parents and blended families) and mutual relationships between family members. They also mentioned the importance of assessing parenting skills, including the following topics: parental trust, setting clear boundaries, parental attitudes and beliefs with regard to upbringing, parental agreements on parenthood, and the experiences of parents with their own upbringing. According to the participants, co-caregivers (e.g. grandparents, daycare workers) who play a role in childcare and who bear some responsibility for upbringing should also be taken into account, given the critical importance of agreements on upbringing and lifestyle behaviour between caregivers.
Grandparents play an important role in families, and their views often conflict with those of the parents. Many parents are glad when grandparents are willing to take on a caregiving role. When grandparents want to reward children with fast food, sweets or salty snacks that the parents don’t approve of, however, this places the children under pressure. It’s obviously important for these things to be clear. The issue thus often goes beyond children and their direct caregivers to include the environment as well. (Focus group 4, R4, Pos. 53)
Finally, the participants noted that it is helpful to consider the environment of the family (e.g. social support, the networks of the parents, perception of weight by peers and culture).
And there should also be a cultural connection: the meaning of food in a family, sociability, hospitality, et cetera. (Focus group 2, R5, Pos. 96)
2.2.1c Parental factors
Participants noted the importance of considering whether parents have a job and what their work situation is. They also considered it important to talk about the financial possibilities, stress and relaxation of the parents.
I would like to see more attention to stress and relaxation, and what they need in that regard. This refers to factors that children experience as stressful, as well as those that parents see as stressful, as they are not necessarily the same. This is an important distinction. (Focus group 4, R4, Pos. 77)
2.2.2 Lifestyle assessment
Given that the focus groups centred on psychosocial factors, and given that participants felt that the current psychosocial and lifestyle assessment places sufficient emphasis on lifestyle factors, no additional lifestyle factors were mentioned.
It can be tempting to focus more on lifestyle issues and less on the underlying psychosocial issues or factors. I think people need more help in order to consider the issue more broadly. (Focus group 1, R4, Pos. 31)
2.3 How to conduct a psychosocial and lifestyle assessment
The experiences and views of HCPs with regard to the assessment of psychosocial and lifestyle factors also addressed the issue of how to conduct the assessment of psychosocial and lifestyle factors. The findings emerging from the analysis of the focus-group discussions were classified according to the three most prominent themes: (a) talking about psychosocial factors, lifestyle and weight; (b) the professional-patient relationship; and (c) attitudes of healthcare professionals.
2.3.1 Talking about psychosocial factors, lifestyle and weight
Participants emphasised the importance of talking about psychosocial factors, lifestyle and weight in order to gain insight into the factors that may contribute to the development and maintenance of obesity and to ensure a contextualised and comprehensive understanding of children with obesity and their circumstances. They specifically highlighted the sensitivity of the topic of obesity and some psychosocial factors. According to the participants, children and their parents may feel guilt and shame because of their weight, possibly leading them to avoid talking about obesity, psychosocial factors, lifestyle and weight, in addition to avoiding future appointments.
The way you introduce the conversation is important, given the vulnerability associated with obesity. The words used and questions asked are very important, as it can quickly seem like an interrogation. (Focus group 3, R6, Pos. 170)
The way you introduce the conversation is important, given the vulnerability associated with obesity. The words used and questions asked are very important, as it can quickly seem like an interrogation. (Focus group 2, R5, Pos. 159)
In order to prepare children and parents, participants stressed the crucial importance of explaining the need to assess the broader circumstances of children and their families, as they are likely to expect the assessment to focus only on weight and lifestyle. The participants also highlighted the need for CPs to acknowledge and explain the complexity of obesity. More specifically, children and parents should be aware of factors that influence their behaviour and weight. According to the participants, practical tools may help professionals to present interacting factors in a visual, non-judgmental manner, thereby facilitating conversations about psychosocial factors, lifestyle and weight.
Even if you already know the families, it’s important to explain why you want to take a broader look at the family at that particular moment. (Focus group 5, R8, Pos. 65)
We all know that conversations on this topic are difficult. It’s extremely important to explain why we’re asking these questions and what they actually have to do with each other. This is obvious to us, but not necessarily to parents. (Focus group 3, R6, Pos. 114)
Sufficient knowledge about the complexity of obesity, healthy food and the tools that are available were mentioned as important means of enabling professionals to conduct psychosocial and lifestyle assessments. Communication skills (e.g. applying various conversational techniques, such as motivational interviewing and solution-focused counselling) were also identified as a key element.
It requires interviewing skills to make contact in an interested, professional manner without going straight for the target. (Focus group 1, R2, Pos. 166)
Participants felt that it is more difficult to discuss psychosocial factors, lifestyle and weight with families with different cultural backgrounds who either have low literacy or face language barriers, and that the assessment thus needs more attention.
For parents with language problems, it is sometimes not until the second or third session that they start to understand what I meant when I asked if a dietician had already visited them or if they have had any previous help. I would actually have liked for that to have been the case at the first session. (Focus group 2, R5, Pos. 62)
I’ve noticed that assessments are quite difficult when dealing with other cultures. It requires a lot of explanation, especially for people with a different background who don’t speak Dutch. This obviously makes the conversation quite different. (Focus group 2, R3, Pos. 22)
2.3.2. The professional-patient relationship
The participants regarded the professional-patient relationship as important to both the assessment and the management of childhood obesity. Given that it often takes considerable time to build rapport and a trusting relationship with children and their parents, the participants noted that multiple consultations may be required in order to conduct psychosocial and lifestyle assessments.
I’ve also noticed that questions can be too daunting for a first conversation. There might still be some resistance if I were to try to address that right away. It sometimes takes several sessions before it’s safe enough. (Focus group 2, R4, Pos. 80)
With regard to the professional-parent relationship, CPs should 1) introduce their role and take time to explain the value of talking about psychosocial and lifestyle factors for both the child and the parents; 2) get to know the family better by asking about and trying to understand their living circumstances; and 3) create clear expectations about the care process.
I also think it’s good for coordinating professionals to introduce themselves: who I am and what I can do for them. This is not always clear to parents. (Focus group 5, R7, Pos. 70)
It’s really helpful to create a bond of trust and to help children and their parents to feel that you’re genuinely interested in them, and not just in the excess weight or how the child is eating and exercising. This completely changes the conversations. (Focus group 4, R4, Pos. 59)
2.3.3 Attitudes of healthcare professionals
Participants expressed that conducting a psychosocial and lifestyle assessment requires an attitude shift for most CPs. They stressed the need for CPs to be ‘demand-oriented’ and patient with regard to the priorities and requests of children and their families. Adopting an interested, curious and empathic attitude was considered helpful during the assessment. The participants highly endorsed the use of open-ended questions and engaging in active listening with a non-patronising attitude.
You have to have a particular mindset. You’re asking something completely different of professionals. Everyone might say, ‘Yeah, we know’. They might hear it, and it might sound good, but translating it into action really does ask something of them. (Focus group 1, R6 Pos. 39)