Free Research Proposal About The Effect Of Nurses' Health Beliefs/Behaviors On BMI And Obesity

Specific Aim

The study aims to explore the dynamics of nurse-patient relationship in the context of obesity management. The specific aim is to understand the effect of nurse’s own knowledge, beliefs and attitudes towards obese individuals, on the treatment of obesity. It will also assess nurse’s awareness and perceptions regarding use of BMI as an obesity monitoring tool.
The purpose of this study is to assess whether subjective biases and perceptions of care providers are a barrier for obesity prevention and treatment interventions. It will explore how nurse’s attitudes and beliefs towards obese individuals may impact the quality and efficacy of obesity management. Given the important role of health education in promoting healthy lifestyles (a key strategy in obesity management), understanding the barriers to, and, determinants of, quality health education is a key imperative.
Obesity is an important risk factor for cardiovascular morbidity and mortality. Despite the known health benefits of preventing and treating obesity, the lack of awareness among patients and care providers has been well documented. Further, ‘Body Mass Index’ (BMI) is a useful tool for weight management. However, it is not consistently employed in health settings. Nurses play an important role in helping patients achieve treatment goals. Several studies have revealed a general tendency among care providers to ignore health education as an integral part of medical treatment. (Engström, Skytt, Ernesäter, Fläckman, a&Mamhidir, 2013) This is often due to constraints of time and resources besides deficiencies in the nurse’s knowledge of the subject. (Engström et al., 2013) The lack of use of BMI as a tool in obesity management may also be the result of a knowledge gap or lack of interpersonal skills, besides unfavorable attitudes of nurse’s towards obese individuals. Studies have shown that in more than half of all clinical encounters, care providers fail to counsel the obese patient on lifestyle modification. (e.g., increasing physical activity, diet counseling) A study of patients with chronic morbidity, health education was not done in more than half of all diabetic and/or obese patients. (Ritsema, Bingenheimer, Scholting, & Cawley, 2014).
Although health education is an important component of care in patients with chronic conditions, the extent of use of health education in nursing practice is rather limited. Further, the tendency to use health education is liable to be influenced by the nurse’s own perceptions and beliefs. In order to overcome this major gap in treatment of obesity, understanding of the contributing factors is important. Moreover, improving obesity prevention and management would require optimal training of nurses in the identified areas. The proposed study will help identify weak areas for nurse capacity building.
The global epidemic of obesity requires a strategic approach including augmenting the ability of clinicians to provide support and education to patients suffering from this chronic condition. (Ogden, et al. 2014) However, the ability to effectively provide this support is often contingent on the beliefs and attitudes of care providers towards obese individuals. In-depth evaluation of this relationship will assist in formulating a better approach and improved compliance with practice recommendations concerning patient education.
It is not clear how the nurse’s own perceptions of obesity influence their ability to provide meaningful health education to obese patients. Moreover the effect of nurses attitudes (towards obesity) on the quality of health education sessions (e.g., by adequate use of educational aids) is a subject worthy of research.

The specific aims are:

The goal of this study is to contribute towards improving nurse’s capacity and efficacy in implementing evidence-based interventions for obesity management. By identifying the key bottlenecks preventing use of evidence-based recommendations for managing obesity, this study will help develop appropriate interventions.

The research questions are as follows:

How does a nurse’s own attitudes and behaviors towards obese individuals affect their capacity and efficacy in managing obese patients.
What is the nurse’s knowledge level and perceptions regarding use of BMI for monitoring obese patients? How does this affect outcomes in obesity management?

Hypotheses (Assumptions)

Nurse’s negative attitude towards obese patients negatively affects the quality of health education as part of treatment of obesity.
Capacity building of nurses in using BMI as an obesity monitoring tool will lead to improved patient compliance and better treatment outcomes in obese patients

Background

Primary care settings are ideal for health promotion interventions that aim to promote healthy lifestyles. Obesity is a major risk factor for chronic cardiovascular morbidity (including, heart disease, diabetes and hypertension, etc.). Management of these diseases requires long term treatment that imposes heavy burden and costs on health systems. Given its increasing prevalence, prevention and management of obesity is a key health priority which can accrue substantial long term gains. Due to their close interaction with patients, nurses can play a key role in prevention and treatment of obesity.
Negative attitudes towards obesity like stigma, discrimination and harassment could be a barrier preventing obese individuals from accessing health care services. Behavioral interventions (e.g., life style modification by counseling) play an important role in prevention and treatment of obesity. Moreover, care providers own attitudes, beliefs and biases may affect the way in which they relate to an obese patient. The hallmark of culturally competent health care is a healthy nurse-patient relationship that is non-discriminatory, non-judgemental and mutually respectful.
Being a key determinant of treatment outcomes, understanding the effect of nurse’s own attitudes and beliefs on treatment outcomes will help obesity management programming.
Several studies concerning obesity are available in the literature. However, few studies have captured the relationship of nurse’s personal attributes on treatment outcomes in its entirety.
A recent survey showed that a lack of knowledge and time may prevent nurses from adequately discussing the subject of BMI with the patients. The study also suggests a generally low awareness among obese patients pertaining to BMI. It is also known that lack of adequate skills among nurses or low level of self-perceived efficacy could lead to frustration and affect job performance. (Rogge and Merrill, 2013)
A cross sectional survey of 352 nursing students and 198 registered nurses in an institutional setting in Hong Kong revealed a high prevalence of negative attitudes towards obese individuals, among both students and registered nurses. (Poon & Tarrant, 2009) More importantly, the authors report that registered nurses were more prone to have negative attitudes than the nursing students. The survey methodology involved calculation of body mass indices, besides use of ‘Fat Phobia Scale’, and, ‘Attitude Towards Obese Adult Patients Scale’. Analysis revealed a high prevalence of negative attitudes and stereotypical perceptions of obese individuals among study subjects. These included attributing obesity to lack of dietary discipline and self control on the part of patient. (Poon & Tarrant, 2009) The study provided a valuable perspective that can feed into appropriately targeted interventions for building capacity of the nursing cadre.
A multi-centre qualitative study of 247 nurses conducted across 33 centers in Sweden reflected a willingness among nurses to educate obese patients. (Engström, Skytt, Ernesäter, Fläckman and Mamhidir, 2013) However, time and resource constraints often limited the quality of health education provided by them to these patients. This might limit their ability to use BMI as a patient education and monitoring tool.
Robinson, et al. (2013) found evidence of improved patient engagement and treatment compliance with use of educational materials that helped understand the concept of BMI. Using BMI for managing obesity, might be a useful value addition in treatment of obesity. (Robinson, Denney-Wilson, Laws, and Harris, 2013)
Also, Stokes (2014) found merit in adequate explanation of the relevance of BMI, as a monitoring tool, to patients. Besides providing objective measure of treatment progress, use of BMI may benefit patient motivation, since it does away with the tendency for frequent weight measurements on the part of patient. (Stokes, 2014)
Nurse’s have a key role in supporting obese patients in the adoption of healthy lifestyles, thereby preventing complications and improving treatment outcomes. (Robinson, D-Wilson, Laws & Harris, 2013). However, the relationship between a nurse’s own opinion about obese patients, and their likelihood of taking interest in educating such patients, is largely unexplored. Since use of health education materials (e.g., visual aids) is likely to improve the patient’s understanding and information retention, the subject is worthy of investigation.
Esposito and Fitzpatrick (2011) have emphasizes the role of nurses in modeling healthy behaviors among patients. In their qualitative study based on Pender Health Promotion theory, they were able to demonstrate the importance of nurse’s own healthy lifestyle as a positive influence that promotes adoption of healthy habits by patients. (Esposito & Fitzpatrick, 2011) The study involved survey of 112 nurses working at Long Island Hospital. The authors resorted to a convenience sampling strategy, a factor that limits the representativeness of the study results. However, the study results do have face validity and it is hard to dismiss the conclusions drawn by the authors; i.e., the nurses' personal image, competence and personal habits influence adoption of healthy lifestyle among obese patients under their care. (Esposito & Fitzpatrick, 2011)
Lewis et al. (2010) conducted a telephonic survey of 141 individuals with moderate to severe obesity in Australia. Thematic data analysis revealed considerable variations in knowledge levels and information needs among this group of individuals that is at risk of serious morbidity owing to obesity. (Lewis, Thomas, Blood & Hyde, et al. 2010)
Karnon et al. (2013) explored the feasibility of alternate models of primary health care in order to improve management of adult obese patients. Their comparative analysis of risk-adjusted cost-effectiveness showed that more efforts and resources spent in improving obesity is possible and doing so would entail system-wide savings in the medium to long term. (Karnon, Afzali, Gray & Holton, et al. 2013) The study conducted in Silver Springs, Colorado also found a major unmet need among obese patients, in terms of lack of support provided by their care providers. The authors claim that using opportunities to educate patients regarding obesity and better use of BMI in weight loss monitoring, may yield substantial benefits without disproportionally escalating costs. With relatively small increase in time and resource investment, management of obesity can be improved with significantly increased system-wide efficiencies. This can also potentially improve patient motivation and thus can improve treatment outcomes in obesity.
Acheampong and Haldeman (2013) explored children's beliefs concerning healthy behaviors in their study involving 364 participants, over a five-year period in North Carolina. (Acheampong & Haldeman, 2013) Investigators elicited children’s attitudes and knowledge regarding BMI and healthy dietary behaviors. About 29.4% of Hispanics and 18.5% of African Americans perceived themselves as unhealthy, and reflected an unmet need for better targeted health education in this vulnerable population subset. As benefits of using educational materials for health education of children are well established, understanding the barriers preventing their optimal utilization in obese children is another important research priority. Relationship between nurse’s attitudes towards obesity and their likelihood of improving the quality of health education in obese patients (e.g., by using education materials) is yet another knowledge gap that this work seeks to address.

Innovation

The proposed study has sufficient rationale to prove its relevance. It addresses a key unexplored aspect related to treatment of obesity. Understanding the dynamics of nurse-patient interaction in the context of obese patients will provide valuable inputs for devising better interventions. By addressing the key barriers identified, the study will fill a knowledge gap, aid programming, and thereby help achieve improved outcomes in obese patients. It will also highlight the training needs of nurses and possibly help improve nursing curriculum. If use of educational material is associated with better patient outcomes, adequate provision for availing educational materials in health facilities will be a pragmatic step towards combating obesity.

Theoretical framework

The proposed study draws on the theoretical framework of the ‘Health Beliefs Model’ (HBM) developed by Rosenstock in 1974. (Reference) HBM offers a social psychology perspective for relating the nurses' health beliefs and attitudes towards obesity with their interest and capacity to provide health education in obese patients. It can also help understand the determinants of patient compliance, and, in particular, the effect of knowledge and attitude of patient on treatment adherence.
A person's health-related behavior depends on his or her perception of four critical areas: the severity of the illness; patient’s susceptibility to disease; the perceived benefits of taking a preventive action; and the barriers to taking that action.
This model can predict the health behaviors of nurses using three primary aspects, i.e., individual perception, modifying factors, and the likelihood of action (Rosenstock, 1974). The major components of HBM include, perceived susceptibility, severity, benefits of preventive actions, modifying factors, and perceived threat.
Individuals often relate their health risk with their family history or current status of health. Individuals may also believe their condition will severely impact them or their family if they do not modify their behavior. For example, if an individual believes that non-compliance with treatment for obesity would result in negative outcomes, he or she would be inclined and more motivated for change. The perceived advantages of taking preventive action can also spur individuals to take positive action. This could improve the outcomes of health education, thereby increasing its adoption as a tool in obesity management. Sometimes, self-perceived barriers such as family influence and fear may affect the decision to take corrective action. The modifying factors may also depend on the patient’s capacity and self-perceived efficacy of the suggested solutions, based on the health education messages that they receive. Cues to action and information reminders serve as persuasive inducements for change in patient’s approach towards using educational material that will influence health.
This model is optimally suited for investigating the relationship between health beliefs and behaviors of nurses towards obesity, and their use of BMI for monitoring patient’s health status, as part of a preventive or curative treatment in obese patients. Health Beliefs Model

Adapted from Rosenstock in 1974

Research Methodology and Design

References:

Acheampong, I., & Haldeman, L. (2013). Are nutrition knowledge, attitudes, and beliefs associated with obesity among low-income Hispanic and African-American women caretakers?Journal of Obesity.1-8.
Bastable, S. B. (2008). Nurse as Educator: Principles of teaching and learning for nursing practice. Sudbury, Mass: Jones and Bartlett.
Engström, M., Skytt, B., Ernesäter, A., Fläckman, B., &Mamhidir, A. (2013). District nurses' self-reported clinical activities, beliefs about and Attitudes towards obesity management. Applied nursing research, 26(4), 198-203.
Esposito, E. M., & Fitzpatrick, J. J. (2011). Registered nurses' beliefs about the benefits of exercise, their exercise behavior and their patient, teaching regarding exercise International Journal of Nursing Practice, 17(4), 351-356.
Karnon, J., Afzali, A., H. H., Gray, J., Holton, C., Banham, D., &Beilby, J. (2013). A risk-adjusted cost-effectiveness analysis of alternative models of nurse involvement in obesity management in primary care. Obesity, 21(3), 472-479.
Lewis, S., Thomas, S. L., Blood, R. W., Hyde, J., Castle, D. J., &Komesaroff, P. A. (2010). Do health beliefs and behaviors differ according to the severity of obesity? A Qualitative Study of Australian Adults, International Journal of Environmental Research and Public Health, 7 (2), 443-459.
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Stokes, A. (2014). Using maximum weight to redefine body mass index categories in studies of the mortality risks of obesity, Population Health Metrics, 12(1).1-7