Attitudes and Practices of School Nurses and Pediatric Primary Care Providers toward Collaboration around Childhood Obesity

Abstract

Background: Addressing childhood obesity requires a multidisciplinary approach. School based BMI screening and referral provided an opportunity for school nurses (SNs) and pediatric primary care physicians to collaborate. Understanding the capacity to collaborate, as well as the barriers and benefits, help to support interprofessional care. Purpose: The purpose of this investigation was to determine SNs’ and pediatric physicians’ attitudes toward collaboration as well as the presence of successful collaboration proposed in the Four Dimension of Collaboration Model (FDCM). Methods & Sample: An exploratory, cross-sectional mixed methods study of SNs’ and pediatric physicians’ attitudes and practices regarding collaboration was conducted using a combination of web-based and mailed survey instruments utilizing both open and closed-ended questions. One hundred and fourteen school nurses and sixty-three pediatric physicians completed the study. Results: While SNs and physicians both reported high scores on the Jefferson Scale of Attitudes toward MD-RN Collaboration (JSAC) indicating a positive attitudes toward physician – nurse collaboration; SNs scores were significantly higher than physician scores (55.05 + 3.30 v 52.42 + 5.74, p = .001). A regression model identified that physician’s age, community location, and having a moderate percentage of obese patients within their practices were associated with positive (age) and negative (community and moderate percent obese patients) effects on attitude toward collaboration. Providers’ responses indicated deficits throughout the FDCM. Dimension indicator, “mutual acquaintanceship” indicated that 37% physicians did not know any SNs. Similarly, 24% SNs reported that they did not “trust” local physicians to listen to their concerns. Qualitative analysis indicated the myriad of challenges faced by both providers. Benefits and barriers were similar for SNs and physicians; however, their experiences suggested a lack of mutual knowledge. Conclusions: Collaboration around childhood obesity is a unique struggle due to its multifaceted nature. School nurses and physicians showed positive attitudes toward collaboration; however, their capacity to act was limited. School nurses and pediatric physicians recognized the value of interprofessional collaboration recommending improvements to the current system.