Assessing Facilitating Factors and Barriers to Body Mass Index Screening Among School Nurses

Abstract

Child obesity among school age children is epidemic in the United States (U.S.). A critical review of literature was completed that concluded that Body Mass Index (BMI) screening for early identification and growth surveillance is needed for successful school-based obesity prevention intervention programs. This study used total survey design methods to identify the BMI screening practices of school nurses (SNs) and to identify the facilitating factors and barriers to BMI screening in public elementary schools among school age populations. Focus groups were used to identify current BMI screening practice in terms of facilitating factors and barriers. Survey methods were used to determine the validity of the barriers and facilitating factors identified in the focus groups. An adapted version of the Health People 2010 Determinants of Health Model guided this research.

Results from 3 focus groups with SNs (N=25) working in public elementary schools indicated that SN BMI screening practice was conditional to policy, school social and physical environments, risk/protection, and access to quality health care. Themes related to geographic area emerged. All SNs described teachers as the most important facilitating factor. Suburban SNs identified that gym teachers were especially important to their BMI screening process. Urban SNs collectively agreed that trained personnel such as aides would be very helpful for data collection and BMI conversion. Rural SNs were also interested in collaborative work but focused on assisting one another as opposed to hiring assistance.

Primary barriers voiced by SNs included lack of privacy, time, and policy. School size and amount of space the SNs had to assess a child were barriers, but for rural SNs this assumed there was a specific area designated as a clinic. For suburban SNs, having space to obtain BMIs located near a gym class was important. Urban SNs focused their concerns primarily on school organization and the logistic of obtaining data. Age and grade level had an effect on how rapidly data were collected. Geography in terms of the number and distance of schools that any one nurse is assigned affects the time a nurse can collect data.

Subsequent to the focus group work a survey entitled the Body Mass Index Screening Survey (BMI-SS) was developed to allow for a more thorough assessment of SN BMI screening practices. Total survey design methods were used to establish face and content validity as well as baseline reliability. Face validity was established by subjective determination using 3 SN in a focus group discussion. Content validity was established with a Content Validity Index (.80) by 3 SN experts and 10 clinicians. Reliability was established through test-retest by 10 SN certification students. Administration of the survey to a randomly selected group of SNs is recommended so that data can be used to support policy and obesity intervention standards for care of school age children.