| BackgroundObesity is a major health problem for all age groups in the world. In the UK, the rates of obesity have more than doubled in the last 25 years, and being overweight has become the norm for adults. Data from the 2002 China National Nutrition and Health Survey (NNAHS) database showed that, of adults,22.8% and 7.1% were overweight and obese, respectively, and that the prevalence of adult overweight increased by nearly 40% from 1992 to 2002. In this regard, it has become very necessary and important to know health professionals'attitudes and practices in weight management. Meanwhile, health professionals'attitudes and practices in health promotion may be related with their own healthy habits, which had been strongly supported by many studies of smoking behaviour of health professionals. Given these associations between health professionals'personal health habits and their relevant attitudes and practices, it seems possible that health professionals'own weight status will be associated with their attitudes and practices in weight management.Objectives1. To know and compare the prevalence of obesity and the overweight in nurse samples from China and UK, respectively;2. To know and compare the Chinese and British nurses'attitudes and practices related to weight management;3. To examine relationship between Chinese and British nurses'weight status and their attitudes and practices related to weight management, separately;4. To explore the predictors for the level of weight management practices;5. To examine psychometric indicators of the scales or scores used in this study and further to develop Chinese version of these scales after cultural adjustment.MethodsBased on the Theory of Planned Behaviour, a cross-sectional survey was undertaken in two simple cluster samples of 588 qualified nurses attending one large university in London, UK, and 519 qualified nurses working at a tertiary hospitals nurses in Shanghai, China. A total of 420 British nurses and 481 Chinese nurses completed questionnaires with a response rate of 71.2% and 92.7%, respectively. Data analyses were based on valid questionnaires from 409 British nurses and 466 Chinese nurses. Additionally, two groups of nurses from UK (n=34) and China (n=34), separately, were recruited to assess test-retest reliability over a two-week period and a six-week period.All analyses were performed using Statistical Package for Social Sciences (SPSS) software, version 16.0 for Windows.Variables included socio-demographics, weight, physical activity, weight locus of control (WLOC), six scores for attitude indicators and the score for practice indicator related to weight management.Continuous variables were presented as means±standard deviation and compared using t tests, while categorical variables were presented as frequencies and percentages and compared by using chi-squared tests or Mann-Whitney U test. Kappa statistics were calculated to assess the agreement between perceived weight status and BMI status. Binary logistic regression (Enter method) analysis was carried out to evaluate associations between the levels of weight management practice and potential variables.95% CIs on the odds ratios for each category (as compared with the reference category) were calculated.All employed scales were evaluated by critical ratio (CR) for items analysis, content validity index (CVI) for content validity, factor analysis for construct validity, Cronbach alpha coefficient for internal consistency reliability and intra-class correlation coefficient (ICC) for test-retest reliability.Results1. Psychometric properties of the scales in the studyExcept for several items, the items of English or Chinese version scales employed in the current study had significant CR values (p<0.01).(1) English version scales1) All scales with cumulative contribution rate of variance greater than 50.0% were confirmed,except for dieting beliefs scale (DBS) and the score of perceived barriers (PB);2) Of all measured scales and its construct factors, alpha coefficients were ranged between 0.521 and 0.864; 50% with Cronbach a>0.80;3) Of all measured scales and its construct factors, ICCs for test-retest reliability (across two weeks) were ranged between 0.598 and 0.896; 83.3% with ICC>0.75. (2) Chinese version scales1) Means of CVI for Chinese version scales were more than 0.95;2) All scales with cumulative contribution rate of variance greater than 50.0% were confirmed, except for DBS;3) Of all measured scales and its construct factors, alpha coefficients were ranged between 0.528 and 0.918; 75.0% with Cronbach a>0.80;4) Of all measured scales and its construct factors, ICCs for test-retest reliability (across six weeks) were ranged between 0.440 and 0.931; 58.3% with ICC>0.75.2. Epidemiological characteristics of the overweight and obesity in Chinese and British nursesIn the sample of Chinese nurses,3.3% were overweight and 0.5% were obese according to WHO's BMI classifications; 6.5% were overweight and 1.0% were obese according to BMI classifications by Chinese guidelines for prevention and control of overweight and obesity in adults. With regard to perceived weight status,19.9% of participants considered themselves as the overweight, with 2.1% as obesity. A low level of agreement between self-perceived weight status and BMI status was indicated by a Kappa of 0.126 or 0.225 in Chinese nurses.In the sample of British nurses,25.5% were overweight and 14.3% were obese according to WHO's BMI classifications. With regard to perceived weight status,30.3% of participants considered themselves as the overweight, with 3.4% as obesity. A moderate level of agreement between self-perceived weight status and BMI status was indicated by a Kappa of 0.424 in British nurses.Chinese nurses'weights were significantly lower than their British counterparts (BMI:20.59 vs.24.97,p<0.001)3. Chinese and British nurses'attitudes and practices in weight management(1) Nine barriers related to weight management perceived by two sub-samples of nurses'Absence of clear practice guidelines'was perceived as a barrier to weight management by 81.3% of Chinese respondents, followed by'unsure of knowledge'with 80.3%,'inadequate training' with 79.1%, 'complex patients'with 78.6%,'insufficient compensation' with 74.1%,'lack of time'with 67.2%,'lack of patient interest'with 64.6%, 'intrusion into patient's privacy' with 55.2% and 'language barrier' with 48.3%.Inconsistently,'complex patients'was perceived as a barrier to weight management by 90.6% of British respondents, followed by'inadequate training'with 90.5%,'lack of patient interest' with 90.3%,'lack of time' with 85.7%,'absence of clear practice guidelines'with 85.3%, 'unsure of knowledge'with 77.4%,'intrusion into patient's privacy' with 77.4%,'language barrier' with 64.6% and'insufficient compensation'with 58.0%.Perceptions of seven barriers were significantly different between two samples (p<0.001), with higher degree recognition by British nurses.(2) Seven skills related to weight management perceived by two sub-samples of nursesOf Chinese nurses,9.9%-18.6% assessed their seven skills related to weight management with high level,42.7%-61.5% with moderate levels and 19.9%-47.4% with low level。Of British nurses,12.5%-48.9% assessed their seven skills related to weight management with high level,35.4%-55.1%with moderate levels and 15.7%-43.5% with low level。The self-assessment for three skills was significantly different between two sub-samples (p<0.001), with higher skill levels considered by British nurses.(3) Weight management behaviours committed by two countries of nursesOf Chinese nurses,25.1% gave detailed advice about diets to patients,23.0% provided emotional support,21.8% gave general lifestyle advice,21.5% gave tailored advice about physical activity,20.5% did a BMI assessment, and the least likelihood was measurement of waist circumference for patients(10.1%). Of British nurses,54.0% did a BMI assessment,51.0% referred patients to another health provider,41.8% provided emotional support and measurement of waist circumference was done only by 11.0% respondents. The score for weight management practice was much less in Chinese nurses than in British-nurses-(19.05 vs.22.21,p<0.001).In addition, compared with British nurses, Chinese nurses had more positive attitudes towards to obese people (71.14 vs.68.08, p=0.001), but had low level of agreement for professional role and identity (17.70 vs.19.79, p<0.001). 4. Nurses' own weight status associated with their attitudes and practices in weight management in two countriesIn Chinese sample, non-overweight (BMI<24) nurses had higher scores for the external control factor of DBS (25.14 vs.22.52,p=0.006) and scores for attitudes towards obese people (ATOP)(71.71 vs.66.44,p=0.071); in contrast, overweight (BMI=24) nurses had higher scores for the internal control of DBS than the non-overweight. Three variables marginally significantly related to perceived weight status:external control factor of DBS (25.17 vs.24.08,p=0.068), internal control factor of DBS (17.35 vs.16.57, p=0.094) and perceived barrier scores (PB) (35.13 vs.33.30,p=0.057)。In British sample, only the score for environmental control factor of DBS was significantly different between non-overweight (BMI<25) and overweight (BMI=25) nurses (16.83 vs.15.30, p<0.001), with a marginally significant variable of PRI factor (19.94 vs.19.31,p=0.096). When compared with perceived overweight nurses, perceived non-overweight nurses had greater scores for environmental control factor (16.41 vs.15.36, p=0.013), self-efficacy factor (34.34 vs.32.70, p=0.041), PRI factor (25.15 vs.19.20, p=0.010) and greater perceived skill scores (14.01 vs.13.14,p=0.023).5. Predictors for the level of weight management practice by Logistic regressionNo significant predictor was found by Logistic regression in Chinese nurses.However, in British nurses, female (OR=3.47; 95%CI:1.33-9.08), community nurses (OR=3.57; 95%CI:1.09-11.63), Perceived Skills score (PS) (OR=1.19; 95%CI:1.06-1.33) and Self Efficacy score (OR=1.11; 95%CI:1.04-1.18) were positive predictors, but the score for environmental control Factor of DBS (OR=0.91; 95%CI:0.82-1.00) and Perceived Barriers score (PB) (OR=0.93; 95%CI:0.88-0.99) were negative predictors for higher level of weight management practices by logistic regression allowing for all covariates.Conclusions1. Psychometric properties of scalesAll scales and its items were easily understandable and readable. All scales, either English versions or Chinese versions, had good reliability and stability. Most scales had valid constructs, which could be explained clearly.Most of Chinese versions were better than English versions in psychometric property. 2. Epidemiological characteristics of the overweight and obesity in Chinese and British nursesBritish nurses were much heavier than their Chinese counterparts, although the percentage of the overweight/obesity in either sample was lower than in the lay population. Chinese nurses might overestimate their weight, while British nurses might underestimate their weight status. A low agreement between perceived weight status and BMI status was identified in Chinese nurses.3. Chinese and British nurses'attitudes and practices in weight managementBoth Chinese and British nurses agreed some barriers to commit weight management, and considered lack of knowledge and skills as the most important barriers. All of them did not think their skills in weight management as high levels, with a big gap between their current practices and goals launched and required by health policies.Chinese nurses had lower levels of skills and practices related to weight management than British counterparts.4. Nurses'own weight status associated with their attitudes and practices in weight management in two countriesIn both countries, overweight nurses were more likely to believe that a person's weight were controlled by fate, gene or other people.No significant association was found in Chinese nurses between individual's weight status and her/his attitudes towards weight management. Unlikely, several significant such correlations were found in British nurses. Perceived non-overweight nurses were more likely to agree their professional role identity, have greater self-confidence or self-efficacy, and highly self assess their skills in weight management.5. Predictors for the level of weight management practice by Logistic regressionNo significant predictors (e.g., socio-demographics and related attitude indicators) for weight management practice was found in Chinese nurses.However, in British nurses, active participants in weight management were more likely to be female, of working in community, of belief that weight is beyond his or her control, of higher level of perceived skills related to weight management and of higher self efficacy; on the contrary, those who perceived more barrers were not likely to practice weight management. |
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