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CHILD AND ADOLESCENT HEALTH
Enabling overweight children to improve their food and exercise
habits – school nurses’ counselling in multilingual settings
Maria B Magnusson, Karin I Kjellgren and Anna Winkvist
Aims and objectives. The study aimed at analysing school nurses’ counselling of overweight and obese children in settings with
many immigrants, focusing on content concerning food and physical activity and how this was communicated.
Background. For people with a predisposition for overweight, the weight control process requires cognitive skills. School
nurses’ counselling of overweight children has the potential to support this process by enabling personal resources in the
children and their families. However, there is uncertainty among nurses about how to conduct supportive counselling.
Design. An explorative design was used when collecting and analysing data.
Method. Twenty-two counselling sessions between eight school nurses and 20 overweight children were audio-recorded and
analysed using qualitative content analysis. Most of the participating schools represented areas with low socioeconomic status
and a high proportion of immigrants and refugees.
Results. Less adequate skills in enabling resources in the children and their parents were observed. Concurrently, school nurses
provided inadequate explanations about food and physical activity. Topics related to general nutrition models were frequently
communicated as general advice instead of individually tailored counselling. Counselling families with other languages and food
cultures than the traditional Swedish created additional difficulties.
Conclusions. Improved nutritional knowledge for nurses may enhance their skills in enabling children’s and families’ resources.
School nurses should be provided with opportunities to cooperate with other professions in counteracting overweight.
Relevance to clinical practice. Our findings demonstrate a relationship between content skills and person-centeredness in the
counselling. This highlights the importance of inter-professional collaboration to ensure a high quality of lifestyle counselling.
School health authorities should give high priority to facilitating school nurses’ evidence-based continuing education.
Key words: child, counselling, cultural, enabling, health promotion, immigrants, obesity, overweight, person-centeredness,
school nursing
Accepted for publication: 22 January 2012
Introduction
In most countries, school nurses play a key role in health
promotion among children (Wainwright et al. 2000), includ-
ing supporting them to attain and/or maintain a healthy
weight (Kubik et al. 2007). Childhood obesity and over-
weight (jointly referred to as OW in this article) constitute a
global epidemic (Shrewsbury & Wardle 2008). In most
populations, OW is unevenly distributed, with an overrepre-
sentation in low socioeconomic groups and certain ethnic
Authors: Maria B Magnusson, PhD, MSc, RD, RN, Postdoc,
Department of Public Health and Community Medicine, Public
Health Epidemiology Unit, Institute of Medicine, The Sahlgrenska
Academy, University of Gothenburg, Gothenburg and Primary Health
Care Clinic Angered, Gothenburg, Sweden; Karin I Kjellgren, PhD,
Professor, Institute of Health and Care Sciences, Sahlgrenska
Academy, University of Gothenburg, Gothenburg and Department
of Medical and Health Sciences, Division of Nursing Science,
Faculty of Health Sciences, Linko
¨ping University, Linko
¨ping; Anna
Winkvist, PhD, Professor, Department of Clinical Nutrition, The
Sahlgrenska Academy, University of Gothenburg, Gothenburg,
Sweden
Correspondence: Maria B Magnusson, Postdoc, Public Health Epi-
demiology Unit, Department of Public Health and Community
Medicine, Box 454 S-405 30 Go
¨teborg, Sweden. Telephone:
+46 31 786 61 18.
E-mail: maria.magnusson@allmed.gu.se
2012 Blackwell Publishing Ltd
2452 Journal of Clinical Nursing,21, 2452–2460, doi: 10.1111/j.1365-2702.2012.04113.x
groups (Kumanyika 2008, Shrewsbury & Wardle 2008). The
potential of school health care to combat this epidemic is
attracting interest from researchers and health care providers
(Lobstein & Baur 2005, Kropski et al. 2008, Della Torre
Swiss et al. 2010).
Background
Food intake and physical activity, complex physiological and
social processes, are the primary determinants of body
weight. For the lay person, understanding the roles of food
intake and physical activity in determining body weight may
be complicated by contradictory messages from, for example,
advertisements (Powell et al. 2007) and the slimming indus-
try (de Beaufort & Vandamme 2008). Thus, in order to attain
and maintain a healthy weight, people with a predisposition
for OW require support to learn meaning-making, defined as
‘…connecting new information with prior knowledge,
affected by one’s intention, motivation and strategies’ (Lee
et al. 2008, p. 112).
Currently, there is consensus that lifestyle change counsel-
ling should be person-centred (McCance et al. 2009), both
for ethical and efficiency reasons. Costain and Croker (2005)
write that health care professionals should strive ‘…to
understand how the patient views their problem, and
working on potential solutions together to culminate in the
patient feeling that they have developed their own realistic
plans for change’ (p. 92). There is a widespread perception
that school nurses’ potential for managing obesity has not yet
been fully realised. Studies of school nurses’ role in managing
obesity in Western countries have generated extensive sup-
port for using school health services for this purpose.
However, there is both uncertainty as to how this should
be undertaken and a lack of guidelines (Clark 2004, Moyers
et al. 2005, Kubik et al. 2007, Nauta et al. 2009, Mu
¨llers-
dorf et al. 2010). To our knowledge, no studies have focused
on school nurses counselling OW children in settings where
language and food culture differ from those of the majority
population. The aim of this study was to analyse school
nurses’ counselling of OW children, in settings with many
immigrants, focusing on content concerning food and exer-
cise and how this content was communicated.
Methods
Design
An explorative design was used when collecting and analy-
sing data on school nurses’ counselling of OW pupils. These
data have previously been used to investigate the communi-
cative aspects (i.e. ‘how?’) of the counselling (Magnusson
et al. 2009). The results raised questions about food and
exercise content (i.e. ‘what?’). Qualitative content analysis
was utilised to gain a deeper understanding of these areas
(Graneheim & Lundman 2004, Krippendorff 2004).
Participants
The inclusion criteria were as follows: counselling session
includes weight management discussions, alone or together
with parent/s, interpreter and/or relatives; pupil attends
primary or secondary school; pupil is overweight or obese,
defined as at risk of having a higher BMI than 25 and 30,
respectively, at age 18 (Cole et al. 2000). Forty school nurses
with key functions in the Gothenburg school health care
organisation were invited to participate in the study, 14
agreed. Eight of the nurses recruited one or more pupils, who
were consecutively included in the study. Most of the schools
represented areas with a low socioeconomic status and a high
proportion of immigrants and refugees. Thirteen of the pupils
had at least one parent born outside Sweden.
Data collection
The data used in this study consist of 22 audio-recorded
counselling sessions between school nurses and OW children,
conducted between January 2005–June 2007. The sessions
lasted between 16–50 minutes. Audio recordings of consul-
tations were used to obtain an authentic impression of the
interaction between nurse and pupil. The sessions were
conducted with only those who would normally be present,
that is, school nurse, pupil and, occasionally, parent/s, other
relatives and/or an interpreter. Data were collected until
saturation, meaning that additional recordings did not
contribute any substantially new information for the crucial
parts of the analysis.
Data analysis
The audio-recorded counselling sessions were transcribed
using a broad transcription format capturing pauses and
listener support items (Linell 1994). Two of the authors read
the transcriptions and listened to the audio recordings
repeatedly. Our unit of analysis consisted of a counselling
session. The original spoken language was Swedish. We
performed all the analyses in Swedish and translated to
English in the final version of the manuscript. Transcriptions
of the counsellings were imported into
NVIVONVIVO
2.0 (QSR Pty
Ltd, Doncaster, Victoria, Australia), a qualitative research
software program designed for non-numerical data. Meaning
Child and adolescent health Enabling overweight children to improve habits
2012 Blackwell Publishing Ltd
Journal of Clinical Nursing,21, 2452–2460 2453
units related to food and exercise were identified and read
repeatedly, frequently returning to the recording and/or
transcript of each session to assess the context and meaning
attached to the utterances. Meaning units were condensed,
that is, shortened while preserving the core (Graneheim &
Lundman 2004). Codes were developed by writing down
keywords that captured aspects assessed as relevant to the
issues in focus. After all the transcripts were coded, they were
re-coded based on influences and reflections emanating from
working on the entire material and simultaneously docu-
menting the significance of each code (Table 1).
Codes were grouped into subcategories in joint discussions
between all the authors. The emerging categories referred
mainly to the manifest level of content. Finally, themes,
considered to be the threads of underlying meaning through-
out the text on an interpretative level, were identified
(Graneheim & Lundman 2004).
Ethical approval
The study was approved by The Regional Ethics Committee
at the University of Gothenburg (Study code 205-04).
Participants and, if the pupil was younger than 15, parents
were informed about study protocol, both in writing and
verbally, before providing written informed consent. It was
emphasised that participation was voluntary. The transcripts
were made anonymous by removing personal information.
The participants were assured of confidentiality.
Results
Eight school nurses, all women and aged between 41–
53 years, participated in the study. They were all registered
nurses with a graduate diploma in specialist nursing in public
health or health care for children and adolescents. Of the 20
pupils who participated in the study, one girl and one boy
each participated in two counselling sessions and two pupils
jointly participated in three counselling sessions. The mean
age of the pupils was 11 years (range 8–16). All the children
were either overweight (n= 7) or obese (n= 13). Among the
girls, the majority (six out of eight) were overweight while
almost all the participating boys were obese (11 out of 12).
The findings from the qualitative analysis are reported by
subcategory, category and theme emerging in the analysis
(Table 2).
Two themes, permeating the categories, were identified:
‘Quality of explanations’ and ‘Enabling children and parents’.
Categories
Human being in equilibrium included ideas about the balance
between energy intake and output, as well as considerations
about how to recognise and handle bodily cues. This category
also included efforts by the nurses to encourage and support
the children to develop their sensitivity to hunger and satiety
signals.
Roles of food concerned aspects such as the pleasure of
eating, the dimension of autonomy in deciding what to eat
and drink as well as eating as a duty and ridiculing certain
eating behaviours.
The nurses’ talk about food, meal patterns and food
components in their attempts to provide nutritional knowl-
edge was included in Components of food and how to handle
them, most often communicated either by lecturing or by
conveying confusing or vague information.
When discussing a desirable meal pattern, all nurses
followed the guidelines recommending three main meals
and one to three smaller meals, such as fruit, daily.
Need for physical activity concerned exercise as pleasur-
able and necessary for health. Barriers to physical activity
were not commonly addressed by the nurses, although severe
climate and the cost of some activities (e.g. horseback riding)
were discussed.
Controlling oneself and others includes both parents’ and
children’s expectations. A patronising tendency among the
nurses when talking to parents was included in this category.
Table 1 Examples of coding
Condensed meaning units Codes
The plate model is good because it
involves a lot of vegetables
Food as a duty
Structure
Nutritional models
You can feast on sweets once a
week
Vagueness about quantity
Structure
You eat too much compared with
the amount of energy you
get rid of
Balance between food and
physical activity
We have different building blocks.
There’s fat and there are proteins
and then there are
carbohydrates...
Lecturing about food
Fat
Macronutrients
Remember to eat slowly! Eat slowly
Specific advice
Your mum knows a lot about
vegetables because you have a
lot of vegetables in your diet
Confusing explanations
about food
Assumption about culture
Every day after breakfast you
could go out and run round the
jogging track once
Physical activity as a duty
Your body needs to move for the
same amount of time that you
sit still
Balance between being
sedentary and in motion
MB Magnusson et al.
2012 Blackwell Publishing Ltd
2454 Journal of Clinical Nursing,21, 2452–2460
One mother responded to this with the comment, ‘I’ve been
given homework’ when the nurse had been lecturing about
fat in milk. The nurses tried to strengthen the parental role by
pointing out that parents should be involved in children’s
decisions about, for example, taking second helpings of food.
In Fig. 1, the subcategories have been positioned in relation
to the themes and their respective endpoints.
Themes
Quality of explanations
In several of the subcategories, inadequate/inappropriate
explanations were frequent (Fig. 1). The nurses neither ex-
plained the relationships between energy, calories, sugar and
fat nor between energy and overweight. In six of the coun-
selling sessions, energy was presented by turns in positive and
negative terms without clarifying the ambiguity, as exempli-
fied in the following passage:
Nurse: Breakfast is sort of the most important meal in the whole day
(ye-es) because it sort of gets you started so you get energy and fuel,
doesn’t it?...
A few minutes later in the same counselling session, ‘energy’
is used in a negative context:
…And then you have fat, let’s say that fat gives you twice as much
energy (mm) and if you eat a lot of fat, and particularly saturated fat,
then you get an awful lot of energy. And then you’ve got to get rid of
it, because otherwise it remains…you put on weight then. (yes)
Subcategory: energy is incomprehensible.
Placed thematically: somewhat inappropriate explanation
and giving general advice without anchoring it in the child’s
life-world.
One nurse affirmed the statement from a pupil that he ate
dark bread ‘because there is a lot of sugar in white bread’.
The only nurse who explained that unsaturated fat is healthy
but saturated fat is not also claimed that unsaturated fat
contains about half the energy of saturated fat.
Giving vague advice, leaving much room for interpretation,
was common. On several occasions, suitable amounts of
sweets and sweetened beverages were described as ‘only a
little, once a week’ and, even more vaguely, ‘once a week you
can eat as much as you like’. The following quote is from a
nurse counselling two teenage girls:
Nurse: So when you realise that you don’t get fat from eating, then
you’re making progress. Because choosing proper…ordinary, proper
food doesn’t make you fat.
Quality of explanations
Inadequate Adequate
Giving general advice Mobilizing resources
Enabling children and parents
Barriers for physical
activity
Seized opportunities
Indispensable messages
Adults as assets
Explaining how
to change
Energy has dual
implications
Physical activity is
necessary
To enjoy physical
activity
Food being an asset
People are whole
beings
Energy is
incomprehensible
Food and obesity
Food being a problem
Energy is good
for you
Energy is
dangerous
Fat
Sugar
Missed
opportunities
Figure 1 Position of subcategories in relation to themes, in counsellings between school nurses and overweight and obese children concerning
food and physical activity. The two themes represent continuums with the endpoints adequate/inadequate and giving general advice/mobilising
resources, respectively. The subcategories are placed in relation to the themes by assessing how they appeared to function in the counselling in
terms of context. ‘Giving general advice’ refers to the practice of pointing out a course of preferred action without anchoring it in the children’s/
parents’ life-world (Magnusson et al. 2009).
Child and adolescent health Enabling overweight children to improve habits
2012 Blackwell Publishing Ltd
Journal of Clinical Nursing,21, 2452–2460 2455
Subcategory: food and obesity.
Placed thematically: inappropriate explanation, giving
general advice.
Language shortcomings were common. Advice based on
traditional Swedish food habits and cooking traditions
further reduced the quality of the counselling of families of
foreign origin. For example, ‘It’s much better to cook food in
the oven, because then you don’t have all that fat’ relates to
Swedish cooking, in which oven-based dishes often represent
a way of cutting down on the fat content, compared to using
a frying pan.
Enabling children and parents
The endpoint ‘Giving general advice’ was defined as pointing
out a course of preferred action on the basis of general
knowledge without anchoring it in the actual life-world. This
method was most often observed in the cases where general
nutritional models were used. Only occasionally, as in the
following example, did the nurse adjust the message to per-
sonal conditions:
Nurse: Then you can also think about what we call the plate model…
Mother: He doesn’t eat any salad
Nurse: What an exciting job you’re going to have now! Because there
are loads of vegetables, I’m going to show you the other picture I
have here. I’d really like to know which ones you like.
Subcategory: explaining how to change.
Placed thematically: appropriate explanation, enabling
resources (by relying on the competence and curiosity of
the child).
When addressing the subject of eating behaviour (fre-
quently occurring within the subcategories People are whole
beings, Seized opportunities and Explaining how to change),
the nurses generally asked about habits and preferences and
initiated a dialogue about spontaneous eating between meals,
for example. Changing unhealthy eating behaviour was
skilfully supported in the following excerpt, in which the
nurse describes the feeling of eating too much as a shared
experience. She creates the impression that the changed
behaviour she is proposing is easy:
Nurse: So what I want you to do is to take a helping, not a really
large helping. And then if you feel like you want a bit more, you say
to Mum and Dad, ‘I’d like to have a bit more. And then I want them
to answer like this, ‘Can you wait 10 minutes and see if you’re
hungry again?’ […………] and here you’ll need help from the
grownups at home…
Father: Yes, exactly
Nurse: So that they sort of say: ‘No, wait a bit.’ So then you can take
a bit more food after 15 minutes. Then you can say, ‘No I’m a little
hungry.’ ‘Okay’, Dad or Mum will say, ‘have a pear or a bit more
fruit or vegetables, then.’ And then they’ll have to help you. And then
when they say no, then you might get angry.
Father, Yes, exactly
Nurse: ‘‘‘I want more!’’ And then it’s Mum and Dad’s job to help you
even more like this, ‘No, this is how it’s going to be and you know
why! It’s because we care about you, we love you. And we want you
to grow and be healthy’.
Subcategory: explaining how to change, adults as assets.
Placed thematically: appropriate information, mobilising
resources (by using the parents’ competence and trusting that
child will cooperate).
An interpreter was present at only one of the six sessions in
which the parties had difficulty understanding each other. In
counselling with children with other maternal languages,
when nurses tried to mobilise resources within families, they
often failed owing to language-related misunderstandings. All
the nurses who counselled pupils with immigrant parents
Table 2 Themes, categories and subcategories in counsellings between school nurses and overweight and obese children, concerning food and
physical activity
Theme
Enabling children and parents
Quality of explanations
Category Human being in
equilibrium
Roles of food Components of food
and how to handle
them
Need of physical
activity
Controlling oneself
and others
Subcategory Energy is dangerous
Energy is good for you
Energy is incomprehensible
Energy has dual implications
People are whole beings
Food is a resource
Food is problematic
Missed opportunities
Seized opportunities
Indispensable
messages
Sugar
Fat
Food and obesity
To enjoy movement
Physical activity is
necessary
Barriers for physical
activity
Adults as assets
Explaining how
to change
MB Magnusson et al.
2012 Blackwell Publishing Ltd
2456 Journal of Clinical Nursing,21, 2452–2460
acknowledged the fact that food cultures differ, for instance
by suggesting that the parent should try to transfer the
message in pictures shown to ‘(his) her kind of cooking’ and/
or offering generalised advice.
Discussion
The main finding in this study is that school nurses, when
counselling OW pupils, gave inadequate explanations and
had difficulties enabling resources of the children and their
families. Counselling families with a language and food
culture other than the traditional Swedish was associated
with additional difficulties.
Intertwined entities, content skills and person-
centeredness
Although research literature acknowledges that the difficul-
ties involved in conducting motivating and reciprocal coun-
selling are multifaceted and persistent in nature, it is
commonly taken for granted that health care professionals
possess adequate knowledge of the topic under discussion in
the counselling (Mishler 1984, Costain & Croker 2005, de
Witte et al. 2006, Maenpaa et al. 2007, Florin et al. 2008,
Mu
¨llersdorf et al. 2010). However, our findings suggest that
improving such knowledge is one step towards making
counselling more individually tailored.
When it came to most aspects of food in the categories
Human being in equilibrium and Components of food
and how to handle them, nurses communicated by means
of general advice, while their talk about physical activity
and eating behaviour tended to be more individually
tailored. The common feature of the two latter topics
was that they were not included in any general educational
material; this, however, does not mean that there is
necessarily a contradiction between mobilising resources
and the use of general nutritional models. Rather, our
results point to a tendency to use such models as
substitutes for tailored information instead of as integrated
parts of it.
Explaining basic issues
To be able to make sense of body weight management, one
needs a basic understanding of energy balance. Interestingly,
none of the nurses in this study explained this concept or its
connections with body weight. The recordings give the
impression that nurses assumed that these issues were well
known. An alternative explanation is that some nurses in this
study did not have a sufficiently deep understanding of energy
balance mechanisms to explain them comprehensibly and
correctly.
Nutritional knowledge
The results of this study indicate that there is a need to
increase nurses’ competence in the area of nutrition. A report
on nutritional information in Sweden confirms this. The
curricula for different levels of graduate nursing education,
such as the nurses in this study had, generated insufficient
competence to communicate relevant nutritional knowledge
on an individual level (Callmer 2005). Developing profes-
sional skills is one course of action, another is to facilitate
cooperation. A method for professionals to share compe-
tences was provided by Melin and Lenner (2008) who
proposed a framework allowing nurses to give advice to OW
children on the basis of a questionnaire drawn up by a
dietician and a physiotherapist.
In the media, there are numerous pseudo-experts on weight
loss methods. However, all the nurses based their advice on
established guidelines. This underlines the scientific approach
in school nursing, suggesting that reasons for shortcomings
described here are to be found in other areas, such as lack of
time and limited access to other professional competence.
The need for structured curricula in school health care has
been confirmed by Morberg et al. (2009).
Language and culture
Nurses expressed assumptions about food habits in families
with non-Swedish origins. However, food acculturation is a
complex process, in which details differ from individual to
individual (Satia-Abouta et al. 2002). When moving from the
Eastern Mediterranean region to the Nordic countries, it is
common to reduce vegetable consumption (Wandel et al.
2008) and assumptions such as ‘you eat a lot of vegetables’
may well be wrong. Moreover, assuming that a generally
‘different’ food culture exists may be harmful because it can
create or strengthen a feeling of deviating from a perceived
normality (Kleinman & Benson 2006). Like families with
Swedish origins, immigrants need concrete advice based on
an assessment of the families’ actual food habits in the light of
their relevance to weight maintenance.
It seems unrealistic that school nurses should be able to
optimise nutritional counselling for a broad range of foods,
habits, beliefs and cooking methods. Access to professionals
with high competence in nutrition is important to ensure that
everyone is offered a high quality of care. This is also
important from a public health perspective, because individ-
uals from groups with low proficiency in the national
Child and adolescent health Enabling overweight children to improve habits
2012 Blackwell Publishing Ltd
Journal of Clinical Nursing,21, 2452–2460 2457
language are overrepresented when it comes to several
conditions and diseases associated with food and exercise
habits (Hjern 2009).
Strengths and limitations
In order to ensure rigour, the concepts of credibility and
dependability were applied (Lincoln & Guba 1985). By
audio recording the counselling sessions with nobody but the
nurse, child and parents (and sometimes an interpreter)
present, we documented authentic performances, thus
improving credibility. Listening to the recordings repeatedly
facilitated the emergence of a multifaceted understanding of
the processes.
The strengths include the authors’ broad competence and
experience: a registered dietician and nurse with experience
of counselling OW children and of collaborating with school
nurses in this context, a nutritionist with experience of
combining quantitative and qualitative methods when eval-
uating health and nutrition and a nurse who has conducted
research on communication and education in different health
care settings. Meaning units, codes, categories and themes
were discussed and developed jointly by the authors until
agreement was reached. This triangulation of researchers
from different health science fields thus further increased
credibility.
We used three different types of analyses (theme-oriented
discourse analysis, quantitative methods (Magnusson et al.
2009) and qualitative content analysis), of which the latter is
presented in this paper. Triangulation provided alternative
ways for the data to be exposed (Lincoln & Guba 1985,
Hammersley 2008). The analyses point in the same direction
for many counselling sessions: that school nurses use general
advice and their own assumptions as starting points, that they
dominate the counselling sessions and that content skills
(Silverman et al. 2005) constitute an area of improvement.
Our interpretations of the counselling sessions were ven-
tilated in member checks, in which preliminary results were
discussed with the nurses. The nurses verified our findings
and acknowledged the difficulties in ‘getting the pupils to
talk’, as well as noting that it was difficult to convey the
amount of information they considered necessary during the
very limited time at their disposal.
Additionally, the involvement of all the researchers
improved dependability. In qualitative research, theories
developed with rigour can be applied beyond the study
sample to similar situations, questions and problems (Morse
1999). We believe that the knowledge gained from our
findings can be transferred to other counselling settings
focusing on lifestyle changes.
The relatively small number of nurses constitutes a
limitation of the study. Only 14 of the invited 40 nurses
agreed to participate, which raises the question of whether
non-participants differed in any systematic way from partic-
ipants. Because participation reflected an interest in develop-
ing methodology for supporting OW pupils, it is probable
that the recorded counselling sessions represent a compara-
tively high level of quality. In view of the fact that our
purpose is to explore the nature of school nurses’ counselling
of OW children, we think that this sample contributes
interesting findings, several of which are consistent in the
data corpus. It is particularly interesting that almost half of
the audio recordings reveal problems relating to language and
food culture, which are highly relevant in this area of
research.
Data collection was extended over a long period of time,
the main reason for the delay being difficulties in recruiting
nurses and, especially, children and parents. We interpret
these difficulties as being symptoms of the stigmatization of
obesity in society. Because our research questions, despite the
time that has passed, have not been answered by current
research and the problems that are outlined in the back-
ground have not been solved, the uniqueness of the data may
be of great interest.
Conclusion
Our findings demonstrate that inadequate explanations are
related to shortcomings in the process of mobilising
personal resources in children and parents. Accordingly,
we suggest that improved nutritional knowledge among
nurses is one way of enhancing person-centred counselling.
This study reveals additional difficulties in both informa-
tion and the enabling process in the case of families with a
foreign language and a food culture that differs from
the traditional Swedish culture. Given the complexity
of childhood obesity, school nurses should be provided
with opportunities to cooperate with other professions
when meeting the challenge of counteracting obesity and
overweight.
Relevance to clinical practice
Our findings demonstrate a relationship between content
skills and person-centeredness in counselling. This highlights
the importance of inter-professional collaboration to ensure a
high quality of lifestyle counselling. School health authorities
should give high priority to facilitating school nurses’
evidence-based continuing education in counselling over-
weight pupils.
MB Magnusson et al.
2012 Blackwell Publishing Ltd
2458 Journal of Clinical Nursing,21, 2452–2460
Acknowledgements
We would like to thank all the participating school nurses,
pupils and parents for allowing us to share the counselling
sessions.
Funding
This research has received funding from Swedish Society of
Nursing and from the Region Va
¨stra Go
¨taland, Sweden.
Contributions
Study design: MBM, KIK; data collection and analysis: MBM,
KIK, AW and manuscript preparation: MBM, KIK, AW.
Conflict of interest
No conflict of interest has been declared by the authors.
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