Original Research School Nurses’ Experiences With Motivational Interviewing for Preventing Childhood Obesity Ane Høstgaard Bonde, MD, MPH, BSc 1 , Peter Bentsen, PhD, MSc, BSc 1 , and Anette Lykke Hindhede, PhD, MA, BA, GDBA, RN 1 Abstract Motivational interviewing is a counseling method used to bring about behavior change; its application by school nurses for preventing obesity in children is still new. This study, based on in-depth interviews with 12 school nurses, shows how school nurses adapted motivational interviewing and integrated it into their daily practice along with other methods they knew from the past. Three dilemmas for school nurses were revealed: when the child was severely overweight and the parents did not perceive this as a problem, when the child and the parents were at different stages of motivation to change, and when applying an individualized approach such as motivational interviewing for preventing a complex societal problem, in this instance obe- sity. The study raises an important issue to consider, with implications for school nursing and obesity prevention: motivational interviewing as either a counseling method or a prevention strategy. Keywords BMI, health education, obesity, school nurse knowledge/perceptions/self-efficacy, qualitative research, motivational interviewing, prevention, dilemma Background This article examines experiences and dilemmas encoun- tered by school nurses when applying motivational inter- viewing in counseling sessions with overweight children and their parents. During the past decade, several studies have investigated the potential role of school nurses in preventing obesity in chil- dren. Surveys among school nurses have found they are well aware of the risk of childhood obesity, and they support the idea of school-based obesity prevention. However, the major- ity of school nurses rarely conducted obesity-prevention tasks themselves, and as barriers, many reported lack of competence, time, or support from the school and health provider (Kubik, Story, & Davey, 2007; Moyers, Bugle, & Jackson, 2005; Nauta, Byrne, & Wesley, 2009). Qualitative research has added to the survey findings that school nurses perceived over- weight and obesity as difficult issues to deal with when communicating with parents. In addition, the nurses perceived barriers in both a lack of parental recognition of their child’s overweight being a problem and a lack of parental support for prevention efforts (Isma, Bramhagen, Ahlstrom, O ¨ stman, & Dykes, 2012; Morrison-Sandberg, Kubik, & Johnson, 2011). A study of audiorecorded counseling sessions between school nurses and overweight children indicated inadequate communication skills in the nurses (Magnusson, Kjellgren, & Winkvist, 2012). This was also found by Steele et al. (2011) who suggested motivational interviewing could prove a useful method for school nurses to apply in overcoming bar- riers when communicating with overweight children and parents. Motivational interviewing is a counseling method devel- oped by Miller and Rollnick (1991, 1995) to elicit behavior change by helping clients explore and resolve ambivalence related to an undesired behavior. Most recently, motiva- tional interviewing is described by Miller and Rose (2009) as a clinical method with two active components that are both needed to accurately call it motivational interviewing: a relational component of therapist empathy and spirit and a technical component of therapist use of motivational inter- viewing methods. The motivational interviewing spirit is 1 Steno Health Promotion Center, Steno Diabetes Center A/S, Gentofte, Denmark Corresponding Author: Ane Høstgaard Bonde, MD, MPH, BSc, Steno Health Promotion Center, Steno Diabetes Center A/S, Niels Steensens Vej 8, DK-2820, Gentofte, Denmark. Email: ahbo@steno.dk The Journal of School Nursing 2014, Vol. 30(6) 448-455 ª The Author(s) 2014 Reprints and permission: sagepub.com/journalsPermissions.nav DOI: 10.1177/1059840514521240 jsn.sagepub.com at Novo Nordisk A/S on September 25, 2015 jsn.sagepub.com Downloaded from