Methods: One-group repeated measures design used surveys immediately before the intervention, immediately after the intervention, and 30 days after the intervention to evaluate the effects of the BSI on nursing students’ attitudes toward obesity and beliefs about obese persons. The BSI was delivered to a convenience sample of 70 first-semester nursing students enrolled in the introductory clinical nursing course of an accelerated BSN program. The entire class viewed the trigger films, participated in a debrief session facilitated by the project investigator, and completed surveys during regularly scheduled class time. Survey completion was optional, but all 70 students elected to participate in the surveys. Student survey packets were coded to ensure anonymity but allow matching of the surveys competed by each student at the 3 time points for analysis. For protection of human rights, this project was reviewed and approved by the institutional review board of the author’s university.
The BSI developed for this project included the creation of 6 short video vignettes, or trigger films, along with a facilitated debrief. Trigger films are short social guidance educational films intended for student audiences and focus on themes that engage the affective domain. The trigger films highlighted simulated scenarios involving interactions among members of the health care team and, in some cases, interactions with patients. Key learning points built into the BSI included: recognizing the multifactorial etiologies of obesity, avoidance of ‘blaming the victim’, and understanding the consequences of attributing the lack of personal willpower as the cause of all obese conditions.
The Nurses’ Attitudes Toward Obesity and Obese Patients Scale (NATOOPS) developed by Watson, Oberle, and Deutscher (2008) is a 36-item questionnaire framed on 100 mm visual analog scale that was used to measure students’ attitudes toward obesity and obese adult patients at 3 time points. The Beliefs About Obese Persons Scale (BAOPS) developed by Reto (2003) is a questionnaire with 8 items, each scored on 6-point Likert scale (total score 0 to 48). Each item assesses extent of agreement or disagreement with statement about controllability of obesity. Both instruments were administered before, immediately after, and 30 days after delivery of the BSI
Results: NATOOPS subscale scores showed significant improvement in attitudes toward obesity for 3 of 5 subscales from pre-intervention to immediately post-intervention and 2 of 5 subscales from pre-intervention to 30-day post-intervention. BAOP total scores showed significantly more positive beliefs about controllability of obesity from pre-intervention to immediately post-intervention, from pre-intervention to 30-day post-intervention.
The BSI produced immediate changes in nursing students’ attitudes (NATOOPS) and underlying (explicit) beliefs about individuals who are obese (BAOP). However, sustainability of this intervention needs to be explored further.
Conclusion: A well-designed Bariatric Sensitivity Intervention (BSI) exploring obesity issues can positively impact nursing students’ attitudes toward and beliefs about caring for obese patients. Attitudes about obese persons are positively changed when obesity is attributed to genetics and/or environmental factors. However, beneficial effects of this intervention may not be sustained unless mechanisms are in place to reinforce its content throughout the educational curriculum. Faculty should consider exposing students to simulations using bariatric-sized mannequins/models and bariatric equipment prior to clinical entry, sharing current research on causes, health risks, and effective nursing interventions associated with obesity with nursing students in order to reduce stigmatization of obese patients. Modeling use of supportive communication / language when talking to overweight or obese patients should be demonstrated by faculty in the classroom, clinical and laboratory settings. This project could be replicated to determine whether delivery of BSI would be more effective if delivered at time points later in the nursing curriculum. Further research is needed to develop effective interventions for improving student attitudes and reducing bias, stigma, and discrimination toward obese patients.
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