An Investigation of Parents' Perceptions of BMI and BMI-for-age, School-Based BMI Screening Programs and BMI Report Cards: Using Framing Theory and Perceptual Mapping Methods to Develop a Tailored BMI Report Card for the School District of Philadelphia

Abstract

School-based body mass index (BMI) screenings seek can improve parents' recall about their child's weight, increase concern about excess weight, and correct parents' misperceptions to help them make informed decisions about their child's health. However, schools have questioned parents' understanding of and attitudes about BMI, and have expressed concern about parents' reactions to BMI reports. Using a sample of school nurses (n=7) and parents/guardians (n=125) from the School District of Philadelphia (SDP), this research addressed these concerns by clarifying: 1) parents'/guardians' perceptions and knowledge about BMI; 2) the challenges schools face in communicating with parents/guardians; and 3) the messages that can be communicated to parents/guardians to help them understand their child's BMI-for-age category and why their child's BMI is measured in his/her school. The research used framing theory and perceptual mapping methods to study and improve communication about BMI to parents/guardians in the School District. The four-phase study design incorporated qualitative (focus groups and semi-structured in-depth interviews) and quantitative (cross-sectional survey) methods to assist in the development of an evidence-informed BMI report card template for the SDP. Messages were constructed to meet the needs of four distinct groups of parents/guardians that emerged from the factor and cluster analyses - "Passive Parents," "Neutral Parents," "Confident Advocates" and "Active Worriers." Although each cluster of parents/guardians had their own unique perceptions and varying degrees of assuredness and confidence related to BMI concepts, the majority of parents/guardians in this study shared common favorable perceptions about BMI measures, school-based screening programs and BMI report cards.