title: Implementation of national guidelines for the prevention and treatment of overweight and obesity in children and adolescents: a phenomenographic analysis of public health nurses' perceptions.
abstract: OBJECTIVE
  To explore and describe how public health nurses (PHNs) perceive the implementation of national guidelines for the prevention and treatment of overweight and obesity among children and adolescents in well-baby clinics and school health services.
  An explorative descriptive design was carried out through individual interviews with 18 PHNs and analysed according to the phenomenographic tradition.
  
  
  RESULTS
  Four implementation strategies were described and assigned a metaphor: the structured PHN, pragmatic PHN, critical PHN, and the resigned PHN. Competence, patient receptiveness, internal consensus, interdisciplinary collaboration, resources, and organizational embedding were the determinants identified that most frequently affect implementation, and these determinants were distributed at different levels of the organization. The extent of facilitation seemed to determine which implementation strategy would be used.
  
  
  CONCLUSIONS
  How PHNs implemented the guidelines for overweight and obesity were affected by determinants at different organizational levels. Contextual facilitation of implementation seemed better in larger organizations, but factors such as leadership, drive, and experience compensated in smaller municipalities. The implementation of guidelines was hindered when the barriers exceeded the benefits.
authors.affiliation: Barn og unge tjenesten, Alta, Norway.
authors.forename: Aina
authors.initials: A
authors.lastname: Nordstrand
authors.affiliation: School of Health and Welfare, Jönköping University, Jönköpig, Sweden.|Faculty of Health and Social Sciences, Bergen University College, Bergen, Norway.
authors.forename: Bengt
authors.initials: B
authors.lastname: Fridlund
authors.affiliation: Faculty of Health and Social Sciences, Bergen University College, Bergen, Norway; rso@hib.no.
authors.forename: Ragnhild
authors.initials: R
authors.lastname: Sollesnes
mesh_terms: D000293:Adolescent; D000328:Adult; D001291:Attitude of Health Personnel; D002648:Child; D002662:Child Health Services; D003695:Delivery of Health Care; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007223:Infant; D007858:Learning; D008875:Middle Aged; D064689:Nurses, Public Health; D009765:Obesity / Q000517:prevention & control / Q000628:therapy*; D011637:Public Health Nursing; D036301:Qualitative Research; D012572:School Health Services
keywords: Evidence-based nursing; health promotion; qualitative methods; risk factors; school health service; well-baby clinic