Date of Award


Document Type


Degree Name

Doctor of Philosophy (Ph.D.) Nursing




Background/Purpose: Obesity has continued to increase over the years with increase in morbidity and mortality. The advancement of psychiatric treatment has resulted in a higher prevalence of obesity among the psychiatric population related to the side-effects of the newer atypical anti-psychotics. This study addresses nurses’ attitudes towards obesity and people who are obese, focusing on psychiatric patients. Negative attitudes and low knowledge about psychiatric patients on atypical anti-psychotics can interfere with psychiatric nurses’ therapeutic potential to support patients with health promotion behaviors. The purpose of this study was to develop an instrument to measure the knowledge, attitudes, and self-reported behavior of psychiatric nurses towards the mentally ill obese patient. The secondary purpose was to determine if psychiatric nurses’ knowledge, attitudes and behaviors are different when the patient is obese versus normal weight. Methods: This study uses a descriptive and comparative design with two phases to develop and psychometrically test one instrument that can be used in future studies. In phase one existing instruments were adapted using 6 expert panelists for content validity. The instrument consists of four subsections; the knowledge (NKAAM), general attitudes towards obesity (NATOP), intrinsic attitudes (IATOP), and the self-reported behaviors (SRBTOP) subsections. In the second phase, the instrument was given to a national sample (n= 149) of psychiatric nurses. Two developed vignette scenarios, of an obese and a normal weight individual with severe mental illness, were randomly assigned to the participants via on-line survey questionnaire or sealed non-identifying paper questionnaires. Data analysis include instrument testing (content validity index, reliability), parametric testing, t-test, ANOVA, and chi square. Results: Reliability could not be obtained for the instrument as a whole. Findings indicate the nurses were generally knowledgeable about the medications and their side-effects but unknowledgeable about dosages. Positive correlation was found between years of psychiatric experience (p=.015) and participant’s weight to thinking that obese patients are aware of associated health risks. A t-test found significance between the 2 groups on items “strong-willed…. weak-willed”, “sociable….not sociable”, “attractive….unattractive”, and “trusting….suspicious” with more biased responses from the obese patient vignette. ANOVA and post-hoc tests found more bias in the older nurses towards the obese patient. On the SRBTOP subsection significance was found between the 2 groups (p=.000) on the mean scores and several of the items indicating bias towards the obese patient in the vignette. Conclusions and Implications: This instrument is a step towards measuring the negative attitudes nurses may have towards psychiatric patients who are obese. Also, understanding nurses’ underlying knowledge and attitude will help educators to identify and direct educational needs of psychiatric nurses, as students and nurses in the clinical areas.

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