Impact of the 5As Team study on clinical practice in primary care obesity management: a qualitative study

Asselin, Jodie; Salami, Eniola; Osunlana, Adedayo; Ogunleye, Ayodele A; Cave, Andrew; Johnson, Jeffrey; Sharma, Arya M.; Campbell‐Scherer, Denise

doi:10.9778/cmajo.20160090

Cited by 23 publications

(16 citation statements)

References 26 publications

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“…Our qualitative results demonstrated multifaceted clinically meaningful impacts on providers and teams to improve obesity management in primary care. 23 However, we did not observe statistically significant increases in clinical activity between the intervention and control arms in this quantitative analysis. This may be due to the greater than anticipated observed variation in nurses' clinical activity and the small sample size, which led to very large confidence intervals around the point estimates.…”

Section: Open Research Limitationscontrasting

confidence: 57%

“…A priori, we conducted and reported on a detailed qualitative evaluation to understand the facilitators and barriers affecting the primary outcome measure. 23,24 Here we report the convergent mixed-methods analysis that assesses the extent to which these barriers and facilitators affected the uptake of the intervention by the nurses and their impact on the quantity of obesity visits.…”

Section: Qualitative and Mixed-methods Analysismentioning

confidence: 99%

“…The qualitative methodology has been published previously. 23 In brief, the core qualitative data set came from semistructured interviews with the multidisciplinary team providers from the 5AsT intervention arm. Interview questions are provided in Appendix 4, available at www.cmajopen.ca/content/ 7/2/E371/suppl/DC1.…”

Section: Qualitative and Mixed-methods Analysismentioning

confidence: 99%

“…Coding and analysis procedures are described in detail elsewhere. 23 The data were analyzed using thematic analysis.…”

Section: Qualitative and Mixed-methods Analysismentioning

confidence: 99%

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Changing provider behaviour to increase nurse visits for obesity in family practice: the 5As Team randomized controlled trial

Campbell‐Scherer

Asselin

Osunlana

et al. 2019

cmajo

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O besity and its chronic disease complications are surging worldwide, 1,2 but health care professionals are poorly prepared to tackle the prevention and treatment of obesity in clinical practice; deficits in knowledge about the complexity of obesity and its management, as well as the need for team-based care, contribute. 3 Evidence is sparse on how to change provider behaviour to improve obesity assessment and management in primary care. 4-6 A suite of tools and resources to support primary care providers called the 5As of Obesity Management (the 5As: ask, assess, advise, agree, assist) has been developed in Canada. 7-11 This approach emphasizes obesity as a chronic disease requiring long-term treatment, the importance of prevention, and assessment of root causes to better understand how psychosocial and medical comorbidities promote obesity. Use of the 5As has been demonstrated to improve practitioners' efficacy in providing obesity counselling 12-14 and patient weight loss. 15 The 5As Team (5AsT) program was developed in collaboration with a large primary care network (PCN) in Alberta, Canada. Our overarching research question was whether a 6-month team-based learning collaborative with educational

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Section: Open Research Limitationscontrasting

confidence: 57%

Section: Qualitative and Mixed-methods Analysismentioning

confidence: 99%

Section: Qualitative and Mixed-methods Analysismentioning

confidence: 99%

“…Coding and analysis procedures are described in detail elsewhere. 23 The data were analyzed using thematic analysis.…”

Section: Qualitative and Mixed-methods Analysismentioning

confidence: 99%

See 2 more Smart Citations

Changing provider behaviour to increase nurse visits for obesity in family practice: the 5As Team randomized controlled trial

Campbell‐Scherer

Asselin

Osunlana

et al. 2019

cmajo

Self Cite

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“…35,36,37 Most notably, we found ISF's consideration of general team capacity and its impact on an individual's capacity building extremely important. 36,37 Our results illuminate the pathways between knowledge transformation, practice support, and practice delivery (Figure 2). They exemplify pragmatic strategies for achieving sustainable practice change.…”

Section: Resultsmentioning

confidence: 98%

Understanding Implementation of Complex Interventions in Primary Care Teams

et al. 2018

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Background:The implementation of interventions to support practice change in primary care settings is complex. Pragmatic strategies, grounded in empiric data, are needed to navigate real-world challenges and unanticipated interactions with context that can impact implementation and outcomes.Objective: This article uses the example of the "5As Team" randomized control trial to explore implementation strategies to promote knowledge transfer, capacity building, and practice integration, and their interaction within the context of an interdisciplinary primary care team.Methods: We performed a qualitative evaluation of the implementation process of the 5As Team intervention study, a randomized control trial of a complex intervention in primary care. We conducted thematic analysis of field notes of intervention sessions, log books of the practice facilitation team members, and semistructured interviews with 29 interdisciplinary clinician participants. We used and further developed the Interactive Systems Framework for dissemination and implementation to interpret and structure findings. Trial registration: Results: Three themes emerged that illuminate interactions between implementation processes, context, and outcomes: (1) facilitating team communication supported collective and individual sense-making and adoption of the innovation, (2) iterative evaluation of the implementation process and real-time

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Investigating the normalization and normative views of gestational weight gain: Balancing recommendations with the promotion and support of healthy pregnancy diets

Moffat

McKerracher

Oresnik

et al. 2021

American J Hum Biol

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Objectives Gestational weight gain (GWG) is increasingly monitored in the United States and Canada. While promoting healthy GWG offers benefits, there may be costs with over‐surveillance. We aimed to explore these costs/benefits. Methods Quantitative data from 350 pregnant survey respondents and qualitative focus group data from 43 pregnant/post‐partum and care‐provider participants were collected in the Mothers to Babies (M2B) study in Hamilton, Canada. We report descriptive statistics and discussion themes on GWG trajectories, advice, knowledge, perceptions, and pregnancy diet. Relationships between GWG monitoring/normalization and worry, knowledge, diet quality, and sociodemographics—namely low‐income and racialization—were assessed using χ2 tests and a linear regression model and contextualized with focus group data. Results Most survey respondents reported GWG outside recommended ranges but rejected the mid‐20th century cultural norm of “eating for two”; many worried about gaining excessively. Conversely, respondents living in very low‐income households were more likely to be gaining less than recommended GWG and to worry about gaining too little. A majority had received advice about GWG, yet half were unable to identify the range recommended for their prepregnancy BMI. This proportion was even lower for racialized respondents. Pregnancy diet quality was associated with household income, but not with receipt or understanding of GWG guidance. Care‐providers encouraged normalized GWG, while worrying about the consequences of pathologizing “abnormal” GWG. Conclusions Translation of GWG recommendations should be done with a critical understanding of GWG biological normalcy. Supportive GWG monitoring and counseling should consider clinical, socioeconomic, and community contexts.

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Impact of the 5As Team study on clinical practice in primary care obesity management: a qualitative study

Cited by 23 publications

References 26 publications

Changing provider behaviour to increase nurse visits for obesity in family practice: the 5As Team randomized controlled trial

Changing provider behaviour to increase nurse visits for obesity in family practice: the 5As Team randomized controlled trial

Understanding Implementation of Complex Interventions in Primary Care Teams

Investigating the normalization and normative views of gestational weight gain: Balancing recommendations with the promotion and support of healthy pregnancy diets

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