Obesity in primary care: a qualitative synthesis of patient and practitioner perspectives on roles and responsibilities

Henderson, Emily

doi:10.3399/bjgp15x684397

Cited by 31 publications

(60 citation statements)

References 28 publications

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“…The main strength of including qualitative evidence in the overarching review was its ability to reveal critical features of WMPs that were hidden or unanticipated; without the qualitative evidence, such features would have gone untested in the QCA. A qualitative evidence syntheses on obesity management in primary care reached a similar conclusion, arguing that “approaches to obesity that engage all actors including the public … are needed to coproduce context‐specific solutions to a complex health issue” (p. e246).…”

Section: Discussionmentioning

confidence: 95%

“…Drawing on this logic, we undertook a mixed‐method systematic review, funded by the Department of Health England, to address the following question: What are the programme characteristics—and combinations of characteristics—that are associated with successful weight loss? This article focuses on the findings of the first stage of the review in which we drew on qualitative evidence to answer the question “What do WMP users and providers feel are the critical features of WMPs and how are these features perceived to impact on weight loss?” Whilst provider views largely underscored the views of service users, this article focuses specifically on the findings of the synthesis of service‐users’ views to illustrate how critical service‐user voices can be for understanding complex interventions. Whilst other qualitative evidence syntheses have examined broader user and provider views on, for example, obesity services in primary care and how WMPs are commissioned, run and viewed, our aim was more specific; we sought to focus in depth on the WMP features perceived to be critical for successful weight loss. In the second stage of the review, we examined evaluations of WMPs, employing qualitative comparative analysis (QCA) to test whether the features and mechanisms perceived to be important are actually associated with greater weight loss .…”

Section: Introductionmentioning

confidence: 99%

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The importance of service‐users’ perspectives: A systematic review of qualitative evidence reveals overlooked critical features of weight management programmes

Sutcliffe

Melendez‐Torres

Burchett

et al. 2018

Health Expectations

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BackgroundExtensive research effort shows that weight management programmes (WMPs) targeting both diet and exercise are broadly effective. However, the critical features of WMPs remain unclear.ObjectiveTo develop a deeper understanding of WMPs critical features, we undertook a systematic review of qualitative evidence. We sought to understand from a service‐user perspective how programmes are experienced, and may be effective, on the ground.Search strategyWe identified qualitative studies from existing reviews and updated the searches of one review.Inclusion criteriaWe included UK studies capturing the views of adult WMP users.Data extraction and synthesisThematic analysis was used inductively to code and synthesize the evidence.Main resultsService users were emphatic that supportive relationships, with service providers or WMP peers, are the most critical aspect of WMPs. Supportive relationships were described as providing an extrinsic motivator or “hook” which helped to overcome barriers such as scepticism about dietary advice or a lack confidence to engage in physical activity.Discussion and conclusionsThe evidence revealed that service‐users’ understandings of the critical features of WMPs differ from the focus of health promotion guidance or descriptions of evaluated programmes which largely emphasize educational or goal setting aspects of WMPs. Existing programme guidance may not therefore fully address the needs of service users. The study illustrates that the perspectives of service users can reveal unanticipated intervention mechanisms or underemphasized critical features and underscores the value of a holistic understanding about “what happens” in complex psychosocial interventions such as WMPs.

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Section: Discussionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

The importance of service‐users’ perspectives: A systematic review of qualitative evidence reveals overlooked critical features of weight management programmes

Sutcliffe

Melendez‐Torres

Burchett

et al. 2018

Health Expectations

View full text Add to dashboard Cite

show abstract

“…However, patient surveys and recordings of consultations suggest that such guidelines are not widely implemented 3, 4. Physicians report several barriers to action, including insufficient time and knowledge, belief that intervention would be ineffective, and fear of causing offence 5, 6, 7, 8. However, patients seem to be open to receiving advice from their doctors 9 …”

Section: Introductionmentioning

confidence: 99%

Screening and brief intervention for obesity in primary care: a parallel, two-arm, randomised trial

et al. 2016

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SummaryBackgroundObesity is a common cause of non-communicable disease. Guidelines recommend that physicians screen and offer brief advice to motivate weight loss through referral to behavioural weight loss programmes. However, physicians rarely intervene and no trials have been done on the subject. We did this trial to establish whether physician brief intervention is acceptable and effective for reducing bodyweight in patients with obesity.MethodsIn this parallel, two-arm, randomised trial, patients who consulted 137 primary care physicians in England were screened for obesity. Individuals could be enrolled if they were aged at least 18 years, had a body-mass index of at least 30 kg/m2 (or at least 25 kg/m2 if of Asian ethnicity), and had a raised body fat percentage. At the end of the consultation, the physician randomly assigned participants (1:1) to one of two 30 s interventions. Randomisation was done via preprepared randomisation cards labelled with a code representing the allocation, which were placed in opaque sealed envelopes and given to physicians to open at the time of treatment assignment. In the active intervention, the physician offered referral to a weight management group (12 sessions of 1 h each, once per week) and, if the referral was accepted, the physician ensured the patient made an appointment and offered follow-up. In the control intervention, the physician advised the patient that their health would benefit from weight loss. The primary outcome was weight change at 12 months in the intention-to-treat population, which was assessed blinded to treatment allocation. We also assessed asked patients' about their feelings on discussing their weight when they have visited their general practitioner for other reasons. Given the nature of the intervention, we did not anticipate any adverse events in the usual sense, so safety outcomes were not assessed. This trial is registered with the ISRCTN Registry, number ISRCTN26563137.FindingsBetween June 4, 2013, and Dec 23, 2014, we screened 8403 patients, of whom 2728 (32%) were obese. Of these obese patients, 2256 (83%) agreed to participate and 1882 were eligible, enrolled, and included in the intention-to-treat analysis, with 940 individuals in the support group and 942 individuals in the advice group. 722 (77%) individuals assigned to the support intervention agreed to attend the weight management group and 379 (40%) of these individuals attended, compared with 82 (9%) participants who were allocated the advice intervention. In the entire study population, mean weight change at 12 months was 2·43 kg with the support intervention and 1·04 kg with the advice intervention, giving an adjusted difference of 1·43 kg (95% CI 0·89–1·97). The reactions of the patients to the general practitioners' brief interventions did not differ significantly between the study groups in terms of appropriateness (adjusted odds ratio 0·89, 95% CI 0·75–1·07, p=0·21) or helpfulness (1·05, 0·89–1·26, p=0·54); overall, four (<1%) patients thought their intervention was inapprop...

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“…By providing obesity-specific training, the program enhanced the perceived self-efficacy and legitimacy of nurses and removed a barrier to their involvement in providing weight management care (Nolan et al 2012;Henderson 2015).…”

Section: Discussionmentioning

confidence: 99%

“…There is evidence that nurse-led programs are effective in providing risk assessment, patient education, counselling and obesity management in primary care (Counterweight Project Team 2008, 2012Wood et al 2008;Sargent et al 2012;Karnon et al 2013) and that patients report high levels of satisfaction with nurses providing chronic disease management (Halcomb et al 2015). However, international evidence suggests that the perceived self-efficacy and legitimacy of GPs and practice nurses in providing weight management care is impeded by a lack of obesity-specific training (Nolan et al 2012;Henderson 2015).…”

Section: Introductionmentioning

confidence: 99%

Is the Counterweight Program a feasible and acceptable option for structured weight management delivered by practice nurses in Australia? A mixed-methods study

Gray

Hoon

Afzali

et al. 2017

Aust. J. Prim. Health

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Abstract. Nurse-led weight management programs, like the Counterweight Program in the United Kingdom, may offer a way for Australian general practices to provide weight management support to adults who are overweight or obese. During Counterweight, nurses provide patients with six fortnightly education sessions and three follow-up sessions to support weight maintenance. This study examined the feasibility, acceptability and perceived value of the Counterweight Program in the Australian primary care setting using a mixed-methods approach. Six practice nurses, from three general practices, were trained and subsidised to deliver the program. Of the 65 patients enrolled, 75% (n = 49) completed the six education sessions. General practitioners and practice nurses reported that the training and resource materials were useful, the program fitted into general practices with minimal disruption and the additional workload was manageable. Patients reported that the program created a sense of accountability and provided a safe space to learn about weight management. Overall, Counterweight was perceived as feasible, acceptable and valuable by Australian practice staff and patients. The key challenge for future implementation will be identifying adequate and sustainable funding. An application to publically fund Counterweight under the Medicare Benefits Schedule would require stronger evidence of effectiveness and costeffectiveness in Australia.

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Obesity in primary care: a qualitative synthesis of patient and practitioner perspectives on roles and responsibilities

Abstract: BackgroundObesity is a top-priority global health issue; however, a clear way to address obesity in primary care is not yet in view.

Cited by 31 publications

References 28 publications

The importance of service‐users’ perspectives: A systematic review of qualitative evidence reveals overlooked critical features of weight management programmes

The importance of service‐users’ perspectives: A systematic review of qualitative evidence reveals overlooked critical features of weight management programmes

Screening and brief intervention for obesity in primary care: a parallel, two-arm, randomised trial

Is the Counterweight Program a feasible and acceptable option for structured weight management delivered by practice nurses in Australia? A mixed-methods study

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