Setting goal and implementation intentions in consultations between practice nurses and patients with overweight or obesity in general practice

Abstract

Objective: Patients with overweight or obesity increasingly attend general practice, which is an ideal setting for weight-loss counselling. The present study is the first to investigate the quality of weight-loss counselling provided by practice nurses in general practice to patients with overweight or obesity, in order to identify points for improvement. Design: An observational checklist was developed to assess goal and implementation intentions and 'missed opportunities for lifestyle counselling'. Comparisons were made with overall consultation goals set by practice nurses, as measured in a post-visit questionnaire. Setting: Dutch general practice. Subjects: One hundred video-taped consultations (2010/2011) between practice nurses and patients with overweight or obesity. Results: Half of the consultations contained a goal intention, of which the majority aimed to change eating behaviour. Only part of these goal intentions could be considered implementation intentions. It appeared that actions (how elements) were not often included here. Lifestyle change was more often perceived as an overall consultation goal than weight change. Regarding patterns of overall consultation goals, the majority addressed only one lifestyle factor at a time. If practice nurses formulated weight change in their overall consultation goal, they also used goal or implementation intentions, especially for weight change. In a quarter of the consultations, practice nurses did not ask any further questions about weight, nutrition or physical activity to gain insight, which is an important 'missed opportunity for lifestyle counselling'. Conclusions: Matching implementation intentions to the broader overall consultation goals of practice nurses would be meaningful, leading to desired goal-directed behaviours and subsequent goal attainment.

Present and future of nutrition guidance : lifestyle advice in primary care

“…It provides a sequence of evidence-based practice behaviors that are effective in helping patients to change health behaviors (33)(34)(35)(36). It can also be used for quality improvement (34 We also investigated the use of goal and implementation intentions to assess the quality of weightloss counselling provided by PNs to overweight or obese patients (160). Half of the consultations contained a goal intention; the majority aimed to change eating behaviour.…”

Prevention and treatment of obesity

“…They are trained to provide more detailed guidance on lifestyle changes, by means of communication techniques such as motivational interviewing. However, it has been shown that they could improve the quality of their lifestyle counselling so as to have more impact, which should also be more fully integrated in their training programme [30].…”

Strategies for using non-participatory video research methods in general practice

“…Video observation in primary care research focuses on the interaction between the practitioner and the patient, and technology or other personnel in the primary care team (Pearce et al, 2006, Spelten et al, 2015. In doing so, rich verbal, nonverbal and para-verbal communication may be extracted for analysis which assists researchers to understand the dynamics and communication techniques, skill development, and engagement in reflective practice in order to improve patient and professional interactions and outcomes (Asan and Montague, 2014, Macdonald et al, 2013, van Dillen et al, 2014a, Van Dillen et al, 2014b, Van Dillen et al, 2015, Verbiest et al, 2014.…”