A qualitative inquiry about weight counseling practices in community health centers

Schauer, Gillian L.; Woodruff, Rebecca C.; Hotz, James; Kegler, Michelle C.

doi:10.1016/j.pec.2014.05.026

Cited by 16 publications

(45 citation statements)

References 22 publications

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“…According to this report, healthcare providers should be engaging in age-appropriate health education and health promotion with patients and/or parents during well-child physicians' visits. Unfortunately, many physicians do not meet these guidelines (Cabana et al, 1999) and when education is conducted, findings indicate that physicians do a poor job of counseling overall due to lack of confidence, knowledge and counseling skills (Leventer-Roberts et al, 2005;Schauer et al, 2014). In addition, research suggests that evidence-based practices were rarely utilized when conducting health education and other allied care professionals were also under-utilized or referred to for counseling (Schauer et al, 2014).…”

Section: Introductionmentioning

confidence: 99%

“…Unfortunately, many physicians do not meet these guidelines (Cabana et al, 1999) and when education is conducted, findings indicate that physicians do a poor job of counseling overall due to lack of confidence, knowledge and counseling skills (Leventer-Roberts et al, 2005;Schauer et al, 2014). In addition, research suggests that evidence-based practices were rarely utilized when conducting health education and other allied care professionals were also under-utilized or referred to for counseling (Schauer et al, 2014). However, when health education is conducted in the form of health counseling using evidence-based techniques, patient attitudes and behaviors showed a significant improvement in relation to weight control (Cox et al, 2011) and smoking (Ridner et al, 2014).…”

Section: Introductionmentioning

confidence: 99%

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Prevention counseling among pediatric patients presenting with unintentional injuries to physicians' offices' in the United States

Hammig

2015

Preventive Medicine

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Prevention counseling among pediatric patients presenting with unintentional injuries to physicians' offices' in the United States

Hammig

2015

Preventive Medicine

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“…This analysis reports results regarding the barriers that CHC clinicians perceive their patients face in maintaining a healthy weight. Results regarding when, to whom, and how clinicians provide weight counseling has been reported in a prior publication [ 22 ]. Barriers to providing weight counseling were assessed using this question: “In general, what is the biggest challenge you face in bringing up or addressing weight with your patients?” All study procedures were approved by the Emory University Institutional Review Board (Study ID: 00059222).…”

Section: Methodsmentioning

confidence: 99%

“…Prior research has documented that clinicians perceive many barriers to providing weight counseling during primary care visits, including lack of time, competing clinical priorities other than obesity, insufficient reimbursement, and lack of community-based resources to which they can refer patients [ 12 , 17 – 22 ]. Several studies have also found that clinicians perceive complex social, cultural, economic, and environmental determinants of obesity [ 12 , 17 – 19 ], though no studies have attempted to characterize clinicians’ perceptions of these determinants in depth.…”

Section: Introductionmentioning

confidence: 99%

Barriers to weight loss among community health center patients: qualitative insights from primary care providers

et al. 2016

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BackgroundCommunity Health Centers (CHCs) are important settings for obesity prevention and control. However, few studies have explored the barriers that CHC clinicians perceive their patients face in maintaining a healthy weight.MethodsSemi-structured in-depth interviews were conducted with thirty physicians, physician assistants, and nurse practitioners recruited from four Community Health Centers (CHCs), located in a rural, southwestern region of the state of Georgia, US. Interviews were digitally recorded, transcribed verbatim, and thematically analyzed.ResultsClinicians perceived that their patients face numerous individual, interpersonal, and community-level barriers to weight loss. Perceived individual-level barriers included interrelated aspects of poverty and limited motivation to lose weight. Perceived interpersonal barriers included social and cultural norms, such as positive associations with larger body sizes, negative associations with smaller body sizes, lack of awareness of obesity as a problem, and beliefs regarding hereditary or generational body types. Perceived community-level barriers included limited healthy food options and aspects of the local food culture in the Southern US.ConclusionsClinicians perceived that their patients face barriers to weight loss at multiple levels of the social ecology, including individual, social, and environmental factors. Results may partly explain limited provision of weight counseling in CHCs and suggest opportunities for intervention.

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“…Although this literature is useful for clinicians who wish to discuss weight with patients, it frequently uses 'expert opinion' to provide hypothetical examples of communication practices that are assumed to work (Kushner, 2011;Strategies to Overcome and Prevent Obesity Alliance, 2014;Vallis et al, 2013;), post-hoc interviews with clinicians and patients which rely upon memories of interaction that do not always accurately represent what happened (Schauer et al, 2014;Ward et al, 2009), or observations and recordings of communication which are considered through 'codes that lock aspects of interaction into a set of predefined strategies' (Maynard & Heritage, 2005: 428;Flocke et al, 2009;Heintze et al, 2010;Pollak et al, 2007;Scott et al, 2004). The disadvantage of these methods is that they neglect the contextualized details of real-life interactions, which are often 'messier' and more nuanced than idealized, invented, or recollected examples.…”

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confidence: 99%

Initiating discussions about weight in a non‐weight‐specific setting: What can we learn about the interactional consequences of different communication practices from an examination of clinical consultations?

Speer

McPhillips

2018

British J Health Psychol

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ObjectivesEffective clinical communication is fundamental to tackling overweight and obesity. However, little is known about how weight is discussed in non‐weight‐specific settings where the primary purpose of the interaction concerns clinical matters apparently unrelated to weight. This study explores how mental health clinicians initiate discussions about a patient's possible weight problem in the non‐weight‐specific setting of a UK NHS Gender Identity Clinic (GIC), where weight is topicalized during discussions about the risks of treatment.DesignA conversation analytic study.MethodsA total of 194 recordings of routine clinician–patient consultations were collected from the GIC. Weight talk was initiated by four clinicians in 43 consultations. Twenty‐one instances contained reference to a possible weight problem. Transcripts were analysed using conversation analysis.ResultsClinicians used three communication practices to initiate discussion of a possible weight problem with patients: (1) announcing that patients are overweight; (2) asking patients whether they are overweight; and (3) deducing that patients are overweight or obese via a body mass index (BMI) calculation. Announcing that patients are overweight is the least aligning practice that denies patient's agency and grammatically constrains them to agree with a negative label. Asking patients whether they are overweight treats them as having limited agency and generates comparatively aligning, but occasionally resistant, responses. Jointly deducing that patients are overweight or obese via a BMI calculation is the most aligning practice, which deflects responsibility for labelling the patient onto an objective instrument.ConclusionsSmall differences in the wording of turns that initiate discussions about a possible weight problem can have significant consequences for interactional alignment. Clinicians from different specialities may benefit from considering the interactional consequences of different practices for initiating discussions about weight during the kinds of real‐life discussions considered here. Statement of contribution What is already known on this subject? There is a correlation between clinical communication about weight and patient weight loss.Clinicians from all specialties are encouraged to discuss diet and exercise with patients, but communication about weight remains problematic.Health psychologists have identified an urgent need for communication training to raise sensitive topics like weight without damaging the doctor–patient relationship. What does this study add? Clinicians in a non‐weight‐specific setting use three communication practices to introduce the possibility that a patient's weight may be a problem.These practices have varying consequences for the interaction and doctor–patient relationship.Conversation analytic findings may be useful in training clinicians how to initiate discussions about weight with patients.

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A qualitative inquiry about weight counseling practices in community health centers

Cited by 16 publications

References 22 publications

Prevention counseling among pediatric patients presenting with unintentional injuries to physicians' offices' in the United States

Prevention counseling among pediatric patients presenting with unintentional injuries to physicians' offices' in the United States

Barriers to weight loss among community health center patients: qualitative insights from primary care providers

Initiating discussions about weight in a non‐weight‐specific setting: What can we learn about the interactional consequences of different communication practices from an examination of clinical consultations?

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