General practitioners' and district nurses' conceptions of the encounter with obese patients in primary health care

Hansson, Lotta; Rasmussen, Finn; Ahlström, Gerd

doi:10.1186/1471-2296-12-7

Cited by 42 publications

(73 citation statements)

References 24 publications

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“…Our findings also suggested that HCPs perceived a shortage of clear recommendations from the policy makers (NBHW), as is so often pointed out in other obesity management studies [10,12,13]. The SBUreport is an evidence based document and an important source of information for decision-making authorities such as the NBHW as well as for those who work practically in health care [25].…”

Section: Discussionmentioning

confidence: 54%

“…However, national [10] and international [11][12][13][14] studies have identified obstacles to the implementation of obesity treatment in daily clinical work within primary care. Some of the more common factors described are lack of knowledge [10,13], lack of positive attitude [11][12][13] among the staff working with obese patients, vague guidelines [10,12] and lack of practical descriptions on how to implement the guidelines [12][13][14].…”

Section: Introductionmentioning

confidence: 99%

“…Some of the more common factors described are lack of knowledge [10,13], lack of positive attitude [11][12][13] among the staff working with obese patients, vague guidelines [10,12] and lack of practical descriptions on how to implement the guidelines [12][13][14]. The choice of treatments offered to patients often depends on local conditions or traditions [13].…”

Section: Introductionmentioning

confidence: 99%

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Low carbohydrate diet and obesity treatment in primary health care: dietary advice after the new Swedish report

2016

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Background: In 2013, the Swedish Council on Health Technology Assessment (SBU) published a report "Dietary treatment of obesity" where low carbohydrate diet (LCD) was established as one of the evidence based diet options in obesity treatment, even without diabetes. No data exists on how much the health care professionals (HCP) in primary care actually are informed of or to which extent they use the knowledge in the new report. We aimed to investigate the HCPs' current knowledge, attitudes and application of LCD in obesity treatment in primary care. Methods: All primary health care centres (PHCC) in Jönköping County Council (JCC) were invited to participate in this cross sectional descriptive study. HCPs who were working with obese patients were sent an online survey by email from January to March 2014. Data was collected about self-estimated knowledge, clinical practice of dietary advice and attitudes on LCD as well as demographic data and work related information. Chi2 and logistic regression were used to analyse associations between the independent and the outcome variables. Results: Two hundred and seventy-one HCPs completed the survey (70.7 %); 95 % gave dietary advice. Those who gave dietary advice, 49 % were uncertain about evidence based dietary advice; 28 % received education on dietary advice last year; 60 % reported patient requests for LCD; 80 % felt hesitant about LCD; 54 % stated that they have good knowledge about LCD and 47 % recommended LCD. Factors that influenced the advisement on LCD were profession (physician and diabetes nurse), patient requests for LCD (OR 0.46, 95 % CI 0.27-0.77, p = 0.003) and good knowledge (self-estimated) about LCD (OR 0.43, 95 % CI 0.26-0.71, p = 0.001). Recent education on dietary advice affected in a positive way the uncertainty about evidence based dietary advice (OR 0.19, p = 0.0001), the hesitancy about LCD (OR 0.37,, p = 0.002) and self-estimated knowledge about LCD (OR 2.67, 95 % CI 1.49-4.80, p = 0.001). Conclusions: HCPs were positive to dietary advisement but had an ambivalent attitude toward LCD as yet another dietary option. This area may be improved with continuous educational training, supposing that this is prioritized. Thus, it is reasonable to believe that LCD will gradually be more common as a tool to deal with obesity in primary care in the future.

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Section: Discussionmentioning

confidence: 54%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Low carbohydrate diet and obesity treatment in primary health care: dietary advice after the new Swedish report

2016

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“…We also looked at patterns in overall consultation goals set by practice nurses and it appeared that the majority addressed only one lifestyle factor at a time in their consultation. Another study among primary-care providers found that they saw it as important to advise the patient with obesity to take small steps and start with one thing at a time (53) . Often, patients were eager to go ahead and make changes in all areas at once.…”

Section: Discussionmentioning

confidence: 99%

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

Dillen¹,

Noordman²,

Dulmen³

et al. 2015

Public Health Nutr.

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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.

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“…HP perceptions of male patients tended to assume that they would be more accepting of a direct approach to discussing obesity. According to Hanson et al (2011), HPs have been shown to exhibit gender specific views that encapsulate traditional masculine (stoical) behaviours and this may partly explain why men have come to be seen as a 'hard to teach' group within healthcare (Connell, 2005).…”

Section: Causal Condition -Health Professionals' Viewsmentioning

confidence: 99%

Gender perceptions and their impact when referring obese patients for exercise

Queen

Parker

Crone

2016

Qualitative Research in Sport, Exercise and Health

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Abstract:Obesity trends in the UK have shown a steady increase over the past 20 years, yet differences have been identified in the uptake and adherence data for obese men and women attending exercise referral schemes (ERS). Moreover, evidence suggests that health professionals (HPs) may hold preconceived gender specific views about their patients and this has been identified as a potential barrier to male patients seeking help from their GPs for chronic conditions. The aim of this paper is to examine the gender dynamics associated with health profession/patient interactions in relation to the uptake of an ERS for obese patients.The ERS in question was based in a Primary Care Health Centre in the South West of England. The respondent cohort comprised 12 patients (8 women, 4 men) aged 55-74 years and their 6 referring HPs (4 women, 2 men). Semi-structured interviews were conducted with patients and HPs over an eight month period and the data were analysed via a grounded theory approach. The study found that HP gender specific perceptions of their patients had an impact on the methods used to encourage patients to participate. HPs typically adopted a direct interactional approach with obese men and a more cautious approach with obese women. Irrespective of gender, male and female patients found being informed of their obesity difficult to accept. The paper concludes that there is a need for a degree of care to be taken when communicating such health concerns and that this kind of approach may lead to increased ERS attendance (and adherence) by men.

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General practitioners' and district nurses' conceptions of the encounter with obese patients in primary health care

Cited by 42 publications

References 24 publications

Low carbohydrate diet and obesity treatment in primary health care: dietary advice after the new Swedish report

Low carbohydrate diet and obesity treatment in primary health care: dietary advice after the new Swedish report

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

Gender perceptions and their impact when referring obese patients for exercise

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