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Oliver TL, Burrell SA, Furman GE, Diewald LK, Mariani B, Starck MR, Shenkman R. Weight bias reduction intervention among nurse practitioner students using simulation-based experiences. J Am Assoc Nurse Pract 2023:01741002-990000000-00173. [PMID: 37788361 DOI: 10.1097/jxx.0000000000000956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 09/01/2023] [Indexed: 10/05/2023]
Abstract
ABSTRACT Few nurse practitioner (NP) programs include obesity and weight bias education in their curriculum. However, NPs will likely provide care for people living with obesity, many of whom have been discriminated against based on their weight by previous providers, and many NP students may feel unprepared to navigate weight management competently. This pilot study included a weight bias reduction (WBR) intervention, which included a simulation-based experience (SBE) with a standardized participant (SP) and educational activities embedded within the NP curriculum. Nineteen NP students participated in this pilot study, but only seven students had matching data for preintervention to postintervention scores. There were no statistically significant differences in preintervention and postintervention Attitudes Toward Obese Persons (ATOP) or Beliefs About Obese Persons (BAOP) scores. Despite this small sample size and not achieving statistical significance, SBE-SP holds promise to depict realistic patient encounters to improve NPs' attitudes and beliefs toward persons with obesity and to reduce weight bias. Therefore, incorporating SBE-SP may be a feasible component of the NP curriculum.
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Affiliation(s)
- Tracy L Oliver
- Villanova University M. Louise Fitzpatrick College of Nursing, Villanova, Pennsylvania
| | - Sherry A Burrell
- Oncology Nursing Fellowship Program, Villanova University M. Louise Fitzpatrick College of Nursing, Villanova, Pennsylvania
| | - Gail E Furman
- Simulation and Learning Resource Center, Villanova University M. Louise Fitzpatrick College of Nursing, Villanova, Pennsylvania
| | - Lisa K Diewald
- MacDonald Center for Obesity Prevention and Education, Villanova University M. Louise Fitzpatrick College of Nursing, Villanova, Pennsylvania
| | - Bette Mariani
- Villanova University M. Louise Fitzpatrick College of Nursing, Villanova, Pennsylvania
| | - Megan R Starck
- Villanova University M. Louise Fitzpatrick College of Nursing, Villanova, Pennsylvania
| | - Rebecca Shenkman
- MacDonald Center for Obesity Prevention and Education, Villanova University M. Louise Fitzpatrick College of Nursing, Villanova, Pennsylvania
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Abbott S, Shuttlewood E, Flint S, Chesworth P, Parretti H. "Is it time to throw out the weighing scales?" Implicit weight bias among healthcare professionals working in bariatric surgery services and their attitude towards non-weight focused approaches. EClinicalMedicine 2023; 55:101770. [PMID: 36568685 PMCID: PMC9772809 DOI: 10.1016/j.eclinm.2022.101770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 11/14/2022] [Accepted: 11/15/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND People living with overweight or obesity (PLwO) can be stigmatised by healthcare professionals (HCPs). Reducing focus on weight is a proposed strategy to provide less threatening healthcare experiences. Given the lack of research on weight bias within obesity services, this study aimed to explore implicit bias among obesity specialist HCPs and explore views on non-weight focused approaches. METHODS Obesity specialist HCPs were invited to a webinar, "An exploration of non-weight focused approaches within bariatric services", held in October 2021. Implicit weight bias was examined using the BiasProof mobile device test, based on the Implicit Association Test. Poll data was analysed descriptively, and qualitative data was analysed using framework analysis. FINDINGS 82 of the 113 HCPs who attended the webinar consented to contribute data to the study. Over half (51%) had an implicit weight bias against PLwO. Most (90%) agreed/strongly agreed that obesity services are too weight focused and that patients should not be weighed at every appointment (86%). Perceived benefits of taking a non-weight focused approach included patient-led care, reducing stigma and supporting patient wellbeing, while perceived barriers included loss of objectivity, inducing risk and difficulty demonstrating effectiveness. INTERPRETATION Our findings indicate that half of obesity specialists HCPs in our sample of 82 providers, who are primarily dieticians and psychologists, have an implicit weight bias against PLwO. HCPs feel that a weight-focused approach within services was a barrier to patient care, but that there is a lack of alternative non-weight focused measures. Further research is needed into substitute outcome measures for clinical practice, also seeking the views of PLwO, and into interventions to address implicit weight bias. FUNDING Johnson & Johnson funded the BiasProof licence and publication open access charge.
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Affiliation(s)
- S. Abbott
- Department of Bariatric Surgery, University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, UK
- Research Centre for Intelligent Healthcare, Coventry University, Richard Crossman Building, Coventry CV1 5RW, UK
- Corresponding author. Research Centre for Intelligent Healthcare, Coventry University, Richard Crossman Building, Coventry CV1 5RW, UK.
| | - E. Shuttlewood
- Department of Bariatric Surgery, University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, UK
| | - S.W. Flint
- School of Psychology, University of Leeds, Leeds, West Yorkshire, UK
- Scaled Insights, Nexus, University of Leeds, Leeds, West Yorkshire, UK
| | - P. Chesworth
- Patient Advocate, National Bariatric Surgery Register, UK
| | - H.M. Parretti
- Norwich Medical School, University of East Anglia, Norwich, Norfolk NR4 7TJ, UK
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Abstract
OBJECTIVE This study explores patients' acceptance of obesity as a chronic disease. DESIGN Cross-sectional, qualitative study using semistructured phone interviews. SETTING The study was conducted in specialty and primary care clinics from a single central tertiary hospital in Lebanon. Recruitment took place between February and March 2021. PARTICIPANTS AND METHODS 25 adult patients with overweight or obesity were interviewed and the interviews were analysed thematically. RESULTS Four themes emerged: (1) patients' knowledge and awareness of obesity are based on their own experience; (2) there is ambivalence or conditional acceptance of obesity as a chronic disease; and patients with overweight or obesity perceived (3) that the role of physicians in obesity management is related to complications and (4) that obesity management is as simple as eating less and exercising more. CONCLUSIONS The study shows the studied population's ambivalence in accepting obesity as a chronic disease. Individuals with overweight or obesity considered the role of the healthcare professional in obesity conditional on morbid obesity and the presence of medical complications of obesity. Findings of this study advocate for educational campaigns about the nature of obesity as a chronic disease and the role of healthcare professionals in obesity management.
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Affiliation(s)
- Natally AlArab
- Family Medicine, American University of Beirut, Beirut, Lebanon
| | - Jumana Antoun
- Family Medicine, American University of Beirut, Beirut, Lebanon
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Sherf-Dagan S, Kessler Y, Mardy-Tilbor L, Raziel A, Sakran N, Boaz M, Kaufman-Shriqui V. The Effect of an Education Module to Reduce Weight Bias among Medical Centers Employees: A Randomized Controlled Trial. Obes Facts 2022; 15:384-394. [PMID: 35066508 PMCID: PMC9210013 DOI: 10.1159/000521856] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 01/06/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Weight bias, stigma, and discrimination are common among healthcare professionals. We aimed to evaluate whether an online education module affects weight bias and knowledge about obesity in a private medical center setting. METHODS An open-label randomized controlled trial was conducted among all employees of a chain of private medical centers in Israel (n = 3,290). Employees who confirmed their consent to participate in the study were randomized into intervention or control (i.e., "no intervention") arms. The study intervention was an online 15-min educational module that included obesity, weight bias, stigma, and discrimination information. Questionnaires on Anti-Fat Attitudes (AFA), fat-phobia scale (F-scale), and beliefs about the causes of obesity were answered at baseline (i.e., right before the intervention), 7 days, and 30 days post-intervention. RESULTS A total of 506, 230, and 145 employees responded to the baseline, 7-day, and 30-day post-intervention questionnaires, respectively. Mean participant age was 43.3 ± 11.6 years, 84.6% were women, and 67.4% held an academic degree. Mean F-scale scores and percentage of participants with above-average fat-phobic attitudes (≥3.6) significantly decreased only within the intervention group over time (p ≤ 0.042). However, no significant differences between groups over time were observed for AFA scores or factors beliefs to cause obesity. CONCLUSIONS A single exposure to an online education module on weight bias and knowledge about obesity may confer only a modest short-term improvement in medical center employees' fat-phobic attitudes toward people with obesity. Future studies should examine if reexposure to such intervention could impact weight bias, stigma, and discrimination among medical center staff in the long-term.
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Affiliation(s)
- Shiri Sherf-Dagan
- Department of Nutrition Sciences, School of Health Sciences, Ariel University, Ariel, Israel
- Department of Nutrition, Assuta Medical Center, Tel Aviv, Israel
| | - Yafit Kessler
- Department of Nutrition Sciences, School of Health Sciences, Ariel University, Ariel, Israel
- Assia Medical Group, Assuta Medical Center, Tel Aviv, Israel
| | | | - Asnat Raziel
- Assia Medical Group, Assuta Medical Center, Tel Aviv, Israel
| | - Nasser Sakran
- Assia Medical Group, Assuta Medical Center, Tel Aviv, Israel
- Department of Surgery, Holy Family Hospital, Nazareth, Israel
- The Azrieli Faculty of Medicine Safed, Bar-Ilan University, Ramat Gan, Israel
| | - Mona Boaz
- Department of Nutrition Sciences, School of Health Sciences, Ariel University, Ariel, Israel
| | - Vered Kaufman-Shriqui
- Department of Nutrition Sciences, School of Health Sciences, Ariel University, Ariel, Israel
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Lawrence BJ, Kerr D, Pollard CM, Theophilus M, Alexander E, Haywood D, O'Connor M. Weight bias among health care professionals: A systematic review and meta-analysis. Obesity (Silver Spring) 2021; 29:1802-1812. [PMID: 34490738 DOI: 10.1002/oby.23266] [Citation(s) in RCA: 78] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 06/22/2021] [Accepted: 07/10/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Weight-biased attitudes and views held by health care professionals can have a negative impact on the patient-provider relationship and the provision of care, but studies have found mixed results about the extent and nature of bias, which warrants a review of the evidence. METHODS A systematic review and random-effects meta-analysis were conducted by including studies up to January 12, 2021. RESULTS A total of 41 studies met inclusion criteria, with 17 studies providing sufficient data to be meta-analyzed. A moderate pooled effect (standardized mean difference = 0.66; 95% CI: 0.37-0.96) showed that health care professionals demonstrate implicit weight bias. Health care professionals also report explicit weight bias on the Fat Phobia Scale, Antifat Attitudes Scale, and Attitudes Towards Obese Persons Scale. Findings show that medical doctors, nurses, dietitians, psychologists, physiotherapists, occupational therapists, speech pathologists, podiatrists, and exercise physiologists hold implicit and/or explicit weight-biased attitudes toward people with obesity. A total of 27 different outcomes were used to measure weight bias, and the overall quality of evidence was rated as very low. CONCLUSIONS Future research needs to adopt more robust research methods to improve the assessment of weight bias and to inform future interventions to address weight bias among health care professionals.
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Affiliation(s)
- Blake J Lawrence
- School of Population Health, Curtin University, Perth, Western Australia, Australia
- Western Australia Cancer Prevention Research Unit, Curtin University, Perth, Western Australia, Australia
| | - Deborah Kerr
- School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Christina M Pollard
- School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Mary Theophilus
- St John of God Hospital, Perth, Western Australia, Australia
| | - Elise Alexander
- School of Population Health, Curtin University, Perth, Western Australia, Australia
- Western Australia Cancer Prevention Research Unit, Curtin University, Perth, Western Australia, Australia
| | - Darren Haywood
- School of Population Health, Curtin University, Perth, Western Australia, Australia
- Western Australia Cancer Prevention Research Unit, Curtin University, Perth, Western Australia, Australia
| | - Moira O'Connor
- School of Population Health, Curtin University, Perth, Western Australia, Australia
- Western Australia Cancer Prevention Research Unit, Curtin University, Perth, Western Australia, Australia
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Lopez‐Olivo MA, des Bordes JK, Lin H, Volk RJ, Rizvi T, Suarez‐Almazor ME. A Randomized Controlled Trial Comparing Two Self-Administered Educational Strategies for Patients With Knee Osteoarthritis. ACR Open Rheumatol 2021; 3:185-195. [PMID: 33590950 PMCID: PMC7966878 DOI: 10.1002/acr2.11222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 11/09/2020] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE The objective of this study was to assess the efficacy of self-administered patient educational tools in improving knowledge and behaviors for the management of knee osteoarthritis. METHODS We conducted a randomized clinical trial in patients with knee osteoarthritis to assess the efficacy of providing a video for entertainment education, in combination with two booklets, compared with providing the booklets alone. We evaluated changes in scores on a patient knowledge questionnaire, the Decisional Conflict Scale, the Arthritis Self-Efficacy Scale, and the Effective Consumer Scale between baseline and same day, 3 months, and 6 months post intervention. We used linear regression models to explore associations between demographic characteristics and outcomes, testing for interactions. RESULTS Two hundred nineteen participants were randomly assigned to receive the video + booklets (n = 109) or the booklets alone (n = 110). The mean age of participants was 64.6 (±8.3) years. At 6 months, statistically significant improvements were observed in knowledge and decisional conflict scores for both groups, and statistically significant improvements in the behavior to participate in their health care were observed in the video + booklets group. The video + booklets group was more knowledgeable immediately post intervention than the booklet group (mean difference 0.39 [95% confidence interval 0.02-0.76]). No other significant changes in outcomes were observed at 6 months between the two groups. The video + booklets combination was associated with decreased decisional conflict in Spanish speakers and increased self-efficacy in those with less than a high school education. CONCLUSION Although both education strategies were associated with improved knowledge and reduced decisional conflict at 6 months, receiving the video + booklets in combination, compared with receiving the booklets alone, proved to be more effective in changing behaviors and appeared to have some advantages for Spanish speakers and those who were less educated.
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Affiliation(s)
| | - Jude K. des Bordes
- McGovern Medical SchoolThe University of Texas Health Science Center at Houston
| | - Heather Lin
- The University of Texas MD Anderson Cancer CenterHouston
| | - Robert J. Volk
- The University of Texas MD Anderson Cancer CenterHouston
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Tapking C, Benner L, Hackbusch M, Schüler S, Tran D, Ottawa GB, Krug K, Müller-Stich BP, Fischer L, Nickel F. Influence of Body Mass Index and Gender on Stigmatization of Obesity. Obes Surg 2020; 30:4926-4934. [PMID: 32772227 PMCID: PMC7719108 DOI: 10.1007/s11695-020-04895-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 07/24/2020] [Accepted: 07/28/2020] [Indexed: 11/01/2022]
Abstract
BACKGROUND Stigmatization and discrimination of people with obesity due to their weight are a common problem that may lead to additional weight gain. This study evaluated the influence of different parameters on the stigmatization of obesity. MATERIAL AND METHODS Participants of six groups (general population, patients with obesity, medical students, physicians, nurses in training and nurses; n = 490) answered the short-form fat phobia scale (FPS) between August 2016 and July 2017. The influence of body mass index (BMI), gender and other factors on total scores and single adjective pairs was analyzed. RESULTS A total of 490 participants were evaluated. The total mean FPS rating was 3.5 ± 0.6. FPS was significantly lower (more positive) in participants with obesity (3.2 ± 0.7) compared with participants without obesity (3.5 ± 0.5, p < 0.001). Individuals with obesity and diabetes rated the FPS significantly lower (more positive), whereas age and gender did not have a significant influence. Participants with obesity linked obesity more often with good self-control (p < 0.001), being shapely (p = 0.002), industrious (p < 0.001), attractive (p < 0.001), active (p < 0.001), self-sacrificing (p < 0.001) and having more willpower (p < 0.001) than the participants without obesity. Females rated more positive in shapely versus shapeless (p = 0.038) and attractive versus non-attractive (p < 0.001) than males. CONCLUSIONS The present study shows that stigmatization of obesity is present in medical professionals as well as the general population. People affected by obesity characterized other people with obesity more positively (e.g. attractive or active), whereas people without obesity linked negative characteristics with obesity. Gender had an influence only on single items of FPS but did not affect overall stigmatization of obesity.
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Affiliation(s)
- Christian Tapking
- Department of General, Visceral and Transplant Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Trauma Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwig-Guttmann-Strasse 13, 67071 Ludwigshafen on the Rhine, Germany
| | - Laura Benner
- Institute of Medical Biometry and Informatics, University of Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
| | - Matthes Hackbusch
- Institute of Medical Biometry and Informatics, University of Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
| | - Svenja Schüler
- Institute of Medical Biometry and Informatics, University of Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
| | - Danny Tran
- School of Medicine, University of Texas Medical Branch, Galveston, TX USA
| | - Gregor B. Ottawa
- Coordination Centre of Clinical Trials, University Hospital of Heidelberg, Im Neuenheimer Feld 110, Heidelberg, Germany
| | - Katja Krug
- Department of General Practice and Health Services Research, University Hospital of Heidelberg, Vossstr. 2, 69115 Heidelberg, Germany
| | - Beat P. Müller-Stich
- Department of General, Visceral and Transplant Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
| | - Lars Fischer
- Department of Surgery, Hospital Mittelbaden, Balger Strasse 50, 76532 Baden-Baden, Germany
| | - Felix Nickel
- Department of General, Visceral and Transplant Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
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Luig T, Wicklum S, Heatherington M, Vu A, Cameron E, Klein D, Sharma AM, Campbell-Scherer DL. Improving obesity management training in family medicine: multi-methods evaluation of the 5AsT-MD pilot course. BMC MEDICAL EDUCATION 2020; 20:5. [PMID: 31910854 PMCID: PMC6947955 DOI: 10.1186/s12909-019-1908-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 12/13/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Quality, evidence-based obesity management training for family medicine residents is needed to better support patients. To address this gap, we developed a comprehensive course based on the 5As of Obesity Management™ (ASK, ASSESS, ADVISE, AGREE, ASSIST), a framework and suite of resources to improve residents' knowledge and confidence in obesity counselling. This study assessed the course's impact on residents' attitudes, beliefs, and confidence with obesity counselling. METHODS The course combines lectures with a bariatric empathy suit experience, standardized and in-clinic patient practice, and narrative reflections. Using a multi-methods design we measured changes in 42 residents' attitudes, beliefs, and self-confidence and thematically analyzed the narrative reflections to understand residents' experience with the course content and pedagogy. RESULTS Following the course, residents reported improved attitudes towards people living with obesity and improved confidence for obesity counselling. Pre/post improvement in BAOP scores (n = 32) were significant (p < .001)., ATOP scores did not change significantly. Residents showed improvement in assessing root causes of weight gain (p < .01), advising patients on treatment options (p < .05), agreeing with patients on health outcomes (p < .05), assisting patients in addressing their barriers (p < .05), counseling patients on weight gain during pregnancy, (p < .05), counseling patients on depression and anxiety (p < .01), counseling patients on iatrogenic causes of weight gain (p < .01), counseling patients who have children with obesity (p < .05), and referring patients to interdisciplinary providers for care (p < .05). Qualitative analysis of narrative reflections illustrates that experiential learning was crucial in increasing residents' ability to empathically engage with patients and to critically reflect on implications for their practice. CONCLUSION The 5AsT-MD course has the potential to increase residents' confidence and competency in obesity prevention and management. Findings reflect the utility of the 5As to improve residents' confidence and competency in obesity management counselling.
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Affiliation(s)
- Thea Luig
- Office of Lifelong Learning & Physician Learning Program, University of Alberta, Edmonton, Canada
| | - Sonja Wicklum
- Cummings School of Medicine, University of Calgary, Calgary, Canada
| | - Melanie Heatherington
- Office of Lifelong Learning & Physician Learning Program, University of Alberta, Edmonton, Canada
| | - Albert Vu
- Core Internal Medicine, University of Alberta, Edmonton, Canada
| | - Erin Cameron
- Department of Human Sciences, Northern Ontario School of Medicine, Sudbury, Canada
| | - Doug Klein
- Department of Family Medicine, University of Alberta, Edmonton, Canada
| | - Arya M. Sharma
- Department of Medicine, Division of Endocrinology, University of Alberta, Edmonton, Canada
- Alberta Diabetes Institute, University of Alberta, Edmonton, Canada
| | - Denise L. Campbell-Scherer
- Office of Lifelong Learning & Physician Learning Program, University of Alberta, Edmonton, Canada
- Department of Family Medicine, University of Alberta, Edmonton, Canada
- Alberta Diabetes Institute, University of Alberta, Edmonton, Canada
- 2-590 Edmonton Clinic Health Academy, Office of Lifelong Learning/Physician Learning Program, University of Alberta, Edmonton, AB T6G 1C9 Canada
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