Patient-practitioner relationships desired by overweight/obese adults

Integrating person-centred care and social justice: a model for practice with larger-bodied patients

Person-centred care (PCC) has been touted as a promising paradigm for improving patients' experiences and outcomes, and the overall therapeutic environment for a range of health conditions, including obesity. While this approach represents an important shift away from a paternalistic and disease-focused paradigm, we argue that PCC must be explicitly informed by a social justice lens to achieve optimal conditions for health and well-being. We suggest that existing studies on PCC for obesity only go so far in achieving social justice goals as they operate within a biomedical model that by default pathologises excess weight and predetermines patients' goals as weight loss and/or management, regardless of patients' embodied experiences and desires. There remains a dearth of empirical research on what social justice-informed PCC looks like in practice with larger patients. This interview study fills a research gap by exploring the perspectives of 1) health practitioners (n=22) who take a critical, social justice-informed approach to weight and 2) larger patients (n=20) served by such practitioners. The research question that informed this paper was: What are the characteristics of social justice-informed PCC that play out in clinical interactions between healthcare practitioners and larger-bodied patients? We identified five themes, namely: 1) Integrating evidence-based practice with compassionate, narrative-based care; 2) Adopting a curious attitude about the patient's world; 3) Centring patients' own wisdom and expertise about their conditions; 4) Working within the constraints of the system to advocate for patients to receive equitable care; 5) Collaborating across professions and with community services to address the multifaceted nature of patient health. The findings illustrate that despite participants' diverse perspectives around weight and health, they shared a commitment to PCC by upholding patient self-determination and addressing weight stigma alongside other systemic factors that affect patient health outcomes.

Digital consultations for weight management in the NHS: A qualitative evaluation

Receiving digital healthcare consultations for weight management, in place of in-person appointments, has proliferated in recent years, accelerated by the COVID-19 pandemic. The objective of the present study was to investigate patients' experiences of digital weight management services (DWMS) provided by the National Health Service (NHS). Particular emphasis was placed on examining the perceived benefits and limitations of DWMS so as to identify potential means of improving provision. Sixteen patients (eight male; eight female) accessing digital consultations at one of two West Midlands (UK) NHS trusts, participated in semi-structured interviews. Interviews were transcribed verbatim and analysed via thematic analysis. We identified three overarching themes and associated sub-themes that reflect the perceived benefits and limitations of service provision as identified by patients. These were technology acceptability (sub-themes 'challenges', 'requirements/facilitators', and 'beneficial features'); treatment acceptability (sub-themes 'treatment features', 'patient attributes', and 'practitioner skills'); and treatment efficacy (sub-themes 'treatment features', 'patient attributes', and 'practitioner skills'). Themes identified in this study have informed recommendations intended to enhance acceptability of DWMS technology and treatment, potentially encouraging engagement and increasing treatment efficacy. Limitations of the present study and recommendations for further research are also presented.

The Collaboration Compass: A Preliminary Model for Navigating Collaborative Practice

Purpose

To investigate the meaning and manifestation of collaboration in practice including the experience and outcomes for patients and professionals.

Methods

Grounded theory was used to investigate collaboration in an integrated outpatient parenteral antimicrobial therapy (OPAT) service. The sample consisted of staff and patients with experience of OPAT. Interviews and focus groups were used to generate data, and grounded theory methods were used to progress the study through constant comparative analysis and theoretical sampling to data saturation. Coding, categorizing, and techniques of situational analysis were used to analyze data and develop theory.

Results

The relationship between the influences in the situation and the interaction which takes place between individuals was found to produce four different types of collaboration: developing, maintaining, limiting, and disrupting collaboration. The collaboration compass model was developed to illustrate and aid interactive navigation of collaborative situations.

Discussion

The findings present the complexity of practice, and a model to explain the multiple influences and interaction which shape collaboration. In this model, patients are part of collaboration, and this ensures that patients’ views and experiences, as well as those of professionals, are included and represented in knowledge about collaboration. This adds a new dimension to existing interprofessional presentations of collaborative practice and examines collaboration as it is operationalized in practice and co-constructed between patients and professionals during day to day practice.

Keeping our staff in mind: Dietary results of a lifestyle intervention targeting mental health staff

ISSUES ADDRESSED

1) Describe the dietary intake of mental health staff within South Eastern Sydney Local Health District and 2) Evaluate the impact of an individualised staff lifestyle program on the following nutrition parameters; (i) energy, (ii) core food groups and (iii) discretionary foods.

METHODS

This was a pragmatic single-arm intervention study, conducted for all staff working in a public mental health service, in Sydney, Australia. A five-session individualised lifestyle intervention delivered over 5 weeks incorporated nutritional counselling delivered by a dietitian. Participants were assessed at baseline, following the intervention, and at follow-up using diet history to assess dietary intake.

RESULTS

Eighty-eight staff completed the dietary intervention and follow-up. An intake of core food groups significantly below national recommendations was reported for total vegetables (-1.75 ± 0.14 serves, P < .001), fruit (-0.29 ± 0.11 serves, P = .01), grains (-1.25 ± 0.20 serves, P < .001) and dairy servings (-1.00 ± 1.08 serves, P < .001), and protein-based foods were significantly above national recommendations (0.2 ± 0.09 serves, P = .03). At completion of the program, energy from discretionary foods was reduced by 460 kJ (95% CI -635 to -285, P < .001), and the serves of total vegetables (0.91 serves, 95% CI 0.59-1.22, P < .001) and dairy (0.31 serves, 95% CI 0.11-0.50, P < .001) were increased significantly.

CONCLUSIONS

A workplace-based well-being program for staff working in the mental health setting coincided with dietary improvements.

SO WHAT

Mental health staff can act as positive role models for clients to promote developing positive physical health behaviours.

Youth perspectives on weight-related words used by healthcare professionals: A qualitative study

BACKGROUND

Although healthcare professionals often consider body weight a sensitive and difficult topic to discuss with children, a contextualized and comprehensive understanding of youth perspectives on weight-related words used in healthcare has yet to be established. This qualitative study aims to explore perspectives of Dutch children on the terminology healthcare professionals use when discussing weight.

METHODS

Fourteen interviews and one focus group discussion were held with children (age 8-16) who were in care because of their weight. A toolkit with customizable interview techniques was used in order to facilitate reflection and tailor the interview to each respondent. A narrative content analysis was conducted.

RESULTS

Respondents attached both clear and subtle differences in meanings to (certain) weight-related words. Their perspectives were not unanimous for any single word. Moreover, at times, respondents framed certain words in positive or negative ways or used a word they disliked to describe themselves. This illustrates that meanings of weight-related words are not fixed but context and situation specific.

CONCLUSION

This study revealed that meanings children assign to weight-related words are shaped by their experiences in the broader social context, especially at school, as well as with (previous) healthcare professionals. It pointed towards the importance of bedside manner, acquaintanceship, and support. Healthcare professionals treating children because of their body weight are advised to invest in a good patient-caregiver relationship, pay attention to children's previous (negative) social weight-related experiences, and reflect critically on their own preconceptions about body weight and the impact these preconceptions might have on their patient-caregiver relationships.

Clinical encounters about obesity: Systematic review of patients' perspectives

Guidelines recommend clinicians intervene on obesity but it is unclear how people with overweight react. In this systematic review, we searched 20 online databases for qualitative studies interviewing people with overweight or obesity who had consulted a primary care clinician. Framework synthesis was used to analyse 21 studies to produce a new theoretical understanding. Consultations in which patients discussed their weight were more infrequent than patients would have liked, which some perceived was because they were unworthy of medical time; others that it indicated doctors feel being overweight is not a serious risk. Patients reported that doctors offered banal advice assuming that the patient ate unhealthily or was not trying to address their weight. Patients reported doctors assumed that their symptoms were due to overweight without a proper history or examination, creating concern that serious illness may be missed. Patients responded positively to offers of support for weight loss and active monitoring of weight. Patients with overweight internalize weight stigma sensitizing them to clues that clinicians are judging them negatively, even if weight is not discussed. Patients' negative experiences in consultations relate to perceived snap judgements and flippant advice and negative experiences appear more salient than positive ones.

Encouraging perspective taking: Using narrative writing to induce empathy for others engaging in negative health behaviors

Societal expectations of self-care and responsible actions toward others may produce bias against those who engage in perceived self-harming behavior. This is especially true for health professionals, who have dedicated themselves to helping reduce the burden of illness and suffering. Research has shown that writing narratives can increase perspective taking and empathy toward other people, which may engender more positive attitudes. Two studies examined whether creating a fictional narrative about a woman who smokes cigarettes while pregnant could increase positive attitudes toward the woman who smokes and reduce the internal attributions made for her behavior. Across both experiments, the narrative writing intervention increased participants’ empathy and perspective taking, evoked more positive attitudes toward a woman who smokes cigarettes while pregnant, and increased external attributions for her behavior. This work supports our hypothesis that narrative writing would be an efficacious intervention promoting attitude change toward patients who engage in unhealthy, and often contentious, behaviors. This work also suggests that narrative writing could be a useful intervention for medical professionals and policy makers leading to more informed policy or treatment recommendations, encouraging empathy for patients, and engendering a stronger consideration of how external forces can play a role in someone’s seemingly irresponsible behavior.

Barriers and facilitators of midwives' physical activity behaviour in hospital and community contexts in Scotland

AIMS

To investigate barriers and facilitators of physical activity in midwives in hospital and community environments.

DESIGN

A sequential mixed-methods approach.

DATA SOURCES

Focus groups and subsequent questionnaire survey.

METHODS

Four focus groups were conducted in urban and rural areas with community and hospital-based midwives in Scotland in 2015. Topics were based on the behaviour change theories via the Theoretical Domains Framework. Findings informed development of a questionnaire, sent to midwives in 2016 in Scottish health boards via managers, or online survey.

RESULTS

Thirty-three midwives participated in focus groups. Workplace environmental context and resources were both barriers and facilitators. Similarly, negative social influences were barriers, whereas positive social support facilitated physical activity. The questionnaire was completed by 345 midwives. Most (90%) were physically active with high levels of activity. Commonest activities included walking, swimming and housework. Physical activity facilitators included subsidized classes and protected breaks. Barriers included tiredness, stress, family responsibilities, unpredictable breaks and shift patterns.

CONCLUSIONS

Interventions should address midwives' workplace context and resources and interpersonal factors such as stress and social support.

IMPACT

Midwives' high levels of overweight/obesity and stress impact on their own health and delivery of patient care. More workplace physical activity could help. We found most were physically active but identified workplace barriers and facilitators, including resources, shift patterns and breaks. Findings could help midwifery managers to recognize and reduce barriers, thereby improving midwives' physical activity in the workplace, supporting weight management and enhancing their health and well-being.

Individual user involvement at Healthy Life Centres: a qualitative study exploring the perspective of health professionals

The aim of this study was to explore how professionals experience user involvement at an individual level and how they describe involving users at Healthy Life Centres. Four focus group interviews were conducted with a total of 23 professionals. Data were analysed using systematic text condensation. Four themes were identified: (1) Involving users through motivational interviewing; (2) Building a good and trustful relation; (3) Assessing and adjusting to the user’s needs and life situation; and(4) Strengthening the user’s ownership and participation in the lifestyle change process. Motivational interviewing was described by the professionals as a way to induce and ensure user involvement. However, seeing motivational interviewing and user involvement as the same concept might reduce user involvement from being a goal in itself and evolve into a means of achieving lifestyle changes. The professionals might be facing opposing discourses in their practice and a dilemma of promoting autonomy and involvement and at the same time promoting change in a predefined direction. Greater emphasis should thus be put on systematic reflection among professionals about what user involvement implies in the local Healthy Life Centre context and in each user’s situation.

Abbreviations: HLC: Healthy Life Centre; MI: Motivational Interviewing; NCD: Non-communicable diseases; STC: Systematic Text Condensation. SDT: Self-determination theory

Obesity and Sexual Dysfunction: Making the Connection

Understanding the relationship between the two may motivate patients to discuss weight loss.

"It is not the diet; it is the mental part we need help with." A multilevel analysis of psychological, emotional, and social well-being in obesity

In this research, we explored the psychological, emotional, and social experiences of individuals living with obesity, and perceptions of health care providers. We conducted a theoretical thematic analysis using two theoretical frameworks applied to transcripts from a previous qualitative study. Themes from a mental well-being framework were subsequently categorized under five environmental levels of the Social-Ecological Model (SEM). Key mental well-being themes appeared across all levels of the SEM, except the policy level. For the individual environment, one main theme was food as a coping mechanism and source of emotional distress. In the interpersonal environment, two themes were (a) blame and shame by family members and friends because of their weight and (b) condemnation and lack of support from health professionals. In the organizational environment, one main theme was inadequate support for mental well-being issues in obesity management programmes. In the community environment, one major theme the negative mental well-being impact of the social stigma of obesity. An overarching theme of weight stigma and bias further shaped the predominant themes in each level of the SEM. Addressing weight stigma and bias, and promoting positive mental well-being are two important areas of focus for supportive management of individuals living with obesity.

Promoting healthy behaviours - do we need to practice what we preach?

The UK faces a public health challenge arising from unhealthy behaviours. Some health care workers engage in the same unhealthy behaviours as the general population. This paper explores the issues arising from some primary care staff adopting unhealthy behaviours upon healthcare organisations, professional practice and patient perceptions in terms of the promotion of health in the primary care setting.

Characterization of Courtesy Stigma Perceived by Parents of Overweight Children with Bardet-Biedl Syndrome

Background

A child’s obesity is generally perceived by the public to be under the control of the child’s parents. While the health consequences of childhood obesity are well understood, less is known about psychological and social effects of having an obese child on parents. We set out to characterize stigma and courtesy stigma experiences surrounding obesity among children with Bardet-Biedl syndrome (BBS), a multisystem genetic disorder, and their parents.

Methods

Twenty-eight parents of children with BBS participated in semi-structured interviews informed by social stigmatization theory, which describes courtesy stigma as parental perception of stigmatization by association with a stigmatized child. Parents were asked to describe such experiences.

Results

Parents of children with BBS reported the child’s obesity as the most frequent target of stigmatization. They perceived health care providers as the predominant source of courtesy stigma, describing interactions that resulted in feeling devalued and judged as incompetent parents.

Conclusions

Parents of children with BBS feel blamed by others for their child’s obesity and described experiences that suggest health care providers may contribute to courtesy stigma and thus impede effective communication about managing obesity. Health care providers may reinforce parental feelings of guilt and responsibility by repeating information parents may have previously heard and ignoring extremely challenging barriers to weight management, such as a genetic predisposition to obesity. Strategies to understand and incorporate parents’ perceptions and causal attributions of their children’s weight may improve communication about weight control.

A qualitative evaluation of an NHS Weight Management Programme for obese patients in Liverpool

Purpose

– The increasing prevalence of obesity in the UK has been of concern for some time. This is particularly true in Liverpool and in response the Liverpool Weight Management Programme (LWMP) was devised. It offers a service involving dietitians and other expert agencies working towards facilitating dietary and lifestyle changes in obese NHS patients in Liverpool via a 12-week education programme. This qualitative study aims to investigate patients' experiences of the LWMP.

Design/methodology/approach

– Informed volunteers participated in focus groups exploring their experiences following the programme. Focus groups were audio recorded and transcribed verbatim, then analysed following a thematic approach utilising constant comparison analysis to allow a qualitative view of the LWMP to be formed.

Findings

– Participants described an increase in immediate self-confidence during the LWMP, as opposed to coercion and pressure experienced elsewhere. The results also show the implementation of dietary changes by participants and favourable opinions towards both the group settings and patient-centred care. Participants also positively described the LWMP regarding the programmes social approach and aspects of programme content; however, there were issues with over-dependence on healthcare professionals. Healthcare professionals also need to recognise that long-term empowerment may still be lacking and that follow-up support and the effectiveness of some areas of programme content need to be considered to ensure patients benefit from sustainable weight management.

Originality/value

– This paper addresses an identified need for qualitative research in the area of health service weight management programmes and highlights the importance of long-term support in empowering patients by exploring their lived experience of the LWMP.