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

Exploring the role of goal setting in weight loss for adults recently diagnosed with pre-diabetes

Background

The management of prediabetes in the community setting is a global priority. We evaluated the feasibility of a 6-month multilevel practice nurse-led prediabetes dietary intervention which involved goal setting. The aim of this paper is to explore the weight loss goals and strategies reported by participants to achieve their weight loss goals as recorded by practice nurses, and report on factors that influenced dietary behaviours.

Methods

This study used a convergent mixed-methods design. A six-month pragmatic non-randomised pilot study with a qualitative process evaluation was conducted in two neighbouring provincial cities in New Zealand. A structured dietary intervention delivered by practice nurses was implemented in four practices in 2014–2016. Content analysis of the text and descriptive statistics were used to analyse the data.

Results

One hundred and fifty seven people with prediabetes were enrolled (85 intervention, 72 control). The intervention group lost a mean 1.3 kg more than the control group (p < .0.001). The majority of the intervention group indicated either a high level of readiness (n = 42, 53%) or some readiness (n = 31, 39%) to make food changes. The majority of weight loss goals aligned with clinical guidelines (between 5 and 10% of body weight). While just over half (n = 47, 55%) demonstrated weight loss at the end of the six month period, the majority of participants did not achieve their predetermined weight loss goal (n = 78, 83%). Gender, ethnicity and budget were not related to weight loss at six months. Readiness to change and reported challenges to making dietary changes were related to weight loss at six months. Negative factors or set-backs included sporadic adherence to diet due to other health problems, change in context or environment and coping with ill health, most notably stress and low mood.

Conclusions

The data relating to weight loss and dietary goals provided insight into the challenges that people faced in making dietary changes for weight loss across a six month period. Simplifying goal setting to those goals with the greatest potential clinical impact or the greatest significance to the person, in a socially supportive environment, may increase the success of goal achievement.

Trial registration

ANZCTR ACTRN1261500080656. Registered 3 August 2015 (Retrospectively registered). https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=366560&isReview=true

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

BACKGROUND

Non-participatory video research is useful for observing and analysing interactions between clinicians, patients and technology. However, few clinical nursing studies have used non-participatory video observation and there is limited literature describing the approach.

AIM

To describe a study that used non-participatory video observation in general practice.

DISCUSSION

The authors' experience of non-participatory video research methods indicates that the acceptability of the technique, workplace organisation and consultation space have implications for preparation and data collection. Strategies for success include engaging stakeholders early on, obtaining contextual knowledge and piloting the approach.

CONCLUSION

Non-participatory video observation is valuable in understanding interactions between nurses and patients in a naturalistic setting. Careful planning is essential to ensure alignment between research aims, context and technology. The methods for analysing data must be chosen carefully to ensure the research question is answered.

IMPLICATIONS FOR PRACTICE

Video observation provides rich data. Careful planning and engagement of participants is required for successful conduct of studies that use the technique.

Introduction of a web portal for an Individual Health Management and observational health data sciences

Background

There is a global trend to a stronger active involvement of persons in the maintenance and restoring of health. The Competence Centre for Complementary Medicine and Naturopathy (CoCoNat) of the Technical University of Munich (TUM) has developed a lifestyle concept to enable each individual to manage his or her health – Individual Health Management (IHM) – and a web-based health portal named Virtual Tool for Education, Reporting, Information and Outcomes (VITERIO^®), which addresses these needs for practice and research.

Objectives

The objectives of this study were to establish a core set of questionnaires for a self-assessment program on certain risk indications and comprehensive protection factors of health and to develop and enhance 1) tools for individual feedback, longitudinal self-monitoring, self-assessment, and (self-)care-planning; 2) training packages; 3) open notes and records for provider and patient; and 4) tools for monitoring groups and single participants in various indicators for individual coaching and scientific evaluation.

Methods

The CoCoNat of TUM, Faculty for Applied Health Science of Technische Hochschule Deggendorf, VITERIO^® company, IHM campus network, and Erich Rothenfußer Foundation, Munich, provide a consortium responsible for content, research strategy, technical production and implication, postgraduate education for IHM coaches, implementation of IHM in various settings, and funding resources.

Results

A data set of indicators for health screening and self-monitoring of findings, symptoms, health behavior, and attitudes are integrated into a web-based health portal named VITERIO^®. The article introduces some implemented graphical solutions of developed tools and gives examples for daily use.

Conclusion

Behavioral change and adaptation in attitudes and personal values are difficult issues of health education and lifestyle medicine. To address this problem best, the implementation of a patient-centric, performance measures-based program including open records and a blended learning concept were elaborated. The combination of an individual web-based health portal with personal coaching allows the implementation of IHM in everyday practice.