Examining the content of weight, nutrition and physical activity advices provided by Dutch practice nurses in primary care: analysis of videotaped consultations

Beliefs, barriers, and promotion practices of Indian nurses' regarding healthy eating for cancer survivors in a tertiary care hospital-A cross sectional survey

Purpose

To describe the beliefs, barriers and promotion practices of Indian nurses' regarding healthy eating (HE) behaviours amongst cancer survivors, and to gain insights into whether their educational qualifications might affect the promotion of HE.

Methods

Data was gathered using a validated questionnaire, 388 of the approached 400 nurses who worked at a tertiary care hospital in India gave informed consent to participate in the study. The Mann-Whitney U test and the Chi square analysis (for continuous and categorical variables respectively) were performed to carry out sub-group comparisons based on the qualification of the nurses i.e., Bachelor of Science in Nursing (BSc) and General Nursing and Midwifery (GNM).

Results

The nurses believed that dieticians/nutritionists were primarily responsible for educating the cancer survivors regarding HE. HE was promoted by nurses' relatively equally across multiple treatment stages ("during" treatment 24.4%, "post" treatment 23.1%; and "pre" treatment 22.3%). Nurses' believed HE practices had numerous benefits, with improved health-related quality of life (HRQoL) (75.7%), and mental health (73.9%) being the most frequent responses. The most frequently cited barriers by the nurses in promoting HE were lack of time (22.2%), and lack of adequate support structure (19.9%). Sub-group comparisons generally revealed no significant difference between the BSc and GNM nurses in their perceptions regarding HE promotion to cancer survivors. Exceptions were how the GNM group had significantly greater beliefs regarding whether HE can "reduce risk of cancer occurrence" (p = 0.004) and "whether or not I promote HE is entirely up to me" (p = 0.002).

Conclusion

The nurses in India believe in the promotion of HE practices among cancer survivors across various stages of cancer treatments. However, they do face a range of barriers in their attempt to promote HE. Overcoming these barriers might facilitate effective promotion of HE among cancer survivors and help improve survivorship outcomes.

Implications for cancer survivors

Indian nurses employed in the two tertiary care hospitals wish to promote HE among cancer survivors, but require further knowledge and support services for more effective promotion of HE.

Nurse-led lifestyle counseling in Polish primary care: the effect of current health status and perceived barriers

Introduction

Our study included counseling on diet and physical activity, smoking, e-cigarette use, and alcohol consumption. The aim was to examine the correlates of counseling provided by primary care nurses with the health status/health behaviors of nurses and the barriers in the advice provided.

Materials and methods

In 2022, we conducted a cross-sectional survey among 331 nurses employed in the primary care sector in Lodz. The questionnaire consisted of three sections: characteristics of the patient population receiving treatment and provided with healthy lifestyle counseling by nurses, barriers to the process of assessing, controlling, and guiding patients, and health status/health behaviors of nurses.

Results

Eighty percent of the nurses in our study provided advice on diet and physical activity to primary care patients. Over 70% of the survey participants performed minimal anti-smoking interventions forsmokers, 67.7% for alcohol drinkers, and 56.8% for e-cigarette users. The correlates of counseling in the field of diet and physical activity turned out to be the knowledge and skills, which enabled nurses to provide advice (OR = 2.57, p < 0.01). The correlates of the conducted minimal anti-smoking interventions in smoking patients were: subjective assessment of overweight and obesity in nurses, knowledge and skills in conducting counseling (OR = 1.92, p < 0.05), and measuring body weight, height and BMI (OR = 2.18, p < 0.01). Among the three most common barriers identified by the nurses in the process of assessing, monitoring, and guiding patients were the opinion that patients are not interested in improving their diet, physical activity, and weight loss (60.7%), lack of time (51.4%), as well as the belief that patients find it too difficult to change their current habits (54.1%).

Conclusion

The results of our survey indicate that nurses' participation in healthy lifestyle counseling in adult patients is unsatisfactory. Interventions in primary care should be designed considering the specific obstacles nurses may face in leading healthy lifestyles. Further training of nursing staff is required to increase their knowledge on healthy lifestyles.

Comparing Lifestyle Modifications and the Magnitude of Their Associated Benefit on Cancer Mortality

Many cancers are associated with poor diet, lack of physical activity, and excess weight. Improving any of these three lifestyle factors would likely reduce cancer deaths. However, modifications to each of these-better nutrition, enhanced activity and fitness, and loss of extra body fat-have different effect sizes on cancer mortality. This review will highlight the relative benefit that each lifestyle change, enacted prior to a diagnosis of cancer, might impart on cancer-related deaths, as well as attempt to quantify the changes required to derive such a benefit. The review relies primarily on epidemiological data, with meta-analyses serving as the backbone for comparisons across interventions and individual studies within the larger meta-analyses providing the data necessary to form more quantitative conclusions. The reader can then use this information to better understand, recommend, and implement behaviors that might ultimately reduce cancer mortality. Of all the interventions, it seems clear that exercise, specifically improving cardiorespiratory fitness, is the best way to decrease the risk of dying from cancer.

Video-based observation research: A systematic review of studies in outpatient health care settings

OBJECTIVE

To examine the use of video-based observation research in outpatient health care encounter research.

METHODS

We conducted a systematic search of MEDLINE, Scopus, Cochrane and other databases from database inception to October 2020 for reports of studies that used video recording to investigate ambulatory patient-clinician interactions. Two authors independently reviewed all studies for eligibility and extracted information related to study setting and purpose, participant recruitment and consent processes, data collection procedures, method of analysis, and participant sample characteristics.

RESULTS

175 articles were included. Most studies (65%) took place in a primary care or family practice setting. Study objectives were overwhelmingly focused on patient-clinician communication (81%). Reporting of key study elements was inconsistent across included studies.

CONCLUSION

Video recording has been used as a research method in outpatient health care in a limited number and scope of clinical contexts and research domains. In addition, reporting of study design, methodological characteristics, and ethical considerations needs improvement.

PRACTICE IMPLICATIONS

Video recording as a method has been relatively underutilized within many clinical and research contexts. This review will serve as a practical resource for health care researchers as they plan and execute future video-based studies.

Analysis of medical appointments for patients with overweight and obesity in a public hospital of Lima, Peru: a cross-sectional study of audio-recorded consultations

Objective

To describe the content of overweight and obesity counseling performed in a public Peruvian hospital.

Methods

We audio-recorded 40 visits of patients with overweight or obesity from the internal medicine, cardiology, endocrinology, and family medicine services at Cayetano Heredia Hospital. Fragments of the recordings in which counseling was performed were transcribed and codified. We established a checklist to score each counseling session and performed descriptive analyses.

Results

Complete counseling (including weight, nutrition, and physical activity) was performed in 32.5% of consultations. The average time spent in counseling was 1.72 minutes. Counseling on weight loss was performed in 65% of consultations, nutrition in 65%, and physical activity in 35%. On average, 8 of 26 checklist items were fulfilled per appointment. Weight loss goals were established in 15% of visits. The most frequent diet recommendations were eating more fruits and vegetables (32.5%) and eating fewer carbohydrates (30.0%). Suggested physical activities were walking (10.0%), running (7.5%), and playing any sport (7.5%).

Conclusions

Complete counseling was only addressed in one-third of the appointments, and most counseling was superficial without considering therapeutic goals. This suggests the need to include lifestyle counseling in consultations, regardless of the medical specialty or patient’s background condition.

Facilitators and barriers for promoting healthy eating among primary care patients: results of a qualitative study among practice nurses

BACKGROUND

Practice nurses have an important role in promoting healthy eating to prevent or delay long-term complications from chronic lifestyle-related diseases.

OBJECTIVE

To identify the facilitators and barriers encountered by practice nurses at a professional level when promoting healthy eating among patients.

METHODS

Face-to-face semi-structured interviews were conducted with 21 Dutch practice nurses. Data were recorded, transcribed and analysed using inductive thematic analysis.

RESULTS

Two main themes were determined: professional characteristics and professional-patient encounter. Professional characteristics included good communication skills and experience facilitated the successful promotion of healthy eating, while a lack of communication skills and lack of knowledge about diet were perceived as barriers. The most frequently identified facilitators for professional-patient encounter included ensuring a personal connection with patients, creating food awareness, focussing on small changes, adopting a tailored approach, motivating and arranging extra consultations. Barriers included lack of skills to raise the topic, lack of persistence, inability to find a common understanding, lack of competence in handling patients' own choices and underuse of existing educational materials.

CONCLUSIONS

Further research using the identified facilitators and barriers for promoting healthy eating in primary care patients with chronic diseases could assist in the development of future training programmes for practice nurses.

When primary care providers and smokers meet: a systematic review and metasynthesis

Primary Care Providers (PCPs) often deal with patients on daily clinical practice without knowing anything about their smoking status and willingness to quit. The aim of this metasynthesis is to explore the PCPs and patients who are smokers perspectives regarding the issue of smoking cessation within primary care settings. It relies on the model of meta-ethnography and follows thematic synthesis procedures. Twenty-two studies are included, reporting on the view of 580 participants. Three main themes emerge: (i) What lacks, (ii) Some expectations but no request, and (iii) How to address the issue and induce patients' motivation. Our results reveal a global feeling of a lack of legitimacy among PCPs when it comes to addressing the issue of tobacco and smoking cessation with their patients, even though they have developed creative strategies based on what is at the core of their practice, that is proximity, continuity, long-term and trustworthy relationship.

Challenges for obesity management in a unified health system: the view of health professionals

BACKGROUND

Obesity is an increasingly prevalent chronic condition. Its multiple causes and the complexity of its treatment pose challenges for health professionals.

OBJECTIVE

To explore and describe the challenges for obesity management in the Brazilian Unified Health System according to health professionals.

METHODS

An exploratory quantitative web-based study, carried out in 2018 with health professionals, developed from the first stage of a national project that aims to examine the management of obesity in Brazil. The questionnaire was self-applied. Invitations to participate in the research were sent by the Ministry of Health, Health Department of Minas Gerais and members of the research group. We collected data on sex, age, professional category, region and level of care. The challenges were investigated using a Likert scale and categorized into structure and work process.

RESULTS

We evaluated 1323 professionals, of which about 45% were dietitians, 90.2% were women, and 83.1% self-reported working in primary health care. The main barriers cited included a high demand for curative and individual assistance, the presence of comorbidities, and the absence or insufficient access to instructional materials, professional qualification and lack of support.

CONCLUSION

Obesity management is a critical challenge for all professionals. Barriers were related to the work process and structural aspects and reinforce the need to empower health teams. We propose that permanent education activities should be established, as well as the development of instructional materials that are applicable to routine work. Finally, the results may be used to develop policies and strategies to improve obesity management.

Physical Activity Promotion: A Systematic Review of The Perceptions of Healthcare Professionals

Physical activity (PA) is a cost-effective and non-pharmacological foundation for the prevention and management of chronic and complex diseases. Healthcare professionals could be viable conduits for PA promotion. However, the evidence regarding the effectiveness and benefits of the current forms of PA promotion are inconclusive. Healthcare professionals' perceptions on key determinants impact on the optimum promotion of PA were explored in this review. Thirty-four (34) studies were identified after systematically searching seven databases for peer-reviewed articles published within the last decade. PA advice or counselling was the most recorded form of PA promotion, limited counselling time was the most reported obstacle while providing incentives was viewed as a key facilitator. There is widespread consensus among healthcare professionals (HCPs) on some aspects of PA promotion. Utilisation of all PA promotional pathways to their full potential could be an essential turning point towards the optimal success of PA promotional goals. Hence, strategies are required to broaden chronic disease treatment methods to include preventive and integrative PA promotion approaches particularly, between frontline HCPs (e.g., GPs) and PA specialists (e.g., EPs). Future studies could explore the functionality of GP to EP referral pathways to determining what currently works and areas requiring further development.

Actions of nurses toward obesity in primary health care units

OBJECTIVES

To understand the actions of nurses toward obesity in primary health care units.

METHODS

A phenomenological study was carried out with 12 nurses of a city in the state of Minas Gerais. The interviews were organized into categories and analyzed according to the social phenomenology of Alfred Schütz and literature associated with the theme.

RESULTS

The following categories emerged, expressing the actions of nurses toward obesity prevention and control: "Guidance on healthy lifestyle habits", "Barriers to the actions of nurses", and "Focusing specifically on obesity".

FINAL CONSIDERATIONS

Considering that guidance on healthy lifestyle habits was mostly carried out during individual and collective activities directed to the general population, regardless of their weight conditions, nurses must reorganize their professional practice in primary health care units by implementing specific actions for users with obesity or at risk of developing it.

Exploring the provision of diabetes nutrition education by practice nurses in primary care settings

BACKGROUND

High-quality nutrition education is recommended as an essential component of diabetes care. In the UK, there has been a gradual shift of inter-professional boundaries with respect to providing nutritional care for people with type 2 diabetes. Only a minority now regularly receive advice from a dietitian. Instead, increased demands for nutrition education are being absorbed by practice nurses. The present study seeks to explore this situation through the views of practice nurses on the services that they provide and the issues they face.

METHODS

A qualitative approach using semi-structured interviews was employed. Practice nurses were recruited using purposive sampling, and nine were interviewed. Data were analysed using the Framework Method. The Theoretical Domains Framework from the COM-B ('capability', 'opportunity', 'motivation' and 'behaviour') model of behaviour change, as increasingly employed to explore the behaviour of healthcare professionals, was used to further frame the findings.

RESULTS

Practice nurses reported that ongoing diabetes nutrition education only took place at annual review appointments and was limited to 5-10 min. They described how they are expected to take on a more advanced role in diabetes nutrition education than they can provide and are becoming increasingly isolated in this role as a result of a lack of time, practical and informational support, and training standards and provision.

CONCLUSIONS

A range of service improvements led by dietitians, which focus on strengthening the working environment and enhancing professional support available for practice nurses who provide diabetes nutrition education, could improve quality of care and health outcomes in people with diabetes within current time restraints.

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.

Patients' experiences with a behaviour change intervention to enhance physical activity in primary care: A mixed methods study

Objective

To explore the experiences of patients at risk for cardiovascular disease in primary care with the Activate intervention in relation to their success in increasing their physical activity.

Methods

A convergent mixed methods study was conducted, parallel to a cluster-randomised controlled trial in primary care, using a questionnaire and semi-structured interviews. Questionnaires from 67 patients were analysed, and semi-structured interviews of 22 patients were thematically analysed. Experiences of patients who had objectively increased their physical activity (responders) were compared to those who had not (non-responders). Objective success was analysed in relation to self-perceived success.

Results

The questionnaire and interview data corresponded, and no substantial differences among responders and non-responders emerged. Participating in the intervention increased patients’ awareness of their physical activity and their physical activity level. Key components of the intervention were the subsequent support of nurses with whom patients’ have a trustful relationship and the use of self-monitoring tools. Patients highly valued jointly setting goals, planning actions, receiving feedback and review on their goal attainment and jointly solving problems. Nurses’ support, the use of self-monitoring tools, and involving others incentivised patients to increase their physical activity. Internal circumstances and external circumstances challenged patients’ engagement in increasing and maintaining their physical activity.

Conclusion

Patients experienced the Activate intervention as valuable to increase and maintain their physical activity, irrespective of their objective change in physical activity. The findings enable the understanding of the effectiveness of the intervention and implementation in primary care.

Trial registration

ClinicalTrials.gov NCT02725203.

Health advice and education given to overweight patients by primary care doctors and nurses: A scoping literature review

Health advice for overweight patients in primary care has been a focus of obesity guidelines. Primary care doctors and nurses are well placed to provide evidence based preventive health advice. This literature review addressed two research questions: ‘When do primary care doctors and nurses provide health advice for weight management?’ and ‘What health advice is provided to overweight patients in primary care settings?’

The study was conducted in the first half of 2018 and followed Arksey and O'Malley (2005) five stage framework to conduct a comprehensive scoping review. The following databases were searched: Emcare, Ovid, Embase, The Cochrane library, Proquest family health, Health source (nursing academic), Joanna Briggs Institute EBP database, Medline, PubMed, Rural and remote, Proquest (nursing and allied health) and TRIP using search term parameters. Two hundred and forty-eight (248) articles were located and screened by two reviewers.

Twenty-three research papers met the criteria and data were analysed using a content analysis method. The results show that primary care doctors and nurses are more likely to give advice as BMI increases and often miss opportunities to discuss weight with overweight patients. Body Mass Index (BMI) is often wrongly categorised as overweight, when in fact it is in the range of obese, or not recorded and when health advice is given, it can be of poor quality. Few studies on this topic included people under 40 years, practice nurses as the focus and those with a BMI of 25–29.9 without a risk factor. A ‘toolkit’ approach to improve advice and adherence to evidence based guidelines should be explored in future research.

Exercise for Multimorbid Patients in Primary Care: One Prescription for All?

The purpose of this article was to discuss guidelines for the management of the most prevalent chronic diseases treated by primary care physicians (PCPs) in order to identify the best exercise regimen for each clinical population, and to provide preliminary guidance for primary care providers on exercise counselling in the 'real-world' context of multimorbidity. After a search of the PubMed electronic database, the 11 most prevalent conditions currently treated by PCPs were identified. The recommendations provided by recognised learned/scientific societies for the management of each disease were then examined and any recommendations involving physical activity and exercise were identified. It was found that the best exercise regimen (i.e. exercise type, intensity, duration, and frequency) was very similar across chronic diseases, which suggests that elaborating and implementing a standardised, minimum exercise guideline for multimorbid patients in primary care may be an alternative approach to time-costly individualised exercise prescriptions. Based on this finding, I propose an example of standardised, cross-disease exercise prescription, and discuss how such a prescription could be operationalised by PCPs in their routine clinical practice.

Recording of weight in electronic health records: an observational study in general practice

Background

Routine weight recording in electronic health records (EHRs) could assist general practitioners (GPs) in the identification, prevention, and management of overweight patients. However, the extent to which weight management is embedded in general practice in the Netherlands has not been investigated. The purpose of this study was to evaluate the frequency of weight recording in general practice in the Netherlands for patients who self-reported as being overweight. The specific objectives of this study were to assess whether weight recording varied according to patient characteristics, and to determine the frequency of weight recording over time for patients with and without a chronic condition related to being overweight.

Methods

Baseline data from the Occupational and Environmental Health Cohort Study (2012) were combined with data from EHRs of general practices (2012–2015). Data concerned 3446 self-reported overweight patients who visited their GP in 2012, and 1516 patients who visited their GP every year between 2012 and 2015. Logistic multilevel regression analyses were performed to identify associations between patient characteristics and weight recording.

Results

In 2012, weight was recorded in the EHRs of a quarter of patients who self-reported as being overweight. Greater age, lower education level, higher self-reported body mass index, and the presence of diabetes mellitus, chronic obstructive pulmonary disease, and/or cardiovascular disorders were associated with higher rates of weight recording. The strongest association was found for diabetes mellitus (adjusted OR = 10.3; 95% CI [7.3, 14.5]). Between 2012 and 2015, 90% of patients with diabetes mellitus had at least one weight measurement recorded in their EHR. In the group of patients without a chronic condition related to being overweight, this percentage was 33%.

Conclusions

Weight was frequently recorded for overweight patients with a chronic condition, for whom regular weight measurement is recommended in clinical guidelines, and for which weight recording is a performance indicator as part of the payment system. For younger patients and those without a chronic condition related to being overweight, weight was less frequently recorded. For these patients, routine recording of weight in EHRs deserves more attention, with the aim to support early recognition and treatment of overweight.

Electronic supplementary material

The online version of this article (10.1186/s12875-018-0863-x) contains supplementary material, which is available to authorized users.

Are healthcare professionals delivering opportunistic behaviour change interventions? A multi-professional survey of engagement with public health policy

BACKGROUND

"Making Every Contact Count" (MECC), a public health policy in the UK, compels healthcare professionals to deliver opportunistic health behaviour change interventions to patients during routine medical consultations. Professionals' awareness of, and engagement with, the policy is unclear. This study examined (1) awareness of the MECC policy, and (2) the prevalence of MECC-related practice in relation to (a) perceived patient benefit, (b) how often healthcare professionals deliver interventions during routine consultations, and (c) the time spent on this activity.

METHODS

Cross-sectional national survey was administered in 2017 of 1387 healthcare professionals working in the UK's National Health Service (NHS). Descriptive statistics were used to assess awareness and practice consistent with the MECC policy. Chi-square was used to gauge the potential representativeness of our sample compared to NHS employment data.

RESULTS

31.4% of healthcare professionals reported having heard of the policy; nevertheless, healthcare professionals perceived a need to provide patients with opportunistic behaviour change interventions in 55.9% (32,946/58,906) of consultations. However, healthcare professionals did not deliver interventions on 50.0% of occasions in which they perceived a need. Where behaviour change interventions were delivered to patients, this constituted 35.3% of the appointment time.

CONCLUSIONS

Policy makers must address the gap between the proportion of patients that healthcare professionals perceive would benefit from opportunistic behaviour change interventions and those receiving them (an estimated 50.0%; 16,473 additional patients could have benefited). Future research should consider how healthcare professionals identify patients who might benefit from opportunistic behaviour change interventions and developing training for efficient delivery of interventions.

A Longitudinal Study of Interactions Between Health Professionals and People With Newly Diagnosed Diabetes

PURPOSE

We undertook a study to observe in detail the primary care interactions and communications of patients with newly diagnosed diabetes over time. In addition, we sought to identify key points in the process where miscommunication might occur.

METHODS

All health interactions of 32 patients with newly diagnosed type 2 diabetes were recorded and tracked as they moved through the New Zealand health care system for a period of approximately 6 months. Data included video recordings of patient interactions with the health professionals involved in their care (eg, general practitioners, nurses, dietitians). We analyzed data with ethnography and interaction analysis.

RESULTS

Challenges to effective communication in diabetes care were identified. Although clinicians showed high levels of technical knowledge and general communication skill, initial consultations were often driven by biomedical explanations out of context from patient experience. There was a perception of time pressure, but considerable time was spent with patients by health professionals repeating information that may not be relevant to patient need. Health professionals had little knowledge of what disciplines other than their own do and how their contributions to patient care may differ.

CONCLUSIONS

Despite current high skill levels of primary care professionals, opportunities exist to increase the effectiveness of communication and consultation in diabetes care. The various health professionals involved in patient care should agree on the length and focus of each consultation.

Unravelling effectiveness of a nurse-led behaviour change intervention to enhance physical activity in patients at risk for cardiovascular disease in primary care: study protocol for a cluster randomised controlled trial

Background

Self-management interventions are considered effective in patients with chronic disease, but trials have shown inconsistent results, and it is unknown which patients benefit most. Adequate self-management requires behaviour change in both patients and health care providers. Therefore, the Activate intervention was developed with a focus on behaviour change in both patients and nurses. The intervention aims for change in a single self-management behaviour, namely physical activity, in primary care patients at risk for cardiovascular disease. The aim of this study is to evaluate the effectiveness of the Activate intervention.

Methods/design

A two-arm cluster randomised controlled trial will be conducted to compare the Activate intervention with care as usual at 31 general practices in the Netherlands. Approximately 279 patients at risk for cardiovascular disease will participate. The Activate intervention is developed using the Behaviour Change Wheel and consists of 4 nurse-led consultations in a 3-month period, integrating 17 behaviour change techniques. The Behaviour Change Wheel was also applied to analyse what behaviour change is needed in nurses to deliver the intervention adequately. This resulted in 1-day training and coaching sessions (including 21 behaviour change techniques). The primary outcome is physical activity, measured as the number of minutes of moderate to vigorous physical activity using an accelerometer. Potential effect modifiers are age, body mass index, level of education, social support, depression, patient-provider relationship and baseline number of minutes of physical activity. Data will be collected at baseline and at 3 months and 6 months of follow-up. A process evaluation will be conducted to evaluate the training of nurses, treatment fidelity, and to identify barriers to and facilitators of implementation as well as to assess participants’ satisfaction.

Discussion

To increase physical activity in patients and to support nurses in delivering the intervention, behaviour change techniques are applied to change behaviours of the patients and nurses. Evaluation of the effectiveness of the intervention, exploration of which patients benefit most, and evaluation of our theory-based training for primary care nurses will enhance understanding of what works and for whom, which is essential for further implementation of self-management in clinical practice.

Trial registration

ClinicalTrials.gov identifier: NCT02725203. Registered on 25 March 2016.

Electronic supplementary material

The online version of this article (doi:10.1186/s13063-017-1823-9) contains supplementary material, which is available to authorized users.

Nursing interventions with people with obesity in Primary Health Care: an integrative review

Objective Identify the knowledge produced on nursing interventions with people suffering from obesity in Primary Health Care. Method Integrative literature review of publications indexed in the databases: CINAHL, LILACS, MEDLINE, SciELO, SCOPUS and WEB OF SCIENCE, between 2011 and 2016. Results Thirty-three articles were selected. The knowledge produced covered two themes: "Counseling aimed at weight control and promotion of healthy lifestyle habits" and "Perception of Primary Health Care nurses regarding interventions with people with obesity." Conclusion The results may help prompt reflections on professional training, management, and health services in terms of the relevance of nurses working with people suffering from obesity, with the support of digital technologies, motivational techniques, and nursing consultations. This could enhance their activities in the multiprofessional teams in which they participate at this healthcare level.

Direct observation of weight-related communication in primary care: a systematic review

BACKGROUND

Primary care is ideally placed to play an effective role in patient weight management; however, patient weight is seldom discussed in this context. A synthesis of studies that directly observe weight discussion in primary care is required to more comprehensively understand and improve primary care weight-related communication.

OBJECTIVE

To systematically identify and examine primary care observational research that investigates weight-related communication and its relationship to patient weight outcomes.

METHODS

A systematic review of literature published up to August 2015, using seven electronic databases (including MEDLINE, Scopus and PsycINFO), was conducted using search terms such as overweight, obese and/or doctor-patient communication.

RESULTS

Twenty papers were included in the final review. Communication analysis focused predominantly on 'practitioner' use of specific patient-centred communication. Practitioner use of motivational interviewing was associated with improved patient weight-related outcomes, including patient weight loss and increased patient readiness to lose weight; however, few studies measured patient weight-related outcomes.

CONCLUSION

Studies directly observing weight-related communication in primary care are scarce and limited by a lack of focus on patient communication and patient weight-related outcomes. Future research should measure practitioner and patient communications during weight discussion and their impact on patient weight-related outcomes. This knowledge may inform the development of a communication intervention to assist practitioners to more effectively discuss weight with their overweight and/or obese patients.

Current nutrition promotion, beliefs and barriers among cancer nurses in Australia and New Zealand

Rationale. Many cancer patients and survivors do not meet nutritional and physical activity guidelines, thus healthier eating and greater levels of physical activity could have considerable benefits for these individuals. While research has investigated cancer survivors’ perspective on their challenges in meeting the nutrition and physical guidelines, little research has examined how health professionals may assist their patients meet these guidelines. Cancer nurses are ideally placed to promote healthy behaviours to their patients, especially if access to dieticians or dietary resources is limited. However, little is known about cancer nurses’ healthy eating promotion practices to their patients. The primary aim of this study was to examine current healthy eating promotion practices, beliefs and barriers of cancer nurses in Australia and New Zealand. A secondary aim was to gain insight into whether these practices, beliefs and barriers were influenced by the nurses’ hospital or years of work experience.

Patients and Methods. An online questionnaire was used to obtain data. Sub-group cancer nurse comparisons were performed on hospital location (metropolitan vs regional and rural) and years of experience (<25 or ≥25 years) using ANOVA and chi square analysis for continuous and categorical data respectively.

Results. A total of 123 Australasian cancer nurses responded to the survey. Cancer nurses believed they were often the major provider of nutritional advice to their cancer patients (32.5%), a value marginally less than dieticians (35.9%) but substantially higher than oncologists (3.3%). The majority promoted healthy eating prior (62.6%), during (74.8%) and post treatment (64.2%). Most cancer nurses felt that healthy eating had positive effects on the cancer patients’ quality of life (85.4%), weight management (82.9%), mental health (80.5%), activities of daily living (79.7%) and risk of other chronic diseases (79.7%), although only 75.5% agreed or strongly agreed that this is due to a strong evidence base. Lack of time (25.8%), adequate support structures (17.3%) nutrition expertise (12.2%) were cited by the cancer nurses as the most common barriers to promoting healthy eating to their patients. Comparisons based on their hospital location and years of experience, revealed very few significant differences, indicating that cancer nurses’ healthy eating promotion practices, beliefs and barriers were largely unaffected by hospital location or years of experience.

Conclusion. Australasian cancer nurses have favourable attitudes towards promoting healthy eating to their cancer patients across multiple treatment stages and believe that healthy eating has many benefits for their patients. Unfortunately, several barriers to healthy eating promotion were reported. If these barriers can be overcome, nurses may be able to work more effectively with dieticians to improve the outcomes for cancer patients.

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

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.

To what extent do primary care practice nurses act as case managers lifestyle counselling regarding weight management? A systematic review

BACKGROUND

In this review study, we are the first to explore whether the practice nurse (PN) can act as case manager lifestyle counselling regarding weight management in primary care.

METHODS

Multiple electronic databases (MEDLINE, PsycINFO) were searched to identify relevant literature after 1995. Forty-five studies fulfilled the inclusion criteria. In addition, all studies were judged on ten quality criteria by two independent reviewers.

RESULTS

Especially in the last three years, many studies have been published. The majority of the studies were positive about PNs' actual role in primary care. However, several studies dealt with competency issues, including disagreement on respective roles. Thirteen studies were perceived as high quality. Only few studies had a representative sample. PNs' role in chronic disease management is spreading increasingly into lifestyle counselling. Although PNs have more time to provide lifestyle counselling than general practitioners (GPs), lack of time still remains a barrier. In some countries, PNs were rather ambiguous about their role, and they did not agree with GPs on this.

CONCLUSION

The PN can play the role of case manager lifestyle counselling regarding weight management in primary care in the UK, and wherever PNs are working under supervision of a GP and a primary health care team is already developed with agreement on roles. In countries in which a primary health care team is still in development and there is no agreement on respective roles, such as the USA, it is still the question whether the PN can play the case manager role.

The contribution of lifestyle coaching of overweight patients in primary care to more autonomous motivation for physical activity and healthy dietary behaviour: results of a longitudinal study

Background

Combined lifestyle interventions (CLIs) have been advocated as an effective instrument in efforts to reduce overweight and obesity. The odds of maintaining higher levels of physical activity (PA) and healthier dietary behaviour improve when people are more intrinsically motivated to change their behaviour. To promote the shift towards more autonomous types of motivation, facilitator led CLIs have been developed including lifestyle coaching as key element. The present study examined the shift in types of motivation to increase PA and healthy dieting among participants of a primary care CLI, and the contribution of lifestyle coaching to potential changes in motivational quality.

Methods

This prospective cohort study included participants of 29 general practices in the Netherlands that implemented a CLI named ‘BeweegKuur’. Questionnaires including items on demographics, lifestyle coaching and motivation were sent at baseline and after 4 months. Aspects of motivation were assessed with the Behavioural Regulation and Exercise Questionnaire (BREQ-2) and the Regulation of Eating Behaviour Questionnaire (REBS). We performed a drop out analysis to identify selective drop-out. Changes in motivation were analysed with t-tests and effect size interpretations (Cohen’s d), and multivariate regression analysis was used to identify predictors of motivational change.

Results

For physical activity, changes in motivational regulation were fully in line with the tenets of Self Determination Theory and Motivational Interviewing: participants made a shift towards a more autonomous type of motivation (i.e. controlled types of motivation decreased and autonomous types increased). Moreover, an autonomy supportive coaching style was generally found to predict a larger shift in autonomous types of motivation. For healthy dietary behaviour, however, except for a small decrease in external motivation, no favourable changes in different types of motivation were observed. The relation between coaching and motivation appeared to be influenced by the presence of physical activity guidance in the programme.

Conclusions

Motivation of participants of a real life primary care CLI had changed towards a more autonomous motivation after 4 months of intervention. Autonomy-supportive lifestyle coaching contributed to this change with respect to physical activity. Lifestyle coaching for healthy diet requires thorough knowledge about the problem of unhealthy dieting and solid coaching skills.

Quality of weight-loss counseling by Dutch practice nurses in primary care: an observational study

BACKGROUND/OBJECTIVE

To assess the quality of weight-loss counseling provided by Dutch primary care practice nurses (PNs) to overweight and obese patients including both PNs' compliance with the Five A's Model for behavioral counseling in primary care, and the use of different communication styles. In addition, relationships between PN/patient characteristics (including Five A's) and communication styles will be examined.

SUBJECTS/METHODS

In this observational study, 100 videotaped real-life consultations, collected in 2010/2011, were viewed using an observational checklist. Selection of consultations was based on PNs' registration of patient's complaint. The quality of weight-loss counseling was assessed by the Five A's Model (sequence of evidence-based practice behaviors that are effective for helping patients to change health behaviors) and by PNs' communication styles. Moreover, several PN and patient characteristics were registered. Descriptive statistics and logistic regression analysis were conducted with significance set at P<0.05.

RESULTS

PNs most frequently arranged follow-up, assessed the risk and current behavior and advised. However, they rarely assisted in addressing barriers and securing support. For weight or physical activity, most PNs used a motivational communication style. In discussions of nutrition, they mostly used an informational communication style. Moreover, PNs used a combination of communication styles. PN characteristics, including their behavior concerning the Five A's, were stronger related to communication styles than patient characteristics.

CONCLUSIONS

PNs reasonably complied with the Five A's Model. The quality of PNs' weight-loss counseling might be increased by routinely providing assistance in addressing barriers and securing support, and routinely reaching agreement with collaboratively set goals.