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

Nurse-related behavioural determinants associated with healthy eating support provided by Dutch community nurses: a cross-sectional study

BACKGROUND

Community nurses (CNs) play an important role in supporting healthy lifestyles, including healthy eating behaviour of patients. However, many CNs do not incorporate healthy eating support in their daily routines to the fullest extent possible. This study aimed to explore (1) the associations between nurse-related behavioural determinants and self-reported healthy eating support practices of Dutch CNs and (2) CNs' need for additional knowledge.

METHODS

In this cross-sectional survey design, 244 Dutch CNs completed an online, self-administered questionnaire in October-November 2021. The 60 questionnaire items were related to CNs' characteristics, nurse-related determinants, healthy eating support practices (observing problems, having a conversation about patients' dietary behaviour, motivating patients to eat and drink healthier and supporting patients in goal setting) and the need for additional knowledge. The items on determinants and practices used a 5-point Likert scale. Adjusted prevalence ratios (PRadjusted) with 95% confidence intervals (95%CIs) were obtained for the associations between determinants and practices, using adjusted Poisson regression with robust variance estimations.

RESULTS

More CNs practiced observing problems (75%) and having a conversation (70%) than did motivating patients (45%) and supporting goal setting (28%) at least often. A more positive attitude (PRadjusted 1.8; 95%CI 1.5-2.2), greater self-efficacy (PRadjusted 1.3; 95%CI 1.1-1.5), greater motivation (PRadjusted 1.5; 95%CI 1.3-1.7) and better abilities (PRadjusted 1.4; 95%CI 1.2-1.6) were associated with a greater prevalence of supporting healthy eating at least often (vs. never to sometimes). Barriers were not associated with healthy eating support (PRadjusted 1.1; 95%CI 1.0-1.2). CNs especially desired more knowledge on diet in relation to cancer, gastrointestinal diseases, severe psychiatric diseases and dementia; methods for motivating patients to start and for supporting patients to sustain healthy eating; and dealing with patient autonomy.

CONCLUSIONS

This study suggests that nurse-related behavioural determinants such as attitude, self-efficacy, motivation and ability should be addressed to improve CNs' competences in healthy eating support. In addition, based on self-reported need for additional knowledge, it is recommended to pay attention to evidence-based behaviour change techniques, dealing with patient autonomy, and diet in relation to cancer, gastrointestinal diseases, severe psychiatric diseases and dementia.

REPORTING METHOD

The STROBE Statement was followed for reporting.

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.

Determinants of lifestyle counseling and current practices: A cross-sectional study among Dutch general practitioners

This study aimed to examine the amount of lifestyle counseling that Dutch general practitioners (GPs) generally provide to their patients, as well as the behavioral determinants of their lifestyle counseling practices. Lifestyle counseling was defined and operationalized through the 5As model (i.e. Assess, Advise, Agree, Assist and Arrange), while determinants were based on an adapted version of the theory of planned behavior. A cross-sectional study was conducted among a sample of 198 GPs, using an online survey questionnaire for collecting data. The results showed that 79.3% of the GPs assessed patients' current lifestyle often or always, while 60.1% reported they often or always assessed patients' motivation to improve their lifestyle. Depending on the lifestyle behavior, Advising to improve lifestyle ranged from 42.5% (sleep) to 92.4% (smoking), while Agree to set goals ranged from 21.7% (sleep) to 46.9% (smoking). Assisting patients to overcome barriers to lifestyle changes varied per patient barrier, ranging from lack of financial resources (25.7%) to stress (81.8%). The findings from the linear hierarchical regression revealed that GPs' self-efficacy (β = .46, p < .001), patient norm (β = .21, p < .001), and attitude (β = .20, p < .05) were the determinants with the strongest associations with lifestyle counseling. The full model explained 47% of the variance in counseling lifestyle. Implications for supporting GPs to counsel patients about their lifestyle are discussed.

Challenges and Perspectives in Nutritional Counselling and Nursing: A Narrative Review

Nutritional counselling has been recognised as the first line approach in the management of numerous chronic diseases. Though usually carried out by dietitians, nutritional counselling may be used by nurses, or other healthcare professionals to improve nutritional status and meet healthcare goals. Healthcare professionals require training and education to facilitate a patient centred approach to effective counselling. Advances in digital technology have the potential to improve access to nutritional counselling for some patients such as those in primary care. However, caution is required to ensure that valuable interpersonal relationships are not lost, as these form the cornerstone of effective nutritional counselling. The aim of this narrative review is to explore aspects of effective nutritional counselling, including advances in e-counselling and areas where nursing input in nutritional counselling might enhance overall nutritional care.

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.

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.

The implementation and sustainability of a combined lifestyle intervention in primary care: mixed method process evaluation

BACKGROUND

The impact of physical inactivity and unhealthy diet on health is increasingly profound. Lifestyle interventions targeting both behaviors simultaneously might decrease the prevalence of overweight and comorbidities. The Dutch 'BeweegKuur' is a combined lifestyle intervention (CLI) in primary care, to improve physical activity and dietary behavior in overweight people. In a cluster randomized controlled trial, the (cost-) effectiveness of an intensively guided program has been compared to a less intensively guided program. This process evaluation aimed to assess protocol adherence and potential differences between clusters. In addition, sustainability (i.e. continuation of the CLI in practice after study termination) was evaluated.

METHODS

Existing frameworks were combined to design the process evaluation for our intervention and setting specifically. We assessed reach, fidelity, dose delivered and received, context and implementation strategy. Both qualitative and quantitative data were used for a comprehensive evaluation. Data were collected in semi-structured interviews with health care providers (HCPs, n = 25), drop-out registration by HCPs, regular questionnaires among participants (n = 411) and logbooks kept by researchers during the trial.

RESULTS

Protocol adherence by professionals and participants varied between the programs and clusters. In both programs the number of meetings with all HCPs was lower than planned in the protocol. Participants of the supervised program attended, compared to participants of the start-up program, more meetings with physiotherapists, but fewer with lifestyle advisors and dieticians. The 'BeweegKuur' was not sustained, but intervention aspects, networks and experiences were still utilized after finalization of the project. Whether clusters continued to offer a CLI seemed dependent on funding opportunities and collaborations.

CONCLUSIONS

Protocol adherence in a CLI was problematic in both HCPs and participants. Mainly the amount of dietary guidance was lower than planned, and decreased with increasing guidance by PT. Thus, feasibility of changing physical activity and dietary habits simultaneously by one intervention in one year was not as high as expected. Also the sustainability of CLI was poor. When a CLI program is started, re-invention should be allowed and maximum effort should be taken to guarantee long term continuation, by planning both implementation and sustainability carefully.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN46574304 . Registered 23 December 2010.

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.