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Norman K, Burrows L, Chepulis L, Mullins H, Lawrenson R. 'They're all individuals, none of them are on the same boat': barriers to weight management in general practice from the rural nurse perspective. Prim Health Care Res Dev 2023; 24:e50. [PMID: 37522349 PMCID: PMC10466201 DOI: 10.1017/s1463423623000439] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 04/25/2023] [Accepted: 06/13/2023] [Indexed: 08/01/2023] Open
Abstract
AIM To explore nurses' experiences with, and barriers to, obesity healthcare in rural general practice. BACKGROUND Obesity is a significant health risk worldwide, which can lead to many other physical and psychosocial health issues that contribute to a poor quality of life. Primary care is considered the most suitable context to deliver obesity management healthcare across the world, including New Zealand, which reportedly has 34% of all adults (and 51% Indigenous Māori) classed as obese. Nurses in primary care have a significant role in the multidisciplinary team and deliver obesity healthcare in general practice contexts. Yet, there is little focus on the nurse perspective of weight management, specifically in rural areas where medical staff and resources are limited, and obesity rates are high. METHODS This was a qualitative research design. Semi-structured interviews with 10 rural nurses from indigenous and non-indigenous health providers were analyzed guided by Braun and Clarke () approach to thematic analysis. FINDINGS Three themes were identified: limitations of a nurse role; patient-level barriers; and cultural barriers. Nurses reported experiencing significant barriers to delivering effective weight management in their practice due to factors outside the scope of their practice such as patient-level factors, social determinants of health, rural locality restrictions, and limitations to their role. While this study highlights that practice nurses are versatile with an invaluable skill repertoire, it also demonstrates the near impossibility for rural nurses to meet their rural patient's complex weight management needs, as there are many social determinants of health, sociocultural, and rural locality factors acting as barriers to effective weight management. Nurses experienced a lack of systemic support in the form of time, resources, funding, and effective weight management referral options. Future investigation should look to address the unique rural weight management healthcare needs that experience many barriers.
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Affiliation(s)
| | | | | | | | - Ross Lawrenson
- University of Waikato, Hamilton, New Zealand
- Waikato District Health Board, Hamilton, New Zealand
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Norman K, Burrows L, Chepulis L, Keenan R, Lawrenson R. Understanding weight management experiences from patient perspectives: qualitative exploration in general practice. BMC PRIMARY CARE 2023; 24:45. [PMID: 36782120 PMCID: PMC9926650 DOI: 10.1186/s12875-023-01998-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 01/30/2023] [Indexed: 02/15/2023]
Abstract
BACKGROUND Obesity is a complex health issue affecting the quality of life of individuals and contributing to an unsustainable strain on healthcare professionals and national health systems. National policy guidelines indicate that general practice is best suited to deliver obesity healthcare, however, obesity rates continue to rise worldwide indicating interventions are ineffective in this space. The aim of this study was to explore the weight management experiences from patient perspectives. METHODS This qualitative study used semi-structured interviews with 16 rural Waikato general practice patients. Interviews were analysed using reflexive thematic analysis. RESULTS Four themes were identified: Inconsistent Information, Significance of Holistic Factors, Obesity Centre Need, and Education. Participants expressed frustration at contradictory health messages, commercial company and 'expert' definition distrust, and that 'holistic' aspects to health significant to the weight management journey were unable to be addressed in general practice. CONCLUSION Whilst primary care is positioned as suitable for delivering obesity healthcare, this study found that participants do not perceive general practice to be equipped to deliver this care. Instead, participants argued for a specialist obesity centre capable of meeting all their obesity healthcare needs. Further, wider issues including on-line commodification of health and neo-liberal capitalism - factors that exploit people with a stigmatised health issue - can cause further harm to the participant. A radical modernisation of education, information, and resources from regulated, qualified and 'trusted' healthcare professionals who can provide safe, non-stigmatising supportive services is recommended to meet the unique and changing food climate, reduce obesity rates and improve health outcomes.
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Affiliation(s)
- Kimberley Norman
- University of Waikato, Gate 1, Knighton Road, Hillcrest, Waikato District Health Board, Pembroke Street, Private Bag, Hamilton, 3200, New Zealand.
| | - Lisette Burrows
- grid.49481.300000 0004 0408 3579University of Waikato, Gate 1, Knighton Road, Hillcrest, Waikato District Health Board, Pembroke Street, Private Bag, Hamilton, 3200 New Zealand
| | - Lynne Chepulis
- grid.49481.300000 0004 0408 3579University of Waikato, Gate 1, Knighton Road, Hillcrest, Waikato District Health Board, Pembroke Street, Private Bag, Hamilton, 3200 New Zealand
| | - Rawiri Keenan
- grid.49481.300000 0004 0408 3579University of Waikato, Gate 1, Knighton Road, Hillcrest, Waikato District Health Board, Pembroke Street, Private Bag, Hamilton, 3200 New Zealand
| | - Ross Lawrenson
- grid.49481.300000 0004 0408 3579University of Waikato, Gate 1, Knighton Road, Hillcrest, Waikato District Health Board, Pembroke Street, Private Bag, Hamilton, 3200 New Zealand
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Norman K, Burrows L, Chepulis L, Lawrenson R. "Sometimes choices are not made, because we have 'a' choice, they're made because they are 'the' choice": Barriers to weight management for clients in rural general practice. BMC PRIMARY CARE 2022; 23:268. [PMID: 36284265 PMCID: PMC9594876 DOI: 10.1186/s12875-022-01874-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 08/18/2022] [Accepted: 09/19/2022] [Indexed: 11/06/2022]
Abstract
Background Obesity is an international health issue which currently affects over 34% of New Zealand adults and leads to further physical and psychosocial health complications. People living in rural communities experience health inequities and have a high-risk of becoming obese. The aim of this study was to explore and identify barriers to effective weight management in rural Waikato general practice. Methods Using semi-structured interviews, 16 rural Waikato participants shared their experiences with barriers to weight management. Interviews were transcribed and analysed using thematic analysis. Results Four themes were identified: resource constraints, rural locality barriers, rural sociocultural norms barriers, and participants’ understanding the solutions needed to overcome their specific barriers to effective weight management. For these participants, finding a feasible weight management strategy was a challenging first step in their weight management journey. A programme that would ‘work’ meant one that was economically viable for low-income persons, accessible, even if living rurally with less resources, and did not cause harm or jeopardise their social connections within family or community. Conclusion Overall, participants noted a lack of weight management strategy ‘choice’ because of income, isolation or accessibility of their rural location and/or the sociocultural norms of the community they lived in restricted options available to them. Future weight management initiatives may be better devised from within communities themselves and will need to be cognisant of the barriers specific to rural communities. Rural perspectives have much to offer in any such reconsideration of weight management initiatives.
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Affiliation(s)
- Kimberley Norman
- grid.49481.300000 0004 0408 3579University of Waikato, Gate 1, Knighton Road, Hillcrest, Hamilton, New Zealand and Waikato District Health Board, Pembroke Street, Private Bag 3200, 3240 Hamilton, New Zealand
| | - Lisette Burrows
- grid.49481.300000 0004 0408 3579University of Waikato, Gate 1, Knighton Road, Hillcrest, Hamilton, New Zealand and Waikato District Health Board, Pembroke Street, Private Bag 3200, 3240 Hamilton, New Zealand
| | - Lynne Chepulis
- grid.49481.300000 0004 0408 3579University of Waikato, Gate 1, Knighton Road, Hillcrest, Hamilton, New Zealand and Waikato District Health Board, Pembroke Street, Private Bag 3200, 3240 Hamilton, New Zealand
| | - Ross Lawrenson
- grid.49481.300000 0004 0408 3579University of Waikato, Gate 1, Knighton Road, Hillcrest, Hamilton, New Zealand and Waikato District Health Board, Pembroke Street, Private Bag 3200, 3240 Hamilton, New Zealand
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Norman K, Chepulis L, Burrows L, Lawrenson R. Barriers to obesity health care from GP and client perspectives in New Zealand general practice: A meta-ethnography review. Obes Rev 2022; 23:e13495. [PMID: 35833727 PMCID: PMC9540793 DOI: 10.1111/obr.13495] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 06/23/2022] [Accepted: 06/24/2022] [Indexed: 12/01/2022]
Abstract
Obesity is a complex international health concern affecting individual quality of life and contributing to an unsustainable strain on national health systems. General practice is positioned as best suited to deliver weight management health care, yet, obesity rates remain high suggesting barriers are experienced within this space. The aim of this review is to synthesize general practitioner and client perspectives of weight management to identify barriers experienced in New Zealand general practice. Six databases were searched resulting in eight articles being included in this review. This interpretive synthesis was guided by principles of meta-ethnography and grounded theory. Four overarching themes were identified from client and general practitioner perspectives: stigma, communication, inadequate health care (system limitations for general practitioners and lack of tailored advice for clients), and sociocultural influences. These four barriers were found to be interdependent, influencing each other outside the general practice context, highlighting the intersectionality of weight management health-care barriers and further complicating effective weight management within general practice. Clients reported wanting tailored, non-stigmatized, effective weight management health care, yet, general practitioners reported being ill-equipped to provide this due to barriers both within and outside the limits of their practice. General practice requires more systemic support to deliver effective weight management including public health campaigns and indigenous health information to reduce health inequities. An appraisal of general practice being "best suited" to deliver effective weight management health care that is culturally appropriate is urgently required to improve obesity related health outcomes in New Zealand.
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Affiliation(s)
- Kimberley Norman
- Te Huataki Waiora School of Health, University of Waikato, Hamilton, New Zealand
| | - Lynne Chepulis
- Te Huataki Waiora School of Health, University of Waikato, Hamilton, New Zealand
| | - Lisette Burrows
- Te Huataki Waiora School of Health, University of Waikato, Hamilton, New Zealand
| | - Ross Lawrenson
- Te Huataki Waiora School of Health, University of Waikato, Hamilton, New Zealand.,Strategy, Investment and Transformation, Waikato District Health Board, Hamilton, New Zealand
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Hawkins M. Let's focus on obesity New Zealand! J Prim Health Care 2021; 13:315-316. [PMID: 34937643 DOI: 10.1071/hc21126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 10/08/2021] [Indexed: 11/23/2022] Open
Affiliation(s)
- Marcus Hawkins
- Botany Doctor Medical Practice, Botany Town Centre, Auckland, New Zealand;
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Dovey S. From the Editor: Reflection on reflection. J Prim Health Care 2021; 13:193-194. [PMID: 34588099 DOI: 10.1071/hcv13n3_ed1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Susan Dovey
- Editor-in-Chief, Journal of Primary Health Care.
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