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Anees A, Saeed ZI, Kemper S, Haggerty T, Davisson L. Surveying the Knowledge and Practices of Primary Care Residents in Managing Adult Patients with Obesity. J Gen Intern Med 2024; 39:1698-1703. [PMID: 38671204 PMCID: PMC11255137 DOI: 10.1007/s11606-024-08777-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 04/18/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND The prevalence of obesity is increasing worldwide at an alarming rate, yet obesity remains under-addressed during clinic encounters. A lack of training in how to treat obesity is one crucial factor contributing to this deficiency. OBJECTIVE This study explored resident physicians' perceptions of their education on obesity and its relationship with confidence and practice behaviors when caring for patients with obesity. DESIGN A survey was distributed to residency directors to share with residents in their programs. Participation was voluntary and anonymous. Data was collected over a 3-month period. PARTICIPANTS Residents in Family Medicine and Internal Medicine programs in West Virginia and Indiana who saw adult patients in an ambulatory care setting. MAIN MEASURES The electronic survey queried the presence of a formal curriculum on Obesity Medicine (OM) and each resident's knowledge, confidence, practice behaviors, and attitudes pertaining to OM. KEY RESULTS The survey was distributed to 490 residents in 12 programs. Response rate was 22.9% (112 resident physicians). All respondents felt that medical training in obesity should be strengthened. Residents who reported having a formal curriculum on OM were more likely than those without a curriculum to rate their confidence as "high" when discussing weight (35.0% vs. 16.7%, p = 0.03) and when counseling patients about diet and nutrition (37.5% vs. 18.1%, p = 0.02). They also more frequently reported learning enough from faculty to manage obesity (65.0% vs. 29.2%, p < 0.001). Residents with an OM curriculum reported discussing obesity as a problem with patients (100.0% vs. 86.1%, p = 0.01), and completing motivational interviews (90.0% vs. 58.3%, p = < 0.001), more frequently than their peers without a curriculum. CONCLUSIONS Residents with a formal OM curriculum were more confident in addressing and discussing obesity with patients. Formal training in OM will strengthen resident training to better address and treat patients with obesity.
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Affiliation(s)
- Amna Anees
- Department of Internal Medicine, Charleston Area Medical Center and WVU School of Medicine-Charleston Division, Charleston, WV, USA.
| | - Zeb Ijaz Saeed
- Division of Endocrinology, Diabetes and Metabolism, Indiana University, Indianapolis, IN, USA
| | - Suzanne Kemper
- Charleston Area Medical Center Institute for Academic Medicine, Charleston, WV, USA
| | - Treah Haggerty
- Department of Family Medicine, West Virginia University School of Medicine and WVU Medicine's Medical Weight Management Program, Morgantown, WV, USA
| | - Laura Davisson
- Department of Internal Medicine, West Virginia University School of Medicine and WVU Medicine's Medical Weight Management Program, Morgantown, WV, USA
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Verhees MJM, Landstra AM, Engbers R, Van De Pol MHJ, Huijbregts R, Van Meggelen RA, Kuijer-Siebelink W, Laan RFJM. Designing a Workplace-Based Learning Environment for Learning Health Promotion: A Design-Based Research. PERSPECTIVES ON MEDICAL EDUCATION 2024; 13:357-367. [PMID: 38948402 PMCID: PMC11212777 DOI: 10.5334/pme.1203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 05/24/2024] [Indexed: 07/02/2024]
Abstract
Introduction The healthcare landscape has a growing emphasis on health promotion (HP), which makes HP important in the training of future physicians. This study employed design-based research to develop a clerkship focused on HP and to outline design principles for shaping workplace learning environments to promote HP learning. Methods We evaluated a nursing-home clerkship designed at Radboud University Medical Center in the Netherlands, and refined it over three rounds. Data collection involved individual and group interviews with students and supervisors, as well as observations during clerkship-related meetings and activities. These interactions also facilitated the exchange of perspectives between participants and generation of new design ideas, fostering co-creation of the clerkship design. Data were analyzed through iterative thematic inquiry to inform new design choices and develop design principles. Results Evolved clerkship designs included an app for capturing practice experiences to discuss in relation to students' professional roles, loosening the strict assessment structure, and collaborative creation of a practice assignment about 'Positive Health'. We constructed four design principles, including: to question and discuss students' professional identity, provide concrete and meaningful assignments, aim for a peer-learner role for supervisors, and foster co-creation of the workplace learning environment. Discussion Our design principles support the design of workplace-based learning for HP, a subject that is novel within healthcare practice. We find that co-creation of workplace-based learning, which requires embracing uncertainty, is pivotal in this context, for students, practitioners, and educational institutions.
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Affiliation(s)
- Myrthe J. M. Verhees
- Radboudumc Health Academy, Radboud University Medical Center, Nijmegen, Netherlands
| | - Anneke M. Landstra
- Radboudumc Health Academy, Radboud University Medical Center, Nijmegen, Netherlands
- Rijnstate, Arnhem, Netherlands
| | - Rik Engbers
- Radboudumc Health Academy, Radboud University Medical Center, Nijmegen, Netherlands
| | - Marjolein H. J. Van De Pol
- Radboudumc Health Academy, Radboud University Medical Center, Nijmegen, Netherlands
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, Netherlands
| | - Renske Huijbregts
- Radboud University, she was an intern at Radboudumc Health Academy, Radboud University Medical Center, Nijmegen, Netherlands
| | - Roos A. Van Meggelen
- Radboud University, she was an intern at Radboudumc Health Academy, Radboud University Medical Center, Nijmegen, Netherlands
| | - Wietske Kuijer-Siebelink
- Radboudumc Health Academy, Radboud University Medical Center, Nijmegen, Netherlands
- HAN University of Applied Sciences, Nijmegen, Netherlands
| | - Roland F. J. M. Laan
- Radboudumc Health Academy, Radboud University Medical Center, Nijmegen, Netherlands
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Tenedero CB, O'Brien KT, Patel BP, Strom M, Deveci AC, Chu L, Jayawardena S, Noseworthy R, McPherson AC, Walsh CM, Hamilton JK. Medical students' perceived comfort and competence performing physical examinations on patients with obesity: A mixed-methods needs assessment. Clin Obes 2024; 14:e12617. [PMID: 37559427 DOI: 10.1111/cob.12617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 07/16/2023] [Accepted: 07/26/2023] [Indexed: 08/11/2023]
Abstract
Physicians are unsatisfied with their training in the care of patients with obesity. Physical examination is a key component of care, and modifications to techniques are often necessary for patients with obesity. To determine learning needs, we examined medical students' perceived comfort and competency in conducting physical examinations on patients with obesity. This mixed-methods study of Canadian medical students used a questionnaire and semi-structured focus groups to assess medical students' perceived comfort and competence in examining patients with obesity. Participants included 175 Canadian medical students. A minority of medical students felt comfortable (42%) or competent (14%) examining patients with obesity. Physical exam challenges included modifying exam manoeuvres, interpreting findings and communicating sensitively around weight. Lack of early exposure to patients with obesity, minimal instruction by preceptors and a lack of curricular focus on obesity were felt to be barriers to improving these skills. Students perceived their lack of confidence as negatively impacting their ability to manage patients with obesity and more training in this area was desired to prevent disparities in care. Medical students feel that adequate training on how to perform an obesity-specific physical examination is lacking. Developing curricula and including formal teaching around these key competencies within medical education is essential.
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Affiliation(s)
- Christine B Tenedero
- Division of Endocrinology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | | | - Barkha P Patel
- Division of Endocrinology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Michele Strom
- Division of Endocrinology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Arin C Deveci
- Division of Endocrinology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Lisa Chu
- Division of Endocrinology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | | | - Rebecca Noseworthy
- Division of Endocrinology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Amy C McPherson
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Catharine M Walsh
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- SickKids Research and Learning Institutes, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jill K Hamilton
- Division of Endocrinology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
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Flores MR, Zuniga SS. Integration of Endogenous Opioid System Research in the Interprofessional Diagnosis and Treatment of Obesity and Eating Disorders. ADVANCES IN NEUROBIOLOGY 2024; 35:357-380. [PMID: 38874732 DOI: 10.1007/978-3-031-45493-6_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2024]
Abstract
This third and final chapter in our trilogy introduces the clinical distinctions and phenotypical similarities between obesity and eating disorders. Research elaborating on the shared neurobiological substrates for obesity and eating disorders is discussed. We present an interprofessional model of treatment for both disordered eating and for obesity. Additionally, this chapter establishes the translational importance of research connecting endogenous opioid activity with both obesity and eating disorders, with an emphasis on clinical interventions. We conclude with a discussion of future directions for research.
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Affiliation(s)
| | - Sylvana Stephano Zuniga
- Obesity and Eating Disorders Clinic, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico
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Nagpal TS, Pearce N, Sockalingam S, Hawa R, Dhaliwal KK, Lee-Baggley D, El-Hussein M, Nutter S, Piccinini-Vallis H, Vallis M, Dennett L, Forhan M, Hadjiyanakkis S, Kushner RF, McMillan M, Wharton S, Wiljer D, Abraham JR. A scoping review of obesity education interventions for current and prospective medical professionals in Canada. OBESITY PILLARS (ONLINE) 2023; 8:100085. [PMID: 38125662 PMCID: PMC10728706 DOI: 10.1016/j.obpill.2023.100085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/14/2023] [Accepted: 08/16/2023] [Indexed: 12/23/2023]
Abstract
Background Obesity is a prevalent chronic disease in Canada. Individuals living with obesity frequently interact with medical professionals who must be prepared to provide evidence-based and person-centred care options. The purpose of this scoping review was to summarize existing educational interventions on obesity in Canada for current and prospective medical professionals and to identify key future directions for practice and research. Methods A scoping review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews. The search strategy was conducted using Medline (via PubMed), Embase, Eric, CBCA, Proquest Education, and Proquest Theses. The inclusion criteria included delivery of an educational intervention on obesity for current medical professionals, medical undergraduate trainees, or residents administered in Canada. Data were extracted from the included studies to thematically summarize the intervention content, and main outcomes assessed. Future directions for research and practice were identified. Results Eight studies met the inclusion criteria. The interventions ranged in terms of the mode of delivery, including interactive in-person workshops and seminars, online learning modules, webinars, and videos. The main outcomes assessed were attitudes towards patients living with obesity, self-efficacy for having sensitive obesity-related discussions, skills to assess obesity and provision of management options. All studies reported improvements in the outcomes. Future directions identified were the need to develop standardized obesity competencies for inclusion across medical education programs, further research on effective pedagogical approaches to integrating content into existing curricula and the need for broader awareness and assessment of the quality of obesity education resources. Conclusion Although there have been few obesity-specific educational interventions for current and prospective medical professionals in Canada, existing evidence shows positive learning outcomes. These findings advocate for continued investment in the development of obesity medical training and educational interventions.
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Affiliation(s)
- Taniya S. Nagpal
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | | | - Sanjeev Sockalingam
- Department of Psychiatry, University of Toronto, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Raed Hawa
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Khushmol K. Dhaliwal
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Dayna Lee-Baggley
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Mohamed El-Hussein
- Faculty of Health, Community & Education, School of Nursing and Midwifery, Mount Royal University, Calgary, Alberta, Canada
| | - Sarah Nutter
- Educational Psychology and Leadership Studies, University of Victoria, Victoria, British Columbia, Canada
| | | | - Michael Vallis
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Liz Dennett
- Scott Health Sciences Library, University of Alberta, Edmonton Alberta Canada
| | - Mary Forhan
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Stasia Hadjiyanakkis
- Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Robert F. Kushner
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Sean Wharton
- University of Toronto, Wharton Medical Clinic, Toronto, Ontario, Canada
| | - David Wiljer
- University Health Network; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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Verhees MJM, Engbers R, Landstra AM, Bremer AE, van de Pol M, Laan RFJM, Assendelft WJJ. Workplace-based learning about health promotion in individual patient care: a scoping review. BMJ Open 2023; 13:e075657. [PMID: 37963689 PMCID: PMC10649380 DOI: 10.1136/bmjopen-2023-075657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 10/25/2023] [Indexed: 11/16/2023] Open
Abstract
OBJECTIVE To outline current knowledge regarding workplace-based learning about health promotion in individual patient care. DESIGN Scoping review. DATA SOURCES PubMed, ERIC, CINAHL and Web of Science from January 2000 to August 2023. ELIGIBILITY CRITERIA We included articles about learning (activities) for healthcare professionals (in training), about health promotion in individual patient care and in the context of workplace-based learning. DATA EXTRACTION AND SYNTHESIS The studies were evaluated using a charting template and were analysed thematically using a template based on Designable Elements of Learning Environments model. RESULTS From 7159 studies, we included 31 that described evaluations of workplace-based learning about health promotion, around a variety of health promotion topics, for different health professions. In the articles, health promotion was operationalised as knowledge, skills or attitudes related to specific lifestyle factors or more broadly, with concepts such as health literacy, advocacy and social determinants of health. We assembled an overview of spatial and instrumental, social, epistemic and temporal elements of learning environments in which health promotion is learnt. CONCLUSIONS The studies included in our analysis varied greatly in their approach to health promotion topics and the evaluation of learning outcomes. Our findings suggest the importance of providing opportunities for health profession learners to engage in authentic practice situations and address potential challenges they may experience translating related theory into practice. Additionally, our results highlight the need for conscious and articulated integration of health promotion in curricula and assessment structures. We recommend the exploration of opportunities for health profession students, professionals and patients to learn about health promotion together. Additionally, we see potential in using participatory research methods to study future health promotion learning. STUDY REGISTRATION Open Science Framework, https://doi.org/10.17605/OSF.IO/6QPTV.
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Affiliation(s)
| | - Rik Engbers
- Radboudumc Health Academy, Radboudumc, Nijmegen, The Netherlands
| | - Anneke M Landstra
- Radboudumc Health Academy, Radboudumc, Nijmegen, The Netherlands
- Paediatrics, Rijnstate, Arnhem, The Netherlands
| | - Anne E Bremer
- Radboudumc Health Academy, Radboudumc, Nijmegen, The Netherlands
| | - Marjolein van de Pol
- Radboudumc Health Academy, Radboudumc, Nijmegen, The Netherlands
- Department of Primary and Community Care, Radboudumc, Nijmegen, The Netherlands
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Orjuela-Grimm M, Butsch WS, Bhatt-Carreño S, Smolarz BG, Rao G. Benchmarking of provider competencies and current training for prevention and management of obesity among family medicine residency programs: a cross-sectional survey. BMC FAMILY PRACTICE 2021; 22:132. [PMID: 34167487 PMCID: PMC8229273 DOI: 10.1186/s12875-021-01484-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 06/07/2021] [Indexed: 11/16/2022]
Abstract
Background U.S. physicians lack training in caring for patients with obesity. For family medicine, the newly developed Obesity Medicine Education Collaborative (OMEC) competencies provide an opportunity to compare current training with widely accepted standards. We aimed to evaluate the current state of obesity training in family medicine residency programs. Methods We conducted a study consisting of a cross-sectional survey of U.S. family medicine residency program leaders. A total of 735 directors (including associate/assistant directors) from 472 family medicine residency programs identified from the American Academy of Family Physicians public directory were invited via postal mail to complete an online survey in 2018. Results Seventy-seven program leaders completed surveys (16% response rate). Sixty-four percent of programs offered training on prevention of obesity and 83% provided training on management of patients with obesity; however, 39% of programs surveyed reported not teaching an approach to obesity management that integrates clinical and community systems as partners, or doing so very little. Topics such as behavioral aspects of obesity (52%), physical activity (44%), and nutritional aspects of obesity (36%) were the most widely covered (to a great extent) by residency programs. In contrast, very few programs extensively covered pharmacological treatment of obesity (10%) and weight stigma and discrimination (14%). Most respondents perceived obesity-related training as very important; 65% of the respondents indicated that expanding obesity education was a high or medium priority for their programs. Lack of room in the curriculum and lack of faculty expertise were reported as the greatest barriers to obesity education during residency. Only 21% of the respondents perceived their residents as very prepared to manage patients with obesity at the end of the residency training. Conclusion Family medicine residency programs are currently incorporating recommended teaching to address OMEC competencies to a variable degree, with some topic areas moderately well represented and others poorly represented such as pharmacotherapy and weight stigma. Very few program directors report their family medicine residents are adequately prepared to manage patients with obesity at the completion of their training. The OMEC competencies could serve as a basis for systematic obesity training in family medicine residency programs. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-021-01484-y.
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Affiliation(s)
- Manuela Orjuela-Grimm
- Departments of Epidemiology and Pediatrics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - W Scott Butsch
- Departments of Surgery and Internal Medicine and Geriatrics, Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Silvia Bhatt-Carreño
- Departments of Epidemiology and Pediatrics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | | | - Goutham Rao
- Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, OH, USA
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Olander EK, Hill B, Skouteris H. Healthcare Professional Training Regarding Gestational Weight Gain: Recommendations and Future Directions. Curr Obes Rep 2021; 10:116-124. [PMID: 33609271 PMCID: PMC8159776 DOI: 10.1007/s13679-021-00429-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/02/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE OF REVIEW The aim of this review was to summarise recent evaluations of healthcare professional training regarding gestational weight gain and provide recommendations for future training. RECENT FINDINGS A number of evaluated healthcare professional training sessions regarding gestational weight gain show promising results in terms of increased participant confidence and knowledge and impact on women's outcomes. It is clear that the interventions which have also implemented resources in the practice environment to support training are the ones most likely to influence gestational weight gain. Support from healthcare professionals are key to influence pregnant women's weight gain and should be offered within the standard curriculum and through mandatory training. Factors influencing this support include women's and healthcare professional characteristics, interpersonal and healthcare system and policy factors. All of these need to be considered when developing healthcare professional training to support women with their gestational weight gain.
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Affiliation(s)
- Ellinor K. Olander
- Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, Northampton Square, London, EC1V 0HB UK
| | - Briony Hill
- National Health and Medical Research Council Early Career Fellow, Monash Centre for Health Research and Implementation, Monash University, Level 1, 43-51 Kanooka Grove, Clayton, VIC 3169 Australia
| | - Helen Skouteris
- Health and Social Care Improvement and Implementation Science, Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Level 1, 43-51 Kanooka Grove, Clayton, VIC 3169 Australia
- Warwick Business School, Warwick University, Coventry, CV47AL UK
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Fox R, Park K, Hildebrand‐Chupp R, Vo AT. Working toward eradicating weight stigma by combating pathologization: A qualitative pilot study using direct contact and narrative medicine. JOURNAL OF APPLIED SOCIAL PSYCHOLOGY 2021. [DOI: 10.1111/jasp.12717] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Rachel Fox
- Department of Communication University of California San Diego CA USA
| | - Kelly Park
- Department of Psychiatry and Behavioral Sciences Keck School of Medicine of the University of Southern California (USC)/Los Angeles County + USC Medical Center Los Angeles CA USA
| | | | - Anne T. Vo
- Department of Medical Education Keck School of Medicine of the University of Southern California (USC) Los Angeles CA USA
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