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Železnik U, Kokol P, Starc J, Železnik D, Završnik J, Vošner HB. Research Trends in Motivation and Weight Loss: A Bibliometric-Based Review. Healthcare (Basel) 2023; 11:3086. [PMID: 38063654 PMCID: PMC10706120 DOI: 10.3390/healthcare11233086] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 11/27/2023] [Accepted: 11/29/2023] [Indexed: 02/28/2024] Open
Abstract
Obesity is a complex disease that, like COVID-19, has reached pandemic proportions. Consequently, it has become a rapidly growing scientific field, represented by an extensive body of research publications. Therefore, the aim of this study was to present the research trends in the scientific literature on motivation and weight loss. Because traditional knowledge synthesis approaches are not appropriate for analyzing large corpora of research evidence, we utilized a novel knowledge synthesis approach called synthetic knowledge synthesis (SKS) to generate new holistic insights into obesity research focusing on motivation. SKS is a triangulation of bibliometric analysis, bibliometric mapping, and content analysis. Using it, we analyzed the corpus of publications retrieved from the Scopus database, using the search string TITLE-ABS-KEY((obesity or overweight) and "weight loss" and motiv*) in titles, keywords, and abstracts, without any additional inclusion or exclusion criteria. The search resulted in a corpus of 2301 publications. The United States of America, the United Kingdom, and Australia were the most productive countries. Four themes emerged, namely, weight loss and weight-loss maintenance through motivational interventions, lifestyle changes supported by smart ICT, maintaining sustainable weight with a healthier lifestyle, and weight management on the level of primary healthcare and bariatric surgery. Further, we established that the volume of research literature is growing, as is the scope of the research. However, we observed a regional concentration of research and its funding in developed countries and almost nonexistent research cooperation between developed and less-developed countries.
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Affiliation(s)
- Uroš Železnik
- Faculty of Health and Social Sciences Slovenj Gradec, 2380 Slovenj Gradec, Slovenia; (D.Ž.); (H.B.V.)
- Health Education Center, Community Healthcare Center Ptuj, 2250 Ptuj, Slovenia
| | - Peter Kokol
- Laboratory for System Design, Faculty of Electrical Engineering and Computer Science, University of Maribor, 2000 Maribor, Slovenia;
- Faculty of Medicine, University of Maribor, 2000 Maribor, Slovenia
| | - Jasmina Starc
- Faculty of Business and Management Sciences, University of Novo Mesto, 8000 Novo Mesto, Slovenia;
| | - Danica Železnik
- Faculty of Health and Social Sciences Slovenj Gradec, 2380 Slovenj Gradec, Slovenia; (D.Ž.); (H.B.V.)
| | - Jernej Završnik
- Community Healthcare Center Dr. Adolf Drolc Maribor, 2000 Maribor, Slovenia;
| | - Helena Blažun Vošner
- Faculty of Health and Social Sciences Slovenj Gradec, 2380 Slovenj Gradec, Slovenia; (D.Ž.); (H.B.V.)
- Community Healthcare Center Dr. Adolf Drolc Maribor, 2000 Maribor, Slovenia;
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van Beurden SB, Greaves CJ, Abraham C, Lawrence NS, Smith JR. "It helps me to stay on the right path, rather than give in": Mixed-method process evaluation of the ImpulsePal app-based intervention for weight management. Digit Health 2023; 9:20552076231220806. [PMID: 38130800 PMCID: PMC10734348 DOI: 10.1177/20552076231220806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 11/28/2023] [Indexed: 12/23/2023] Open
Abstract
Background Empirical research indicates that impulsive processes that operate below conscious monitoring can undermine peoples' attempts to change behaviour patterns, especially those that have become habitual. This may, therefore, be a serious challenge for those trying to lose weight. A novel smartphone app-based intervention (ImpulsePal) offers practical strategies to manage impulsive urges to facilitate reductions in the consumption of energy-dense processed food and overeating. Aim This process evaluation of ImpulsePal aimed to explore what was delivered/received and used, mechanisms of action, and potential contextual factors impacting intervention engagement and outcomes. Methods A mixed-methods process evaluation, with composite analysis of the quantitative (app usage statistics) and qualitative data (semi-structured interviews), was conducted alongside a feasibility randomised controlled trial with individuals with a body mass index of at least 25 kg/m2 who wanted to lose weight. Results Of 58 participants receiving ImpulsePal, 56 had successfully shared app usage statistics, and 36 (62%) were interviewed. Although usage statistics indicated reductions in the use of some features, interviews indicated that participants were still using app-recommended strategies without requiring them to open ImpulsPal. Overall, interviews highlighted that participants valued having access to in-the-moment support, felt more aware of their own eating behaviour and influences on it, and felt an increased ability to avoid and reconceptualise, in-the-moment temptations. Conclusion This process evaluation offers support for a logic model suggesting that impulse management, using ImpulsePal, can promote healthier eating among those motivated to lose weight. It also highlights the necessity of using multimodal methods to explore the delivery and use of digital interventions.
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Affiliation(s)
| | - Colin J Greaves
- School of Sport, Exercise and Rehabilitation, University of Birmingham, Birmingham, UK
| | | | | | - Jane R Smith
- University of Exeter Medical School, University of Exeter, Exeter, UK
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Rozenblum R, De La Cruz BA, Nolido NV, McNulty S, McManus KD, Halperin F, Block JP, Bates DW, Baer HJ. Primary care patients' and providers' perspectives about an online weight management program integrated with population health management: Post-intervention qualitative results from the PROPS study. PEC INNOVATION 2022; 1:100057. [PMID: 37213741 PMCID: PMC10194385 DOI: 10.1016/j.pecinn.2022.100057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 05/12/2022] [Accepted: 06/07/2022] [Indexed: 05/23/2023]
Abstract
Objective To assess patients' and providers' attitudes about the online weight management program and population health management approach in the PROPS Study, which examined the effectiveness of these strategies in primary care. Methods We conducted semi-structured interviews with 22 patients and nine providers. Using thematic analysis, we analyzed transcripts of the interviews to identify key themes. Results Most patients found the online program to be well-structured and easy to use, although a few noted that the information was overwhelming or could be more personalized. Patients mentioned that the support from the population health managers was critical for their success, and several reported that they would have liked more involvement from their primary care provider or a dietitian. Providers also were satisfied with the interventions, and several stated that the population health management support was helpful because it added accountability. Providers suggested that the interventions could be improved by tailoring the information and integrating the online program with the electronic health record. Conclusion Most patients and providers were satisfied with the interventions, with several recommendations for improvements. Innovation These findings give additional information about patients' and providers' experience with this innovative approach for managing overweight and obesity in primary care.
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Affiliation(s)
- Ronen Rozenblum
- Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | | | | | | | | | - Florencia Halperin
- Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Jason P. Block
- Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - David W. Bates
- Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Heather J. Baer
- Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Corresponding author at: Division of General Internal Medicine and Primary Care, Brigham and Women’s Hospital, 1620 Tremont St, Boston, MA 02120, USA.
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Leach B, Parkinson S, Gkousis E, Abel G, Atherton H, Campbell J, Clark C, Cockcroft E, Marriott C, Pitchforth E, Sussex J. Digital Facilitation to Support Patient Access to Web-Based Primary Care Services: Scoping Literature Review. J Med Internet Res 2022; 24:e33911. [PMID: 35834301 PMCID: PMC9335178 DOI: 10.2196/33911] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 02/15/2022] [Accepted: 04/10/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The use of web-based services within primary care (PC) in the National Health Service in England is increasing, with medically underserved populations being less likely to engage with web-based services than other patient groups. Digital facilitation-referring to a range of processes, procedures, and personnel that seek to support patients in the uptake and use of web-based services-may be a way of addressing these challenges. However, the models and impact of digital facilitation currently in use are unclear. OBJECTIVE This study aimed to identify, characterize, and differentiate between different approaches to digital facilitation in PC; establish what is known about the effectiveness of different approaches; and understand the enablers of digital facilitation. METHODS Adopting scoping review methodology, we searched academic databases (PubMed, EMBASE, CINAHL, Web of Science, and Cochrane Library) and gray literature published between 2015 and 2020. We conducted snowball searches of reference lists of included articles and articles identified during screening as relevant to digital facilitation, but which did not meet the inclusion criteria because of article type restrictions. Titles and abstracts were independently screened by 2 reviewers. Data from eligible studies were analyzed using a narrative synthesis approach. RESULTS A total of 85 publications were included. Most (71/85, 84%) were concerned with digital facilitation approaches targeted at patients (promotion of services, training patients to improve their technical skills, or other guidance and support). Further identified approaches targeted PC staff to help patients (eg, improving staff knowledge of web-based services and enhancing their technical or communication skills). Qualitative evidence suggests that some digital facilitation may be effective in promoting the uptake and use of web-based services by patients (eg, recommendation of web-based services by practice staff and coaching). We found little evidence that providing patients with initial assistance in registering for or accessing web-based services leads to increased long-term use. Few studies have addressed the effects of digital facilitation on health care inequalities. Those that addressed this suggested that providing technical training for patients could be effective, at least in part, in reducing inequalities, although not entirely. Factors affecting the success of digital facilitation include perceptions of the usefulness of the web-based service, trust in the service, patients' trust in providers, the capacity of PC staff, guidelines or regulations supporting facilitation efforts, and staff buy-in and motivation. CONCLUSIONS Digital facilitation has the potential to increase the uptake and use of web-based services by PC patients. Understanding the approaches that are most effective and cost-effective, for whom, and under what circumstances requires further research, including rigorous evaluations of longer-term impacts. As efforts continue to increase the use of web-based services in PC in England and elsewhere, we offer an early typology to inform conceptual development and evaluations. TRIAL REGISTRATION PROSPERO International Prospective Register of Systematic Reviews CRD42020189019; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=189019.
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Affiliation(s)
| | | | | | - Gary Abel
- University of Exeter Medical School, Exeter, United Kingdom
| | | | - John Campbell
- University of Exeter Medical School, Exeter, United Kingdom
| | | | - Emma Cockcroft
- University of Exeter Medical School, Exeter, United Kingdom
| | - Christine Marriott
- National Institute of Health and Care Research Collaboration South West Peninsula Patient Engagement Group, University of Exeter Medical School, Exeter, United Kingdom
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Brenton-Peters JM, Consedine NS, Cavadino A, Roy R, Serlachius AS. Investigating the effect of an online self-compassion for weight management (SC4WM) intervention on self-compassion, eating behaviour, physical activity and body weight in adults seeking to manage weight: protocol for a randomised controlled trial. BMJ Open 2022; 12:e056174. [PMID: 35105594 PMCID: PMC8808316 DOI: 10.1136/bmjopen-2021-056174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Individual weight management, defined as engaging in behaviours to maintain or lose weight, can improve health and well-being. However, numerous factors influence weight management outcomes, such as genetics, biology, stress, the social and physical environment. Consequently, weight management can be hard. Self-compassion, described as treating oneself kindly in times of failure or distress, has shown promise in improving weight management outcomes. The objectives of this study are twofold: (1) to examine the efficacy of an online self-compassion for weight management (SC4WM) intervention coupled with an online commercial weight management programme (WW Weight Watchers reimagined) with increasing self-compassion and improving weight management outcomes (eating behaviour, physical activity and body weight) in comparison with the WW programme only and (2) to explore whether improvements in weight management outcomes are moderated by eating restraint, weight self-stigma, perceived stress and psychological coping. METHODS AND ANALYSIS To achieve these objectives, 240 participants seeking to manage their weight were randomised to either an online behavioural commercial weight management programme (WW) or the online WW +SC4 WM intervention. Validated measures of self-compassion, stress, weight self-stigma, eating restraint, psychological coping and weight management outcomes were administered online at baseline, 4 weeks and at a 12-week follow-up. ETHICS AND DISSEMINATION Ethics has been granted by the University of Auckland Health Research Ethics committee. Results will be communicated in peer-review journals, conferences and a doctoral thesis. If effective in increasing self-compassion and improving weight management outcomes, the intervention could be made more widely available to supplement behavioural weight management programmes. TRIAL REGISTRATION NUMBER ACTRN12621000580875; Pre-results.
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Affiliation(s)
| | - Nathan S Consedine
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand
| | - Alana Cavadino
- Section of Epidemiology and Biostatistics, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Rajshri Roy
- Department of Nutrition and Dietetics, The University of Auckland, Auckland, New Zealand
| | - Anna Sofia Serlachius
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand
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Tyldesley-Marshall N, Greenfield SM, Parretti HM, Jolly K, Jebb S, Daley AJ. The experiences of postnatal women and healthcare professionals of a brief weight management intervention embedded within the national child immunisation programme. BMC Pregnancy Childbirth 2021; 21:462. [PMID: 34187564 PMCID: PMC8243541 DOI: 10.1186/s12884-021-03905-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 05/27/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND After childbirth, most women do not lose the extra weight gained during pregnancy. This is important because postnatal weight retention contributes to the development of obesity in later life. Research shows that postnatal women living with overweight would prefer to weigh less, are interested in implementing weight loss strategies, and would like support. Without evidence for the benefit of weight management interventions during pregnancy, postnatal interventions are increasingly important. Research has focused on intensive weight loss programmes, which cannot be offered to all postnatal women. Instead, we investigated the feasibility of a brief intervention delivered to postnatal women at child immunisation appointments. This qualitative study explored the views of women who received the intervention and healthcare professionals who delivered it. METHODS The intervention was delivered within the context of the national child immunisation programme. The intervention group were offered brief support encouraging self-management of weight when attending general practices to have their child immunised at two, three and four months of age. The intervention involved motivation and support from practice nurses to encourage women to make healthier lifestyle choices through self-monitoring of weight and signposting to an online weight management programme. Nurses provided external accountability for weight loss. Women were asked to weigh themselves weekly and record this on a weight record card. Nested within this trial, semi-structured interviews explored the experiences of postnatal women who received the intervention and nurses who delivered it. RESULTS The intervention was generally acceptable to participants and child immunisation appointments considered a suitable intervention setting. Nurses were hesitant to discuss maternal weight, viewing the postnatal period as a vulnerable time. Whilst some caveats to implementation were discussed by nurses, they felt the intervention was easy to deliver and would motivate postnatal women to lose weight. CONCLUSIONS Participants were keen to lose weight after childbirth. Overall, they reported that the intervention was acceptable, convenient, and, appreciated support to lose weight after childbirth. Although nurses, expressed concerns about raising the topic of weight in the early postnatal period, they felt the intervention was easy to deliver and would help to motivate women to lose weight.
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Affiliation(s)
- Natalie Tyldesley-Marshall
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, Leicestershire LE11 3TU UK
| | - Sheila M Greenfield
- Institute for Applied Health Research, University of Birmingham, Birmingham, Edgbaston B15 2TT UK
| | - Helen M Parretti
- Norwich Medical School, University of East Anglia, Norwich, Norfolk NR4 7TJ UK
| | - Kate Jolly
- Institute for Applied Health Research, University of Birmingham, Birmingham, Edgbaston B15 2TT UK
| | - Susan Jebb
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG UK
| | - Amanda J Daley
- The Centre for Lifestyle Medicine and Behaviour, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, Leicestershire LE11 3TU UK
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van Beurden SB, Greaves CJ, Abraham C, Lawrence NS, Smith JR. ImpulsePal: The systematic development of a smartphone app to manage food temptations using intervention mapping. Digit Health 2021; 7:20552076211057667. [PMID: 34868619 PMCID: PMC8637692 DOI: 10.1177/20552076211057667] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 10/14/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Impulsive processes driving eating behaviour can often undermine peoples' attempts to change their behaviour, lose weight and maintain weight loss. AIM To develop an impulse management intervention to support weight loss in adults. METHODS Intervention Mapping (IM) was used to systematically develop the "ImpulsePal" intervention. The development involved: (1) a needs assessment including a qualitative study, Patient and Public advisory group and expert group consultations, and a systematic review of impulse management techniques; (2) specification of performance objectives, determinants, and change objectives; (3) selection of intervention strategies (mapping of change techniques to the determinants of change); (4) creation of programme materials; (5) specification of adoption and implementation plans; (6) devising an evaluation plan. RESULTS Application of the IM Protocol resulted in a smartphone app that could support reductions in unhealthy (energy dense) food consumption, overeating, and alcoholic and sugary drink consumption. ImpulsePal includes inhibition training, mindfulness techniques, implementation intentions (if-then planning), visuospatial loading, use of physical activity for craving management, and context-specific reminders. An "Emergency Button" was also included to provide access to in-the-moment support when temptation is strong. CONCLUSIONS ImpulsePal is a novel, theory- and evidence-informed, person-centred app that aims to support impulse management for healthier eating. Intervention Mapping facilitated the incorporation of app components that are practical operationalisations of change techniques targeting our specific change objectives and their associated theoretical determinants. Using IM enabled transparency and provided a clear framework for evaluation, and enhances replicability and the potential of the intervention to accomplish the desired outcome of facilitating weight loss through dietary change.
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Affiliation(s)
| | - Colin J Greaves
- School of Sport, Exercise and Rehabilitation, University of Birmingham, Birmingham, UK
| | - Charles Abraham
- School of Psychology, University of Melbourne, Melbourne, AUS
| | | | - Jane R Smith
- College of Medicine of Health, University of Exeter, Exeter, UK
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Abbott S, Parretti HM, Hazlehurst J, Tahrani AA. Socio-demographic predictors of uptake of a virtual group weight management program during the COVID-19 pandemic. J Hum Nutr Diet 2020; 34:480-484. [PMID: 33368737 DOI: 10.1111/jhn.12850] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/08/2020] [Accepted: 11/23/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND The COVID-19 pandemic has had a significant adverse impact on the delivery of weight management programmes (WMPs), in order to ensure the safety of patients and healthcare professionals. Videoconferencing could provide safe remote access to group WMPs during the COVID-19 pandemic. The objectives of this study were to determine the uptake of a virtual group WMP and its predictors. METHODS All patients enrolled on a face-to-face group WMP, which constitutes part of a Tier 3 WMP delivered by the NHS, at the time of the COVID-19 pandemic lockdown were invited to transfer to a virtual format of the group WMP. Baseline data included weight, BMI, age, gender, ethnicity and Index of Multiple Deprivation (IMD) quintile score. The outcomes were accept/decline transfer to the virtual group WMP. Logistic regression was performed to assess for predictors of uptake. RESULTS The 315 participants were included, of which 72.1% (n = 227) accepted. After adjusting for gender, deprivation and BMI; older patients (OR 0.966, [95% CI 0.944, 0.989]; p = 0.003) and Black, Asian and Minority Ethnicity (BAME) patients (OR 0.460 [95% 0.248, 0.851]; p = 0.023) were less likely to accept the virtual group WMP. CONCLUSION Strategies aimed at improving uptake of group WMP among BAME and older adult groups are needed, particularly considering the increased risk of severe COVID-19 in these two groups, and the links between obesity and poor COVID-19 outcomes.
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Affiliation(s)
- Sally Abbott
- Department of Diabetes and Endocrinology, University Hospital Birmingham Foundation Trust, Birmingham, UK.,Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Helen M Parretti
- Norwich Medical School, Faculty of Medicine and Health, University of East Anglia, Norwich, UK
| | - Jonathan Hazlehurst
- Department of Diabetes and Endocrinology, University Hospital Birmingham Foundation Trust, Birmingham, UK.,Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Abd A Tahrani
- Department of Diabetes and Endocrinology, University Hospital Birmingham Foundation Trust, Birmingham, UK.,Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK.,Centre for Endocrinology Diabetes and Metabolism (CEDAM), Birmingham Health Partners, Birmingham, UK
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Keyworth C, Epton T, Goldthorpe J, Calam R, Armitage CJ. Perceptions of receiving behaviour change interventions from GPs during routine consultations: A qualitative study. PLoS One 2020; 15:e0233399. [PMID: 32437462 PMCID: PMC7241720 DOI: 10.1371/journal.pone.0233399] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 05/04/2020] [Indexed: 01/19/2023] Open
Abstract
General Practitioners (GPs) are expected to provide patients with health behaviour change interventions, yet little is known about the views of patients themselves. We aimed to understand recent patients': (1) general expectations about GPs delivering health behaviour change interventions during routine consultations (including perceptions of appropriateness and helpfulness for receiving interventions), (2) perceptions of responsibility for GPs to talk about health behaviours, and (3) experiences of receiving behaviour change interventions. Twenty-four semi-structured interviews were conducted with people who had recently attended a routine GP consultation. Data were analysed thematically. Three major themes were identified: (1) acceptability of discussions about behaviour change, (2) establishing clinician-patient rapport, and (3) healthcare professionals as a credible source and well placed to offer behaviour change interventions. Most patients were positive about, and were willing to accept behaviour change interventions from their GP during a routine consultation. Although behaviour change was perceived as a sensitive topic for patients, the doctor-patient relationship was perceived to provide an effective platform to discuss behaviour change, with the GP perceived as an appropriate and important healthcare professional from whom to receive advice. Contrary to the views of GPs, behaviour change interventions were perceived by patients as appropriate and helpful during routine medical consultations, particularly where behaviour change could have a positive effect on long-term condition management. Behaviour change interventions delivered by GPs during routine consultations could be used effectively in time-restricted consultations.
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Affiliation(s)
- Chris Keyworth
- Division of Psychology and Mental Health, Manchester Centre for Health Psychology, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Tracy Epton
- Division of Psychology and Mental Health, Manchester Centre for Health Psychology, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Joanna Goldthorpe
- Division of Psychology and Mental Health, Manchester Centre for Health Psychology, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Rachel Calam
- Division of Psychology and Mental Health, Manchester Centre for Health Psychology, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Christopher J. Armitage
- Division of Psychology and Mental Health, Manchester Centre for Health Psychology, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
- Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester, United Kingdom
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Espel-Huynh HM, Wing RR, Goldstein CM, Thomas JG. Rationale and design for a pragmatic effectiveness-implementation trial of online behavioral obesity treatment in primary care. Contemp Clin Trials 2019; 82:9-16. [PMID: 31063870 DOI: 10.1016/j.cct.2019.05.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 04/22/2019] [Accepted: 05/02/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Current guidelines recommend behavioral intervention to achieve a modest weight loss (e.g., 3-5%) as a first-line obesity treatment. Online behavioral obesity treatment, delivered via the Rx Weight Loss (RxWL) program, produces clinically significant initial weight losses. However, the program's pragmatic utility in routine medical care has yet to be tested. Further, additional research is needed to determine how best to extend the RxWL program to facilitate weight loss maintenance. This paper summarizes methods for a pragmatic trial aimed at identifying optimal methods for implementation of RxWL in primary care and evaluating relative effectiveness of two approaches to weight loss maintenance. STUDY DESIGN RxWL will be implemented in a network of approximately 60 primary care clinics. Implementation outcomes (program uptake and completion metrics) will be compared between a Basic Implementation Intervention consisting primarily of access to RxWL, and an Enhanced Implementation Intervention with additional training in strategies for motivating and supporting patients in their use of RxWL and online clinician support tools for tracking patient progress. Second, two intervention approaches (Monthly Lessons versus Refresher Courses) within the RxWL patient platform will be tested against an educational control condition, and effects on 1-year weight loss maintenance will be compared. CONCLUSION This study will provide essential information about the feasibility and utility of online obesity treatment in primary care. It will provide novel information on two approaches to weight loss maintenance for patients in this setting. This project fills key gaps in evidence regarding best practices for obesity treatment in primary care.
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Affiliation(s)
- Hallie M Espel-Huynh
- Weight Control and Diabetes Research Center, The Miriam Hospital, 196 Richmond St., Providence, RI 02903, USA; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, 222 Richmond St., Providence, RI 02903, USA.
| | - Rena R Wing
- Weight Control and Diabetes Research Center, The Miriam Hospital, 196 Richmond St., Providence, RI 02903, USA; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, 222 Richmond St., Providence, RI 02903, USA
| | - Carly M Goldstein
- Weight Control and Diabetes Research Center, The Miriam Hospital, 196 Richmond St., Providence, RI 02903, USA; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, 222 Richmond St., Providence, RI 02903, USA
| | - J Graham Thomas
- Weight Control and Diabetes Research Center, The Miriam Hospital, 196 Richmond St., Providence, RI 02903, USA; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, 222 Richmond St., Providence, RI 02903, USA
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