An analysis of directly observed weight-related communication during routine primary healthcare consultations

Abstract

Introduction
Overweight and obesity present a significant public health challenge for Scotland. Primary health care is well placed to manage patient weight effectively. However, weight issues are reportedly infrequently discussed in primary care and the process of primary care weight discussion is poorly understood. This doctoral research investigates the communication process of weight discussion between primary care practitioners and overweight and obese patients, during routine primary care consultations in Scotland.
Methodology
A mixed methods cross-sectional approach was applied, combining three data types: (1) direct video observation of weight discussion in primary care consultations, (2) primary care practitioner and patient questionnaires assessing weight-related beliefs and attitudes, (3) practitioner semi-structured interviews exploring beliefs about obesity and weight management. Participants included primary care practices, practitioners and patients, recruited across four NHS Scotland Health Boards.
Results
Fourteen primary care practitioners (12 general practitioners, 2 practice nurses) and 305 patients (218 overweight/obese) participated in the research. Weight discussion was observed in 25% of routine consultations with overweight/obese patients. Practitioner use of partnership building and activating communications predicted weight discussion.
Contextualising weight as a ‘problem’, and higher numbers of distinct weight discussions were associated with weight-related consultation outcomes. Practitioners’ reported weight management practices were incongruent with observed practice and patient beliefs. Practitioners identified service and patient-related barriers to weight discussion and management, and many practitioners did not perceive weight management to be a responsibility of primary care.
Conclusions
Despite a lack of routine weight discussion in primary care consultation, and the multiple barriers to weight discussion perceived by practitioners, the way practitioners contextualise and communicate about weight issues was observed to facilitate effective weight discussion. These findings provide evidence for the development of a practitioner weight-related communication training intervention, assisting practitioners to more effectively discuss and manage weight.

Date of Award	29 Jun 2018
Original language	English
Awarding Institution	University of St Andrews
Supervisor	Joanne Elizabeth Cecil (Supervisor) & Anita Helen Laidlaw (Supervisor)