Socioeconomically disadvantaged adults are both more likely to be obese and have lower levels of health literacy. This trial evaluated the implementation and effectiveness of primary care nurses acting as prevention navigators to support obese patients with low health literacy to lose weight.

Project Status

Completed Projects

Chief investigators

Mark Harris (CPHCE), Nigel Stocks (University of Adelaide)

Project coordinator

Nighat Faruqi (CPHCE)

Team members

Catherine Spooner (CPHCE), Nouhad El-Haddad (CPHCE)

Project Rationale

In Australia, obesity is one of the most significant problems facing the healthcare system. Obesity is common (27%) among patients presenting in Australian general practice. The Australian National

Health and Medical Research Council’s Clinical practice guidelines for the management of  overweight and obesity in adults, adolescents and children in Australia (the Guidelines) make recommendations for obesity management in clinical practice. However, there is evidence that general practitioners (GPs) do not adequately implement these recommendations.

Project Aim/s

The Better Management of Weight in General Practice (BMWGP) study aimed to evaluate a multi-level intervention for obese patients with low health literacy attending primary health care. The intervention aimed to improve patients’ health literacy for weight management and assist them to attend community-based weight management lifestyle modification programs. 

Project Design and Method

This was a cluster randomised trial with practices randomised to intervention and control groups.  The study was conducted in 20 general practices in Sydney (with South West Sydney Medicare Local) and Adelaide (with Central Adelaide Hills Medicare Local) over 12 months from August 2014 to August 2015.

Evaluation

General practitioners and practice nurses were interviewed and completed a questionnaire at baseline and 12 months.  Patients were surveyed by telephone at baseline and 6 and 12 months and a sample of patients were also interviewed at baseline and 12 months. 

Intervention

One practice nurse in each intervention practice were trained as Prevention Navigator to assist patients to attend community-based referral programs and services.

The practice level intervention involved:

  1. One clinical audit report and face to face 1.5-hour long meeting with general practitioners (GPs) and Prevention Navigators in their own practices to identify priorities and strategies for improvement in the assessment and management of obese patients; 
  2. One 3-hour long training session (for GPs and PNs including the Prevention Navigators), which covered management of obese patients across the 5As of the chronic disease model approach – Assess, Advise, Agree, Assist and Arrange.
  3. Prevention Navigators were trained the concept of care navigation and their role in this.
  4. Results from the health literacy screening were discussed at one 1.5-hour long meeting involving GPs and Prevention Navigators in own practices.

Training materials for the intervention practices are available here.

The clinical level intervention involved:

  1. Patients in the waiting room were screened for low health literacy (using three validated questions translated into several languages). Those that were eligible and consented were invited to attend a Health Check visit with the Prevention Navigators.
  2. At the Health Check visit, which was approximately 30 minutes long, the patient received brief advice, set goals related to weight loss, was referred to community-based services or programs and made a follow-up appointment with the GP or Prevention Navigator.

Ethics approval

All participants provided full informed consent.  Ethics approval was granted by the UNSW Australia Human Research Ethics Advisory Panel (HREAP) (2014-7-05) and the University of Adelaide Human Research Ethics committee.

Publications

1.           Faruqi N, Spooner C, Joshi C, Lloyd J, Dennis S, Stocks N, Taggart J, Harris M: Primary healthcare-level interventions improving health literacy for weight loss: A systematic review of the literature. BMC Obesity 2015, 2(6):6. DOI: 10.1186/s40608-015-0035-7
2.           Faruqi N, Stocks N, Spooner C, Haddad Ne, Harris M: Research Protocol: Management of obesity in patients with low health literacy in primary health care. BMC Obesity 2015, 2(5):5. https://doi.org/10.1186/s40608-015-0036-6

Contact

Mark Harris Email: m.f.harris@unsw.edu.au

Funding

APHCRI

Project lead centre
CPHCE
Project stream
Prevention and Management of Long Term Conditions
Project start date
2013
Project end date
2016