Effectiveness of behaviour change techniques on lifestyle interventions of patients with a high risk of developing cardiovascular disease. Using a qualitative approach

This study aimed to identify key active ingredients on the maintenance of behaviour change for lifestyle interventions of patients with a high risk of developing cardiovascular disease (CVD) who participated in a MOtiVational intErviewing InTervention (MOVE IT) randomised control trial (RCT). A process evaluation was carried out using focus groups. Twenty‐six participants of the MOVE IT RCT were purposively recruited and split into six focus groups. Four groups had attended six or more sessions of the intensive phase (completers) and two groups had withdrawn before the end of the intensive phase or had not attended any sessions (non‐completers). Focus groups were audio recorded, transcribed verbatim and analysed inductively using thematic analysis. Three overall themes were generated from the six focus groups: (a) long‐term benefits from diet and physical activity education, (b) group versus individual structure and adherence and (c) impact on health beliefs and risk of CVD. A fourth theme was generated from the two groups of non‐completers only: (d) need for professional rapport building and feedback. We found that the key active ingredients for effective behavioural change in lifestyle interventions are having well‐developed rapport between facilitators and patients; and providing alternative forms of feedback to encourage maintenance of behaviour change. Furthermore, such programmes also need to have established and strong relationships with associated health professionals (i.e. the General Practitioner) to increase participation and maintenance of engagement.     

An initial evaluation of a family‐based approach to weight management in adolescents attending a community weight management group

Background: Family‐based approaches are recommended for the prevention and management of childhood obesity. Given the large numbers of obese children, scalable practical solutions are required. The present study evaluated a family‐based national programme that aimed to empower adolescents to adopt healthier lifestyles. Methods: Group facilitators supporting more than six young members (11–15 years) participated in the study. A questionnaire was designed to determine the characteristics of the adult attending with the adolescent, any health professional recommendations given and the young member’s integration within traditional adult weight management groups. Data on measured height and weight [and calculated body mass index (BMI)], sex and attendance were collated from member’s records. Results: Questionnaires were completed by 22 facilitators (15% response rate), representing data for 128 young members with complete weight data available for 106. All members had a joining BMI > 91st centile, with 68% >98th centile. The mean (SD) number of weeks attended was 12.5 (8.1), with 19% (20) having attended for more than 20 weeks with 62% still attending. A mean (SD) BMI Z‐score change of 2.49 (0.72) to 2.27 (0.74) was achieved (P < 0.001). The relationship of the adult supporter to the young member was varied, with 62% either already members or joining alongside their daughter/son. Limited guidance was provided by health professionals before or during attendance. Facilitators were comfortable about the age mix within groups. Conclusions: The community weight management organisation studied takes a family‐based approach and successfully supports young members to manage their weight.     

Comparison of Child Obesity Prevention and Control Content in Mainstream and Spanish-Language US Parenting Magazines

Mass media coverage of child obesity is rising, paralleling the child obesity epidemic's growth, and there is evidence that parents seek parenting advice from media sources. Yet little to no research has examined the coverage of child obesity in parenting magazines or Spanish-language media. The purpose of this study was to use qualitative and quantitative content analysis methods to identify, quantify, and compare strategies for child obesity prevention and control presented in mainstream and Spanish-language US parenting magazines. Child obesity?related editorial content in 68 mainstream and 20 Spanish-language magazine issues published over 32 months was gathered. Magazine content was coded with a manual developed by refining themes from the sample and from an evidence-based child obesity prevention action plan. Seventy-three articles related to child obesity prevention and control were identified. Most focused on parental behavior change rather than environmental change, and only 3 in 10 articles referred to the social context in which parental behavior change takes place. Child obesity?focused articles were not given high prominence; only one in four articles in the entire sample referred to child obesity as a growing problem or epidemic. Key differences between genres reflect culturally important Latino themes, including family focus and changing health beliefs around child weight status. Given mass media's potential influence on parenting practices and public perceptions, nutrition communication professionals and registered dietitians need to work to reframe media coverage of childhood obesity as an environmental problem that requires broad-based policy solutions. Spanish-speaking media can be an ally in helping Latina women change cultural health beliefs around child weight status.     

Patients' and professionals' experiences and perspectives of obesity in health‐care settings: a synthesis of current research

Background Obesity‐related stigma likely influences how obese people interact with health‐care professionals and access health care. Aim To undertake a synthesis of studies examining the views and experiences of both obese people in relation to their health‐care provision and health‐care professionals in providing care to obese patients. Search strategy A systematic search of key electronic databases relating to professional or patient experiences of, or perspectives on, obesity was performed in 2008 and updated in 2010. Reference lists of article bibliographies were searched, along with hand searches of relevant journals. Inclusion Criteria Studies were screened against explicit inclusion criteria and published between 1990 and 2010. Findings were examined and organized thematically. Data Extraction Data were extracted focusing on obesity, stigma and access to health‐care services. All included studies were subject to critical appraisal to assess the quality of the research. Findings Thirty studies were identified. All the studies reported obesity impacting on health‐care interactions. Key themes identified were experiences of stigma and feelings of powerlessness, treatment avoidance, psycho‐emotional functioning, professional attitudes, confidence and training, variations in health contact time and finally, differences in treatment options and preventative measures. Conclusion Obesity is a stigmatized condition that impacts negatively on the relationship between patients and health‐care providers. Given the increasing prevalence of obesity and the range of therapeutic options available, further work is necessary to understand how the presence of obesity affects health‐care interactions and decision making.     

Being ‘fat’ in today’s world: a qualitative study of the lived experiences of people with obesity in Australia

Objective To develop an in‐depth picture of both lived experience of obesity and the impact of socio‐cultural factors on people living with obesity. Design Qualitative methodology, utilizing in‐depth semi‐structured interviews with a community sample of obese adults (body mass index ≥30). Community sampling methods were supplemented with purposive sampling techniques to ensure a diverse range of individuals were included. Results Seventy‐six individuals (aged 16–72) were interviewed. Most had struggled with their weight for most of their lives (n = 45). Almost all had experienced stigma and discrimination in childhood (n = 36), as adolescents (n = 41) or as adults (n = 72). About half stated that they had been humiliated by health professionals because of their weight. Participants felt an individual responsibility to lose weight, and many tried extreme forms of dieting to do so. Participants described an increasing culture of ‘blame’ against people living with obesity perpetuated by media and public health messages. Eighty percent said that they hated or disliked the word obesity and would rather be called fat or overweight. Discussion and Conclusion There are four key conclusions: (i) the experiences of obesity are diverse, but there are common themes, (ii) people living with obesity have heard the messages but find it difficult to act upon them, (iii) interventions should be tailored to address both individual and community needs and (iv) we need to rethink how to approach obesity interventions to ensure that avoid recapitulating damaging social stereotypes and exacerbating social inequalities.     

Meeting the health needs of older people with intellectual disabilities: exploring the experiences of residential social care staff

Older people with intellectual disabilities often experience high levels of health needs and multiple morbidities but they may be supported by residential care staff with little or no previous experience of identifying and meeting health needs. Little is known regarding how they undertake this health‐related role and this exploratory study seeks to address this gap. A purposive sample of 14 managers of supported living accommodation in Wales were interviewed in 2014 to determine their experiences of supporting tenants in relation to age‐related health needs. The semi‐structured interviews were transcribed and thematically analysed. Three of the emerging themes are reported in this paper: meeting health needs, the consequences of ageing and relationships. Findings indicate that residential care staff support older people with intellectual disabilities with complex and multiple health needs: they monitor health status, support access to healthcare, provide additional support arising from changing health needs and advocate for tenants in the context of healthcare. However, their role is often not understood by healthcare professionals. The importance of staff having a long‐term relationship with those they support was identified as being important to identifying any health‐related changes. The need to develop effective relationships with healthcare staff was also noted. It is concluded that there is a need for better understanding among health staff of the role of residential social care workers and for further research regarding health‐related communication.     

Involving users in low back pain research

Objective To involve users in the design of a research project that aims at describing a 12‐month course of low back pain in an adult population sample (epidemiological strand), and to determine how patient and professional perceptions of low back pain and its treatment relate to the use of health‐care and to subsequent outcome (qualitative strand). Design Three focus groups were organized in the preparatory phase of the project with general practitioners, other health professionals and low back pain sufferers. Issues pertaining to the experience of living with, or treating low back pain were explored and users were asked to identify relevant research questions for consideration within the study. Findings The focus groups revealed tensions between involving users as co‐researchers for design issues and their role as sufferers and health professionals who want to share their narrative accounts of low back pain. The group discussions produced a wealth of material for analysis, but no explicitly stated research topics. Three key themes and the process of user involvement in the focus groups are discussed. Conclusions The focus group format could be restrictive in that it allows for detailed exchange between participants, but is insufficiently geared towards the production of a research agenda. We draw conclusions as to possible approaches for user involvement in health services research design.     

Patient–professional partnerships and chronic back pain self‐management: a qualitative systematic review and synthesis

Chronic back pain is common, and its self‐management may be a lifelong task for many patients. While health professionals can provide a service or support for pain, only patients can actually experience it. It is likely that optimum self‐management of chronic back pain may only be achieved when patients and professionals develop effective partnerships which integrate their complementary knowledge and skills. However, at present, there is no evidence to explain how such partnerships can influence patients' self‐management ability. This review aimed to explore the influence of patient–professional partnerships on patients' ability to self‐manage chronic back pain, and to identify key factors within these partnerships that may influence self‐management. A systematic review was undertaken, aiming to retrieve relevant studies using any research method. Five databases were searched for papers published between 1980 and 2014, including Cochrane Library, CINAHL, Medline, EMBASE and PsycINFO. Eligible studies were those reporting on patients being supported by professionals to self‐manage chronic back pain; patients being actively involved for self‐managing chronic back pain; and the influence of patient–professional partnerships on self‐management of chronic back pain. Included studies were critically appraised for quality, and findings were extracted and analysed thematically. A total of 738 studies were screened, producing 10 studies for inclusion, all of which happened to use qualitative methods. Seven themes were identified: communication, mutual understanding, roles of health professionals, information delivery, patients' involvement, individualised care and healthcare service. These themes were developed into a model suggesting how factors within patient–professional partnerships influence self‐management. Review findings suggest that a partnership between patients and professionals supports patients' self‐management ability, and effective communication is a fundamental factor underpinning their partnerships in care. It also calls for the development of individualised healthcare services offering self‐referral or telephone consultation to patients with chronic conditions.     

Men living with obesity in New Zealand: What does this mean for health care in general practice?

IntroductionMore men than women live with overweight and obesity in New Zealand, yet we know little about their everyday lives or their weight management experiences in primary care. This study sought to link the weight management experiences of these men in primary care, with their experiences of life in general as big men.MethodsSemi-structured interviews with participants selected purposively based on a priori criteria were conducted. Interviews were either face to face or via telephone. Interviews were digitally recorded and transcribed and text coded into a priori codes where established.ResultsFourteen men were interviewed. Analysis of text data revealed three overarching themes. The first, social experience of life as a big man highlighted the significance of social transitions as times of weight gain. The second theme related to experiences of weight management in primary care, with communication the largest sub-theme. Finally, stigma materialised as a key and widespread issue.ConclusionScant attention has been paid to the experiences of overweight and obese men in primary care or the impact of their size on their daily lives. Effective, tailored communication by health professionals in primary care is sorely needed. Times of social transition can be exploited as appropriate instances to offer advice on effective strategies to reduce the risk of weight gain. Men also need to be made aware of their vulnerability for weight gain at these times through effective, gender specific health promotion messages. The widespread nature of stigmatising experiences within personal networks was a concerning finding.     

Healthy weight maintenance strategy in early childhood: The views of black African migrant parents and health visitors

In Europe and the US, childhood obesity is found to be higher in migrant children from black African communities and other visible minority ethnic groups. However, very little is known about the factors that contribute to the significant rates of obesity in these groups. The material for this study is drawn from a community‐based qualitative study that examined the sociocultural, familial and environmental factors that either facilitate or hinder healthy weight in black African children during early childhood. The participants for the study were black African parents (n = 30) and health visitors (n = 32), residing and working in the East Midlands, UK. The participants were purposively selected according to an inclusion/exclusion criterion and invited to participate in seven focus groups (FG‐7) conducted for parents (FG‐4) and health visitors (FG‐3) at a time and place convenient to the participants, between March and June 2018. The focus groups examined a number of issues, including the participants’ views on the barriers and facilitators to achieving and maintaining a healthy weight. Thematic analysis was used to identify themes within the data. Although participants were knowledgeable about the need for a healthy weight in early childhood, the parents discussed how immigration status and experiences of discrimination had an impact on their children's diet and well‐being, also discussing how structural factors influenced the decisions they made regarding healthy weight in early childhood. While the health visitors in general felt they did not have the skills to advise black African parents about the cultural influences on diet during early childhood, findings highlighted a need for a system‐based approach in meeting the nutritional needs of black African children. This study concludes by suggesting the need for broad social‐environment and economic changes that address factors such as migration status, deprivation and discrimination, coupled with culturally specific healthy diet messages.     

Individualizing recommendations for weight management in the elderly

PURPOSE OF REVIEW: This review provides current strategies for weight management in the elderly population as it can be different from young adults due to multiple factors: co-morbidities, polypharmacy, limitation of functional activities, social issues. RECENT FINDINGS: The recommendations for weight management for all age groups include exercise, diet, pharmacotherapy and surgery. In the elderly population, because of changes in age-related body composition, reduced energy requirement and expenditure, the standard young adult recommendations cannot be applied directly. The goal of weight management in the elderly differs from the young adult. The preferred method is maintenance of weight rather than aggressive weight loss with achieving a healthy, functional, and good quality of life. SUMMARY: The growing prevalence of obesity in the elderly population is becoming a major health problem and can affect functional status, can contribute to frailty and decline in activity, as well as worsening co-morbid medical problems. Practical recommendations for weight management in the elderly are challenging because of the obesity paradox in the elderly, and the lack of substantial research in this population. Individualized recommendations should be considered for elderly patients with a focus on the underlying medical problems, functional status and living environments.     

Lay Meanings of Health Among Rural Older Adults in Appalachia

Purpose: Self‐perceptions of health vary depending on one's social and cultural context. Rural residents have been characterized as having a distinct culture, and health differences by residence have been well documented. While there is evidence of poor health among rural older adults, little research has examined how they perceive and define health. Qualitative methods may help capture these lay meanings of health. The purpose of our study was to use a qualitative approach to examine what perceptions community‐dwelling rural older adults have regarding their health. Methods: The study involved thirteen 90‐minute focus groups and short self‐administered surveys with community‐dwelling persons aged 60 years or older residing in 6 rural West Virginia communities. A total of 101 participants were asked questions about their personal definitions of health. With professional transcribed tapes from the focus group discussions, we used a systematic text analysis approach. Findings: Discussions included 4 themes on the meaning of health: (1) health as a value, (2) dimensions of life, (3) holistic nature of health, and (4) health care use and adherence. Conclusion: Our results expand on previous studies and demonstrate that health is a subjective, multidimensional construct deeply embedded in the everyday experience of rural older adults. We found that older adults’ perceptions about health contain components which most medical professionals would not take into account. Health care providers may consider supplementing traditional medical approaches with a more contextually sensitive recognition of rural elders’ desired health goals and outcomes.     

Rural obesity, healthy weight and perceptions of risk: struggles, strategies and motivation for change

Objective: To explore risk logics, embodiment (the interplay between the physical, social and subjective body) and issues related to adult obesity in remote New South Wales. Design: Qualitative multiple‐method design using semistructured interviews and visual aids (food and exercise palm cards) to explore the saliency of food and exercise options. A one‐page demographic survey incorporated self‐reported body mass index. Participants: A total of 19 rural adults (13 female; six male). Setting: Community in remote New South Wales, Australia. Results: Thematic analysis revealed 14 major weight‐related themes. Respondents raised numerous explanations for their weight gain, reported struggles with weight loss, revealed a range of motivations for weight loss and a variety of approaches to risk, not all of which are aligned to dominant health discourse. The need for realistic interventions incorporating social meaning and pleasure seeking is revealed. Conclusion: Obesity interventions promoting ‘easy’ healthy choices also need to acknowledge embodiment and social status linked to consumption. Interventions that ignore the complexity surrounding consumption (e.g. the interplay of social taste, group distinction and embodiment) will have lower relevance and effectiveness.     

From awareness to involvement? A qualitative study of respiratory patients’ awareness of health service change

Background Despite the policy rhetoric, patient involvement in health service decisions remains limited. Highlighted barriers include a concern that most patients are unable to see beyond personal aspects of their care in order to contribute meaningfully to health service development, and a perception that professionals do not welcome patient involvement. Objectives We aimed to explore respiratory patients’ awareness of changes in local health service provision and provide insight into health professionals’ attitudes to engaging patients. Methods Nested within an ethnographic study of health service reconfiguration, we recruited 31 patients with a range of respiratory diseases from four case study areas in England and Wales. Data from telephone interviews, illness diaries and focus groups with patients, and interviews with health professionals and managers were transcribed and analysed using the Framework approach. Results Participants were not only aware of trends in health service provision (e.g. emergence of new professional roles, shift from secondary to primary care) but interpreted changes in the light of local and national events. Despite this awareness, none of the patients was formally involved in service development, though some contributed to local voluntary groups. Professionals generally welcomed the need for patients’ views to be heard. Discussion and conclusions Our data give grounds for optimism. Patients are aware of and interested in a broad range of health‐related issues. Professionals’ motivation to involve patients in service development may be underestimated. Although practical obstacles remain, our findings should encourage the ongoing search for effective models of promoting patient engagement in health‐care services.     

The process of embarking on a weight control program

The purpose of this study was to describe the process of embarking on a weight control program, to understand more about the decision to seek treatment for obesity, a chronic health problem. Obese women were interviewed using field methods. The grounded theory approach was utilized to analyze the data. Loss and isolation were predominant themes and stages through which women progressed before entering treatment. The entering of treatment was viewed as a way of adapting to sex role norms, or what was expected of women by society. Body image concerns‐the loss of attractiveness—was an overriding theme. Physical health played a minor role in this decision to seek treatment for obesity. This investigation generated hypotheses for further study related to the importance of body image versus physical health as a motivator for weight control.