Freya Ashman, Elizabeth Sturgiss, Kirsty Douglas, Emily

Transcription

Freya Ashman, Elizabeth Sturgiss, Kirsty Douglas, Emily
SHIFTING THE FRAME
Exploring self-efficacy in GPs
managing patient obesity
Freya Ashman, Elizabeth Sturgiss, Kirsty Douglas, Emily Haesler
Academic Unit of General Practice, ANU Medical School
INTRODUCTION:
Self-efficacy is the perception that people have of their ability to perform the
actions necessary to achieve a desired outcome. Self-efficacy may predict a
person’s willingness to persevere with action in that area1. This research aimed
to explore GP’s sense of self-efficacy in obesity management in primary care.
Change
THE
PROGRAM
METHOD:
Twelve GPs recruited to deliver a pilot of an obesity management program
participated in semi-structured interviews. A self-efficacy questionnaire adapted
from previously validated tools was used to prompt discussion. Interpretive
analysis based on phenomenology was performed on the interview transcripts.
RESULTS:
Four main themes were identified:
1. PERCEPTION OF ONE’S SKILLS OR KNOWLEDGE LEVEL
2. PRESENCE OR ABSENCE OF A STRUCTURED THERAPEUTIC APPROACH
GPs reported feeling a lack of knowledge regarding specifics of nutrition and exercise.
assistance.
GPs reported that a lack of structure to their follow up and long term management negatively
affected their confidence.
I don’t feel confident to really get into the nitty gritty of… patients questions about this diet, this
food and that food, and I think, oh, I’ll leave that to somebody else to do (S04)
I feel like a lot of my obesity management has been very opportunistic with not a lot of protocol
or system around it. (S09)
Every encounter is an independent encounter. There’s not a lot of continuity. (S10)
3. PERCEPTION OF PATIENT CHALLENGES IN WEIGHT LOSS
4. FRAMING FAILURE IN TERMS OF PATIENT WEIGHT LOSS OUTCOMES
GPs were aware of multiple barriers to both lifestyle change and to weight loss itself, including
the obesogenic environment, life pressures, biological contributions to obesity, and the lack of
evidence for sustained and significant weight loss being achievable for the majority of people.
The primary reason for poor GP confidence was previous of patients to successfully achieve
weight loss, and the GP’s low expectation of being able to achieve this in the future.
I look at the social difficulties for them to lose weight, whether they’re the person who does the
cooking or the shopping in the family, who else is at home, who else are they having to cater
for…what sort of work she’s doing, whether it’s sedentary work or not… Whether she actually
has any free time for herself or whether her whole life revolves around work and shopping and
rushing the children around. (S07)
I don’t want to be falsely saying…’I really believe if you do this this would be effective’ … I just
think if people have put on weight often their body’s fighting to get back up to that weight…
and I know some people lose weight and they do keep it off with a lot of effort, but I think the
majority of people put it back on… So I don’t feel confident empowering people. (S03)
I’ve been treating patients who are overweight or obese for years, and I wouldn’t say that my
success rate is particularly high…in seeing my patients lose weight, so that’s why I don’t feel
particularly confident that I’m good at it…I’ve made suggestions that I think would be effective,
but in so many times… we don’t actually get very far. (S07)
So I find in general when patients come back they haven’t lost as much weight as we would
have liked to, or they haven’t lost weight at all… yeah, that’s difficult. (S03)
And even for the ones that lose the weight … not many of them will keep it off over time is my
experience. Most of them will, you know, just be on a sine wave. (S02)
I think that’s a really hard one when people come and they say, ‘I’m not… I’m eating all the
right stuff and I’m doing all the right activities and I’m still overweight, what’s going on?’ (S05)
DISCUSSION:
KEY POINTS
The primary factors affecting GP confidence with weight management was a feeling of
failure from previous patients and a lack of structure to their current management. Our
group suggests that GPs might feel more confident and positive about obesity management
if concepts of ‘success’ and ‘failure’ were reframed to focus less on weight loss itself
and more on medical endpoints. The GPs were interested in tools for a more structured
approach to weight management.
• By reframing successful management to focus on supporting patients in lifestyle change
and medical endpoints regardless of weight, GPs may feel more positive and confident
about obesity management.
• Tools to support GPs in a more structured approach to weight management are likely to
be well received.
REFERENCES
1
Bandura, A. (2004). Health promotion by social cognitive means. Health Education and Behavior, 31(2), 143-164.
This research is supported by funding from the Australian Government under the Australian General Practice Training Programme.

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