What next for behaviour change professional development in general practice? Insights from an environmental scan and workshops.

BACKGROUND: A key role of general practice professionals (that is, GPs, and general practice nurses [GPNs]) is to support patients to change behaviours. Traditional approaches to assisting patients with, and learning about, behaviour change have modest outcomes. AIM: To explore behaviour change with GPs and GPNs and the availability of related professional development (PD) opportunities. DESIGN & SETTING: Multi-methods study comprising an environmental scan survey of behaviour change tools and PD opportunities, and online workshops with Australian GPs and GPNs. METHOD: Survey data were analysed using qualitative content analysis, informing the design of the workshops. Workshop data included observation, note-taking, and collaborative reflection, which were analysed thematically and synthesised with survey data. RESULTS: The survey had 18 complete responses. For the two virtual workshops, workshop 1 had 16 participants and workshop 2 had eight participants. There was diversity in awareness of existing behaviour change tools and resources. Preferences for future tools and PD opportunities related to specific aspects of its design, content, activities, and delivery. The following three themes developed from the workshop data: recognising the importance of relationships; recognising the importance of continuity; and keeping context in mind. In the absence of tools and resources, GPs and GPNs discussed behaviour change as something that occurs best through a patient-centred alliance that is continuing, respectful, grounded in trust and an understanding of their patient, and prioritises patient autonomy. CONCLUSION: Future general practice behaviour change PD should support clinicians to 'assist' patients and recognise the social and contextual influences on behaviour.

The experience of living with obesity for adults in Asian countries: A scoping review of qualitative studies.

Sociocultural and biological backgrounds significantly influence people's experience of obesity. Yet the experience within the Asian sociocultural context is underexplored. This scoping review aims to summarize the qualitative evidence that explores the lived experience of adults with obesity in Asian countries. Guided by the Joanna Briggs Institute (JBI) approach, we systematically searched five databases (MEDLINE, EMBASE, PsychINFO, CINAHL, and Scopus) for studies exploring the lived experience of adults with obesity in Asian countries. Eligible studies with English full text were screened by two reviewers and analyzed using a descriptive qualitative content analysis. Of the 16,764 articles retrieved, 11 were included. The qualitative data can be summarized into three categories: (1) cultural norms shaped the lived experience with obesity, (2) the influence of obesity on social relationships, and (3) coping with life challenges. Despite the small number of studies, a strong influence of the sociocultural environment on the lived experience of obesity was evident, particularly on social roles and expectations, social relationships, the stigma of obesity, and life challenges. The extent and significance of this sociocultural influence on the Asian population warrant further exploration. Future research should fully report the qualitative methods to provide contextual information about the study.

Type 2 diabetes remission in Australian primary care: Protocol for an implementation study of the DiRECT-Aus trial.

BACKGROUND AND OBJECTIVES: Type 2 diabetes is one of the most common chronic conditions managed in Australian general practice. DiRECT-Aus is replicating the UK Diabetes Remission Clinical Trial (DiRECT) in general practices across NSW. The aim of the study will be to explore the implementation of DiRECT-Aus to inform future scale-up and sustainability. METHOD: This is a cross-sectional qualitative study using semi-structured interviews to explore the experiences of patients, clinicians and stakeholders in the DiRECT-Aus trial. The Consolidated Framework for Implementation Research (CFIR) will be used to guide the exploration of the implementation factors, and the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework to report on implementation outcomes. Interviews will be conducted with patients and key stakeholders. Initial coding will be based on the CFIR, with inductive coding used to develop the themes. DISCUSSION: This implementation study will identify factors to be considered and addressed so that future scale-up and national delivery will be equitable and sustainable.

Who is at the centre of what? A scoping review of the conceptualisation of 'centredness' in healthcare.

OBJECTIVES: We aimed to identify the core elements of centredness in healthcare literature. Our overall research question is: How has centredness been represented within the health literature published between 1990 and 2019? METHODS: A scoping review across five databases (Medline (Ovid), PsycINFO, CINAHL, Embase (Ovid) and Scopus; August 2019) to identify all peer-reviewed literature published since 1990 that focused on the concept of centredness in any healthcare discipline or setting. Screening occurred in duplicate by a multidisciplinary, multinational team. The team met regularly to iteratively develop and refine a coding template that was used in analysis and discuss the interpretations of centredness reported in the literature. RESULTS: A total of 23 006 title and abstracts, and 499 full-text articles were screened. A total of 159 articles were included in the review. Most articles were from the USA, and nursing was the disciplinary perspective most represented. We identified nine elements of centredness: Sharing power; Sharing responsibility; Therapeutic relationship/bond/alliance; Patient as a person; Biopsychosocial; Provider as a person; Co-ordinated care; Access; Continuity of care. There was little variation in the concept of centredness no matter the preceding word (eg, patient-/person-/client-), healthcare setting or disciplinary lens. Improving health outcomes was the most common justification for pursuing centredness as a concept, and respect was the predominant driving value of the research efforts. The patient perspective was rarely included in the papers (15% of papers). CONCLUSIONS: Centredness is consistently conceptualised, regardless of the preceding word, disciplinary lens or nation of origin. Further research should focus on centring the patient perspective and prioritise research that considers more diverse cultural perspectives.

The Role of Health Literacy in Postpartum Weight, Diet, and Physical Activity.

BACKGROUND: Postpartum weight retention is a significant contributor to obesity in women, adverse perinatal events in subsequent pregnancies, and chronic disease risk. Health literacy is known to impact health behaviors. The study aimed to identify the health literacy domains utilized in postpartum weight management interventions and to determine their impact on weight, diet and physical activity in postpartum women. METHODS: We searched MEDLINE, CINAHL, EMBASE, PSYCINFO, and EBM databases. We included random control trials of lifestyle intervention in postpartum women (within two years post-delivery) published up to 3 May 2019. Subgroup analyses were performed to determine the effect of health literacy domains on outcomes. RESULTS: Out of 5000 studies, 33 studies (n = 3905) were included in the systematic review and meta-analysis. The health literacy domain self-care (skills and knowledge) was associated with a significant reduction in body weight (mean difference (MD) -2.46 kg; 95% confidence interval (CI) from -3.65 to -1.27) and increase in physical activity (standardized mean difference (SMD) 0.61; 95% CI 0.20 to 1.02). No other health literacy domain was associated with significant outcomes in weight, energy intake, or physical activity. CONCLUSIONS: Health literacy skills such as knowledge of self-care are effective in improving weight and in increasing physical activity in postpartum women. The efficacy of other health domains was not supported.

The Relationship Between Pregnancy Intentions and Diet or Physical Activity Behaviors in the Preconception and Antenatal Periods: A Systematic Review and Meta-Analysis.

INTRODUCTION: Healthy preconception and antenatal diet and physical activity behaviors may optimize maternal and offspring outcomes. These behaviors are thought to be linked to pregnancy intentions. The aim of this study was to conduct a systematic review and meta-analysis to determine the association between women's pregnancy intentions and diet or physical activity behaviors in the preconception and antenatal periods. METHODS: MEDLINE Complete, PsycINFO, CINAHL Complete, Global Health, Embase, and INFORMIT: Health Subset were searched in September 2018 for studies that evaluated relationships between pregnancy intentions and dietary and physical activity behaviors. Risk of bias was assessed, and random effects meta-analyses were conducted for dietary (food groups; energy and macronutrients; diet quality; and caffeine, iodine, and folate intake) and physical activity outcomes. RESULTS: Of 2623 screened records, 19 eligible studies were identified. The overall risk of bias was moderate to high. Twelve studies measured diet and physical activity behaviors during preconception, 5 during pregnancy, and 2 across both periods. Eleven studies measured pregnancy intention retrospectively, and 8 prospectively measured pregnancy intention. The number of studies available for meta-analyses of individual dietary and physical activity outcomes ranged from 2 to 5. Pregnancy intentions were not associated with preconception fruit, vegetable, or caffeine intake or physical activity. Antenatally, women with intended pregnancies were more likely to report healthier diets, lower caffeine intake, and higher physical activity. Insufficient studies were available to conduct subgroup comparisons for prospective or retrospective assessment. DISCUSSION: Pregnancy intentions were not associated with preconception diet or physical activity behaviors. In contrast, antenatally, women with intended pregnancies demonstrated better diet and physical activity behaviors. Given the small number of studies available for meta-analyses, further research is needed to consolidate our findings. Meanwhile, health professionals can assess women's pregnancy intentions during preconception and pregnancy and encourage a healthy lifestyle.

The effect of oral iron with or without multiple micronutrients on hemoglobin concentration and hemoglobin response among nonpregnant Cambodian women of reproductive age: a 2 x 2 factorial, double-blind, randomized controlled supplementation trial.

Background: Despite a high prevalence of anemia among nonpregnant Cambodian women, current reports suggest that iron deficiency (ID) prevalence is low. If true, iron supplementation will not be an effective anemia reduction strategy.Objective: We measured the effect of daily oral iron with or without multiple micronutrients (MMNs) on hemoglobin concentration in nonpregnant Cambodian women screened as anemic.Design: In this 2 × 2 factorial, double-blind, randomized trial, nonpregnant women (aged 18-45 y) with hemoglobin concentrations ≤117 g/L (capillary blood) were recruited from 26 villages in Kampong Chhnang province and randomly assigned to receive 12 wk of iron (60 mg; Fe group), MMNs (14 other micronutrients; MMN group), iron plus MMNs (Fe+MMN group), or placebo capsules. A 2 × 2 factorial intention-to-treat analysis with the use of a generalized mixed-effects model was used to assess the effects of iron and MMNs and the interaction between these factors. Results: In July 2015, 809 women were recruited and 760 (94%) completed the trial. Baseline anemia prevalence was 58% (venous blood). Mean (95% CI) hemoglobin concentrations at 12 wk in the Fe, MMN, Fe+MMN, and placebo groups were 121 (120, 121), 116 (116, 117), 123 (122, 123), and 116 (116, 117) g/L, with no iron × MMN interaction (P = 0.66). Mean (95% CI) increases in hemoglobin were 5.6 g/L (3.8, 7.4 g/L) (P < 0.001) among women who received iron (n = 407) and 1.2 g/L (-0.6, 3.0 g/L) (P = 0.18) among women who received MMNs (n = 407). The predicted proportions (95% CIs) of women with a hemoglobin response (≥10 g/L at 12 wk) were 19% (14%, 24%), 9% (5%, 12%), 30% (24%, 35%), and 5% (2%, 9%) in the Fe, MMN, Fe+MMN, and placebo groups, respectively.Conclusions: Daily iron supplementation for 12 wk increased hemoglobin in nonpregnant Cambodian women; however, MMNs did not confer additional significant benefit. Overall, ∼24% of women who received iron responded after 12 wk; even fewer would be likely to respond in the wider population. This trial was registered at clinicaltrials.gov as NCT02481375.