Suchergebnisse

Background: Socioeconomically disadvantaged adults are both more likely to be obese and have lower levels of health literacy. Our trial evaluates the implementation and effectiveness of primary care nurses acting as prevention navigators to support obese patients with low health literacy to lose weight. Methods/Design: A pragmatic cluster randomised trial will be conducted. Twenty practices in socioeconomically deprived areas, 10 each in Sydney and Adelaide, will be recruited and randomised to intervention and control groups. Twenty to 40 eligible obese patients aged 40-70 years with a BMI ≥ 30 kg/m2 and with low health literacy will be enrolled per practice. The intervention is based on the '5As' of the chronic disease model approach - Assess, Advise, Agree, Assist and Arrange - and the recommendations of the 2013 Clinical practice guidelines for the management of overweight and obesity in adults, adolescents and children in Australia. In the intervention practices, patients will be invited to attend a health check with the prevention navigator who will assess the patient's risk and provide brief advice, assistance with goal setting and referral navigation. Provider training and educational meetings will be held. The providers' attitudes to obesity, confidence in treating obesity and preventive care they provide to obese people with low health literacy will be evaluated through questionnaires and interviews. Patients' self-assessment of lifestyle risk factors, perception of preventive care received in general practice, health-related quality of life, and health literacy will be assessed in telephone interviews. Patients' anthropometric measures will be recorded and their health service usage will be determined via linkage to the Australian government-held medical and pharmaceutical data. Discussion: Our trial will provide evidence for the effectiveness of practice nurses as prevention navigators to support better weight management for obese patients with low health literacy.

Policy contextObesity rates have increased in Australia and present a significant health challenge, particularly for people from low socio-economic communities and people with low health literacy. General practices have an important role to play in helping obese patients to manage their weight. The NHMRC guidelines for the management of overweight and obesity use the 5As model to guide practice: Ask, Assess, Advise, Assist, and Arrange. However, significant barriers exist to the implementation of Advice Assist (referral) and Arrange (follow-up). Barriers include the complexity of information involved in weight management and the level of patient's health literacy required to deal with this. A program of research was conducted to evaluate the feasibility and impact of a primary health care approach to weight management for obese patients tailored to their level of health literacy.Key messagesStrategies recommended at Primary Health Network level:> Training is needed for practice nurses (PNs) and general practitioners (GPs) in identifying and better supporting obese patients with low health literacy to manage their weight across the 5As. It is needed in particular to:o identify obese patients with low health literacy and differentiate low health literacy from low motivation;o tailor advice and education to their health literacy while not stigmatising patients; ando support patient navigation to evidence-based referral programs.> Simplified referral pathways for obese patients with low health literacy need to be developed.Strategies recommended at national and state government levels:> Readily available patient education materials on weight management that are appropriate for patients with low health literacy and for different language groups are required.> A funding model that supports GPs in being more proactive in the identification and support of obese patients with low health literacy is needed.> Training and remuneration of PNs is needed for the time spent tailoring advice and education for obese patients with low health literacy and providing them with navigation support to attend referral programs.