Communicating weight loss advice in primary care: Using conversation analysis to develop online education resources for clinicians

Conference:

SAPC ASM 2023 - Brighton

Talk Code:

5D.1

Presenter:

Charlotte Albury

Twitter:

@AlburyCharlotte

Co-authors:

Charlotte Albury (1), Madeleine Tremblett (2), Joseph J. Lee (1), Elizabeth Stokoe (3), Helena Webb (4), Sue Ziebland (1), Paul Aveyard (1)

Author institutions:

(1)Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK; (2) Health and Social Sciences, University of the West of England, Bristol, UK (3) Department of Psychological and Behavioural Science, London School of Economics and Political Science, UK (4) 4School of Computer Science, University of Nottingham, Nottingham, UK

Problem

The problem

Communicating effectively about weight loss with people living with obesity is a key concern for primary care staff. Whilst guidelines recommend that primary care staff should offer advice and support opportunistically, evidence shows this rarely happens. Staff report that they do not know what to say and are concerned about causing offence. A crucial difficulty is that existing education, training, and guidance relies on retrospective reports about what to say. Consequently, they mostly share general advice, such as ‘be respectful’, rather than specifying how this might be realized in practice. This means primary care staff do not have access to the actual communication strategies most likely to support effective conversations, including what works best under the time and organisational constraints of the primary care setting. Primary care staff have called for more detailed training to raise the topic of weight and offer advice in ways which are well received and effective.

Approach

The approach

We conducted a three-year project (TalkWeL) to identify evidence of how best to communicate brief weight loss advice with people living with obesity, and to develop online educational resources for primary care staff. We used conversation analysis (CA) to analyse 237 recorded interactions between clinicians and patients with obesity, where clinicians offered brief weight loss advice. CA is a well-established method for studying social interaction and enables creation of an evidence base of effective practice, generated from real interactions. We identified specific conversational patterns used by clinicians that patients responded to well in the consultation, and which were linked to patent-reported satisfaction afterwards. We ran workshops with a diverse group of people living with obesity, carers, primary care staff (including GPs, health and wellbeing coaches, and nurses), and collaborators from the Royal College of GPs, and government Office for Health Improvement and Disparities. During workshops the groups (a) guided analysis (b)prioritised our most important results, and (c) suggested key design elements for the educational resources. We developed draft resources and then ran further workshops with patients, primary care staff, and collaborators to iterate these.

Findings

Online educational resources comprise an interactive training resource and one-page, downloadable, illustrated guidance. Training includes real audio clips of clinicians and patients talking together, and highlights examples of best practice. Following multi-stakeholder input the training programme includes different difficulty levels, optional quizzes (and certificates), and brief modules.

Consequences

Implications

Using evidence from real consultations ensures educational materials highlight specific communication strategies which have been shown to be well received and effective, under the real time and organisational constraints of the primary care setting. Involving patients, clinicians, and policy makers in the development process maximised the training’s usability and acceptability.

Submitted by:

Charlote Albury

Funding acknowledgement:

This work is funded by the British heart Foundation (BHF).