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Discussing weight loss opportunistically and effectively in family practice: a qualitative study of clinical interactions using conversation analysis in UK family practice
journal contributionposted on 08.10.2020 by Charlotte VA Albury, Sue Ziebland, Helena Webb, Elizabeth Stokoe, Paul Aveyard
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Background: General practitioners are encouraged to make brief interventions to support weight loss, but they report concern about these conversations, stating they need more details on what to say. Knowing how engage in these conversations could encourage GPs to deliver brief interventions for weight loss more frequently.
Objective: To examine which specific words and phrases were successful in achieving conversational alignment and minimising misunderstanding, contributing to effective interventions.
Methods: A conversation analysis of English Family practice patients participating in a trial of opportunistic weight-management interventions which incorporated the offer of referral to community weight-management services (CWMS). Qualitative conversation analysis was applied to 246 consultation recordings to identify communication patterns which contributed to clear, efficient interventions.
Results: Analysis showed variation in how GPs delivered interventions. Some ways of talking created misunderstandings, or misalignment, whilst others avoided these. There were five components of clear and efficient opportunistic weight-management referrals. These were (1) exemplifying CWMS with a recognisable brand name (2) saying weight-management “programme” or “service”, rather than “group” or “club” (3) stating that the referral is “free” early on (4) saying the number CWMS visits available on referral (5) stating that the CWMS programme available was “local”.
Conclusions: When making a brief opportunistic intervention to support weight loss, clinicians can follow these five steps to create a smooth and efficient intervention. Knowing this may allay clinicians’ fears about these consultations being awkward and improve adherence to guidelines.
Charlotte Albury was funded by the National Institute for Health Research School for Primary Care Research. The consultation data was from the BWeL trial which was funded by National Prevention Research Initiative. The funding partners are Alzheimer’s Research UK, Alzheimer’s Society, Biotechnology and Biological Sciences Research Council, British Heart Foundation, Cancer Research UK, Chief Scientist Office, Scottish Government Health Directorate, Department of Health, Diabetes UK, Economic and Social Research Council, Engineering and Physical Sciences Research Council, Health and Social Care Research Division, Public Health Agency, Northern Ireland, MRC, Stroke Association, Wellcome Trust, Welsh Government, and World Cancer Research Fund (Grant ref number: MR/J000515/1). Helena Webb is a Senior Researcher at the University of Oxford, funded by EPSRC. Sue Ziebland is an NIHR senior investigator. Paul Aveyard is an NIHR senior investigator, funded by the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC) Obesity, Diet and Lifestyle Theme and National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) Oxford and Thames Valley.
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