GP-delivered brief weight loss interventions: a cohort study of patient responses and subsequent actions, using conversation analysis in UK primary care
journal contributionposted on 14.05.2018, 15:56 by Charlotte Albury, Elizabeth Stokoe, Sue Ziebland, Helena Webb, Paul Aveyard
Background Guidelines encourage GPs to make brief opportunistic interventions to support weight loss. However, GPs fear that starting these discussions will lead to lengthy consultations. Recognising that patients are committed to take action could allow GPs to shorten brief interventions. Aim To examine which patient responses indicated commitment to action, and the time saved if these had been recognised and the consultation closed sooner. Design and setting A mixed-method cohort study of UK primary care patients participating in a trial of opportunistic weight management interventions. Method Conversation analysis was applied to 226 consultation audiorecordings to identify types of responses from patients that indicated that an offer of referral to weight management was well received. Odds ratios (OR) were calculated to examine associations between response types and likelihood of weight management programme attendance. Results Affirmative responses, for example ‘yes’, displayed no conversational evidence that the referral was well received and showed no association with attendance: ‘yes’ (OR 1.2, 95% confidence interval [CI] = 0.37 to 3.95, P = 0.97). However, ‘oh’-prefaced responses and marked positive responses, for example ‘lovely’, showed conversational evidence of enthusiasm and were associated with higher odds of commercial weight management service attendance. Recognising these could have saved doctors a mean of 31 seconds per consultation. Conclusion When doctors make brief opportunistic interventions that incorporate the offer of help, ‘oh’-prefaced or marked positive responses indicate enthusiastic acceptance of the offer and a higher likelihood of take-up. Recognising these responses and moving swiftly to facilitate patient action would shorten the brief intervention in many cases.
Charlotte Albury is 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). Paul Aveyard is an NIHR Senior Investigator and is part funded by the Oxford NIHR Biomedical Research Centre and CLAHRC. Sue Ziebland is an NIHR and BRC senior investigator.
- Social Sciences
- Communication, Media, Social and Policy Studies