Clinical usefulness of brief screening tool for activating weight management discussions in primary cARE (AWARE): A nationwide mixed methods pilot study

Evan Atlantis; James Rufus John; Paul Patrick Fahey; Samantha Hocking; Kath Peters

doi:10.1371/journal.pone.0259220

Clinical usefulness of brief screening tool for activating weight management discussions in primary cARE (AWARE): A nationwide mixed methods pilot study

PLoS One. 2021 Oct 28;16(10):e0259220. doi: 10.1371/journal.pone.0259220. eCollection 2021.

Authors

Evan Atlantis^{1

2}, James Rufus John^{3

4

5}, Paul Patrick Fahey¹, Samantha Hocking^{6

7}, Kath Peters⁸

Affiliations

¹ School of Health Sciences, Western Sydney University, Penrith, New South Wales, Australia.
² Discipline of Medicine, Nepean Clinical School, Faculty of Medicine and Health, The University of Sydney, Nepean, New South Wales, Australia.
³ BestSTART-SWS, South Western Sydney Local Health District, Liverpool, New South Wales, Australia.
⁴ Academic Unit of Child Psychiatry, School of Psychiatry, Faculty of Medicine, University of New South Wales, Kensington, New South Wales, Australia.
⁵ Ingham Institute of Applied Medical Research, Liverpool, New South Wales, Australia.
⁶ The Boden Collaboration for Obesity, Nutrition, Exercise & Eating Disorders, Charles Perkins Centre, The University of Sydney, Camperdown, New South Wales, Australia.
⁷ Metabolism & Obesity Services, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.
⁸ School of Nursing and Midwifery, Western Sydney University, Penrith, New South Wales, Australia.

Abstract

Objective: The Edmonton Obesity Staging System (EOSS) is based on weight related health complications among individuals with overweight and obesity requiring clinical intervention. We aimed to assess the clinical usefulness of a new screening tool based on the EOSS for activating weight management discussions in general practice.

Methods: We enrolled five General Practitioners (GPs) and 25 of their patients located nationwide in metropolitan areas of Australia to test the feasibility, acceptability, and accuracy of the new 'EOSS-2 Risk Tool', using cross-sectional and qualitative study designs. Diagnostic accuracy of the tool for the presence of EOSS ≥2 criteria was based on clinical information collected prospectively. To assess feasibility and applicability, we explored the views of GP and patient participants by thematic analysis of transcribed verbatim and de-identified data collected by semi-structured telephone interviews.

Results: Nineteen (76%) patients were aged ≥45 years, five (20%) were male, and 20 (80%) were classified with obesity. All 25 patients screened positive for EOSS ≥2 criteria by the tool. Interviews with patients continued until data saturation was reached resulting in a total of 23 interviews. Our thematic analysis revealed five themes: GP recognition of obesity as a health priority (GPs expressed strong interest in and understanding of its importance as a health priority); obesity stigma (GPs reported the tool helped them initiate health based and non-judgmental conversations with their patients); patient health literacy (GPs and patients reported increased awareness and understanding of weight related health risks), patient motivation for self-management (GPs and patients reported the tool helped focus on self-management of weight related complications), and applicability and scalability (GPs stated it was easy to use, relevant to a range of their patient groups, and scalable if integrated into existing patient management systems).

Conclusion: The EOSS-2 Risk Tool is potentially clinically useful for activating weight management discussions in general practice. Further research is required to assess feasibility and applicability.

Publication types

Evaluation Study
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Female
General Practitioners / psychology
Health Knowledge, Attitudes, Practice*
Humans
Male
Middle Aged
Patients / psychology
Primary Health Care / methods
Self-Management / methods
Sensitivity and Specificity
Weight Reduction Programs / methods*
Weight Reduction Programs / standards

Grants and funding

This pilot work was supported by grants from iNova Pharmaceuticals (Australia) Pty Ltd (https://inovapharma.com/), in partnership with the National Association of Clinical Obesity Services Incorporated (https://www.nacos.org.au/) and Western Sydney University (https://www.westernsydney.edu.au/) (P00026836: EA, JRJ, PPF, and KP). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.