Remember Me
Or use your Academic/Social account:


Or use your Academic/Social account:


You have just completed your registration at OpenAire.

Before you can login to the site, you will need to activate your account. An e-mail will be sent to you with the proper instructions.


Please note that this site is currently undergoing Beta testing.
Any new content you create is not guaranteed to be present to the final version of the site upon release.

Thank you for your patience,
OpenAire Dev Team.

Close This Message


Verify Password:
Verify E-mail:
*All Fields Are Required.
Please Verify You Are Human:
fbtwitterlinkedinvimeoflicker grey 14rssslideshare1
Brown, I.; Deighton, M. (2013)
Publisher: OMICS International
Languages: English
Types: Article
Patient non-attendance after referral to weight management support is a problem in routine health care. The decision making process prior to referral is a useful focus for research. The present study aimed to develop a patient decision aid intervention and to investigate patient and clinician perspectives on its acceptability and implementation in primary care. The content of a decision aid booklet was developed following in-depth interviews with 52 adults (mean age 56 years; 26 women, 26 men). The content was refined within a study of patients (n=21, 15 women) and clinicians (n=45) comprising doctors (n=12), nurses (n=15) and allied professions (n=18). An exploratory study of implementation was undertaken in primary care with feedback obtained from 18 patients (mean age 52 years; 12 women) and 5 nurses in relation to weight review consultations. Study findings show the weight management decision process is potentially complex and challenging to patients for both cognitive and social reasons. A decision aid developed to address patient needs was liked by patients and, to a lesser extent, by clinicians. The intervention was viewed as acceptable and feasible for implementation into routine practice. Active ingredients within a complex intervention appeared to be improvements in cognitive processing for patients but also improvements in rapport between patient and clinician. Further research should now evaluate outcomes including consultation rapport and patient attendance.
  • The results below are discovered through our pilot algorithms. Let us know how we are doing!

    • 1. (2000) Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser 894: 1-253.
    • 2. Government Office for Science: Foresight (2007) Tackling Obesities: Future Choices. Department of Innovation, London, UK.
    • 3. NHS Information Centre (2012) Statistics on Obesity, Physical Activity and Diet in England. The Health and Social Care Information Centre, London, England.
    • 4. National Institute for Health and Clinical Excellence (NICE) (2006) Obesity: Guidance on the prevention, identification, assessment and management of overweight and obesity in adults and children. NICE, London, England.
    • 5. Scottish Intercollegiate Guidelines Network (SIGN) (2010) Management of obesity: A national clinical guideline. SIGN, Edinburgh, Scotland.
    • 6. National Institutes of Health & NHLBI (1998) Clinical guidelines on the identification, evaluation and treatment of overweight and obesity in adults - the evidence report. Obes Research 6: 1-209.
    • 7. HM Government (2008). Healthy weight healthy lives: A cross government strategy for England. Department of Health, London, England.
    • 8. Wass J, Finer N (2013) Action on obesity: comprehensive care for all. Clin Med 13: 4-5.
    • 9. Douketis JD, Macie C, Thabane L, Williamson DF (2005) Systematic review of long-term weight loss studies in obese adults: clinical significance and applicability to clinical practice. Int J Obes (Lond) 29: 1153-1167.
    • 10. Loveman E, Frampton GK, Shepherd J, Picot J, Cooper K, et al. (2011) The clinical effectiveness and cost-effectiveness of long-term weight management schemes for adults: a systematic review. Health Technol Assess 15: 1-182.
    • 11. Inelmen EM, Toffanello ED, Enzi G, Gasparini G, Miotto F, et al. (2005) Predictors of drop-out in overweight and obese outpatients. Int J Obes (Lond) 29: 122-128.
    • 12. Finley CE, Barlow CE, Greenway FL, Rock CL, Rolls BJ, et al. (2007) Retention rates and weight loss in a commercial weight loss program. Int J Obes (Lond) 31: 292-298.
    • 13. Moroshko I, Brennan L, O'Brien P (2011) Predictors of dropout in weight loss interventions: a systematic review of the literature. Obes Rev 12: 912-934.
    • 14. Toth-Capelli KM, Brawer R, Plumb J, Daskalakis C (2013) Stage of change and other predictors of participant retention in a behavioral weight management program in primary care. Health Promot Pract 14: 441-450.
    • 15. Counterweight Project Team (2008) Evaluation of the Counterweight Programme for obesity management in primary care: a starting point for continuous improvement. Br J Gen Pract 58: 548-554.
    • 16. Morrison D, Boyle S, Morrison C, Allardice G, Greenlaw N, et al. (2011) Evaluation of the first phase of a specialist weight management programme in the UK National Health Service: prospective cohort study. Public Health Nutrition 15: 28-38.
    • 17. Brown I, Gould J (2011) Decisions about weight management: a synthesis of qualitative studies of obesity. International Association for the Study of Obesity. Clinical Obesity 1: 99-109.
    • 18. Brown I, McClimens A (2012) Ambivalence and obesity stigma in decisions about weight management: a qualitative study. Health 4:1562-1569.
    • 19. Coulter A, Collins A (2011) Making Shared Decision Making a Reality. No Decision About Me, Without Me. King's Fund, London, England.
    • 20. Drug and Therapeutics Bulletin (2013) An introduction to patient decision aids. BMJ 347: f4147.
    • 21. Edwards A, Elwyn G (eds.) (2009). Shared decision-making in health care: Achieving evidence-based patient choice. Second ed., Oxford, Oxford University Press.
    • 22. Stacy D, Bennett C, Barry M, Col N, Eden KB et al. (2011) Decision aids for people facing health treatment or screening decisions. Cochrane Database of Systematic Reviews.
    • 23. O'Connor A, (2006) Ottawa decision support framework to support decisional conflict. OHRI 2006
    • 24. Medical Research Council (MRC) (2008) Developing and evaluating complex interventions: New guidance. MRC, London, England.
    • 25. Ritchie J, Lewis J (2003) Qualitative research practice. Sage, London.
    • 26. PLoS Medicine Editors (2007) Qualitative research: understanding patients' needs and experiences. PLoS Med 4: e258.
    • 27. Green J, Thorogood N (2009) Qualitative methods for health research. Sage, London, England.
    • 28. Mays N, Pope C (2000) Qualitative research in health care. Assessing quality in qualitative research. BMJ 320: 50-52.
    • 29. Gibbs G (2002) Qualitative Data Analysis: Explorations with NVivo. Open University Press, Buckingham, UK.
    • 30. Richie J, Spencer L, O'Connor W (2003) Carrying out qualitative analysis. In: Richie J, Lewis J Eds., Qualitative Research Practice, London, Sage, London, UK.
    • 31. Akabas S, Lederman S, Moore B (2012) Textbook of Obesity: Biological, Psychological and Cultural Influences. Chichester: John Wiley & Sons.
    • 32. Brownell K, Puhl R, Schwartz M (2005) Weight Bias: Nature, Consequences and Remedies. New York: Guilford Press.
    • Citation: Brown I, Deighton M (2013) A Decision Aid Intervention to Improve Decisions about Weight Management Referral in Primary Care: Development and Feasibility Study. J Obes Weight Loss Ther 3: 195.doi:10.4172/2165- 7904.1000195
    • 33. Puhl RM, Heuer CA (2009) The stigma of obesity: a review and update. Obesity (Silver Spring) 17: 941-964.
    • 34. Malterud K, Ulriksen K (2011) Obesity, stigma, and responsibility in health care: A synthesis of qualitative studies. Int J Qual Stud Health Well-being 6.
    • 35. Mold F, Forbes A (2013) Patients' and professionals' experiences and perspectives of obesity in health-care settings: a synthesis of current research. Health Expect 16: 119-142.
    • 36. Brown I (2006) Nurses' attitudes towards adult patients who are obese: literature review. Journal of Advanced Nursing 53: 221-232.
    • 37. Sabin JA, Marini M, Nosek BA (2012) Implicit and explicit anti-fat bias among a large sample of medical doctors by BMI, race/ethnicity and gender. PLoS One 7: e48448.
    • 38. Brown I, Flint S (2013) Weight bias and the training of health professionals to better manage obesity: What do we know and what should we do? Current Obesity Reports 13.
    • 39. Brown I, Thompson J (2007) Primary care nurses' attitudes, beliefs and own body size in relation to obesity management. J Adv Nurs 60: 535-543.
    • 40. Gudzune KA, Beach MC, Roter DL, Cooper LA (2013) Physicians build less rapport with obese patients. Obesity (Silver Spring) 21: 2146-2152.
    • 41. Street RL Jr, Makoul G, Arora NK, Epstein RM (2009) How does communication heal? Pathways linking clinician-patient communication to health outcomes. Patient Educ Couns 74: 295-301.
    • 42. Hojat M, Louis DZ, Markham FW, Wender R, Rabinowitz C, et al. (2011) Physicians' empathy and clinical outcomes for diabetic patients. Acad Med 86: 359-364.
    • 43. Brown I, Stride C, Psarou A, Brewins L, Thompson J (2007) Management of obesity in primary care: nurses' practices, beliefs and attitudes. J Adv Nurs 59: 329-341.
    • 44. NHS Shared Decision Making Programme (2013) Obesity.
    • 45. Elwyn G, Rix A, Holt T, Jones D (2012) Why do clinicians not refer patients to online decision support tools? Interviews with front line clinics in the NHS. BMJ Open 2.
    • 46. Cou√ęt N, Desroches S, Robitaille H, Vaillancourt H, Leblanc A, et al. (2013) Assessments of the extent to which health-care providers involve patients in decision making: a systematic review of studies using the OPTION instrument. Health Expect.
    • 47. The Health Foundation (2013) Implementing Shared Decision Making. The Health Foundation London.
  • No related research data.
  • No similar publications.

Share - Bookmark

Cite this article