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HEBS obesity campaign: training needs assessment

Summary

This Training Needs Assessment was designed to inform the development of strategies to promote the use of the SIGN guidelines Obesity in Scotland, Integrating Prevention and Weight Management (SIGN 1996). The overriding aims were to identify factors which could promote or impede the use of the SIGN guidelines in primary care and to assess the feasibility of the use of online learning packages for primary care teams. The main objectives were: first, to explore attitudes, levels of knowledge, current practice and training needs in relation to overweight and obesity management; and second, to explore computer training needs and perceptions of online learning.

A qualitative approach was adopted. A total of 41 semi-structured interviews exploring overweight and obesity management issues were conducted with primary care team members from 20 practices in five health board areas in Scotland. Computer training needs and perceptions of online learning were explored in the same 20 practices by questionnaire. A total of 106 (48.6%) questionnaires were returned completed. Nine community dietitians from the same health board areas were also interviewed to explore their roles in terms of primary care inputs and their activities in response to the SIGN guidelines.

The main findings were as follows:

• Motivation to address overweight and obesity management is low within primary care.
• An increase in health promotion activity in primary care is perceived to have serious resource implications.
• Greater enthusiasm to tackle obesity management might be generated if effective methods for promoting long-term weight reduction and healthier lifestyle can be demonstrated.
• The identification of best practice based on past and present service initiatives is impeded by the lack of formal evaluation or audit. Infrastructures are required to support evaluation and audit activity in this area.
• There is a need to raise GPs awareness of their potential role in promoting the development of overweight and obesity management initiatives.
• The forthcoming Health Co-operatives may promote the development of health promotion activity in primary care, influenced by the Public Health Green Paper ‘Working Together for a Healthier Scotland.’
• There is a need for a re-launch of the SIGN guidelines and promotion of its main recommendations. Such effort should be directed not only at GPs but also at the nursing and health visiting professions; PN’s and HVs in particular.
• There is a considerable amount of obesity screening activity in primary care but this information is not generally being used to target patients for intervention.
• Screening activity could be promoted as a first stage in a continuum of activity for the management of obesity in primary care if effective intervention strategies for the management of obesity can be identified and promoted.
• Most practices offer some form of obesity management to patients. This is usually 1:1 contact with PN’s.
• Despite the lack of awareness of the SIGN guidelines, most obesity management initiatives identified operate within its broad parameters.
• It may be useful to reassure practices that operating to the main recommendations of the SIGN guidelines may not represent a large modification to current practice. This is not to say that current practice does not require to be improved or made more consistent across practices.
• Primary care teams could be encouraged to run group programmes. This may increase the clinical and cost effectiveness of the provision of weight reduction support in primary care. Such initiatives could be supported by collaboration between PN’s, HVs and Community Dietitians.
• Greater emphasis should be placed on encouraging an active lifestyle within primary care.
• With appropriate training for staff and adequate resource, one exemplar practice in particular demonstrates the feasibility of the full integration of lifestyle change clinics and support activities for patients in a primary care setting. Even small practices can make a significant contribution.
• Community dietitians may be in greater demand and have a more central role to play in the development of overweight and obesity management initiatives in primary care as a result of the development of Health Co-operatives.
• Community dietitians are actively exploring their role and service delivery structures to identify best methods for maximising their outputs. Increased emphasis is being placed on training activities and groupwork programmes
• Community dietitians could have a central role to play in not only training primary care team staff but also encouraging and supporting them in the development of their weight reduction programmes.
• There would appear to be an urgent need for training and resources to support overweight and obesity management activities in primary care.
• Training for obesity management is generally perceived as a low priority in primary care.
• PN’s and HVs, but particularly PN’s, should be targeted for support and training in this topic in the first instance as they are the most active and motivated in this area
• For nursing staff, obesity training would be more appealing, and permission to attend more readily gained, if it was linked in some way to chronic disease management.
• There appear to be no significant barriers to training attendance for primary care teams, although DNs, HVs and MWs may require additional support due to shortages of training funds and of staff to cover for colleagues’ absences.
• For all primary care team professions, personal choice is a significant component influencing training attendance.
• For all primary care team professions, any training event organised should preferably be accredited, local and clearly applicable to professional practice.
• Access to computers is not equitable across primary care team professions.
• There is a need for considerable training and support in relation to computer use within primary care teams. The vast majority of all professions are motivated to acquire such training.
• Access to the internet is not immediately possible for all professions or practices at this time although all practices should be connected this year.
• The experience/skills to use the internet are limited, particularly among DNs, HVs and MWs.
• The concept of on-line learning was greeted with some enthusiasm. Any future online training package would need to address the issues of access and technical familiarisation highlighted and should incorporate tutor contact and tutorials to combat feelings of isolation and lack of support among participants.