Provider experiences of delivering nutrition focussed lifestyle interventions for adults with metabolic syndrome and obesity: a qualitative systematic review

Abstract

Background: Globally, the prevalence of chronic disease is increasing and there is strong evidence to indicate that the development of conditions can be prevented or delayed through modification of behavioural risk factors, such as diet and exercise. Chronic disease prevention and care typically occurs in primary health care settings and primary health care providers are expected to play a significant role in the management of lifestyle risk factors, such as high body weight. However, there are many barriers to the implementation of lifestyle management strategies. The experiences of primary care providers in discussing nutrition and weight-based issues with people with lifestyle risk factors are important in helping to identify gaps in service delivery, and this kind of information can be captured through qualitative research. As such, examining literature that investigates primary care providers’ experiences in delivering nutrition focussed lifestyle interventions through a qualitative systematic review may provide useful insights that can inform future delivery of such interventions. Objectives: The objective of this qualitative systematic review is to synthesise the best available evidence on primary care provider experiences of delivering nutrition focussed lifestyle interventions to adult patients with metabolic syndrome and obesity. Methods: This review considered studies that included providers of nutrition-focussed lifestyle interventions in primary health care, including registered nurses, general practitioners and allied health clinicians. Provider experiences including congruence with role, approach and willingness to discuss lifestyle issues, perceived effectiveness and client acceptability of lifestyle interventions were considered, in addition to any other experiences. Primary health care settings including general practice, family medical services, community health and private allied health services in high income countries were considered. The search strategy aimed to locate both published and unpublished studies, from 2000. All studies which met the inclusion criteria were retrieved and assessed by two reviewers for methodological quality. The standard Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Qualitative Research was used. Data was extracted using a standardised JBI data extraction form. Data extraction was completed for all studies, regardless of their methodological quality. Data extracted included specific details about the populations, context, culture, geographical location, study methods and the phenomena of interest. Qualitative research findings were pooled using the JBI System for the Unified Management, Assessment and Review of Information (JBI SUMARI) meta-aggregation approach, which involved the synthesis of findings to generate statements based on similarity in meaning which could be used to inform decision making. Results: From the 23 papers which were included in the review, five synthesised findings were generated from 15 categories and 172 findings. The five synthesised findings were: i) Primary care providers may have varying levels of confidence in their own knowledge and skills regarding "obesity management", which may be impacted by education and training, with some experiencing uncertainty regarding the effectiveness of the interventions and strategies they are recommending to their patients; ii) There are complexities surrounding obesity and "weight management", and as such primary care providers may search for opportunities to address weight related issues in a sensitive way so as to be able to deliver important messages whilst maintaining positive relationships with patients; iii) Although primary care providers are aware of the importance of patient centred care and patient autonomy, if patients are unsuccessful with their weight management attempts, the professionals may assign blame to the patients due to perceived poor motivation and compliance; iv) Practice nurses and pharmacists feel well-placed and often responsible for providing early intervention weight management, however, referral to a dietitian is the preferred approach for further care when this service is available; and v) Primary care providers can identify the importance of weight management and would like to address lifestyle related issues with patients, however, some do not feel well supported at the organisational level to be able to do this consistently. Conclusions: These findings highlight the challenges faced by primary care providers when attempting to address issues of weight and lifestyle in their practice, including lack of education and training, poor confidence in themselves, lack of confidence in the effectiveness of the intervention and limited organisational support.