研究方案：初级卫生保健中健康素养低的患者的肥胖管理
Research protocol: Management of obesity in patients with low health literacy in primary health care.
作者信息
Faruqi Nighat, Stocks Nigel, Spooner Catherine, El Haddad Nouhad, Harris Mark F
机构信息
Centre for Obesity Management and Prevention Research Excellence in Primary Health Care, UNSW Australia, Sydney, Australia ; Centre for Primary Health Care and Equity, UNSW Australia, Sydney, Australia.
Centre for Obesity Management and Prevention Research Excellence in Primary Health Care, UNSW Australia, Sydney, Australia ; Discipline of General Practice, University of Adelaide, Adelaide, Australia.
出版信息
BMC Obes. 2015 Feb 15;2:5. doi: 10.1186/s40608-015-0036-6. eCollection 2015.
BACKGROUND
Socioeconomically disadvantaged adults are both more likely to be obese and have lower levels of health literacy. Our trial evaluates the implementation and effectiveness of primary care nurses acting as prevention navigators to support obese patients with low health literacy to lose weight.
METHODS/DESIGN: A pragmatic cluster randomised trial will be conducted. Twenty practices in socioeconomically deprived areas, 10 each in Sydney and Adelaide, will be recruited and randomised to intervention and control groups. Twenty to 40 eligible obese patients aged 40-70 years with a BMI ≥ 30 kg/m(2) and with low health literacy will be enrolled per practice. The intervention is based on the '5As' of the chronic disease model approach - Assess, Advise, Agree, Assist and Arrange - and the recommendations of the 2013 Clinical practice guidelines for the management of overweight and obesity in adults, adolescents and children in Australia. In the intervention practices, patients will be invited to attend a health check with the prevention navigator who will assess the patient's risk and provide brief advice, assistance with goal setting and referral navigation. Provider training and educational meetings will be held. The providers' attitudes to obesity, confidence in treating obesity and preventive care they provide to obese people with low health literacy will be evaluated through questionnaires and interviews. Patients' self-assessment of lifestyle risk factors, perception of preventive care received in general practice, health-related quality of life, and health literacy will be assessed in telephone interviews. Patients' anthropometric measures will be recorded and their health service usage will be determined via linkage to the Australian government-held medical and pharmaceutical data.
DISCUSSION
Our trial will provide evidence for the effectiveness of practice nurses as prevention navigators to support better weight management for obese patients with low health literacy.
TRIAL REGISTRATION
This trial is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12614001021662). Date registered 24/09/2014.
背景
社会经济地位不利的成年人更有可能肥胖，且健康素养水平较低。我们的试验评估初级保健护士作为预防导航员，以支持健康素养低的肥胖患者减肥的实施情况和效果。
方法/设计：将进行一项实用的整群随机试验。将招募社会经济贫困地区的20家医疗机构，悉尼和阿德莱德各10家，并随机分为干预组和对照组。每家医疗机构将招募20至40名符合条件的40 - 70岁肥胖患者，其体重指数（BMI）≥30kg/m²且健康素养低。干预基于慢性病模式方法的“5A”——评估、建议、商定、协助和安排——以及2013年澳大利亚成人、青少年和儿童超重与肥胖管理临床实践指南的建议。在干预医疗机构中，患者将被邀请与预防导航员一起参加健康检查，预防导航员将评估患者的风险并提供简短建议、协助设定目标和转诊导航。将举行提供者培训和教育会议。将通过问卷调查和访谈评估提供者对肥胖的态度、治疗肥胖的信心以及他们为健康素养低的肥胖者提供的预防保健。将通过电话访谈评估患者对生活方式风险因素的自我评估、对在全科医疗中接受的预防保健的认知、健康相关生活质量以及健康素养。将记录患者的人体测量指标，并通过与澳大利亚政府持有的医疗和药品数据建立联系来确定其医疗服务使用情况。
讨论
我们的试验将为实践护士作为预防导航员支持健康素养低的肥胖患者更好地管理体重的有效性提供证据。
试验注册
本试验已在澳大利亚新西兰临床试验注册中心注册（ACTRN12614001021662）。注册日期为2014年9月24日。
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