增强全科医生管理肥胖症的信心和自我效能：一项混合方法研究。
Increasing general practitioners' confidence and self-efficacy in managing obesity: a mixed methods study.
作者信息
Sturgiss Elizabeth, Haesler Emily, Elmitt Nicholas, van Weel Chris, Douglas Kirsty
机构信息
Academic Unit of General Practice, Australian National University Medical School, Canberra, Australian Capital Territory, Australia.
School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Australian Capital Territory, Australia.
出版信息
BMJ Open. 2017 Jan 27;7(1):e014314. doi: 10.1136/bmjopen-2016-014314.
OBJECTIVES
Internationally, general practitioners (GPs) are being encouraged to take an active role in the care of their patients with obesity, but as yet there are few tools for them to implement within their clinics. This study assessed the self-efficacy and confidence of GPs before and after implementing a weight management programme in their practice.
DESIGN
Nested mixed methods study within a 6-month feasibility trial.
SETTING
4 urban general practices and 1 rural general practice in Australia.
PARTICIPANTS
All vocationally registered GPs in the local region were eligible and invited to participate; 12 GPs were recruited and 11 completed the study.
INTERVENTIONS
The Change Programme is a structured GP-delivered weight management programme that uses the therapeutic relationship between the patient and their GP to provide holistic and person-centred care. It is an evidence-based programme founded on Australian guidelines for the management of obesity in primary care.
PRIMARY OUTCOME MEASURES
Self-efficacy and confidence of the GPs when managing obesity was measured using a quantitative survey consisting of Likert scales in conjunction with pro forma interviews.
RESULTS
In line with social cognitive theory, GPs who experienced performance mastery during the pilot intervention had an increase in their confidence and self-efficacy. In particular, confidence in assisting and arranging care for patients was improved as demonstrated in the survey and supported by the qualitative data. Most importantly from the qualitative data, GPs described changing their usual practice and felt more confident to discuss obesity with all of their patients.
CONCLUSIONS
A structured management tool for obesity care in general practice can improve GP confidence and self-efficacy in managing obesity. Enhancing GP 'professional self-efficacy' is the first step to improving obesity management within general practice.
TRIAL REGISTRATION NUMBER
ACTRN12614001192673; Results.
目的
在国际上，鼓励全科医生（GPs）在肥胖患者的护理中发挥积极作用，但目前他们在诊所内可实施的工具很少。本研究评估了全科医生在其诊所实施体重管理计划前后的自我效能感和信心。
设计
在一项为期6个月的可行性试验中进行嵌套混合方法研究。
地点
澳大利亚的4个城市全科诊所和1个农村全科诊所。
参与者
当地所有职业注册全科医生均符合条件并被邀请参加；招募了12名全科医生，11名完成了研究。
干预措施
“改变计划”是一项由全科医生提供的结构化体重管理计划，利用患者与其全科医生之间的治疗关系提供全面和以患者为中心的护理。它是一项基于澳大利亚初级保健中肥胖管理指南的循证计划。
主要结局指标
使用由李克特量表组成的定量调查结合形式访谈来测量全科医生在管理肥胖时的自我效能感和信心。
结果
与社会认知理论一致，在试点干预期间经历过绩效掌握的全科医生的信心和自我效能感有所提高。特别是，如调查所示并得到定性数据支持，在协助和安排患者护理方面的信心得到了改善。从定性数据来看，最重要的是，全科医生描述了他们改变了通常的做法，并且在与所有患者讨论肥胖问题时更有信心。
结论
一种用于全科医疗中肥胖护理的结构化管理工具可以提高全科医生在管理肥胖方面的信心和自我效能感。增强全科医生的“专业自我效能感”是改善全科医疗中肥胖管理的第一步。
试验注册号
ACTRN12614001192673；结果。
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