Exploring organisational readiness to implement a preventive intervention in Australian general practice for overweight and obese patients: key learnings from the HeLP-GP trial

Sharon Parker; An Tran; Shoko Saito; Carmel McNamara; Elizabeth Denney-Wilson; Don Nutbeam; Mark Fort Harris

doi:10.1071/PY23085

RESEARCH ARTICLE (Open Access)

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Exploring organisational readiness to implement a preventive intervention in Australian general practice for overweight and obese patients: key learnings from the HeLP-GP trial

Sharon Parker

^A ^* , An Tran ^A , Shoko Saito ^A , Carmel McNamara

^B , Elizabeth Denney-Wilson

^C , Don Nutbeam ^D , Mark Fort Harris

^A and on behalf of the Health e-Literacy for Prevention in General Practice (HeLP-GP) Trial Group

+ Author Affiliations

- Author Affiliations

^A Centre for Primary Health Care and Equity, The University of NSW, Sydney, NSW 2052, Australia.

^B Discipline of General Practice, The University of Adelaide, Adelaide, SA 5005, Australia.

^C Sydney Local Health District and Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia.

^D School of Public Health, University of Sydney, Sydney, NSW 2006, Australia.

^* Correspondence to: Sharon.Parker@unsw.edu.au

Australian Journal of Primary Health 30, PY23085 https://doi.org/10.1071/PY23085

Submitted: 24 July 2023 Accepted: 13 January 2024 Published: 8 February 2024

© 2024 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of La Trobe University. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)

Abstract

Background

The HeLP-GP trial aimed to increase the capacity of practice nurses to deliver weight management to overweight and obese patients through an intervention comprising a health check, a lifestyle app and/or telephone coaching. This paper describes implementation through the lens of organisational readiness with emphasis on the role of the practice nurse.

Methods

Routinely collected mixed method research data including practice surveys, field notes, and diaries and process data were mapped against the domains: motivation to implement, general capacity and intervention-specific capacity.

Results

Organisational readiness varied considerably, particularly the domain of intervention-specific capacity. Practice nurse turnover negatively impacted the implementation, affecting half of the practices. We observed a general lack of practice-based support for intervention delivery, and varying levels of interest, skill and confidence in delivering the intervention. Nurses struggled to complete the research and intervention tasks in a timely way. Conducting risk assessments and referring to coaching were generally not problematic; however, we noted lower confidence levels with the lifestyle app and instructing patients to use it.

Conclusions

We found a lack of general ‘readiness’ inherent in the nursing role, particularly related to their capacity to complete intervention tasks and practice-level support to implement the intervention. For nurses in general practice to fulfil their potential in supporting patients to reduce risk and adopt healthier life choices, our study indicates that more could be done to improve their workforce positioning and remuneration, which may, in turn, improve continuity of care, retention and individual motivation.

Keywords: family practice, general practice nurse, obesity, organisational readiness, overweight, practice nurse, primary care, primary health, weight management.

References

Australian College of Nursing (2019) A new horizon for health service: optimising advanced practice nursing. A white paper by ACN. Australian College of Nursing.

Australian Institute of Health and Welfare (2017) A picture of overweight and obesity in Australia 2017. AIHW, Canberra.

Campbell-Scherer DL, Asselin J, Osunlana AM, Ogunleye AA, Fielding S, Anderson R, Cave A, Johnson JA, Sharma AM (2019) Changing provider behaviour to increase nurse visits for obesity in family practice: the 5As Team randomized controlled trial. CMAJ Open 7, E371-E378.
| Crossref | Google Scholar | PubMed |

Cranley LA, Cummings GG, Profetto-McGrath J, Toth F, Estabrooks CA (2017) Facilitation roles and characteristics associated with research use by healthcare professionals: a scoping review. BMJ Open 7, e014384.
| Crossref | Google Scholar | PubMed |

Dawson AJ, Stasa H, Roche MA, Homer CSE, Duffield C (2014) Nursing churn and turnover in Australian hospitals: nurses perceptions and suggestions for supportive strategies. BMC Nursing 13, 11.
| Crossref | Google Scholar | PubMed |

Forgione N, Deed G, Kilov G, Rigas G (2018) Managing obesity in primary care: breaking down the barriers. Advances in Therapy 35, 191-198.
| Crossref | Google Scholar | PubMed |

Glasgow RE, Emont S, Miller DC (2006) Assessing delivery of the five ‘As’ for patient-centered counseling. Health Promotion International 21, 245-255.
| Crossref | Google Scholar | PubMed |

Gray J, Hoon EA, Afzali HHA, Spooner C, Harris MF, Karnon J (2017) Is the Counterweight Program a feasible and acceptable option for structured weight management delivered by practice nurses in Australia? A mixed-methods study. Australian Journal of Primary Health 23, 348-363.
| Crossref | Google Scholar | PubMed |

Halcomb E, Hickman L (2016) Attitudes and immunisation practices of Australian general practice nurses. Contemporary Nurse 52, 440-446.
| Crossref | Google Scholar | PubMed |

Halcomb E, Bird S, Mcinnes S, Ashley C, Huckel K (2021) Exploring job satisfaction and turnover intentions among general practice nurses in an Australian Primary Health Network. Journal of Nursing Management 29, 943-952.
| Crossref | Google Scholar | PubMed |

Henderson J, Koehne K, Verrall C, Gebbie K, Fuller J (2014) How is Primary Health Care conceptualised in nursing in Australia? A review of the literature. Health and Social Care in the Community 22, 337-351.
| Crossref | Google Scholar | PubMed |

Heywood T, Laurence C (2018) The general practice nurse workforce: estimating future supply. Australian Journal of General Practice 47, 788-795.
| Crossref | Google Scholar | PubMed |

Hinks SR (2022) Exploring community nurses’ views on the implementation of a local Weight Management Pathway. British Journal of Community Nursing 27, 612-618.
| Crossref | Google Scholar | PubMed |

Hobbs M, Radley D (2020) Obesogenic environments and obesity: a comment on ‘Are environmental area characteristics at birth associated with overweight and obesity in school-aged children? Findings from the SLOPE (Studying Lifecourse Obesity PrEdictors) population-based cohort in the south of England’. BMC Medicine 18, 59.
| Crossref | Google Scholar | PubMed |

Li S, Yin Z, Lesser J, Li C, Choi BY, Parra-Medina D, Flores B, Dennis B, Wang J (2022) Community health worker-led mHealth-enabled diabetes self-management education and support intervention in rural latino adults: single-arm feasibility trial. JMIR Diabetes 7, e37534.
| Crossref | Google Scholar | PubMed |

McElwaine KM, Freund M, Campbell EM, Bartlem KM, Wye PM, Wiggers JH (2015) Systematic review of interventions to increase the delivery of preventive care by primary care nurses and allied health clinicians. Implementation Science 11, 50.
| Crossref | Google Scholar | PubMed |

McInnes S, Peters K, Bonney A, Halcomb E (2015) An integrative review of facilitators and barriers influencing collaboration and teamwork between general practitioners and nurses working in general practice. Journal of Advanced Nursing 71, 1973-1985.
| Crossref | Google Scholar | PubMed |

NSW Agency for Clinical Innovation (2015) Understanding and working with general practice. NSW Agency for Clinical Innovation, Sydney, NSW. Available at https://aci.health.nsw.gov.au/

Parker SM, Stocks N, Nutbeam D, Thomas L, Denney-Wilson E, Zwar N, Karnon J, Lloyd J, Noakes M, Liaw S-T, Lau A, Osborne R, Harris MF (2018) Preventing chronic disease in patients with low health literacy using eHealth and teamwork in primary healthcare: protocol for a cluster randomised controlled trial. BMJ Open 8, e023239.
| Crossref | Google Scholar |

Parker SM, Barr M, Stocks N, Denney-Wilson E, Zwar N, Karnon J, Kabir A, Nutbeam D, Roseleur J, Liaw S-T, McNamara C, Frank O, Tran A, Osborne R, Lau AYS, Harris M (2022) Preventing chronic disease in overweight and obese patients with low health literacy using eHealth and teamwork in primary healthcare (HeLP-GP): a cluster randomised controlled trial. BMJ Open 12, e060393.
| Crossref | Google Scholar | PubMed |

Phillips K, Wood F, Kinnersley P (2014) Tackling obesity: the challenge of obesity management for practice nurses in primary care. Family Practice 31, 51-59.
| Crossref | Google Scholar | PubMed |

Ross HM, Laws R, Reckless J, Lean M, Counterweight Project Team (2008) Evaluation of the Counterweight Programme for obesity management in primary care: a starting point for continuous improvement. British Journal of General Practice 58, 548-554.
| Crossref | Google Scholar |

Scaccia JP, Cook BS, Lamont A, Wandersman A, Castellow J, Katz J, Beidas RS (2015) A practical implementation science heuristic for organizational readines: R=MC². Journal of Community Psychology 43, 484-501.
| Crossref | Google Scholar | PubMed |

Shaw EK, Howard J, West DR, Crabtree BF, Nease DE, Tutt B, Nutting PA (2012) The role of the champion in primary care change efforts: from the State Networks of Colorado Ambulatory Practices and Partners (SNOCAP). The Journal of the American Board of Family Medicine 25, 676-685.
| Crossref | Google Scholar | PubMed |

Slater S, Lambkin D, Schumacher T, Williams A, Baillie J (2022) Testing the effectiveness of a novel, evidence-based weight management and lifestyle modification programme in primary care: the Healthy Weight Initiative. Journal of Primary Health Care 14, 64-73.
| Crossref | Google Scholar | PubMed |

Zhu DQ, Norman IJ, While AE (2013) Nurses’ self-efficacy and practices relating to weight management of adult patients: a path analysis. International Journal of Behavioral Nutrition and Physical Activity 10, 131.
| Crossref | Google Scholar | PubMed |