Weight management for patients in general practice tailored to health literacy

Our aim was to develop and evaluate the feasibility and impact of a PHC approach to weight management tailored to the level of health literacy of obese patients. There were three key activities undertaken in this regard: 1) a literature review; 2) a pilot study; and 3) a weight management trial called “Better Management of Weight in General Practice” (BMWGP). In this report we describe the three activities and use the BMWGP baseline data to explore three issues. First, we look at the effectiveness of a screening tool to identify patients with low health literacy in general practice. Second, we describe the association between health literacy and a range of factors, behavioural intentions, lifestyle behaviours and quality of life to better understand the link between health literacy and health in a population of patients with obesity attending general practices. Third, we identify the groups most likely to experience weight stigma and how stigma relates to health literacy.The research reported in this paper is a project of the Australian Primary Health Care Research Institute which is supported by a grant from the Australian Government Department of Health and Ageing under the Primary Health Care Research Evaluation and Development Strategy

The interaction between ethnicity and health literacy for weight management among obese Arabic-speaking immigrants in Australian primary health care

Obesity affects many Australians, particularly Arabic-speaking immigrants, who experience challenges in weight management due to a range of factors including inadequate health literacy. While there is little controversy about the importance of health literacy for weight management, there is comparatively little research exploring the influence of health literacy on weight management among culturally and linguistically diverse population groups. Using a mixed methods instrumental single case study with repeated measures at baseline, six months and 12 months, this thesis investigates the interaction between ethnicity and health literacy for weight management among obese Arabic-speaking immigrants with low health literacy in a South Western Sydney general practice.This research was nested within a cluster randomised controlled trial of weight management in general practice. The trial aimed to evaluate the implementation and effectiveness of the role of practice nurses as ‘prevention navigators’ to support obese patients with low health literacy to better manage their weight. Data collection included a self-completed questionnaire and a face-to-face qualitative interview with five health care providers who treated predominantly Arabic-speaking patients and a telephone quantitative survey and qualitative interview with twelve Arabic-speaking patients in Arabic. The triangulated data were analysed through an inductive, constructivist lens.The study found a complex relationship between ethnicity and health literacy for weight management. While many similarities existed between Arabic-speaking and non- Arabic-speaking patients and their health care providers, the effects of low health literacy on weight management were amplified by ethnicity-related factors among Arabic-speaking patients, particularly their ability to actively manage their own health and their ability to read and understand written health information. Examples of these ethnicity-related factors included the traditional Arabic diet, cultural norms of hospitality and generosity, religious celebrations, changes to the physical environment following migration, social support and depressed mood. In turn, these negatively interacted with the attitudes of primary health care providers, which they often conflated patient’s low health literacy with a lack of motivation, and the overall health system’s goals and capabilities to improve access, efficiency and integration of care. Primary health care providers need to understand how ethnicity and low health literacy among Arabic-speaking patients may interact and confound their attempts to address obesity in this population

A Case Study of an SMS Text Message Community Panel Survey and Its Potential for Use During the COVID-19 Pandemic.

During the COVID-19 pandemic many traditional methods of data collection, such as intercept surveys or focus groups, are not feasible. This paper proposes that establishing community panels through SMS text messages may be a useful method during the pandemic, by describing a case study of how an innovative SMS text message community panel was used for the "Shisha No Thanks" project to collect data from young adults of Arabic-speaking background about their attitudes on the harms of waterpipe smoking. Participants were asked to complete an initial recruitment survey, and then subsequently sent 1 survey question per week. The study recruited 133 participants to the SMS text message community panel and the mean response rate for each question was 73.0% (97.1/133) (range 76/133 [57.1%] to 112/133 [84.2%]). The SMS text message community panel approach is not suited for all populations, nor for all types of inquiry, particularly due to limitations of the type of responses that it allows and the required access to mobile devices. However, it is a rapid method for data collection, and therefore during the COVID-19 pandemic, it can provide service providers and policymakers with timely information to inform public health responses. In addition, this method negates the need for in-person interactions and allows for longitudinal data collection. It may be useful in supplementing other community needs assessment activities, and may be particularly relevant for people who are considered to be more difficult to reach, particularly young people, culturally and linguistically diverse communities, and other groups that might otherwise be missed by traditional methods

Vitamin B12 in Obese Adolescents with Clinical Features of Insulin Resistance

Emerging evidence indicates an association between obesity, metformin use and reduced vitamin B12 status, which can have serious hematologic, neurologic and psychiatric consequences. This study aimed to examine B12 status in obese adolescents with pre-diabetes and/or clinical features of insulin resistance. Serum B12 was measured using chemiluminescence immunoassay in 103 (43 male, 60 female) obese (mean body mass index (BMI) z-score ± SD (2.36 ± 0.29)), adolescents aged 10 to 17 years, median (range) insulin sensitivity index of 1.27 (0.27 to 3.38) and 13.6% had pre-diabetes. Low B12 (<148 pmol/L) was identified in eight (7.8%) and borderline status (148 to 221 pmol/L) in an additional 25 (24.3%) adolescents. Adolescents with borderline B12 concentrations had higher BMI z-scores compared to those with normal concentrations (2.50 ± 0.22 vs. 2.32 ± 0.30, p = 0.008) or those with low B12 concentration (2.50 ± 0.22 vs. 2.27 ± 0.226, p = 0.041). In conclusion, nearly a third of obese adolescents with clinical insulin resistance had a low or borderline serum B12 status. Therefore, further investigations are warranted to explore the cause and the impact of low B12 status in obese pediatric populations