Knowledge, attitudes and management skills of medical practitioners regarding weight management

Background: Overweight and obesity have become a global problem. Health professionals are poorly prepared in weight management, which has an effect on their attitudes and management skills with regard to overweight and obese patients. Aim and setting: To assess the knowledge, attitudes and management skills of medical practitioners regarding weight management at Odi District Hospital, Gauteng Province, South Africa. Methods: We conducted a cross-sectional study on 48 medical practitioners at Odi Hospital between 01 October and 31 October 2013. A self-administered questionnaire was used to assess their knowledge, attitudes and management skills in weight management. The SPSS® statistical software (Version 22) was used for data analysis. A p < 0.05 was considered significant. Results: Fifty medical practitioners were recruited, 48 consented to participate and 28 (58.3%) were male. Their categories were community service doctors (3), medical officers (21), registrars (22) and others (2). Thirty-seven (77.1%) never received training in weight management (p < 0.001). Thirty-two (66.7%) regarded weight management as not confined to a dietician (p < 0.001) and 27 (56.2%) regarded weight management as usually unsuccessful (p = 0.004). Forty-seven (97.9%) provided lifestyle modifications and 43 (89.6%) involved the patient’s family in weight management (p < 0.001). More non-registrars [14 (77.8%)] than registrars [8 (38.1%)] measured the body mass index (BMI) routinely (p = 0.013). Conclusion: Few medical practitioners received training in weight management. They regarded weight management as usually unsuccessful and lacked confidence in the same owing to lack of training. They provided lifestyle modifications and involved the patient’s family in weight management. Non-registrars measured the BMI routinely. There is a need for training in weight management at undergraduate and post-graduate levels

Reflections on the training of counsellors in motivational interviewing for programmes for the prevention of mother to child transmission of HIV in sub-Saharan Africa

Introduction: Within the Southern African prevention of mother to child transmission (PMTCT) programmes, counsellors talk with pregnant mothers about a number of interrelated decisions and behaviour changes. Current counselling has been characterised as ineffective in eliciting behaviour change and as adopting a predominantly informational and directive approach. Motivational interviewing (MI) was chosen as a more appropriate approach to guide mothers in these difficult decisions, as it is designed for conversations about behaviour change. MI has not previously been attempted in this context. This paper reflects on how MI can be incorporated successfully into PMTCT counselling and what lessons can be learnt regarding how to conduct training with counsellors. Methods: Thirty-eight lay and nurse counsellors at four sites in Southern Africa were trained in MI. After the initial training, they participated in a five-month inquiry group at each site, where an action researcher (AR) facilitated ongoing learning of new counselling skills and reflection. Transcripts of recorded counselling sessions were then analysed using the motivational interviewing treatment integrity (MITI) code to assess their skills in MI. The MITI analysis was discussed with the action researchers and a consensus was reached on how to improve training. Results: Overall, the counsellors showed a global rating score of four out of seven, a reflection-to-question ratio of 0, a 43% open question score, an 18% complex reflection score and a 58% MI-adherent score. There were significant differences between the sites and between nurses and lay counsellors (p < 0.05). The action researchers suggested that the following factors were important in enabling learning and change: assessment of the baseline level of skills and readiness to change, reflection on real consultations, differences between the ARs and counsellors, a focus on the overall spirit of MI versus technical skills, the approach to information giving, managerial support and an appreciative versus a critical facilitation style. Conclusion: Nurse counsellors in Namibia and Swaziland demonstrated beginning proficiency in MI, while lay counsellors in South Africa did not. From the dialogue with the action researchers, nine recommendations were made to guide the development of future training programmes.Articl