Developing the evidence-base for a digital intervention to address weight stigma in general practice: A patient and practitioner- informed approach to obesity education and training

Background: Obesity is a significant global health challenge, with profound implications for individuals' physical and mental well-being, as well as healthcare systems. It is linked to numerous comorbidities and is influenced by a complex interplay of genetic, physiological, behavioural, and environmental factors. Weight stigma, a pervasive form of discrimination and prejudice against individuals with obesity, can exacerbate its health consequences and hinder effective management. This thesis is grounded in the recognition that addressing weight stigma, especially within patient-provider interactions in general practice, is critical. General practice settings often serve as the initial point of contact for healthcare, and general practitioners’ attitudes and behaviours can significantly impact patients' experiences and outcomes. The rationale for delivering the intervention digitally using virtual human technology was to capitalise on their unique abilities to provide personalised, engaging, and standardised learning experiences. This approach aims to enhance general practitioners' self-efficacy and clinical skills in managing obesity through the delivery of obesity education and training that supports the reduction of weight stigma in this setting. Aims: This thesis aimed to advance our understanding of weight stigma in patient-provider interactions. This evidence was used within the thesis to inform the systematic development of a virtual human-based digital intervention designed to reduce weight stigma in patient-provider interactions. Methodology: The research employed a multiple-methods approach, integrating the Medical Research Council's framework for complex interventions and the principles of Intervention Mapping. The studies conducted in this thesis followed steps 1- 4 of the intervention mapping protocol to establish the evidence-base and inform the development of the digital intervention. Four interconnected studies were completed. Study 1: a qualitative evidence synthesis was conducted exploring weight stigma experienced by patients with obesity across healthcare settings to establish a comprehensive understanding of the problem and to identify the target population for intervention. Study 2: a reflexive thematic analysis was used to contextualise patients experiences of weight stigma to general practice settings. Study 3 used an abductive thematic analysis underpinned by the Theoretical Domains Framework to explore GP perspectives on obesity management in general practice settings. The Behaviour Change Wheel was used to guide the translation of the findings into intervention options to support GPs to deliver non-stigmatising obesity care to patients with obesity. Study 4 describes the process of organising and translating the evidence-base into a prototype for testing the initial version of the virtual-human-based digital intervention following the structured guidelines of the Intervention Mapping protocol. Findings: The qualitative evidence synthesis findings revealed that weight stigma in healthcare settings was predominantly experienced within interpersonal interactions. This highlighted the need for targeted interventions to address these interactions. The reflexive thematic analysis provided deeper insights into how weight stigma was perceived by patient in general practice, indicating that weight-based conversations within the context of weight management in general practice settings required specific attention. The qualitative interview study exploring the influences on GPs obesity-related clinical practices indicated a deficit in obesity-related knowledge and skills among general practitioners, emphasising the need for training on initiating weight-based conversations and guiding person-centred clinical decision- making. Studies 1,2,3 established the evidence-base by exploring patient experiences and examining factors influencing clinical practices in weight management. These findings informed the development of a virtual human-driven digital intervention in Study 4, which followed the Intervention Mapping protocol to develop a digital intervention to address weight stigma in general practice. In collaboration with a planning group, the study identified core theoretical components necessary for the intervention. These components were then translated into practical applications within the virtual human digital intervention to address weight stigma through obesity education and training. Conclusion: In conclusion, this research represents a significant step forward in the development of weight stigma reduction interventions in general practice. This thesis offers a comprehensive approach to addressing this complex issue by integrating empirical insights, theoretical frameworks, and practical applications that can be adapted for other healthcare contexts. Future research should build upon these foundations to further refine and evaluate the acceptability, usability, and impact of the virtual human-based digital intervention, ensuring its sustainability in general practice settings.

Funder

Science Foundation Ireland Centre for Research Training in Digitally-Enhanced Reality (d-real)

Publisher

University of Galway

Rights

Attribution-NonCommercial-NoDerivatives 4.0 International

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Collections

University of Galway Theses (PhD Theses)