The Behavior Mechanism Of Community Healthcare Professionals In Implementing Adult Weight Management And Correspondent Strategies

ObjectivesObesity has become a severe public health problem of China.Community healthcare professionals are key people in preventing and treating over weight and obesity.Previous studies focused little on the group of community healthcare professionals,and have not revealed factors which could result in their poor weight management behaviors.The study attempted to explore the factors that influence community healthcare professionals’ behaviors,which is based on the conceptual framework of community medical professionals in implementing adult weight management.The interventions to promote community healthcare professionals’ weight management is to be developed,which will provide available suggestions for the prevention and control of overweight and obesity in community of China.MethodsThe research process comprised the following stages:Stage1:The scale which was formed during the previous study is tested though the Delphi Method and reliability and validity tests.Subsequently,we modified the questionnaire according to the results.Stage2:A cross-sectional survey of 1055 community healthcare professionals were performed to explore the influencing factors of weight management behaviors.Stratified sampling method was used according to regionalism of Shanghai.We also used path analysis to explore the relations among the factors.The mechanism of community healthcare professionals in implementing adult weight management was achieved based on these analyses.Stage3:Delphi method was used to modify the intervention strategies which is formed according to the results of Stage 2 and literature review.Results1.Reliability and validity tests indicated: The questionnaire has high reliability and validity,and it included 4 subscales:(1)Self-rating scale of weight management behaviors(8items);(2)Self-rating scale of weight management knowledge and skills(9 items);(3)Scale of perceived barriers to weight management(8 items);(4)Scale of beliefs about weight management(25 items).(1)Content validity: 13 experts were involved in the Delphi method.According tothem,item-level content validity index(I-CVI)were 0.75~1.00,and the scale-level content validity index(S-CVI)was 0.90.(2)Item analysis suggested that the CR value had reached a significant level at each item.(3)Construct validity: Factor analysis suggested that the cumulative variance contribution rate of each scale had reached more than 70%.(4)Internal consistency reliability: Cronbach α of the scales were 0.863~0.950.(5)Test-retest reliability(at 2-week intervals): Intra-class correlation coefficient(ICC)were 0.307~0.649.2.The results of the questionnaire-based cross-sectional study(n=904)indicated that:(1)Results of descriptive statistics:(1)The behavior of community healthcare professionals in implementing weight management was not ideal,and the average score of each item was 1.59~2.18.The most commonly implemented behavior was providing general advice for patients(2.18±1.05),while the least was measuring one’s waist circumference(1.59±0.86);(2)community healthcare professionals had not enough knowledge and skills on weight management,and the average score of each item was1.80~2.37.The best was risks of obesity and overweight(2.37±0.63),while the worst was making goals and plans on weight loss.(1.85±0.62);(3)on perceived barriers on weight management,the average score of each item was 4.07~4.82.The most identified was the deficiency of fund on weight management(4.82±1.81).(2)Several statistical analyses(T test,single factor analysis of variance,Pearson correlation analysis)indicated that factors affecting medical professionals’ weight management behaviors were:(1)Demographics variables: gender,degree,experience of whether one had once been faced with weight problems;(2)Professional variables:profession,title,knowledge and skills,training;(3)Attitudes and beliefs: professional role identity,environment and resources(perceived barriers),self-efficacy,outcome expectations,intentions,social pressure,power and common practice.(3)According to the results of path analysis,knowledge and skills affect directly(43.3%/47.6% effect)to doctors/ nurses’ behaviors or indirectly(0.2%/0.4% effect)by the mediating effect of beliefs.Social variables(social support,social pressure,power)indirectly(2.1%/9.9% effect)influence behavior by the mediating effect of individual intention or belief.Individual beliefs like self-efficacy(1.4%/2.3% effect)and professional role identity(0.3%/9.1% effect)influence his behavior through the mediating effect ofintention and common practice.The Psychological mechanism of community healthcare professionals in implementing adult weight management was achieved based on these results,and the factors accounted for 26.3%/25.4% of total variance.χ2/df<3、GFI、AGFI、NFI、IFI、CFI of the model are higher than 0.9,RMSEA<0.08,which shows that the model fitting is in good condition.3.The final program to promote weight management practice of community healthcare professionals included:(1)Interventions to promote weight management:(1)More training about weight management;(2)Identified responsibilities and supervision on them;(3)Providing materials and resources to make it benefit for them to perform weight management;(4)Cooperation with other department,like nutritional department and endocrinology department.(2)evaluation criteria and time:(1)healthcare professionals related criteria,including weight management behaviors,knowledge and skills,attitudes and beliefs;(2)patients related criteria,including weight,waist circumstance,BMI and healthcare behaviors;(3)evaluation time: 3 months,6 months,1 yearafter the interventions.Conclusion1.The behavior of community healthcare professionals’ in adult weight management is not ideal,it may be the interaction result of a variety of factors among the individual,interpersonal and social environment.The nested model ofTPB and SCT has revealed interactions between behaviors and other influencingfactors from the individual,interpersonal and social level,which can explain the mechanism of community healthcare professionals in implementing adult weight management.2.Knowledge and skills and perceived social support are key variables of weight management practice of community healthcare professionals.Improving knowledge and skills of community healthcare professionals and stimulating their initiative are key measures to promote them to implement weight management in community.