Cluster randomized trial of obesity management in patients with low health literacy in general practice
Co-investigators and Research Team
Nigel Stocks, Don Nutbeam, Nick Zwar, Jon Karnon, Elizabeth Denney-Wilson, Manny Noakes, Siaw Teng-Liaw, Annie Lau, Upali Jayasinghe
The burden of chronic disease is an urgent public health priority, accounting for 90% of deaths in Australia. This is especially important for disadvantaged Australians for whom there are widening disparities in the burden of chronic diseases and their risk factors. Low health literacy (HL) affects 59% of the population and contributes directly and indirectly to these disparitie. For example low HL explains a substantial proportion of the difference in the uptake of preventive programs and self-management of chronic diseases. People with low health literacy communicate less well with health care providers, miss opportunities for prevention and suffer adverse health outcomes as a result. Providers communicate less successfully with patients with low HL, often incorrectly assuming they are not interested in an active role in their health care. To achieve better outcomes for these patients we need to adjust communication to fit patient health literacy and to take opportunities to develop HL skills. This project uses both these approaches to preventive care for patients with low HL in Australian general practice.
To evaluate the implementation and effectiveness of a preventive care intervention that is tailored to the needs of and develops the knowledge and skills of patients with low health literacy in primary health care.
Design: A cluster randomised controlled trial with practices randomly assigned to the intervention compared to practices assigned to provide usual preventive care.
Setting: The study will be conducted in two regions of Sydney and Adelaide in collaboration with Primary Health Networks (PHN).
Participants: Practice recruitment: Practices will be recruited with the assistance of the PHNs. Patient recruitment: Patients will be invited to participate if they aged 40-74 years, be overweight (BMI>25) and have low HL based on screening questions or limited English language proficiency. Exclusion criteria include patients with cardiovascular disease or type 2 diabetes.
Intervention: Eligible patients are invited to attend a practice visit based on the 5As including education and referral coaching programs. Following the health check the patients participate in the online support program through Healthy.me.
Evaluation: The intervention model will be evaluated against practice and patient variables:-
• Adoption by providers, patients registered, nurse visit fidelity and participation online,
• Patient participation and attendance, change in health literacy for preventive care, use of health services, reported diet, physical activity and other risk behaviours; weight and physiological risk factors (BP, lipids) and health-related quality of life.
A health economic evaluation will also be undertaken.
Protocol paper progress.