Behaviour Change Training
West Midlands Obesity Training Project
Report
March 2010
Contents
Page
Executive Summary3
Main Report
Aim4
Content4
Numbers Trained4
The Training7
Types of Staff Trained8
Expected Outcomes8
Audit Results9
Key Observations10
Feedback from Participants12
Trainers Comments13
Recommendations14
Conclusion15
Post Training Evaluation16
Executive Summary
Behaviour Change Training (BCT) was commissioned in May 2007 by West Midlands Regional Public Health Department to deliver adult and childhood obesity training to 17 PCTs within the region.The aim of the training was to equip healthcare professionals with the essential knowledge and skills to become more effective practitioners in the management of obesity. The training delivery commenced in September 2008 and,apart from 1 PCT,has now been completed.
The 2 day training sessions were well received and practitioners’ feedback was generally very positive. A total of 506 staff were trained (a take up rate of 72% of places available) on the adult & childhood 2 day courses. 83% of those attending thought the course was either very or extremely relevant to them and 88% thought the information was presented in a way which was either very or extremely interesting.
Take-up for the follow-up sessions was a disappointing 29% of places available although of those that did attend 84% thought the material was both very or extremely relevant and also very or extremely well presented. Low attendance seems to have been caused mainly by communication difficulties within PCTs.
A variety of adult education methods were used, combining information exchange with practical exercises and the opportunity for reflection and discussion.
The expected outcomes of increasing knowledge and skills have been met as perceived by participants in their evaluation of the training.
Key observations
Some general observations include:
- Lack of a co-ordinated and structured approach to obesity management. Individual PCTs are different stages in the development of their services
- There seemed to be a lack of clarity within some PCTs around responsibility for organising and administering courses
- Adult courses were easier to fill than childhood courses. This seems to be because PCTs have been slower to develop childhood services
Common frustrations expressed by participants during the training included:
-A lack of clear care pathways for the management of obesity across related services and, where care pathways existed, failure to communicate these to all practitioners/related services. Many pathways were in the process of being developed
-A lack of central coordination of services.
-A lack of consistent community based support initiatives for referral from primary care.
-A lack of consistent patient education literature.
-Lack of help and support to tailor the service to specific at risk groups e.g. those with learning disabilities
-staff working with adults are struggling to offer the necessary follow up
-staff working with children sometimes feel isolated
-Many staff are expected to run Weight Management Groups without proper Group Skills training (not included in this project)
An audit of current practice which was completed by just over 50% of those who attended the training indicates a need to ensure that appropriate height and weight measuring equipment is available and that measurements are done correctly and with privacy.
The wider support offered to practitioners from the host PCT varied in quality and quantity with some excellent examples of well thought out and resourced inclusive care pathways through to chaotic responses which were characterised by a lack of basic communication between practitioners and the PCT.
Feedback from participants described an increase in confidence in their knowledge and skills thus increasing their ability to undertake weight management interventions. Trainers reported a high level of interest and enthusiasm from participants who attended the training.
Recommendations
- Communication about local initiatives needs to be improved
- More awareness raising training for all staff (even if they are not working specifically in obesity) to ensure that the importance of prevention and treatment is well recognised
- Services need to include weight maintenance support for patients who have lost weight in line with current evidence on the management of this chronic disease
- Recommendations for future training include:
- Further training on prevention and treatment of obesity for those working with overweight adults and children – perhaps a rolling programme to ensure staff changes mean that new staff are equipped with the necessary knowledge and skills
- Training should be targeted towards specific groups of staff e.g. clinical, non-clinical, those working with learning disabilities, midwives
- Group Skills Training needs to be offered to those running groups to maximise the effectiveness of this approach
Conclusion:
Overall the training was well received and all found it a good experience. Participants were all very keen to have training in this area to equip them to be more effective practitioners. Most described finding weight management as being very challenging and felt they need ongoing support to develop their skills.
The training has contributed to equipping the practitioners with essential knowledge and skills but it needs to be emphasised that ongoing training and support are essential to improve management of this chronic disease.
The follow up evaluation confirmed that participants felt they had benefited from the training and now feel more comfortable raising the issue of weight. They feel more confident regarding their own knowledge and skills in undertaking weight management interventions. Most participants felt they would like ongoing support. Organisational difficulties prevented people from attending follow-up sessions
Behaviour Change Training
The Training Project
AIM
To provide a programme of training for NHS staff in primary and community settings to the 17 PCTs in the West Midlands region to equip them with the essential knowledge and skills to become more effective practitioners in the management of obesity.
Content
An agreed training programme was to offer each PCT:
- Adult Interventions (2 days):
- diet, physical activity and behavioural skills
- Childhood Interventions (2 days):
- diet, physical activity and behavioural skills including working with families
- facilitation for implementation in practice this would be offered at PCT or practice level, depending on requirements (2 x ½ days)
Sample programmes are attached for each of the above courses(Appendix 1a, 1b & 1c)
Numbers Trained - Training Schedule Attached(Appendix 2)
Places offered700Places offered700
Adult 2 Day Courses287Adult Follow- Up Sessions143
Childhood 2 Day Courses219Childhood Follow-Up Sessions103
Total506Total206
Take Up72%Take Up29%
23 sessions were cancelled and re-arranged.
The Training
The training was delivered using a combination of adult teaching methods: information exchange (checking what they already knew or their previous experience, providing new information and given for questions, reflection and discussion before moving onto new material), quizzes, small working groups and role-play to practice skills. Practical sessions included the use of food examples, food labels, ‘walk & talk’ discussion exercises. Participants were asked to reflect on their own experiences between follow up sessions, to set their own goals for implementing the training into their everyday practice and review these.
The content of the 2 day adult course focused on knowledge and skills – evidence-based and up to date information on diet and physical activity, as well as skills to deliver that information, and work with clients in a way that is likely to influence sustainable behaviour change. Attitudes to obesity and helpful ways to raise the issue and discuss weight in a sensitive manner were also covered.
The 2 day childhood course also focused on evidence based information on diet and activity. A key component of that course was helping practitioners develop their skills in raising the issue and talking about weight in a sensitive and helpful way with families and children. It also focused onuseful behaviouralinterventions that can be used with children and families to influence change.
As a training organisation BCT is concerned that any training offered to practitioners is carried out in a way that maximises the transfer of skills and knowledge learned from the protective environment of the training room into wider clinical practice. This underpinning principle led to the design of a training model, which offered two follow up sessions placed approximately 6 weeks apart from the core training. The aim of the follow up sessions was to provide a period of extended support to help them integrate the evidence of effective obesity management into their current practice thereby maximising patient outcomes. Each follow up session was 3 hours in length.
The content of the follow up sessions allowed practitioners to consider the impact of the adult and childhood obesity training both on their individual practice and to the wider obesity management service as a whole. It achieved this by providing time and space for those practitioners engaged in obesity management to review their current practice/service thereby bringing it into line with the current evidence of effectiveness. Practitioners were encouraged to identify specific barriers to the implementation of the evidence of good practice and to help them create an action plan to overcome those barriers. The second follow up session focused on reinforcing the learning that practitioners gained on the training while also providing an opportunity to further review their action plans for change. The outcomes of discussions were communicated to the specific PCT
Types of Staff Trained:
A wide range of staff attended the training. Applications were processed by the Obesity Leads within each PCT. Therefore a breakdown of who attended and their roles will be held by each PCT. Participants were not asked to record their roles on the attendance sheets. The overall impression of the trainers was that:
- On Adult Courses it was mainly practice nurses and healthcare assistants (approx 70%). Others included health visitors, community nurses, community food workers and health trainers, some leisure service staff and prison staff.
- Childhood Courses included health visitors, school nurses, and nursery nurses (approx 70%). Others included practice nurses & leisure service staff.
- The level of experience and seniority varied on each course from newly qualified staff to those with many years of experience.
- There was a higher proportion of clinical to non-clinical staff (approx 70:30)
Expected Outcomes of the Training
(Aims & objectives attached: Appendix 3)
As a result of the training it was expected that practitioners would
- Have a sound knowledge of up to date evidence-based key messages on diet and activity in relation to weight management
- Have the skills and confidence to support clients through weight management interventions
- Have the ability to raise the issue and discuss weight in a sensitive and helpful way
- Appreciate the need to offer structured interventions that link in with other local initiatives
- Always keep the focus on interventions that would support sustained changes to eating and activity to aid weight maintenance
It was not envisaged that the sessions would equip participants to cascade the training onto others. This would require further training.
Audit Results(copy of audit questionnaire attached as appendix 4)
Obesity Leads were asked to distribute pre-course audit questionnaires to participants, to be collected on the course. The questionnaire was geared towards clinicians and so was not relevant to non-clinical staff.
Completed audit questionnaires of those who attended the training:
Adult Courses:
Pre-course audit: 161 (56%)Post course audit: 32(22%)
Childhood Courses:
Pre-course audit: 111 (50%)Post course audit: 3 (3%)
The response rate for the post course audit was disappointing and therefore impossible to draw any meaningful conclusions from the data collected.
The pre-course audit highlighted some useful information:
- Most participants were not aware of the existence of an obesity strategy
- Most practices do not have anyone with overall responsibility for obesity
- Weight management is shared amongst practitioners within surgeries with no one person taking overall responsibility
- BMI are recorded for most adult patients
- There is wide variation in the types of scales used – many not suitable for heavy patients but scales seem to be calibrated annually
- A significant number of surgeries do not weigh patients in private
- Practitioners do not all use standard methods of measuring height and weight
- Waist measurements are done routinely by a small number of practitioners
- Most weight interventions are recorded in notes or IT system, but not all, leaving the possibility of duplication and a lack of a co-ordinated approach
Key Observations
- The training was very well received and uptake was generally good. Adult courses were easier to fill than childhood courses. This seems to be because PCTs have been slower to develop childhood services and more recently the demand for childhood places has increased
- In some PCTs there seemed to be a lack of clarity about whose responsibility it was to advertise the courses and ensure the places were filled. There were a number of changes of Obesity Leads at PCT level and this made it difficult for a new person in post to organise the courses resulting in a number of last minute cancellations and re-arrangement of courses.
- Most PCTs seem to be developing local obesity strategies and setting up initiatives both for adults and children. Obesity management requires a co-ordinated and structured approach which incorporates the delivery of prevention and treatment programmes at local level – there is wide variation in how services are structured
- Common frustrations expressed by participants included:
- A lack of community based support initiatives for referral from primary care
- A lack of consistent education literature
- A lack of help and support to tailor the service to specific at risk groups e.g. learning disabilities
- The training was often an opportunity for staff to learn about local services and initiatives. Although it was requested that representatives from local dietetic and physical activity services were invited to the training to give information about their services, thishappened in only a few PCTs
- Participants expressed a strong desire for further local support with implementation of knowledge and skills covered on the training
- Attendance at follow up sessions (which was intended as support for implementation in practice) was poor. This suggests that support for implementation needs to happen in a more ‘hands on’ way.
- Staff working with adults experience difficulty in meeting the competing demands of their service and struggle to offer the necessary follow up and support required to patients who are struggling to manage their weight.
- Current evidence indicates a need for ongoing support for weight maintenance. Weight maintenance programmes need be built into services and this does not happen at the moment
- Managing childhood obesity is complex and needs to include multi-agency working. Staff often reported feeling isolated when dealing with difficult cases highlighting the need for good clinical supervision
- Many staff are expected to run weight management groups without having had any group facilitation skills training (not covered in this project)
Feedback from Participants
Overall the training was very well received
1. Was the material presented, relevant to you?96% scored 3 or more
(0 ‘not at all relevant to me’ - 5 ‘extremely relevant to me’)
Delegate Scores
0 / 1 / 2 / 3 / 4 / 51% / 3% / 14% / 33% / 50%
2. Wasthe information presented in a way that was interesting?
98% scored 3 or more
Delegate Scores
0 / 1 / 2 / 3 / 4 / 50 / 0 / 2% / 10% / 36% / 52%
- Were there Points of discussion that were not raised that you would have liked to see discussed?
-more on 11 – 18 year olds
-application in a wider range of settings
-more on Learning Disabilities
-No one from PCT Obesity strategy group here today.
-Managing obesity in babies
-More on Obesity in pregnancy
- Do you have any other comments about the course?
-feel more confident about talking to parents and families about weight
-I will listen more carefully to my patients
-I have new tools to use
-It was good to have a review of up to date evidence-based information on diet and activity
- Do you have any other comments about the Follow up?
-Very good for reflection.
-Very informative. Opportunity to share experiences.
-Found this follow up really useful/extremely useful.
-Good to think about practical – realistic ways of putting learning into practice.
- What one thing have you identified that you can do now to progress your action plan?
- Focus on making small changes with clients and not underestimate listening and reflecting skills
- Awareness of the patient control re change and the facilitating by health professionals
- To meet and draw up a protocol.
- Review things currently doing to incorporate new information and knowledge gained.
8. Additional comments
- Very interesting and informative and presented in a very good way. I enjoyed the practical tasks
- Make sure there are more places available next time – very valuable course
- Have learnt new skills and built confidence.
- Good networking opportunity, collaboration with different health disciplines.
- So, so informative and helpful and relevant.
9. What we would like/need
-More access to dietetic support
-More time for weight management
-More support
10. What has happened as a result of the training?
This was hard to capture as the attendance at the follow up sessions was so disappointing. From those who attended, they reported the following changes:
-using a more structured approached
-feeling more confident about raising the issue and talking about weight
-focusing on key messages for diet and activity
-focusing on sustainable changes
-improved record keeping
-discussions with other staff and managers about the service and equipment e.g. scales
Comments from the Trainers
Overall the training was well received and the trainers all found it a good experience. Participants were all very keen to have training in this area to equip them to be more effective practitioners. Most described finding weight management as being very challenging and felt they need ongoing support to develop their skills.