Australian Journal of Primary Health Australian Journal of Primary Health Society
The issues influencing community health services and primary health care
RESEARCH ARTICLE (Open Access)

Is the Counterweight Program a feasible and acceptable option for structured weight management delivered by practice nurses in Australia? A mixed-methods study

Jodi Gray A B D , Elizabeth A. Hoon A , Hossein Haji Ali Afzali A , Catherine Spooner B C , Mark F. Harris B C and Jonathan Karnon A B
+ Author Affiliations
- Author Affiliations

A School of Public Health, University of Adelaide, Level 7, 178 North Terrace, Adelaide, SA 5005, Australia.

B Centre for Obesity Management and Prevention Research Excellence in Primary Health Care (COMPaRE-PHC), c/o CPHCE, University of NSW, Level 3, AGSM Building, Sydney, NSW 2052, Australia.

C Centre for Primary Health Care and Equity (CPHCE), University of NSW, Level 3, AGSM Building, Sydney, NSW 2052, Australia.

D Corresponding author. Email: jodi.gray@adelaide.edu.au

Australian Journal of Primary Health 23(4) 348-363 https://doi.org/10.1071/PY16105
Submitted: 26 August 2016  Accepted: 5 February 2017   Published: 11 May 2017

Abstract

Nurse-led weight management programs, like the Counterweight Program in the United Kingdom, may offer a way for Australian general practices to provide weight management support to adults who are overweight or obese. During Counterweight, nurses provide patients with six fortnightly education sessions and three follow-up sessions to support weight maintenance. This study examined the feasibility, acceptability and perceived value of the Counterweight Program in the Australian primary care setting using a mixed-methods approach. Six practice nurses, from three general practices, were trained and subsidised to deliver the program. Of the 65 patients enrolled, 75% (n = 49) completed the six education sessions. General practitioners and practice nurses reported that the training and resource materials were useful, the program fitted into general practices with minimal disruption and the additional workload was manageable. Patients reported that the program created a sense of accountability and provided a safe space to learn about weight management. Overall, Counterweight was perceived as feasible, acceptable and valuable by Australian practice staff and patients. The key challenge for future implementation will be identifying adequate and sustainable funding. An application to publically fund Counterweight under the Medicare Benefits Schedule would require stronger evidence of effectiveness and cost-effectiveness in Australia.

Additional keywords: general practice, obesity, overweight, primary care.


References

Afzali HHA, Karnon J, Beilby J, Gray J, Holton C, Banham D (2014) Practice nurse involvement in general practice clinical care: policy and funding issues need resolution. Australian Health Review 38, 301–305.
Practice nurse involvement in general practice clinical care: policy and funding issues need resolution.CrossRef |

Australian Bureau of Statistics (2013) Census of population and housing: Socio-Economic Indexes for Areas (SEIFA), Australia, 2011. (ABS: Canberra, ACT, Australia) Available at http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/2033.0.55.0012011?OpenDocument [Verified 1 February 2017].

Australian Institute of Health and Welfare (2014) ‘Australia’s Health 2014.’ (AIHW: Canberra, ACT, Australia)

Braun V, Clarke V (2006) Using thematic analysis in psychology. Qualitative Research in Psychology 3, 77–101.
Using thematic analysis in psychology.CrossRef |

Cant R (2010) Today’s profession: views and practices of private practice dietitians re Medicare Chronic Disease Management program. Nutrition & Dietetics: the Journal of the Dietitians Association of Australia 67, 77–83.
Today’s profession: views and practices of private practice dietitians re Medicare Chronic Disease Management program.CrossRef |

Colagiuri S, Lee CM, Colagiuri R, Magliano D, Shaw JE, Zimmet PZ, Caterson ID (2010) The cost of overweight and obesity in Australia. The Medical Journal of Australia 192, 260–264.

Counterweight Project Team (2008) Evaluation of the Counterweight Programme for obesity management in primary care: a starting point for continuous improvement. The British Journal of General Practice 58, 548–554.
Evaluation of the Counterweight Programme for obesity management in primary care: a starting point for continuous improvement.CrossRef |

Counterweight Project Team (2012) The implementation of the Counterweight Programme in Scotland, UK. Family Practice 29, i139–i144.
The implementation of the Counterweight Programme in Scotland, UK.CrossRef |

Department of Health (2014) ‘Annual Medicare Statistics – Financial Year 2007–2008 to 2013–14.’ (Commonwealth of Australia: Canberra, ACT, Australia)

Halcomb EJ, Davidson PM, Salamonson Y, Ollerton R, Griffiths R (2008) Nurses in Australian general practice: implications for chronic disease management. Journal of Clinical Nursing 17, 6–15.
Nurses in Australian general practice: implications for chronic disease management.CrossRef |

Halcomb EJ, Salamonson Y, Cook A (2015) Satisfaction and comfort with nursing in Australian general practice. Collegian 22, 199–205.
Satisfaction and comfort with nursing in Australian general practice.CrossRef |

Henderson E (2015) Obesity in primary care: a qualitative synthesis of patient and practitioner perspectives on roles and responsibilities. The British Journal of General Practice 65, e240–e247.
Obesity in primary care: a qualitative synthesis of patient and practitioner perspectives on roles and responsibilities.CrossRef |

Hetherington SA, Borodzicz JA, Shing CM (2015) Assessing the real world effectiveness of the Healthy Eating Activity and Lifestyle (HEALTM) program. Health Promotion Journal of Australia 26, 93–98.
Assessing the real world effectiveness of the Healthy Eating Activity and Lifestyle (HEALTM) program.CrossRef |

Hoare KJ, Mills J, Francis K (2012) The role of Government policy in supporting nurse-led care in general practice in the United Kingdom, New Zealand and Australia: an adapted realist review. Journal of Advanced Nursing 68, 963–980.
The role of Government policy in supporting nurse-led care in general practice in the United Kingdom, New Zealand and Australia: an adapted realist review.CrossRef |

Karnon J, Afzali HHA, Gray J, Holton C, Banham D, Beilby J (2013) A risk adjusted cost-effectiveness analysis of alternative models of nurse involvement in obesity management in primary care. Obesity 21, 472–479.
A risk adjusted cost-effectiveness analysis of alternative models of nurse involvement in obesity management in primary care.CrossRef | 1:STN:280:DC%2BC3srlvFSmuw%3D%3D&md5=641543fb866e648ca4431c87f4c8f37cCAS |

Malterud K, Ulriksen K (2011) Obesity, stigma, and responsibility in health care: a synthesis of qualitative studies. International Journal of Qualitative Studies on Health and Well-being 6, 8404
Obesity, stigma, and responsibility in health care: a synthesis of qualitative studies.CrossRef |

McInnes S, Peters K, Bonney A, Halcomb E (2017) The influence of funding models on collaboration in Australian general practice. Australian Journal of Primary Health 23, 31–36.
The influence of funding models on collaboration in Australian general practice.CrossRef |

Moroshko I, Brennan L, O’Brien P (2011) Predictors of dropout in weight loss interventions: a systematic review of the literature. Obesity Reviews 12, 912–934.
Predictors of dropout in weight loss interventions: a systematic review of the literature.CrossRef | 1:STN:280:DC%2BC3MbhslGrsw%3D%3D&md5=e0e683a2323e15f4be767f241ad4d341CAS |

National Health and Medical Research Council (2013) ‘Clinical practice guidelines for the management of overweight and obesity in adults, adolescents and children in Australia.’ (NHMRC: Melbourne, Vic., Australia)

National Institute for Health and Care Excellence (2014) Managing overweight and obesity in adults – lifestyle weight management services: NICE public health guidance 53. (NICE: London, UK) Available at www.nice.org.uk/guidance/ph53 [Verified 1 February 2017]

Nolan C, Deehan A, Wylie A, Jones R (2012) Practice nurses and obesity: professional and practice-based factors affecting role adequacy and role legitimacy. Primary Health Care Research and Development 13, 353–363.
Practice nurses and obesity: professional and practice-based factors affecting role adequacy and role legitimacy.CrossRef |

Pearce C, Phillips C, Hall S, Sibbald B, Porritt J, Yates R, Dwan K, Kljakovic M (2011) Following the funding trail: financing, nurses and teamwork in Australian general practice. BMC Health Services Research 11, 38
Following the funding trail: financing, nurses and teamwork in Australian general practice.CrossRef |

Prochaska JO, Diclemente CC, Norcross JC (1992) In search of how people change. The American Psychologist 47, 1102–1114.
In search of how people change.CrossRef | 1:STN:280:DyaK3s%2Fjs1OnsA%3D%3D&md5=4255e31aae6be521ece1cb7e9b9d926eCAS |

Puhl RM, Heuer CA (2009) The stigma of obesity: a review and update. Obesity (Silver Spring) 17, 941–964.
The stigma of obesity: a review and update.CrossRef |

Sargent GM, Forrest LE, Parker RM (2012) Nurse delivered lifestyle interventions in primary health care to treat chronic disease risk factors associated with obesity: a systematic review. Obesity Reviews 13, 1148–1171.
Nurse delivered lifestyle interventions in primary health care to treat chronic disease risk factors associated with obesity: a systematic review.CrossRef | 1:STN:280:DC%2BC38bmsFOnsg%3D%3D&md5=031050c073d532fede054420e5b66829CAS |

Spahlholz J, Baer N, König H-H, Riedel-Heller S, Luck-Sikorski C (2016) Obesity and discrimination – a systematic review and meta-analysis of observational studies. Obesity Reviews 17, 43–55.
Obesity and discrimination – a systematic review and meta-analysis of observational studies.CrossRef | 1:STN:280:DC%2BC28vksVejug%3D%3D&md5=2d63de2edad93ea501001afc2c5c46ffCAS |

Wood DA, Kotseva K, Connolly S, Jennings C, Mead A, Jones J, Holden A, De Bacquer D, Collier T, De Backer G, Faergeman O (2008) Nurse-coordinated multidisciplinary family based cardiovascular disease prevention programme (EUROACTION) for patients with coronary heart disease and asymptomatic individuals at high risk of cardiovascular disease: a paired cluster-randomised controlled trial. Lancet 371, 1999–2012.
Nurse-coordinated multidisciplinary family based cardiovascular disease prevention programme (EUROACTION) for patients with coronary heart disease and asymptomatic individuals at high risk of cardiovascular disease: a paired cluster-randomised controlled trial.CrossRef | 1:STN:280:DC%2BD1czoslWktA%3D%3D&md5=1c79861100db815ccc7f4d093e2da606CAS |


Full Text PDF (268 KB) Export Citation

View Altmetrics