Patient views on supplementing dietetic interventions and the potential of text messaging in primary care: a focus group study

Abstract

Background: There is a critical need for effective weight management and long-term condition treatment. In New Zealand, Māori, Pacific, and people living in areas of high deprivation experience obesity, overweight and long-term conditions at a proportionately higher extent compared to the rest of the population. Dietetic counselling within primary care is one way to address these issues and improve health outcomes. Fostering adherence to lifestyle goals in a patient’s everyday environment is likely to assist in the treatment and management of obesity and the associated long term conditions. In order to develop adjunct interventions for between dietetic consultations, that suit those they are intended to serve, patient input should be sought to inform interventions. mHealth (mobile Health) text messaging interventions have the potential to supplement dietetic intervention. Before clinical initiation, the acceptability of the use of text messaging in this setting needs to be explored. To maximise the success of a text messaging intervention it is important to seek patient input to align the development with their wants and needs. Objective: Explore overweight and obese patients’ perceptions of what could enhance dietetic interventions in primary care, and how patients perceive text messaging as an adjunct to dietitian counselling to support them to achieving their health related goals. Design: The research was based at Te Awakairangi Health Network a primary healthcare organisation in Lower Hutt, Wellington. A qualitative approach was utilised for this study using focus groups for the collection of relevant perspectives and opinions. Following a review of the literature, an interview schedule was developed to guide focus group discussions to address the research objectives. Focus group participants were selected by purposive sampling. Overweight and obese adults who were Māori, Pacific, or living in an area of high deprivation, who had partaken in an appointment with a dietitian between January 2015 and August 2015, were eligible for inclusion in the study. The focus group audio recordings were transcribed and thematically analysed. Themes were organised into a framework relating to the research objectives. Results: Twenty-one participants took part in one of five focus groups. Thematic analysis indicated that participants seeing dietitians believed that an increase in social support from family, the dietitian, and from peers going through similar experiences would further help them to achieve their lifestyle related goals. Participants also described that being informed about their health and the use of informational tools given to them by the dietitian had been helpful in making lifestyle changes. Participant responses established that the idea of text messaging between the dietitian and patient in this setting was positively received. Participant preferences for this kind of intervention included a desire for a high level of personalisation of text messages to the individual, as well as for the content of messages to be motivational, informational, and goal related. The idea of being in more frequent contact with their dietitian generated positive responses from participants. Conclusion: This study elicited perspectives from patients in a dietetic primary care setting about what could improve the achievement of weight management goals in their daily environment. Participants perceived that adjunct interventions in this setting would be helpful to them if they included social support. Text messaging if personalised, as a way to support patients to achieving their goals is acceptable to this population