Changing provider behaviour to increase nurse visits for obesity in family practice: the 5As Team randomized controlled trial

BACKGROUND: There is increasing recognition that health care professionals often fail to provide meaningful obesity care in routine clinical practice. There is scant information on how to support practice change. The objective of the 5AsT trial was to assess whether a co-created educational intervention would increase the quantity of obesity visits conducted by family practice nurses. METHODS: We conducted a randomized controlled trial with convergent mixed-methods evaluation in a primary care network in Alberta, Canada. The intervention, based on the Theoretical Domains Framework and 5As of Obesity Management, included 12 2-hour interactive educational sessions from November 2013 to April 2014. Twenty-four teams of nurses, mental health workers and dietitians were randomly assigned to receive the intervention or regular training. The primary outcome measure was the rate ratio of nurse visits for adult obesity care to total clinical visits. Qualitative thematic analysis was previously used to identify barriers and facilitators to intervention uptake. In this study, mixed-methods analysis assessed the impact of these factors on individual nurses' outcomes. RESULTS: There was no significant increase in visits over the 6-month intervention (rate ratio 1.30, 95% confidence interval [CI] 0.83-2.03) nor the 9-month post-intervention period (rate ratio 1.38, 95% CI 0.87-2.19). However, provider confidence, views of obesity management, role identity and team and patient relationships were found to affect individual nurses' uptake of the intervention. INTERPRETATION: ClinicalTrials.gov, no. NCT01967797.