Today’s blog post is brought to you by Dr. Denise Campbell-Scherer and Melanie Heatherington. Dr. Campbell-Scherer, a Professor of Family Medicine and Associate Dean of the Physician Learning Program and Office of Lifelong Learning at the University of Alberta, and the lead investigator for the 5AsT Program. Melanie Heatherington is an Education Specialist with the Physician Learning Program and Research Coordinator for the 5AsT Program.
The 5As Team (5AsT) program of research aims to improve health through revolutionizing the prevention and management of obesity and related comorbidities in primary care. The team consists of interdisciplinary researchers, healthcare professionals, educators, and patient advocates who are dedicated to conducting methodologically rigorous, patient-centred, community engaged, mixed methods research in primary care. The 5AsT program focuses on pragmatic solutions to problems that occur in real-world practice. The team respects and seeks input from clinicians and people living with obesity.
The 5As Team Intervention project
Funded by an Alberta Innovates CRIO grant, the 5As Team (5AsT) partnered with the Edmonton Southside Primary Care Network to co-create a project to understand why frontline interdisciplinary team members were not conducting clinical obesity care despite being trained to do so. We worked together with frontline healthcare providers to understand what they wanted to learn to help them advance their skills; they identified 42 topics. We then used this information to develop an intervention with the aim of changing provider behaviour in order to improve obesity prevention and management in practice. The intervention was effective in addressing provider-identified gaps and lead to increased confidence in conducting obesity assessments and interdisciplinary work. Integration new knowledge required that providers change their own mental models of their practice and increased success was achieved when the entire team developed a new way of working together to integrate their different roles to support patients and each other.
5AsT tools to support collaborative conversations
Funded by CIHR this project focused on the improvement of 4 existing tools developed by the 5As Team research program. The tools aim to anchor our collaborative clinical approach. To understand how well the tools responded to the users’ needs, we developed three co-design workshops. We used personas, role playing, dialogue prompters, and prototypes to foster collaboration and communication between patients, health professionals and researchers. The first workshop helped to identify patients’ needs and expectations about the tools. It also helped develop performance specifications and a first prototype. Ten patients and ten healthcare providers participated in the other two design workshops to tailor the tools. We started an iterative design process to improve the design of the four tools. Information design principles were applied to enhance the effectiveness of the tools. The toolkit is available for download from our website: https://www.obesitycanada.ca/5as-team
5AsT – MD
A labour of love, the 5AsT-MD Course project reacted to the Lancet’s call in 2015 to improve training for healthcare providers in obesity prevention and management. 5AsT-MD is a comprehensive educational program that was developed, piloted, and refined for use with medical residents. The course combines didactic lectures, experiential learning, and clinical practice to provide learners with knowledge of the complexity and pathophysiology of obesity as well as an overview of therapeutic approaches, tools and resources to help them better care for their patient’s living with obesity. Evaluation of the 5AsT-MD pilot project shows increases of residents’ understanding of the complexity and chronicity of obesity, and improved confidence with their weight management practice. The course has now been implemented with residents in family medicine, pediatrics, psychiatry and internal medicine at the University of Alberta and under the direction of Dr. Sonja Wicklum, has been implemented within the family medicine residency program at the University of Calgary as well.
5AsT – Lifelong Learning
In partnership with the Office of Lifelong Learning the 5AsT-MD course has also been offered to practicing physicians, and interdisciplinary care providers as Continuing Professional Development. The workshop takes the learners outside of the classroom and engages them in activities to foster reflection about obesity discourse, to question assumptions, and promote understanding of what it is like to live with obesity. The workshop emphasizes experiential learning and incorporates didactic lectures. Learners have the opportunity to wear a bariatric suit, simulating the encumbrance of a larger body. In addition, learners explore a therapeutic approach that transforms clinical into collaborative deliberation about improving health within the specific life context of the individual patient, and practice the approach with tools that guide the conversation. To date we have trained over 400 learners, including physicians, residents, dietitians, nurses, pharmacists, and psychologists. We are now in the process of creating a virtual training course for obesity prevention and management that we will be launching soon.
Addressing clinical and social determinants of health to advance obesity and diabetes prevention and management in vulnerable newcomer ethnocultural communities
Funded by NOVAD, a collaborative grant between the University Hospital Foundation, the Alberta Government and Novo-Nordisk, this project extends the work to people who often fall outside the formal primary care system. Developing contextually appropriate interventions for people living with obesity and type 2 diabetes in vulnerable ethnocultural newcomer communities is a highly complex problem. To develop an intervention, we need to understand this problem more deeply. Our project seeks to understand care gaps through a mixed-methods approach that integrates population-level data about these communities with the perspectives of people with obesity and diabetes and interdisciplinary primary healthcare providers. Our coalition links community health workers, primary care providers, newcomer patients with obesity and diabetes, public health professionals, policy makers, and researchers to build the foundation for sustainable solutions to improve obesity/diabetes care for vulnerable populations.
Using NAPCReN data we have intergrated clinical and material/social deprivation data and analyze patterns of obesity, diabetes, and related comorbidities in newcomers to establish our baseline data. We will work with our stakeholders to co-design strategies with stakeholders to make the data clinically actionable for primary health care teams, community health workers, and policy makers.
We are in the process of conducting environmental audits and integrating this data with qualitative data on community perceptions to demonstrate gaps in care on a population level and inform design of personalized, actionable interventions.
The Multicultural Health Brokers (MCHBs) is an innovative Edmonton cooperative of community health workers committed to improving health equity by bridging cultural and social distance between newcomers, healthcare, social, and community services and systems. The Edmonton Southside Primary Care Network (ESPCN) is the largest Edmonton Zone PCN and aims to increase connectivity with the ‘health neighbourhood’ – community resources, including community health workers, to support needs of people with deficits in key determinants of health.
For further information, please visit our webpage at: https://www.obesitycanada.ca/5as-team
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