Article Figures & Data
Tables
ID Approximate length of interview, minutes Sex Clinician GP practice deprivation score(England 21.8) % aged <18 years in GP area(England: 20.7%) % unemployed in GP area(England: 4.4%) % obesity: QOF prevalence(England: 9.5%) 1 36:07 F GP 7.9 27.9 3.0 8.65 2 53:01 F GP 50.8 26.5 15.4 12.07 3 21:37 F GP 22.8 19.5 15.0 11.74 4 19:23 F GP 34.7 14.5 7.1 9.28 5 44:19 M GP 28.6 18.7 3.0 13.12 6 20:48 M GP 34.7 14.5 7.1 9.28 7 21:50 F GP 22.8 19.5 15.0 11.74 8 33:46 F Practice nurse 34.8 20.8 11.8 18.12 9 36:18 M GP 9.0 18.1 2.3 8.21 10 27:30 F GP 16.3 20.6 7.6 9.95 11 26:33 F GP 17.7 22.6 10.6 14.43 12 18:29 F GP 13.2 17.7 0.9 7.81 13 21:16 M GP 31.7 18.9 0.9 14.81 14 31:26 F Practice nurse 31.7 18.9 0.9 14.81 15 52:42 F GP 15.7 15.8 0.8 11.86 16 1:21:51 M GP 13.3 16.6 4.8 13.13 17 44:48 F GP 26.0 12.4 0.0 6.81 18 35:04 F Practice nurse 15.4 16.7 0.9 10.47 19 29:02 F GP (locum) 48.4 20.0 14.2 13.40 20 38:53 F Practice nurse 16.3 20.6 7.6 9.95 QOF = Quality and Outcomes Framework.
Sub-theme Example quotes Clinicians’ experiences using QoL tools in clinical practice 'I suppose I do use questionnaires. I use mood questionnaires for patients who are depressed or that sort of thing, use that sort of thing … But not for people who are overweight.' (P1, Female, GP)'I haven’t really used them, to be honest. I’m trying to think. The only thing … doing the questionnaire or anything I’ve not used specific quality-of-life tools. The only questionnaire thing I used to routinely give to patients is a PHQ9 about depression, but I don’t routinely use quality-of-life tools.' (P11, Female, GP)'I can’t remember using a quality-of-life tool. I know some exist so there’s the rheumatoid arthritis quality-of-life tool … What I’ve always preferred to use is just general talk and intuition.' (P16, Male, GP) Perceived advantages of QoL tools 'It will bring up a subject, doesn’t it, so it allows you to explore that subject a little bit more, and thinking about quality of life and maybe how we can improve it.' (P8, Female, practice nurse)'I think they can be very useful because I think they often just start a conversation. They’re a good opener to ask sometimes difficult questions.' (P12, Female, GP)'It’s useful for monitoring patients as well. So even for things like depression and so it’s something that you can work on and you can actually see this is what your score was before, it’s better now.' (P10, Female, GP) Divergent views of usefulness of QoL tools 'They can do in private and then it’s returned almost anonymously sometimes they can be more honest with their answers.' (P3, Female, GP)'If you’ve got a patient who wants to give an answer that they think the doctor will want or what they [the patient] actually wants to come out of [the consultation] at the end … the tool can actually do more harm than good.' (P16, Male, GP)'Some of them can be very long winded.' (P15, Female, GP)'I find it particularly useful partly because time is very precious in general practice and so anything that allows us to generate structured information that can be tracked over time without picking up a lot of time is helpful.' (P4, Female, GP) QoL = quality of life.
Sub-theme Example quotes Views of the level of focus on weight in the WAItE tool 'So I have to say I struggle a little bit with this tool because many of the questions, I think, are so non-specific.' (P4, Female, GP)'It could be really useful, but maybe not mentioning weight.' (P2, Female, GP) Views on the WAItE questionnaire length 'I think first of all on a positive it’s short and it’s easy to use, and I think that’s a real benefit to it.' (P15, Female, GP)'I definitely thought it was a good length, so I didn’t feel it was too long or too short or anything like that, which is good. I certainly think it’s long enough to get some decent information.' (P13, Male, GP) Clarity and relevance of WAItE tool items 'They [the questions] certainly look very relatable to children and young people.' (P11, Female, GP)'I thought it [the WAItE questionnaire] was quite simple and easy to look at, and I think it would be quite easy for them [young people] to understand.' (P14, Female, Practice nurse)'They [the questions] very much suit that age group.' (P12, Female, GP)'I think the questions would have been fine for that young man [a patient with Down’s syndrome].' (P2, Female, GP)'”People treat me differently when I go out” — differently to who? Differently to when I stay in, or differently to other people I go out with?' (P4, Female, GP)'I mean I don’t know how an 11 year old would … I think it all depends on what their mental status is and how smart they are for them to answer those questions.' (P10, Female, GP) Views on the WAItE tool response scale 'People are more likely to answer questionnaires like that where they’ve got tick-boxes.' (P18, Female, Practice nurse)'I also think you’ve got, in terms of “never, almost never, sometimes, often, and always”, that’s good. I like the fact you’ve got ”sometimes” in the middle. A lot of questionnaires don’t have an absolute in the middle.' (P13, Male, GP)'Now the questions of "never", "sometimes", "often", and "always", when would you say "sometimes" and when would you say "often"?' (P10, Female, GP)'I think if this was to generate a number or for example if somebody ticked "always" for everything, then that certainly could help.' (P16, Male, GP) WAItE = Weight-specific Adolescent Instrument for Economic-evaluation.
- Table 4. Supporting quotes for the 'Perceived challenges, benefits, and methods of implementing the WAItE tool' theme
Sub-theme Example quotes Using the WAItE tool during a clinical consultation 'A lot of people get the impression that a patient is going to think you’re trying to reduce them to a number by getting them to do a questionnaire. And that puts me off using them quite a bit at the end of the day.' (P13, Male, GP)'It makes it a bit more robotic … it can actually take out some of the interpersonal relationship that you have with the patient … actually what you may find if you do it the second way, in open questions, is you get so much information.' (P16, Male, GP)'It’s just much more subtle and its questions, I think, are really good … It’s actually opening a line of questioning for the future rather than just are you worried about your weight, would you like to make a change, which is very difficult to move from there.' (P3, Female, GP)'And it either works as a complete tick-box so you get a number from it, or as an opening to the consultation and discussion. You can use them either way, so if somebody came back with that I’d say “well, I never get tired and I can keep up, but I feel embarrassed shopping for clothes.” That would be the start of your conversation to intervene.' (P5, Male, GP)'We’re not very good at addressing the underlying problems, I think. When we do see children that are overweight we tend to deal with the sore throat or the rash or whatever it is they’ve come in with and forget to deal with it, and I think this [the WAItE] is a useful way of addressing it.' (P12, Female, GP) Ways to encourage clinicians to use the WAItE tool 'If it was something that was set in a guideline that this is the kind of gold standard for using then hopefully it would just become common practice.' (P14, Female, Practice nurse)'If you got a little flag that says … the little template to say “this person is between those ages, you haven’t got a BMI do you want to measure one?” Or it says “this person is within the age group and their BMI is above let’s say 30, here’s a questionnaire that comes straight up on the screen”, and then you can just hit the button so it’s done in 60 seconds.' (P5, Male, GP)'I think the key thing is that there needs to be a what happens at the end of it to be able to refer people on to or something.' (P19, Female, GP)'Giving out a questionnaire in my opinion is fine, but what we don’t want is those two actually then have no follow-up.' (P18, Female, Practice nurse) Suggestions of future clinical practice using the WAItE tool 'I guess the other thing is some forms I know these days are getting put into electronic format, like on apps where you can direct children to an app and get them to complete these things … so I guess that would be another thing that young people quite like.' (P7, Female, GP)'I was also thinking you might actually want to have a poster or something up in the waiting room with some of these questions.' (P2, Female, GP)'Patients, when they check-in, they use an electronic system just to check-in rather than coming to a reception desk … I’m not sure if there’s a way of putting questionnaires on there, is something I’ll have to ask the tech guys, but that might be a way of just doing it when somebody isn’t necessarily attending for a GP appointment.' (P12, Female, GP) WAItE = Weight-specific Adolescent Instrument for Economic-evaluation. BMI = body mass index.
Supplementary Data
- BJGPO.2021.0052.pdf -
Supplementary material is not copyedited or typeset, and is published as supplied by the author(s). The author(s) retain(s) responsibility for its accuracy.
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Implementing a weight-specific quality-of-life tool for young people in primary health care: a qualitative study
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