Perceived barriers and facilitators to implementing a weight management programme in a primary care setting in Singapore: a qualitative study.

Abstract

Background: Obesity, a growing problem worldwide and locally, is a risk factor for many chronic conditions. Weight loss has been shown to improve health outcomes and weight management programmes are effective in achieving weight loss. However, the effectiveness and sustainability of weight management programmes are variable. The six-month, seven-touch-point Weight Management Programme (WeightWise) is a locally developed multidisciplinary programme based on the latest evidence and expert opinion. This study aimed to explore the perceived barriers and facilitators to delivering WeightWise prior to its implementation in the Singapore public primary care setting (polyclinics).

Methods: Between September 2023 and January 2024, a qualitative study was conducted across two polyclinics designated to pilot WeightWise. Twenty-six healthcare practitioners, including clinic directors, doctors, nurses, dietitians and physiotherapists, who would be involved in running WeightWise or referring patients to WeightWise, were interviewed by the researchers using an interview guide, in either a focus group or individually. Interviews were audio-recorded, transcribed verbatim, checked and analysed thematically using the NVivo software.

Results: The participants in this study expressed a gap in weight management in primary care and found WeightWise relevant and timely. However, they highlighted potential barriers to implementing WeightWise in terms of patient enrolment and programme delivery. For enrolment to WeightWise, the participants were concerned about a lack of prioritisation by the practitioners on weight management, time constraint, complex referral criteria and pricing. However, they highlighted potential facilitators to enrolment including targeting young and motivated patients, as well as identifying eligible patients at pre-consult vitals measurement stations. For WeightWise delivery, the perceived barriers were: increased workload for nurses, difficulty in accessing information on community exercise programmes, lack of weight management knowledge amongst practitioners, inconvenient programme timings and uncertainty in long-term benefits of WeightWise. The perceived facilitators to delivering WeightWise were: the use of remote care modalities, preventive care awareness through Healthier SG (a national health initiative), training programmes for practitioners and continuous peer support for patients.

Conclusion: This study identified the need to focus on both enrolment and delivery when implementing WeightWise. It also identified low prioritisation of weight management, lack of practitioner knowledge, lack of resources and costs as key barriers when implementing a weight management programme. Tailored healthcare professionals training, additional resources and cost analysis is recommended before its implementation.

Clinical trial number: Not applicable.