Award Date

5-15-2018

Degree Type

Dissertation

Degree Name

Doctor of Nursing (ND)

Department

Nursing

First Committee Member

Michael Johnson, Ph.D.

Second Committee Member

Alona Angosta, Ph.D.

Third Committee Member

James Navalta, Ph.D.

Number of Pages

93

Abstract

Many Americans are either overweight or obese, but commercial truck drivers are at an even higher risk by nature of their occupation. The 2010 Survey of U.S. Long-Haul Truck Drivers found that 22.8% were overweight, 68.9% were obese, and 17.4% were considered morbidly obese. The concern is that obesity is a gateway to multiple medical disorders, to include obstructive sleep apnea, cancer, diabetes, and cardiac disease. Despite growing concerns of obesity, healthcare providers face problems when counseling and discussing the issue with patients. The failure of healthcare providers to discuss obesity or the impending issue with patients (i.e., truck drivers) can lead to negative consequences, and the lack of weight management counseling and discussions can lead to poor health-related outcomes.

The purposes of the doctoral in nursing practice (DNP) project were to 1) determine healthcare providers’ attitudes, beliefs, and perceived self-efficacy when counseling overweight and obese truck drivers and 2) preliminarily evaluate whether an evidence-based obesity counseling tool could improve healthcare providers’ perceived self-efficacy when counseling overweight and obese truck drivers. To accomplish this practice intervention DNP project, healthcare providers at PepsiCo clinics from around the country were recruited to voluntarily participate.

Prochaska and DiClemente’s Transtheoretical Model (or Stages of Change) was used to support the theoretical framework for the DNP project. The Transtheoretical Model represents change as an ongoing process that involves a series of six stages over time: pre-contemplation, contemplation, preparation, action, maintenance, and termination. This model was used to support the development and implementation of the intervention.

Participants’ self-efficacy in counseling obese and overweight truck drivers was assessed in the pre- and post-webinar-based practice intervention using the Attitudes Toward Obese Persons Scale (ATOP), Beliefs About Obese Persons Scale (BAOP), and healthcare provider General Self-Efficacy Scale (GSES). The ATOP scale had twenty questions that measured attitudes regarding obesity, and the BAOP scale had eight questions designed to measure beliefs regarding obesity (Gujral, Tea, & Sheridan, 2011). The greater the score on the ATOP and BAOP scales, the more favorable the attitudes and beliefs held by a healthcare provider regarding an obese truck driver. The GSES was used to query the healthcare provider regarding one’s competence with difficult patient situations, such as counseling a truck driver on obesity.

The setting for this project was select on-site wellness clinics across the country that were associated with the Pepsi Beverages Company and managed by the Johns Hopkins Division of Occupational and Environmental Medicine, a large non-profit teaching hospital. Healthcare providers from this setting were recruited to participate in the study. The participants completed identical pre- and post-webinar-based practice intervention surveys that included the ATOP, BAOP, and GSES questionnaires. All data were collected anonymously through online questionnaires using the Qualtrics website. The DNP student distributed the survey web link to all participants via email. The dissertation chair and DNP student analyzed the statistical data using IBM SPSS Statistics for Windows, version 23. The first data analysis phase occurred immediately after the pre-intervention data were collected. The purpose of this phase was to analyze the data for descriptive statistics to inform the development of the intervention.

The intervention was a webinar-based practice intervention that used evidenced-based tools to help healthcare providers when counseling obese truck drivers. The webinar presentation was based on three evidence-based tools used for obesity counseling: the Maine Youth Overweight Collaborative program, the Five A’s framework on obesity counseling, and the U.S. Department of Health and Human Services obesity counseling algorithm. The 60-minute webinar consisted of a 45-minute presentation followed by a 15-minute question and answer session.

Healthcare providers who participated in the pre-webinar survey questionnaires and webinar-based practice interventions received a second survey questionnaire link identical to the first for completion. The second data analysis phase occurred after the post-intervention data were collected. The purpose of this phase was to compare the pre- and post-intervention data. The pre- and post-intervention data were first coded to the instrument instructions and then inputted into SPSS. Then, frequency and descriptive statistics (mean and standard deviation) were conducted to evaluate for trends between the pre- and post-intervention data. Although the goal was to conduct independent t-tests, the sample sizes were too small.

The project identified improved healthcare provider attitudes toward obese patients and beliefs that obesity was not under an obese person’s control. Further, post-intervention surveys identified an improvement in healthcare provider self-efficacy when counseling obese patients (i.e., truck drivers) with the use of evidenced-based tools, including specific, measurable, achievable, realistic, and time-bound (i.e., SMART) goals. Improving the communication between providers and truck drivers theoretically should result in more honest and effective conversations about weight management. This could ultimately result in improved weight management in overweight and obese truck drivers, leading to improved health.

Keywords

Counseling Overweight Truck Drivers; Evidenced-Based Tools & Obesity Bias Training; Obesity; Obesity Bias Training; Overweight Truck Drivers; Truck Drivers & Obesity

Disciplines

Nursing

Language

English


Included in

Nursing Commons

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