title: Research protocol: Management of obesity in patients with low health literacy in primary health care.
abstract: BACKGROUND
  Socioeconomically disadvantaged adults are both more likely to be obese and have lower levels of health literacy. Our trial evaluates the implementation and effectiveness of primary care nurses acting as prevention navigators to support obese patients with low health literacy to lose weight.
  
  
  METHODS
  A pragmatic cluster randomised trial will be conducted. Twenty practices in socioeconomically deprived areas, 10 each in Sydney and Adelaide, will be recruited and randomised to intervention and control groups. Twenty to 40 eligible obese patients aged 40-70 years with a BMI ≥ 30 kg/m(2) and with low health literacy will be enrolled per practice. The intervention is based on the '5As' of the chronic disease model approach - Assess, Advise, Agree, Assist and Arrange - and the recommendations of the 2013 Clinical practice guidelines for the management of overweight and obesity in adults, adolescents and children in Australia. In the intervention practices, patients will be invited to attend a health check with the prevention navigator who will assess the patient's risk and provide brief advice, assistance with goal setting and referral navigation. Provider training and educational meetings will be held. The providers' attitudes to obesity, confidence in treating obesity and preventive care they provide to obese people with low health literacy will be evaluated through questionnaires and interviews. Patients' self-assessment of lifestyle risk factors, perception of preventive care received in general practice, health-related quality of life, and health literacy will be assessed in telephone interviews. Patients' anthropometric measures will be recorded and their health service usage will be determined via linkage to the Australian government-held medical and pharmaceutical data.
  
  
  CONCLUSIONS
  Our trial will provide evidence for the effectiveness of practice nurses as prevention navigators to support better weight management for obese patients with low health literacy.
  
  
  BACKGROUND
  This trial is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12614001021662). Date registered 24/09/2014.
authors.affiliation: Centre for Obesity Management and Prevention Research Excellence in Primary Health Care, UNSW Australia, Sydney, Australia ; Centre for Primary Health Care and Equity, UNSW Australia, Sydney, Australia.
authors.forename: Nighat
authors.initials: N
authors.lastname: Faruqi
authors.affiliation: Centre for Obesity Management and Prevention Research Excellence in Primary Health Care, UNSW Australia, Sydney, Australia ; Discipline of General Practice, University of Adelaide, Adelaide, Australia.
authors.forename: Nigel
authors.initials: N
authors.lastname: Stocks
authors.affiliation: Centre for Obesity Management and Prevention Research Excellence in Primary Health Care, UNSW Australia, Sydney, Australia ; Centre for Primary Health Care and Equity, UNSW Australia, Sydney, Australia.
authors.forename: Catherine
authors.initials: C
authors.lastname: Spooner
authors.affiliation: Centre for Obesity Management and Prevention Research Excellence in Primary Health Care, UNSW Australia, Sydney, Australia ; Centre for Primary Health Care and Equity, UNSW Australia, Sydney, Australia.
authors.forename: Nouhad
authors.initials: N
authors.lastname: El Haddad
authors.affiliation: Centre for Obesity Management and Prevention Research Excellence in Primary Health Care, UNSW Australia, Sydney, Australia ; Centre for Primary Health Care and Equity, UNSW Australia, Sydney, Australia.
authors.forename: Mark F
authors.initials: MF
authors.lastname: Harris
keywords: Health literacy; Obesity; Prevention navigation; Primary care nurses; Weight management