|Year : 2014 | Volume
| Issue : 2 | Page : 54-58
Knowledge, attitude and practice of primary health care physicians in Aseer region regarding obesity
Yahia M Al-Khaldi1, Waleed S Abu Melha2, Abdullah M Al-Shahrani3, Safar A Al-Saleem3, Mohammed A Hamam3
1 Department of Family Medicine and Research, Forces Armed Hospital, Southern Region, Aseer Region, Saudi Arabia
2 Preventive Medicine, Forces Armed Hospital, Southern Region, Aseer Region, Saudi Arabia
3 Department of Public Health, Directorate General of Health Affairs Aseer Region, Saudi Arabia
|Date of Web Publication||18-Dec-2014|
Safar A Al-Saleem
P.O. Box: Wasel 4809 unit No. 1 Khamis Mushayt 62431 7509, Wasel Aalami -SP 637725281
Source of Support: None, Conflict of Interest: None
Background: Obesity is one of the most common chronic diseases that could be managed at PHCC settings. Objectives: The objective of this study was to explore knowledge, attitudes, and practice of PHCC physicians in Aseer region, regarding obesity. Materials and Methods: This cross-sectional study was conducted among physicians working at PHCC in 2012. In order to achieve the objectives of this study, the investigators designed a questionnaire which composed of three parts namely; sociodemographic data, knowledge related questions, attitude related questions, practice related questions in addition to some questions related to infrastructures, and barriers facing management of obesity at PHCC. Questionnaire was distributed to all PHCC doctors using post. Data entry and statistical analysis was carried out using SPSS version 21. Results: The total number of doctors responded was 294 out of 339, giving a response rate of (87%). Mean age of participants was 38 year, male represented 63%, 61% had no post MBBS qualification and one third are working in big cities. More than 50% of centers were having registers, guidelines and screening program for obesity. The most common encountered barriers to care for obesity at PHCC were lack of (time, health education materials, guideline and referral system). Most of physicians showed good attitude regarding management of obesity compared to knowledge which was inadequate as reflected by total knowledge score which was less than 7 points among 64% of participants. More than half of participants reported that they gave advices about the roles of diet, exercise in management of obesity to their clients. Conclusion: This study revealed that PHCCs in Aseer region need adequate infrastructures to care for obese patients while PHCC doctors are in need of training to improve their knowledge and develop their skills in order to introduce good care for their obese patients.
Keywords: Knowledge, attitude, practice, obesity, primary care centers, Saudi Arabia
|How to cite this article:|
Al-Khaldi YM, Abu Melha WS, Al-Shahrani AM, Al-Saleem SA, Hamam MA. Knowledge, attitude and practice of primary health care physicians in Aseer region regarding obesity. Saudi J Obesity 2014;2:54-8
|How to cite this URL:|
Al-Khaldi YM, Abu Melha WS, Al-Shahrani AM, Al-Saleem SA, Hamam MA. Knowledge, attitude and practice of primary health care physicians in Aseer region regarding obesity. Saudi J Obesity [serial online] 2014 [cited 2019 Nov 15];2:54-8. Available from: http://www.saudijobesity.com/text.asp?2014/2/2/54/147343
| Introduction|| |
Obesity and overweight affect more than 75% of Saudi citizens according to many national studies and surveys that were conducted in Saudi Arabia during the past two decades. ,,,,,, Many causes of obesity were mentioned in some of these studies mainly sedentary life styles and unhealthy diet intake. [8-11] In Saudi Arabia, there is more than 2200 PHCCs with more than 7000 PHCC physicians who are responsible for providing promotive, preventive, and curative measures for Saudis.  These health care providers could manage overweight and obesity if they are clinically competent and have adequate infrastructures in their health care settings. In spite of the important roles of PHCCs in management chronic diseases such as diabetes and hypertension which were reported in many studies, there is one single report about this issue regarding management of obesity in PHCC in Saudi Arabia.  The aim of this study is to explore knowledge, attitude, and practice of PHCC physicians regarding obesity in Aseer region, Saudi Arabia.
| Materials and methods|| |
This study was conducted among PHCC physicians in Aseer region, southwest of Saudi Arabia by 2012. The investigators designed the questionnaire based on some research conducted in this regard. ,, It consisted of the following parts: first part was about socio-demographic data, types of services and activities provided to obese patients, availability of infrastructures to care for obesity, professional competency to manage obese patients, barriers facing management obesity at PHCC, attending training courses in obesity and roles of PHCC physician in management of obesity. The second part consisted of eleven statements about attitude of PHCC toward obesity. The third part consisted of eight statements about practice of PHCC physicians regarding obesity. Statements of attitude were assessed based on scale (3 agree, 2 neutral, 1 disagree, 0 no comment). The last part consisted of ten statements which assessed the knowledge among the participants. This part was constructed based on national studies and clinical guideline of obesity published by SIGN.  Participant was considered to have good knowledge if he/she scored 7 points or more out of ten points. Before conducting the study, four family medicine consultants reviewed the questionnaire and pilot study was conducted on 20 PHCC doctors to test the questionnaire reliability. These 20 doctors were not included in this study. The questionnaire was distributed by post to all physicians working at PHCCs and requested to reply within 2 weeks. In order to get high response rate, another reminding letters were sent to those who did not submit the questionnaire after 2 weeks of the first letter. Data were coded and entered to computer provided with the SPSS version 21. Statistical analysis was carried out using the appropriate tests and considering P values as significant if less than 0.05.
| Results|| |
The total number of physicians participated in this study was 294 out of 339 physicians working in PHCCs in Aseer region, giving a response rate of (87%). [Table 1] depicts the characteristics of participants. About two-third was males, 61% have MBBS qualification, with a median of seven year experience in PHCC. [Table 2] showed some infrastructures, types of services available and barriers facing management of obesity at PHCCs.
|Table 1: Socio-demographic characteristics of PHCC physicians, Aseer, 2012|
Click here to view
|Table 2: Physicians' opinions regarding the Structure/services introduced and barriers to care for obese patient in PHCC, Aseer region, 2012|
Click here to view
More than 50% of PHCCs have registers, guidelines and screening program. Less than half of participants mentioned that they counseled obese patients about diet, 36% about exercise, 10% prescribed drugs and 15% referring obese to hospitals. Lack of time was the most common reported barrier (41%), lack of health education materials (36%), lack of guideline (29%) and lastly lack of effective referral system (22%). Regarding personal related barriers; lack of skills (18%), negative attitude (11%), and lack of knowledge (10%) while more than 1/3 mentioned that they did not attend training course about obesity. [Table 3] shows the assessment of knowledge regarding obesity among participants physician. About 70% were able to know the prevalence of obesity among Saudi adults and to define morbid obesity, 51% knew the most common causes of obesity, 66% knew the degree of weight that could be reduced by using anti-obesity drugs, 59% recognized the common cause of weight regain, 53% correctly knew the weekly target of weight loss and the first choice of anti-obesity drug. About 70% mentioned the appropriate method for screening for obesity while 10% knew the indications for prescribing anti-obesity drugs.
Generally, just above one-third of participants (36%%) got 7 points out of 10 scores for knowledge. [Table 4] shows attitudes of PHCC toward management of obesity, more than 90% mentioned that PHCC doctors have important role to manage obesity and 90% of participants strongly agreed that adult with normal weight should be advised by his GP to maintain his weight, 82% strongly agreed that even small weight loss can produce important medical benefits, 66% disagreed regarding the best role for GPs in management obesity, 77% strongly disagreed regarding offering advice to obese patient only when he requested, 57% pointed out that they are competent to treat patient with overweight compared to 41% to treat patient with obesity while 59% stated that management of obesity is difficult comparing to management of diabetes or hypertension. [Table 5] depicts the responses of participants regarding some practical points concerning management of obese patients in PHCCs. Most of participants mentioned that they advised their obese patients regarding physical activity (79%), lower excess calorie intake (73%), reduce dairy foods (48%) increase intake of fruits and vegetables (76%), and to reduce watching TV (70%).
Studying the association between the mean score of knowledge and gender revealed no significance, excluding the missing data (males scored 5.8 points VS 5.3 points, P = 0.09, CI(−0.75 to 0.98). It was found that the total score of knowledge was not affected by qualification, attending training course or availability of guideline at PHCC, degree of competency and degree of experience. Further analysis revealed that those who attended training course mentioned that they are competent (X2 = 12, P = 0.02). Those whose PHCC have guidelines mentioned that they were more competent (X2 = 11, P = 0.03) and more expert in managing obesity (X2 = 12, P = 0.002).
|Table 3: Knowledge of PHCC physicians about obesity in Aseer region, KSA, 2012|
Click here to view
|Table 4: Attitude of PHC physicians towards management of obesity in Aseer region, 2012|
Click here to view
|Table 5: Practice of physicians regarding management obesity in PHCC, Aseer region, KSA, 2012|
Click here to view
| Discussion|| |
One of the vital role of PHCC doctors is managing common health problems including overweight and obesity.  This study tries to explore the knowledge, attitude and practice of doctors working in PHCCs in Aseer region regarding obesity. Results of this study revealed that more than 90% of doctors agreed that they have important role in management of obese patients. This figure reflects that PHCC have positive attitude which may affect their practice regarding management of obesity and it is similar to that reported among Australian GPs.  In this study, it was found that the average number of obese patients seen at PHCC was four patients per month per doctor which indicates the increased number of obesity seen in PHCC as reported earlier. 
Regarding infrastructures needed for introducing good care for obese, it was obvious that there is shortage in most of items such as registers (53%), guideline (54%) and screening program (61%), lack of health education materials (36%), counseling about diet and exercise (47%, 36%), availability of drugs (10%), and effective referral to hospitals (15%). These important items should be provided as soon as possible in order to enable PHCC physicians to care for obese patients efficiently.
The other essential aspect of obesity care is relating to lack of knowledge, attitude and skills among PHCC doctors (competency of PHCC doctors). This study revealed that large number of doctors were lacking of adequate knowledge as only 36% of them had seven scores or higher concerning essential knowledge about obesity and 85% reported that they were not adequately competent to manage obesity. In a study conducted by Sebiany (2013) in eastern region of KSA, he found that knowledge of PHCC doctors regarding obesity was inconsistent according to given questions  which emphasize the importance of training and continuous professional development of PHCC doctor in this subject.
Regarding attitude, it was found that 11% showed negative response while 59% thought that management of obese patient is considered difficult compared to management patients with diabetes or hypertension. In one study conducted in Australia, most of GPs felt confidence to manage patients with obesity.  These defects in attitude could be due to inadequate training which was reported by 35% of them in addition to lack of clinical guidelines. In order to improve the knowledge, attitude and skills, PHCC doctors should be given adequate training including lectures, workshops and provided with evidence based guideline and make easy access with consultant in nearby hospitals.
Despite shortage in infrastructures, some services were introduced to manage obesity. One of the most important service is screening which was reported by 44%, counseling (36-47%) and referral to hospital (15%). These efforts should be appreciated particularly in absence of logistic support such as training, availability of drugs and lack of effective referral system.
More than 2/3 of participants agreed that obesity prevention should target every patient even those with normal BMI, while 78% agreed that patients with DM or HTN should be the primary target of obesity prevention. These figures are comparable to that reported from France (88% and 67% respectively).  Regarding advice about physical activity and lowering calorie intake as primary targets to prevent obesity, 79% and 73% agreed and did such interventions for their patients. These figure were less than that reported by Thunan and Avignon (97% and 98% respectively) and that reported from Iraq (94% for physical exercise and 91% for lowering calories intake but higher than that reported from USA (46%). ,, Advice to increasing fruits and vegetables was agreed by 76% which is slightly lower than reported from USA (81%).  About 70% of the participants advised their obese patients to reduce duration of watching TV. This figure is lower than that reported by Iraqi family physicians (82%) but higher than that reported by non-family physician from the same study (54%). 
Based on the findings of this study the following recommendations are suggested to provide high quality health care services to control and treat patients at high risk or suffer from obesity.
- All PHCCs should be provided with essential infrastructures such registers, clinical guideline, health education materials and anti-obesity drugs
- Doctors and health professional teams at PHCC should be given training about obesity including national guideline for prevention and management of obesity.
- Effective referral system from PHCCs to hospitals should be emphasized particularly for morbid and obese patients with comorbidities.
| Conclusion|| |
This study revealed that most of PHCC in Aseer region lack the essential infrastructures and PHCCs physicians lack essential knowledge and skills to care for obese patients. In order to introduce high quality health services for obese patients, urgent provision of PHCCs with the above mentioned infrastructures are highly recommended in addition to conduct short training course for doctors and health professional teams working at PHCCs.
| References|| |
Al-Nozha MM, Al-Mazrou YY, Al-Maatouq MA, Arafah MR, Khalil MZ, Khan NB, et al
. Obesity in Saudi Arabia. Saudi Med J 2005;26:824-9.
Al-Othaimeen AI, Al-Nozha M, Osman AK. Obesity: An emerging problem in Saudi Arabia. Analysis of data from the National Nutrition Survey. East Mediterr Health J 2007;13:441-8.
Al-Daghri NM, Al-Attas OS, Alokail MS, Alkharfy KM, Yousef M, Sabico SL, et al
. Diabetes mellitus type 2 and other chronic non-communicable diseases in the central region, Saudi Arabia (Riyadh cohort 2): A decade of an epidemic. BMC Med 2011;9:76.
Al-Baghli NA, Al-Ghamdi AJ, Al-Turki KA, El-Zubaier AG, Al-Ameer MM, Al-Baghli FA. Overweight and obesity in the eastern province of Saudi Arabia. Saudi Med J 2008;29:1319-25.
Al-Hazzaa HM. Prevalence and trends in obesity among school boys in Central Saudi Arabia between 1988 and 2005. Saudi Med J 2007;28:1569-74.
Al-Saleem SA. Al-Shahrani AM, Al-Khaldi YM. Obesity among patients attending primary care centers, Aseer Region, Saudi Arabia. Saudi J Obes 2013;1:67-70.
Bin Horaib G, Al-Khashan HI, Mishriky AM, Selim MA, Alnowaiser N, Binsaeed AA, et al
. Prevalence of obesity among military personnel in Saudi Arabia and associated risk factors. Saudi Med J 2013;34:401-7.
Mahfouz AA, Shatoor AS, Khan MY, Daffalla AA, Mostafa OA, Hassanein MA. Nutrition, physical activity, and gender risks for adolescent obesity in Southwestern Saudi Arabia. Saudi J Gastroenterol 2011;17:318-22.
Al Qauhiz NM. Obesity among Saudi Female University Students: Dietary Habits and Health Behaviors. J Egypt Public Health Assoc 2010;85:45-59.
Amin TT, Al-Sultan AI, Ali A. Overweight and obesity and their relation to dietary habits and socio-demographic characteristics among male primary school children in Al-Hassa, Kingdom of Saudi Arabia. Eur J Nutr 2008;47:310-8.
Al-Nozha MM, Al-Hazzaa HM, Arafah MR, Al-Khadra A, Al-Mazrou YY, Al-Maatouq MA, et al
. Prevalence of physical activity and inactivity among Saudis aged 30-70 years. A population-based cross-sectional study. Saudi Med J 2007;28:559-68.
King Dom of Saudi Arabia, Ministry Of Health, Department of statistics. Location: Health Statistical Year Book; 2011. p. 118, 238.
Sebiany AM. Primary care physicians′ knowledge and perceived barriers in the management of overweight and obesity. J Family Community Med 2013;20:147-52.
Thuan JF, Avignon A. Obesity management: Attitude and practice of French general practitioners in a region of France. Int J Obes (Lond) 2005;29:1100-6.
Buffart LM, Allman-Farinelli M, King LA, van der Ploeg HP, Smith BJ, Kurko J, et al
. Are general practitioners ready and willing to tackle obesity management? Obes Res Clin Pract 2008;2:189-94.
Campbell C, Engel H, Timperio A, Cooper C, Crawford D. Obesity management: Australian General Practitioners′ attitude and practice. Obes Res 2000;8:459-66.
Scottish Intercollegiate Guidelines Network (SIGN). Management of Obesity National Clinical Guideline 2010.
Al-Gelban KS, Al-Khaldi YM, Diab MM. Family Medicine: A Practical Approach. Obesity and Overweight. 1 st
ed. Saudi Arabia, 2007. p. 307-13.
Habib HA, Abdul Rahman Y, Al-Khalid IM. Knowledge, attitude and practice regarding obesity management among family and Non Family Physicians working in primary care centers in Baghdad. Iraqi Postgrad Med J 2012;11:6-12.
Ferrante JM, Piasecki AK, Ohman-Strickland PA, Crabtree BF. Family Physicians′ Practice and attitudes regarding care of extremely obese patient. Obesity 2009;17:1710-6.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]