care providers and administrators from WVPBRN sites to minimize the number of survey requests sent to these practices each year . Proposals for CORE survey questions are submitted by investigators interested in primary care perspectives , and state-specific health priority areas are considered when deciding which questions to include . A snowball convenience sampling technique was used as members of WVPBRN were encouraged to share the survey with colleagues within their health systems . The link to the survey was emailed to practice sites with a personalized greeting between March 25th , 2020 and May 1st , 2020 . Retention of participants was addressed by sending nonresponders three follow-up emails .
Members of the research team ( L . D . and T . H .) collaborated with the West Virginia Clinical and Translational Sciences Institute and the Design Studio of WVPBRN to develop the proposed questions which were ultimately selected for inclusion in the 2020 CORE survey . The survey consisted of eight questions with subsections that assessed perception of needs for caring for patients with obesity in WV . It evaluated respondents ’ knowledge of obesity topics and confidence in managing several aspects of obesity treatment in clinical practice . Moreover , the survey aimed to measure interest in topics for future obesity medical education courses and best modalities for delivery of education . Attitudes regarding obesity and obesity management needs were topics covered in the survey that were not directly related to medical education , so are described in a separate manuscript . Respondents were able to skip questions throughout the survey .
Survey results were analyzed using descriptive statistics to summarize demographics ; obesity treatment knowledge and confidence ; topics of interest ; and preferred educational delivery methods . The responses , such as strongly agree and agree , on the four-point Likert scale were merged into one variable . The same procedure was conducted for the negative responses . This approach dichotomized the survey responses to obtain more clear perspectives about obesity management needs in the state . Non-responders for each section were removed from the analysis .
RESULTS
Survey responses from 17 different health systems around WV were captured in REDCap , a secure web-based application for building and managing online surveys and data bases . The number of respondents varied by question with a maximum of 83 and a minimum of 71 participants . Out of the 83 needs assessment participants , 72 were clinicians ( physicians , nurse practitioners , and physician assistants ) ( Figure 1 ). The majority of specialties represented in the survey were from primary care , most commonly family medicine ( Figure 2 ).
The majority of needs assessment respondents agreed there is a need to strengthen medical training ( 96.4 %, n = 80 / 83 ). Additionally , most felt obesity intervention is part of the scope of primary care practice ( 98.8 %, n = 82 / 83 ). The survey aimed to assess the obesity medicine base knowledge of health care professionals in WV ( Table 1 ). Knowledge was reported as highest in the topics of obesity pathophysiology and causes ( 94.0 %, n = 78 / 83 ), food / diet / nutrition ( 90.4 %, n = 75 / 83 ), and behavior changes for weight loss ( 89.0 %, n = 73 / 82 ). Knowledge was reported as lowest (< 75 % respondents total ) among WV clinicians in bariatric surgery ( 62.2 %, n = 51 / 82 ) and anti-obesity medications ( 62.7 %, n = 52 / 83 ).
In terms of managing obesity , respondents reported having the most confidence in counseling about food , diets , and nutrition ( 95.1 %, n = 78 / 82 ), as well as motivational interviewing for behavior change to help with weight manage ment ( 80.7 %, n = 67 / 83 ). Lower confidence (< 75 % respondents total ) was reported in addressing the topics of optimizing chronic medications for weight management ( 61.0 %, n = 50 / 82 ), counseling / managing patients before / after bariatric surgery ( 52.4 %, n = 43 / 82 ), and prescribing anti-obesity medications ( 49.4 %, n = 40 / 81 ) ( Table 2 ).
For future obesity education courses , the topics with the highest reported level of interest were strategies for discussing weight with patients ( 87.2 %, n = 68 / 78 ), food and nutrition ( 85.7 %, n = 66 / 77 ), physical activity plans ( 84.4 %, n = 65 / 77 ), motivational interviewing ( 84.0 %, n = 63 / 75 ), optimizing chronic medications for weight management ( 79.2 %, n = 61 / 77 ), obesity pathophysiology ( 78.8 %, n = 61 / 78 ), and psychology related to weight management ( 78.2 %, n = 61 / 78 ). The categories with lower level of interest (< 75 % respondents favoring ) were reported in billing ( 71.8 %, n = 56 / 78 ), bariatric surgery ( 71.8 %, n = 56 / 78 ), meal replacement programs ( 70.5 %, n = 55 / 78 ), group medical appointments ( 68.8 %, n = 53 / 77 ), prescribing anti-obesity medications ( 67.5 %, n = 52 / 77 ), medico-legal issues related to obesity treatment ( 65.4 %, n = 51 / 78 ), and managing obesity around pregnancy ( 64.1 %, n = 50 / 78 ) ( Table 3 ). However , it is noted that despite them being rated relatively lower , a majority of participants ( more than 64 %) were interested in training in these topics .
Lastly , the survey collected data on the best mode of delivery for obesity medical education ( Table 4 ). The highest rated preference was for virtual Continuing Medical Education ( CME ) courses not requiring travel ( 91.5 %, n = 65 / 71 ) as opposed to live courses ( 79.2 %, n = 57 / 72 ). Of the CME options , lectures ( 89.0 %, n = 65 / 73 ) case scenarios ( 87.5 %, n = 63 / 72 ), and workshops ( 86.3 %, n = 63 / 73 ) were the highest rated formats . E-consults ( 72.2 %, n = 52 / 72 ), obesity medicine practice immersion courses ( 64.8 %, n = 46 / 71 ), and books ( 50.0 %, n = 36 / 72 ) were rated lower as CME options . Within the survey there was an “ unacceptable ” response choice . Six of the 11 educational modalities received at least one “ unacceptable ” choice , but the only one to receive more than one was “ books ” ( 3 choosing “ unacceptable ” for this option ). Of the non-CME options , project ECHO was preferred by 83.3 % ( n = 60 / 72 ). Project ECHO is used for primary care outreach in WV , but for respondents who were not familiar with it , it was briefly described on the survey as an educational technique consisting of video conferences , brief lectures , and case-based learning . A mobile application was preferred by 84.7 % ( n = 61 / 72 ) of clinicians , and obesity educational websites were preferred by 80.8 % ( n = 59 / 73 ).
DISCUSSION
Obesity is not a simple condition solely caused by over-eating . Instead , it is a complex and multifactorial disease asso-
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