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Benoit Pétré,1 Remi Gagnayre,2 Vincent De Andrade,2 Olivier Ziegler,3 Michèle Guillaume1 1Department of Public Health, University of Liège, Liège, Belgium; 2Educations and Health Practices Laboratory (LEPS), (EA 3412), UFR SMBH, Paris 13 University, Sorbonne Paris Cite, Bobigny, 3Department of Diabetes, Metabolic diseases and Nutrition, Nancy University Hospital, Nancy, France Abstract: Educative attitude is an essential, if implicit, aspect of training to acquire competency in therapeutic patient education (TPE). With multiple (or nonexistent) definitions in the literature, however, the concept needs clarification. The primary aim of this study was to analyze the representations and transformations experienced by health care professionals in the course of TPE training in order to characterize educative attitude. We conducted an exploratory qualitative study using several narrative research-based tools with participants of two TPE continuing education courses. We then performed an inductive thematic analysis. Thirty-three people participated in the study; the majority were women (n=29), nurses (n=17) working in a hospital setting (n=28). Seven categories of statements were identified: time-related (“the right moment, how much time it takes”), the benefits of TPE (to health care professionals’ personal well-being), emotions and feelings (quality of exchanges, sharing), the professional nature of TPE (educational competencies required), the holistic, interdisciplinary approach (complexity of the person and value of teamwork), the educational nature of the care relationship (education an integral part of care) and the ethical dimension (introspection essential). The first three components appear fairly innovative, at least in formulation. The study’s originality rests primarily in its choice of participants – highly motivated novices who expressed themselves in a completely nontheoretical way. Health models see attitude as critical for adopting a behavior. Best TPE practices should encourage personal work on this, opening professionals to the social, experiential and emotional aspects of managing chronic illness. Keywords: therapeutic patient education, attitude of health personnel, competence, professional

Benoit Pétré,1 André J Scheen,2 Olivier Ziegler,3 Anne-Françoise Donneau,1 Nadia Dardenne,1 Eddy Husson,1 Adelin Albert,1 Michèle Guillaume1 1Department of Public Health, University of Liège, Liège, Belgium; 2Division of Diabetes, Nutrition and Metabolic Disorders, Department of Medicine, CHU Sart Tilman, University of Liège, Liège, Belgium; 3Department of Diabetes, Metabolic Diseases and Nutrition, Nancy University Hospital, Nancy, France Background and objective: Despite the strength and consistency of the relationship between body mass index (BMI) and quality of life (QoL), a reduction in BMI does not necessarily lead to an improvement in QoL. Between-subject variability indicates the presence of mediators and moderators in the BMI–QoL association. This study aimed to examine the roles of body image discrepancy (BID) and subjective norm (SN) as potential mediators and moderators. Subjects and methods: In 2012, 3,016 volunteers (aged ≥18 years) participated in a community-based survey conducted in the French-speaking region of Belgium. Participation was enhanced using a large multimedia campaign (which was supported by a large network of recruiters) that employed the nonstigmatizing slogan, “Whatever your weight, your opinion will count”. Participants were invited to complete a web-based questionnaire on their weight-related experiences. Self-reported measures were used to calculate each participant’s BMI, BID, SN, and QoL (a French obesity-specific QoL questionnaire was used to calculate the participants’ physical dimension of QoL scores [PHY-QoL], psychosocial dimension of QoL scores [PSY/SOC-QoL], and their total scores). The covariates included gender, age, subjective economic status, level of education, household size, and perceived health. The mediation/moderation tests were based on Hayes’ method. Results: Tests showed that the relationships between BMI and PHY-QoL, PSY/SOC-QoL, and TOT-QoL were partially mediated by BID in both males and females and by SN in females. Moreover, BID was a moderator of the relationship between BMI and PSY/SOC-QoL in males and females. SN was a moderator of the relationship between BMI and PSY/SOC-QoL in males and between BMI and total scores in males (when used without BID in the models). Conclusion: BID and SN should be considered as important factors in obesity management strategies. The study shows that targeting BMI only is not sufficient to improve the QoL of overweight and obese subjects, and that other variables, including perceptual factors, should be considered. Keywords: obesity, quality of life, mediators and moderators, body image