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Moghadam S, Hollands L, Calitri R, Swancutt D, Lloyd J, Hawkins L, Sheaff R, Dean S, Perry S, Watkins R, Pinkney J, Tarrant M. Development of a group-based behaviour change intervention for people with severe obesity informed by the social identity approach to health. Br J Health Psychol 2024. [PMID: 38965643 DOI: 10.1111/bjhp.12737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 05/23/2024] [Accepted: 06/09/2024] [Indexed: 07/06/2024]
Abstract
INTRODUCTION Interventions to support behaviour change in people living with chronic health conditions increasingly use patient groups as the mode of delivery, but these are often designed without consideration of the group processes that can shape intervention outcomes. This article outlines a new approach to designing group-based behaviour change interventions that prioritizes recipients' shared social identity as group members in facilitating the adoption of established behaviour change techniques (BCTs). The approach is illustrated through an example drawn from research focused on people living with severe obesity. METHODS A prioritization process was undertaken in collaboration with stakeholders, including behaviour change experts, clinicians, and a former patient to develop an evidence-based, group intervention informed by the social identity approach to health. Three phases of development are reported: (1) identification of the health problem; (2) delineation of intervention mechanisms and operationalization of BCTs for group delivery and (3) intervention manualization. The fourth phase, intervention testing and optimization, is reported elsewhere. RESULTS A group-based behaviour change intervention was developed, consisting of 12 group sessions and 3 one-to-one consultations. The intervention aimed to support the development of shared social identity among recipients, alongside the delivery of evidence-based BCTs, to improve the likelihood of successful intervention and health outcomes among people living with severe obesity. CONCLUSIONS A manualized intervention, informed by the social identity approach to health, was systematically designed with input from stakeholders. The development approach employed can inform the design of behavioural interventions in other health contexts where group-based delivery is planned.
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Singh S, Naicker A, Grobbelaar H, Singh ES, Spiegelman D, Shrestha A. Barriers and Facilitators of Implementing a Healthy Lifestyle Intervention at Workplaces in South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:389. [PMID: 38673303 PMCID: PMC11050208 DOI: 10.3390/ijerph21040389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 03/13/2024] [Accepted: 03/19/2024] [Indexed: 04/28/2024]
Abstract
Current evidence indicates that workplace health and wellness programmes provide numerous benefits concerning altering cardiovascular risk factor profiles. Implementing health programmes at workplaces provide an opportunity to engage adults towards positive and sustainable lifestyle choices. The first step in designing lifestyle interventions for the workplace is understanding the barriers and facilitators to implementing interventions in these settings. The barriers and facilitators to implementing lifestyle interventions in the workplace environment was qualitatively explored at two multinational consumer goods companies among seven workplaces in South Africa. Semi-structured in-depth interviews (IDIs) were conducted with ten workplace managers. Five focus group discussions (FGDs) were conducted among workplace employees. The IDI findings revealed that the main facilitators for participation in a lifestyle intervention programme were incentives and rewards, educational tools, workplace support, and engaging lessons. In contrast, the main facilitator of the FGDs was health and longevity. The main barriers from the IDIs included scheduling time for lifestyle interventions within production schedules at manufacturing sites, whereas time limitations, a lack of willpower and self-discipline were the main barriers identified from the FGDs. The findings of this study add to literature on the barriers and facilitators of implementing healthy lifestyle interventions at workplaces and suggest that there is a potential for successfully implementing intervention programmes to improve health outcomes, provided that such efforts are informed and guided through the engagement of workplace stakeholders, an assessment of the physical and food environment, and the availability of workplace resources.
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Affiliation(s)
- Shivneta Singh
- Department of Food and Nutrition, Faculty of Applied Sciences, Durban University of Technology, 70 Steve Biko Road, Musgrave, Berea 4001, South Africa; (A.N.); (H.G.); (E.S.S.)
| | - Ashika Naicker
- Department of Food and Nutrition, Faculty of Applied Sciences, Durban University of Technology, 70 Steve Biko Road, Musgrave, Berea 4001, South Africa; (A.N.); (H.G.); (E.S.S.)
| | - Heleen Grobbelaar
- Department of Food and Nutrition, Faculty of Applied Sciences, Durban University of Technology, 70 Steve Biko Road, Musgrave, Berea 4001, South Africa; (A.N.); (H.G.); (E.S.S.)
| | - Evonne Shanita Singh
- Department of Food and Nutrition, Faculty of Applied Sciences, Durban University of Technology, 70 Steve Biko Road, Musgrave, Berea 4001, South Africa; (A.N.); (H.G.); (E.S.S.)
| | - Donna Spiegelman
- Department of Chronic Disease Epidemiology, Center of Methods for Implementation and Prevention Science, Yale School of Public Health, New Haven, CT 06510, USA; (D.S.); (A.S.)
| | - Archana Shrestha
- Department of Chronic Disease Epidemiology, Center of Methods for Implementation and Prevention Science, Yale School of Public Health, New Haven, CT 06510, USA; (D.S.); (A.S.)
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Newsome FA, Cardel MI, Chi X, Lee AM, Miller D, Menon S, Janicke DM, Gurka MJ, Butryn ML, Manasse S. Wellness Achieved Through Changing Habits: A Randomized Controlled Trial of an Acceptance-Based Intervention for Adolescent Girls With Overweight or Obesity. Child Obes 2023; 19:525-534. [PMID: 36394498 PMCID: PMC10734897 DOI: 10.1089/chi.2022.0116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Obesity prevalence among adolescent girls continues to rise. Acceptance-based therapy (ABT) is effective for weight loss in adults and feasible and acceptable for weight loss among adolescents. This pilot randomized controlled trial (RCT) assessed effectiveness of an adolescent-tailored ABT intervention on decreasing weight-related outcomes and improving psychological outcomes compared with enhanced care. Methods: In this 6-month, two-arm pilot RCT, participants were randomized to the ABT intervention or to enhanced care. The ABT intervention condition attended 15 virtual, 90-minute group sessions. The enhanced care comparison received 15 healthy lifestyle handouts and virtually met twice with a registered dietitian. The primary outcome assessed was change in BMI expressed as a percentage of the 95th percentile (%BMIp95). Results: Participants included 40 girls (ages 14-19) assigned to ABT (n = 20) or enhanced care (n = 20). A decrease in %BMIp95 was observed within the ABT intervention [d = -0.19, 95% confidence interval, CI: (-0.36 to -0.02)], however, not within the enhanced care comparison [d = -0.01, 95% CI: (-0.09 to 0.07)]. The ABT group showed slight changes in psychological flexibility [d = -0.34, 95% CI: (-0.62 to -0.06)] over enhanced care [d = -0.11, 95% CI: (-0.58 to 0.37)]. There was no significant intervention effect noted between groups. Conclusion: In this pilot RCT, the ABT intervention was as effective as enhanced care for weight loss. However, previous ABT studies occurred in person, and this study was conducted virtually due to COVID-19. Thus, future research investigating the potential effectiveness of ABT in-person among adolescents and optimization of virtual interventions is needed.
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Affiliation(s)
- Faith A. Newsome
- Department of Health Outcomes and Biomedical Informatics and University of Florida, Gainesville, FL, USA
| | - Michelle I. Cardel
- Department of Health Outcomes and Biomedical Informatics and University of Florida, Gainesville, FL, USA
- WW International, Inc., New York, NY, USA
- Center for Integrative Cardiovascular and Metabolic Disease, University of Florida, Gainesville, FL, USA
| | - Xiaofei Chi
- Department of Health Outcomes and Biomedical Informatics and University of Florida, Gainesville, FL, USA
| | - Alexandra M. Lee
- Department of Health Outcomes and Biomedical Informatics and University of Florida, Gainesville, FL, USA
- WW International, Inc., New York, NY, USA
| | - Darci Miller
- Department of Health Outcomes and Biomedical Informatics and University of Florida, Gainesville, FL, USA
| | - Sarada Menon
- Department of Health Outcomes and Biomedical Informatics and University of Florida, Gainesville, FL, USA
| | - David M. Janicke
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Matthew J. Gurka
- Department of Health Outcomes and Biomedical Informatics and University of Florida, Gainesville, FL, USA
| | - Meghan L. Butryn
- Department of Psychological and Brain Sciences, Drexel University, Philadelphia, PA, USA
- Center for Weight, Eating and Lifestyle Science, Drexel University, Philadelphia PA, USA
| | - Stephanie Manasse
- Center for Weight, Eating and Lifestyle Science, Drexel University, Philadelphia PA, USA
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Seidman LC, Handy AB, Temme CR, Greenfield SF, Payne LA. Reflections on the group dynamic in a group cognitive behavioral therapy intervention for young adult women with moderate to severe dysmenorrhea: a qualitative analysis. J Psychosom Obstet Gynaecol 2023; 44:2264486. [PMID: 37800565 PMCID: PMC10640904 DOI: 10.1080/0167482x.2023.2264486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 09/24/2023] [Indexed: 10/07/2023] Open
Abstract
A recent group cognitive behavioral therapy (gCBT) intervention for dysmenorrhea conducted by our team demonstrated feasibility, acceptability, and preliminary efficacy at reducing menstrual pain. This study aimed to use qualitative analyses to explore participants' reflections about the intervention's group dynamic. Participants included 20 young women ages 18-24 years with average menstrual pain of 8.0 (SD = 1.1) on a 0-10 (0 = none, 10 = worst pain possible) numeric rating scale. Semi-structured individual and group interviews were conducted after the intervention. Researchers then conducted deductive, iterative thematic analysis using a template analysis approach. Two themes were generated: benefit and logistics. The benefit theme included two sub-themes: (1) camaraderie (an emotional, psychological, or social connection between participants); and (2) sharing (information, advice, or experiences). The logistics theme highlighted how the structure of the group influenced the dynamic and was divided into two sub-themes according to the time frame being described: (1) reactions (participants' experiences with how the group dynamic was facilitated); and (2) future (how the group structure could be improved). Results of this study contribute to the growing body of literature related to gCBT for pain conditions. Future research is needed to optimize the group dynamic and evaluate its specific therapeutic role in the treatment.
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Affiliation(s)
| | | | | | | | - Laura A. Payne
- McLean Hospital, Belmont, MA
- Harvard Medical School, Boston, MA
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Everitt JD, Battista-Dowds EM, Heggs D, Hewlett P, Squire ALM. Determinants of completion and early dropout in an adult weight management service: a prospective observational study. J Hum Nutr Diet 2023; 36:1931-1941. [PMID: 37357716 DOI: 10.1111/jhn.13196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 06/05/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND High attrition rates in weight management interventions (WMIs) undermine their effectiveness but are poorly understood. This study aimed to identify determinants of completion and early dropout in National Health Service (NHS) WMIs. METHODS In this prospective observational study, 329 patients recruited at initial consultation appointments satisfied the eligibility criteria: age ≥18 years and body mass index (BMI) ≥30 kg/m2 . Multivariate logistic regression analyses were performed to identify the odds ratios (OR, given with 95% confidence interval) of completion and early dropout. RESULTS Intervention completion rate was 39.8% (131 of 329). Variables that increased the likelihood of completion included engagement in support sessions, OR10.6 (4.7-23.6, p < 0.001); male sex, OR2.5 (1.4-4.5, p = 0.002); osteoarthritis, OR1.9 (1.1-3.3, p = 0.014); and one or more missed intervention appointments marked as 'could not attend' (notified nonattendance), OR1.8 (1.1-2.9, p = 0.032). Odds of early dropout were higher for participants with anxiety and depression OR2.0 (1.0-4.0, p = 0.039). Dietetic 1:1 participants were less likely to drop out early compared with group programme participants, OR0.3 (0.2-0.7, p = 0.002), but were less likely to complete the full intervention, OR0.5 (0.3-0.9, p = 0.02). Age, BMI, social deprivation and travel distance were among the variables not associated with completion or early dropout. CONCLUSIONS This study provides further evidence of the importance of support for participants of WMIs and the need for services to consider how support networks can be incorporated. Patients with poorer mental health may be more likely to drop out early and consequently benefit less from WMIs. Future research should qualitatively explore why these factors contribute to attrition to improve WMI effectiveness.
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Affiliation(s)
| | - Enzo M Battista-Dowds
- Weight Management Service, Nutrition and Dietetics Department, Cwm Taff Morgannwg University Health Board, Merthyr Tydfil, Wales, UK
| | - Daniel Heggs
- Department of Applied Psychology, School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, Wales, UK
| | - Paul Hewlett
- Department of Applied Psychology, School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, Wales, UK
| | - Amanda L M Squire
- Department of Healthcare and Food, School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, Wales, UK
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Borgatti AC, Crockett KB, Jacob AE, Davis AL, Dutton GR. Correlates of psychological distress among adults with obesity during the COVID-19 pandemic. Psychol Health 2022; 37:1547-1564. [PMID: 35156476 PMCID: PMC9946156 DOI: 10.1080/08870446.2022.2038790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 11/03/2021] [Accepted: 01/04/2022] [Indexed: 02/01/2023]
Abstract
OBJECTIVE The present study evaluated changes in stress and loneliness among participants with obesity engaged in weight loss self-management in the United States (US) during COVID-19, and identified factors that may increase risk or protect against psychosocial distress during this time. DESIGN Participants who were enrolled in a weight self-management program prior to the COVID-19 pandemic (N = 55, 91% female, 36% Caucasian, mean age = 49.8 years) completed an online survey about social, economic and health behaviour changes during COVID-19 and their relationship to changes in perceived stress and loneliness. MAIN OUTCOME MEASURES Perceived Stress (PSS-4), Loneliness (PROMIS loneliness and social isolation questionnaire). RESULTS Compared to pre-COVID assessments, stress and loneliness increased 40% two months into the COVID-19 pandemic-related shutdown. Higher body mass index (BMI) and social distancing were associated with increases in both loneliness and stress. Alcohol intake was associated with increased stress, and working from home was associated with increased loneliness. CONCLUSION Individuals with obesity endorsed increased stress and loneliness during COVID-19, which may be exacerbated among those with a higher BMI and greater adherence to social distancing guidelines. Ongoing attention to psychosocial well-being among individuals with obesity will remain imperative both during the ongoing pandemic and beyond.
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Affiliation(s)
- Alena C Borgatti
- Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
- Department of Psychology, UAB, Birmingham, AL, USA
| | - Kaylee B Crockett
- Department of Health Care Organization and Policy, School of Public Health, UAB, Birmingham, AL, USA
| | | | - Andrea L Davis
- Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
- Department of Psychology, UAB, Birmingham, AL, USA
| | - Gareth R Dutton
- Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
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Street S, Avenell A. Are individual or group interventions more effective for long-term weight loss in adults with obesity? A systematic review. Clin Obes 2022; 12:e12539. [PMID: 35765718 PMCID: PMC9542282 DOI: 10.1111/cob.12539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 05/03/2022] [Accepted: 05/18/2022] [Indexed: 11/15/2022]
Abstract
Guidelines recommend individual and group interventions for weight loss, based on preference. Our 2009 systematic review compared long-term effectiveness of individual or group approaches to the same intervention, but there are new randomized controlled trials (RCTs) of high-quality data. We updated and expanded our previous systematic review. We searched Medline and Embase from 1966 to May 2021, and a clinical trial register from 1966 to 2017. Review Manager (5.4.1) was used to conduct meta-analysis. Ten RCTs were included. The primary outcome, mean weight change at final follow-up, was -1.33 kg (95% confidence interval CI: -2.04, -0.62; 10 trials, 2169 participants), favouring group interventions (p < .001). For the secondary outcomes, attainment of ≥5% body weight loss at final follow-up, the risk ratio (RR) was 1.36 (95% CI 1.05, 1.77; three trials, 1520 participants), favouring group interventions (p = .02); attrition at final follow-up was similar between group and individual arms of trials, RR 0.93 (95% CI 0.82, 1.07) (p = .31). Group interventions can be more effective than individual interventions for long-term weight loss in adults with obesity. However, few studies were included in the clinically relevant, secondary outcome measures. Research on delivering group processes in weight management is needed.
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Affiliation(s)
- Sarah Street
- Health Services Research Unit, Institute of Applied Health SciencesUniversity of AberdeenAberdeenScotland
| | - Alison Avenell
- Health Services Research Unit, Institute of Applied Health SciencesUniversity of AberdeenAberdeenScotland
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Swancutt D, Tarrant M, Ingram W, Baldrey S, Burns L, Byng R, Calitri R, Creanor S, Dean S, Evans L, Gill L, Goodwin E, Hawkins L, Hayward C, Hind S, Hollands L, Hosking J, Lloyd J, Moghadam S, Neilens H, O’Kane M, Perry S, Sheaff R, Spencer A, Taylor A, Ward T, Watkins R, Wilding J, Pinkney J. A group-based behavioural intervention for weight management (PROGROUP) versus usual care in adults with severe obesity: a feasibility randomised controlled trial protocol. Pilot Feasibility Stud 2022; 8:206. [PMID: 36088457 PMCID: PMC9463813 DOI: 10.1186/s40814-022-01167-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 08/25/2022] [Indexed: 11/24/2022] Open
Abstract
Background Approximately 15 million people in the UK live with obesity, around 5 million of whom have severe obesity (body mass index (BMI) ≥35kg/m2). Having severe obesity markedly compromises health, well-being and quality of life, and substantially reduces life expectancy. These adverse outcomes are prevented or ameliorated by weight loss, for which sustained behavioural change is the cornerstone of treatment. Although NHS specialist ‘Tier 3’ Weight Management Services (T3WMS) support people with severe obesity, using individual and group-based treatment, the current evidence on optimal intervention design and outcomes is limited. Due to heterogeneity of severe obesity, there is a need to tailor treatment to address individual needs. Despite this heterogeneity, there are good reasons to suspect that a structured group-based behavioural intervention may be more effective and cost-effective for the treatment of severe obesity compared to usual care. The aims of this study are to test the feasibility of establishing and delivering a multi-centre randomised controlled clinical trial to compare a group-based behavioural intervention versus usual care in people with severe obesity. Methods This feasibility randomised controlled study is a partially clustered multi-centre trial of PROGROUP (a novel group-based behavioural intervention) versus usual care. Adults ≥18 years of age who have been newly referred to and accepted by NHS T3WMS will be eligible if they have a BMI ≥40, or ≥35 kg/m2 with comorbidity, are suitable for group-based care and are willing to be randomised. Exclusion criteria are participation in another weight management study, planned bariatric surgery during the trial, and unwillingness or inability to attend group sessions. Outcome assessors will be blinded to treatment allocation and success of blinding will be evaluated. Clinical measures will be collected at baseline, 6 and 12 months post-randomisation. Secondary outcome measures will be self-reported and collected remotely. Process and economic evaluations will be conducted. Discussion This randomised feasibility study has been designed to test all the required research procedures and additionally explore three key issues; the feasibility of implementing a complex trial at participating NHS T3WMS, training the multidisciplinary healthcare teams in a standard intervention, and the acceptability of a group intervention for these particularly complex patients. Trial registration ISRCTN number 22088800. Supplementary Information The online version contains supplementary material available at 10.1186/s40814-022-01167-0.
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Kurz D, McCrea-Robertson S, Nelson-Brantley H, Befort C. Rural engagement in primary care for optimizing weight reduction (REPOWER): A mixed methods study of patient perceptions. PATIENT EDUCATION AND COUNSELING 2022; 105:2371-2381. [PMID: 34865892 DOI: 10.1016/j.pec.2021.11.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 11/10/2021] [Accepted: 11/27/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To report on patients' satisfaction and experience of care across three different modes of weight loss counseling. METHODS 1407 patients with obesity in the rural Midwest were enrolled to a 2-year weight management trial through their primary care practice and assigned to one of three treatment conditions: in-clinic individual, in-clinic group, phone group counseling. Patients completed surveys assessing seven domains of satisfaction and experience of care at 6 and 24-months. Post-treatment interviews were conducted to add context to survey responses. RESULTS 1295 (92.0%) and 1230 (87.4%) completed surveys at 6 and 24-months, respectively. Patients in phone group counseling reported lower satisfaction than patients who received in-clinic group or in-clinic individual counseling across all domains at 6-months and five out of seven domains at 24-months. Interviews revealed that patients were more satisfied when they received face-to-face counseling and had meaningful interactions with their primary care provider (PCP) about their weight. CONCLUSION Rural patients with obesity have higher satisfaction and experience of care when weight loss counseling is delivered in a face-to-face environment and when their PCP is involved with their treatment. PRACTICE IMPLICATIONS Primary care practices looking to offer weight loss treatment should consider incorporating some level of face-to-face treatment plans that involves meaningful interaction with the PCP.
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Affiliation(s)
- Daniel Kurz
- University of Kansas School of Medicine, Department of Population Health, Kansas City, KS USA.
| | - Stacy McCrea-Robertson
- University of Kansas School of Medicine, Department of Population Health, Kansas City, KS USA
| | | | - Christie Befort
- University of Kansas School of Medicine, Department of Population Health, Kansas City, KS USA
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Kurz D, Befort C. Travel burden in a rural primary care behavioral weight loss randomized trial: Impact on visit attendance and weight loss. J Rural Health 2022; 38:980-985. [DOI: 10.1111/jrh.12652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Daniel Kurz
- Department of Population Health University of Kansas School of Medicine Kansas City Kansas USA
| | - Christie Befort
- Department of Population Health University of Kansas School of Medicine Kansas City Kansas USA
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Soni A, Beeken RJ, McGowan L, Lawson V, Chadwick P, Croker H. 'Shape-Up', a Modified Cognitive-Behavioural Community Programme for Weight Management: Real-World Evaluation as an Approach for Delivering Public Health Goals. Nutrients 2021; 13:2807. [PMID: 34444967 PMCID: PMC8402118 DOI: 10.3390/nu13082807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 08/04/2021] [Accepted: 08/07/2021] [Indexed: 11/17/2022] Open
Abstract
Obesity is widespread, with serious health consequences; addressing it requires considerable effort at a public health level, incorporating prevention and management along with policies to support implementation. Behavioural weight-management programmes are widely used by public health bodies to address overweight and obesity. Shape-Up is an evidence-based programme combining a structured behavioural intervention (targeting nutrition and physical activity behaviours) within a peer-learning framework. This study was a service-evaluation of Shape-Up, as delivered in Rotherham by a local leisure provider, and included a secondary analysis of data collected in the community by service providers. The RE-AIM (Reach Effectiveness Adoption Implementation Maintenance) framework was used to explore programme effectiveness, implementation, and whom it reached. A total of 141 participants were included. Compared to local demographics, participants were older, at 48.9 (SD 14.47) years, with a lower employment rate (41% employed) and greater proportion female (67% female). Mean BMI was 38.0 (SD 7.54) kg/m2. Mean weight-change between baseline and endpoint (12 weeks, 10 group sessions) was -4.4 (SD 3.38) kg, and degree of weight change was associated with session attendance (F (9, 131) = 6.356, p < 0.0005). There were positive effects on participants' weight, health-related behaviours, and quality of life. The intervention content (including the focus of nutritional recommendations) and structure were adapted during implementation to better suit national guidelines and local population needs. RE-AIM was found to be a useful framework for evaluating and adapting an existing evidence-based weight management programme in line with local population needs. This could be a more cost-effective approach, compared to developing new programmes, for delivering public health goals relating to obesity, nutrition, and physical activity.
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Affiliation(s)
- Amber Soni
- Research Department of Behavioural Science and Health, University College London, London WC1E 6BT, UK;
| | - Rebecca J Beeken
- Leeds Institute of Health Sciences, University of Leeds, Leeds LS2 9JT, UK;
| | - Laura McGowan
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Science, Queen’s University Belfast, Belfast BT9 7BL, UK;
- Institute for Global Food Security, School of Biological Sciences, Queen’s University Belfast, Belfast BT9 5DL, UK
| | - Victoria Lawson
- Talking Therapies Southwark, Maudsley Hospital, London SE5 8AZ, UK;
| | - Paul Chadwick
- Centre for Behaviour Change, University College London, London WC1E 6BT, UK;
| | - Helen Croker
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK
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Tarrant M, Lamont RA, Carter M, Dean SG, Spicer S, Sanders A, Calitri R. Measurement of Shared Social Identity in Singing Groups for People With Aphasia. Front Psychol 2021; 12:669899. [PMID: 34220642 PMCID: PMC8248786 DOI: 10.3389/fpsyg.2021.669899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 05/10/2021] [Indexed: 11/13/2022] Open
Abstract
Community groups are commonly used as a mode of delivery of interventions for promoting health and well-being. Research has demonstrated that developing a sense of shared social identity with other group members is a key mechanism through which the health benefits of group membership are realized. However, there is little understanding of how shared social identity emerges within these therapeutic settings. Understanding the emergence of shared social identity may help researchers optimize interventions and improve health outcomes. Group-based singing activities encourage coordination and a shared experience, and are a potential platform for the development of shared social identity. We use the "Singing for People with Aphasia" (SPA) group intervention to explore whether group cohesiveness, as a behavioral proxy for shared social identity, can be observed and tracked across the intervention. Video recordings of group sessions from three separate programmes were rated according to the degree of cohesiveness exhibited by the group. For all treatment groups, the final group session evidenced reliably higher levels of cohesiveness than the first session (t values ranged from 4.27 to 7.07; all p values < 0.003). As well as providing confidence in the design and fidelity of this group-based singing intervention in terms of its capacity to build shared social identity, this evaluation highlighted the value of observational methods for the analysis of shared social identity in the context of group-based singing interventions.
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Affiliation(s)
- Mark Tarrant
- College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Ruth A Lamont
- College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Mary Carter
- Department of Pharmacy and Pharmacology, University of Bath, Bath, United Kingdom
| | - Sarah G Dean
- College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Sophie Spicer
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Amy Sanders
- College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Raff Calitri
- College of Medicine and Health, University of Exeter, Exeter, United Kingdom
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Carlén K, Kylberg E. An intervention of sustainable weight change: Influence of self-help group and expectations. Health Expect 2021; 24:1498-1503. [PMID: 34089622 PMCID: PMC8369104 DOI: 10.1111/hex.13290] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 05/10/2021] [Accepted: 05/14/2021] [Indexed: 12/30/2022] Open
Abstract
Background Obesity is one of the most challenging public health problems in Western societies. Group activities are a way to empower individuals to make sustainable lifestyle changes. Self‐help groups enable individuals to share expectations and experiences on an equal basis. Objective The aim was to find a model for sustainable weight reduction for people with obesity and to evaluate the importance of expectations before entering the weight reduction programme. Methods Persons with a BMI >30 and aged over 30 years were recruited. Weekly seminars for 6 months with discussions concerning physical activity, eating habits and how to change one's lifestyle occurred. After the seminars, a self‐help group was initiated. The participants were encouraged to express their expectations before each step in the study. Results Our findings showed that those who had joined a self‐help group had reduced their weight significantly (−6.0 kg) compared with those who had not (−1.4 kg). Further, those who expressed a more mature expectation of the coming change in behaviour towards a healthy lifestyle showed slightly larger weight reduction (−6.1 kg) than those who expressed low expectations (−3.7 kg). Patient or public contribution Participants expressed their thoughts and views, which were considered and included in the programme. Conclusions Our findings indicate that the self‐help group can be an essential part of a weight reduction programme. The self‐help group is a novel strategy to strengthen sustainability in reducing weight. The study also highlights the importance of identifying behaviour change expectations before participating in a programme.
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Affiliation(s)
- Kristina Carlén
- School of Health Sciences, University of Skövde, Skövde, Sweden
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14
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Howard KA, Rennert L, Pericot-Valverde I, Heo M, Norton BL, Akiyama MJ, Agyemang L, Litwin AH. Utilizing patient perception of group treatment in exploring medication adherence, social support, and quality of life outcomes in people who inject drugs with hepatitis C. J Subst Abuse Treat 2021; 126:108459. [PMID: 34116813 DOI: 10.1016/j.jsat.2021.108459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 01/15/2021] [Accepted: 04/28/2021] [Indexed: 11/26/2022]
Abstract
People who inject drugs (PWID) have a high prevalence of hepatitis C virus (HCV). Group treatment is a practical option for addressing barriers to treatment in this population. Prior research on group treatment has resulted in mixed conclusions about its effectiveness in addressing barriers to treatment. A patient's perception of the group environment may help to explain this variability. This study sought to explore the association between indicators of group treatment environment and improved outcomes in HCV-infected PWID. This secondary analysis of a randomized controlled trial exploring different models of treatment for HCV in a PWID population consisted of 42 participants randomized to the group treatment branch of the trial. Independent variables consisted of group sessions attended and group climate constructs of engagement, conflict, and avoidance. Dependent variables consisted of medication adherence, social support, and health-related quality of life. The study implemented generalized estimating equations to assess associations with the outcomes at the end of treatment. Factors indicative of group treatment environment were related to medication adherence and other barriers to health for HCV-infected PWID: social support and health-related quality of life. Perceptions of conflict or avoidance were associated with worse outcomes, while increased session attendance was generally associated with better outcomes. The study attests to the importance of examining group environment factors during treatment interventions. Although preliminary, the study provides specific indicators of treatment success for HCV-infected PWID and practical implications to improve patients' health outcomes and better tailor treatment to the patient.
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Affiliation(s)
- Kerry A Howard
- Department of Public Health Sciences, Clemson University, Clemson, SC, USA
| | - Lior Rennert
- Department of Public Health Sciences, Clemson University, Clemson, SC, USA
| | - Irene Pericot-Valverde
- Clemson University School of Health Research, Clemson, SC, USA; Department of Medicine, Prisma Health-Upstate, Greenville, SC, USA
| | - Moonseong Heo
- Department of Public Health Sciences, Clemson University, Clemson, SC, USA
| | - Brianna L Norton
- Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Matthew J Akiyama
- Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Linda Agyemang
- Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Alain H Litwin
- Clemson University School of Health Research, Clemson, SC, USA; Department of Medicine, Prisma Health-Upstate, Greenville, SC, USA; University of South Carolina School of Medicine Greenville, Greenville, SC, USA.
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15
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Malik Z, Holden ACL, Sohn W, Williams K. A disability-based exploration of psychosocial barriers and enablers to accessing dental services for people with clinically severe obesity: A qualitative study. Clin Obes 2021; 11:e12429. [PMID: 33615711 DOI: 10.1111/cob.12429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 10/23/2020] [Accepted: 10/27/2020] [Indexed: 11/30/2022]
Abstract
This qualitative study aimed to explore psychosocial barriers and enablers to accessing dental services for people with clinically severe obesity (PwCSO). Eight focus groups were conducted by one researcher with 40 adult participants at the Adult Healthy Weight Clinic within a hospital-based obesity service. Thematic analysis of focus group transcripts was performed to reveal insights relating to how PwCSO experience dental care and view oral health. A total of 11 participants were male, 29 female, all between the ages of 23 to 74 (mean age of 50). The body mass index of participants ranged from 31.6 to 84.6 kg/m2 . The results highlighted four key themes, including "disempowerment to act to improve oral health", "weight-related stigma and discrimination", "unpredictability of the dental environment" and a "lack of tailored services for PwCSO". A number of subthemes were identified, which reflect the six categories of barriers to access from the disability literature: availability, affordability, acceptability, accommodation, accessibility and appropriateness. These were explored to further appreciate the unique psychosocial considerations for this group. This study concluded that PwCSO face significant barriers to accessing dental services across all six categories highlighted in the disability literature. The study findings provide valuable patient-based information regarding the psychosocial barriers to accessing dental services, which are relevant for all healthcare professionals. The study reflected an increased need for promotion of the dentist's role in obesity management and obesity-related dental training, including familiarization with the biopsychosocial domains of obesity to reduce weight related stigma and discrimination, as an area for further study. The findings also guide the design of Specialized Bariatric Dental Services in the future, with a focus on enablers to access.
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Affiliation(s)
- Zanab Malik
- Department of Oral Medicine, Oral Pathology and Special Needs Dentistry, Westmead Centre for Oral Health, Westmead Hospital, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney School of Dentistry, Sydney, New South Wales, Australia
| | - Alexander C L Holden
- Faculty of Medicine and Health, The University of Sydney School of Dentistry, Sydney, New South Wales, Australia
| | - Woosung Sohn
- Faculty of Medicine and Health, The University of Sydney School of Dentistry, Sydney, New South Wales, Australia
| | - Kathryn Williams
- Nepean Family Metabolic Health Service (NFMHS), Nepean Blue Mountains Local Health District, Kingswood, New South Wales, Australia
- Charles Perkins Centre-Nepean, The University of Sydney, Sydney, New South Wales, Australia
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16
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Clark-Sienkiewicz SM, Caño A, Zeman LL, Lumley MA, Gothe N. Development of a Multicomponent Intervention to Initiate Health Behavior Change in Primary Care: The Kickstart Health Program. J Clin Psychol Med Settings 2021; 28:694-705. [PMID: 33398641 DOI: 10.1007/s10880-020-09755-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2020] [Indexed: 11/25/2022]
Abstract
There is a growing movement to integrate behavioral health specialists into primary care settings in order to better manage patients' health behaviors. Group interventions in healthcare settings can provide services to multiple individuals simultaneously; however, the participants' experiences taking part in these activities and the logistics of integrating them into clinical settings are largely under-studied. This article describes the development and implementation of a novel group intervention for health behavior change, The Kickstart Health Program, which integrates components of cognitive, behavioral, acceptance, and experiential therapies. Participant feasibility, acceptability, experiences, and treatment course were assessed. Acceptability among a small sample of attendees was high, and initial data on behavior change suggest there were benefits to patients who attended the program. Increases in mindfulness practice and decreases in exercise barriers from baseline to 10-week follow-up were detected as were improvements in overall perceived health and well-being. Participants expressed that the program was acceptable and successful at helping them reach their individual health goals; however, enrollment barriers negatively impacted the feasibility of the program in regard to attendance. Modification to the enrollment process such as embedding referrals into the electronic medical record, encouraging spouse or family co-enrollment, and peer coaching may address these barriers. The Kickstart Health Program has the potential to improve health behaviors and paves the way for unique studies of dissemination and implementation of efficacious behavioral health interventions into real-world healthcare settings.
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Affiliation(s)
- Shannon M Clark-Sienkiewicz
- Department of Psychology, Wayne State University, Detroit, MI, USA. .,Beaumont Health, Sterling Heights, MI, USA. .,Huntsman Cancer Institute, University of Utah, 2000 Cir of Hope Dr, #1950, Salt Lake City, UT, 84112, USA.
| | - Annmarie Caño
- Department of Psychology, Wayne State University, Detroit, MI, USA.,College of Arts and Sciences, Gonzaga University, Spokane, WA, USA
| | | | - Mark A Lumley
- Department of Psychology, Wayne State University, Detroit, MI, USA
| | - Neha Gothe
- Department of Kinesiology & Community Health, University of Illinois At Urbana-Champaign, Champaign, IL, USA
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17
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Bauer K, Schild S, Sauer H, Teufel M, Stengel A, Giel KE, Schellhorn P, Junne F, Nieß A, Zipfel S, Mack I. Attitude Matters! How Attitude towards Bariatric Surgery Influences the Effects of Behavioural Weight Loss Treatment. Obes Facts 2021; 14:531-542. [PMID: 34521092 PMCID: PMC8546453 DOI: 10.1159/000517850] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 06/09/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Multidisciplinary obesity services at university hospitals usually treat patients with more complex and severe obesity. In addition, patients with Class 3 obesity, in particular, have different attitudes regarding the choices of therapy. METHODS This explorative study investigated the effect of patient attitudes towards bariatric surgery on body weight change (primary outcome) and psychological improvement (secondary outcomes: quality of life, depression, anxiety, and eating behaviour) in a 6-month moderate behavioural weight loss (BWL) programme in a university outpatient setting. RESULTS 297 patients with mostly Class 3 obesity participated in the programme. The patients did not yet have any indications for bariatric surgery. Of the participants, 37% had a positive attitude towards bariatric surgery (POS), whereas 38% had a negative attitude (NEG). The drop-out rate was 8%. NEG participants lost significantly more body weight than the POS participants (intention-to-treat population: 4.5 [SD: 6.3] kg versus 0.4 [SD: 5.8] kg; p < 0.001). In both subgroups, anxiety, depression, the mental score for quality of life, and eating behaviour improved. CONCLUSION A BWL treatment in a clinical setting identified 2 distinct groups with different attitudes towards bariatric surgery that were associated with different body weight change outcomes. These groups may require differently targeted programmes to achieve the best body weight loss results.
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Affiliation(s)
- Kerstin Bauer
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany,
| | - Sandra Schild
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Helene Sauer
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Martin Teufel
- LVR-Clinic for Psychosomatic Medicine and Psychotherapy, University of Duisburg-Essen, Essen, Germany
| | - Andreas Stengel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
- Department for Psychosomatic Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Charité Center for Internal Medicine and Dermatology, Berlin, Germany
| | - Katrin Elisabeth Giel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Philipp Schellhorn
- Department of Sports Medicine, University Hospital Tübingen, Tübingen, Germany
| | - Florian Junne
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Magdeburg, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Andreas Nieß
- Department of Sports Medicine, University Hospital Tübingen, Tübingen, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Isabelle Mack
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
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18
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Carter A, Gilbert P, Kirby JN. Compassion-focused therapy for body weight shame: A mixed methods pilot trial. Clin Psychol Psychother 2020; 28:93-108. [PMID: 32515067 DOI: 10.1002/cpp.2488] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 05/10/2020] [Accepted: 06/04/2020] [Indexed: 12/19/2022]
Abstract
Individuals with bigger bodies (body mass index greater than 30) often experience body weight shame and are at increased risk for mental health vulnerabilities such as depression and anxiety. To date, there have been no studies specifically designed and pilot tested to help with body weight shame for individuals with bigger bodies that do not have a diagnosed clinical condition. The aim of current study is to investigate the initial feasibility of compassion-focused therapy (CFT) as a 12-session group intervention for the reduction in body weight shame for individuals with bigger bodies. The study used a mixed method repeated measure design, with both quantitative and qualitative measures, to assess the initial feasibility of the CFT group-based intervention. Participants (N = 5) attended a 12-session/2-h group CFT programme aimed to directly target body weight shame by cultivating compassion. Measurements were conducted at three time points (pre-, post- and 3-month follow-up intervention). Results indicated that CFT had a positive impact on reducing body weight shame, increasing compassion and improving health-engaging behaviours. Qualitative feedback indicated the importance of the group dynamics to help with the de-shaming of body appearance for individuals. Results from this feasibility trial are promising, and future research using randomized controlled trial methodologies should be conducted to evaluate the effectiveness of CFT as a treatment option for body weight shame for individuals with bigger bodies.
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Affiliation(s)
- Alicia Carter
- Compassionate Mind Research Group, School of Psychology, The University of Queensland, Brisbane, Queensland, Australia
| | - Paul Gilbert
- Psychology Department, Derby University, Derby, UK
| | - James N Kirby
- Compassionate Mind Research Group, School of Psychology, The University of Queensland, Brisbane, Queensland, Australia
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19
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Khan SS, Tarrant M, Kos K, Daly M, Gimbuta C, Farrow CV. Making connections: Social identification with new treatment groups for lifestyle management of severe obesity. Clin Psychol Psychother 2020; 27:686-696. [PMID: 32267579 DOI: 10.1002/cpp.2454] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 04/02/2020] [Accepted: 04/03/2020] [Indexed: 11/11/2022]
Abstract
Groups are regularly used to deliver healthcare services, including the management of obesity, and there is growing evidence that patients' experiences of such groups fundamentally shape treatment effects. This study investigated factors related to patients' shared social identity formed within the context of a treatment group for the management of severe obesity. A cross-sectional survey was administered to patients registered with a UK medical obesity service and enrolled on a group-based education and support programme. Patients (N = 78; MBMI = 48 on entry to the service) completed measures of group demographics (e.g., group membership continuity) and psychosocial variables (e.g., past experiences of weight discrimination) and reported their social identification with the treatment group. The results showed that patients identified with the treatment group to the extent that there was continuity in membership across the programme and they perceived themselves more centrally in terms of their weight status. Weight centrality was negatively associated with external social support and positively associated with experiences of weight discrimination. Group continuity was positively correlated with session attendance frequency. Patients presenting to clinical treatment services with severe obesity often do so after sustained weight loss failure and exposure to negative societal experiences. This study highlights that providing a treatment environment wherein these experiences can be shared with other patients may provide common ground for development of a new, positive social identity that can structure programme engagement and progression.
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Affiliation(s)
- Sammyh S Khan
- University of Exeter Medical School, University of Exeter, Exeter, UK.,School of Psychology, Keele University, Keele, UK
| | - Mark Tarrant
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Katarina Kos
- University of Exeter Medical School, University of Exeter, Exeter, UK.,Royal Devon and Exeter NHS Hospital Trust, Exeter, UK
| | - Mark Daly
- Royal Devon and Exeter NHS Hospital Trust, Exeter, UK
| | - Chloe Gimbuta
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Claire V Farrow
- School of Life and Health Sciences, Aston University, Birmingham, UK
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20
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Abstract
PURPOSE OF REVIEW Rising demand for specialised "Tier 3" weight management services in England is exceeding capacity, leading many services to offer group-based care programmes. This review considers the organisation of current provision, exploring how group programmes may enhance services and how these could be scaled up for wider implementation. RECENT FINDINGS Existing group-based programmes mainly focus on providing patients with information and education about their condition. Evidence suggests that groups themselves offer therapeutic benefits beyond this, by underpinning patients' engagement with programme materials and contributing to wider health and well-being. To maximise these benefits, there is a need to attend to the group processes that emerge in treatment groups which, left unchecked, may limit or even adversely impact programme outcomes. Group-based interventions may be of benefit to patients in Tier 3 specialist weight management services, although their format is complex and reliant on facilitators' expertise.
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Affiliation(s)
- Dawn Swancutt
- Peninsula Schools of Medicine and Dentistry, Plymouth University, ITTC Building, Plymouth Science Park, Plymouth, PL6 8BX, UK
| | - Mark Tarrant
- College of Medicine and Health , University of Exeter, Heavitree Road, Exeter, EX1 2LU, UK.
| | - Jonathan Pinkney
- Peninsula Schools of Medicine and Dentistry, Plymouth University, ITTC Building, Plymouth Science Park, Plymouth, PL6 8BX, UK
- University Medicine, Level 7, University Hospitals Plymouth NHS Trust, Derriford Road, Plymouth, Plymouth PL6 8DH, UK
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21
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Wang J, Chen Y, Jin Y, Zhu L, Yao Y. Sleep quality is inversely related to body mass index among university students. ACTA ACUST UNITED AC 2019; 65:845-850. [PMID: 31340315 DOI: 10.1590/1806-9282.65.6.845] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 07/10/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate the prevalence of overweight and obesity and its association with sleep quality in university students from the Anhui province in China. METHODS A cross-sectional study was conducted in China with 1328 participants. The prevalence of underweight and obesity in university students was estimated according to the reference working group on obesity in China. The sleep quality was evaluated using the standard PSQI (Pittsburgh Sleep Quality Index). RESULTS This study included 470 male and 858 female students from a university in Anhui; 4.4% of the females and 17.7% of the males were overweight or obese. The prevalence of obesity in males was significantly higher than in females, and the prevalence of obesity in higher years was greater than in other years (p<0.05). In general, the mean score for sleep quality was 4.91±2.67; 36.5% of male and 39.1% of female students had poor sleep quality (PSQI score >5). Among the seven components of sleep quality, sleep duration and the use of sleep medication showed significant differences between male and female students and different years (p<0.05). An obvious correlation was found between sleep quality and body mass index (BMI)(p<0.000) in females who took hypnotic drugs. CONCLUSION This study suggests that the sleep quality of females is probably associated with their BMI. College students are a special group of young adults whose cause of poor sleeping quality and BMI may be significant to study, so the health status of university students can be improved.
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Affiliation(s)
- Jun Wang
- Department of epidemiology and biostatistics, School of public health, Wannan Medical College, Wuhu 241001, China
| | - Yan Chen
- Department of epidemiology and biostatistics, School of public health, Wannan Medical College, Wuhu 241001, China
| | - Yuelong Jin
- Department of epidemiology and biostatistics, School of public health, Wannan Medical College, Wuhu 241001, China
| | - Lijun Zhu
- Department of epidemiology and biostatistics, School of public health, Wannan Medical College, Wuhu 241001, China
| | - Yingshui Yao
- Department of epidemiology and biostatistics, School of public health, Wannan Medical College, Wuhu 241001, China
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22
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Borek AJ, Abraham C, Greaves CJ, Tarrant M, Garner N, Pascale M. 'We're all in the same boat': A qualitative study on how groups work in a diabetes prevention and management programme. Br J Health Psychol 2019; 24:787-805. [PMID: 31273908 DOI: 10.1111/bjhp.12379] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 05/07/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Although many health interventions are delivered in groups, it is unclear how group context can be best used to promote health-related behaviour change and what change processes are most helpful to participants. This study explored participants' experiences of attending type 2 diabetes prevention and management programme, and their perceptions of how group participation influenced changes in diet and physical activity. DESIGN Qualitative. METHODS Semi-structured telephone interviews were conducted with 20 participants (twelve men) from nine groups in the Norfolk Diabetes Prevention Study. Interviews were audio-recorded, transcribed verbatim, and analysed using thematic analysis in NVivo. RESULTS Participants benefited from individual change processes, including information provision, structuring and prioritizing health goals, action planning, self-monitoring, and receiving feedback. They also benefited from group processes, including having a common purpose, sharing experiences, making social comparisons, monitoring and accountability, and providing and receiving social support in the groups. Participants' engagement with, and benefits from, the groups were enhanced when there was a supportive group context (i.e., group cohesion, homogeneous group composition, and a positive group atmosphere). Optimal facilitation to develop an appropriate group context and initiate effective change processes necessitated good facilitator interpersonal and professional skills, credibility and empathy, and effective group facilitation methods. Participants reported developing a sense of responsibility and making behaviour changes that resulted in improvements in health outcomes and weight loss. CONCLUSIONS This study highlights the role of individual and group processes in facilitating health-promoting behaviour change, and the importance of group context and optimal facilitation in promoting engagement with the programme. Statement of contribution What is already known on this subject? Many health interventions, including programmes to help prevent or manage diabetes and facilitate weight loss, are delivered in groups. Such group-based behaviour-change interventions are often effective in facilitating psychological and behaviour change. There is considerable research and theory on individual change processes and techniques, but less is known about which change processes and techniques facilitate behaviour change in group settings. What does this study add? This study contributes to our understanding of how participating in group-based health programmes may enhance or impede individual behaviour change. It identified individual (intrapersonal) and group (interpersonal, facilitated through group interaction) change processes that were valued by group participants. The findings also show how these change processes may be affected by the group context. A diagram summarizes the identified themes helping to understand interactions between these key processes occurring in groups. The study offers an insight into participants' views on, and experiences of, attending a group-based diabetes prevention and management programme. Thus, it helps better understand how the intervention might have helped them (or not) and what processes may have influenced intervention outcomes. Key practical recommendations for designing and delivering group-based behaviour-change interventions are presented, which may be used to improve future group-based health interventions.
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Affiliation(s)
- Aleksandra J Borek
- University of Exeter Medical School, University of Exeter, UK.,Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - Charles Abraham
- University of Exeter Medical School, University of Exeter, UK.,School of Psychological Sciences, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria, Australia
| | - Colin J Greaves
- University of Exeter Medical School, University of Exeter, UK.,School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, UK
| | - Mark Tarrant
- University of Exeter Medical School, University of Exeter, UK
| | - Nikki Garner
- Norfolk Diabetes Prevention Study, Norfolk & Norwich University Foundation Healthcare Trust, UK
| | - Melanie Pascale
- Norfolk Diabetes Prevention Study, Norfolk & Norwich University Foundation Healthcare Trust, UK
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23
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Borek AJ, Abraham C, Greaves CJ, Gillison F, Tarrant M, Morgan-Trimmer S, McCabe R, Smith JR. Identifying change processes in group-based health behaviour-change interventions: development of the mechanisms of action in group-based interventions (MAGI) framework. Health Psychol Rev 2019; 13:227-247. [PMID: 31190619 DOI: 10.1080/17437199.2019.1625282] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Group-based interventions are widely used to promote health-related behaviour change. While processes operating in groups have been extensively described, it remains unclear how behaviour change is generated in group-based health-related behaviour-change interventions. Understanding how such interventions facilitate change is important to guide intervention design and process evaluations. We employed a mixed-methods approach to identify, map and define change processes operating in group-based behaviour-change interventions. We reviewed multidisciplinary literature on group dynamics, taxonomies of change technique categories, and measures of group processes. Using weight-loss groups as an exemplar, we also reviewed qualitative studies of participants' experiences and coded transcripts of 38 group sessions from three weight-loss interventions. Finally, we consulted group participants, facilitators and researchers about our developing synthesis of findings. The resulting 'Mechanisms of Action in Group-based Interventions' (MAGI) framework comprises six overarching categories: (1) group intervention design features, (2) facilitation techniques, (3) group dynamic and development processes, (4) inter-personal change processes, (5) selective intra-personal change processes operating in groups, and (6) contextual influences. The framework provides theoretical explanations of how change occurs in group-based behaviour-change interventions and can be applied to optimise their design and delivery, and to guide evaluation, facilitator training and further research.
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Affiliation(s)
- Aleksandra J Borek
- a University of Exeter Medical School , University of Exeter , Exeter , UK
| | - Charles Abraham
- a University of Exeter Medical School , University of Exeter , Exeter , UK
| | - Colin J Greaves
- a University of Exeter Medical School , University of Exeter , Exeter , UK
| | - Fiona Gillison
- b Department for Health , University of Bath , Bath , UK
| | - Mark Tarrant
- a University of Exeter Medical School , University of Exeter , Exeter , UK
| | | | - Rose McCabe
- a University of Exeter Medical School , University of Exeter , Exeter , UK
| | - Jane R Smith
- a University of Exeter Medical School , University of Exeter , Exeter , UK
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24
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"C.H.A.M.P. Families": Description and Theoretical Foundations of a Paediatric Overweight and Obesity Intervention Targeting Parents-A Single-Centre Non-Randomised Feasibility Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15122858. [PMID: 30558152 PMCID: PMC6313348 DOI: 10.3390/ijerph15122858] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 12/07/2018] [Accepted: 12/10/2018] [Indexed: 12/22/2022]
Abstract
Childhood obesity represents a significant global health challenge, and treatment interventions are needed. The purpose of this paper is to describe the components and theoretical model that was used in the development and implementation of a unique parent-focussed paediatric overweight/obesity intervention. C.H.A.M.P. Families was a single-centre, prospective intervention offered to parents of children aged between 6–14 years with a body mass index (BMI) ≥85th percentile for age and sex. The intervention included: (1) eight group-based (parent-only) education sessions over 13-weeks; (2) eight home-based activities; and (3) two group-based (family) follow-up support sessions. The first section of the manuscript contains a detailed description of each intervention component, as well as an overview of ongoing feasibility analyses. The theoretical portion details the use of evidence-based group dynamics principles and motivational interviewing techniques within the context of a broader social cognitive theory foundation. This paper provides researchers with practical examples of how theoretical constructs and evidence-based strategies can be applied in the development and implementation of parent-focussed paediatric obesity interventions. Given the need for transparent reporting of intervention designs and theoretical foundations, this paper also adds to the areas of implementation science and knowledge translation research.
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Nahum-Shani I, Dziak JJ, Collins LM. Multilevel factorial designs with experiment-induced clustering. Psychol Methods 2018; 23:458-479. [PMID: 28383950 PMCID: PMC5630520 DOI: 10.1037/met0000128] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Factorial experimental designs have many applications in the behavioral sciences. In the context of intervention development, factorial experiments play a critical role in building and optimizing high-quality, multicomponent behavioral interventions. One challenge in implementing factorial experiments in the behavioral sciences is that individuals are often clustered in social or administrative units and may be more similar to each other than to individuals in other clusters. This means that data are dependent within clusters. Power planning resources are available for factorial experiments in which the multilevel structure of the data is due to individuals' membership in groups that existed before experimentation. However, in many cases clusters are generated in the course of the study itself. Such experiment-induced clustering (EIC) requires different data analysis models and power planning resources from those available for multilevel experimental designs in which clusters exist prior to experimentation. Despite the common occurrence of both experimental designs with EIC and factorial designs, a bridge has yet to be built between EIC and factorial designs. Therefore, resources are limited or nonexistent for planning factorial experiments that involve EIC. This article seeks to bridge this gap by extending prior models for EIC, developed for single-factor experiments, to factorial experiments involving various types of EIC. We also offer power formulas to help investigators decide whether a particular experimental design involving EIC is feasible. We demonstrate that factorial experiments can be powerful and feasible even with EIC. We discuss design considerations and directions for future research. (PsycINFO Database Record
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Affiliation(s)
- Inbal Nahum-Shani
- Institute for Social Research, 426 Thompson Street, Suite 2204, Ann Arbor, MI 48104-2321, University of Michigan
| | - John J. Dziak
- The Methodology Center, 404 Health and Human Development Building, Penn State, University Park, PA 16802, Pennsylvania State University
| | - Linda M. Collins
- Department of Human Development & Family Studies and The Methodology Center, 404 Health and Human Development Building, Penn State, University Park, PA 16802, Pennsylvania State University
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Taylor SS, Olsen MK, McVay MA, Grubber J, Gierisch JM, Yancy WS, Voils CI. The role of group cohesion in a group-based behavioral weight loss intervention. J Behav Med 2018; 42:162-168. [PMID: 30076501 DOI: 10.1007/s10865-018-9953-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 07/14/2018] [Indexed: 10/28/2022]
Abstract
Behavioral weight loss interventions are often delivered in groups. Group cohesion may enhance program attendance and, thereby, weight loss. In this secondary analysis, our goals were to: (1a) assess whether group cohesion measured early in a behavioral weight loss intervention predicts program attendance and weight loss outcomes and, if so, (1b) explore whether attendance mediates the link between group cohesion and weight loss; (2) characterize the association between change in group cohesion and weight loss throughout the intervention. Veterans (n = 324) initiated a 16-week, group-based behavioral weight loss program involving biweekly in-person group visits. In linear regression models, early group cohesion was unrelated to group attendance or weight loss. Although group cohesion significantly increased during the intervention, this change was not associated with weight loss. These findings are consistent with the limited literature; however, they are inconsistent with theoretical assertions and clinical observations of the influence of group factors on outcomes.
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Affiliation(s)
- Shannon S Taylor
- Department of Behavioral, Social and Population Health Sciences, University of South Carolina School of Medicine, Columbia, USA.,Department of Family Medicine, Greenville Health System, Greenville, USA
| | - Maren K Olsen
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA.,Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, USA
| | - Megan A McVay
- Department of Health Education and Behavior, University of Florida, Gainesville, FL, USA
| | - Janet Grubber
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - Jennifer M Gierisch
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA.,Department of Population and Health Sciences, Duke University Medical Center, Durham, NC, USA
| | - William S Yancy
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA.,Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Corrine I Voils
- William S. Middleton Memorial Veterans Hospital, Madison, WI, USA. .,Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, K6/100 CSC, Madison, WI, 53792-1690, USA.
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Borek AJ, Abraham C. How do Small Groups Promote Behaviour Change? An Integrative Conceptual Review of Explanatory Mechanisms. Appl Psychol Health Well Being 2018; 10:30-61. [PMID: 29446250 DOI: 10.1111/aphw.12120] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Small groups are used to promote health, well-being, and personal change by altering members' perceptions, beliefs, expectations, and behaviour patterns. An extensive cross-disciplinary literature has articulated and tested theories explaining how such groups develop, function, and facilitate change. Yet these theoretical understandings are rarely applied in the development, description, and evaluation of health-promotion, group-based, behaviour-change interventions. METHODS Medline database, library catalogues, search engines, specific journals and reference lists were searched for relevant texts. Texts were reviewed for explanatory concepts or theories describing change processes in groups, which were integrated into the developing conceptual structure. This was designed to be a parsimonious conceptual framework that could be applied to design and delivery. RESULTS Five categories of interacting processes and concepts were identified and defined: (1) group development processes, (2) dynamic group processes, (3) social change processes, (4) personal change processes, and (5) group design and operating parameters. Each of these categories encompasses a variety of theorised mechanisms explaining individual change in small groups. CONCLUSION The final conceptual model, together with the design issues and practical recommendations derived from it, provides a practical basis for linking research and theory explaining group functioning to optimal design of group-based, behaviour-change interventions.
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Mitchell NS, Furniss AL, Helmkamp LJ, Van Pelt RE. Factors Associated with Achievement of Clinically Significant Weight Loss by Women in a National Nonprofit Weight Loss Program. J Womens Health (Larchmt) 2017; 26:911-917. [PMID: 28686527 PMCID: PMC5576220 DOI: 10.1089/jwh.2016.6264] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Clinically significant weight loss (CSWL) is ≥5% of initial weight. The purpose of the study is to determine factors associated with women achieving CSWL in Take Off Pounds Sensibly (TOPS), a national, nonprofit weight loss program. METHODS This is a retrospective analysis of 48,674 females who joined TOPS from 2005 to 2011 and had a birth date in the database. Predictors of CSWL were evaluated using log-binomial regression and adjusted relative risks [99% CI] for participant age, initial weight, number of members per chapter, and chapter age. RESULTS Older women were more likely to achieve CSWL, with women ≥70 years 1.23 (1.18, 1.28) times more likely to achieve CSWL compared to women 18 to <45 years. Women who weighed 113 to <136 kg and ≥136 kg were 1.06 (1.02, 1.10) and 1.07 (1.02, 1.14) times more likely to achieve CSWL compared to women <80 kg, respectively. Women in chapters with 25 to <35 members and ≥35 members more were 1.09 (1.05, 1.13) and 1.14 (1.10, 1.18) times more likely to achieve CSWL than those in chapters with less than 15 members. Women in older chapters were less likely to achieve CSWL, with women in chapters 10 to 20 years old 0.95 (0.92, 0.99) times as likely to lose weight as those in chapters less than 10 years old. CONCLUSIONS Women in TOPS were more likely to achieve CSWL if older, ≥113 kg, and in larger, newer chapters. Future studies should address ways to modify the program to improve achievement of CSWL.
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Affiliation(s)
- Nia S. Mitchell
- Division of General Internal Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Anschutz Health and Wellness Center, Aurora, Colorado
| | - Anna L. Furniss
- Adult and Child Center for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Laura J. Helmkamp
- Adult and Child Center for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Rachael E. Van Pelt
- Division of Geriatric Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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Tronieri JS, Alfaris N, Chao AM, Pearl RL, Alamuddin N, Bakizada ZM, Berkowitz RI, Wadden TA. Lorcaserin plus lifestyle modification for weight loss maintenance: Rationale and design for a randomized controlled trial. Contemp Clin Trials 2017; 59:105-112. [PMID: 28600158 DOI: 10.1016/j.cct.2017.06.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 05/31/2017] [Accepted: 06/05/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND/AIMS Few studies have examined the efficacy of recently approved medications for chronic weight management in facilitating the maintenance of lost weight. This paper provides an overview of the design and rationale for a trial investigating whether lorcaserin, when combined with behavioral weight loss maintenance sessions (WLM), will facilitate the maintenance of losses of ≥5% of initial weight. METHODS In this two-phase trial, participants with obesity will enroll in a 14-week run-in diet program consisting of weekly group lifestyle modification sessions and a 1000-1200kcal/d meal replacement diet. Participants who complete this weight induction phase and lose at least 5% of initial weight will then be randomized to 52weeks of WLM plus lorcaserin or WLM plus placebo. We hypothesize that at 52weeks post randomization, participants assigned to WLM plus lorcaserin will achieve significantly better maintenance of the prior 5% weight loss. RESULTS We will recruit 182 adults with obesity to participate in the diet run-in, 136 of whom (75%) are expected to become eligible for the randomized controlled trial. Co-primary outcomes include the percentage of participants who maintain a loss of at least 5% of initial weight at week 52 and change in weight (kg) from randomization to week 52. CONCLUSIONS This two-phase design will allow us to determine the potential efficacy of chronic weight management using lorcaserin for maintaining initial losses of at least 5% body weight, induced by the use of a structured meal-replacement diet. This combined approach holds promise of achieving larger long-term weight losses. CLINICAL TRIAL REGISTRATION NCT02388568 on ClinicalTrials.gov.
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Affiliation(s)
- Jena Shaw Tronieri
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, United States.
| | - Nasreen Alfaris
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, United States
| | - Ariana M Chao
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, United States; Department of Family and Community Health, School of Nursing, University of Pennsylvania, United States
| | - Rebecca L Pearl
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, United States
| | - Naji Alamuddin
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, United States; Institute for Diabetes, Obesity, and Metabolism, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, United States
| | - Zayna M Bakizada
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, United States
| | - Robert I Berkowitz
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, United States; Department of Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Thomas A Wadden
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, United States
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Aschbrenner KA, Naslund JA, Bartels SJ. A mixed methods study of peer-to-peer support in a group-based lifestyle intervention for adults with serious mental illness. Psychiatr Rehabil J 2016; 39:328-334. [PMID: 27560454 PMCID: PMC5125856 DOI: 10.1037/prj0000219] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE There is potential for peer support to enhance healthy lifestyle interventions targeting changes in body weight and fitness for adults with serious mental illness. The purpose of this study was to explore peer-to-peer support among individuals participating in a group lifestyle intervention that included social media to enhance in-person weight management sessions. METHOD A mixed methods study design was used to explore participants' perceptions and experiences of support from other group members during a 6-month group lifestyle intervention. Twenty-five individuals with serious mental illness reported their perceptions of the peer group environment and social support during the intervention. Seventeen of these individuals also participated in focus group interviews further exploring their experiences with group members. RESULTS More than 80% of participants agreed that other group members were trustworthy and dependable, and 92% reported a high level of shared purpose and active participation in the group. Participants described how shared learning and group problem-solving activities fostered friendships and provided essential support for health behavior change. Sharing information, personal successes and challenges, and "being in the same boat" as other group members were key features of peer-to-peer support. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Findings from this exploratory study suggest that participants enrolled in a group-based lifestyle intervention for people with serious mental illness experience peer-to-peer support in various ways that promote health behavior change. These findings highlight opportunities to enhance future lifestyle interventions with collaborative learning and social network technologies that foster peer support among participants. (PsycINFO Database Record
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Affiliation(s)
| | - John A Naslund
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College
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Naslund JA, Aschbrenner KA, Marsch LA, Bartels SJ. Feasibility and acceptability of Facebook for health promotion among people with serious mental illness. Digit Health 2016; 2. [PMID: 28367321 PMCID: PMC5370548 DOI: 10.1177/2055207616654822] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective Elevated obesity rates are a major contributor to the significantly reduced life expectancy impacting people with serious mental illness. With over 1.5 billion Facebook users worldwide, this platform may afford opportunities for reaching individuals with serious mental illness outside professional settings and fostering social support for adopting healthier behaviors. In this mixed methods pilot study, we explored the feasibility and acceptability of using Facebook to support a group lifestyle intervention for weight loss among obese adults with serious mental illness. Methods Nine of eleven participants enrolled in a six-month lifestyle intervention delivered through a community mental health center agreed to join a private Facebook group to support their healthy eating and exercise goals. We measured participants’ use of the Facebook group and collected post-intervention feasibility and acceptability questionnaires followed by in-depth qualitative interviews to elicit participants’ perspectives and recommendations for improving the use of Facebook. Results Of 188 posts to the Facebook group, the majority (79%) were from participants compared to study staff (21%). Participants also posted 186 comments, 299 likes, and recorded 1316 page views. Participants were positive about opportunities to interact and support each other outside group sessions, found content posted by other participants to be helpful, and indicated that the Facebook group was safe to use. Participants provided constructive feedback, including recommendations for more detailed instructions for accessing the group and posting content, finding ways to encourage more interaction within the group, and tips for responding to notifications or alerts directly from the Facebook website. Conclusions These findings suggest that Facebook may be feasible for supporting health promotion efforts targeting people with serious mental illness. Participants provided valuable feedback that can inform the use of Facebook for future health promotion efforts targeting this high-risk group.
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Affiliation(s)
- John A Naslund
- Health Promotion Research Center at Dartmouth, USA; The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, USA
| | - Kelly A Aschbrenner
- Health Promotion Research Center at Dartmouth, USA; The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, USA; Department of Psychiatry, Geisel School of Medicine at Dartmouth, USA
| | - Lisa A Marsch
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, USA; Center for Technology and Behavioral Health, Dartmouth College, USA
| | - Stephen J Bartels
- Health Promotion Research Center at Dartmouth, USA; The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, USA; Center for Technology and Behavioral Health, Dartmouth College, USA; Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, USA
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Ruiz JM, Hamann HA, Mehl MR, O’Connor MF. The Hispanic health paradox: From epidemiological phenomenon to contribution opportunities for psychological science. GROUP PROCESSES & INTERGROUP RELATIONS 2016. [DOI: 10.1177/1368430216638540] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Similar to non-Hispanic Blacks, Hispanics/Latinos experience a range of psychosocial and physical health challenges, including high rates of poverty, neighborhood segregation, discrimination, poor healthcare access, and high rates of obesity, diabetes, and undiagnosed and late-stage diagnosed diseases. Despite such risks, Hispanics generally experience better physical health and lower mortality than non-Hispanic Whites, an epidemiological phenomenon commonly referred to as the Hispanic or Latino health paradox. With the basic phenomenon increasingly well-established, attention now turns to the sources of such resilience. The current aims are to briefly examine the epidemiological paradox and highlight potential sociocultural resilience factors that may contribute to the paradoxical effects. We conclude with presentation of a framework for modeling sociocultural resilience and discuss future directions for psychological contributions.
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Fazzino TL, Sporn NJ, Befort CA. A qualitative evaluation of a group phone-based weight loss intervention for rural breast cancer survivors: Themes and mechanisms of success. Support Care Cancer 2016; 24:3165-73. [PMID: 26932848 DOI: 10.1007/s00520-016-3149-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 02/24/2016] [Indexed: 12/20/2022]
Abstract
PURPOSE Obesity is prevalent in breast cancer survivors and is a significant risk factor for recurrence and mortality. Weight management interventions for survivors have been diverse in design (in-person vs. phone-based, group vs. individual) and yielded varying weight loss results. Given these issues, participants themselves may provide insight into treatment-based factors that contributed to their weight loss outcomes. Here, we report qualitative results from interviews with survivors in a group phone-based weight loss intervention, with the objective of identifying mechanisms that facilitated or hindered adherence and weight loss. We explored interest in paying for continued treatment as an indicator of dissemination potential. METHODS Individual interviews were conducted with 186 rural, obese breast cancer survivors upon completion of a 6-month weight loss intervention that produced clinically meaningful weight loss (>5 %) in 91 % of participants. A thematic analysis of the interview data was performed. RESULTS Five themes were identified as impacting adherence and success: (1) accountability; (2) importance of the group, with varying levels of connectedness; (3) dietary convenience; (4) difficulty maintaining intervention components that required more effort; and (5) importance of internal motivation to attributions of physical activity success or failure. Most were interested in paying to continue the program if it were extended beyond the study. CONCLUSIONS Key intervention components that participants attributed to their success included supportive group processes and convenience. Results highlight the group phone-based approach as a potential venue for disseminating an effective weight loss program for breast cancer survivors. TRIAL REGISTRATION NCT01441011.
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Affiliation(s)
- Tera L Fazzino
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA.
| | - Nora J Sporn
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA.,Department of Psychology, University of Kansas, Lawrence, KS, USA
| | - Christie A Befort
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA.,Department of Psychology, University of Kansas, Lawrence, KS, USA
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