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Vandyousefi S, Oettingen G, Wittleder S, Moin T, Sweat V, Aguilar AD, Ruan A, Angelotti G, Wong L, Orstad SL, Illengberger N, Nicholson A, Lim S, Cansler R, Portelli D, Sherman S, Jay MR. Protocol for a prospective, randomized, controlled trial of Mental Contrasting with Implementation Intentions (MCII) to enhance the effectiveness of VA's MOVE! weight management program: WOOP (Wish, Outcome, Obstacle, Plan) VA. Contemp Clin Trials 2024; 141:107523. [PMID: 38608752 DOI: 10.1016/j.cct.2024.107523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 03/31/2024] [Accepted: 04/08/2024] [Indexed: 04/14/2024]
Abstract
INTRODUCTION Intensive weight management programs are effective but often have low enrollment and high attrition. Lack of motivation is a key psychological barrier to enrollment, engagement, and weight loss. Mental Contrasting with Implementation Intentions (MCII) is a unique imagery technique that increases motivation for behavior change. We describe our study protocol to assess the efficacy and implementation of MCII to enhance the effectiveness of VA's MOVE! or TeleMOVE! weight management programs using a procedure called "WOOP" (Wish, Outcome, Obstacle, Plan) for Veterans. We hypothesize that WOOP+MOVE! or TeleMOVE! (intervention) will lead to greater MOVE!/TeleMOVE! program engagment and consequently weight loss than MOVE!/TeleMOVE! alone (control). METHOD Veterans are randomized to either the intervention or control. Both arms receive the either MOVE! or TeleMOVE! weight management programs. The intervention group receives an hour long WOOP training while the control group receives patient education. Both groups receive telephone follow up calls at 3 days, 4 weeks, and 2 months post-baseline. Eligible participants are Veterans (ages 18-70 years) with either obesity (BMI ≥ 30 kg/m2) or overweight (BMI ≥ 25 kg/m2) and an obesity-associated co-morbidity. At baseline, 6 and 12 months, we assess weight, diet, physical activity in both groups. The primary outcome is mean percent weight change at 6 months. Secondary outcomes include changes in waist circumference, diet, physical activity, and dieting self-efficacy and engagement in regular physical activity. We assess implementation using the RE-AIM framework. CONCLUSION If WOOP VA is found to be efficacious, it will be an important tool to facilitate weight management and improve weight outcomes. CLINICAL TRIAL REGISTRATION NCT05014984.
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Affiliation(s)
- Sarvenaz Vandyousefi
- New York Harbor Veterans Health Affairs, New York, NY, United States of America; Department of Medicine, New York University Grossman School of Medicine, New York, NY, United States of America
| | - Gabriele Oettingen
- Department of Psychology, New York University, New York, NY, United States of America
| | - Sandra Wittleder
- New York Harbor Veterans Health Affairs, New York, NY, United States of America; Department of Medicine, New York University Grossman School of Medicine, New York, NY, United States of America
| | - Tannaz Moin
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States of America; Department of Medicine, David Geffen School of Medicine, The University of California, Los Angeles, Los Angeles, CA, United States of America
| | - Victoria Sweat
- New York Harbor Veterans Health Affairs, New York, NY, United States of America; Department of Medicine, New York University Grossman School of Medicine, New York, NY, United States of America
| | - Adrian D Aguilar
- New York Harbor Veterans Health Affairs, New York, NY, United States of America; Department of Medicine, New York University Grossman School of Medicine, New York, NY, United States of America
| | - Andrea Ruan
- New York Harbor Veterans Health Affairs, New York, NY, United States of America; Department of Medicine, New York University Grossman School of Medicine, New York, NY, United States of America
| | - Gina Angelotti
- New York Harbor Veterans Health Affairs, New York, NY, United States of America; Department of Medicine, New York University Grossman School of Medicine, New York, NY, United States of America
| | - Laura Wong
- New York Harbor Veterans Health Affairs, New York, NY, United States of America; Department of Medicine, New York University Grossman School of Medicine, New York, NY, United States of America
| | - Stephanie L Orstad
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, United States of America
| | - Nicholas Illengberger
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States of America
| | - Andrew Nicholson
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States of America
| | - Sahnah Lim
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States of America
| | - Rachel Cansler
- New York Harbor Veterans Health Affairs, New York, NY, United States of America; Department of Medicine, New York University Grossman School of Medicine, New York, NY, United States of America
| | - Dilara Portelli
- New York Harbor Veterans Health Affairs, New York, NY, United States of America; Department of Medicine, New York University Grossman School of Medicine, New York, NY, United States of America
| | - Scott Sherman
- New York Harbor Veterans Health Affairs, New York, NY, United States of America; Department of Medicine, New York University Grossman School of Medicine, New York, NY, United States of America; Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States of America
| | - Melanie R Jay
- New York Harbor Veterans Health Affairs, New York, NY, United States of America; Department of Medicine, New York University Grossman School of Medicine, New York, NY, United States of America; Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States of America.
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Kaur J, Lee YL, Stortz E, Palani G, Elkin B, Gravely A, Westanmo A, Billington CJ, Ercan-Fang N, Sibley SD. Telephone Virtual Versus In-Person Pharmacotherapy-Based Obesity Care: A COVID-19-Related Experience at a Veterans Administration Facility. Telemed J E Health 2024; 30:e1110-e1118. [PMID: 37883630 DOI: 10.1089/tmj.2023.0049] [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] [Indexed: 10/28/2023] Open
Abstract
Background: Most of the Veterans Administration (VA) population is either overweight or obese, which is a serious health concern. Medical weight management visits have traditionally occurred through in-person clinics. However, the COVID-19 pandemic forced care delivery to virtual platforms. Methods: We compared weight loss with in-person versus telephone-based medical weight management (lifestyle counseling coupled with pharmacotherapy) delivered by physician and nurse practitioner visits during the pandemic. We designed a program evaluation utilizing a naturalistic (pragmatic) observational study structure, including both newly enrolled and previously established participants in the Minneapolis VA MOVE! program between 2017 and 2021. A "transition" cohort (n = 74) received in-person care from March 2019 to March 2020, and then transitioned to virtual care. A "new start" virtual care cohort (n = 149) enrolled after March 2020 was compared to a separate historical group (n = 180) that received in-person care between January 2017 and December 2019. Weight loss was accessed over a 9-month period in both cohorts. Results: Mean weight loss over 9 months was -6.5 ± 18.2 and -2.5 ± 13.3 lbs in the in-person and virtual phases of the transition cohort, respectively, without significant difference between the two phases (p = 0.22). Mean weight loss over 9 months in the new start (virtual) cohort was -14.4 ± 17.0 lbs compared to -16.7 ± 21.0 lbs in the historical cohort, without significant difference between groups (p = 0.44). Conclusions: In our naturalistic study in a single-site VA clinic setting, weight loss with telephone-based medical weight management during the pandemic was comparable to in-person care. These findings are important for veterans living in rural and/or underserved areas.
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Affiliation(s)
- Jasleen Kaur
- Division of Endocrinology and Diabetes, Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Yee L Lee
- Division of Endocrinology and Diabetes, Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Ethan Stortz
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Guru Palani
- Division of Endocrinology and Diabetes, Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Baila Elkin
- University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Amy Gravely
- Research Service, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, USA
| | - Anders Westanmo
- Department of Pharmacy, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, USA
| | - Charles J Billington
- Division of Endocrinology and Diabetes, Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
- Department of Medicine, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, USA
| | - Nacide Ercan-Fang
- Division of Endocrinology and Diabetes, Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
- Department of Medicine, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, USA
| | - Shalamar D Sibley
- Division of Endocrinology and Diabetes, Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
- Department of Medicine, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, USA
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Abstract
BACKGROUND The coronavirus pandemic of 2019 (COVID-19) forced worldwide recognition and implementation of telehealth as a means of providing continuity of care by varied health care institutions. Diabetes is a global health threat with rates that continue to accelerate, thereby causing an increased need for clinicians to provide diabetes care and education to keep up with demand. Utilizing technology to provide education via phone/smartphone, video/audio, web, text message, mobile apps, or a combination of these methods can help improve patient access and clinical outcomes, cut costs, and close gaps in care. METHODS While numerous publications have summarized the various tools and technologies available for capturing remote clinical data and their relevance to diabetes care and self-management, this review focuses on self-educational telehealth tools available for diabetes self-management, their advantages and disadvantages, and factors that need to be considered prior to implementation. Recent relevant studies indexed by PubMed were included. RESULTS The widespread use and popularity of phones/smartphones, tablets, computers, and the Internet by patients of all age groups, cultures, socioeconomic and geographic areas allow for increased outreach, flexibility, and engagement with diabetes education, either in combination or as an adjunct to traditional in-person visits. Demonstrated benefits of using health technologies for diabetes self-management education include improved lifestyle habits, reduced hemoglobin A1C levels, decreased health care costs, and better medication adherence. Potential drawbacks include lack of regulation, need for staff training on methodologies used, the requirement for patients to be tech savvy, privacy concerns, lag time with technology updates/glitches, and the need for more long-term research data on efficacy. CONCLUSIONS Telehealth technologies for diabetes self-education improve overall clinical outcomes and have come a long way. With increasing numbers of patients with diabetes, it is expected that more optimal and user-friendly methodologies will be developed to fully engage and help patients communicate with their physicians.
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Affiliation(s)
- Vidya Sharma
- Department of Nutrition & Dietetics, College for Health, Community and Policy, The University of Texas at San Antonio, San Antonio, TX, USA
| | | | - Ramaswamy Sharma
- Department of Cell Systems and Anatomy, Joe R. & Teresa Lozano Long School of Medicine, UT Health San Antonio, San Antonio, TX, USA
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Robinson KM, Vander Weg M, Laroche HH, Carrel M, Wachsmuth J, Kazembe K, Vaughan Sarrazin M. Obesity treatment initiation, retention, and outcomes in the Veterans Affairs MOVE! Program among rural and urban veterans. Obes Sci Pract 2022; 8:784-793. [PMID: 36483119 PMCID: PMC9722450 DOI: 10.1002/osp4.622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 05/10/2022] [Accepted: 05/23/2022] [Indexed: 11/08/2022] Open
Abstract
Objective Rural veterans have high obesity rates. Yet, little is known about this population's engagement with the Veterans Affairs (VA) weight management program (MOVE!). The study objective is to determine whether MOVE! enrollment, anti-obesity medication use, bariatric surgery use, retention, and outcomes differ by rurality for veterans with severe obesity. Methods This is a retrospective cohort study using Veterans Health Administration patient databases, including VA patients with severe obesity during 2015-2017. Patients were categorized using Rural-Urban Commuting Area codes. Primary outcomes included proportion of patients and risk-adjusted likelihood of initiating VA MOVE!, anti-obesity medication, or bariatric surgery and risk-adjusted highly rural|Hazard Ratio (HR) of any obesity treatment. Secondary outcomes included treatment retention (≥12 weeks) and successful weight loss (5%) among patients initiating MOVE!, and risk-adjusted odds of retention and successful weight loss. Results Among 640,555 eligible veterans, risk-adjusted relative likelihood of MOVE! treatment was significantly lower for rural and HR veterans (HR = 0.83, HR = 0.67, respectively). Initiation rates of anti-obesity medication use were significantly lower as well, whereas bariatric surgery rates, retention, and successful weight loss did not differ. Conclusions Overall treatment rates with MOVE!, bariatric surgery, and anti-obesity medications remain low. Rural veterans are less likely to enroll in MOVE! and less likely to receive anti-obesity medications than urban veterans.
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Affiliation(s)
- Kathleen M. Robinson
- Department of Internal Medicine University of Iowa Carver College of Medicine Iowa City Iowa USA
| | - Mark Vander Weg
- Center for Access & Delivery Research and Evaluation (CADRE) Iowa City VA Health Care System Iowa City Iowa USA
- Department of Behavioral and Community Health University of Iowa College of Public Health Iowa City Iowa City Iowa USA
| | - Helena H. Laroche
- Center for Children's Healthy Lifestyles and Nutrition University of Missouri‐Kansas City School of Medicine Kansas City Missouri USA
| | - Margaret Carrel
- Department of Geography University of Iowa College of Liberal Arts Iowa City Iowa USA
| | - Jason Wachsmuth
- Department of Internal Medicine University of Iowa Carver College of Medicine Iowa City Iowa USA
| | - Krista Kazembe
- MOVE! Treatment Program Iowa City VA Health Care System Iowa City Iowa USA
| | - Mary Vaughan Sarrazin
- Department of Internal Medicine University of Iowa Carver College of Medicine Iowa City Iowa USA
- Center for Access & Delivery Research and Evaluation (CADRE) Iowa City VA Health Care System Iowa City Iowa USA
- Investigator VA Office of Rural Health Veterans Rural Health Resource Center‐Iowa City (VRHRC‐IC) Iowa City Veterans Affairs Health Care System Iowa City Iowa USA
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Mellor R, Saunders-Dow E, Mayr HL. Scope of Use and Effectiveness of Dietary Interventions for Improving Health-Related Outcomes in Veterans: A Systematic Review. Nutrients 2022; 14:nu14102094. [PMID: 35631235 PMCID: PMC9147269 DOI: 10.3390/nu14102094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/13/2022] [Accepted: 05/15/2022] [Indexed: 01/13/2023] Open
Abstract
Military veterans often have numerous physical and mental health conditions and can face unique challenges to intervention and management. Dietary interventions can improve the outcomes in many health conditions. This study aimed to evaluate the scope of health conditions targeted with dietary interventions and the effectiveness of these interventions for improving health-related outcomes in veterans. A systematic literature review was performed following PRISMA guidelines to identify and evaluate studies related to veterans and dietary interventions. Five electronic databases were searched, identifying 2669 references. Following screening, 35 studies were evaluated, and 18 were related to a US national veteran weight-loss program. The included studies were critically appraised, and the findings were narratively synthesized. Study designs ranged from randomised controlled trials to cohort studies and were predominantly U.S. based. The intervention durations ranged from one to 24 months. The mean subject age ranged from 39.0 to 69.7 years, with often predominantly male participants, and the mean body mass index ranged from 26.4 to 42.9 kg/m2. Most dietary interventions for veterans were implemented in populations with overweight/obesity or chronic disease and involved single dietary interventions or dietary components of holistic lifestyle interventions. The most common primary outcome of interest was weight loss. The success of dietary interventions was generally moderate, and barriers included poor compliance, mental health conditions and large drop-out rates. The findings from this review illustrate the need for further refinement of dietary and lifestyle interventions for the management of veterans with chronic health conditions.
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Affiliation(s)
- Rebecca Mellor
- Gallipoli Medical Research Foundation, Greenslopes Private Hospital, Greenslopes, QLD 4021, Australia;
- Correspondence:
| | - Elise Saunders-Dow
- Gallipoli Medical Research Foundation, Greenslopes Private Hospital, Greenslopes, QLD 4021, Australia;
| | - Hannah L. Mayr
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Woolloongabba, QLD 4102, Australia;
- Centre for Functioning and Health Research, Metro South Hospital and Health Service, Buranda, QLD 4102, Australia
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6
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Gray KE, Hoerster KD, Spohr SA, Breland JY, Raffa SD. National Veterans Health Administration MOVE! Weight Management Program Participation During the COVID-19 Pandemic. Prev Chronic Dis 2022; 19:E11. [PMID: 35271436 PMCID: PMC8937622 DOI: 10.5888/pcd19.210303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction In response to COVID-19, the Veterans Health Administration (VHA) converted appropriate outpatient visits to virtual care, including MOVE! Weight Management Program for Veterans (MOVE!) visits. Before the pandemic, most veterans participated in MOVE! in person, with several telehealth modalities available. We sought to describe national trends in MOVE! participation during the pandemic (March 2020–January 2021) overall and by modality and to compare participation to prepandemic levels. Methods We conducted a national retrospective cohort study of veterans who participated in MOVE! from January 2018 through January 2021. We examined MOVE! participation across VHA aggregated at the national level by month, including the number of visits, participants, and new participants in person and via telehealth, including telephone, clinic-to-clinic synchronous video, anywhere-to-anywhere (eg, provider home to patient home) synchronous video, and remote education and monitoring. We also determined the percentage of all MOVE! visits attributable to each modality and the monthly percentage change in participation during the pandemic compared with monthly averages in prior years. Results Before March 2020, 20% to 30% of MOVE! was delivered via telehealth, which increased to 90% by April 2020. Early in the pandemic, telephone-delivered MOVE! was the most common modality, but anywhere-to-anywhere synchronous video participation increased over time. Compared with the same months in prior years, total monthly MOVE! participation remained 20% to 40% lower at the end of 2020 and into January 2021. Conclusion The VHA MOVE! program rapidly shifted to telehealth delivery of weight management services in response to the pandemic. However, a gap remained in the number of veterans receiving these services compared with prior years, suggesting potential unmet needs for weight management.
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Affiliation(s)
- Kristen E. Gray
- Health Services Research & Development, VA Puget Sound Health Care System, Seattle Division, Seattle, Washington
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, Washington
| | - Katherine D. Hoerster
- Health Services Research & Development, VA Puget Sound Health Care System, Seattle Division, Seattle, Washington
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, Washington
- Mental Health Service, VA Puget Sound Health Care System, Seattle Division, Seattle, Washington
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
| | - Stephanie A. Spohr
- National Center for Health Promotion and Disease Prevention, Veterans Health Administration, Durham, North Carolina
| | - Jessica Y. Breland
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California
| | - Susan D. Raffa
- National Center for Health Promotion and Disease Prevention, Veterans Health Administration, Durham, North Carolina
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina
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Zare H, Delgado P, Spencer M, Thorpe RJ, Thomas L, Gaskin DJ, Werrell LK, Carter EL. Using Community Health Workers to Address Barriers to Participation and Retention in Diabetes Prevention Program: A Concept Paper. J Prim Care Community Health 2022; 13:21501319221134563. [PMID: 36331112 PMCID: PMC9638527 DOI: 10.1177/21501319221134563] [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] [Indexed: 11/06/2022] Open
Abstract
Objective: The PreventionLink of Southern Maryland is a 5-year project to eliminate
barriers to participation and retention in the National Diabetes Prevention
Program (DPP) lifestyle change program to prevent or delay the onset of type
2 diabetes in adults with prediabetes. This is the study to identify the
obstacles to participation and retention in the DPP lifestyle change program
among high burden populations and learn how CHWs have reduced the identified
barriers to participation and retention for high burden populations. Methods: We followed the Preferred Reporting Items for Systematic Reviews and
Meta-Analyses (PRISMA) to conduct this literature review. We have used the
Scopus and PubMed, including all types of studies and peer-reviewed
documents published in English between 2010 and 2020. Results: From 131 identified articles, 18 articles were selected for qualitative
synthesis. The reviewed literature documented following as main barriers to
participate in a DPP lifestyle change program: time, cost, lack of
transportation, cost of transportation, commute distance, technology access,
access to facilities and community programs, caregiver responsibilities,
lack of health literacy and awareness, and language. CHWs can address these
barriers to participation and retention, they were involved in educating and
supporting roles; they worked as bridges between healthcare providers and
participants and as intervention team members. Conclusions: Diabetes prevention program participants with social determinant risk factors
who most need CHW services are unlikely to have financial resources to pay
for CHW services out-of-pocket. Hence, the public and private health plans
that pay for their prediabetes care should consider paying for these CHW
services and there is a need to trust more to CHW and have them as a
“community health teams” member.
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Affiliation(s)
- Hossein Zare
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- University of Maryland Global Campus, Adelphi, MD, USA
| | - Paul Delgado
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- OSU College of Osteopathic Medicine, Tulsa, OK, USA
| | - Michelle Spencer
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Roland J. Thorpe
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Laurine Thomas
- Independent Health Services Research & Evaluation Consultant, Baltimore, MD, USA
| | | | - Lori K. Werrell
- MedStar Southern Maryland Hospital Center, Clinton, MD, USA
- Medstar St. Mary’s Hospital, Leonardtown, MD, USA
| | - Ernest L. Carter
- Prince George’s County Department of Health, Silver Spring, MD, USA
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Affiliation(s)
- Scott Hagan
- From the Department of Medicine, University of Washington School of Medicine, Seattle
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9
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Maston G, Franklin J, Hocking S, Swinbourne J, Gibson A, Manson E, Sainsbury A, Markovic T. Dietary adherence and program attrition during a severely energy-restricted diet among people with complex class III obesity: A qualitative exploration. PLoS One 2021; 16:e0253127. [PMID: 34138917 PMCID: PMC8211265 DOI: 10.1371/journal.pone.0253127] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 06/01/2021] [Indexed: 12/27/2022] Open
Abstract
Meal replacement Severely Energy-Restricted Diets (SERDs) produce ≥ 10% loss of body mass when followed for 6 weeks or longer in people with class III obesity (BMI ≥ 40 kg/m2). The efficacy of SERDs continues to be questioned by healthcare professionals, with concerns about poor dietary adherence. This study explored facilitators and barriers to dietary adherence and program attrition among people with class III obesity who had attempted or completed a SERD in a specialised weight loss clinic. Participants who commenced a SERD between January 2016 to May 2018 were invited to participate. Semi-structured in-depth interviews were conducted from September to October 2018 with 20 participants (12 women and 8 men). Weight change and recounted events were validated using the participants' medical records. Data were analysed by thematic analysis using line-by-line inductive coding. The mean age ± SD of participants was 51.2 ± 11.3 years, with mean ± SD BMI at baseline 63.7 ± 12.6 kg/m2. Five themes emerged from participants' recounts that were perceived to facilitate dietary adherence: (1.1) SERD program group counselling and psychoeducation sessions, (1.2) emotionally supportive clinical staff and social networks that accommodated and championed change in dietary behaviours, (1.3) awareness of eating behaviours and the relationship between these and progression of disease, (1.4) a resilient mindset, and (1.5) dietary simplicity, planning and self-monitoring. There were five themes on factors perceived to be barriers to adherence, namely: (2.1) product unpalatability, (2.2) unrealistic weight loss expectations, (2.3) poor program accessibility, (2.4) unforeseeable circumstances and (2.5) externalised weight-related stigma. This study highlights opportunities where SERD programs can be optimised to facilitate dietary adherence and reduce barriers, thus potentially improving weight loss outcomes with such programs. Prior to the commencement of a SERD program, healthcare professionals facilitating such programs could benefit from reviewing participants to identify common barriers. This includes identifying the presence of product palatability issues, unrealistic weight loss expectations, socio-economic disadvantage, and behaviour impacting experiences of externalised weight-related stigma.
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Affiliation(s)
- Gabrielle Maston
- The Boden Collaboration for Obesity, Nutrition, Exercise & Eating Disorders, Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia
- Metabolism & Obesity Services, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Janet Franklin
- Metabolism & Obesity Services, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Samantha Hocking
- The Boden Collaboration for Obesity, Nutrition, Exercise & Eating Disorders, Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia
- Metabolism & Obesity Services, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
- Sydney School of Medicine (Central Clinical School), Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Jessica Swinbourne
- Metabolism & Obesity Services, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Alice Gibson
- Menzies Centre for Health Policy, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Elisa Manson
- Metabolism & Obesity Services, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Amanda Sainsbury
- School of Human Sciences, Faculty of Science, The University of Western Australia, Crawley, WA, Australia
| | - Tania Markovic
- The Boden Collaboration for Obesity, Nutrition, Exercise & Eating Disorders, Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia
- Metabolism & Obesity Services, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
- Sydney School of Medicine (Central Clinical School), Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
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Batsis JA, Petersen CL, Clark MM, Cook SB, Kotz D, Gooding TL, Roderka MN, Al-Nimr RI, Pidgeon D, Haedrich A, Wright KC, Aquila C, Mackenzie TA. Feasibility and acceptability of a technology-based, rural weight management intervention in older adults with obesity. BMC Geriatr 2021; 21:44. [PMID: 33435877 PMCID: PMC7801868 DOI: 10.1186/s12877-020-01978-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 12/21/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Older adults with obesity residing in rural areas have reduced access to weight management programs. We determined the feasibility, acceptability and preliminary outcomes of an integrated technology-based health promotion intervention in rural-living, older adults using remote monitoring and synchronous video-based technology. METHODS A 6-month, non-randomized, non-blinded, single-arm study was conducted from October 2018 to May 2020 at a community-based aging center of adults aged ≥65 years with a body mass index (BMI) ≥30 kg/m2. Weekly dietitian visits focusing on behavior therapy and caloric restriction and twice-weekly physical therapist-led group strength, flexibility and balance training classes were delivered using video-conferencing to participants in their homes. Participants used a Fitbit Alta HR for remote monitoring with data feedback provided by the interventionists. An aerobic activity prescription was provided and monitored. RESULTS Mean age was 72.9±3.9 years (82% female). Baseline anthropometric measures of weight, BMI, and waist circumference were 97.8±16.3 kg, 36.5±5.2 kg/m2, and 115.5±13.0 cm, respectively. A total of 142 participants were screened (n=27 ineligible), and 53 consented. There were nine dropouts (17%). Overall satisfaction with the trial (4.7+ 0.6, scale: 1 (low) to 5 (high)) and with Fitbit (4.2+ 0.9) were high. Fitbit was worn an average of 81.7±19.3% of intervention days. In completers, mean weight loss was 4.6±3.5 kg or 4.7±3.5% (p< 0.001). Physical function measures of 30-s sit-to-stand repetitions increased from 13.5±5.7 to 16.7±5.9 (p< 0.001), 6-min walk improved by 42.0±77.3 m (p=0.005) but no differences were observed in gait speed or grip strength. Subjective measures of late-life function improved (3.4±4.7 points, p< 0.001). CONCLUSIONS A technology-based obesity intervention is feasible and acceptable to older adults with obesity and may lead to weight loss and improved physical function. CLINICAL TRIAL REGISTRATION Registered on Clinicaltrials.gov # NCT03104205 . Registered on April 7, 2017. First participant enrolled on October 1st, 2018.
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Affiliation(s)
- John A Batsis
- Division of Geriatric Medicine, School of Medicine, and Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 5017 Old Clinic Building, Chapel Hill, NC, 27599, USA.
- Dartmouth-Hitchcock, Geisel School of Medicine, and The Dartmouth Institute for Health Policy, Hanover, NH, USA.
| | | | - Matthew M Clark
- Mayo Clinic Rochester, Department of Psychiatry and Psychology, and Division of Endocrinology, Rochester, MN, USA
| | | | | | - Tyler L Gooding
- Dartmouth-Hitchcock, Geisel School of Medicine, and The Dartmouth Institute for Health Policy, Hanover, NH, USA
| | - Meredith N Roderka
- Dartmouth-Hitchcock, Geisel School of Medicine, and The Dartmouth Institute for Health Policy, Hanover, NH, USA
| | - Rima I Al-Nimr
- Dartmouth-Hitchcock, Geisel School of Medicine, and The Dartmouth Institute for Health Policy, Hanover, NH, USA
| | - Dawna Pidgeon
- Dartmouth-Hitchcock, Geisel School of Medicine, and The Dartmouth Institute for Health Policy, Hanover, NH, USA
| | - Ann Haedrich
- Dartmouth-Hitchcock, Geisel School of Medicine, and The Dartmouth Institute for Health Policy, Hanover, NH, USA
| | - K C Wright
- Dartmouth-Hitchcock, Geisel School of Medicine, and The Dartmouth Institute for Health Policy, Hanover, NH, USA
| | - Christina Aquila
- Dartmouth-Hitchcock, Geisel School of Medicine, and The Dartmouth Institute for Health Policy, Hanover, NH, USA
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11
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Batsis JA, McClure AC, Weintraub AB, Sette D, Rotenberg S, Stevens CJ, Gilbert-Diamond D, Kotz DF, Bartels SJ, Cook SB, Rothstein RI. Barriers and facilitators in implementing a pilot, pragmatic, telemedicine-delivered healthy lifestyle program for obesity management in a rural, academic obesity clinic. Implement Sci Commun 2020; 1:83. [PMID: 33015640 PMCID: PMC7526351 DOI: 10.1186/s43058-020-00075-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 09/17/2020] [Indexed: 12/19/2022] Open
Abstract
PURPOSE Few evidence-based strategies are specifically tailored for disparity populations such as rural adults. Two-way video-conferencing using telemedicine can potentially surmount geographic barriers that impede participation in high-intensity treatment programs offering frequent visits to clinic facilities. We aimed to understand barriers and facilitators of implementing a telemedicine-delivered tertiary-care, rural academic weight-loss program for the management of obesity. METHODS A single-arm study of a 16-week, weight-loss pilot evaluated barriers and facilitators to program participation and exploratory measures of program adoption and staff confidence in implementation and intervention delivery. A program was delivered using video-conferencing within an existing clinical infrastructure. Elements of Consolidated Framework for Implementation Research (CFIR) provided a basis for assessing intervention characteristics, inner and outer settings, and individual characteristics using surveys and semi-structured interviews. We evaluated elements of the RE-AIM model (reach, adoption) to assess staff barriers to success for future scalability. FINDINGS There were 27 patients and 8 staff completing measures. Using CFIR, the intervention was valuable from a patient participant standpoint; staff equally had positive feelings about using telemedicine as useful for patient care. The RE-AIM framework demonstrated limited reach but willingness to adopt was above average. A significant barrier limiting sustainability was physical space for intervention delivery and privacy and dedicated resources for staff. Scheduling stressors were also a challenge in its implementation. CONCLUSIONS The need to engage staff, enhance organizational culture, and increase reach are major factors for rural health obesity clinics to enhance sustainability of using telemedicine for the management of obesity. TRIAL REGISTRATION Clinicaltrials.gov NCT03309787. Registered on 16 October 2017.
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Affiliation(s)
- John A. Batsis
- Division of Geriatric Medicine, Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Auden C. McClure
- Geisel School of Medicine at Dartmouth and The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, NH USA
- Dartmouth Weight & Wellness Center, Lebanon, NH USA
| | | | - Diane Sette
- Dartmouth Weight & Wellness Center, Lebanon, NH USA
| | - Sivan Rotenberg
- Dartmouth Weight & Wellness Center, Lebanon, NH USA
- Department of Psychiatry, Dartmouth-Hitchcock, Lebanon, NH USA
| | - Courtney J. Stevens
- Dartmouth Weight & Wellness Center, Lebanon, NH USA
- Department of Psychiatry, Dartmouth-Hitchcock, Lebanon, NH USA
- Dartmouth Centers for Health and Aging, Dartmouth College, Hanover, NH USA
| | - Diane Gilbert-Diamond
- Geisel School of Medicine at Dartmouth and The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, NH USA
- Dartmouth Weight & Wellness Center, Lebanon, NH USA
- Department of Epidemiology, Dartmouth College, Hanover, NH USA
| | - David F. Kotz
- Department of Computer Science, Dartmouth College, Hanover, NH USA
| | | | | | - Richard I. Rothstein
- Geisel School of Medicine at Dartmouth and The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, NH USA
- Dartmouth Weight & Wellness Center, Lebanon, NH USA
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12
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Cuthbert K, Hardin S, Zelkowitz R, Mitchell K. Eating Disorders and Overweight/Obesity in Veterans: Prevalence, Risk Factors, and Treatment Considerations. Curr Obes Rep 2020; 9:98-108. [PMID: 32361915 DOI: 10.1007/s13679-020-00374-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW Eating disorders (EDs) and overweight/obesity (OW/OB) have a significant impact on veterans. This review highlights current research on EDs and OW/OB in this population. RECENT FINDINGS Prevalence estimates for both EDs and OW/OB among veterans remain consistent with and possibly higher than those in the general population. Both diagnoses share multiple risk factors, including trauma history, and mental health comorbidities. Although weight loss treatments have been fairly well studied among veteran samples, there are no published investigations on psychotherapies for EDs in this population. The Veterans Healthcare Administration is working to train providers in ED treatments. VHA treatments for OW/OB show some benefits and areas for improvement. Areas for future research include structured assessments for EDs and disordered eating behaviors in veterans to clarify prevalence estimates. There is a need for interventions that consider common mechanisms for ED and OW/OB, and there is a need for more research on the associations between different types of trauma and ED/OW/OB in veterans.
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Affiliation(s)
- Kristy Cuthbert
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
- National Center for PTSD at the VA Boston Healthcare System, Boston, MA, 02130, USA
| | - Sabrina Hardin
- National Center for PTSD at the VA Boston Healthcare System, Boston, MA, 02130, USA
| | - Rachel Zelkowitz
- National Center for PTSD at the VA Boston Healthcare System, Boston, MA, 02130, USA
| | - Karen Mitchell
- National Center for PTSD at the VA Boston Healthcare System, Boston, MA, 02130, USA.
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA.
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13
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Batch BC, Brown CS, Goldstein KM, Danus S, Sperber NR, Bosworth HB. Women Veterans Experience with the VA MOVE! Weight Management Program. WOMEN'S HEALTH REPORTS 2020; 1:65-72. [PMID: 33786475 PMCID: PMC7784794 DOI: 10.1089/whr.2019.0009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Background: Obesity prevalence is higher in women veterans overall than their civilian counterparts considering 44% of women veterans are obese. Thus, there is a critical need to understand the facilitators and barriers to women veterans' participation in weight management programs. The objective of this study is to explore facilitators and barriers to weight loss for women veterans enrolled in the Veterans Health Administration Motivating Overweight/Obese Veterans Everywhere (VA MOVE!) weight management program and gather feedback on the design and delivery of the MOVE! program. Materials and Methods: Primary qualitative data were collected from women veterans who completed at least one MOVE! visit via semistructured telephone interviews. Two authors independently reviewed transcripts for data-derived codes. A content analysis approach was used within the software to code the transcripts. Results: The mean age of participants was 52 years. Sixty-eight percent (N = 17/25) were black, and 52% (N = 13/25) lived >64 kilometers from the location of the MOVE! program. Facilitators to participation included both intrinsic (e.g., drive to become healthy) and extrinsic (e.g., drive to improve laboratories) motivating factors. Women expressed difficulty with learning in a group setting and applying lessons to their everyday lives. Others reported the setup of group classes triggered their post-traumatic stress disorder and prevented them from fully participating in the program. Additional barriers included distance traveled to group sessions and lack of access to exercise space. Conclusions: Our results illuminate barriers and facilitators to engagement in the MOVE! program. Many of the barriers highlighted by these women veterans mirror barriers civilian women face, highlighting the possibility that our results could be applied to other programs designed to target weight loss in women.
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Affiliation(s)
- Bryan C Batch
- Division of Endocrinology, Department of Medicine, Durham VA Medical Center, Durham, North Carolina.,Division of Endocrinology, Metabolism and Nutrition, Duke University, Durham, North Carolina
| | - Candace S Brown
- Department of Public Health Sciences, UNC-Charlotte, North Carolina.,Motivated Cognition and Aging Brain Laboratory, Center for Cognitive Neuroscience, Duke University, Durham, North Carolina
| | - Karen M Goldstein
- Durham VA Health Care System, Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, North Carolina.,Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Susanne Danus
- Durham VA Health Care System, Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, North Carolina
| | - Nina R Sperber
- Durham VA Health Care System, Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, North Carolina.,Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Hayden B Bosworth
- Durham VA Health Care System, Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, North Carolina.,Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina.,Department of Psychiatry and Behavioral Sciences, School of Nursing, Duke University, Durham, North Carolina
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14
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Sciarra T, Ciccotti M, Aiello P, Minosi P, Munzi D, Buccolieri C, Peluso I, Palmery M, Lista F. Polypharmacy and Nutraceuticals in Veterans: Pros and Cons. Front Pharmacol 2019; 10:994. [PMID: 31551790 PMCID: PMC6746907 DOI: 10.3389/fphar.2019.00994] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 08/06/2019] [Indexed: 12/14/2022] Open
Affiliation(s)
- Tommaso Sciarra
- Joint Veteran Center, Scientific Department, Army Medical Center, Rome, Italy
| | - Mario Ciccotti
- Joint Veteran Center, Scientific Department, Army Medical Center, Rome, Italy.,Department of Physiology and Pharmacology "V. Erspamer," La Sapienza University of Rome, Rome, Italy
| | - Paola Aiello
- Department of Physiology and Pharmacology "V. Erspamer," La Sapienza University of Rome, Rome, Italy.,Research Centre for Food and Nutrition, Council for Agricultural Research and Economics (CREA-AN), Rome, Italy
| | - Paola Minosi
- Department of Physiology and Pharmacology "V. Erspamer," La Sapienza University of Rome, Rome, Italy.,National Center for Drug Research and Evaluation, Istituto Superiore di Sanità, Rome, Italy
| | - Diego Munzi
- Joint Veteran Center, Scientific Department, Army Medical Center, Rome, Italy
| | - Cosimo Buccolieri
- Joint Veteran Center, Scientific Department, Army Medical Center, Rome, Italy
| | - Ilaria Peluso
- Research Centre for Food and Nutrition, Council for Agricultural Research and Economics (CREA-AN), Rome, Italy
| | - Maura Palmery
- Department of Physiology and Pharmacology "V. Erspamer," La Sapienza University of Rome, Rome, Italy
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15
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Wischik DL, Magny-Normilus C, Whittemore R. Risk Factors of Obesity in Veterans of Recent Conflicts: Need for Diabetes Prevention. Curr Diab Rep 2019; 19:70. [PMID: 31368008 PMCID: PMC7530827 DOI: 10.1007/s11892-019-1191-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE OF REVIEW To identify factors associated with obesity in veterans of the recent, Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND) war conflicts. RECENT FINDINGS Over 44% OEF/OIF/OND veterans are obese (BMI > 30 kg/m2), which exceeds the national obesity prevalence rate of 39% in people younger than 45. Obesity increases morbidity, risk for type 2 diabetes (T2D), and mortality as well as decreases quality of life. A scoping review method was used to identify factors associated with obesity in young veterans. Military exposures, such as multiple deployments and exposure to combat, contribute to challenges in re-integration to civilian life in all veterans. Factors that contribute to increased risk for obesity include changes in eating patterns/eating disorders, changes in physical activity, physical disability, and psychological comorbidity. These conditions can contribute to a rapid weight gain trajectory, changes in metabolism, and obesity. Young veterans face considerable challenges related to obesity risk. Further research is needed to better understand young veterans' experiences and health needs in order to adapt or expand existing programs and improve access, engagement, and metabolic outcomes in this vulnerable population.
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Affiliation(s)
| | | | - Robin Whittemore
- Yale School of Nursing, 400 West Campus Drive, Orange, CT, 06477, USA
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16
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Asbjørnsen RA, Smedsrød ML, Solberg Nes L, Wentzel J, Varsi C, Hjelmesæth J, van Gemert-Pijnen JE. Persuasive System Design Principles and Behavior Change Techniques to Stimulate Motivation and Adherence in Electronic Health Interventions to Support Weight Loss Maintenance: Scoping Review. J Med Internet Res 2019; 21:e14265. [PMID: 31228174 PMCID: PMC6611151 DOI: 10.2196/14265] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Revised: 05/10/2019] [Accepted: 05/11/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Maintaining weight after weight loss is a major health challenge, and eHealth (electronic health) solutions may be a way to meet this challenge. Application of behavior change techniques (BCTs) and persuasive system design (PSD) principles in eHealth development may contribute to the design of technologies that positively influence behavior and motivation to support the sustainable health behavior change needed. OBJECTIVE This review aimed to identify BCTs and PSD principles applied in eHealth interventions to support weight loss and weight loss maintenance, as well as techniques and principles applied to stimulate motivation and adherence for long-term weight loss maintenance. METHODS A systematic literature search was conducted in PsycINFO, Ovid MEDLINE (including PubMed), EMBASE, Scopus, Web of Science, and AMED, from January 1, 2007 to June 30, 2018. Arksey and O'Malley's scoping review methodology was applied. Publications on eHealth interventions were included if focusing on weight loss or weight loss maintenance, in combination with motivation or adherence and behavior change. RESULTS The search identified 317 publications, of which 45 met the inclusion criteria. Of the 45 publications, 11 (24%) focused on weight loss maintenance, and 34 (76%) focused on weight loss. Mobile phones were the most frequently used technology (28/45, 62%). Frequently used wearables were activity trackers (14/45, 31%), as well as other monitoring technologies such as wireless or digital scales (8/45, 18%). All included publications were anchored in behavior change theories. Feedback and monitoring and goals and planning were core behavior change technique clusters applied in the majority of included publications. Social support and associations through prompts and cues to support and maintain new habits were more frequently used in weight loss maintenance than weight loss interventions. In both types of interventions, frequently applied persuasive principles were self-monitoring, goal setting, and feedback. Tailoring, reminders, personalization, and rewards were additional principles frequently applied in weight loss maintenance interventions. Results did not reveal an ideal combination of techniques or principles to stimulate motivation, adherence, and weight loss maintenance. However, the most frequently mentioned individual techniques and principles applied to stimulate motivation were, personalization, simulation, praise, and feedback, whereas associations were frequently mentioned to stimulate adherence. eHealth interventions that found significant effects for weight loss maintenance all applied self-monitoring, feedback, goal setting, and shaping knowledge, combined with a human social support component to support healthy behaviors. CONCLUSIONS To our knowledge, this is the first review examining key BCTs and PSD principles applied in weight loss maintenance interventions compared with those of weight loss interventions. This review identified several techniques and principles applied to stimulate motivation and adherence. Future research should aim to examine which eHealth design combinations can be the most effective in support of long-term behavior change and weight loss maintenance.
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Affiliation(s)
- Rikke Aune Asbjørnsen
- Center for eHealth and Wellbeing Research, Department of Psychology, Health, and Technology, University of Twente, Enschede, Netherlands.,Research and Innovation Department, Vestfold Hospital Trust, Tønsberg, Norway.,Center for Shared Decision Making and Collaborative Care Research, Division of Medicine, Oslo University Hospital, Oslo, Norway
| | - Mirjam Lien Smedsrød
- Norwegian Regional Advisory Unit on Patient Education, Sørlandet Hospital Trust, Kristiansand, Norway
| | - Lise Solberg Nes
- Center for Shared Decision Making and Collaborative Care Research, Division of Medicine, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, United States
| | - Jobke Wentzel
- Center for eHealth and Wellbeing Research, Department of Psychology, Health, and Technology, University of Twente, Enschede, Netherlands.,Saxion University of Applied Sciences, Deventer, Netherlands
| | - Cecilie Varsi
- Center for Shared Decision Making and Collaborative Care Research, Division of Medicine, Oslo University Hospital, Oslo, Norway
| | - Jøran Hjelmesæth
- Morbid Obesity Center, Vestfold Hospital Trust, Tønsberg, Norway.,Department of Endocrinology, Morbid Obesity, and Preventive Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Julia Ewc van Gemert-Pijnen
- Center for eHealth and Wellbeing Research, Department of Psychology, Health, and Technology, University of Twente, Enschede, Netherlands.,University Medical Center Groningen, Groningen, Netherlands.,University of Waterloo, Waterloo, ON, Canada
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17
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Goodrich DE, Lowery JC, Burns JA, Richardson CR. The Phased Implementation of a National Telehealth Weight Management Program for Veterans: Mixed-Methods Program Evaluation. JMIR Diabetes 2018; 3:e14. [PMID: 30305265 PMCID: PMC6307696 DOI: 10.2196/diabetes.9867] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 05/16/2018] [Accepted: 07/12/2018] [Indexed: 11/13/2022] Open
Abstract
Background The burden of obesity is high among US veterans, yet many face barriers to engaging in in-person, facility-based treatment programs. To improve access to weight-management services, the Veterans Health Administration (VHA) developed TeleMOVE, a home-based, 82-day curriculum that utilizes in-home messaging devices to promote weight loss in VHA patients facing barriers to accessing facility-based services. Objective The primary aim was to establish preliminary evidence for the program by comparing outcomes for TeleMOVE with standard, facility-based MOVE weight-management services (group, individual modalities) over the evaluation period based on the number of patients enrolled per site and the program’s clinical effectiveness, as demonstrated by average weight lost per patient. The secondary aim was to understand factors influencing TeleMOVE implementation variability across demonstration sites to develop recommendations to improve national program dissemination. Methods We employed a formative mixed-methods design to evaluate the phased implementation of TeleMOVE at 9 demonstration sites and compare patient- and site-level measures of program uptake. Data were collected between October 1, 2009 and September 30, 2011. Patient-level program outcomes were extracted from VHA patient care databases to evaluate program enrollment rates and clinical outcomes. To assess preliminary clinical effectiveness, weight loss outcomes for veterans who enrolled in TeleMOVE were compared with outcomes for veterans enrolled in standard MOVE! at each demonstration site, as well as with national averages during the first 2 years of program implementation. For the secondary aim, we invited program stakeholders to participate in 2 rounds of semistructured interviews about aspects of TeleMOVE implementation processes, site-level contextual factors, and program delivery. Twenty-eight stakeholders participated in audio-recorded interviews. Results Although stakeholders at 3 sites declined to be interviewed, objective program uptake was high at 2 sites, delayed-high at 2 sites, and low at 5 sites. At 6 months post enrollment, the mean weight loss was comparable for TeleMOVE (n=417) and MOVE! (n=1543) participants at −5.2 lb (SD 14.4) and −5.1 lb (SD 12.2), respectively (P=.91). All sites reported high program complexity because TeleMOVE required more staff time per participant than MOVE! due to logistical and technical assistance issues related to the devices. High-uptake sites overcame implementation challenges by leveraging communication networks with stakeholders, adapting the program to patient needs whenever possible, setting programmatic goals and monitoring feedback of results, and taking time to reflect and evaluate on delivery to foster incremental delivery improvements, whereas low-uptake sites reported less leadership support and effective communication among stakeholders. Conclusions This implementation evaluation of a clinical telehealth program demonstrated the value of partnership-based research in which researchers not only provided operational leaders with feedback regarding the effectiveness of a new program but also relevant feedback into contextual factors related to program implementation to enable adaptations for national deployment efforts.
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Affiliation(s)
- David E Goodrich
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, United States
| | - Julie C Lowery
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, United States
| | - Jennifer A Burns
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, United States
| | - Caroline R Richardson
- Department of Family Medicine, School of Medicine, University of Michigan, Ann Arbor, MI, United States
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18
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Maciejewski ML, Shepherd-Banigan M, Raffa SD, Weidenbacher HJ. Systematic Review of Behavioral Weight Management Program MOVE! for Veterans. Am J Prev Med 2018; 54:704-714. [PMID: 29550164 DOI: 10.1016/j.amepre.2018.01.029] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 01/09/2018] [Accepted: 01/29/2018] [Indexed: 12/22/2022]
Abstract
CONTEXT Since 2006, the Veterans Health Administration has delivered a population-based behavioral weight management program (MOVE!) to Veterans, which numerous studies have examined. The purpose of this study was to systematically review these studies to understand MOVE! participation rates and the association between MOVE! participation and weight change. EVIDENCE ACQUISITION A December 2016 PubMed search identified 320 English-language abstracts published between January 1, 2005 and December 31, 2016, of which 42 underwent full-text review. Twenty-six articles were determined to be eligible for final inclusion and data elements extracted from these articles included study years, study design, content of MOVE! and control intervention (if any), inclusion/exclusion criteria, initial sample size and sample loss, intervention duration and follow-up, patient characteristics, and outcomes. Quality was assessed using the Newcastle-Ottawa Quality Scale. EVIDENCE SYNTHESIS Studies were judged to be of good quality. Twenty-one of the 26 studies were retrospective cohort studies, one was a prospective cohort study and four were randomized trials. Program participation varied substantially (2%-12%) across studies. Six-month weight loss ranged from -0.95 kg to -1.84 kg, whereas 12-month weight loss ranged from -0.13 kg to -3.3 kg. A maximum of 25% of MOVE! users engaged in intense and sustained participation (eight or more visits within 6 months), but higher participation levels were consistently associated with greater weight change (-1.18 kg to -5.3 kg at 6 months, -1.68 kg to -3.58 kg at 12 months). CONCLUSIONS MOVE! participation is associated with modest short-term weight loss, with greater weight loss as participation increases. More research is needed to understand the barriers and facilitators to participation and the effect of MOVE! participation on long-term health and economic outcomes.
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Affiliation(s)
- Matthew L Maciejewski
- Center for Health Services Research in Primary Care, Durham Department of Veterans Affairs Medical Center, Durham, North Carolina; Department of Population Health Sciences, Duke University Medical Center, Durham, North Carolina.
| | - Megan Shepherd-Banigan
- Center for Health Services Research in Primary Care, Durham Department of Veterans Affairs Medical Center, Durham, North Carolina
| | - Susan D Raffa
- Veterans Health Administration National Center for Health Promotion and Disease Prevention, Durham, North Carolina
| | - Hollis J Weidenbacher
- Center for Health Services Research in Primary Care, Durham Department of Veterans Affairs Medical Center, Durham, North Carolina
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19
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Sieverink F, Kelders SM, van Gemert-Pijnen JE. Clarifying the Concept of Adherence to eHealth Technology: Systematic Review on When Usage Becomes Adherence. J Med Internet Res 2017; 19:e402. [PMID: 29212630 PMCID: PMC5738543 DOI: 10.2196/jmir.8578] [Citation(s) in RCA: 181] [Impact Index Per Article: 25.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 10/18/2017] [Accepted: 11/03/2017] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND In electronic health (eHealth) evaluations, there is increasing attention for studying the actual usage of a technology in relation to the outcomes found, often by studying the adherence to the technology. On the basis of the definition of adherence, we suggest that the following three elements are necessary to determine adherence to eHealth technology: (1) the ability to measure the usage behavior of individuals; (2) an operationalization of intended use; and (3) an empirical, theoretical, or rational justification of the intended use. However, to date, little is known on how to operationalize the intended usage of and the adherence to different types of eHealth technology. OBJECTIVE The study aimed to improve eHealth evaluations by gaining insight into when, how, and by whom the concept of adherence has been used in previous eHealth evaluations and finding a concise way to operationalize adherence to and intended use of different eHealth technologies. METHODS A systematic review of eHealth evaluations was conducted to gain insight into how the use of the technology was measured, how adherence to different types of technologies was operationalized, and if and how the intended use of the technology was justified. Differences in variables between the use of the technology and the operationalization of adherence were calculated using a chi-square test of independence. RESULTS In total, 62 studies were included in this review. In 34 studies, adherence was operationalized as "the more use, the better," whereas 28 studies described a threshold for intended use of the technology as well. Out of these 28, only 6 reported a justification for the intended use. The proportion of evaluations of mental health technologies reporting a justified operationalization of intended use is lagging behind compared with evaluations of lifestyle and chronic care technologies. The results indicated that a justification of intended use does not require extra measurements to determine adherence to the technology. CONCLUSIONS The results of this review showed that to date, justifications for intended use are often missing in evaluations of adherence. Evidently, it is not always possible to estimate the intended use of a technology. However, such measures do not meet the definition of adherence and should therefore be referred to as the actual usage of the technology. Therefore, it can be concluded that adherence to eHealth technology is an underdeveloped and often improperly used concept in the existing body of literature. When defining the intended use of a technology and selecting valid measures for adherence, the goal or the assumed working mechanisms should be leading. Adherence can then be standardized, which will improve the comparison of adherence rates to different technologies with the same goal and will provide insight into how adherence to different elements contributed to the outcomes.
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Affiliation(s)
- Floor Sieverink
- Centre for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands
| | - Saskia M Kelders
- Centre for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands
- Optentia Research Focus Area, North-West University, Vanderbijlpark, South Africa
| | - Julia Ewc van Gemert-Pijnen
- Centre for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands
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20
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Abstract
PURPOSE OF REVIEW The high prevalence of prediabetes and success of the diabetes prevention program (DPP) has led to increasing efforts to provide readily accessible, cost-effective DPP interventions to the general public. Technology-assisted DPP interventions are of particular interest since they may be easier to widely distribute and sustain as compared to traditional in-person DPP. The purpose of this article is to provide an overview of currently available technology-assisted DPP interventions. RECENT FINDINGS This review focuses on studies that have examined the use of mobile phone text messaging, smartphone/web-based apps, and telehealth programs to help prevent or delay the onset of incident type 2 diabetes. While there is variability in the results of studies focused on technology-assisted DPP and weight loss interventions, there is evidence to suggest that these programs have been associated with clinically meaningful weight loss and can be cost-effective. Patients who are at risk for diabetes can be offered technology-assisted DPP and weight loss interventions to lower their risk of incident diabetes. Further research should determine what specific combination of intervention features would be most successful.
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Affiliation(s)
- Shira Grock
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, David Geffen School of Medicine at UCLA, 900 Veteran Avenue, 24-130 Warren Hall, Los Angeles, CA, 90095, USA.
| | - Jeong-Hee Ku
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, David Geffen School of Medicine at UCLA, 900 Veteran Avenue, 24-130 Warren Hall, Los Angeles, CA, 90095, USA
| | - Julie Kim
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, David Geffen School of Medicine at UCLA, 900 Veteran Avenue, 24-130 Warren Hall, Los Angeles, CA, 90095, USA
| | - Tannaz Moin
- Veterans Affairs Greater Los Angeles Healthcare Systems, 10940 Wilshire Boulevard, Suite 700, Los Angeles, CA, 90024, USA
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