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Toon J, Bennett SE, Lavin J, Pallister C, Avery A. A service evaluation of more than 1 million self-funding adults attending a community weight management programme. Clin Obes 2024:e12665. [PMID: 38655763 DOI: 10.1111/cob.12665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 02/29/2024] [Accepted: 04/02/2024] [Indexed: 04/26/2024]
Abstract
Scaled interventions are required to address levels of overweight and obesity and reduce health inequalities. Little data is available on the effectiveness of community weight management programmes for participants self-selecting to attend across different socio-economic backgrounds. This analysis investigates 3, 6, and 12-month outcomes of adults joining a real-life community weight management programme. Weight, attendance and Indices of Multiple Deprivation (IMD) data from all fee-paying adults joining Slimming World in 2016 were collated. Data were analysed using descriptive and inferential statistics to determine predictors of weight loss. Mean BMI of 1 094 676 adults (7.6% male) was 33.0 ± 6.4 kg/m2. Mean % weight change at 3, 6, and 12 months was -5.0% ± 3.6%, -5.9% ± 5.2%, and -6.0% ± 5.8%. Those attending 75% sessions achieved greater weight loss with mean weight losses at 3, 6, and 12-months of 7.7% ± 3.3%, 11.3% ± 5.2%, and 14.1% ± 7.5%, respectively. Effect sizes from comparison of weight change between deprivation deciles were negligible, with similar outcomes in the most and least deprived deciles at 12-months (-5.7% ± 5.9% vs. -6.2% ± 5.9%). This service evaluation of more than 1 million adults attending a community weight management programme found they were able to achieve and/or maintain an average 6% weight loss at 12 months, with high attenders achieving >14% loss. Men and those with higher levels of deprivation were accessing the support and achieving significant weight losses. Slimming World as a real-life, scalable weight management programme is well placed to help adults manage their weight and address health inequalities.
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Affiliation(s)
- Josef Toon
- Division of Psychology, De Montfort University & Nutrition Research & Health Policy, Slimming World, Leicester, UK
| | | | - Jacquie Lavin
- Nutrition, Research and Health Policy Team, Slimming World, Alfreton, UK
| | - Carolyn Pallister
- Nutrition, Research and Health Policy Team, Slimming World, Alfreton, UK
| | - Amanda Avery
- Division of Food, Nutrition & Dietetics, University of Nottingham & Nutrition, Research & Health Policy, Slimming World, Leicester, UK
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Darling KE, Warnick J, Guthrie KM, Santos M, Jelalian E. Weight Management Engagement for Teens From Low-Income Backgrounds: Qualitative Perspectives From Adolescents and Caregivers. J Pediatr Psychol 2023; 48:593-601. [PMID: 36794640 PMCID: PMC10357942 DOI: 10.1093/jpepsy/jsad008] [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: 12/13/2022] [Revised: 01/31/2023] [Accepted: 01/31/2023] [Indexed: 02/17/2023] Open
Abstract
OBJECTIVE Adolescents from low-income backgrounds are at increased risk for obesity and related negative health outcomes. Furthermore, these adolescents have less access to, and success in, weight management (WM) programs. This qualitative study sought to better understand engagement in a hospital-based WM program from the perspective of adolescents and caregivers at different levels of program initiation and engagement. METHODS Qualitative interviews were conducted with 55 participants (29 adolescents and 26 caregivers). This included: (a) those that were referred to, but never initiated, WM treatment (non-initiators); (b) those that prematurely disengaged from treatment (drop-outs); and (c) those that had ongoing participation in treatment (engaged). Data were analyzed using applied thematic analysis. RESULTS Related to program initiation, participants across all groups (including adolescents and caregivers) noted that they did not have a full understanding of the scope or goals of the WM program following initial referral. In addition, many participants identified misperceptions of the program (e.g., perceptions of a screening visit as compared to an intensive program). Both caregivers and adolescents identified caregivers as drivers of engagement, with adolescents often hesitant about participation in the program. However, engaged adolescents found the program valuable and sought ongoing participation following caregiver initiation. CONCLUSIONS When considering initiation and engagement in WM services for adolescents at highest risk, healthcare providers should provide more detailed information concerning WM referrals. Future research is needed to improve adolescent perception of WM, especially for adolescents from low-income backgrounds, which could increase initiation and engagement for this population.
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Affiliation(s)
- Katherine E Darling
- Weight Control and Diabetes Research Center, The Miriam Hospital, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, USA
| | - Jennifer Warnick
- Weight Control and Diabetes Research Center, The Miriam Hospital, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, USA
| | - Kate M Guthrie
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, USA
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, USA
| | - Melissa Santos
- Division of Pediatric Psychology, Connecticut Children’s, USA
| | - Elissa Jelalian
- Weight Control and Diabetes Research Center, The Miriam Hospital, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, USA
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Brankovic A, Hendrie GA, Baird DL, Khanna S. Predicting Disengagement to Better Support Outcomes in a Web-Based Weight Loss Program Using Machine Learning Models: Cross-Sectional Study. J Med Internet Res 2023; 25:e43633. [PMID: 37358890 DOI: 10.2196/43633] [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: 10/26/2022] [Revised: 03/21/2023] [Accepted: 04/16/2023] [Indexed: 06/27/2023] Open
Abstract
BACKGROUND Engagement is key to interventions that achieve successful behavior change and improvements in health. There is limited literature on the application of predictive machine learning (ML) models to data from commercially available weight loss programs to predict disengagement. Such data could help participants achieve their goals. OBJECTIVE This study aimed to use explainable ML to predict the risk of member disengagement week by week over 12 weeks on a commercially available web-based weight loss program. METHODS Data were available from 59,686 adults who participated in the weight loss program between October 2014 and September 2019. Data included year of birth, sex, height, weight, motivation to join the program, use statistics (eg, weight entries, entries into the food diary, views of the menu, and program content), program type, and weight loss. Random forest, extreme gradient boosting, and logistic regression with L1 regularization models were developed and validated using a 10-fold cross-validation approach. In addition, temporal validation was performed on a test cohort of 16,947 members who participated in the program between April 2018 and September 2019, and the remaining data were used for model development. Shapley values were used to identify globally relevant features and explain individual predictions. RESULTS The average age of the participants was 49.60 (SD 12.54) years, the average starting BMI was 32.43 (SD 6.19), and 81.46% (39,594/48,604) of the participants were female. The class distributions (active and inactive members) changed from 39,369 and 9235 in week 2 to 31,602 and 17,002 in week 12, respectively. With 10-fold-cross-validation, extreme gradient boosting models had the best predictive performance, which ranged from 0.85 (95% CI 0.84-0.85) to 0.93 (95% CI 0.93-0.93) for area under the receiver operating characteristic curve and from 0.57 (95% CI 0.56-0.58) to 0.95 (95% CI 0.95-0.96) for area under the precision-recall curve (across 12 weeks of the program). They also presented a good calibration. Results obtained with temporal validation ranged from 0.51 to 0.95 for area under a precision-recall curve and 0.84 to 0.93 for area under the receiver operating characteristic curve across the 12 weeks. There was a considerable improvement in area under a precision-recall curve of 20% in week 3 of the program. On the basis of the computed Shapley values, the most important features for predicting disengagement in the following week were those related to the total activity on the platform and entering a weight in the previous weeks. CONCLUSIONS This study showed the potential of applying ML predictive algorithms to help predict and understand participants' disengagement with a web-based weight loss program. Given the association between engagement and health outcomes, these findings can prove valuable in providing better support to individuals to enhance their engagement and potentially achieve greater weight loss.
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Affiliation(s)
- Aida Brankovic
- The Australian e-Health Research Centre, Health & Biosecurity, Commonwealth Scientific Industrial Research Organisation, Brisbane, Australia
| | - Gilly A Hendrie
- Human Health Program, Health & Biosecurity, Commonwealth Scientific Industrial Research Organisation, Adelaide, Australia
| | - Danielle L Baird
- Human Health Program, Health & Biosecurity, Commonwealth Scientific Industrial Research Organisation, Adelaide, Australia
| | - Sankalp Khanna
- The Australian e-Health Research Centre, Health & Biosecurity, Commonwealth Scientific Industrial Research Organisation, Brisbane, Australia
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Dragomir AI, Voisard B, Gosselin Boucher V, Szczepanik G, Bacon SL, Lavoie KL. Effectiveness of Motivational Interviewing in Managing Overweight and Obesity. Ann Intern Med 2022; 175:W104-W105. [PMID: 36122402 DOI: 10.7326/l22-0237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Anda I Dragomir
- Centre Intégré Universitaire de santé et services sociaux du Nord-de-l'Ile-de-Montréal and Concordia University, Montreal, Quebec, Canada
| | - Brigitte Voisard
- Centre Intégré Universitaire de santé et services sociaux du Nord-de-l'Ile-de-Montréal and Université du Québec à Montréal, Montreal, Quebec, Canada
| | - Vincent Gosselin Boucher
- Centre Intégré Universitaire de santé et services sociaux du Nord-de-l'Ile-de-Montréal and University of British Columbia, Montreal, Quebec, and Vancouver, British Columbia, Canada
| | - Geneviève Szczepanik
- Centre Intégré Universitaire de santé et services sociaux du Nord-de-l'Ile-de-Montréal, Montreal, Quebec, Canada
| | - Simon L Bacon
- Centre Intégré Universitaire de santé et services sociaux du Nord-de-l'Ile-de-Montréal and Concordia University, Montreal, Quebec, Canada
| | - Kim L Lavoie
- Centre Intégré Universitaire de santé et services sociaux du Nord-de-l'Ile-de-Montréal and Université du Québec à Montréal, Montreal, Quebec, Canada
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Kinlin LM, Oreskovich SM, Dubrowski R, Ball GD, Barwick M, Dettmer E, Haines J, Hamilton J, Kim TH, Klaassen M, Luca P, Maguire JL, Moretti ME, Stasiulis E, Toulany A, Birken CS. Managing Obesity in Young Children: A Multiple Methods Study Assessing Feasibility, Acceptability, and Implementation of a Multicomponent, Family-Based Intervention. Child Obes 2022; 18:409-421. [PMID: 35085455 PMCID: PMC9492792 DOI: 10.1089/chi.2021.0221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Background: We developed a multicomponent, family-based intervention for young children with obesity consisting of parent group sessions, home nursing visits, and multidisciplinary clinical encounters. Our objective was to assess intervention feasibility, acceptability, and implementation. Methods: From 2017 to 2020, we conducted a multiple methods study in the obesity management clinic at a tertiary children's hospital (Toronto, Canada). We included 1-6 year olds with a body mass index ≥97th percentile and their parents; we also included health care providers (HCPs) who delivered the intervention. To assess feasibility, we performed a pilot randomized controlled trial (RCT) comparing the intervention to usual care. To explore acceptability, we conducted parent focus groups. To explore implementation, we examined contextual factors with HCPs using the Consolidated Framework for Implementation Research. Results: There was a high level of ineligibility (n = 34/61) for the pilot RCT. Over 21 months, 11 parent-child dyads were recruited; of 6 randomized to the intervention, 3 did not participate in group sessions or home visits. In focus groups, themes identified by parents (n = 8) related to information provided at referral; fit between the intervention and patient needs; parental gains from participating in the intervention; and feasibility of group sessions. HCPs (n = 10) identified contextual factors that were positively and negatively associated with intervention implementation. Conclusions: We encountered challenges related to intervention feasibility, acceptability, and implementation. Lessons learned from this study will inform the next iteration of our intervention and are relevant to intervention development and implementation for young children with obesity. Clinical Trial Registration number: NCT03219658.
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Affiliation(s)
- Laura M. Kinlin
- Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
| | - Stephan M. Oreskovich
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
| | - Raluca Dubrowski
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
| | - Geoff D.C. Ball
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Melanie Barwick
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Elizabeth Dettmer
- Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jess Haines
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, Ontario, Canada
| | - Jill Hamilton
- Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Endocrinology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Theresa H.M. Kim
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
| | | | - Paola Luca
- Section of Pediatric Endocrinology, Department of Pediatrics, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Jonathon L. Maguire
- Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Myla E. Moretti
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Clinical Trials Unit, Ontario Child Health Support Unit, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Elaine Stasiulis
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Alene Toulany
- Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
- Division of Adolescent Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Catherine S. Birken
- Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Address correspondence to: Catherine S. Birken, MD, MSc, FRCPC, Division of Paediatric Medicine, The Hospital for Sick Children, Toronto M5G 1X8, Ontario, Canada
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Harshman SG, Castro I, Perkins M, Luo M, Mueller KB, Cena H, Portale S, Raspini B, Taveras E, Fiechtner L. Pediatric weight management interventions improve prevalence of overeating behaviors. Int J Obes (Lond) 2022; 46:630-636. [PMID: 34862470 PMCID: PMC8883500 DOI: 10.1038/s41366-021-00989-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 09/20/2021] [Accepted: 10/06/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To examine changes in prevalence of overeating behaviors in a comparative effectiveness study of two pediatric weight management interventions. METHODS Four-hundred and seven children, ages 6-12 years, with a BMI ≥ 85th percentile were enrolled in a comparative effectiveness trial of two pediatric weight management interventions. Prevalence of "sneaking, hiding or hoarding food", and 'eating in the absence of hunger' was evaluated at baseline and 12 months. Statistical methods included McNemar's test and longitudinal logistic regression. RESULTS Prevalence of "sneak, hide, or hoard food" significantly decreased in all participants from 29.1% to 20.7% at 12 months. The prevalence of "eating in the absence of hunger" decreased in all participants from 46.7% to 22.4% at 12 months. Use of SNAP benefits, free/reduced meals at school, parental stress, housing, and food insecurity at baseline were associated with an increased likelihood of endorsing overeating behaviors at 12 months. Conversely, those who engaged in at least one session of the pediatric weight management intervention were significantly less likely to endorse "eating in the absence of hunger" at 12 months. CONCLUSIONS Participation in pediatric weight management interventions improves the prevalence of overeating behaviors and is associated with participant engagement and social determinants of health, specifically food security status. Efforts to engage populations impacted by food insecurity and other social determinants of health risk factors will be critical for success of weight management interventions. CLINICAL TRIAL REGISTRATION This trial has been registered at ClinicalTrials.gov (identifier: NCT03012126).
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Affiliation(s)
- Stephanie G. Harshman
- Neuroendocrine Unit, Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts;,Eating Disorders Clinical and Research Program, Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts
| | - Ines Castro
- Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, 125 Nashua Street, Suite 860, Boston, Massachusetts
| | - Meghan Perkins
- Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, 125 Nashua Street, Suite 860, Boston, Massachusetts
| | - Man Luo
- Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, 125 Nashua Street, Suite 860, Boston, Massachusetts
| | - Katelee B. Mueller
- Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, 125 Nashua Street, Suite 860, Boston, Massachusetts
| | - Hellas Cena
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy.,Clinical Nutrition and Dietetics Service, Unit of Internal Medicine and Endocrinology, ICS Maugeri IRCCS, Pavia, Italy
| | - Sandra Portale
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Benedetta Raspini
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Elsie Taveras
- Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, 125 Nashua Street, Suite 860, Boston, Massachusetts
| | - Lauren Fiechtner
- Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, 125 Nashua Street, Suite 860, Boston, Massachusetts;,Department of Gastroenterology and Nutrition, MassGeneral Hospital for Children, 175 Cambridge St, Boston, Massachusetts,,Greater Boston Food Bank, 70 S. Bay Avenue, Boston, MA 02118
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Smith WA, Gray E, Jones TL, Han JC, Burton ET. Waitlist management in a pediatric weight management clinic: implementing an orientation session. BMC Pediatr 2021; 21:416. [PMID: 34551757 PMCID: PMC8456555 DOI: 10.1186/s12887-021-02868-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 08/30/2021] [Indexed: 11/16/2022] Open
Abstract
Background This study evaluates implementation of an orientation session to address a waitlist of more than 2000 referrals to a pediatric weight management clinic in the Mid-South United States. Methods An hour-long group-based orientation to the pediatric weight management clinic was implemented to provide information about the structure and expectations of the clinic as well as education on healthy lifestyle recommendations. Families were contacted from the waitlist by telephone and invited to attend an orientation session prior to scheduling a clinic appointment. Results Of 2251 patients contacted from the waitlist, 768 scheduled an orientation session, of which 264 (34 %) attended. Of the 264 orientation participants, 246 (93 %) scheduled a clinic appointment. Of those, 193 (79 %) completed a clinic visit. Waitlist times decreased from 297.8 ± 219.4 days prior to implementation of orientation sessions to 104.1 ± 219.4 days after. Conclusions Orientation has been an effective and efficient way to triage patient referrals while maximizing attendance in limited clinic slots for patients and families demonstrating interest and motivation. Elements of this approach are likely generalizable to other pediatric clinical settings that must strategically manage a large volume of patient referrals.
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Affiliation(s)
- Webb A Smith
- Department of Pediatrics, College of Medicine, University of Tennessee Health Science Center, 50 North Dunlap Street, Room 453R, TN, 38103, Memphis, USA. .,Children's Foundation Research Institute, Le Bonheur Children's Hospital, 50 North Dunlap Street, Room 453R, TN, 38103, Memphis, USA.
| | - Emily Gray
- Department of Health Promotion and Disease Prevention, College of Nursing, University of Tennessee Health Science Center, TN, Memphis, USA
| | - Tamekia L Jones
- Department of Pediatrics, College of Medicine, University of Tennessee Health Science Center, 50 North Dunlap Street, Room 453R, TN, 38103, Memphis, USA.,Children's Foundation Research Institute, Le Bonheur Children's Hospital, 50 North Dunlap Street, Room 453R, TN, 38103, Memphis, USA.,Department of Preventive Medicine, College of Medicine, University of Tennessee Health Science Center, TN, Memphis, USA
| | - Joan C Han
- Department of Pediatrics, College of Medicine, University of Tennessee Health Science Center, 50 North Dunlap Street, Room 453R, TN, 38103, Memphis, USA.,Children's Foundation Research Institute, Le Bonheur Children's Hospital, 50 North Dunlap Street, Room 453R, TN, 38103, Memphis, USA.,Department of Physiology, College of Medicine, University of Tennessee Health Science Center, TN, Memphis, USA
| | - E Thomaseo Burton
- Department of Pediatrics, College of Medicine, University of Tennessee Health Science Center, 50 North Dunlap Street, Room 453R, TN, 38103, Memphis, USA.,Children's Foundation Research Institute, Le Bonheur Children's Hospital, 50 North Dunlap Street, Room 453R, TN, 38103, Memphis, USA
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Predictors of attrition from a weight loss program. A study of adult patients with obesity in a community setting. Eat Weight Disord 2021; 26:1729-1736. [PMID: 32816208 PMCID: PMC8292291 DOI: 10.1007/s40519-020-00990-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 08/11/2020] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Obesity unit attrition is frequent and contributes to treatment failure. Many studies evaluating attrition predictors were part of randomized trials, and different terminology and criteria were used in the engagement field. We aimed to investigate the factors potentially implicated in early (< 12 weeks) and late (> 12 weeks) attrition from an obesity unit in a community setting METHODS: This was a retrospective cohort study of 250 patients with obesity who were followed-up at our obesity unit. Our program included at least 6 meetings in 12 months. Sociodemographic and anthropometric data, and psychometric questionnaires were collected from all participants. RESULTS One-hundred thirty-four (53.6%) participants dropped out. Those individuals showed lower BMI, lower overall health status, and increased depression scores. In a multiple regression model, BMI (inversely; OR = 0.90; 95%CI 0.84-0.96) and depression score (directly, OR = 1.05; 1.00-1.10) were associated with attrition risk. Early dropouts (n = 47) had lower weights, smaller waist circumferences and worse mental health scores than late dropouts (n = 87) and more frequently lived alone. When compared to completers, early dropouts had lower weights, BMIs, waist circumferences, overall health and mental status scores, increased depression scores and percentage of individuals living alone. In a multiple regression, lower BMI (OR = 0.83; 0.75-0.92), lower mental status score (OR = 3.17; 1.17-8.59) and living alone (OR = 2.25; 1.02-4.97) were associated with early attrition risk. CONCLUSION Lower BMI and increased depression score were associated with attrition. Early attrition was associated with lower weight, decreased mental well-being, and living alone. Individuals with these characteristics might need tailored approaches to enhance their engagement. LEVEL OF EVIDENCE Level V, retrospective descriptive study.
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Ball GDC, Sebastianski M, Wijesundera J, Keto-Lambert D, Ho J, Zenlea I, Perez A, Nobles J, Skelton JA. Strategies to reduce attrition in managing paediatric obesity: A systematic review. Pediatr Obes 2021; 16:e12733. [PMID: 32959990 DOI: 10.1111/ijpo.12733] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 08/27/2020] [Accepted: 09/07/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To conduct a systematic review of the literature for strategies designed to reduce attrition in managing paediatric obesity. METHODS We searched Ovid Medline (1946 to May 6, 2020), Ovid Embase (1974 to May 6, 2020), EBSCO CINAHL (inception to May 6, 2020), Elsevier Scopus (inception to April 14, 2020), and ProQuest Dissertations & Theses (inception to April 14, 2020). Reports were eligible if they included any obesity management intervention, included 2 to 18 year olds with overweight or obesity (or if the mean age of participants fell within this age range), were in English, included experimental study designs, and had attrition reduction as a main outcome. Two team members screened studies, abstracted data, and appraised study quality. RESULTS Our search yielded 5,415 original reports; six met inclusion criteria. In three studies, orientation sessions (n = 2) and motivational interviewing (MI) (n = 1) were used as attrition-reduction strategies before treatment enrollment; in three others, text messaging (n = 2) and MI (n = 1) supplemented existing obesity management interventions. Attrition-reduction strategies led to decreased attrition in two studies, increased in one, and no difference in three. For the two strategies that reduced attrition, (a) pre-treatment orientation and (b) text messaging between children and intervention providers were beneficial. The quality of the six included studies varied (good [n = 4]; poor [n = 2]). CONCLUSION Some evidence suggests that attrition can be reduced. The heterogeneity of approaches applied and small number of studies included highlight the need for well-designed, experimental research to test the efficacy and effectiveness of strategies to reduce attrition in managing paediatric obesity.
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Affiliation(s)
- Geoff D C Ball
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
| | - Meghan Sebastianski
- Alberta Strategy for Patient-Oriented Research (SPOR) SUPPORT Unit Knowledge Translation Platform, University of Alberta, Edmonton, Canada
| | - Jessica Wijesundera
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
| | - Diana Keto-Lambert
- Alberta Strategy for Patient-Oriented Research (SPOR) SUPPORT Unit Knowledge Translation Platform, University of Alberta, Edmonton, Canada
| | - Josephine Ho
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Ian Zenlea
- Institute for Better Health, Trillium Health Partners, Mississauga, Canada
| | - Arnaldo Perez
- School of Dentistry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
| | - James Nobles
- The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol National Health Service Foundation Trust, Bristol, UK.,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Joseph A Skelton
- Department of Pediatrics, Wake Forest University, Winston-Salem, North Carolina, USA
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Brock DJP, Estabrooks PA, Yuhas M, Wilson JA, Montague D, Price BE, Elliott K, Hill JL, Zoellner JM. Assets and Challenges to Recruiting and Engaging Families in a Childhood Obesity Treatment Research Trial: Insights From Academic Partners, Community Partners, and Study Participants. Front Public Health 2021; 9:631749. [PMID: 33692983 PMCID: PMC7937718 DOI: 10.3389/fpubh.2021.631749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 01/25/2021] [Indexed: 12/18/2022] Open
Abstract
Background: There is need for the childhood obesity treatment literature to identify effective recruitment and engagement strategies for rural communities that are more likely to lack supportive infrastructure for healthy lifestyles and clinical research relative to their urban counterparts. This community case study examines recruitment and engagement strategies from a comparative effectiveness research (CER) trial of two family-based childhood obesity (FBCO) treatment interventions conducted in a medically underserved, rural region. Guided by a Community Based Participatory Research (CBPR) and systems-based approach, the primary aim was to analyze interviews from academic partners, community partners, and parent study participants for recruitment and engagement assets, challenges, and lessons learned. Methods: Over the 3-year lifespan of the study, researchers conducted 288 interviews with Community Advisory Board members (n = 14), Parent Advisory Team members (n = 7), and study participants (n = 100). Using an inductive-deductive approach, interviews were broadly coded for recruitment and engagement assets, challenges, and recommendations; analyzed for descriptive sub-coding; and organized into stakeholder/organization and participant level themes. Codes were analyzed aggregately across time and examined for differences among stakeholders and parent study participants. Results: Adherence to CBPR principles and development of strong community partnerships facilitated recruitment and engagement; however, variability in recruitment and engagement success impacted partner confidence, threatened outcome validity, and required additional resources. Specifically, assets and challenges emerged around eight key needs. Three were at the stakeholder/organization level: (1) readiness of stakeholders to conduct CBPR research, (2) development of sustainable referral protocols, and (3) development of participant engagement systems. The remaining five were at the participant level: (1) comfort and trust with research, (2) awareness and understanding of the study, (3) intervention accessibility, (4) intervention acceptability, and (5) target population readiness. Future recommendations included conducting readiness assessments and awareness campaigns, piloting and evaluating recruitment and engagement strategies, identifying participant barriers to engagement and finding a priori solutions, and fostering stakeholder leadership to develop sustainable protocols. Conclusion: Collective findings from multiple perspectives demonstrate the need for multi-leveled approaches focusing on infrastructure supports and strategies to improve stakeholder and participant awareness of, and capacity for, recruiting and engaging medically underserved, rural families in a FBCO CER trial.
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Affiliation(s)
- Donna-Jean P. Brock
- Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, VA, United States
| | - Paul A. Estabrooks
- College of Public Health, University of Nebraska Medical Center, Omaha, NE, United States
| | - Maryam Yuhas
- Department of Nutrition and Food Studies, Syracuse University, Syracuse, NY, United States
| | | | | | - Bryan E. Price
- Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, VA, United States
| | - Kenya Elliott
- Piedmont Access to Health Services, Danville, VA, United States
| | - Jennie L. Hill
- College of Public Health, University of Nebraska Medical Center, Omaha, NE, United States
| | - Jamie M. Zoellner
- Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, VA, United States
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Determinants of attrition in a pediatric healthy lifestyle intervention: The CIRCUIT program experience. Obes Res Clin Pract 2021; 15:157-162. [PMID: 33608233 DOI: 10.1016/j.orcp.2021.01.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 01/18/2021] [Accepted: 01/28/2021] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Attrition in pediatric weight management programs is notoriously high. Greater understanding of its determinants is needed to inform retention strategies. We identified determinants of attrition in CIRCUIT, a healthy lifestyle intervention program for youth at risk of cardiovascular disease. METHODS A one-arm intervention study of children aged 4-18 years who initiated the CIRCUIT program in the first five years of its existence (N = 403). We defined attrition as attending the baseline visit but ceasing attendance prior to the 1-year follow-up. Potential determinants of dropout included the child's age, sex, ethnicity, body mass index (BMI) z-score, family socio-demographic characteristics, and estimated driving time to the program, all measured at baseline. Associations were estimated bivariately, using chi-squared- and t-tests, and simultaneously in a multivariable logistic regression model. RESULTS Of the 403 participants who started the program, 198 (49%) dropped out within 12 months of enrollment. Youth who dropped out were older (mean age 12.8y vs. 11.3y; p < 0.01), were less likely to live with both parents (62% vs. 71%; p = 0.05), and to have mothers who had completed high school (79% vs. 88%; p = 0.01). No group differences were observed for sex, ethnicity, baseline BMI z-score, fathers' education, or driving time to the program. In multivariate models, only older age at initiation of the intervention (OR: 1.2; CI: 1.1,1.3) and lower maternal education (OR: 2.0; CI: 1.0,3.8) were associated with dropout. CONCLUSION Improved tailoring of interventions to older pediatric participants and to families of lower maternal education may help reduce attrition in CIRCUIT and similar lifestyle intervention programs.
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Park J, Woo S, Ju YS, Seo YG, Lim HJ, Kim YM, Noh HM, Lee HJ, Park SI, Park KH. Factors associated with dropout in a lifestyle modification program for weight management in children and adolescents. Obes Res Clin Pract 2020; 14:566-572. [PMID: 33004301 DOI: 10.1016/j.orcp.2020.09.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 08/05/2020] [Accepted: 09/02/2020] [Indexed: 01/21/2023]
Abstract
BACKGROUND Significant dropout rates remain a serious concern in pediatric weight control program, but few studies have identified predictors of dropout. AIMS The objective of the study is to identify factors associated with dropout from a pediatric lifestyle modification weight control program at different phases. METHODS Data on overweight and obese participants (n = 242) aged 11-18 years in the Intervention for Childhood and Adolescent Obesity via Activity and Nutrition (ICAAN) study were collected at baseline, 6-months, and 24-months through self-report and a laboratory test. Logistic regression analysis was performed for those who dropped out during the first 6-months, and multivariate generalized estimating equation analysis identified longitudinal factors associated with those who dropped out after 24 months. RESULTS Lower family functioning (OR = 2.30, 95% CI [1.18-4.46]), exercise group (OR = 0.36, 95% CI [0.15-0.86]), lower initial attendance rate (OR = 6.09, 95% CI [2.94-12.6]), and non-self -referral pathways (OR = 2.35, 95% CI [1.05-5.27]) were significantly associated with 6-month dropouts. For late dropout, lower family functioning (OR = 1.71, 95% CI [1.06-2.77]) and lower initial attendance rates (OR = 2.06, 95% CI [1.12-3.81]) remained significant. CONCLUSION Family function and initial attendance rate were associated with lower dropout rates. Developing a supportive family environment and focusing on the early-stage factors at the intervention's outset may reduce overall dropout rates in obesity prevention intervention.
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Affiliation(s)
- Jane Park
- Department of Social Welfare, College of Social Sciences, Seoul National University, Seoul, Republic of Korea.
| | - Sarah Woo
- Major in Biomedical Science, Department of Medical Sciences, College of Medicine, Hallym University, Gangwon-do, Republic of Korea.
| | - Young-Su Ju
- Department of Occupational Medicine, National Medical Center, Seoul, Republic of Korea.
| | - Young-Gyun Seo
- Department of Family Medicine, Hallym University Sacred Heart Hospital, Hallym University, Gyeonggi-do, Republic of Korea.
| | - Hyun-Jung Lim
- Department of Medical Nutrition, Kyung Hee University, Yongin, Republic of Korea.
| | - Yoon-Myung Kim
- University College, Yonsei University International Campus, Incheon, Republic of Korea.
| | - Hye-Mi Noh
- Department of Family Medicine, Hallym University Sacred Heart Hospital, Hallym University, Gyeonggi-do, Republic of Korea.
| | - Hye-Ja Lee
- Center for Biomedical Sciences, Korea National Institute of Health, Cheongju, Chungbuk, Republic of Korea.
| | - Sang Ick Park
- Center for Biomedical Sciences, Korea National Institute of Health, Cheongju, Chungbuk, Republic of Korea.
| | - Kyung Hee Park
- Department of Family Medicine, Hallym University Sacred Heart Hospital, Hallym University, Gyeonggi-do, Republic of Korea.
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Atkins M, Castro I, Sharifi M, Perkins M, O'Connor G, Sandel M, Taveras EM, Fiechtner L. Unmet Social Needs and Adherence to Pediatric Weight Management Interventions: Massachusetts, 2017-2019. Am J Public Health 2020; 110:S251-S257. [PMID: 32663093 DOI: 10.2105/ajph.2020.305772] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. To examine effects of unmet social needs on adherence to pediatric weight management intervention (PWMI).Methods. We examined individual associations of positive screens for parental stress, parental depression, food insecurity, and housing insecurity with intervention adherence, and associations of 0, 1 or 2, and 3 or 4 unmet social needs with adherence, among children enrolled in a 2017-2019 comparative effectiveness trial for 2 high-intensity PWMIs in Massachusetts. Models were adjusted for child age, body mass index (BMI), parent BMI, and intervention arm.Results. Families with versus without housing insecurity received a mean of 5.3 (SD = 8.0) versus 8.3 (SD = 10.9) contact hours (P < .01). There were no statistically significant differences in adherence for families reporting other unmet social needs. Children with 3 to 4 unmet social needs versus without received a mean of 5.2 (SD = 8.1) versus 9.2 (SD = 11.8) contact hours (P < .01). In fully adjusted models, those with housing insecurity attended a mean difference of -3.14 (95% confidence interval [CI] = -5.41, -0.88) hours versus those without. Those with 3 or 4 unmet social needs attended -3.74 (95% CI = -6.64, -0.84) hours less than those with none.Conclusions. Adherence to PWMIs was lower among children with housing insecurity and in families with 3 or 4 unmet social needs. Addressing social needs should be a priority of PWMIs to improve intervention adherence and reduce disparities in childhood obesity.Trial Registration: ClinicalTrials.gov identifier: NCT03012126.
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Affiliation(s)
- Micaela Atkins
- Micaela Atkins, Ines Castro, Meghan Perkins, Giselle O'Connor, and Man Luo are with Department of Pediatrics, Division of General Academic Pediatrics, MassGeneral Hospital for Children, Boston, MA. Mona Sharifi is with Section of General Pediatrics, Department of Pediatrics, Yale University School of Medicine, New Haven, CT. Megan Sandel is with Division of General Academic Pediatrics, Boston Medical Center, Boston. Lauren Fiechtner is with Department of Pediatrics, Division of General Academic Pediatrics and Division of Gastroenterology and Nutrition, MassGeneral Hospital for Children. Elsie M. Taveras is with Department of Pediatrics, Division of General Academic Pediatrics, MassGeneral Hospital for Children, and Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston
| | - Ines Castro
- Micaela Atkins, Ines Castro, Meghan Perkins, Giselle O'Connor, and Man Luo are with Department of Pediatrics, Division of General Academic Pediatrics, MassGeneral Hospital for Children, Boston, MA. Mona Sharifi is with Section of General Pediatrics, Department of Pediatrics, Yale University School of Medicine, New Haven, CT. Megan Sandel is with Division of General Academic Pediatrics, Boston Medical Center, Boston. Lauren Fiechtner is with Department of Pediatrics, Division of General Academic Pediatrics and Division of Gastroenterology and Nutrition, MassGeneral Hospital for Children. Elsie M. Taveras is with Department of Pediatrics, Division of General Academic Pediatrics, MassGeneral Hospital for Children, and Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston
| | - Mona Sharifi
- Micaela Atkins, Ines Castro, Meghan Perkins, Giselle O'Connor, and Man Luo are with Department of Pediatrics, Division of General Academic Pediatrics, MassGeneral Hospital for Children, Boston, MA. Mona Sharifi is with Section of General Pediatrics, Department of Pediatrics, Yale University School of Medicine, New Haven, CT. Megan Sandel is with Division of General Academic Pediatrics, Boston Medical Center, Boston. Lauren Fiechtner is with Department of Pediatrics, Division of General Academic Pediatrics and Division of Gastroenterology and Nutrition, MassGeneral Hospital for Children. Elsie M. Taveras is with Department of Pediatrics, Division of General Academic Pediatrics, MassGeneral Hospital for Children, and Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston
| | - Meghan Perkins
- Micaela Atkins, Ines Castro, Meghan Perkins, Giselle O'Connor, and Man Luo are with Department of Pediatrics, Division of General Academic Pediatrics, MassGeneral Hospital for Children, Boston, MA. Mona Sharifi is with Section of General Pediatrics, Department of Pediatrics, Yale University School of Medicine, New Haven, CT. Megan Sandel is with Division of General Academic Pediatrics, Boston Medical Center, Boston. Lauren Fiechtner is with Department of Pediatrics, Division of General Academic Pediatrics and Division of Gastroenterology and Nutrition, MassGeneral Hospital for Children. Elsie M. Taveras is with Department of Pediatrics, Division of General Academic Pediatrics, MassGeneral Hospital for Children, and Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston
| | - Giselle O'Connor
- Micaela Atkins, Ines Castro, Meghan Perkins, Giselle O'Connor, and Man Luo are with Department of Pediatrics, Division of General Academic Pediatrics, MassGeneral Hospital for Children, Boston, MA. Mona Sharifi is with Section of General Pediatrics, Department of Pediatrics, Yale University School of Medicine, New Haven, CT. Megan Sandel is with Division of General Academic Pediatrics, Boston Medical Center, Boston. Lauren Fiechtner is with Department of Pediatrics, Division of General Academic Pediatrics and Division of Gastroenterology and Nutrition, MassGeneral Hospital for Children. Elsie M. Taveras is with Department of Pediatrics, Division of General Academic Pediatrics, MassGeneral Hospital for Children, and Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston
| | - Megan Sandel
- Micaela Atkins, Ines Castro, Meghan Perkins, Giselle O'Connor, and Man Luo are with Department of Pediatrics, Division of General Academic Pediatrics, MassGeneral Hospital for Children, Boston, MA. Mona Sharifi is with Section of General Pediatrics, Department of Pediatrics, Yale University School of Medicine, New Haven, CT. Megan Sandel is with Division of General Academic Pediatrics, Boston Medical Center, Boston. Lauren Fiechtner is with Department of Pediatrics, Division of General Academic Pediatrics and Division of Gastroenterology and Nutrition, MassGeneral Hospital for Children. Elsie M. Taveras is with Department of Pediatrics, Division of General Academic Pediatrics, MassGeneral Hospital for Children, and Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston
| | - Elsie M Taveras
- Micaela Atkins, Ines Castro, Meghan Perkins, Giselle O'Connor, and Man Luo are with Department of Pediatrics, Division of General Academic Pediatrics, MassGeneral Hospital for Children, Boston, MA. Mona Sharifi is with Section of General Pediatrics, Department of Pediatrics, Yale University School of Medicine, New Haven, CT. Megan Sandel is with Division of General Academic Pediatrics, Boston Medical Center, Boston. Lauren Fiechtner is with Department of Pediatrics, Division of General Academic Pediatrics and Division of Gastroenterology and Nutrition, MassGeneral Hospital for Children. Elsie M. Taveras is with Department of Pediatrics, Division of General Academic Pediatrics, MassGeneral Hospital for Children, and Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston
| | - Lauren Fiechtner
- Micaela Atkins, Ines Castro, Meghan Perkins, Giselle O'Connor, and Man Luo are with Department of Pediatrics, Division of General Academic Pediatrics, MassGeneral Hospital for Children, Boston, MA. Mona Sharifi is with Section of General Pediatrics, Department of Pediatrics, Yale University School of Medicine, New Haven, CT. Megan Sandel is with Division of General Academic Pediatrics, Boston Medical Center, Boston. Lauren Fiechtner is with Department of Pediatrics, Division of General Academic Pediatrics and Division of Gastroenterology and Nutrition, MassGeneral Hospital for Children. Elsie M. Taveras is with Department of Pediatrics, Division of General Academic Pediatrics, MassGeneral Hospital for Children, and Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston
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Brown CL, Dovico J, Garner-Edwards D, Moses M, Skelton JA. Predictors of Engagement in a Pediatric Weight Management Clinic after Referral. Child Obes 2020; 16:238-243. [PMID: 32484761 PMCID: PMC7262647 DOI: 10.1089/chi.2020.0032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: Little is known about factors that affect a family's ability to engage in pediatric weight management clinics (PWMCs). We aimed at comparing child and family characteristics of patients referred to a PWMC by participants' attendance at orientation, attendance at intake, or completing the program. Methods: We performed a retrospective study of patients ages 2-18 years referred to a PWMC between 2014 and 2017. We extracted data from electronic medical records and clinic databases, including age, sex, race/ethnicity, language, referral year, address, and insurance. We performed t-tests and chi-square tests to examine the association of engagement outcomes with covariates. We used separate multivariate logistic regression models to assess the predictors of engagement outcomes, including significant covariates from bivariate analyses. Results: Participants (N = 2020 referred) had a mean age of 11.5 ± 3.5 years; 72% had Medicaid, and 34% lived in city limits. Participants were 39% white, 30% black, and 27% Hispanic. Of those referred, 41% attended orientation, 14% attended intake, and 9% completed. Significant predictors of attending orientation were age [odds ratio (OR): 0.93, 95% confidence interval (CI): 0.91-0.96], male sex (OR: 0.74, 95% CI: 0.60-0.91), Hispanic ethnicity (OR: 1.69, 95% CI: 1.26-2.26), living in city limits (OR: 1.39, 95% CI: 1.11-1.75), and Medicaid (OR: 0.77, 95% CI: 0.60-0.98). Significant predictors of attending intake were age (OR: 0.93, 95% CI: 0.90-0.96), Medicaid (OR: 0.61, 95% CI: 0.46-0.81), and 2017 referral year (OR: 0.21, 95% CI: 0.12-0.35). Hispanic ethnicity was associated with twice the odds of completion (OR: 2.07, 95% CI: 1.10-3.91). Conclusions: Child and family characteristics more strongly predicted initial engagement with a PWMC than completion. Future research should examine how targeting these predictors (e.g., referring at younger age) can improve PWMC engagement.
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Affiliation(s)
- Callie L. Brown
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC, USA.,Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA.,Address correspondence to: Callie L. Brown, MD, MPH, Department of Pediatrics, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA
| | - Jaclyn Dovico
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Dara Garner-Edwards
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC, USA.,Brenner FIT, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Melissa Moses
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC, USA.,Brenner FIT, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Joseph A. Skelton
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC, USA.,Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA.,Brenner FIT, Wake Forest School of Medicine, Winston-Salem, NC, USA
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15
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Predictors of engagement and outcome achievement in a behavioural intervention targeting sugar-sweetened beverage intake among rural adults. Public Health Nutr 2019; 23:554-563. [PMID: 31796129 DOI: 10.1017/s1368980019003392] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To describe relationships among baseline characteristics, engagement indicators and outcomes for rural participants enrolled in SIPsmartER, a behavioural intervention targeting sugar-sweetened beverage (SSB) intake. DESIGN A secondary data analysis. Bivariate analyses determined relationships among baseline characteristics (e.g. age, gender, race, education, income), engagement indicators (completion of 6-month health screening, class attendance, call completion) and SSB outcomes (SSB ounce reduction (i.e. US fluid ounces; 1 US fl. oz = 29·57 ml), reduced ≥12 ounces, achieved ≤8 ounce intake). Generalized linear models tested for significant effects of baseline characteristics on engagement indicators and of baseline characteristics and engagement indicators on SSB outcomes. SETTING South-west Virginia, USA, a rural, medically underserved region. PARTICIPANTS Participants' (n 155) mean age was 41 years; most were female (81 %), White (91 %) and earned ≤$US 20 000 per annum (61 %). RESULTS All final models were significant. Engagement models predicted 12-17 % of variance, with age being a significant predictor in all three models. SSB outcome models explained 5-70 % of variance. Number of classes attended was a significant predictor of SSB ounce reduction (β = -6·12, P < 0·01). Baseline SSB intake significantly predicted SSB ounce reduction (β = -0·90, P < 0·001) and achieved ≤8 ounce intake (β = 0·98, P < 0·05). CONCLUSIONS The study identifies several participant baseline characteristics that may impact engagement in and outcomes from a community-based intervention targeting SSB intake. Findings suggest greater attendance of SIPsmartER classes is associated with greater reduction in overall SSB intake; yet engagement variables did not predict other outcomes. Findings will inform the future implementation of SIPsmartER and research studies of similar design and intent.
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Recruitment and retention of families interested in a parent-based pediatric obesity intervention. Contemp Clin Trials Commun 2019; 16:100467. [PMID: 31701041 PMCID: PMC6831663 DOI: 10.1016/j.conctc.2019.100467] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 10/06/2019] [Accepted: 10/10/2019] [Indexed: 11/27/2022] Open
Abstract
Recruitment and retention in pediatric obesity treatment remains challenging, especially for groups at highest risk of this condition, including African Americans. However, most investigations examine attrition during intervention or follow-up. Little is known about those who refuse enrollment, or drop out at baseline. Thus, the trajectory of recruitment, enrollment, and retention, especially at these early stages, is not well understood, limiting knowledge of treatment access. This study examined enrollment in a pediatric weight management intervention. We provide demographic information on nested consort flow groups. We compared non-overlapping interest/enrollment groups to examine differences between those who progressed to the next consort flow group and those who did not; specifically the four groups examined were: (1) eligible at screening, did not attend baseline (nchildren = 261), (2) attended baseline, did not enroll (nchildren = 46), (3) enrolled, did not complete posttesting (nchildren = 81), and (4) completed posttesting (nchildren = 284). Of enrolled families, >70% were African American; >78% completed posttesting. No differences emerged across groups on sex, ethnicity, or race (ps > .05). Attrition was unrelated to initial child BMI. In this trial, the goal of enrolling diverse parents of children with obesity was achieved, and most enrollees completed treatment.
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Bean MK, Ingersoll KS, Powell P, Stern M, Evans RK, Wickham EP, Mazzeo SE. Response to Vorland et al's Letter to the Editor about "Impact of motivational interviewing on outcomes of an adolescent obesity treatment: Results from the MI Values randomized controlled pilot trial". Clin Obes 2019; 9:e12333. [PMID: 31397052 DOI: 10.1111/cob.12333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 07/11/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Melanie K Bean
- Department of Pediatrics, Virginia Commonwealth University, Richmond, Virginia
| | - Karen S Ingersoll
- Department of Psychiatry and Neurobehavioral Sciences, Center for Behavioral Health and Technology, University of Virginia, Charlottesville, Virginia
| | - Priscilla Powell
- Department of Pediatrics, Virginia Commonwealth University, Richmond, Virginia
| | - Marilyn Stern
- Department of Child and Family Services, University of South Florida, Tampa, Florida
| | - Ronald K Evans
- Department of Kinesiology and Health Sciences, Virginia Commonwealth University, Richmond, Virginia
| | - Edmond P Wickham
- Department of Pediatrics, Virginia Commonwealth University, Richmond, Virginia
- Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia
| | - Suzanne E Mazzeo
- Department of Pediatrics, Virginia Commonwealth University, Richmond, Virginia
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia
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Bean MK, Thornton LM, Jeffers AJ, Gow R, Mazzeo SE. Impact of motivational interviewing on engagement in a parent-exclusive paediatric obesity intervention: randomized controlled trial of NOURISH+MI. Pediatr Obes 2019; 14:e12484. [PMID: 30515995 PMCID: PMC6474345 DOI: 10.1111/ijpo.12484] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 09/05/2018] [Accepted: 09/17/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Attrition and treatment adherence are notorious challenges in paediatric obesity interventions. OBJECTIVE To evaluate if brief, pretreatment motivational interviewing (MI) can improve retention (at baseline, post-assessment and follow-up assessment) and adherence (i.e. attendance) in a parent-exclusive paediatric obesity intervention. METHODS MI was implemented with parents as an adjunct to a larger randomized controlled trial of Nourishing Our Understanding of Role-modeling to Improve Support and Health (NOURISH+ ), a parent intervention for children with overweight ages 5-11 years. Parents (N = 112) were randomized to receive two MI sessions (one telephone and one in person) or reminder calls. RESULTS Parents (91% women; 52% African American) who completed one telephone MI session were more likely to attend baseline (74%) compared with parents who received reminder calls only (53%, p < .001). After a second MI session, there were no group differences in treatment initiation (p > .05). Treatment attendance, post or 4-month follow-up assessment completion did not differ between conditions (p > .05). CONCLUSION One MI session implemented prior to treatment can improve baseline attendance; a second MI session did not enhance these effects. A single-session telephone-based MI pretreatment might be a cost and time-effective strategy to enhance recruitment efforts. Further strategies to address retention and treatment attendance are needed.
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Affiliation(s)
- Melanie K. Bean
- Department of Pediatrics, Children’s Hospital of Richmond at Virginia Commonwealth University, Richmond, VA
| | - Laura M. Thornton
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Amy J. Jeffers
- Department of Pediatrics, Children’s Hospital of Richmond at Virginia Commonwealth University, Richmond, VA
| | - Rachel Gow
- Department of Pediatrics, Children’s Hospital of Richmond at Virginia Commonwealth University, Richmond, VA,Department of Psychology, Virginia Commonwealth University, Richmond, VA
| | - Suzanne E. Mazzeo
- Department of Pediatrics, Children’s Hospital of Richmond at Virginia Commonwealth University, Richmond, VA,Department of Psychology, Virginia Commonwealth University, Richmond, VA
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