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McMullen B, Duncanson K, Collins C, MacDonald-Wicks L. A systematic review of the mechanisms influencing engagement in diabetes prevention programmes for people with pre-diabetes. Diabet Med 2024; 41:e15323. [PMID: 38829966 DOI: 10.1111/dme.15323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 03/02/2024] [Accepted: 03/20/2024] [Indexed: 06/05/2024]
Abstract
AIMS To identify barriers and enablers that influence engagement in and acceptability of diabetes prevention programmes for people with pre-diabetes. The results will provide insights for developing strategies and recommendations to improve design and delivery of diabetes prevention programmes with enhanced engagement and acceptability for people with pre-diabetes. METHODS This review used a critical realist approach to examine context and mechanisms of diabetes prevention programmes. Medline, Embase, PsycInfo, Cinahl, Web of Science, Scopus and Pre-Medline were searched for English language studies published between 2000 and 2023. A quality assessment was conducted using Joanna Briggs Institute critical appraisal tools. RESULTS A total of 90 papers met inclusion criteria. The included studies used a variety of quantitative and qualitative methodologies. Data extracted focused on barriers and enablers to engagement in and acceptability of diabetes prevention programmes, with seven key mechanisms identified. These included financial, environmental, personal, healthcare, social and cultural, demographic and programme mechanisms. Findings highlighted diverse factors that influenced engagement in preventive programmes and the importance of considering these factors when planning, developing and implementing future diabetes prevention programmes. CONCLUSIONS Mechanisms identified in this review can inform design and development of diabetes prevention programmes for people with pre-diabetes and provide guidance for healthcare professionals and policymakers. This will facilitate increased participation and engagement in preventive programmes, potentially reducing progression and/or incidence of pre-diabetes to type 2 diabetes and improving health outcomes.
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Affiliation(s)
- Britney McMullen
- Mid North Coast Local Health District, University of Newcastle, Coffs Harbour, Australia
| | - Kerith Duncanson
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Australia
| | - Clare Collins
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Australia
- Food and Nutrition Research Program, Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Lesley MacDonald-Wicks
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Australia
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2
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Kukla A, Sahi SS, Navratil P, Benzo RP, Smith BH, Duffy D, Park WD, Shah M, Shah P, Clark MM, Fipps DC, Denic A, Schinstock CA, Dean PG, Stegall MD, Kudva YC, Diwan TS. Weight Loss Surgery Increases Kidney Transplant Rates in Patients With Renal Failure and Obesity. Mayo Clin Proc 2024; 99:705-715. [PMID: 38702124 DOI: 10.1016/j.mayocp.2024.01.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 12/23/2023] [Accepted: 01/25/2024] [Indexed: 05/06/2024]
Abstract
OBJECTIVE To describe the outcomes of kidney transplant (KT) candidates with obesity undergoing sleeve gastrectomy (SG) to meet the criteria for KT. METHODS Retrospective analysis was conducted of electronic medical records of KT candidates with obesity (body mass index >35 kg/m2) who underwent SG in our institution. Weight loss, adverse health events, and the listing and transplant rates were abstracted and compared with the nonsurgical cohort. RESULTS The SG was performed in 54 patients; 50 patients did not have surgery. Baseline demographic characteristics were comparable at the time of evaluation. Mean body mass index ± SD of the SG group was 41.7±3.6 kg/m2 at baseline (vs 41.5±4.3 kg/m2 for nonsurgical controls); at 2 and 12 months after SG, it was 36.4±4.1 kg/m2 and 32.6±4.0 kg/m2 (P<.01 for both). In the median follow-up time of 15.5 months (interquartile range, 6.4 to 23.9 months), SG was followed by active listing (37/54 people), and 20 of 54 received KT during a median follow-up time of 20.9 months (interquartile range, 14.7 to 28.3 months) after SG. In contrast, 14 of 50 patients in the nonsurgical cohort were listed, and 5 received a KT (P<.01). Three patients (5.6%) experienced surgical complications. There was no difference in overall hospitalization rates and adverse health outcomes, but the SG cohort experienced a higher risk of clinically significant functional decline. CONCLUSION In KT candidates with obesity, SG appears to be effective, with 37% of patients undergoing KT during the next 18 months (P<.01). Further research is needed to confirm and to improve the safety and efficacy of SG for patients with obesity seeking a KT.
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Affiliation(s)
- Aleksandra Kukla
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN; Von Liebig Transplant Center, Mayo Clinic, Rochester, MN.
| | - Sukhdeep S Sahi
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Pavel Navratil
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN; Department of Urology, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic; Faculty of Medicine in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
| | - Roberto P Benzo
- Department of Pulmonary Medicine, Mayo Clinic, Rochester, MN
| | - Byron H Smith
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Dustin Duffy
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Walter D Park
- Department of Cardiovascular Surgery Research, Mayo Clinic, Rochester, MN
| | - Meera Shah
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Pankaj Shah
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Matthew M Clark
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN; Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| | - David C Fipps
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| | - Aleksandar Denic
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Carrie A Schinstock
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN; Von Liebig Transplant Center, Mayo Clinic, Rochester, MN
| | - Patrick G Dean
- Von Liebig Transplant Center, Mayo Clinic, Rochester, MN; Department of Surgery and Immunology, Mayo Clinic, Rochester, MN
| | - Mark D Stegall
- Von Liebig Transplant Center, Mayo Clinic, Rochester, MN; Department of Surgery and Immunology, Mayo Clinic, Rochester, MN
| | - Yogish C Kudva
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Tayyab S Diwan
- Von Liebig Transplant Center, Mayo Clinic, Rochester, MN; Department of Surgery and Immunology, Mayo Clinic, Rochester, MN
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3
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Benzo MV, Kelpin SS, Werneburg B, Hoult J, Clark MM, Novotny P, Benzo R. Patient Engagement in Health Coaching and Self-Management Abilities in Chronic Obstructive Pulmonary Disease. Am J Lifestyle Med 2024; 18:243-251. [PMID: 38559791 PMCID: PMC10979730 DOI: 10.1177/15598276221120523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
Objective: Health coaching has the potential to improve self-management abilities (SM) in patients with Chronic Obstructive Pulmonary Disease (COPD). Patient engagement with health care providers has a beneficial effect on patient outcomes. We examined the association of patient engagement with the health coach on SM abilities in patients with COPD. Methods: We analyzed the association between the degree of engagement measured by the Working Alliance Inventory (WAI-SR) and the SM measured by the Self-Management-Ability-Scale-30 (SMAS-30) at the end of a COPD health coaching intervention. Results: The cohort included 146 moderate to severe COPD patients. The WAI-SR total score was 85% of the maximum possible scores indicating a high degree of engagement between the health coach and the patients. The WAI-SR Task and Bond domains were positively associated with SM abilities after adjusting for lung function (FEV1 %) and depression symptoms (PHQ-2). Conclusion: The degree of engagement between a health coach and patients is associated with the perception of SM abilities in patients with COPD. Our results may inform self-management intervention and clinical practice.
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Affiliation(s)
- Maria V. Benzo
- Mindful Breathing Lab, Mayo Clinic, Rochester, MN, USA (MVB, JH, RB); Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA (SSK, MMC); Patient Experience-Training, Education & Coaching, Mayo Clinic, Rochester, MN, USA (BW); and Research Services, Mayo Clinic, Rochester, MN, USA (PN)
| | - Sydney S. Kelpin
- Mindful Breathing Lab, Mayo Clinic, Rochester, MN, USA (MVB, JH, RB); Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA (SSK, MMC); Patient Experience-Training, Education & Coaching, Mayo Clinic, Rochester, MN, USA (BW); and Research Services, Mayo Clinic, Rochester, MN, USA (PN)
| | - Brooke Werneburg
- Mindful Breathing Lab, Mayo Clinic, Rochester, MN, USA (MVB, JH, RB); Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA (SSK, MMC); Patient Experience-Training, Education & Coaching, Mayo Clinic, Rochester, MN, USA (BW); and Research Services, Mayo Clinic, Rochester, MN, USA (PN)
| | - Johanna Hoult
- Mindful Breathing Lab, Mayo Clinic, Rochester, MN, USA (MVB, JH, RB); Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA (SSK, MMC); Patient Experience-Training, Education & Coaching, Mayo Clinic, Rochester, MN, USA (BW); and Research Services, Mayo Clinic, Rochester, MN, USA (PN)
| | - Matthew M. Clark
- Mindful Breathing Lab, Mayo Clinic, Rochester, MN, USA (MVB, JH, RB); Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA (SSK, MMC); Patient Experience-Training, Education & Coaching, Mayo Clinic, Rochester, MN, USA (BW); and Research Services, Mayo Clinic, Rochester, MN, USA (PN)
| | - Paul Novotny
- Mindful Breathing Lab, Mayo Clinic, Rochester, MN, USA (MVB, JH, RB); Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA (SSK, MMC); Patient Experience-Training, Education & Coaching, Mayo Clinic, Rochester, MN, USA (BW); and Research Services, Mayo Clinic, Rochester, MN, USA (PN)
| | - Roberto Benzo
- Mindful Breathing Lab, Mayo Clinic, Rochester, MN, USA (MVB, JH, RB); Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA (SSK, MMC); Patient Experience-Training, Education & Coaching, Mayo Clinic, Rochester, MN, USA (BW); and Research Services, Mayo Clinic, Rochester, MN, USA (PN)
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4
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Nanda S, Chon TY, Mahapatra S, Lindeen SA, Fischer KM, Krüger M, Schierwater B, Schmidt CO, Wahner-Roedler DL, Bauer BA. Preventiometer, a Novel Wellness Assessment Device, Used With Healthy Volunteers: A Phase 2 Study. Glob Adv Health Med 2021; 10:21649561211045016. [PMID: 34840917 PMCID: PMC8619782 DOI: 10.1177/21649561211045016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 08/23/2021] [Indexed: 11/16/2022] Open
Abstract
Background We previously reported on a pilot study to assess the incorporation of a novel wellness assessment device, the Preventiometer (iPEx5 GmbH, Greifswald, Germany), into an academic medical practice. The present follow-up study expands on those data and evaluates the acceptability of the assessment process in a larger sample population. Objective The aim of this study was to evaluate participant satisfaction with the Preventiometer wellness assessment. Methods A total of 60 healthy volunteers participated. Each participant underwent a comprehensive wellness assessment with the Preventiometer and received data from more than 30 diagnostic tests. A 32-question survey (with a numeric rating scale from 0 to 10) was used to rate the wellness assessment tests and participants' impressions of the wellness assessment. Results Each assessment had a significantly higher rating than 7 (P < .001), and the majority of participants agreed or strongly agreed that they were satisfied (98.3%), and they strongly agreed that they were engaged the entire time (93.2%), and liked the instant test results feature of the Preventiometer device (93.2%). Conclusion This study confirms findings from our previous pilot study regarding the feasibility of the Preventiometer as a wellness assessment tool. The study further demonstrated that 98% of participants were satisfied with the assessment and that all of them would recommend it to others.
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Affiliation(s)
| | - Tony Y Chon
- Division of General Internal Medicine, MN, USA
| | | | | | | | - Markus Krüger
- Institute for Community Medicine, Mayo Clinic, Rochester, MN, USA.,Center for Oral Health, Universitätsmedizin Greifswald, Germany
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5
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Stan DL, Cutshall SM, Adams TF, Ghosh K, Clark MM, Wieneke KC, Kebede EB, Donelan Dunlap BJ, Ruddy KJ, Hazelton JK, Butts AM, Jenkins SM, Croghan IT, Bauer BA. Wellness Coaching: An Intervention to Increase Healthy Behavior in Breast Cancer Survivors. Clin J Oncol Nurs 2021; 24:305-315. [PMID: 32441691 DOI: 10.1188/20.cjon.305-315] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Regular physical activity after breast cancer diagnosis improves survival rates and quality of life (QOL). However, breast cancer survivors rarely meet guidelines for recommended levels of physical activity. Wellness coaching interventions (WCIs) have improved exercise and health behaviors in other patient populations. OBJECTIVES This study assessed the feasibility and effectiveness of WCIs for increasing physical activity in breast cancer survivors; secondary measures included changes in dietary habits, weight, and QOL. METHODS 20 obese or overweight breast cancer survivors who recently completed active breast cancer treatment were recruited into a single-arm, 12-week WCI pilot feasibility study. The intervention was comprised of one in-person wellness coaching visit followed by four telephone calls over 12 weeks and 12 weekly emails containing wellness recommendations. FINDINGS Significant improvements from pre- to postintervention were seen in physical activity level, dietary habits, and in some aspects of QOL. Forty percent of participants achieved the 3% postintervention weight-loss goal, but this was not sustained at 30 weeks.
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6
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Lin CL, Huang LC, Chang YT, Chen RY, Yang SH. Under COVID-19 Pandemic: A Quasi-Experimental Trial of Observation on Diabetes Patients' Health Behavior Affected by the Pandemic From a Coaching Intervention Program. Front Public Health 2021; 9:580032. [PMID: 34055704 PMCID: PMC8160086 DOI: 10.3389/fpubh.2021.580032] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 04/22/2021] [Indexed: 11/21/2022] Open
Abstract
Introduction: The aim of this study was to explore the impact of diabetes self-management and HbA1c affected by the COVID-19 pandemic and the epidemic prevention work. Methods: This quasi-experimental study collected a pooled data from a randomized-control study between February and May 2020 in which 114 participants who presented type 2 diabetes were recruited. The intervention group had health coaching and usual care, whereas the control had usual care only. The main outcome variables of this observation study were the change of HbA1c, physical activity, and eating out behavior within this time interval. Results: We found that the eating out behavior of both groups had decreased, and if a health coach helped the patients set physical activity goals in the two groups, the physical activity behavior will not be impacted due to the pandemic. Conclusions: While every country is focusing on COVID-19 pandemic prevention, especially when strict home quarantine measures and social distancing are adopted, reminding and assisting chronic patients to maintain good self-management behavior may lessen the social and medical system burdens caused by the deterioration of chronic conditions due to the excessive risk prevention behavior and the epidemic prevention work. Trial Registration:www.isrctn.com, identifier number: ISRCTN14167790, date: 12 July, 2019.
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Affiliation(s)
- Ching-Ling Lin
- Department of Endocrinology and Metabolism, Cathay General Hospital, Taipei, Taiwan.,Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Li-Chi Huang
- Department of Endocrinology and Metabolism, Cathay General Hospital, Taipei, Taiwan
| | - Yao-Tsung Chang
- School of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Ruey-Yu Chen
- School of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Shwu-Huey Yang
- School of Nutrition and Health Sciences, Taipei Medical University, Taipei, Taiwan.,Nutrition Research Center, Taipei Medical University Hospital, Taipei, Taiwan.,Research Center of Geriatric Nutrition, College of Nutrition, Taipei Medical University, Taipei, Taiwan
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7
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Ledford CJW, Fulleborn ST, Jackson JT, Rogers T, Samar H. Dissonance in the discourse of the duration of diabetes: A mixed methods study of patient perceptions and clinical practice. Health Expect 2021; 24:1187-1196. [PMID: 33949058 PMCID: PMC8369085 DOI: 10.1111/hex.13245] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 02/02/2021] [Accepted: 03/14/2021] [Indexed: 12/16/2022] Open
Abstract
Background Remission of diabetes can be rewarding for patients and physicians, but there is limited study of how patients perceive the timeline of a disease along the continuum of glycaemic control. Objective To explore how patients perceive the timeline of diabetes along the continuum of glycaemic control and their goals of care and to identify whether family physicians communicate the principles of regression and remission of diabetes. Design Mixed methods approach of qualitative semi‐structured interviews with purposive sampling followed by cross‐sectional survey of physicians. Participants Thirty‐three patients living with prediabetes (preDM) or type 2 diabetes mellitus (T2DM) at medical centres in Georgia and Nevada; and 387 family physicians providing primary care within the same health system. Results Patients described two timelines of diabetes: as a lifelong condition or as a condition that can be cured. Patients who perceived a lifelong condition described five treatment goals: reducing glucose‐related laboratory values, losing weight, reducing medication, preventing treatment intensification and avoiding complications. For patients who perceived diabetes as a disease with an end, the goal of care was to achieve normoglycaemia. In response to patient vignettes that described potential cases of remission and regression, 38.2% of physician respondents would still communicate that a patient has preDM and 94.6% would tell the patient that he still had diabetes. Conclusions Most physicians here exhibited reluctance to communicate remission or regression in patient care. Yet, patients describe two different potential timelines, including a subset who expect their diabetes can be ‘cured’. Physicians should incorporate shared decision making to create a shared mental model of diabetes and its potential outcomes with patients. Patient or Public Contribution In this mixed methods study, as patients participated in the qualitative phase of this study, we asked patients to tell us what additional questions we should ask in subsequent interviews. Data from this qualitative phase informed the design and interpretation of the quantitative phase with physician participants.
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Affiliation(s)
- Christy J W Ledford
- Department of Family Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | | | - Jeremy T Jackson
- Military Primary Care Research Network, Department of Family Medicine, Henry M. Jackson Foundation, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Tyler Rogers
- Department of Family Medicine, Madigan Army Medical Center, Tacoma, WA, USA
| | - Haroon Samar
- Department of Family Medicine, Madigan Army Medical Center, Tacoma, WA, USA
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8
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Nelson A, Moses O, Rea B, Morton K, Shih W, Alramadhan F, Singh PN. Pilot Feasibility Study of Incorporating Whole Person Care Health Coaching Into an Employee Wellness Program. Front Public Health 2021; 8:570458. [PMID: 33869121 PMCID: PMC8044742 DOI: 10.3389/fpubh.2020.570458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 08/20/2020] [Indexed: 11/17/2022] Open
Abstract
Prior research supports positive health coaching outcomes, but there is limited literature on the integration of employer-sponsored health coaching into employee wellness strategy. The aim of our mixed methods study was to assess feasibility, acceptability, and preliminary efficacy of incorporating a whole-person care model of health coaching into an employee wellness program (i.e., weight loss, smoking cessation) that is made available by an employer-sponsored health plan. For the quantitative study, eligible employees and covered spouses (n = 39) from Loma Linda University Health were recruited into a novel, 12-week, whole person care intervention that combined health coaching and health education and examined outcomes from surveys detailing the participants' experience and biometric data from the intervention and maintenance periods. For the qualitative study, data were collected through key informant interviews from three health coaches and six intervention participants who were recruited via random sampling. Health coaching was well-received by the participants, and led to a slight albeit positive behavioral change for obesity. A significant decrease in body mass index occurred over 12 weeks of intervention (−0.36 kg/m2, p = 0.016), that did not continue during the maintenance phase (−0.17 kg/m2, p = 0.218). Qualitative findings indicated improved personal health awareness, accountability, motivation, and self-efficacy along with goal setting and barrier overcoming skills among the key themes. Our pilot study findings identify positive behavior change effects of an employee health intervention based on a whole person care model of health coaching with integrated health education, and also identify the need for methods to maintain behavior change (i.e., mHealth, peer-support) post-intervention. Further investigation in randomized controlled trials is the next step in this research.
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Affiliation(s)
- Anna Nelson
- School of Public Health, Loma Linda University, Loma Linda, CA, United States
| | - Olivia Moses
- School of Public Health, Loma Linda University, Loma Linda, CA, United States.,Risk Management, Loma Linda University, Loma Linda, CA, United States
| | - Brenda Rea
- School of Public Health, Loma Linda University, Loma Linda, CA, United States.,Department of Preventive Medicine, Loma Linda University, Loma Linda, CA, United States
| | - Kelly Morton
- School of Behavioral Health, Loma Linda University, Loma Linda, CA, United States
| | - Wendy Shih
- School of Public Health, Loma Linda University, Loma Linda, CA, United States
| | - Fatimah Alramadhan
- School of Public Health, Loma Linda University, Loma Linda, CA, United States
| | - Pramil N Singh
- School of Public Health, Loma Linda University, Loma Linda, CA, United States.,Transdisciplinary Tobacco Research Program, Loma Linda University Cancer Center, Loma Linda, CA, United States
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9
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Yost O, DeJonckheere M, Stonebraker S, Ling G, Buis L, Pop-Busui R, Kim N, Mizokami-Stout K, Richardson C. Continuous Glucose Monitoring With Low-Carbohydrate Diet Coaching in Adults With Prediabetes: Mixed Methods Pilot Study. JMIR Diabetes 2020; 5:e21551. [PMID: 33325831 PMCID: PMC7773517 DOI: 10.2196/21551] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 09/21/2020] [Accepted: 10/26/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) is preventable; however, few patients with prediabetes participate in prevention programs. The use of user-friendly continuous glucose monitors (CGMs) with low-carbohydrate diet coaching is a novel strategy to prevent T2DM. OBJECTIVE This study aims to determine the patient satisfaction and feasibility of an intervention combining CGM use and low-carbohydrate diet coaching in patients with prediabetes to drive dietary behavior change. METHODS We conducted a mixed methods, single-arm pilot and feasibility study at a suburban family medicine clinic. A total of 15 adults with prediabetes with hemoglobin A1c (HbA1c) levels between 5.7% and 6.4% and a BMI >30 kg/m2 were recruited to participate. The intervention and assessments took place during 3 in-person study visits and 2 qualitative phone interviews (3 weeks and 6 months after the intervention). During visit 1, participants were asked to wear a CGM and complete a food intake and craving log for 10 days. During visit 2, the food intake and craving log along with the CGM results of the participants were reviewed and the participants received low-carbohydrate diet coaching, including learning about carbohydrates and personalized feedback. A second CGM sensor, with the ability to scan and record glucose trends, was placed, and the participants logged their food intake and cravings as they attempted to reduce their total carbohydrate intake (<100 g/day). During visit 3, the participants reviewed their CGM and log data. The primary outcome was satisfaction with the use of CGM and low-carbohydrate diet. The secondary outcomes included feasibility, weight, and HbA1c change, and percentage of time spent in hyperglycemia. Changes in attitudes and risk perception of developing diabetes were also assessed. RESULTS The overall satisfaction rate of our intervention was 93%. The intervention induced a weight reduction of 1.4 lb (P=.02) and a reduction of HbA1c levels by 0.71% (P<.001) since enrollment. Although not significantly, the percentage of time above glucose goal and average daily glucose levels decreased slightly during the study period. Qualitative interview themes indicated no major barriers to CGM use; the acceptance of a low-carbohydrate diet; and that CGMs helped to visualize the impact of carbohydrates on the body, driving dietary changes. CONCLUSIONS The use of CGMs and low-carbohydrate diet coaching to drive dietary changes in patients with prediabetes is feasible and acceptable to patients. This novel method merits further exploration, as the preliminary data indicate that combining CGM use with low-carbohydrate diet coaching drives dietary changes, which may ultimately prevent T2DM.
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Affiliation(s)
- Olivia Yost
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Melissa DeJonckheere
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, United States
| | - Spring Stonebraker
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Grace Ling
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Lorraine Buis
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, United States
| | - Rodica Pop-Busui
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Noa Kim
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Kara Mizokami-Stout
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, United States.,Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Caroline Richardson
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, United States
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10
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Diet and Oral Health Coaching Methods and Models for the Independent Elderly. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10114021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Health-related behavior based on diet is an important determinant of oral health in independent elderly. Aging impairs senses, mastication, oral status, and function, causing nutritional needs and diet insufficiencies that contribute to a vicious circle of impairment. But the present needs of independent older adults suggest that health research and oral health care should shift from disease management and therapy to integral customized and personal treatment plans, including lifestyle, psychological, nutritional, and oral health coaching approaches. In this paper health coaching approaches in medical and dental settings are valued as to their effectiveness for older adults. Furthermore, coaching approaches for seniors are discussed and coaching models for better senior patient-dentist cooperation on the diet issue are suggested. Diet and oral health coaching is proven to be a modern senior patient-centered approach that needs to be incorporated at all relevant settings. It should aim to empower older adults in co-management of their oral diseases or bad diet habits affecting their oral health. This can be carried out through an incorporated educational plan for dentists either at the postgraduate or professional level since advantages seem to enhance the quality of life of the independent elderly.
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11
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Gray ID, Kross AR, Renfrew ME, Wood P. Precision Medicine in Lifestyle Medicine: The Way of the Future? Am J Lifestyle Med 2020; 14:169-186. [PMID: 32231483 PMCID: PMC7092395 DOI: 10.1177/1559827619834527] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 12/21/2018] [Accepted: 02/08/2019] [Indexed: 02/06/2023] Open
Abstract
Precision medicine has captured the imagination of the medical community with visions of therapies precisely targeted to the specific individual's genetic, biological, social, and environmental profile. However, in practice it has become synonymous with genomic medicine. As such its successes have been limited, with poor predictive or clinical value for the majority of people. It adds little to lifestyle medicine, other than in establishing why a healthy lifestyle is effective in combatting chronic disease. The challenge of lifestyle medicine remains getting people to actually adopt, sustain, and naturalize a healthy lifestyle, and this will require an approach that treats the patient as a person with individual needs and providing them with suitable types of support. The future of lifestyle medicine is holistic and person-centered rather than technological.
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Affiliation(s)
- Ian D. Gray
- Avondale College of Higher Education, Cooranbong,
New South Wales, Australia
| | - Andrea R. Kross
- Avondale College of Higher Education, Cooranbong,
New South Wales, Australia
| | - Melanie E. Renfrew
- Avondale College of Higher Education, Cooranbong,
New South Wales, Australia
| | - Paul Wood
- Avondale College of Higher Education, Cooranbong,
New South Wales, Australia
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12
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Wang X, Gao H, Xu H. Cluster Analysis of Unhealthy Lifestyles among Elderly Adults with Prediabetes: A Cross-Sectional Study in Rural China. Diabetes Ther 2019; 10:1935-1948. [PMID: 31410710 PMCID: PMC6778567 DOI: 10.1007/s13300-019-00676-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION To explore the clustering and influencing factors of unhealthy lifestyles among elderly adults with prediabetes in rural China. METHODS A cross-sectional study was conducted in Yiyang, Hunan Province, China. Through multistage cluster random sampling and an oral glucose tolerance test, we screened 461 elderly adults aged 60 years and older with prediabetes out of 2144 elderly adults who were sampled. The prediabetic adults completed a survey examining four common lifestyle factors: diet, exercise, smoking, alcohol use and the ability to acquire diabetes-related knowledge and thereby promote one's own health-diabetes health literacy. The influencing factors were analyzed retrospectively with the Kruskal-Wallis test and ordinal logistic regression. RESULTS A total of 425 elderly adults completed the survey, of whom 325 were identified with unhealthy lifestyle clustering. The Kruskal-Wallis test showed significant differences between unhealthy lifestyle clusters by age, gender, marital status, occupation and hyperlipidemia (P < 0.05). Ordinal logistic regression showed that female gender (OR = 0.23, 95% CI: 0.15 0.37), personal annual income ≥ 2800 CNY (OR = 0.61, 95% CI: 0.38 0.99) and occupation as a worker (OR = 0.56, 95% CI: 0.34 0.92) were protective factors against unhealthy lifestyle clustering. An unsatisfactory marital status (OR = 1.60, 95% CI: 1.02 2.51) and low diabetes health literacy (OR = 3.17, 95% CI: 1.03 9.81) were risk factors. CONCLUSION In total, 76.47% of the prediabetic elderly adults in rural China showed unhealthy lifestyle clusters. Being male and having an unsatisfactory marital status, a low personal annual income, an occupation as a farmer and low diabetes health literacy were the main risk factors for unhealthy lifestyle clustering. More effective interventions should be implemented based on these risk factors to prevent diabetes in rural elderly adults.
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Affiliation(s)
- Xiaofen Wang
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Hailiang Gao
- Department of Human Resources, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Huilan Xu
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, Hunan, China.
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13
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DeJesus RS, Bauer KW, Bradley DP, Haller I, Bradley SM, Schroeder DR, St. Sauver J, Phelan SM, Croghan IT. Experience and expectations of patients on weight loss: The Learning Health System Network Experience. Obes Sci Pract 2019; 5:479-486. [PMID: 31687172 PMCID: PMC6820006 DOI: 10.1002/osp4.364] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 07/20/2019] [Accepted: 07/22/2019] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE Weight perception and degree of confidence in achieving healthy lifestyle can be determinants of engagement in obesity interventions. This study explored patients' perceived need for weight loss and the degree of self-confidence in ability to lose weight and sought to identify factors associated with patients' self-confidence in ability to lose weight. METHODS The authors analysed data from a survey mailed to primary care patients within five sites of the Learning Health Systems Network that explored participants' prior experience with weight management. RESULTS Among the 2,263 participants who completed the survey section on 'Patients' Experience with Weight Management', perceived need to lose 51 lb or more was statistically significant among those with class III obesity compared with other body mass index (BMI) groups (p value < 0.001). Reported desire to lose weight was also significantly higher among those with the highest BMI than those who were overweight (p value < 0.001). However, this same group had the lowest belief in ability to lose weight (p value < 0.001). In a multiple regression analysis, female gender, higher BMI and need to lose >10 lb were each independently associated with less belief in being able to lose weight. CONCLUSIONS Patients had varying perceptions on weight loss; those with category III obesity had the highest desire to lose weight but had the least confidence in ability to lose weight. Higher BMI, female gender and need to lose >10 lb were associated with decreased self-confidence in ability to lose weight.
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Affiliation(s)
| | - K. W. Bauer
- Department of Nutritional SciencesUniversity of Michigan School of Public HealthAnn ArborMIUSA
| | - D. P. Bradley
- Diabetes and Metabolism Research Center, Division of Endocrinology, Diabetes & Metabolism, Department of Internal MedicineThe Ohio State UniversityColumbusOHUSA
| | - I. Haller
- Essentia Institute of Rural Health, Essential HealthDuluthMNUSA
| | - S. M. Bradley
- Center for Healthcare Delivery InnovationMinneapolis Heart Institute and Minneapolis Heart Institute FoundationMinneapolisMNUSA
| | - D. R. Schroeder
- Department of Health Sciences ResearchMayo ClinicRochesterMNUSA
| | - J. St. Sauver
- Department of Health Sciences ResearchMayo ClinicRochesterMNUSA
- Robert D. and Patricia E. Kern Center for the Science of Health Care DeliveryMayo ClinicRochesterMNUSA
| | - S. M. Phelan
- Department of Health Sciences ResearchMayo ClinicRochesterMNUSA
| | - I. T. Croghan
- Department of MedicineMayo ClinicRochesterMNUSA
- Department of Health Sciences ResearchMayo ClinicRochesterMNUSA
- Robert D. and Patricia E. Kern Center for the Science of Health Care DeliveryMayo ClinicRochesterMNUSA
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14
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Meurer ST, Lopes ACS, Almeida FA, Mendonça RDD, Benedetti TRB. Effectiveness of the VAMOS Strategy for Increasing Physical Activity and Healthy Dietary Habits: A Randomized Controlled Community Trial. HEALTH EDUCATION & BEHAVIOR 2019; 46:406-416. [PMID: 30636448 DOI: 10.1177/1090198118820095] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
This study aimed to evaluate the effectiveness of the VAMOS strategy (Health-Improving Active Life) in improving physical activity (PA), dietary habits, and anthropometric variables of primary health care (PHC) users in Brazil. A randomized controlled community trial was conducted at two units of the Health Academy Program (HAP; a service provided by PHC), which were randomly assigned either to control group (CG) or intervention group (IG). Participants in both groups (CG = 156 and IG = 135) took part in physical activity classes provided by HAP facilities with those in IG also participating in the VAMOS strategy for 12 weeks. This strategy is based on social cognitive theory. The main behavioral constructs addressed were self-efficacy, goal setting, self-monitoring, identification of social support and barriers, and solutions for the identified barriers. Physical activity was measured with accelerometers, and nutritional status was assessed using dietary habits questionnaires and anthropometric measurements. Intention-to-treat analysis revealed that participants in IG increased the daily time of moderate-vigorous PA and the frequency of raw vegetable intake, while the intake of ultra-processed foods was reduced. Weight loss among participants who were classified as overweight/obese at baseline was observed in the intervention group compared to control. These results suggest that the VAMOS strategy was effective in increasing PA, healthy dietary habits, and decreasing weight among PHC users. Therefore, VAMOS could be used as a strategy to strengthen individuals' autonomy regarding healthy choices and improve their overall health.
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Affiliation(s)
- Simone Teresinha Meurer
- 1 Federal University of Santa Catarina, Florianópolis, Brazil.,2 Federal Institute of Minas Gerais, Belo Horizonte, Brazil
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15
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DeJesus RS, Clark MM, Rutten LJF, Hathaway JC, Wilson PM, Link SM, Sauver JS. Wellness Coaching to Improve Lifestyle Behaviors Among Adults With Prediabetes: Patients' Experience and Perceptions to Participation. J Patient Exp 2018; 5:314-319. [PMID: 30574554 PMCID: PMC6295805 DOI: 10.1177/2374373518769118] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background: Health and Wellness Coaching has been shown to enhance treatment outcomes in the primary care setting. However, little is known about the experience and perceptions of patients who worked with a wellness coach as an integrated member of their primary health-care team. Objective: This project assessed patients’ experience and obtained their perceptions on barriers and facilitators to participation in a primary care–based wellness coaching program. Method: A survey was mailed to 99 primary care patients with prediabetes who participated in a 12-week wellness coaching program. Results: Sixty-two (63%) completed the survey; responders felt that participation in the wellness coaching program helped move them toward healthier lifestyle behavior and created a personal vision of wellness. Major themes associated with participation were supportive coaching relationship, increased self-accountability, increased goal-setting, and healthy behavior strategies. No significant barrier to participation was reported. Conclusion: Participants reported highly positive experience with the program; how to best integrate health and wellness coaching into the primary care setting needs to be explored.
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Affiliation(s)
- Ramona S DeJesus
- Robert D and Patricia E Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.,Division of Primary Care Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Matthew M Clark
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Lila J Finney Rutten
- Robert D and Patricia E Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.,Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Julie C Hathaway
- Office of Patient Education and Consulting Services, Mayo Clinic, Rochester, MN, USA
| | - Patrick M Wilson
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Sara M Link
- Dan Abrahams Healthy Living Center, Mayo Clinic, Rochester, MN, USA
| | - Jennifer St Sauver
- Robert D and Patricia E Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.,Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
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