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Buckell J, Mitchell CA, Fryer K, Newbert C, Brennan A, Joyce J, Jebb SA, Aveyard P, Guess N, Morris E. Identifying Preferred Features of Weight Loss Programs for Adults With or at Risk of Type 2 Diabetes: A Discrete Choice Experiment With 3,960 Adults in the U.K. Diabetes Care 2024; 47:739-746. [PMID: 38377531 PMCID: PMC10973915 DOI: 10.2337/dc23-2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 01/24/2024] [Indexed: 02/22/2024]
Abstract
OBJECTIVE To understand preferences for features of weight loss programs among adults with or at risk of type 2 diabetes in the U.K. RESEARCH DESIGN AND METHODS We conducted a discrete choice experiment with 3,960 U.K. adults living with overweight (n = 675 with type 2 diabetes). Preferences for seven characteristics of weight loss programs were analyzed. Simulations from choice models using the experimental data predicted uptake of available weight loss programs. Patient groups comprising those who have experience with weight loss programs, including from minority communities, informed the experimental design. RESULTS Preferences did not differ between individuals with and without type 2 diabetes. Preferences were strongest for type of diet. Healthy eating was most preferred relative to total diet replacement (odds ratio [OR] 2.24; 95% CI 2.04-2.44). Individual interventions were more popular than group interventions (OR 1.40; 95% CI 1.34-1.47). Participants preferred programs offering weight loss of 10-15 kg (OR 1.37; 95% CI 1.28-1.47) to those offering loss of 2-4 kg. Online content was preferred over in-person contact (OR 1.24; 95% CI 1.18-1.30). There were few differences in preferences by gender or ethnicity, although weight loss was more important to women than to men, and individuals from ethnic minority populations identified more with programs where others shared their characteristics. Modeling suggested that tailoring programs to individual preferences could increase participation by ∼17 percentage points (68% in relative terms). CONCLUSIONS Offering a range of weight loss programs targeting the preferred attributes of different patient groups could potentially encourage more people to participate in weight loss programs and support those living with overweight to reduce their weight.
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Affiliation(s)
- John Buckell
- Health Economics Research Centre, Oxford Population Health, University of Oxford, Oxford, U.K
| | - Caroline A. Mitchell
- School of Medicine and Population Health, University of Sheffield, Sheffield, U.K
| | - Kate Fryer
- School of Medicine and Population Health, University of Sheffield, Sheffield, U.K
| | | | - Alan Brennan
- School of Medicine and Population Health, University of Sheffield, Sheffield, U.K
| | - Jack Joyce
- Nuffield Department of Primary Health Care Sciences, University of Oxford, Oxford, U.K
| | - Susan A. Jebb
- Nuffield Department of Primary Health Care Sciences, University of Oxford, Oxford, U.K
| | - Paul Aveyard
- Nuffield Department of Primary Health Care Sciences, University of Oxford, Oxford, U.K
| | - Nicola Guess
- Nuffield Department of Primary Health Care Sciences, University of Oxford, Oxford, U.K
| | - Elizabeth Morris
- Nuffield Department of Primary Health Care Sciences, University of Oxford, Oxford, U.K
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Ehmann MM, LaFata EM, McCausland HC, Knudsen FM, Butryn ML. Perceived importance of moderate-to-vigorous physical activity as a weight control strategy in behavioral weight loss. Obes Sci Pract 2023; 9:631-640. [PMID: 38090685 PMCID: PMC10712407 DOI: 10.1002/osp4.695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 06/13/2023] [Accepted: 06/27/2023] [Indexed: 02/01/2024] Open
Abstract
Background Previous research has established the importance of moderate-to-vigorous physical activity (MVPA) for weight control. One area of unexplored investigation is the relationship between individuals' perceptions of the importance of MVPA for weight control and MVPA engagement. This study examined the associations between the perceived importance of MVPA and MVPA engagement, weight loss, barriers to PA, and exercise enjoyment in adults enrolled in a long-term behavioral weight loss (BWL) intervention. Methods Adults (N = 301) with overweight/obesity (BMI = 27-45 kg/m2) completed an 18-month BWL intervention, followed by a no-intervention 18-month follow-up. At baseline, 6 months, 18 months (i.e., post-treatment), and 36 months (i.e., follow-up), participants ranked the importance of six strategies for weight control: keeping a food record, MVPA, light PA, self-weighing, small portions, and low-calorie diet. Observed MVPA (measured by accelerometer), percent weight loss, perceived barriers to PA, and exercise enjoyment were also measured at each assessment. Results Results showed that most participants perceived MVPA as a primary weight control strategy (first, second, or third most important) throughout the intervention, regardless of the weight control goal (weight loss vs. maintenance). Individuals who ranked MVPA as a primary strategy for weight control at concurrent time points, compared to those who did not, engaged in significantly more MVPA at post-treatment, had greater weight loss at follow-up, endorsed fewer barriers to PA at post-treatment and follow-up, and reported greater exercise enjoyment at baseline and post-treatment. Conclusion Perceived importance of MVPA was related to subjective experiences of MVPA, MVPA adherence, and weight loss in a long-term BWL intervention.
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Affiliation(s)
- Marny M. Ehmann
- Department of Psychological and Brain Sciences and Center for WeightEating and Lifestyle Science (WELL Center)Drexel UniversityPhiladelphiaPennsylvaniaUSA
| | - Erica M. LaFata
- Department of Psychological and Brain Sciences and Center for WeightEating and Lifestyle Science (WELL Center)Drexel UniversityPhiladelphiaPennsylvaniaUSA
| | - Hannah C. McCausland
- Department of Psychological and Brain Sciences and Center for WeightEating and Lifestyle Science (WELL Center)Drexel UniversityPhiladelphiaPennsylvaniaUSA
| | - Francesca M. Knudsen
- Department of Psychological and Brain Sciences and Center for WeightEating and Lifestyle Science (WELL Center)Drexel UniversityPhiladelphiaPennsylvaniaUSA
| | - Meghan L. Butryn
- Department of Psychological and Brain Sciences and Center for WeightEating and Lifestyle Science (WELL Center)Drexel UniversityPhiladelphiaPennsylvaniaUSA
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Huang J, Chang R, Ma R, Zhan J, Lu X, Tian Y. Effects of structure and physical chemistry of resistant starch on short-term satiety. Food Hydrocoll 2022. [DOI: 10.1016/j.foodhyd.2022.107828] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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An introduction to "discrete choice experiments" for behavior analysts. Behav Processes 2022; 198:104628. [PMID: 35354088 PMCID: PMC9885321 DOI: 10.1016/j.beproc.2022.104628] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 03/18/2022] [Accepted: 03/22/2022] [Indexed: 02/01/2023]
Abstract
In this paper, we introduce discrete choice experiments (DCEs) and provide foundational knowledge on the topic. DCEs are one of the most popular methods within econometrics to study the distribution of choices within a population. DCEs are particularly useful when studying the effects of categorical variables on choice. Procedurally, a DCE involves recruiting a large sample of individuals exposed to a set of choice arrays. The factors that are suspected to affect choice are varied systematically across the choice arrays. Most commonly, DCE data are analyzed with a multinomial logit statistical model with a goal of determining the relative utility of each relevant factor. We also discuss DCEs in comparison with behavioral choice models, such as those based on the matching law, and we show an example of a DCE to illustrate how a DCE can be used to understand choice with behavioral, social, and organizational factors.
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Dombrowski SU, McDonald M, van der Pol M, Grindle M, Avenell A, Carroll P, Calveley E, Elders A, Glennie N, Gray CM, Harris FM, Hapca A, Jones C, Kee F, McKinley MC, Skinner R, Tod M, Hoddinott P. Text messaging and financial incentives to encourage weight loss in men with obesity: the Game of Stones feasibility RCT. PUBLIC HEALTH RESEARCH 2020. [DOI: 10.3310/phr08110] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Background
In 2016, 26% of UK men were estimated to be obese. Systematic reviews suggest that few men engage in formal weight loss interventions that support weight reduction and improve health.
Objective
To co-produce, with patient and public involvement, an acceptable and feasible randomised controlled trial design to test a men-only weight management intervention.
Design
This was a two-phase feasibility study. Phase 1 was the development of intervention components, study procedures and materials including a discrete choice experiment with survey questions. Phase 2 was an individually randomised three-arm feasibility trial over 12 months. Qualitative interviews were conducted at 3 and 12 months.
Setting
The setting was two sites in Scotland that had disadvantaged urban and rural areas and differed in employment levels and ethnic groups.
Participants
In phase 1, 1045 men with obesity were recruited by Ipsos MORI (London, UK; www.ipsos.com/ipsos-mori/en-uk) to represent the UK population. In phase 2, 105 men with obesity were recruited in the community or through general practice obesity registers. Qualitative interviews were conducted with 50 men at 3 months and with 33 men at 12 months.
Interventions
The trial arms were narrative short message service (SMS) for 12 months (SMS only), financial endowment incentive informed by loss aversion and linked to achievement of weight loss targets plus narrative SMS for 12 months (SMS + I), and waiting list control group for 12 months followed by 3 months of an alternative SMS style developed based on feedback from men who had received the narrative SMS (control).
Main outcome measures
The main outcome measures were acceptability and feasibility of recruitment, retention, engagement, intervention components and trial procedures. Outcomes were assessed by examining procedural, quantitative and qualitative data at 3, 6 and 12 months.
Results
The most acceptable incentive strategy, based on the discrete choice experiment results, was to verify weight loss of 5% at 3 months, verify weight loss of 10% at 6 months and maintain weight loss of 10% at 12 months. Overall, 105 men with obesity from across the socioeconomic spectrum were successfully recruited to target, 59% of whom lived in more disadvantaged areas. Retention at 12 months was acceptable (74%) and was higher among individuals from disadvantaged areas. Narrative SMS were acceptable to many men, with a minority reporting negative reactions. Incentives were acceptable but were not the primary motivation for behaviour change. Twelve men in the incentive arm (33%) secured at least some money and three (8%) secured the full amount. Both intervention arms lost some weight, with greater weight loss in the arm that received SMS and incentives. The alternative SMS based on men’s feedback received no strong negative reactions.
Limitations
Fewer participants from the SMS + I arm (64%) completed the study at 12 months than did those in the SMS-only (79%) and control (83%) arms. The reasons for this difference were complex.
Conclusions
The men-only weight management intervention consisting of narrative SMS and financial incentives was acceptable and feasible, meeting the progression criteria for a full trial. Tailoring of SMS may improve acceptability and retention.
Future work
Minor refinements to the intervention components based on the study findings will be made prior to testing in a multisite definitive randomised controlled trial.
Trial registration
ClinicalTrials.gov NCT03040518.
Funding
This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 8, No. 11. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Stephan U Dombrowski
- Faculty of Kinesiology, University of New Brunswick, Fredericton, NB, Canada
- Division of Psychology, Faculty of Natural Sciences, University of Stirling, Stirling, UK
| | - Matthew McDonald
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, UK
| | | | - Mark Grindle
- Division of Rural Health and Wellbeing, University of the Highlands and Islands, Inverness, UK
| | - Alison Avenell
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | | | - Eileen Calveley
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, UK
| | - Andrew Elders
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Nicola Glennie
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, UK
| | - Cindy M Gray
- Institute of Health & Wellbeing, College of Social Sciences, University of Glasgow, Glasgow, UK
| | - Fiona M Harris
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, UK
| | - Adrian Hapca
- Tayside Clinical Trials Unit, University of Dundee, Dundee, UK
| | - Claire Jones
- Health Informatics Centre, University of Dundee, Dundee, UK
| | - Frank Kee
- Centre for Public Health, Institute of Clinical Sciences, Queen’s University Belfast, Belfast, UK
| | | | - Rebecca Skinner
- Division of Psychology, Faculty of Natural Sciences, University of Stirling, Stirling, UK
| | | | - Pat Hoddinott
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, UK
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Benning TM, Dellaert BGC, Arentze TA. The impact of health vs. non-health goals on individuals' lifestyle program choices: a discrete choice experiment approach. BMC Public Health 2020; 20:411. [PMID: 32228545 PMCID: PMC7106806 DOI: 10.1186/s12889-020-8416-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 02/26/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Goals play an important role in the choices that individuals make. Yet, there is no clear approach of how to incorporate goals in discrete choice experiments. In this paper, we present such an approach and illustrate it in the context of lifestyle programs. Furthermore, we investigate how non-health vs. health goals affect individuals' choices via non-goal attributes. METHODS We used an unlabeled discrete choice experiment about lifestyle programs based on two experimental conditions in which either a non-health goal (i.e., looking better) or a health goal (i.e., increasing life expectancy) was presented to respondents as a fixed attribute level for the goal attribute. Respondents were randomly distributed over the experimental conditions. Eventually, we used data from 407 Dutch adults who reported to be overweight (n = 212 for the non-health goal, and n = 195 for the health goal). RESULTS Random parameter logit model estimates show that the type of goal significantly (p < 0.05) moderates the effect that the attribute diet has on lifestyle program choice, but that this is not the case for the attributes exercise per week and expected weight loss. CONCLUSIONS A flexible diet is more important for individuals with a non-health goal than for individuals with a health goal. Therefore, we advise policy makers to use information on goal interactions for developing new policies and communication strategies to target population segments that have different goals. Furthermore, we recommend researchers to consider the impact of goals when designing discrete choice experiments.
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Affiliation(s)
- Tim M Benning
- Department of Applied Economics, Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - Benedict G C Dellaert
- Department of Business Economics, Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, The Netherlands.,Monash Business School, Monash University, Melbourne, Australia
| | - Theo A Arentze
- Urban systems and real estate, Department of the Built Environment, Eindhoven University of Technology, Eindhoven, The Netherlands
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Dombrowski SU, McDonald M, van der Pol M, Grindle M, Avenell A, Carroll P, Calveley E, Elders A, Glennie N, Gray CM, Harris FM, Hapca A, Jones C, Kee F, McKinley MC, Skinner R, Tod M, Hoddinott P. Game of Stones: feasibility randomised controlled trial of how to engage men with obesity in text message and incentive interventions for weight loss. BMJ Open 2020; 10:e032653. [PMID: 32102807 PMCID: PMC7045214 DOI: 10.1136/bmjopen-2019-032653] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 12/06/2019] [Accepted: 01/08/2020] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES To examine the acceptability and feasibility of narrative text messages with or without financial incentives to support weight loss for men. DESIGN Individually randomised three-arm feasibility trial with 12 months' follow-up. SETTING Two sites in Scotland with high levels of disadvantage according to Scottish Index for Multiple Deprivation (SIMD). PARTICIPANTS Men with obesity (n=105) recruited through community outreach and general practitioner registers. INTERVENTIONS Participants randomised to: (A) narrative text messages plus financial incentive for 12 months (short message service (SMS)+I), (B) narrative text messages for 12 months (SMS only), or (C) waiting list control. OUTCOMES Acceptability and feasibility of recruitment, retention, intervention components and trial procedures assessed by analysing quantitative and qualitative data at 3, 6 and 12 months. RESULTS 105 men were recruited, 60% from more disadvantaged areas (SIMD quintiles 1 or 2). Retention at 12 months was 74%. Fewer SMS+I participants (64%) completed 12-month assessments compared with SMS only (79%) and control (83%). Narrative texts were acceptable to many men, but some reported negative reactions. No evidence emerged that level of disadvantage was related to acceptability of narrative texts. Eleven SMS+I participants (31%) successfully met or partially met weight loss targets. The cost of the incentive per participant was £81.94 (95% CI £34.59 to £129.30). Incentives were acceptable, but improving health was reported as the key motivator for weight loss. All groups lost weight (SMS+I: -2.51 kg (SD=4.94); SMS only: -1.29 kg (SD=5.03); control: -0.86 kg (SD=5.64) at 12 months). CONCLUSIONS This three-arm weight management feasibility trial recruited and retained men from across the socioeconomic spectrum, with the majority from areas of disadvantage, was broadly acceptable to most participants and feasible to deliver. TRIAL REGISTRATION NUMBER NCT03040518.
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Affiliation(s)
- Stephan U Dombrowski
- Department of Kinesiology, University of New Brunswick Fredericton, Fredericton, New Brunswick, Canada
- Division of Psychology, University of Stirling, Stirling, UK
| | - Matthew McDonald
- Nursing, Midwifery and Allied Health Professional Research Unit, University of Stirling, Stirling, UK
| | | | - Mark Grindle
- Institute for Health Research and Innovation, University of the Highlands and Islands, Inverness, Highland, UK
| | - Alison Avenell
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | | | - Eileen Calveley
- Nursing, Midwifery and Allied Health Professional Research Unit, University of Stirling, Stirling, UK
| | - Andrew Elders
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Nicola Glennie
- Nursing, Midwifery and Allied Health Professional Research Unit, University of Stirling, Stirling, UK
| | - Cindy M Gray
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Fiona M Harris
- Nursing, Midwifery and Allied Health Professional Research Unit, University of Stirling, Stirling, UK
| | - Adrian Hapca
- Tayside Clinical Trials Unit, University of Dundee, Dundee, UK
| | - Claire Jones
- Health Informatics Centre, University of Dundee, Dundee, UK
| | - Frank Kee
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | | | - Rebecca Skinner
- Division of Psychology, University of Stirling, Stirling, UK
| | | | - Pat Hoddinott
- Nursing, Midwifery and Allied Health Professional Research Unit, University of Stirling, Stirling, UK
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8
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Sripipatana A, Pourat N, Chen X, Zhou W, Lu C. Exploring racial/ethnic disparities in hypertension care among patients served by health centers in the United States. J Clin Hypertens (Greenwich) 2019; 21:489-498. [PMID: 30861288 PMCID: PMC8030503 DOI: 10.1111/jch.13504] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 01/03/2019] [Accepted: 01/16/2019] [Indexed: 02/02/2023]
Abstract
Some racial/ethnic minorities are more likely to have hypertension and experience increased hypertension-related morbidity and mortality compared to whites. Health Resources and Services Administration-funded health centers care for over 27 million patients, 62 percent of whom are racial/ethnic minorities. We assessed the presence of racial/ethnic disparities in (a) hypertension management and (b) hypertension outcomes among health center patients. We used data from the 2014 Health Center Patient Survey and performed multilevel logistic regression models to predict hypertension management counseling, patient adherence to counseling and medication regimen, management plan receipt, high blood pressure at last clinical visit, confidence in hypertension self-management, and hypertension-related emergency department (ED) episodes or hospitalizations in the past year. We controlled for patient characteristics including age, sex, education, nativity, health behaviors, health care access, and comorbidities. We found significantly higher odds of diet counseling (African Americans, OR: 1.87; Asian Americans, OR: 3.02, AIAN, OR: 2.01), reduced sodium intake (African American, OR: 2.42), and adherence to exercise counseling (African American, OR: 3.52; Asian Americans, OR: 2.93). We also found lower odds of taking hypertension control medication (AIAN, OR: 0.50) and higher odds of hypertension-related ED visits (African Americans, OR: 3.61, AIAN, OR: 5.31). These results highlight the success of health centers in managing hypertension by race/ethnicity but found adverse hypertension outcomes for some groups. Racial/ethnically tailored efforts might be required to manage hypertension and improve outcomes.
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Affiliation(s)
- Alek Sripipatana
- Health Services and Resources Administration, Bureau of Primary Health Care, Office of Quality ImprovementRockvilleMaryland
| | - Nadereh Pourat
- Center for Health Policy ResearchUniversity of CaliforniaLos AngelesCalifornia
| | - Xiao Chen
- Center for Health Policy ResearchUniversity of CaliforniaLos AngelesCalifornia
| | - Weihao Zhou
- Center for Health Policy ResearchUniversity of CaliforniaLos AngelesCalifornia
| | - Connie Lu
- Center for Health Policy ResearchUniversity of CaliforniaLos AngelesCalifornia
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Newlands RSN, Ntessalen M, Clark J, Fielding S, Hoddinott P, Heys SD, McNeill G, Craig LCA. Pilot randomised controlled trial of Weight Watchers® referral with or without dietitian-led group support for weight loss in women treated for breast cancer: the BRIGHT (BReast cancer weIGHT loss) trial. Pilot Feasibility Stud 2019; 5:24. [PMID: 30805199 PMCID: PMC6373055 DOI: 10.1186/s40814-019-0405-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 01/24/2019] [Indexed: 12/24/2022] Open
Abstract
Background Being overweight or obese following breast cancer diagnosis can increase cancer recurrence and mortality, so effective interventions for weight loss in this group could enhance survival. A pilot randomised controlled trial was conducted to assess whether a weight loss programme comprising generic Weight Watchers® referral offered to women treated for breast cancer with or without additional breast cancer-tailored dietetic support is feasible and shows promise for improving weight and quality of life (QoL). Methods Participants were randomly allocated to 3 groups: Weight Watchers® referral (for 12 sessions of meetings and digital tools) plus 5 breast cancer-tailored dietitian-led group support sessions (WW Plus: n = 14), Weight Watchers® referral only (WW: n = 16) or control (Weight Watchers® referral after 3 months, n = 15). Feasibility was assessed based on retention rate, recruitment and randomisation process, meeting attendance, suitability of the setting and outcome measurement tools, unintended consequences, cost and observations of the dietetic sessions. Outcomes were measured at 0, 3 (‘trial exit’) and 12 months post intervention. Results The response rate to the invitation was 43% (140/327) of whom 58 were eligible and 45 (median age 61.0 years; body mass index 30.2 kg/m2) were randomised. Data from 38 (84%) and 30 (67%) participants were available at trial exit and 12 months respectively. Feasibility issues included slow recruitment process, lack of blinding throughout, weighing scales not measuring > 150 kg, lack of clear instructions for completing QoL questionnaire and workload and time pressures in delivering dietetic sessions. Participants had good attendance rate at group meetings and no serious unintended consequences were reported. WW Plus was most expensive to run. Mean (95% CI) weight change at trial exit was − 3.67 kg (− 5.67, − 2.07) in WW Plus, − 6.03 kg (− 7.61, − 4.44) in WW group and + 0.19 kg (− 1.45, + 1.83) in control group. About 40% of the WW Plus, 64% of the WW group and 56% of the control group lost ≥ 5% of their baseline weight by 12 months. All groups showed promise for improving QoL at trial exit but only the WW group maintained significant improvements from baseline at 12 months. Conclusions The trial procedures were feasible, with some modifications. This pilot trial indicates the benefits of providing free WW vouchers for weight loss maintenance and improving QoL but provided no evidence that including additional dietetic support would add any extra value. Further research with WW with long-term follow-up should be undertaken to assess weight loss sustainability and benefit on health outcomes in this patient group. Trial registration ISRCTN-29623418. Electronic supplementary material The online version of this article (10.1186/s40814-019-0405-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rumana S N Newlands
- 1Health Services Research Unit, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, 3rd floor Health Sciences Building, Foresterhill, Aberdeen, AB25 2ZD UK
| | - Maria Ntessalen
- 1Health Services Research Unit, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, 3rd floor Health Sciences Building, Foresterhill, Aberdeen, AB25 2ZD UK
| | - Julia Clark
- 2NHS Grampian Department of Nutrition and Dietetics, Aberdeen, UK
| | - Shona Fielding
- 3Medical Statistics Team, Institute of Applied Health Sciences, School of Medicine and Dentistry, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD UK
| | - Pat Hoddinott
- 4Nursing Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, FK9 4LA UK
| | - Steven D Heys
- 5School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD UK.,6NHS Grampian, Scotland, UK
| | - Geraldine McNeill
- 7Institute of Applied Health Sciences & The Rowett Institute, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD UK
| | - Leone C A Craig
- 7Institute of Applied Health Sciences & The Rowett Institute, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD UK
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10
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Soekhai V, de Bekker-Grob EW, Ellis AR, Vass CM. Discrete Choice Experiments in Health Economics: Past, Present and Future. PHARMACOECONOMICS 2019; 37:201-226. [PMID: 30392040 PMCID: PMC6386055 DOI: 10.1007/s40273-018-0734-2] [Citation(s) in RCA: 408] [Impact Index Per Article: 81.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
OBJECTIVES Discrete choice experiments (DCEs) are increasingly advocated as a way to quantify preferences for health. However, increasing support does not necessarily result in increasing quality. Although specific reviews have been conducted in certain contexts, there exists no recent description of the general state of the science of health-related DCEs. The aim of this paper was to update prior reviews (1990-2012), to identify all health-related DCEs and to provide a description of trends, current practice and future challenges. METHODS A systematic literature review was conducted to identify health-related empirical DCEs published between 2013 and 2017. The search strategy and data extraction replicated prior reviews to allow the reporting of trends, although additional extraction fields were incorporated. RESULTS Of the 7877 abstracts generated, 301 studies met the inclusion criteria and underwent data extraction. In general, the total number of DCEs per year continued to increase, with broader areas of application and increased geographic scope. Studies reported using more sophisticated designs (e.g. D-efficient) with associated software (e.g. Ngene). The trend towards using more sophisticated econometric models also continued. However, many studies presented sophisticated methods with insufficient detail. Qualitative research methods continued to be a popular approach for identifying attributes and levels. CONCLUSIONS The use of empirical DCEs in health economics continues to grow. However, inadequate reporting of methodological details inhibits quality assessment. This may reduce decision-makers' confidence in results and their ability to act on the findings. How and when to integrate health-related DCE outcomes into decision-making remains an important area for future research.
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Affiliation(s)
- Vikas Soekhai
- Section of Health Technology Assessment (HTA) and Erasmus Choice Modelling Centre (ECMC), Erasmus School of Health Policy & Management (ESHPM), Erasmus University Rotterdam (EUR), P.O. Box 1738, Rotterdam, 3000 DR The Netherlands
- Department of Public Health, Erasmus MC, University Medical Center, P.O. Box 2040, Rotterdam, 3000 CA The Netherlands
| | - Esther W. de Bekker-Grob
- Section of Health Technology Assessment (HTA) and Erasmus Choice Modelling Centre (ECMC), Erasmus School of Health Policy & Management (ESHPM), Erasmus University Rotterdam (EUR), P.O. Box 1738, Rotterdam, 3000 DR The Netherlands
| | - Alan R. Ellis
- Department of Social Work, North Carolina State University, Raleigh, NC USA
| | - Caroline M. Vass
- Manchester Centre for Health Economics, The University of Manchester, Manchester, UK
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Mott DJ. Incorporating Quantitative Patient Preference Data into Healthcare Decision Making Processes: Is HTA Falling Behind? PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2018; 11:249-252. [PMID: 29500706 DOI: 10.1007/s40271-018-0305-9] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- David John Mott
- Office of Health Economics, Southside 7th Floor, 105 Victoria Street, London, SW1E 6QT, UK.
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12
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Grisolía JM, Longo A, Hutchinson G, Kee F. Comparing mortality risk reduction, life expectancy gains, and probability of achieving full life span, as alternatives for presenting CVD mortality risk reduction: A discrete choice study of framing risk and health behaviour change. Soc Sci Med 2018; 211:164-174. [PMID: 29957508 DOI: 10.1016/j.socscimed.2018.06.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 06/15/2018] [Accepted: 06/17/2018] [Indexed: 12/01/2022]
Abstract
The growing rate of obesity has recently required governments to divert considerable resources in the promotion of healthy lifestyles. We explored the relative effectiveness in inducing healthy behaviour change of three different communication strategies about the benefits of an intervention that reduces the mortality risks of cardiovascular disease (CVD) and encourages respondents to embrace healthier lifestyles. We designed a Discrete Choice Experiments questionnaire to analyse the trade-off between lifestyles, defined in terms of diet and exercise, and reduction in cardiovascular disease (CVD) mortality risk. We set three ways of framing an identical benefit: (A) as a reduction in mortality risk from cardiovascular disease, (B) as an increase in months of life expectancy, and (C) as an increase in the probability of reaching an individual's full lifespan. The experiment was tailored for each subject in the sample according to his/her individual's baseline information on diet and physical activity. During the period February 2010-July 2011, we interviewed 1008 individuals in Northern Ireland, split randomly into three samples for the three CVD risk reduction frames. Considering the models' goodness of fit and significance, we conclude that the most effective way of communicating these CVD health benefits is using an increase in life expectancy, since with this frame individuals are more inclined to state that they would change to a healthier lifestyle.
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Affiliation(s)
- José M Grisolía
- Department of Applied Economics Analysis, Universidad de Las Palmas de Gran Canaria, Campus Universitario de Tafira Baja, 35017, Las Palmas, de Gran Canaria, Spain; Nottingham University Business School China, The University of Nottingham Ningbo China, 199 Taikang East Road, Ningbo, 315100, China.
| | - Alberto Longo
- Gibson Institute for Land, Food and Environment, School of Biological Sciences, Queen's University, Belfast, Ireland
| | - George Hutchinson
- Gibson Institute for Land, Food and Environment, School of Biological Sciences, Queen's University, Belfast, Ireland
| | - Frank Kee
- Queen's School of Medicine, Dentistry and Biomedical Sciences, Queen's University, UKCRC Centre of Excellence for Public Health (NI), Belfast, Ireland
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Ryan M, Krucien N, Hermens F. The eyes have it: Using eye tracking to inform information processing strategies in multi-attributes choices. HEALTH ECONOMICS 2018; 27:709-721. [PMID: 29280222 DOI: 10.1002/hec.3626] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 07/07/2017] [Accepted: 10/23/2017] [Indexed: 06/07/2023]
Abstract
Although choice experiments (CEs) are widely applied in economics to study choice behaviour, understanding of how individuals process attribute information remains limited. We show how eye-tracking methods can provide insight into how decisions are made. Participants completed a CE, while their eye movements were recorded. Results show that although the information presented guided participants' decisions, there were also several processing biases at work. Evidence was found of (a) top-to-bottom, (b) left-to-right, and (c) first-to-last order biases. Experimental factors-whether attributes are defined as "best" or "worst," choice task complexity, and attribute ordering-also influence information processing. How individuals visually process attribute information was shown to be related to their choices. Implications for the design and analysis of CEs and future research are discussed.
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Affiliation(s)
- Mandy Ryan
- Health Economics Research Unit, Institute of Applied Health Sciences,, University of Aberdeen, Aberdeen, UK
| | - Nicolas Krucien
- Health Economics Research Unit, Institute of Applied Health Sciences,, University of Aberdeen, Aberdeen, UK
| | - Frouke Hermens
- School of Psychology, University of Lincoln, Lincoln, UK
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Pinto D, Danilovich MK, Hansen P, Finn DJ, Chang RW, Holl JL, Heinemann AW, Bockenholt U. Qualitative Development of a Discrete Choice Experiment for Physical Activity Interventions to Improve Knee Osteoarthritis. Arch Phys Med Rehabil 2016; 98:1210-1216.e1. [PMID: 28034720 DOI: 10.1016/j.apmr.2016.11.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Revised: 11/30/2016] [Accepted: 11/30/2016] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To describe the qualitative process used to develop attributes and attribute levels for inclusion in a discrete choice experiments (DCE) for older adult physical activity interventions. DESIGN Five focus groups (n=41) were conducted, grounded in the Health Action Process Approach framework. Discussion emphasized identification and prioritization attributes for a DCE on physical activity. Semi-structured interviews (n=6) investigated attribute levels and lay-language for the DCE. A focus group with physical activity researchers and health care providers was the final stakeholder group used to establish a comprehensive approach for the generation of attributes and levels. A DCE pilot test (n=8) was then conducted with individuals of the target patient population. All transcripts were analyzed using a constant comparative approach. SETTING General community and university-based research setting. PARTICIPANTS Volunteers (N=55) aged >45 years with knee pain, aches, or stiffness for at least 1 month over the previous 12 months. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Interview guides, attributes, attribute levels, and discrete choice experiment. RESULTS The most influential identified attributes for physical activity were time, effort, cost, convenience, enjoyment, and health benefits. Each attribute had 3 levels that were understandable in the pilot test of the DCE. CONCLUSIONS The identification of 6 physical activity attributes that are most salient to adults with knee osteoarthritis resulted from a systematic qualitative process, including attribute-ranking exercises. A DCE will provide insight into the relative importance of these attributes for participating in physical activity, which can guide intervention development.
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Affiliation(s)
- Daniel Pinto
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL; Center for Healthcare Studies, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL.
| | - Margaret K Danilovich
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Paul Hansen
- Department of Economics, University of Otago, Dunedin, New Zealand
| | - Daniel J Finn
- Center for Healthcare Studies, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Rowland W Chang
- Center for Healthcare Studies, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Jane L Holl
- Center for Healthcare Studies, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Allen W Heinemann
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL; Center for Rehabilitation Outcomes Research, Rehabilitation Institute of Chicago, Chicago, IL
| | - Ulf Bockenholt
- Department of Marketing, Kellogg School of Management, Northwestern University, Chicago, IL
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15
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Kullgren JT, Williams GC, Resnicow K, An LC, Rothberg A, Volpp KG, Heisler M. The Promise of Tailoring Incentives for Healthy Behaviors. INTERNATIONAL JOURNAL OF WORKPLACE HEALTH MANAGEMENT 2016; 9:2-16. [PMID: 29242715 PMCID: PMC5726567 DOI: 10.1108/ijwhm-12-2014-0060] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE To describe how tailoring financial incentives for healthy behaviors to employees' goals, values, and aspirations might improve the efficacy of incentives. DESIGN/METHODOLOGY/APPROACH We integrate insights from self-determination theory (SDT) with principles from behavioral economics in the design of financial incentives by linking how incentives could help meet an employee's life goals, values, or aspirations. FINDINGS Tailored financial incentives could be more effective than standard incentives in promoting autonomous motivation necessary to initiate healthy behaviors and sustain them after incentives are removed. RESEARCH IMPLICATIONS Previous efforts to improve the design of financial incentives have tested different incentive designs that vary the size, schedule, timing, and target of incentives. Our strategy for tailoring incentives builds on strong evidence that difficult behavior changes are more successful when integrated with important life goals and values. We outline necessary research to examine the effectiveness of this approach among at-risk employees. PRACTICAL IMPLICATIONS Instead of offering simple financial rewards for engaging in healthy behaviors, existing programs could leverage incentives to promote employees' autonomous motivation for sustained health improvements. SOCIAL IMPLICATIONS Effective application of these concepts could lead to programs more effective at improving health, potentially at lower cost. ORIGINALITY/VALUE Our approach for the first time integrates key insights from SDT, behavioral economics, and tailoring to turn an extrinsic reward for behavior change into an internalized, self-sustaining motivator for long-term engagement in risk-reducing behaviors.
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Affiliation(s)
- Jeffrey T Kullgren
- VA Center for Clinical Management Research and Department of Internal Medicine, VA Ann Arbor Healthcare System and University of Michigan, Ann Arbor, MI, USA
| | - Geoffrey C Williams
- Departments of Medicine and Clinical Social Sciences in Psychology, University of Rochester, Rochester, NY, USA
| | - Kenneth Resnicow
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI, USA
| | - Lawrence C An
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Amy Rothberg
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Kevin G Volpp
- Departments of Medicine and Health Care Management, Philadelphia VA Medical Center and University of Pennsylvania, Philadelphia, PA, USA
| | - Michele Heisler
- VA Center for Clinical Management Research and Departments of Internal Medicine and Health Behavior and Health Education, VA Ann Arbor Healthcare System and University of Michigan, Ann Arbor, MI, USA
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Mott DJ, Najafzadeh M. Whose preferences should be elicited for use in health-care decision-making? A case study using anticoagulant therapy. Expert Rev Pharmacoecon Outcomes Res 2015; 16:33-9. [PMID: 26560704 DOI: 10.1586/14737167.2016.1115722] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The question of whose preferences to elicit in health-state valuation has been widely discussed in the literature. The importance of this debate lies in the fact that health-state utility values are used in health technology assessment (HTA); therefore, an individual's preferences can influence decision-making. If preferences differ across groups, making decisions based on one group's preferences may be suboptimal for the other. Preferences for benefits, risks, experiences and health states associated with anticoagulant therapies have been elicited by researchers due to the underutilization of warfarin and the introduction of non-vitamin K antagonist oral anticoagulants. The majority of existing studies elicit preferences from patient populations as opposed to other stakeholders such as the general public. This paper extends the preference debate by using this clinical area as a case study, with a particular focus on HTA guidelines and the recent advocacy of the use of preference information in benefit-risk assessments.
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Affiliation(s)
- David John Mott
- a Health Economics Group, Institute of Health & Society , Newcastle University , Newcastle upon Tyne , UK
| | - Mehdi Najafzadeh
- b Division of Pharmacoepidemiology and Pharmacoeconomics , Brigham & Women's Hospital, Harvard Medical School , Boston , MA , USA
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