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Provvidenza CF, Bonder R, McPherson AC. Putting weight-related conversations into practice: Lessons learned from implementing a knowledge translation casebook in a disability context. Child Care Health Dev 2024; 50:e13257. [PMID: 38587273 DOI: 10.1111/cch.13257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 01/31/2024] [Accepted: 03/04/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND Due to reported challenges experienced by healthcare providers (HCPs) when having weight-related conversations with children with disabilities and their families, a knowledge translation (KT) casebook was developed, providing key communication principles with supportive resources. Our aim was to explore how the KT casebook could be implemented into a disability context. Study objectives were to develop and integrate needs-based implementation supports to help foster the uptake of the KT casebook communication principles. METHODS A sample of nurses, physicians, occupational therapists and physical therapists were recruited from a Canadian paediatric rehabilitation hospital. Informed by the Theoretical Domains Framework, group interviews were conducted with participants to understand barriers to having weight-related conversations in their context. Implementation strategies were developed to deliver the KT casebook content that addressed these identified barriers, which included an education workshop, simulations, printed materials, and a huddle and email strategy. Participant experiences with the implementation supports were captured through workshop evaluations, pre-post surveys and qualitative interviews. Post-implementation interviews were analysed using descriptive content analysis. RESULTS Ten HCPs implemented the KT casebook principles over 6 months. Participants reported that the workshop provided a clear understanding of the KT casebook content. While HCPs appreciated the breadth of the KT casebook, they found the abbreviated printed educational materials more convenient. Strategies developed to address participants' need for a sense of community and opportunities to learn from each other did not achieve their aim. Increased confidence in integrating the KT casebook principles into practice was not demonstrated, due, in part, to having few opportunities to practice. This was partly because of the increase in competing clinical demands at the onset of the COVID-19 pandemic. CONCLUSIONS Despite positive feedback on the product itself, changes in the organisational and environmental context limited the success of the implementation plan. Monitoring and adapting implementation processes in response to unanticipated changes is critical to the success of implementation efforts.
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Affiliation(s)
- Christine F Provvidenza
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Institute, Toronto, Canada
| | - Revi Bonder
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Institute, Toronto, Canada
| | - Amy C McPherson
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Institute, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
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Jessen-Winge C, Kolind M, Lee K, Leth MB, Surrow S, Knürr DS, Christensen CS, Christensen JR. Occupational balance as a component in weight loss interventions. Scand J Occup Ther 2023; 30:1028-1036. [PMID: 37247198 DOI: 10.1080/11038128.2023.2217544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 05/19/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUND Obesity can limit occupational participation because of physical and mental barriers. Weight loss programmes emphasizing dietary and physical activity may lower body weight; however, mental barriers and sustainable weight loss seemed to be challenged. Weight loss influences daily patterns and structure of occupations and finding a balance in daily life during the weight loss process might improve sustainable weight loss. AIM To explore if and how health professionals conducting weight loss programmes in Danish municipalities address elements related to occupational balance in the daily life of citizens with obesity. MATERIAL AND METHODS Twenty individual interviews with health professionals from Danish municipalities were conducted and analysed. RESULTS (1) Helping participants find the time and energy to lose weight, (2) Emphasizing small steps for sustainable changes and (3) Utilizing the citizen's life experience for direction. CONCLUSION Elements of occupational balance might be addressed by the participants, however values and meaningfulness regarding occupations seem to be missing. Integrating occupational balance in weight loss programmes could enable health professionals to understand and address sustainable weight loss. SIGNIFICANCE Occupational therapists may be ideally suited to support citizens with obesity to sustain weight loss by supporting a balanced life focussing on meaningfulness and values in occupations.
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Affiliation(s)
- C Jessen-Winge
- Department of Occupational Therapy, Institute of Physiotherapy and Occupational Therapy, University College Copenhagen, Copenhagen, Denmark
- User Perspectives and Community-based Interventions, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - M Kolind
- User Perspectives and Community-based Interventions, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - K Lee
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
- Department of Occupational Therapy, University College South, Esbjerg, Denmark
| | - M B Leth
- User Perspectives and Community-based Interventions, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - S Surrow
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - D S Knürr
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - C S Christensen
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - J R Christensen
- User Perspectives and Community-based Interventions, Department of Public Health, University of Southern Denmark, Odense, Denmark
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
- Research Unit of General Practice, Aarhus University, Aarhus, Denmark
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Muntefering C, Fields B, Christensen JR. Going Beyond Management and Maintenance: Occupational Therapy's Role in Primary Prevention for Adults at Risk of Obesity. Am J Occup Ther 2023; 77:7705347020. [PMID: 37824722 DOI: 10.5014/ajot.2023.050154] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023] Open
Abstract
There is a critical need to address the escalating obesity epidemic by examining new methods of care. Adult obesity has historically been addressed through management and maintenance once an individual is clinically diagnosed as obese. Research and practice demonstrate that significant weight loss can be difficult to achieve and even harder to maintain. Despite this, preventive interventions targeted toward adult obesity have been limited in many health care professions, including occupational therapy. As professionals who are skilled in supporting clients' holistic development of healthy habits and routines, occupational therapists are equipped to play a key role in moving health care practices away from a reactive model of care to a proactive one that emphasizes primary prevention. This column identifies how this issue is aligned with occupational therapy's domain and presents potential examples of interventions to support adult obesity prevention.
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Affiliation(s)
- Chloe Muntefering
- Chloe Muntefering, MS, OTR/L, is Doctoral Candidate, Department of Kinesiology, University of Wisconsin-Madison;
| | - Beth Fields
- Beth Fields, PhD, OTR/L, BCG, is Assistant Professor, Department of Kinesiology, University of Wisconsin-Madison
| | - Jeanette Reffstrup Christensen
- Jeanette Reffstrup Christensen, PhD, OTR/L, is Associate Professor, Department of Public Health, University of Southern Denmark, Odense, Denmark, and Senior Researcher, Research Unit of General Practice, Aarhus, Denmark
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Christensen JR, Hesseldal L, Olesen TB, Olsen MH, Jakobsen PR, Laursen DH, Lauridsen JT, Nielsen JB, Søndergaard J, Brandt CJ. Long-term weight loss in a 24-month primary care-anchored telehealth lifestyle coaching program: Randomized controlled trial. J Telemed Telecare 2022; 28:764-770. [DOI: 10.1177/1357633x221123411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Long-term weight loss can reduce the risk of type 2 diabetes for people living with obesity and reduce complications for patients diagnosed with type 2 diabetes. We investigated whether a telehealth lifestyle-coaching program (Liva) leads to long-term (24 months) weight loss compared to usual care. In a randomized controlled trial, n = 340 participants living with obesity with or without type 2 diabetes were enrolled and randomized via an automated computer algorithm to an intervention group ( n = 200) or to a control group ( n = 140). The telehealth lifestyle-coaching program comprised of an initial one-hour face-to-face motivational interview followed by asynchronous telehealth coaching. The behavioural change techniques used were enabled by individual live monitoring. The primary outcome was a change in body weight from baseline to 24 months. Data were assessed for n = 136 participants (40%), n = 81 from the intervention group and n = 55 from the control group, who completed the 24-month follow-up. After 24 months mean body weight and body mass index were reduced significantly for completers in both groups, but almost twice as much was registered for those in the intervention group which was not significant between groups −4.4 (CI −6.1; −2.8) kg versus −2.5 (CI −3.9; −1.1) kg, P = 0.101. Haemoglobin A1c was significantly reduced in the intervention group −3.1 (CI −5.0; −1.2) mmol/mol, but not in the control group −0.2 (CI −2.4; −2.0) mmol/mol without a significant between group difference ( P = 0.223). Low completion was partly due to coronavirus disease 2019. Telehealth lifestyle coaching improve long-term weight loss (> 24 months) for obese people with and without type 2 diabetes compared to usual care.
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Affiliation(s)
- Jeanette R Christensen
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
- User Perspectives and Community-based Interventions, Department of Public Health, University of Southern Denmark, Odense, Denmark
- Research Unit of General Practice, Aarhus University, Aarhus, Denmark
| | - Laura Hesseldal
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
- Department of Internal Medicine, Holbaek Hospital and Steno Diabetes Center Zealand, Holbaek, Denmark
| | - Thomas B Olesen
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
| | - Michael H Olsen
- Department of Internal Medicine, Holbaek Hospital and Steno Diabetes Center Zealand, Holbaek, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Pernille R Jakobsen
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Ditte H Laursen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jørgen T Lauridsen
- Department of Economics and Data Science, University of Southern Denmark, Odense, Denmark
| | - Jesper B Nielsen
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Jens Søndergaard
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
| | - Carl J Brandt
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
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Christensen JR, Laursen DH, Lauridsen JT, Hesseldal L, Jakobsen PR, Nielsen JB, Søndergaard J, Brandt CJ. Reversing Type 2 Diabetes in a Primary Care-Anchored eHealth Lifestyle Coaching Programme in Denmark: A Randomised Controlled Trial. Nutrients 2022; 14:nu14163424. [PMID: 36014930 PMCID: PMC9414066 DOI: 10.3390/nu14163424] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 08/12/2022] [Accepted: 08/17/2022] [Indexed: 12/12/2022] Open
Abstract
The goal of this trial was to investigate whether an eHealth lifestyle coaching programme led to significant weight loss and decreased Haemoglobin A1c (HbA1c) in patients with type 2 diabetes. In an RCT, 170 patients were enrolled from 2018 to 2019 for intervention or control. Inclusion criteria were diagnosed with type 2 diabetes, BMI 30−45 kg/m2, and aged 18−70 years. Exclusion criteria were lacks internet access, pregnant or planning a pregnancy, or has a serious disease. Primary and secondary outcomes were a reduction in body weight and HbA1c. At six months, 75 (75%) patients in the intervention group and 53 (76%) patients in the control group remained in the trial. The mean body weight loss was 4.2 kg (95% CI, −5.49; −2.98) in the intervention group and 1.5 kg (95% CI, −2.57; −0.48) in the control group (p = 0.005). In the intervention group, 24 out of 62 patients with elevated HbA1c at baseline (39%) had a normalized HbA1c < 6.5% at six months, compared to 8 out of 40 patients with elevated HbA1c at baseline (20%) in the control group (p = 0.047). The eHealth lifestyle coaching programme can lead to significant weight loss and decreased HbA1c among patients with type 2 diabetes, compared to standard care.
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Affiliation(s)
- Jeanette Reffstrup Christensen
- Research Unit of General Practice, Department of Public Health, The Faculty of Health Sciences, University of Southern Denmark, 5000 Odense, Denmark
- User Perspectives and Community-Based Interventions, Department of Public Health, The Faculty of Health Sciences, University of Southern Denmark, 5000 Odense, Denmark
- The MOVE Unit, Research Unit of General Practice, The Faculty of Health, Aarhus University, 8000 Aarhus, Denmark
- Correspondence:
| | - Ditte Hjorth Laursen
- Department of Public Health, Faculty of Health and Medical Science, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Jørgen Trankjær Lauridsen
- Department of Economics, The Faculty of Business and Social Sciences, University of Southern Denmark, 5000 Odense, Denmark
| | - Laura Hesseldal
- Research Unit of General Practice, Department of Public Health, The Faculty of Health Sciences, University of Southern Denmark, 5000 Odense, Denmark
| | - Pernille Ravn Jakobsen
- Research Unit of General Practice, Department of Public Health, The Faculty of Health Sciences, University of Southern Denmark, 5000 Odense, Denmark
| | - Jesper Bo Nielsen
- Research Unit of General Practice, Department of Public Health, The Faculty of Health Sciences, University of Southern Denmark, 5000 Odense, Denmark
| | - Jens Søndergaard
- Research Unit of General Practice, Department of Public Health, The Faculty of Health Sciences, University of Southern Denmark, 5000 Odense, Denmark
| | - Carl J. Brandt
- Research Unit of General Practice, Department of Public Health, The Faculty of Health Sciences, University of Southern Denmark, 5000 Odense, Denmark
- Liva Healthcare, 1434 Copenhagen, Denmark
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Jessen-Winge C, Lee K, Surrow S, Christensen JR. Five Vital Components in an Occupational Therapy-Based Municipal Weight Loss Program Obtained Through Research Circles. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:822896. [PMID: 36188971 PMCID: PMC9397691 DOI: 10.3389/fresc.2022.822896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 05/16/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Currently 1.9 billion adults worldwide are estimated to be overweight or obese. Weight loss sustainability is difficult, and weight loss rehabilitation programs have been criticised for having an individualistic approach. It has been suggested that occupational therapists could be used as part of a transdisciplinary approach because of their holistic perspective. During the development of an occupational therapy- based weight loss program five components arose as essential from earlier interviews with health professionals and citizens with obesity: diet, physical activities, social relations, habits and balancing everyday life. Before developing the program, we needed a clearer picture of which strategies should support the five components. The aim of this study was to obtain a description of strategies related to the five components that could support weight loss to become part of everyday life of people with obesity. METHODS This study took a participatory design by using research circle (RC) methodology. Two RC groups were created, one with occupational therapists and one with citizens with obesity. Researchers participated in both RC groups. Data was obtained through democratic principles. The two RC groups met four times over a period of 4 months. Qualitative content analysis was conducted. RESULTS Five themes arose: (1) Diet-Find the line between either-or, (2) Physical activity-Break the comfort zone, (3) Social relations-Stand strong together, (4) Habits-Focus on possibilities instead of bad habits, and (5) Balancing everyday life-Handling life's bumps. CONCLUSION The strategies for a weight loss program including the five components should include awareness of senses and activity patterns surrounding meals, taking one step at a time when focusing of physical activities and be conscious of values, include family and friends in the program to find common ground and self-confidence and use re-placement activities. We suggest that the component of balancing everyday life should be seen as an overall component as all strategies are related to finding meaning and variation in activities which is part of an ongoing weight loss process.
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Affiliation(s)
- Christina Jessen-Winge
- User Perspectives and Community-Based Interventions, Department of Public Health, University of Southern Denmark, Odense, Denmark
- Department of Occupational Therapy, Institute of Physiotherapy and Occupational Therapy, University College Copenhagen, Copenhagen, Denmark
| | - Kim Lee
- User Perspectives and Community-Based Interventions, Department of Public Health, University of Southern Denmark, Odense, Denmark
- Department of Occupational Therapy, University College South, Esbjerg, Denmark
| | - Signe Surrow
- User Perspectives and Community-Based Interventions, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Jeanette R. Christensen
- User Perspectives and Community-Based Interventions, Department of Public Health, University of Southern Denmark, Odense, Denmark
- Research Unit for General Practice, Department of Public Health, University of Soutern Denmark, Odense, Denmark
- Research Unit for General Practice, Aarhus University, Aarhus, Denmark
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7
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Christensen JR, Konge MB, Devantier M, Brandt CJ, Gommesen JB, Kolind MI. Preferred Content in Occupational Therapy-Based Weight Loss Interventions: A Survey. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2022; 42:199-208. [PMID: 35481436 DOI: 10.1177/15394492221088511] [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: 11/16/2022]
Abstract
Despite decades of attempts from doctors and dietitians to break the obesity curve, obesity rates are increasing in Denmark. To counteract this, municipal occupational therapy-based interventions are in development as part of the Danish Obesity Intervention Trial (DO: IT). The objective was to survey Danish adults on preferred content in an occupational therapy municipal weight loss intervention and determine if preferences differed by gender and age. A 21-item questionnaire was developed to explore preferences related to diet, physical activity, occupational balance, habits, and social relations. In all, 429 respondents were included. Chi-square statistics were performed to determine if preferences differed by gender and age. A total of 15 of the 21 items indicated gender-based differences in preferences. Two items indicated age-based differences. Notably, compared to men, women indicated significantly more interest in content relating to habit formation and occupational balance. Gender-based differences should be considered when developing a weight loss intervention.
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Affiliation(s)
- Jeanette Reffstrup Christensen
- Department of Public Health, University of Southern Denmark, Odense, Denmark.,Research Unit for General Practice, Aarhus University, Aarhus, Denmark
| | - Maria B Konge
- Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Martin Devantier
- Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Carl J Brandt
- Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Joakim B Gommesen
- Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Mikkel I Kolind
- Department of Public Health, University of Southern Denmark, Odense, Denmark
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Jessen-Winge C, Ilvig PM, Fritz H, Brandt CJ, Lee K, Christensen JR. What a weight loss programme should contain if people with obesity were asked - a qualitative analysis within the DO:IT study. BMC Public Health 2021; 21:28. [PMID: 33407271 PMCID: PMC7789717 DOI: 10.1186/s12889-020-09850-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 11/05/2020] [Indexed: 12/31/2022] Open
Abstract
Background Currently 1.9 billion adults worldwide are estimated to be overweight or obese. In Denmark the municipalities hold the responsibility to deliver weight loss programmes to overweight and obese citizens. There is a tendency to assume that weight loss programmes that show positive effects in specialized hospital settings are directly transferrable to municipal settings. However, municipality-based weight loss programmes have not produced clinically significant reductions in body weight. One reason for this may be that much research evidence regarding obesity programming neglects the perspectives of people with obesity. The first step in developing a weight loss programme designed for municipal settings is to understand what people with obesity want and need from a programme. The aim of this study was to examine what people with obesity find important in a weight loss programme for weight loss and weight maintenance. Methods We used a qualitative, explorative, descriptive design with individual interviews. We included men and women age 17 and older with a BMI ≥ 25 kg/m2. Participants were recruited from the wait lists of 13 municipality programmes and through Facebook posts. Data were analyzed using content analysis. Results Thirty-four participants with overweight or obesity were individually interviewed (ages between 19 and 74). Findings suggest that weight loss programmes should; a) support participants in structuring days; b) consider the use of replacement activities to reduce cognitive and emotional burden; c) aide individuals to increase self-efficacy and; d) include family and friends as well as health professionals and peers in the weight loss process. Diet and exercise, while important, should be balanced with other meaningful activities in everyday life. Conclusion Participants in this study wished to balance weight loss related activities with overall everyday life as well as finding the believe in their ability to lose weight in social relations.
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Affiliation(s)
- Christina Jessen-Winge
- Department of Midwifery, Physiotherapy, Occupational Therapy and Psycomotore therapy, University College Copenhagen, Sigurdsgade 26, 2200, Copenhagen, Denmark. .,Department of Public Health, University of Southern Denmark, JB Winsløwsvej 9A, 5000, Odense C, Denmark.
| | - Pia Maria Ilvig
- Department of Public Health, University of Southern Denmark, JB Winsløwsvej 9A, 5000, Odense C, Denmark
| | - Heather Fritz
- Department of Health Care sciences, Occupational Therapy Program, Wayne State University, 259 Mack Ave, Detroit, MI, 48201, USA
| | - Carl J Brandt
- Department of Public Health, University of Southern Denmark, JB Winsløwsvej 9A, 5000, Odense C, Denmark
| | - Kim Lee
- Department of Public Health, University of Southern Denmark, JB Winsløwsvej 9A, 5000, Odense C, Denmark.,Department of Occupational Therapy, University College South, Degnevej 16, 6705, Esbjerg, Denmark
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Jessen-Winge C, Ilvig PM, Thilsing T, Lee K, Fritz H, Christensen JR. Health professionals' perceptions of weight loss programmes and recommendations for future implementation: a qualitative study. BMJ Open 2020; 10:e039667. [PMID: 33208329 PMCID: PMC7677371 DOI: 10.1136/bmjopen-2020-039667] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Obesity is an increasing public health challenge and most weight loss programmes are still inadequate to support sustainable weight loss. One reason for the continued lack of success might be the dominant biomedical, individualised approach to weight loss. Holistic approaches that focus on overall health and well-being in addition to weight loss are increasingly recommended. In Denmark, health professionals in the municipalities are responsible for developing and conducting weight loss programmes. The objective of this study was to explore what health professional's perceived as an ideal, holistic weight loss programme that could be feasibly implemented in the municipalities. DESIGN A phenomenological-hermeneutical qualitative study was performed using semistructured interviews. SETTING Thirty-two Danish municipalities were weight loss programmes are developed and conducted. PARTICIPANTS Thirty-five health professionals with experience conducting weight loss programmes. RESULTS Three themes emerged from the analysis: Support from the social network are important both during and after a weight loss, Changing the self-belief by positive discussions and doing activities, Maintaining changes through daily life. CONCLUSION Future municipal weight loss programmes should emphasise overall health and well-being instead of weight loss and adopt a holistic approach including a focus on social relationships, meaningful activities and successes as part of a balanced daily life.
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Affiliation(s)
- Christina Jessen-Winge
- Department of Public Health, University of Southern Denmark Faculty of Health Sciences, Odense, Denmark
- Department of Health, University College Copenhagen, Kobenhavn, Denmark
| | - Pia Marie Ilvig
- Department of Public Health, University of Southern Denmark Faculty of Health Sciences, Odense, Denmark
| | - Trine Thilsing
- Department of Public Health, University of Southern Denmark Faculty of Health Sciences, Odense, Denmark
| | - Kim Lee
- Department of Public Health, University of Southern Denmark Faculty of Health Sciences, Odense, Denmark
| | - Heather Fritz
- Department of occupational therapy, Wayne State University, Detroit, Michigan, USA
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Brandt CJ, Christensen JR, Lauridsen JT, Nielsen JB, Søndergaard J, Sortsø C. Evaluation of the Clinical and Economic Effects of a Primary Care Anchored, Collaborative, Electronic Health Lifestyle Coaching Program in Denmark: Protocol for a Two-Year Randomized Controlled Trial. JMIR Res Protoc 2020; 9:e19172. [PMID: 32584260 PMCID: PMC7380992 DOI: 10.2196/19172] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/12/2020] [Accepted: 05/14/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Obesity is linked to a number of chronic health conditions, such as type 2 diabetes, heart disease, and cancer, and weight loss interventions are often expensive. Recent systematic reviews concluded that app and web-based interventions can improve lifestyle behaviors and weight loss at a reasonable cost, but long-term sustainability needs to be demonstrated. OBJECTIVE This study protocol is for a 2-year randomized controlled trial that aims to evaluate the clinical and economic effects of a primary care, anchored, collaborative, electronic health (eHealth) lifestyle coaching program (long-term Lifestyle change InterVention and eHealth Application [LIVA] 2.0) in obese participants with and without type 2 diabetes. The program's primary outcome is weight loss. Its secondary outcome is the hemoglobin A1c (HbA1c) level, and its tertiary outcomes are retention rate, quality of life (QOL), and cost effectiveness. Analytically, the focus is on associations of participant characteristics with outcomes and sustainability. METHODS We conduct a multicenter trial with a 1-year intervention and 1-year retention. LIVA 2.0 is implemented in municipalities within administrative regions in Denmark, specifically eight municipalities located within the Region of Southern Denmark and two municipalities located within the Capital Region of Denmark. The participants are assessed at baseline and at 6-, 12-, and 24-month follow-ups. Individual data from the LIVA 2.0 platform are combined with clinical measurements, questionnaires, and participants' usage of municipality and health care services. The participants have a BMI ≥30 but ≤45 kg/m2, and 50% of the participants have type 2 diabetes. The participants are randomized in an approximately 60:40 manner, and based on sample size calculations on weight loss and intention-to-treat statistics, 200 participants are randomized to an intervention group and 140 are randomized to a control group. The control group is offered the conventional preventive program of the municipality, and it is compared to the intervention group, which follows the LIVA 2.0 in addition to the conventional preventive program. RESULTS The first baseline assessments have been carried out in March 2018, and the 2-year follow-up will be carried out between March 2020 and April 2021. The hypothesis is that the trial results will demonstrate decreased body weight and that the number of patients who show normalization of their HbA1c levels in the intervention group will be much higher than that in the control group. The participants in the intervention group are also expected to show a greater decrease in their use of glucose-lowering medication and a greater improvement in their QOL when compared with the control group. Operational costs are expected to be lower than standard care, and the intervention is expected to be cost-effective. CONCLUSIONS This is the first time that an app and web-based eHealth lifestyle coaching program implemented in Danish municipalities will be clinically and economically evaluated. If the LIVA 2.0 eHealth lifestyle coaching program is proven to be effective, there is great potential for decreasing the rates of obesity, diabetes, and related chronic diseases. TRIAL REGISTRATION ClinicalTrials.gov NCT03788915; https://clinicaltrials.gov/ct2/show/NCT03788915. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/19172.
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Affiliation(s)
- Carl J Brandt
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | | | - Jørgen T Lauridsen
- Department of Business and Economics, University of Southern Denmark, Odense, Denmark
| | - Jesper Bo Nielsen
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Jens Søndergaard
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
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11
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Surrow S, Jessen-Winge C, Ilvig PM, Christensen JR. The motivation and opportunities for weight loss related to the everyday life of people with obesity: A qualitative analysis within the DO:IT study. Scand J Occup Ther 2020; 28:479-487. [PMID: 32065553 DOI: 10.1080/11038128.2020.1726451] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Unsuccessful weight loss or weight loss maintenance is due to different barriers and physical limitations related to participation in everyday life. It will, therefore, be relevant to investigate the field from an occupational therapy perspective, since occupational therapists are uniquely trained in focussing on people's resources, meaningfulness and participation in everyday life. AIM The aim was to explore what motivates people to lose weight from an OT perspective and which opportunities people with obesity experience in their everyday lives to achieve and maintain lost weight. MATERIAL AND METHODS A descriptive phenomenological study including 21 semi-structured individual interviews was conducted as part of the DO:IT study. RESULTS The data analysis led to the identification of three main themes: The influence of external circumstances on the desire for weight loss; use of time in everyday life; and changes in habits, routines and structure. CONCLUSION People who are overweight or obese are motivated to lose weight because of health issues and feeling more comfortable with their body. The opportunities for weight loss lie in creating habits, routines and structuring everyday life activities to facilitate a healthier lifestyle. SIGNIFICANCE The findings indicate that an occupational therapist should be part of weight-loss interventions.
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Affiliation(s)
- Signe Surrow
- Department of Public Health, The Research Initiative for Occupational Science and Occupational Therapy, University of Southern Denmark, Odense C, Denmark
| | - Christina Jessen-Winge
- Department of Public Health, The Research Initiative for Occupational Science and Occupational Therapy, University of Southern Denmark, Odense C, Denmark.,Department of Midwifery, Physiotherapy, Occupational therapy, University College Copenhagen, Copenhagen, Denmark
| | - Pia Maria Ilvig
- Department of Public Health, The Research Initiative for Occupational Science and Occupational Therapy, University of Southern Denmark, Odense C, Denmark
| | - Jeanette Reffstrup Christensen
- Department of Public Health, The Research Initiative for Occupational Science and Occupational Therapy, University of Southern Denmark, Odense C, Denmark
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