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Matthews JA, Matthews S, Faries MD, Wolever RQ. Supporting Sustainable Health Behavior Change: The Whole is Greater Than the Sum of Its Parts. Mayo Clin Proc Innov Qual Outcomes 2024; 8:263-275. [PMID: 38807973 PMCID: PMC11130595 DOI: 10.1016/j.mayocpiqo.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2024] Open
Abstract
Behavior change is the foundation for effective lifestyle prescriptions, yet such change is individualized, nonlinear and typically requires ongoing support. Health and wellness coaching (HWC) is a behavior change intervention with rapidly accruing evidence of positive impact on health behaviors such as exercise, nutrition and stress management. Furthermore, HWC enhances prevention and mitigates exacerbation of chronic lifestyle diseases, at least in the short-term (up to 6 months post intervention). Although the impact on long-term stability of behavior change remains unclear, it is evident that effective partnering with patients using key communication strategies, autonomy promotion, and flexible permissiveness can empower patients to develop healthy lifestyles. This partnership can be cultivated by clinicians as well as clinical team members including nationally board-certified coaches. Although much research is needed regarding the ongoing maintenance of lifestyle changes beyond 6 months, this article seeks to equip clinicians with current evidence, theoretical insights and practical strategies from a "coach approach" to foster more intrinsic forms of motivation which, in turn, empowers patients to adopt and maintain health-promoting behaviors.
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Affiliation(s)
- Jessica A. Matthews
- College of Health Sciences, Point Loma Nazarene University, San Diego, CA
- Department of Family Medicine, Centers for Integrative Health, UC San Diego Health, San Diego, CA
| | - Simon Matthews
- Lifestyle Medicine and Health Research Centre, Avondale University, Cooranbong, Australia
- Wellcoaches School of Coaching, Wellesley, MA
| | - Mark D. Faries
- Family & Community Health, Texas A&M AgriLife Extension, College Station, TX
- Texas A&M School of Medicine and School of Public Health, College Station, TX
| | - Ruth Q. Wolever
- Department of Physical Medicine and Rehabilitation, Vanderbilt Health Coaching, Vanderbilt University Medical Center, Nashville, TN
- Vanderbilt University School of Nursing, Nashville, TN
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Patel ML, Wakayama LN, Bass MB, Breland JY. Motivational interviewing in eHealth and telehealth interventions for weight loss: A systematic review. Prev Med 2019; 126:105738. [PMID: 31153917 DOI: 10.1016/j.ypmed.2019.05.026] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 05/03/2019] [Accepted: 05/28/2019] [Indexed: 12/23/2022]
Abstract
The alarming prevalence of adult obesity warrants consideration of treatments with broad reach; digital health interventions meet this need and have demonstrated efficacy for weight loss. One approach that can be delivered remotely is motivational interviewing - a counseling style that helps resolve ambivalence to change unhealthy behavior. This is the first review to systematically examine eHealth and telehealth interventions that incorporate motivational interviewing for weight loss. We searched four electronic databases (PubMed, Embase, PsycInfo, CINAHL) for publications from November 2009-May 2018. Included papers were weight loss RCTs conducted among adults with overweight or obesity that examined eHealth or telehealth interventions with motivational interviewing, compared to any type of treatment arm without it. Results were presented separately by comparison arm (control vs. active comparator). Sixteen papers (15 trials) were included. Twelve used telephone-based counseling to deliver motivational interviewing, two used email and phone, and one used online chats. When compared to a no-treatment control arm, the motivational interviewing arm was associated with greater weight loss on 6 of 11 occasions, but performed better than an active comparator on only 1 of 7 occasions. Retention and engagement were generally high, though few trials examined the relation with weight loss. No trial had high risk of bias, but five lacked power calculations and only two reported fidelity to motivational interviewing. Telephone-based interventions that incorporate motivational interviewing hold promise as effective obesity treatments. There is a dearth of evidence to support the use of motivational interviewing via eHealth, signaling a needed research area.
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Affiliation(s)
- Michele L Patel
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA, USA; Department of Psychology and Neuroscience, Duke University, Durham, NC, USA.
| | - Lindsay N Wakayama
- PGSP-Stanford Psy.D. Consortium, Palo Alto University, Palo Alto, CA, USA
| | - Michelle B Bass
- Lane Medical Library and Knowledge Management Center, Stanford University, Stanford, CA, USA
| | - Jessica Y Breland
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA, USA
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Fisher A, Craigie AM, Macleod M, Steele RJC, Anderson AS. The impact of social deprivation on the response to a randomised controlled trial of a weight management intervention (BeWEL) for people at increased risk of colorectal cancer. J Hum Nutr Diet 2017; 31:306-313. [PMID: 29171112 PMCID: PMC6001549 DOI: 10.1111/jhn.12524] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Although 45% of colorectal cancer (CRC) cases may be avoidable through appropriate lifestyle and weight management, health promotion interventions run the risk of widening health inequalities. The BeWEL randomised controlled trial assessed the impact of a diet and activity programme in overweight adults who were diagnosed with a colorectal adenoma, demonstrating a significantly greater weight loss at 12 months in intervention participants than in controls. The present study aimed to compare BeWEL intervention outcomes by participant deprivation status. METHODS The intervention group of the BeWEL trial (n = 163) was classified by the Scottish Index of Multiple Deprivation (SIMD) quintiles into 'more deprived' (SIMD 1-2, n = 58) and 'less deprived' (SIMD 3-5, n = 105). Socio-economic and lifestyle variables were compared at baseline to identify potential challenges to intervention adherence in the more deprived. Between group differences at 12 months in primary outcome (change in body weight) and secondary outcomes (cardiovascular risk factors, diet, physical activity, knowledge of CRC risk and psychosocial variables) were assessed by deprivation status. RESULTS At baseline, education (P = 0.001), income (P < 0.001), spending on physical activity (P = 0.003) and success at previous weight loss attempts (P = 0.007) were significantly lower in the most deprived. At 12 months, no between group differences by deprivation status were detected for changes in primary and main secondary outcomes. CONCLUSIONS Despite potential barriers faced by the more deprived participants, primary and most secondary outcomes were comparable between groups, indicating that this intervention is unlikely to worsen health inequalities and is equally effective across socio-economic groups.
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Affiliation(s)
- A Fisher
- Division of Cancer Research, Centre for Research into Cancer Prevention and Screening, Ninewells Hospital & Medical School, Dundee, UK
| | - A M Craigie
- Division of Cancer Research, Centre for Research into Cancer Prevention and Screening, Ninewells Hospital & Medical School, Dundee, UK
| | - M Macleod
- Division of Cancer Research, Centre for Research into Cancer Prevention and Screening, Ninewells Hospital & Medical School, Dundee, UK
| | - R J C Steele
- Division of Cancer Research, Centre for Research into Cancer Prevention and Screening, Ninewells Hospital & Medical School, Dundee, UK
| | - A S Anderson
- Division of Cancer Research, Centre for Research into Cancer Prevention and Screening, Ninewells Hospital & Medical School, Dundee, UK
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Awareness of Lifestyle and Colorectal Cancer Risk: Findings from the BeWEL Study. BIOMED RESEARCH INTERNATIONAL 2015; 2015:871613. [PMID: 26504842 PMCID: PMC4609381 DOI: 10.1155/2015/871613] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 07/08/2015] [Indexed: 12/01/2022]
Abstract
It is estimated that 47% of colorectal cancers (CRC) could be prevented by appropriate lifestyles. This study aimed to identify awareness of the causes of CRC in patients who had been diagnosed with a colorectal adenoma through the Scottish Bowel Screening Programme and subsequently enrolled in an intervention trial (using diet and physical activity education and behavioural change techniques) (BeWEL). At baseline and 12-month follow-up, participants answered an open-ended question on factors influencing CRC development. Of the 329 participants at baseline, 40 (12%) reported that they did not know any risk factors and 36 (11%) failed to identify specific factors related to diet and activity. From a potential knowledge score of 1 to 6, the mean score was 1.5 (SD 1.1, range 0 to 5) with no difference between intervention and control groups. At follow-up, the intervention group had a significantly greater knowledge score and better weight loss, diet, and physical activity measures than the control group. Awareness of relevant lifestyle factors for CRC remains low in people at increased risk of the disease. Opportunities within routine NHS screening to aid the capability (including knowledge of risk factors) of individuals to make behavioural changes to reduce CRC risk deserve exploration.
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Steele RJC, Anderson AS, Macleod M, Craigie AM, Caswell S, Belch J, Treweek S. Colorectal adenomas and diabetes: implications for disease prevention. Colorectal Dis 2015; 17:589-94. [PMID: 25581207 PMCID: PMC4833180 DOI: 10.1111/codi.12895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 11/19/2014] [Indexed: 12/14/2022]
Abstract
AIM This study assessed the baseline type II diabetes mellitus (T2DM) risk status among overweight patients with screen-detected colorectal adenomas and explored the implications of the findings for preventative practice. METHOD Participants aged between 50 and 74 years (73% of whom were men) were recruited from four Scottish health boards and assessed for diabetes risk. Participants were categorized as at 'high' diabetes risk if glycated haemoglobin (HbA1c) was between 6.0 and 6.4% or fasting plasma glucose (FPG) was between 5.5 and 6.9 mmol/l and as potentially undiagnosed T2DM when HbA1c ≥ 6.5% or FPG ≥ 7 mmol/l. Secondary outcome measures included anthropometric measurements, blood pressure and the plasma lipid profile. The tests were repeated at 12 months and diabetes risk categories were reassessed following intervention procedures. RESULTS Forty-seven (14.3%) of the 329 participants had a preexisting diagnosis of T2DM. Of the remainder with complete biochemistry results (n = 250), 19 (7.6%) were classified as having potentially undiagnosed T2DM and 125 (50.0%) as being at high risk of developing diabetes. More than a quarter of participants in all categories had raised waist circumference, hypertension and plasma lipids, indicative of raised cardiovascular risk. At 12 months' follow-up, the diabetes risk category diminished in 20% of the intervention group vs 11% in the controls [OR 2.26 (95% CI 1.03-4.96)]. CONCLUSION Our results suggest that a diagnosis of adenoma in overweight patients provides a health service opportunity for diabetes assessment, prevention and management in a high-risk population at a potentially teachable moment.
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Affiliation(s)
- R J C Steele
- Centre for Research into Cancer Prevention and Screening, Medical Research Institute, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
| | - A S Anderson
- Centre for Research into Cancer Prevention and Screening, Medical Research Institute, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
| | - M Macleod
- Centre for Research into Cancer Prevention and Screening, Medical Research Institute, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
| | - A M Craigie
- Centre for Research into Cancer Prevention and Screening, Medical Research Institute, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
| | - S Caswell
- Centre for Research into Cancer Prevention and Screening, Medical Research Institute, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
| | - J Belch
- Vascular Diseases Research Unit, Medical Research Institute, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
| | - S Treweek
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
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Stead M, Craigie AM, Macleod M, McKell J, Caswell S, Steele RJC, Anderson AS. Why are some people more successful at lifestyle change than others? Factors associated with successful weight loss in the BeWEL randomised controlled trial of adults at risk of colorectal cancer. Int J Behav Nutr Phys Act 2015; 12:87. [PMID: 26112014 PMCID: PMC4487855 DOI: 10.1186/s12966-015-0240-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 06/12/2015] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The BeWEL (BodyWEight and physicaL activity) randomised controlled trial demonstrated that a weight management programme offered in the colorectal cancer screening setting was effective. However, the differential responses of participants to the programme were notable. This study aimed to explore the factors associated with success and to identify implications for future programme design. METHODS Analyses were conducted of quantitative data (n = 148) from the BeWEL intervention group to compare demographic and psychosocial characteristics and lifestyle changes in those who met and exceeded the target 7% weight loss ('super-achievers') with those who achieved only 'moderate' or 'low' amounts of weight loss (2-7% loss, or <2% loss, respectively). In-depth qualitative interviews (n = 24) explored in detail the motivations, actions, pathways to weight loss and circumstances of study participants. RESULTS Over the 12 month intervention period, mean percentage weight loss of super-achievers (n = 33) was 11.5%, compared with moderate-achievers (n = 58) who lost 4.2%, and low-achievers (n = 57) who gained 0.8%. Compared to other groups, super- achievers increased their fruit and vegetable intake (p < 0.01) and physical activity (step count, p < 0.01). 'Super-achievers' did not differ in baseline demographic characteristics from other participants. However, significantly fewer reported that their activities were limited by physical and emotional health and they were more likely to perceive their current diet as harmful. Qualitative analyses found no consistent patterns among super-achievers in relation to some factors identified as important in previous studies, such as social support. However, super-achievers shared several characteristics such as determination and consistency in their engagement with the intervention, receptivity to new information and prompts, previous positive experience of changing health behaviours, being motivated by early success, making changes routine, and an ability to devise and apply strategies for dealing with setback and 'relapse' triggers. CONCLUSIONS Successful lifestyle change depends on active engagement as well as effective intervention ingredients. Weight loss interventions are likely to be more effective where they can adapt to participants' differing characteristics and needs, while also providing core elements likely to build success.
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Affiliation(s)
- Martine Stead
- Institute for Social Marketing, University of Stirling, Stirling, FK9 4LA, Scotland, UK.
| | - Angela M Craigie
- Centre for Research into Cancer Prevention and Screening, Cancer Division, Medical Research Institute, Level 7, Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK.
| | - Maureen Macleod
- Centre for Research into Cancer Prevention and Screening, Cancer Division, Medical Research Institute, Level 7, Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK.
| | - Jennifer McKell
- Institute for Social Marketing, University of Stirling, Stirling, FK9 4LA, Scotland, UK.
| | - Stephen Caswell
- Centre for Research into Cancer Prevention and Screening, Cancer Division, Medical Research Institute, Level 7, Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK.
| | - Robert J C Steele
- Centre for Research into Cancer Prevention and Screening, Cancer Division, Medical Research Institute, Level 7, Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK.
| | - Annie S Anderson
- Centre for Research into Cancer Prevention and Screening, Cancer Division, Medical Research Institute, Level 7, Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK.
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Anderson AS, Craigie AM, Caswell S, Treweek S, Stead M, Macleod M, Daly F, Belch J, Rodger J, Kirk A, Ludbrook A, Rauchhaus P, Norwood P, Thompson J, Wardle J, Steele RJC. The impact of a bodyweight and physical activity intervention (BeWEL) initiated through a national colorectal cancer screening programme: randomised controlled trial. BMJ 2014; 348:g1823. [PMID: 24609919 PMCID: PMC3945930 DOI: 10.1136/bmj.g1823] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/20/2014] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To evaluate the impact of a diet and physical activity intervention (BeWEL) on weight change in people with a body mass index >25 weight (kg)/height (m)(2) at increased risk of colorectal cancer and other obesity related comorbidities. DESIGN Multicentre, parallel group, randomised controlled trial. SETTING Four Scottish National Health Service health boards. PARTICIPANTS 329 overweight or obese adults (aged 50 to 74 years) who had undergone colonoscopy after a positive faecal occult blood test result, as part of the national bowel screening programme, and had a diagnosis of adenoma confirmed by histopathology. 163 were randomised to intervention and 166 to control. INTERVENTION Participants were randomised to a control group (weight loss booklet only) or 12 month intervention group (three face to face visits with a lifestyle counsellor plus monthly 15 minute telephone calls). A goal of 7% reduction in body weight was set and participants received a personalised energy prescription (2508 kJ (600 kcal) below that required for weight maintenance) and bodyweight scales. Motivational interviewing techniques explored self assessed confidence, ambivalence, and personal values concerning weight. Behavioural strategies included goal setting, identifying intentions of implementation, self monitoring of body weight, and counsellor feedback about reported diet, physical activity, and weight change. MAIN OUTCOME MEASURES The primary outcome was weight change over 12 months. Secondary outcomes included changes in waist circumference, blood pressure, fasting cardiovascular biomarkers, and glucose metabolism variables, physical activity, diet, and alcohol consumption. RESULTS At 12 months, data on the primary outcome were available for 148 (91%) participants in the intervention group and 157 (95%) in the control group. Mean weight loss was 3.50 kg (SD 4.91) (95% confidence interval 2.70 to 4.30) in the intervention group compared with 0.78 kg (SD 3.77) (0.19 to 1.38) in the control group. The group difference was 2.69 kg (95% confidence interval 1.70 to 3.67). Differences between groups were significant for waist circumference, body mass index, blood pressure, blood glucose level, diet, and physical activity. No reported adverse events were considered to be related to trial participation. CONCLUSIONS Significant weight loss can be achieved by a diet and physical activity intervention initiated within a national colorectal cancer screening programme, offering considerable potential for risk reduction of disease in older adults. TRIAL REGISTRATION Current Controlled Trials ISRCTN53033856.
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Affiliation(s)
- Annie S Anderson
- Centre for Research into Cancer Prevention and Screening, Cancer Division, Medical Research Institute, Ninewells Medical School, Dundee, UK
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