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Newton RL, Zhang D, Johnson WD, Martin CK, Apolzan JW, Denstel KD, Brantley PJ, Davis TC, Arnold C, Sarpong DF, Price-Haywood EG, Lavie CJ, Thethi TK, Katzmarzyk PT. Predictors of racial differences in weight loss: the PROPEL trial. Obesity (Silver Spring) 2024; 32:476-485. [PMID: 38058232 PMCID: PMC10922207 DOI: 10.1002/oby.23936] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 09/05/2023] [Accepted: 09/18/2023] [Indexed: 12/08/2023]
Abstract
OBJECTIVE Studies have consistently shown that African American individuals lose less weight in response to behavioral interventions, but the mechanisms leading to this result have been understudied. METHODS Data were derived from the PROmoting Successful Weight Loss in Primary CarE in Louisiana (PROPEL) study, which was a cluster-randomized, two-arm trial conducted in primary care clinics. In the PROPEL trial, African American individuals lost less weight compared with patients who belonged to other racial groups after 24 months. In the current study, counterfactual mediation analyses among 445 patients in the intervention arm of PROPEL were used to determine which variables mediated the relationship between race and weight loss. The mediators included treatment engagement, psychosocial, and lifestyle factors. RESULTS At 6 months, daily weighing mediated 33% (p = 0.008) of the racial differences in weight loss. At 24 months, session attendance and daily weighing mediated 35% (p = 0.027) and 66% (p = 0.005) of the racial differences in weight loss, respectively. None of the psychosocial or lifestyle variables mediated the race-weight loss association. CONCLUSIONS Strategies specifically targeting engagement, such as improving session attendance and self-weighing behaviors, among African American individuals are needed to support more equitable weight losses over extended time periods.
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Affiliation(s)
| | - Dachaun Zhang
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | | | | | | | | | | | - Terry C. Davis
- Internal Medicine, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | - Connie Arnold
- Internal Medicine, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | - Daniel F. Sarpong
- Office of Health Equity Research, Yale University School of Medicine, New Haven, CT, USA
| | | | - Carl J. Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School- the UQ School of Medicine, New Orleans, LA, USA
| | - Tina K. Thethi
- AdventHealth Translational Research Institute, Orlando, FL, USA
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Goldstein SP, Mwenda KM, Hoover AW, Shenkle O, Jones RN, Thomas JG. The Fully Understanding Eating and Lifestyle Behaviors (FUEL) trial: Protocol for a cohort study harnessing digital health tools to phenotype dietary non-adherence behaviors during lifestyle intervention. Digit Health 2024; 10:20552076241271783. [PMID: 39175923 PMCID: PMC11339753 DOI: 10.1177/20552076241271783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 06/25/2024] [Indexed: 08/24/2024] Open
Abstract
Objective Lifestyle intervention can produce clinically significant weight loss and reduced disease risk/severity for many individuals with overweight/obesity. Dietary lapses, instances of non-adherence to the recommended dietary goal(s) in lifestyle intervention, are associated with less weight loss and higher energy intake. There are distinct "types" of dietary lapse (e.g., eating an off-plan food, eating a larger portion), and behavioral, psychosocial, and contextual mechanisms may differ across dietary lapse types. Some lapse types also appear to impact weight more than others. Elucidating clear lapse types thus has potential for understanding and improving adherence to lifestyle intervention. Methods This 18-month observational cohort study will use real-time digital assessment tools within a multi-level factor analysis framework to uncover "lapse phenotypes" and understand their impact on clinical outcomes. Adults with overweight/obesity (n = 150) will participate in a 12-month online lifestyle intervention and 6-month weight loss maintenance period. Participants will complete 14-day lapse phenotyping assessment periods at baseline, 3, 6, 12, and 18 months in which smartphone surveys, wearable devices, and geolocation will assess dietary lapses and relevant phenotyping characteristics. Energy intake (via 24-h dietary recall) and weight will be collected at each assessment period. Results This trial is ongoing; data collection began on 31 October 2022 and is scheduled to complete by February 2027. Conclusion Results will inform novel precision tools to improve dietary adherence in lifestyle intervention, and support updated theoretical models of adherence behavior. Additionally, these phenotyping methods can likely be leveraged to better understand non-adherence to other health behavior interventions. Trial Registration This study was prospectively registered https://clinicaltrials.gov/study/NCT05562427.
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Affiliation(s)
- Stephanie P. Goldstein
- Department of Psychiatry and Human Behavior, Weight Control and Diabetes Research Center, The Miriam Hospital/Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Kevin M. Mwenda
- Spatial Structures in the Social Sciences, Population Studies and Training Center, Brown University, Providence, Rhode Island, USA
| | - Adam W. Hoover
- Holcombe Department of Electrical and Computer Engineering, Clemson University, Clemson, South Carolina, USA
| | - Olivia Shenkle
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, Rhode Island, USA
| | - Richard N. Jones
- Quantitative Science Program, Department of Psychiatry and Human Behavior, Department of Neurology, Warren Alpert Medical School, Brown University, Butler Hospital, Providence, Rhode Island, USA
| | - John Graham Thomas
- Department of Psychiatry and Human Behavior, Weight Control and Diabetes Research Center, The Miriam Hospital/Alpert Medical School of Brown University, Providence, Rhode Island, USA
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Nyman SJ, Vogel ME, Heller GM, Hella JR, Illes RA, Kirkpatrick HA. Development and Evaluation of a Health Behavior Change Clinic in Primary Care: An Interdisciplinary Partnership. J Clin Psychol Med Settings 2023; 30:909-923. [PMID: 36869987 PMCID: PMC9985097 DOI: 10.1007/s10880-023-09945-5] [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] [Accepted: 01/31/2023] [Indexed: 03/05/2023]
Abstract
Providing effective healthy behavior change interventions within primary care presents numerous challenges. Obesity, tobacco use, and sedentary lifestyle negatively impact the health quality of numerous medical patients, particularly in underserved patient populations with limited resources. Primary Care Behavioral Health (PCBH) models, which incorporate a Behavioral Health Consultant (BHC), can offer point-of-contact psychological consultation, treatment, and also provide opportunities for interdisciplinary psychologist-physician clinical partnerships to pair a BHC's health behavior change expertise with the physician's medical care. Such models can also enhance medical training programs by providing resident physicians with live, case-based learning opportunities when partnered with a BHC to address patient health behaviors. We will describe the development, implementation, and preliminary outcomes of a PCBH psychologist-physician interdisciplinary health behavior change clinic within a Family Medicine residency program. Patient outcomes revealed significant reductions (p < .01) in weight, BMI, and tobacco use. Implications and future directions are discussed.
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Affiliation(s)
- Scott J. Nyman
- Department of Clinical Health Psychology, Ascension Genesys Hospital, Grand Blanc, MI USA
- Departments of Family Medicine and Psychiatry, Michigan State University College of Human Medicine, Lansing, MI USA
- Department of Psychology, Ascension Genesys Family Health Center, 1460 N. Center Rd, Burton, MI 48509 USA
| | - Mark E. Vogel
- Department of Clinical Health Psychology, Ascension Genesys Hospital, Grand Blanc, MI USA
- Departments of Family Medicine and Psychiatry, Michigan State University College of Human Medicine, Lansing, MI USA
| | - Grant M. Heller
- Spectrum Health Lakeland, Saint Joseph, MI USA
- Department of Psychiatry, Michigan State University College of Osteopathic Medicine, Lansing, MI USA
| | - Jennifer R. Hella
- Department of Research, Ascension Genesys Hospital, Grand Blanc, MI USA
| | - Rose A. Illes
- Florida State University Family Medicine Residency Program at Lee Health, Fort Myers, FL USA
| | - Heather A. Kirkpatrick
- Department of Clinical Health Psychology, Ascension Genesys Hospital, Grand Blanc, MI USA
- Departments of Family Medicine and Psychiatry, Michigan State University College of Human Medicine, Lansing, MI USA
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Hailey L, Howells L, Bundy C, Kirtley S, Martin S, O'Sullivan D, Steinkoening I, Stepney M, Coates LC. Developing evidence-based patient-focused learning materials to support health behaviour change for people living with psoriatic arthritis. RMD Open 2023; 9:e003190. [PMID: 37652555 PMCID: PMC10476110 DOI: 10.1136/rmdopen-2023-003190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 05/24/2023] [Indexed: 09/02/2023] Open
Abstract
OBJECTIVES In psoriatic arthritis (PsA), self-management is important for patient function and quality of life. Behaviour change can be difficult, patients could benefit from high-quality support to initiate change. Our aim was to codesign the project as theory-informed, evidence-based, patient-focused, materials supporting healthy lifestyle changes for patients diagnosed with PsA. METHODS Development of the materials was overseen by a steering group of patients with PsA, psychologists, rheumatologists, a design team and researchers. First, a literature review was performed to establish the evidence base for behaviours and potential interventions in PsA, including diet, weight, alcohol, smoking, exercise, anxiety, depression and stress. An initial roundtable of patients with PsA prioritised areas and content ideas. Draft materials including a website and downloadable materials were produced. A second roundtable of patients with PsA collected feedback on the draft content and design. A third roundtable was held with patients with PsA and a fourth with clinicians to refine the materials and ensuring that they were evidence based, accessible, interesting, and helpful to initiate and maintain change. A final evaluation survey was performed to review the draft website before launching the final materials. RESULTS 15 candidate topics were prioritised. A website and set of postcards summarising the topics were developed by the design team and refined following feedback from the roundtable groups. CONCLUSION This project created patient-focused resources to support behaviour change. It addresses common concerns of patients with PsA about how they may optimise their health by providing practical and brief interventions to challenge and support them to make changes.
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Affiliation(s)
- Louise Hailey
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Laura Howells
- Centre for Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Christine Bundy
- Behavioural Medicine/ Health Psychology School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Shona Kirtley
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Samantha Martin
- Nuffield Department of Primary Care Health Sciences, University of Oxford Nuffield, Oxford, UK
| | | | | | - Melissa Stepney
- Nuffield Department of Primary Care Health Sciences, University of Oxford Nuffield, Oxford, UK
| | - Laura C Coates
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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Hartmann-Boyce J, Theodoulou A, Oke JL, Butler AR, Bastounis A, Dunnigan A, Byadya R, Cobiac LJ, Scarborough P, Hobbs FR, Sniehotta FF, Jebb SA, Aveyard P. Long-Term Effect of Weight Regain Following Behavioral Weight Management Programs on Cardiometabolic Disease Incidence and Risk: Systematic Review and Meta-Analysis. Circ Cardiovasc Qual Outcomes 2023; 16:e009348. [PMID: 36974678 PMCID: PMC10106109 DOI: 10.1161/circoutcomes.122.009348] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 01/13/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND Behavioral weight management programs (BWMPs) enhance weight loss in the short term, but longer term cardiometabolic effects are uncertain as weight is commonly regained. We assessed the impact of weight regain after BWMPs on cardiovascular risk factors, diabetes, and cardiovascular disease. METHODS Trial registries, 11 databases, and forward-citation searching (latest search, December 19) were used to identify articles published in English, from any geographical region. Randomized trials of BWMPs in adults with overweight/obesity reporting cardiometabolic outcomes at ≥12 months at and after program end were included. Differences between more intensive interventions and comparator groups were synthesized using mixed-effects, meta-regression, and time-to-event models to assess the impact of weight regain on cardiovascular disease incidence and risk. RESULTS One hundred twenty-four trials reporting on ≥1 cardiometabolic outcomes with a median follow-up of 28 (range, 11-360) months after program end were included. Median baseline participant body mass index was 33 kg/m2; median age was 51 years. Eight and 15 study arms (7889 and 4202 participants, respectively) examined the incidence of cardiovascular disease and type 2 diabetes, respectively, with imprecise evidence of a lower incidence for at least 5 years. Weight regain in BWMPs relative to comparators reduced these differences. One and 5 years after program end, total cholesterol/HDL (high-density lipoprotein) ratio was 1.5 points lower at both times (82 studies; 19 003 participants), systolic blood pressure was 1.5 mm mercury and 0.4 mm lower (84 studies; 30 836 participants), and HbA1c (%) 0.38 lower at both times (94 studies; 28 083 participants). Of the included studies, 22% were judged at high risk of bias; removing these did not meaningfully change results. CONCLUSIONS Despite weight regain, BWMPs reduce cardiometabolic risk factors with effects lasting at least 5 years after program end and dwindling with weight regain. Evidence that they reduce the incidence of cardiovascular disease or diabetes is less certain. Few studies followed participants for ≥5 years. REGISTRATION URL: https://www.crd.york.ac.uk/PROSPERO/; Unique identifier: CRD42018105744.
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Affiliation(s)
- Jamie Hartmann-Boyce
- Nuffield Department of Primary Care Health Sciences (J.H.-B., A.T., A.R.B., A.B., R.B., F.D.R.H., S.A.J., P.A.), University of Oxford, United Kingdom
| | - Annika Theodoulou
- Nuffield Department of Primary Care Health Sciences (J.H.-B., A.T., A.R.B., A.B., R.B., F.D.R.H., S.A.J., P.A.), University of Oxford, United Kingdom
| | - Jason L. Oke
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, United Kingdom (J.L.O.)
| | - Ailsa R. Butler
- Nuffield Department of Primary Care Health Sciences (J.H.-B., A.T., A.R.B., A.B., R.B., F.D.R.H., S.A.J., P.A.), University of Oxford, United Kingdom
| | - Anastasios Bastounis
- Nuffield Department of Primary Care Health Sciences (J.H.-B., A.T., A.R.B., A.B., R.B., F.D.R.H., S.A.J., P.A.), University of Oxford, United Kingdom
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, United Kingdom (A.B.)
| | - Anna Dunnigan
- Oxford University Hospitals NHS Foundation Trust, United Kingdom (A.D.)
- Royal Free London NHS Foundation Trust, United Kingdom (A.D.)
| | - Rimu Byadya
- Nuffield Department of Primary Care Health Sciences (J.H.-B., A.T., A.R.B., A.B., R.B., F.D.R.H., S.A.J., P.A.), University of Oxford, United Kingdom
- United Nations World Food Programme, Cox’s Bazar, Bangladesh, India (R.B.)
| | - Linda J. Cobiac
- Nuffield Department of Population Health, Centre on Population Approaches for Non-Communicable Disease Prevention (L.J.C.), University of Oxford, United Kingdom
| | - Peter Scarborough
- Nuffield Department of Population Health, Oxford Biomedical Research Centre (P.S.), University of Oxford, United Kingdom
| | - F.D. Richard Hobbs
- Nuffield Department of Primary Care Health Sciences (J.H.-B., A.T., A.R.B., A.B., R.B., F.D.R.H., S.A.J., P.A.), University of Oxford, United Kingdom
| | - Falko F. Sniehotta
- Faculty of Medical Sciences, Population Health Sciences Institute, Newcastle University, United Kingdom (F.F.S.)
| | - Susan A. Jebb
- Nuffield Department of Primary Care Health Sciences (J.H.-B., A.T., A.R.B., A.B., R.B., F.D.R.H., S.A.J., P.A.), University of Oxford, United Kingdom
| | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences (J.H.-B., A.T., A.R.B., A.B., R.B., F.D.R.H., S.A.J., P.A.), University of Oxford, United Kingdom
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Miller ST, Akohoue SA, Murry VM, Tabatabai M, Wilus D, Foxx A. SISTER (Sisters Inspiring Sisters to Engage in Relevant Diabetes Self-Care) Diabetes Study: Protocol for diabetes medical nutrition therapy randomized clinical trial among African American women. Contemp Clin Trials 2023; 125:107052. [PMID: 36526256 DOI: 10.1016/j.cct.2022.107052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 12/08/2022] [Accepted: 12/12/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND African American (AA) women with type 2 diabetes (T2D) carry disproportionate diabetes-related morbidity and mortality burdens. Diabetes medical nutrition therapy (MNT) improves glycemic, blood pressure, and cholesterol control, all critical in preventing and reducing diabetes complications. Yet, MNT does not address low motivation for dietary intake management, which is frequently reported among AA women with T2D living in the Southeastern US. METHODS A randomized controlled trial will be used to test the central hypothesis that diabetes MNT plus culturally-tailored motivational interviewing (MI) (diabetes MNT plus MI) is more effective than diabetes MNT alone (diabetes MNT). Two hundred ninety-one Southeastern AA women who are at risk for development and/or progression of T2D complications will be randomized to diabetes MNT plus MI or diabetes MNT. Both groups will include: 1) a 3-month active intervention period, consisting of group-based, nutritionist-facilitated MNT sessions; 2) a 3-month maintenance intervention period, including one group-based, nutritionist-facilitated maintenance support session; and 3) a 6-month inactive period. Culturally-adapted MI exercises will be integrated into the diabetes MNT plus MI group only. Primary (HbA1c) and secondary (systolic blood pressure, LDL cholesterol) outcomes will be assessed at baseline and 3, 6, and 12 months following the active intervention period. DISCUSSION The results from this study, called the SISTER (Sisters Inspiring Sisters to Engage in Relevant Diabetes Self-Care) Diabetes Study, are vital to the adoption and uptake of rigorously-tested MNT interventions that address motivation among AA women with T2D as a way to reduce their risk and/or progression of diabetes-related complications.
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Affiliation(s)
- Stephania T Miller
- Department of Surgery, School of Medicine, Meharry Medical College, 1005 Dr. D.B. Todd, Jr. Blvd, Nashville, TN 37208-3599, USA.
| | - Sylvie A Akohoue
- Department of Family and Community Medicine, School of Medicine, Meharry Medical College, 1005 Dr. D.B. Todd, Jr. Blvd, Nashville, TN 37208-3599, USA
| | - Velma M Murry
- Departments of Health Policy & Human & Organizational Development, Vanderbilt University, 2525 West End, Ave., Nashville, TN 37203, USA
| | - Mohammad Tabatabai
- School of Graduate Studies and Research, Meharry Medical College, 1005 Dr. D.B. Todd, Jr. Blvd, Nashville, TN 37208-3599, USA
| | - Derek Wilus
- School of Graduate Studies and Research, Meharry Medical College, 1005 Dr. D.B. Todd, Jr. Blvd, Nashville, TN 37208-3599, USA
| | - Ardana Foxx
- Patient Advisory Group, SISTER Diabetes Study, Nashville, TN, USA
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Killeen OJ, Niziol LM, Cho J, Heisler M, Resnicow K, Darnley-Fisch D, Musch DC, Lee PP, Newman-Casey PA. Glaucoma Medication Adherence 1 Year after the Support, Educate, Empower Personalized Glaucoma Coaching Program. Ophthalmol Glaucoma 2023; 6:23-28. [PMID: 35953021 PMCID: PMC10246914 DOI: 10.1016/j.ogla.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 07/29/2022] [Accepted: 08/03/2022] [Indexed: 06/09/2023]
Abstract
PURPOSE To assess the efficacy of the Support, Educate, Empower (SEE) glaucoma coaching program on medication adherence among poorly adherent patients with glaucoma for 12 months after cessation of the intervention. DESIGN Uncontrolled intervention study with a pre-post design. PARTICIPANTS The SEE cohort was recruited from the University of Michigan and included patients with glaucoma aged ≥ 40 years, taking ≥ 1 medication, who self-reported poor adherence. Electronic medication monitoring of those who completed the program continued for up to 1 year after the coaching intervention. METHODS Adherence was monitored electronically (AdhereTech) during the 7-month program and 12-month follow-up period. Adherence was the percentage of doses taken on time. Participants were censored for surgery, change in glaucoma medications, or adherence monitor disuse. The SEE program included automated medication reminders, 3 in-person motivational interviewing-based counseling sessions with a glaucoma coach, and 5 phone calls with the coach for between-session support. There was no contact between the study team and participants during the 12-month follow-up after program cessation. Baseline participant characteristics were summarized with descriptive statistics. Paired t tests and Wilcoxon signed rank tests were used to investigate significant changes in monthly adherence during follow-up. MAIN OUTCOME MEASURES Change in electronically monitored medication adherence over the 12 months following the conclusion of the SEE program. RESULTS Of 48 participants, 39 (81%) completed the SEE program and continued electronic medication monitoring for up to 1 year after program cessation. The mean age of the participants was 64 years (standard deviation [SD], 10); of the 39 participants, 56% were male, 49% were Black, and 44% were White. The mean length of follow-up was 284 days (SD, 110; range, 41-365 days). Censoring occurred in 18 (56%) participants. The mean adherence during the follow-up period was 67% (SD, 22%). This was significantly lower than the adherence during the SEE program (mean, 81%; SD, 18%; P < 0.0001) but significantly higher than the baseline preprogram adherence (mean, 60%; SD, 18%; P = 0.0393). The largest monthly losses occurred at months 1 (mean, 7%; P = 0.0001) and 4 (mean, 6%; P = 0.0077). CONCLUSIONS Glaucoma medication adherence decreased significantly in the year after cessation of the SEE coaching program but remained significantly higher than baseline adherence. To maintain excellent long-term medication adherence, intermittent reinforcement sessions may be necessary.
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Affiliation(s)
- Olivia J Killeen
- Department of Ophthalmology and Visual Sciences, School of Medicine, University of Michigan, Ann Arbor, Michigan
| | - Leslie M Niziol
- Department of Ophthalmology and Visual Sciences, School of Medicine, University of Michigan, Ann Arbor, Michigan
| | - Juno Cho
- Department of Ophthalmology and Visual Sciences, School of Medicine, University of Michigan, Ann Arbor, Michigan
| | - Michele Heisler
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan; Department of Internal Medicine, School of Medicine, University of Michigan, Ann Arbor, Michigan
| | - Ken Resnicow
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | | | - David C Musch
- Department of Ophthalmology and Visual Sciences, School of Medicine, University of Michigan, Ann Arbor, Michigan; Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Paul P Lee
- Department of Ophthalmology and Visual Sciences, School of Medicine, University of Michigan, Ann Arbor, Michigan
| | - Paula Anne Newman-Casey
- Department of Ophthalmology and Visual Sciences, School of Medicine, University of Michigan, Ann Arbor, Michigan.
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Suh S, Cho N, Jeoung S, An H. Developing a Psychological Intervention for Decreasing Bedtime Procrastination: The BED-PRO Study. Behav Sleep Med 2022; 20:659-673. [PMID: 34524942 DOI: 10.1080/15402002.2021.1979004] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Bedtime Procrastination (BP) is defined as the behavior of going to bed later than intended, without having external reasons for doing so. Previous studies have shown that BP has a negative effect on sleep and health, emphasizing the need to develop interventions to decrease BP. This intervention development study is a proof-of-concept study for a psychological intervention designed for decreasing bedtime procrastination, namely BED-PRO. MATERIAL AND METHOD The intervention was developed based on behavioral modification principles and motivational interviewing techniques. The final intervention was a weekly three-session intervention, with one additional booster call. Twenty individuals with high BP participated in the study, and data was collected for pre- and post-intervention, and one-month follow-up. Individuals completed the Bedtime Procrastination Scale, Epworth Sleepiness Scale, Fatigue Severity Scale, Morningness-Eveningness Questionnaire, Insomnia Severity Index, and a sleep diary. RESULT Significant changes were found for BPS scores, bedtime procrastination duration (Δ51 mins, 63.8% reduction compared to baseline), wake after sleep onset, sleep efficiency and feeling refreshed upon awakening measured by sleep diaries following the intervention. In addition, changes in BPS, ISI, and ESS scores, wake after sleep onset, sleep efficiency and feeling refreshed upon awakening were maintained or continued to improve at 1-month follow-up. CONCLUSION This study verified the feasibility and acceptability of the BED-PRO intervention and the potential for being the first intervention to target bedtime procrastination. Considering the research about negative implications of BP, we expect that this intervention could be a step forward in considering BP as a serious health behavior.
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Affiliation(s)
- Sooyeon Suh
- Department of Psychology, Sungshin University, Seoul, Republic of Korea
| | - Nayoung Cho
- Department of Psychology, Sungshin University, Seoul, Republic of Korea
| | - Sonhye Jeoung
- Department of Psychology, Sungshin University, Seoul, Republic of Korea
| | - Hyeyoung An
- Department of Psychology, Sungshin University, Seoul, Republic of Korea
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Effects of health coaching on menopausal symptoms in postmenopausal and perimenopausal women. Menopause 2022; 29:1189-1195. [PMID: 36070877 DOI: 10.1097/gme.0000000000002050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aimed to determine the effects of health coaching on reducing menopausal symptoms in postmenopausal and perimenopausal women. METHODS This randomized controlled study was performed on 94 postmenopausal and perimenopausal women aged 45 to 55 years. The participants were randomly divided into intervention and control groups. In the intervention group, health coaching was performed in five coaching sessions biweekly (30-45 minutes each) by a midwifery coach. The primary outcome of this study was the menopausal score based on the modified Kupperman Index at 4 months after randomization. Depression (based on Zung's Self-Rating Depression Scale), physical activity (based on the International Physical Activity Questionnaire), quality of life (based on the 12-Item Short-Form Survey), smoking, alcohol intake, and anthropometric indices were also evaluated as secondary outcomes. RESULTS There was a significant mean difference between the coaching and control groups in terms of change in the scores of menopausal symptoms from baseline (T0) to 4 months after the intervention (T1; -12.51; 95% confidence interval [CI], -10.59 to -14.42; P = 0.001). Moreover, a significant mean difference was observed between the two groups in terms of change in depression symptoms from T0 to T1 (-5.72; 95% CI, -7.61 to -3.83; P < 0.001) and in terms of quality of life (4.13; 95% CI, 2.95 to 5.31; P < 0.001). Health coaching, however, had no effects on the physical activity of the participants. CONCLUSION Based on the present results, the coaching intervention is a suitable method to improve quality of life by reducing weight, waist circumference, body mass index, depression, and menopausal symptoms in postmenopausal and perimenopausal women. It can have important effects on the development of health promotion programs to reduce menopausal symptoms in menopause clinics.
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Bilgin A, Muz G, Yuce GE. The effect of motivational interviewing on metabolic control and psychosocial variables in individuals diagnosed with diabetes: Systematic review and meta-analysis. PATIENT EDUCATION AND COUNSELING 2022; 105:2806-2823. [PMID: 35501227 DOI: 10.1016/j.pec.2022.04.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 04/03/2022] [Accepted: 04/12/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE The current study aimed to analyze the effects of motivational interviewing (MI) on metabolic and psychosocial variables among individuals with diabetes. METHODS Four databases were searched between 2000 and 2021 years. Randomized controlled studies were included. The standardized mean differences were determined. The heterogeneity was analyzed using the I2 test. The methodological quality was evaluated independently by three researchers. RESULTS This meta-analysis included 16 studies. Glycated hemoglobin, postprandial plasma glucose (PG), systolic blood pressure (BP) significantly decreased after MI. There are no significant effects of MI on fasting PG, body mass index, diastolic BP, total cholesterol, high-density lipoprotein, low-density lipoprotein and triglyceride. MI had an overall significant impact on depression, emotional distress, and self-efficacy. Only four studies had 7 points based on the Modified Jadad Scale. The Egger's test showed no evidence of publication bias. CONCLUSION MI effectively reduced glycated hemoglobin, postprandial plasma glucose, systolic blood pressure, depressive symptoms, emotional distress, and increased self-efficacy. PRACTICE IMPLICATIONS This meta-analysis showed that MI was effective at improving metabolic control and psychosocial variables. MI should be considered a complementary treatment for people diagnosed with diabetes. Future studies should be structured as long-term studies with higher methodological quality.
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Affiliation(s)
- Aylin Bilgin
- Hacettepe University, Faculty of Nursing, Internal Medicine Nursing Department, Ankara, Turkey
| | - Gamze Muz
- Nevsehir Haci Bektas Veli University, Department of Internal Medicine Nursing, Nevsehir, Turkey.
| | - Gulyeter Erdogan Yuce
- Aksaray University, Department of Emergency Assistance and Disaster Management, Aksaray, Turkey
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11
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Jayedi A, Zeraattalab-Motlagh S, Jabbarzadeh B, Hosseini Y, Jibril AT, Shahinfar H, Mirrafiei A, Hosseini F, Bidar SS. Dose-dependent effect of carbohydrate restriction for type 2 diabetes management: a systematic review and dose-response meta-analysis of randomized controlled trials. Am J Clin Nutr 2022; 116:40-56. [PMID: 35537861 DOI: 10.1093/ajcn/nqac066] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 03/09/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Carbohydrate restriction is effective for type 2 diabetes management. OBJECTIVES We aimed to evaluate the dose-dependent effect of carbohydrate restriction in patients with type 2 diabetes. METHODS We systematically searched PubMed, Scopus, and Web of Science to May 2021 for randomized controlled trials evaluating the effect of a carbohydrate-restricted diet (≤45% total calories) in patients with type 2 diabetes. The primary outcome was glycated hemoglobin (HbA1c). Secondary outcomes included fasting plasma glucose (FPG); body weight; serum total, LDL, and HDL cholesterol; triglyceride (TG); and systolic blood pressure (SBP). We performed random-effects dose-response meta-analyses to estimate mean differences (MDs) for a 10% decrease in carbohydrate intake. RESULTS Fifty trials with 4291 patients were identified. At 6 months, compared with a carbohydrate intake between 55%-65% and through a maximum reduction down to 10%, each 10% reduction in carbohydrate intake reduced HbA1c (MD, -0.20%; 95% CI, -0.27% to -0.13%), FPG (MD, -0.34 mmol/L; 95% CI, -0.56 to -0.12 mmol/L), and body weight (MD, -1.44 kg; 95% CI, -1.82 to -1.06 kg). There were also reductions in total cholesterol, LDL cholesterol, TG, and SBP. Levels of HbA1c, FPG, body weight, TG, and SBP decreased linearly with the decrease in carbohydrate intake from 65% to 10%. A U-shaped effect was seen for total cholesterol and LDL cholesterol, with the greatest reduction at 40%. At 12 months, a linear reduction was seen for HbA1c and TG. A U-shaped effect was seen for body weight, with the greatest reduction at 35%. CONCLUSIONS Carbohydrate restriction can exert a significant and important reduction on levels of cardiometabolic risk factors in patients with type 2 diabetes. Levels of most cardiometabolic outcomes decreased linearly with the decrease in carbohydrate intake. U-shaped effects were seen for total cholesterol and LDL cholesterol at 6 months and for body weight at 12 months.
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Affiliation(s)
- Ahmad Jayedi
- Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran.,Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Sheida Zeraattalab-Motlagh
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Bahareh Jabbarzadeh
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Yasaman Hosseini
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Aliyu Tijen Jibril
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Shahinfar
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Amin Mirrafiei
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Hosseini
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Sakineh Shab- Bidar
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
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Solomon S, Shank LM, Lavender JM, Higgins Neyland MK, Gallager-Teske J, Markos B, Haynes H, Repke H, Rice AJ, Sbrocco T, Wilfley DE, Schvey NA, Jorgensen S, Ford B, Ford CB, Haigney M, Klein DA, Quinlan J, Tanofsky‐Kraff M. The Relationship Between Anxiety, Coping, and Disordered-Eating Attitudes in Adolescent Military-Dependents at High-Risk for Excess Weight Gain. MILITARY PSYCHOLOGY 2022; 35:95-106. [PMID: 36968637 PMCID: PMC10012895 DOI: 10.1080/08995605.2022.2083448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 05/23/2022] [Indexed: 10/18/2022]
Abstract
Adolescent military-dependents are an understudied population who face unique stressors due to their parents' careers. Research suggests that adolescent military-dependents report more anxiety and disordered-eating than their civilian counterparts. While anxiety symptoms predict the onset and worsening of disordered-eating attitudes, the mechanisms underlying this relationship remain unclear. One factor that may underlie this relationship, and be particularly relevant for military-dependent youth, is coping. Therefore, we examined adolescent military-dependents (N=136; 14.5±1.5 years; 59.6% female; BMI-z: 1.9±0.4) who were at-risk for adult obesity and binge-eating disorder due to an age- and sex-adjusted BMI ≥ 85th percentile and loss-of-control eating and/or elevated anxiety. Participants completed an interview assessing disordered-eating attitudes and questionnaires on anxiety symptoms and coping strategies at a single time point. Bootstrapping models were conducted to examine the indirect paths between anxiety symptoms and disordered-eating attitudes through five coping subscales (aggression, distraction, endurance, self-distraction, and stress-recognition). Adjusting for relevant covariates, no significant indirect paths through the coping subscales (ps > .05) were found in any models. General coping, non-specific to eating, may not be a pathway between anxiety symptoms and disordered-eating attitudes among adolescents. Future research should examine other potential mediators of this relationship.
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Affiliation(s)
- Senait Solomon
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USU), Bethesda, Maryland, USA
- Military Cardiovascular Outcomes Research (MiCOR) Program, USU, Bethesda, Maryland, USA
- Metis Foundation, San Antonio, Texas, USA
| | - Lisa M. Shank
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USU), Bethesda, Maryland, USA
- Military Cardiovascular Outcomes Research (MiCOR) Program, USU, Bethesda, Maryland, USA
- Metis Foundation, San Antonio, Texas, USA
- Department of Medicine, USU, Bethesda, Maryland, USA
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, DHHS, Bethesda, Maryland, USA
| | - Jason M. Lavender
- Military Cardiovascular Outcomes Research (MiCOR) Program, USU, Bethesda, Maryland, USA
- Metis Foundation, San Antonio, Texas, USA
- Department of Medicine, USU, Bethesda, Maryland, USA
| | - M. K. Higgins Neyland
- Military Cardiovascular Outcomes Research (MiCOR) Program, USU, Bethesda, Maryland, USA
- Metis Foundation, San Antonio, Texas, USA
- Department of Medicine, USU, Bethesda, Maryland, USA
| | - Julia Gallager-Teske
- Military Cardiovascular Outcomes Research (MiCOR) Program, USU, Bethesda, Maryland, USA
- Metis Foundation, San Antonio, Texas, USA
- Department of Medicine, USU, Bethesda, Maryland, USA
| | - Bethelhem Markos
- Military Cardiovascular Outcomes Research (MiCOR) Program, USU, Bethesda, Maryland, USA
- Metis Foundation, San Antonio, Texas, USA
- Department of Medicine, USU, Bethesda, Maryland, USA
| | - Hannah Haynes
- Military Cardiovascular Outcomes Research (MiCOR) Program, USU, Bethesda, Maryland, USA
- Metis Foundation, San Antonio, Texas, USA
- Department of Medicine, USU, Bethesda, Maryland, USA
| | - Hannah Repke
- Military Cardiovascular Outcomes Research (MiCOR) Program, USU, Bethesda, Maryland, USA
- Metis Foundation, San Antonio, Texas, USA
- Department of Medicine, USU, Bethesda, Maryland, USA
| | - Alexander J. Rice
- Military Cardiovascular Outcomes Research (MiCOR) Program, USU, Bethesda, Maryland, USA
- Metis Foundation, San Antonio, Texas, USA
- Department of Medicine, USU, Bethesda, Maryland, USA
| | - Tracy Sbrocco
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USU), Bethesda, Maryland, USA
| | - Denise E. Wilfley
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Natasha A. Schvey
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USU), Bethesda, Maryland, USA
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, DHHS, Bethesda, Maryland, USA
| | - Sarah Jorgensen
- Department of Family Medicine, University of Iowa Hospitals & Clinics, Iowa City, Iowa, USA
| | - Brian Ford
- Department of Family Medicine, USU, Bethesda, Maryland, USA
| | - Caitlin B. Ford
- Department of Family Medicine, Fort Belvoir Community Hospital, Fort Belvoir, Virginia, USA
| | - Mark Haigney
- Military Cardiovascular Outcomes Research (MiCOR) Program, USU, Bethesda, Maryland, USA
- Department of Medicine, USU, Bethesda, Maryland, USA
| | - David A. Klein
- Department of Family Medicine, USU, Bethesda, Maryland, USA
- Department of Pediatrics, USU, Bethesda, Maryland, USA
| | - Jeffrey Quinlan
- Department of Family Medicine, University of Iowa Hospitals & Clinics, Iowa City, Iowa, USA
| | - Marian Tanofsky‐Kraff
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USU), Bethesda, Maryland, USA
- Military Cardiovascular Outcomes Research (MiCOR) Program, USU, Bethesda, Maryland, USA
- Department of Medicine, USU, Bethesda, Maryland, USA
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, DHHS, Bethesda, Maryland, USA
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González-Rivas JP, Pavlovska I, Polcrova A, Nieto-Martínez R, Mechanick JI. Transcultural Lifestyle Medicine in Type 2 Diabetes Care: Narrative Review of the Literature. Am J Lifestyle Med 2022. [DOI: 10.1177/15598276221095048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Disparities in type 2 diabetes (T2D) care is a global problem across diverse cultures. The Dysglycemia-Based Chronic Disease (DBCD) model promotes early and sustainable interventions along the insulin resistance (stage 1), prediabetes (stage 2), T2D (stage 3), and complications (stage 4) spectrum. In this model, lifestyle medicine is the cornerstone of preventive care to reduce DBCD progression and the socioeconomic/biological burden of disease. A comprehensive literature review, spanning 2000 to 2021, was performed and 55 studies were included examining the effects of lifestyle medicine and their cultural adaptions with different prevention modalities. In stage 1, primordial prevention targets modifiable primary drivers (behavior and environment), unhealthy lifestyles, abnormal adiposity, and insulin resistance with educational and motivational health promotion activities at individual, group, community, and population-based scales. Primary, secondary, and tertiary prevention targets individuals with mild hyperglycemia, severe hyperglycemia, and complications, respectively, using programs that incorporate structured lifestyle interventions. Culturally adapted lifestyle change in primary and secondary prevention improved quality of life and biomarkers, but with a limited impact of tertiary prevention on cardiovascular events. In conclusion, lifestyle medicine with cultural adaptations is an integral part of preventive care in patients with T2D. However, considerable research gaps exist, especially for tertiary prevention.
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Affiliation(s)
- Juan P. González-Rivas
- International Clinical Research Centre (ICRC), St Anne’s University Hospital Brno (FNUSA), Czech Republic
- Departments of Global Health and Population and Epidemiology, Harvard TH Chan School of Public Health. Harvard University, Boston, MA, USA
- Foundation for Clinic, Public Health, and Epidemiology Research of Venezuela (FISPEVEN INC), Caracas, Venezuela
| | - Iuliia Pavlovska
- International Clinical Research Centre (ICRC), St Anne’s University Hospital Brno (FNUSA), Czech Republic
- Department of Public Health, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Anna Polcrova
- International Clinical Research Centre (ICRC), St Anne’s University Hospital Brno (FNUSA), Czech Republic
- RECETOX, Faculty of Science, Masaryk University, Kotlarska 2, Brno, Czech Republic
| | - Ramfis Nieto-Martínez
- Departments of Global Health and Population and Epidemiology, Harvard TH Chan School of Public Health. Harvard University, Boston, MA, USA
- Foundation for Clinic, Public Health, and Epidemiology Research of Venezuela (FISPEVEN INC), Caracas, Venezuela
- LifeDoc Health, Memphis, TN, USA
| | - Jeffrey I. Mechanick
- he Marie-Josée and Henry R. Kravis Center for Cardiovascular Health at Mount Sinai Heart, and Division of Endocrinology, Diabetes and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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14
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Michalopoulou M, Ferrey AE, Harmer G, Goddard L, Kebbe M, Theodoulou A, Jebb SA, Aveyard P. Effectiveness of Motivational Interviewing in Managing Overweight and Obesity : A Systematic Review and Meta-analysis. Ann Intern Med 2022; 175:838-850. [PMID: 35344379 DOI: 10.7326/m21-3128] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Motivational interviewing (MI) is potentially useful in management of overweight and obesity, but staff training and increased delivery time are barriers, and its effectiveness independent of other behavioral components is unclear. PURPOSE To assess the independent contribution of MI as part of a behavioral weight management program (BWMP) in controlling weight and improving psychological well-being. DATA SOURCES 6 electronic databases and 2 trial registries, searched from database inception through 24 September 2021. STUDY SELECTION Randomized controlled trials in adults or adolescents aimed at weight loss or maintenance and comparing programs incorporating MI versus interventions without MI. DATA EXTRACTION Two reviewers independently screened studies, extracted data, and assessed risk of bias. Outcomes included weight, anxiety, depression, quality of life, and other aspects of psychological well-being. Pooled mean differences or standardized mean differences were obtained using random- and fixed-effects meta-analyses. DATA SYNTHESIS Forty-six studies involving 11 077 participants, predominantly with obesity, were included. At 6 months, BWMPs using MI were more effective than no/minimal intervention (-0.88 [95% CI, -1.27 to -0.48] kg; I 2 = 0%) but were not statistically significantly more effective than lower-intensity (-0.88 [CI, -2.39 to 0.62] kg; I 2 = 55.8%) or similar-intensity (-1.36 [CI, -2.80 to 0.07] kg; I 2 = 18.8%) BWMPs. At 1 year, data were too sparse to pool comparisons with no/minimal intervention, but MI did not produce statistically significantly greater weight change compared with lower-intensity (-1.16 [CI, -2.49 to 0.17] kg; I 2 = 88.7%) or similar-intensity (-0.18 [CI, -2.40 to 2.04] kg; I 2 = 72.7%) BWMPs without MI. Studies with 18-month follow-up were also sparse; MI did not produce statistically significant benefit in any of the comparator categories. There was no evidence of subgroup differences based on study, participant, or intervention characteristics. Too few studies assessed effects on psychological well-being to pool, but data did not suggest that MI was independently effective. LIMITATIONS High statistical heterogeneity among studies, largely unexplained by sensitivity and subgroup analyses; stratification by comparator intensity and follow-up duration resulted in pooling of few studies. CONCLUSION There is no evidence that MI increases effectiveness of BWMPs in controlling weight. Given the intensive training required for its delivery, MI may not be a worthwhile addition to BWMPs. PRIMARY FUNDING SOURCE National Institute for Health Research Biomedical Research Centre. (PROSPERO: CRD42020177259).
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Affiliation(s)
- Moscho Michalopoulou
- Nuffield Department of Primary Care Health Sciences, Radcliffe Primary Care Building, University of Oxford, and National Institute for Health Research Oxford Biomedical Research Centre, Oxford University Hospitals, Oxford, United Kingdom (M.M., A.E.F., S.A.J., P.A.)
| | - Anne E Ferrey
- Nuffield Department of Primary Care Health Sciences, Radcliffe Primary Care Building, University of Oxford, and National Institute for Health Research Oxford Biomedical Research Centre, Oxford University Hospitals, Oxford, United Kingdom (M.M., A.E.F., S.A.J., P.A.)
| | - Georgina Harmer
- Nuffield Department of Primary Care Health Sciences, Radcliffe Primary Care Building, University of Oxford, Oxford, United Kingdom (G.H., L.G., M.K., A.T.)
| | - Lucy Goddard
- Nuffield Department of Primary Care Health Sciences, Radcliffe Primary Care Building, University of Oxford, Oxford, United Kingdom (G.H., L.G., M.K., A.T.)
| | - Maryam Kebbe
- Nuffield Department of Primary Care Health Sciences, Radcliffe Primary Care Building, University of Oxford, Oxford, United Kingdom (G.H., L.G., M.K., A.T.)
| | - Annika Theodoulou
- Nuffield Department of Primary Care Health Sciences, Radcliffe Primary Care Building, University of Oxford, Oxford, United Kingdom (G.H., L.G., M.K., A.T.)
| | - Susan A Jebb
- Nuffield Department of Primary Care Health Sciences, Radcliffe Primary Care Building, University of Oxford, and National Institute for Health Research Oxford Biomedical Research Centre, Oxford University Hospitals, Oxford, United Kingdom (M.M., A.E.F., S.A.J., P.A.)
| | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, Radcliffe Primary Care Building, University of Oxford, and National Institute for Health Research Oxford Biomedical Research Centre, Oxford University Hospitals, Oxford, United Kingdom (M.M., A.E.F., S.A.J., P.A.)
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15
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Kinsey AW, Phillips J, Desmond R, Gowey M, Jones C, Ard J, Clark JM, Lewis CE, Dutton GR. Factors Associated with Weight Loss Maintenance and Weight Regain Among African American and White Adults Initially Successful at Weight Loss. J Racial Ethn Health Disparities 2022; 9:546-565. [PMID: 33544328 PMCID: PMC8339173 DOI: 10.1007/s40615-021-00985-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 01/27/2021] [Accepted: 01/28/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Providing ongoing treatment through extended care programs can improve weight loss maintenance (WLM), but the effectiveness of these programs for African Americans (AA) are mixed and may be due to unique cultural factors. PURPOSE To identify, prioritize, and organize factors associated with WLM as experienced by AA and White adults initially successful with weight loss. METHODS Adults identified their greatest amount of lifetime weight loss, and those achieving ≥5% weight loss were classified as maintainers (continued >5% weight reduction for ≥1 year) or regainers (≤5% weight reduction) based on current weight. The nominal group technique was conducted to identify and rank WLM facilitators and barriers. Online card sorting tasks and hierarchical clustering were performed to illustrate conceptual relationships between facilitators (maintainers only) and barriers (regainers only). RESULTS Participants (maintainers, n = 46; regainers, n = 58; 81.7% women, 48.1% AA) identified known factors associated with successful weight management (daily weighing, self-monitoring, regular physical activity, mindful eating). However, the perceived importance of these factors differed between groups (maintainer vs. regainers; AA vs. Whites). Unique factors affecting WLM were also identified (refresher groups recommended by White maintainers and regainers; self-accountability identified by AA maintainers). Salient facilitators and barriers were best represented in 2-3 clusters; each group had ≥1 unique cluster(s) revealing group-specific higher-order domains associated with successful WLM. CONCLUSIONS As lifestyle interventions for WLM (particularly for AA) are developed, attention to the preferences, and lived experiences of these groups is recommended. Strategies targeting physical activity maintenance and autonomy-supportive approaches may improve WLM among AA.
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Affiliation(s)
- Amber W Kinsey
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, 1717 11th Avenue South, Medical Towers 615, Birmingham, AL, 35205, USA
| | - Janice Phillips
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, 1717 11th Avenue South, Medical Towers 615, Birmingham, AL, 35205, USA
| | - Renee Desmond
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, 1717 11th Avenue South, Medical Towers 615, Birmingham, AL, 35205, USA
| | - Marissa Gowey
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Catherine Jones
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jamy Ard
- Wake Forest School of Medicine, Wake Forest University, Winston-Salem, NC, USA
| | - Jeanne M Clark
- Division of General Internal Medicine, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Cora E Lewis
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Gareth R Dutton
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, 1717 11th Avenue South, Medical Towers 615, Birmingham, AL, 35205, USA.
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Brown LD, Vasquez D, Lopez DI, Portillo EM. Addressing Hispanic Obesity Disparities Using a Community Health Worker Model Grounded in Motivational Interviewing. Am J Health Promot 2022; 36:259-268. [PMID: 34791885 PMCID: PMC8995140 DOI: 10.1177/08901171211049679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE To determine whether Hispanic residents receiving the Healthy Fit intervention enhanced with Motivational Interviewing (MI) experienced greater improvements in body composition, relative to participants receiving the initial intervention. DESIGN Quasi-experimental evaluation. SETTING El Paso, Texas. SAMPLE Among 656 baseline participants, 374 (54%) completed the 12-month assessment. INTERVENTION In Healthy Fit, community health workers (CHWs) promote nutrition and exercise. To strengthen intrinsic motivation and help participants overcome barriers to change, we incorporated a 30-minute motivational interview into the baseline assessment. Follow-up phone calls at 1, 3, and 6 months were identical across conditions. MEASURES CHWs assessed body mass index (BMI) and body fat percentage (BFP) using a bioelectrical impedance scale. ANALYSIS Regression models estimated differences between intervention conditions on change in BMI and BFP from baseline to the 12-month assessment. RESULTS Participants receiving MI had 2.13 times higher odds of losing weight (OR = 2.14, 95% CI [1.30, 3.53], P = .003) and 2.59 times higher odds of reduced BFP (OR = 2.59, 95% CI [1.51, 4.41], P < .001), relative to initial intervention participants. MI participants lost an average of 1.23 kg (2.71 lbs.) and their BFP declined 2% over 12 months. CONCLUSION Findings suggest CHW use of MI is a promising approach for promoting incremental changes in diet and exercise, which Healthy Fit integrates into a low-cost intervention.
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Affiliation(s)
- Louis D. Brown
- School of Public Health, The University of Texas Health Science Center at Houston, El Paso, TX, USA
| | - Denise Vasquez
- School of Public Health, The University of Texas Health Science Center at Houston, El Paso, TX, USA
| | - Diane I. Lopez
- School of Public Health, The University of Texas Health Science Center at Houston, El Paso, TX, USA
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Buro AW, Baskin M, Miller D, Ward T, West DS, Gore LR, Gwede CK, Epel E, Carson TL. Rationale and study protocol for a randomized controlled trial to determine the effectiveness of a culturally relevant, stress management enhanced behavioral weight loss intervention on weight loss outcomes of black women. BMC Public Health 2022; 22:193. [PMID: 35090433 PMCID: PMC8795937 DOI: 10.1186/s12889-022-12519-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 01/05/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Obesity is a persistent public health concern and a risk factor for many chronic diseases including at least 13 different cancers. Adult Black females have the highest prevalence of obesity (57%) compared to other racial/gender groups in the U.S. Although behavioral weight loss (BWL) interventions have demonstrated effectiveness, Black females tend to lose less weight than White counterparts. The higher prevalence of chronic psychological stress reported by Black females may contribute to their disproportionate prevalence of obesity and observed suboptimal weight loss. This study will examine the effectiveness of a 12-month culturally-targeted, stress management-enhanced BWL intervention on weight loss and stress reduction among Black females in a fully-powered randomized, controlled trial. METHODS Adult Black females with obesity (n = 340) will be randomized to either a culturally targeted stress management-enhanced BWL intervention (BWL-Stress) or the same BWL intervention alone (BWL-alone). The primary outcome is weight change at month 6. Secondary outcomes will include changes in stress measures (e.g., perceived stress, cortisol), energy intake, and physical activity at month 6. We will also assess process measures (e.g., treatment adherence, treatment burden). Each outcome will also be evaluated at month 12 to assess longer-term effects of the intervention. DISCUSSION This novel approach for enhancing an evidence-based BWL program with culturally-targeted stress management strategies for Black females addresses an understudied barrier to effective weight management among a population at high risk for obesity and obesity-related chronic diseases. This study will potentially elucidate psychological or behavioral mechanisms linking our novel intervention to study outcomes. If the intervention is proven to be effective, this study will have significant clinical and public health implications for weight management among Black females. TRIAL REGISTRATION This study was registered on ClinicalTrials.gov , identifier NCT04335799t , on April 6, 2020.
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Affiliation(s)
- Acadia W Buro
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 4117 E Fowler Ave, Tampa, FL, 33617, USA
| | - Monica Baskin
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Darci Miller
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 4117 E Fowler Ave, Tampa, FL, 33617, USA
| | - Tayler Ward
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 4117 E Fowler Ave, Tampa, FL, 33617, USA
| | - Delia Smith West
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - L Robert Gore
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, FL, USA
| | - Clement K Gwede
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 4117 E Fowler Ave, Tampa, FL, 33617, USA
| | - Elissa Epel
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA
| | - Tiffany L Carson
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 4117 E Fowler Ave, Tampa, FL, 33617, USA.
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Winkley K, Upsher R, Stahl D, Pollard D, Kasera A, Brennan A, Heller S, Ismail K. Psychological interventions to improve self-management of type 1 and type 2 diabetes: a systematic review. Health Technol Assess 2021; 24:1-232. [PMID: 32568666 DOI: 10.3310/hta24280] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND For people with diabetes mellitus to achieve optimal glycaemic control, motivation to perform self-management is important. The research team wanted to determine whether or not psychological interventions are clinically effective and cost-effective in increasing self-management and improving glycaemic control. OBJECTIVES The first objective was to determine the clinical effectiveness of psychological interventions for people with type 1 diabetes mellitus and people with type 2 diabetes mellitus so that they have improved (1) glycated haemoglobin levels, (2) diabetes self-management and (3) quality of life, and fewer depressive symptoms. The second objective was to determine the cost-effectiveness of psychological interventions. DATA SOURCES The following databases were accessed (searches took place between 2003 and 2016): MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, PsycINFO, EMBASE, Cochrane Controlled Trials Register, Web of Science, and Dissertation Abstracts International. Diabetes conference abstracts, reference lists of included studies and Clinicaltrials.gov trial registry were also searched. REVIEW METHODS Systematic review, aggregate meta-analysis, network meta-analysis, individual patient data meta-analysis and cost-effectiveness modelling were all used. Risk of bias of randomised and non-randomised controlled trials was assessed using the Cochrane Handbook (Higgins JP, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, et al. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ 2011;343:d5928). DESIGN Systematic review, meta-analysis, cost-effectiveness analysis and patient and public consultation were all used. SETTING Settings in primary or secondary care were included. PARTICIPANTS Adolescents and children with type 1 diabetes mellitus and adults with types 1 and 2 diabetes mellitus were included. INTERVENTIONS The interventions used were psychological treatments, including and not restricted to cognitive-behavioural therapy, counselling, family therapy and psychotherapy. MAIN OUTCOME MEASURES Glycated haemoglobin levels, self-management behaviours, body mass index, blood pressure levels, depressive symptoms and quality of life were all used as outcome measures. RESULTS A total of 96 studies were included in the systematic review (n = 18,659 participants). In random-effects meta-analysis, data on glycated haemoglobin levels were available for seven studies conducted in adults with type 1 diabetes mellitus (n = 851 participants) that demonstrated a pooled mean difference of -0.13 (95% confidence interval -0.33 to 0.07), a non-significant decrease in favour of psychological treatment; 18 studies conducted in adolescents/children with type 1 diabetes mellitus (n = 2583 participants) that demonstrated a pooled mean difference of 0.00 (95% confidence interval -0.18 to 0.18), indicating no change; and 49 studies conducted in adults with type 2 diabetes mellitus (n = 12,009 participants) that demonstrated a pooled mean difference of -0.21 (95% confidence interval -0.31 to -0.10), equivalent to reduction in glycated haemoglobin levels of -0.33% or ≈3.5 mmol/mol. For type 2 diabetes mellitus, there was evidence that psychological interventions improved dietary behaviour and quality of life but not blood pressure, body mass index or depressive symptoms. The results of the network meta-analysis, which considers direct and indirect effects of multiple treatment comparisons, suggest that, for adults with type 1 diabetes mellitus (7 studies; 968 participants), attention control and cognitive-behavioural therapy are clinically effective and cognitive-behavioural therapy is cost-effective. For adults with type 2 diabetes mellitus (49 studies; 12,409 participants), cognitive-behavioural therapy and counselling are effective and cognitive-behavioural therapy is potentially cost-effective. The results of the individual patient data meta-analysis for adolescents/children with type 1 diabetes mellitus (9 studies; 1392 participants) suggest that there were main effects for age and diabetes duration. For adults with type 2 diabetes mellitus (19 studies; 3639 participants), baseline glycated haemoglobin levels moderated treatment outcome. LIMITATIONS Aggregate meta-analysis was limited to glycaemic control for type 1 diabetes mellitus. It was not possible to model cost-effectiveness for adolescents/children with type 1 diabetes mellitus and modelling for type 2 diabetes mellitus involved substantial uncertainty. The individual patient data meta-analysis included only 40-50% of studies. CONCLUSIONS This review suggests that psychological treatments offer minimal clinical benefit in improving glycated haemoglobin levels for adults with type 2 diabetes mellitus. However, there was no evidence of benefit compared with control interventions in improving glycated haemoglobin levels for people with type 1 diabetes mellitus. FUTURE WORK Future work should consider the competency of the interventionists delivering a therapy and psychological approaches that are matched to a person and their life course. STUDY REGISTRATION This study is registered as PROSPERO CRD42016033619. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 28. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Kirsty Winkley
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK
| | - Rebecca Upsher
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Daniel Stahl
- Department of Biostatistics, Institute of Psychiatry, King's College London, London, UK
| | - Daniel Pollard
- Health Economics and Decision Science, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Architaa Kasera
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Alan Brennan
- Health Economics and Decision Science, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Simon Heller
- Academic Unit of Diabetes, Endocrinology and Metabolism, Department of Oncology & Metabolism, University of Sheffield, Sheffield, UK
| | - Khalida Ismail
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Makin H, Chisholm A, Fallon V, Goodwin L. Use of motivational interviewing in behavioural interventions among adults with obesity: A systematic review and meta-analysis. Clin Obes 2021; 11:e12457. [PMID: 33955152 DOI: 10.1111/cob.12457] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 03/29/2021] [Accepted: 04/06/2021] [Indexed: 01/29/2023]
Abstract
This review aimed to identify whether motivational interviewing (MI) (a counselling approach for supporting behaviour change [BC]) helps to reduce bodyweight and BMI in an adult obesity context. This included evaluating effectiveness of MI interventions within this population and reporting the methodology used, including theoretical underpinnings and identification of BC and MI techniques. Eight databases were searched using controlled vocabulary. Eligible studies included adults with obesity (BMI ≥30 kg/m2 ), author-reported interventions using MI aiming to reduce body weight or BMI, and comparator groups not receiving an MI intervention. Data extraction and quality appraisal tools were used to identify study characteristics, intervention content was coded for techniques, and random-effects meta-analysis were conducted to investigate effects. Meta-analysis of 12 studies indicated no overall pooled effect on bodyweight and BMI outcomes between intervention and control groups (SMD = -0.01 [95%CI -0.13 to 0.12, P = .93]). Findings were limited by multiple sources accounting for risk of bias, and poor reporting of intervention fidelity and content. Intervention and control content descriptions indicated similar techniques, with social support, goal setting (behaviour) and self-monitoring of behaviour occurring most frequently across both. Findings do not contribute additional evidence for MI use in this context, however methodological limitations were identified which must be resolved to better identify the intervention effects on obesity-related outcomes.
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Affiliation(s)
- Harriet Makin
- Department of Psychology, Institute of Population Health, University of Liverpool, Merseyside, UK
| | - Anna Chisholm
- Department of Psychology, Institute of Population Health, University of Liverpool, Merseyside, UK
| | - Victoria Fallon
- Department of Psychology, Institute of Population Health, University of Liverpool, Merseyside, UK
| | - Laura Goodwin
- Department of Psychology, Institute of Population Health, University of Liverpool, Merseyside, UK
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20
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Reading JM, Snell LM, LaRose JG. A systematic review of weight-related communication trainings for physicians. Transl Behav Med 2021; 10:1110-1119. [PMID: 33044535 DOI: 10.1093/tbm/ibaa014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Obesity is a leading cause of preventable death in the USA. Given the high number of adults seeking routine health care services, physicians have an opportunity to address weight loss during routine clinical encounters. It's often reported that physicians lack the training to address weight. Training programs are implemented in medical settings to prepare physicians to have conversations with patients. Yet, the degree of consistency among training programs and factors associated with better outcomes is unclear. The purpose of this study is to systematically review literature in physician communication trainings related to weight-to compare the content, outcomes, and implementation of existing studies examining weight-related communication training programs for physicians and determine factors associated with physician and patient outcomes. Articles were extracted from PubMed, Proquest, and Embase. Search terms included: health communication, physician training, weight, and obesity. Studies implementing a training program addressing weight among physicians were included. Trainings using either motivational interviewing (MI) or 5 As (Ask, Advise, Assess, Assist, and Arrange) framework found improvements in physicians' communication skills. A small number of trainings including experiential components were also associated with improvements in positive physician outcomes. Findings suggest trainings based in MI or 5 As framework improve physicians' communication skills, but few programs affected patient outcomes. Gaps remain with trainings that can demonstrate weight loss in patients. While work is needed to enhance the effects of these trainings on patient outcomes, data suggest that trainings should be longer in duration and include an experiential component.
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Affiliation(s)
- Jean M Reading
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - L Morgan Snell
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Jessica Gokee LaRose
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
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21
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Upsher R, Onabajo D, Stahl D, Ismail K, Winkley K. The Effectiveness of Behavior Change Techniques Underpinning Psychological Interventions to Improve Glycemic Levels for Adults With Type 2 Diabetes: A Meta-Analysis. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2021; 2:699038. [PMID: 36994330 PMCID: PMC10012110 DOI: 10.3389/fcdhc.2021.699038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 06/18/2021] [Indexed: 11/13/2022]
Abstract
An existing systematic review and meta-analysis found a significant reduction in glycemic levels for adults with type 2 diabetes who received a psychological intervention over control conditions. To help develop effective interventions in the future, there is a need to understand the active ingredients which underpin these psychological interventions. We conducted a secondary meta-analysis including 67 randomized controlled trials (RCTs) reported in English. We reviewed the psychological intervention descriptions of the included studies of the existing review and extracted the behavior change techniques (BCTs) according to the BCT taxonomy (BCTTv1). We also extracted information on primary behavioral target versus primary outcome, and presence of fidelity assessment. The most frequent BCTs across RCTs were ‘social support (unspecified)’ (n=50), ‘problem solving’ (n=38) and ‘goal setting (behavior’) (n=30). These BCTs were independently associated with a significant reduction in glycemic levels (HbA1c) compared to control conditions, but not significantly different from studies that did not include these BCTs. Meta-regressions revealed no significant associations between HbA1c, and psychological intervention category (counselling versus cognitive behavioral therapy interventions) (p=0.84), frequency of BCTs per psychological intervention (p=0.29), primary behavioral target versus primary outcome (p=0.48), or presence of fidelity assessment (p=0.15). Social support (unspecified), problem solving, and goal setting (behavior) could be useful BCTs to develop psychological interventions for people with type 2 diabetes to improve glycemic levels. However, more research is required to understand which combination of individual BCTs are most effective for this population.Systematic Review RegistrationRegistered with the international prospective register of systematic reviews registration (PROSPERO) CRD42016033619.
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Affiliation(s)
- Rebecca Upsher
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- *Correspondence: Rebecca Upsher,
| | - Deborah Onabajo
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Daniel Stahl
- Department of Biostatistics, Institute of Psychiatry, King’s College London, London, United Kingdom
| | - Khalida Ismail
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Kirsty Winkley
- Florence Nightingale Faculty of Nursing and Midwifery, King’s College London, James Clerk Maxwell Building, London, United Kingdom
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22
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Rose VA, Klyushnenkova EN, Zhang M, Warrington VO. The effect of a primary care-based Medical Weight Loss Program on weight loss and anthropomorphic metrics. Fam Pract 2021; 38:11-17. [PMID: 32525542 DOI: 10.1093/fampra/cmaa050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Diet and lifestyle intervention programs have been shown to be effective in decreasing obesity/overweight and many associated comorbidities in specialty research settings. There is very little information however as to the efficacy of such programs conducted in usual/typical primary care practices. We analysed effectiveness of the Medical Weight Loss Program (MWLP) designed to specifically address overweight/obesity in the setting of an urban academic primary care practice. OBJECTIVE To determine whether participation in the MWLP within a general primary care setting can result in weight loss. METHODS A retrospective medical chart review of patients treated in MWLP and a control group of patients with obesity receiving regular care in the general primary care setting. From the practice database (1 April 2015-31 March 2016), 209 patients (≥18 years old) who participated in the MWLP were identified; 265 controls were selected from the remaining population based on the presence of the obesity-related diagnoses. RESULTS MWLP patients lost on average 2.35 ± 5.88 kg in 6 months compared to their baseline weight (P < 0.0001). In contrast, the control group demonstrated a trend of gaining on average 0.37 ± 6.03 kg. Having three or more visits with the MWLP provider within 6 months after program initiation was the most important factor associated with successful loss of at least 5% of the baseline weight. Weight loss also correlated with a decrease in abdominal girth. CONCLUSION MWLP integrated into the general primary care practice may potentially be an effective model for managing obesity and related morbidities.
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Affiliation(s)
- Vivienne A Rose
- Department of Family and Community Medicine, University of Maryland Baltimore, Baltimore, MD
| | - Elena N Klyushnenkova
- Department of Family and Community Medicine, University of Maryland Baltimore, Baltimore, MD
| | - Min Zhang
- Department of Epidemiology and Public Health, University of Maryland Baltimore, Baltimore, MD
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23
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Kinsey AW, Gowey MA, Tan F, Zhou D, Ard J, Affuso O, Dutton GR. Similar weight loss and maintenance in African American and White women in the Improving Weight Loss (ImWeL) trial. ETHNICITY & HEALTH 2021; 26:251-263. [PMID: 29966428 PMCID: PMC6314901 DOI: 10.1080/13557858.2018.1493435] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 06/06/2018] [Indexed: 06/08/2023]
Abstract
Objective: African Americans (AA) are often underrepresented and tend to lose less weight than White participants during the intensive phase of behavioral obesity treatment. Some evidence suggests that AA women experience better maintenance of lost weight than White women, however, additional research on the efficacy of extended care programs (i.e. continued contacts to support the maintenance of lost weight) is necessary to better understand these differences.Methods: The influence of race on initial weight loss, the likelihood of achieving ≥5% weight reduction (i.e. extended care eligibility), the maintenance of lost weight and extended care program efficacy was examined in 269 AA and White women (62.1% AA) participating in a 16-month group-based weight management program. Participants achieving ≥5% weight reduction during the intensive phase (16 weekly sessions) were randomized to a clustered campaign extended care program (12 sessions delivered in three, 4-week clusters) or self-directed control.Results: In adjusted models, race was not associated with initial weight loss (p = 0.22) or the likelihood of achieving extended care eligibility (odds ratio 0.64, 95% CI [0.29, 1.38]). AA and White women lost -7.13 ± 0.39 kg and -7.62 ± 0.43 kg, respectively, during initial treatment. There were no significant differences in weight regain between AA and White women (p = 0.64) after adjusting for covariates. Clustered campaign program participants (AA: -6.74 ± 0.99 kg, White: -6.89 ± 1.10 kg) regained less weight than control (AA: -5.15 ± 0.99 kg, White: -4.37 ± 1.04 kg), equating to a 2.12 kg (p = 0.03) between-group difference after covariate adjustments.Conclusions: Weight changes and extended care eligibility were comparable among all participants. The clustered campaign program was efficacious for AA and White women. The high representation and retention of AA participants may have contributed to these findings.
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Affiliation(s)
- Amber W. Kinsey
- Nutrition Obesity Research Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Marissa A. Gowey
- Nutrition Obesity Research Center, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Fei Tan
- Department of Mathematical Sciences, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | - Dali Zhou
- Department of Mathematical Sciences, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | - Jamy Ard
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston Salem, NC, USA
| | - Olivia Affuso
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Gareth R. Dutton
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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24
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Maula A, Kendrick D, Kai J, Griffiths F. Evidence generated from a realist synthesis of trials on educational weight loss interventions in type 2 diabetes mellitus. Diabet Med 2021; 38:e14394. [PMID: 32871624 DOI: 10.1111/dme.14394] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 07/29/2020] [Accepted: 08/25/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Obesity and diabetes are major public health problems. Current approaches to weight loss show varying success. Complex community-based interventions work through several interconnected stages. An individual's actions in response to an intervention depend on many known and unknown factors, which vary among individuals. AIM To conduct a realist synthesis to identify in which context, for whom, in what circumstances, and how weight loss interventions work in obese or overweight individuals with type 2 diabetes. METHODS A total of 49 trials identified during a systematic review were subsequently analysed using realist methodology. This iterative process involved hypothesis generation about how participants within a particular context respond to an intervention's resources producing the outcomes. We used established behaviour change theory to look for repeating themes. Theory and 'mechanisms' were tested against the literature on what is shown to be effective. Where established theory was lacking, we discussed issues during discussion groups with individuals living with the condition to generate our own programme theories. RESULTS Mechanisms that were repeatedly identified included high-frequency contact with those delivering the intervention, social support, education increasing awareness of diabetes-related modifiable risk factors, motivational interviewing and counselling, goal-setting, self-monitoring and feedback and meal replacements. The central theme underlying successful mechanisms was personalising each intervention component to the participants' gender, culture and family setting. CONCLUSION This is the first comprehensive realist synthesis in this field. Our findings suggest that, for weight loss interventions to be successful in those with diabetes, they must be personalized to the individual and their specific context.
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Affiliation(s)
- Asiya Maula
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - Denise Kendrick
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - Joe Kai
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - Frances Griffiths
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
- School of Public Health, University of Witwatersrand, Johannesburg, South Africa
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25
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Savoie-Roskos MR, Brown KN. Motivational Interviewing Confidence and Perceived Competence Among Undergraduate and Graduate Dietetics Students. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2021; 8:23821205211052418. [PMID: 34734121 PMCID: PMC8558585 DOI: 10.1177/23821205211052418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 09/22/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Motivational interviewing (MI) aligns with the scope of practice and competency standards for Registered Dietitian Nutritionists; however, few dietitians receive adequate training. Furthermore, little is known about MI training within dietetics curricula. OBJECTIVE The objective of this study was to determine differences in undergraduate and graduate-level dietetics students' confidence and perceived competence before/after taking a MI course. METHODS A 38-item pre-postsurvey was completed by students enrolled in a Basic and Advanced MI course at Utah State University. The survey included demographic questions and questions related to confidence and perceived competence using MI techniques. Paired t-tests were used to compare pre/post results and analysis of variance was used to compare groups. RESULTS Increased confidence and perceived competence were observed for Basic MI students (n = 72) (P < .0001) and Advanced MI students (n = 32) (P < .0001) after course completion. In the presurvey, Advanced MI students had higher confidence in 5 of 14 MI skills, higher competence in 2 of 11 MI skills, and higher overall MI competence scores (P = .008) than Basic MI students. Following completion of the course, Advanced MI students had higher overall MI confidence scores (P = .03). CONCLUSIONS Students' confidence and perceived competence with using MI increased after taking a college-level MI course. Incorporating MI courses into dietetics curricula may be an effective way to increase confidence and perceived competence of using MI techniques and therefore improving communication between dietitians and patients.
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Affiliation(s)
| | - Katie N. Brown
- Katie N. Brown, Department of Nutrition, Dietetics and Food Sciences, Utah State University, 8700 Old Main Hill, Logan, UT 84322-8700, USA.
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26
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Jones AC, Hilton R, Ely B, Gororo L, Danesh V, Sevin CM, Jackson JC, Boehm LM. Facilitating Posttraumatic Growth After Critical Illness. Am J Crit Care 2020; 29:e108-e115. [PMID: 32929457 PMCID: PMC7646602 DOI: 10.4037/ajcc2020149] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
The theory of posttraumatic growth arose from accounts of various trauma survivors experiencing not only distress but also growth and change. An intensive care unit admission is an unplanned, sudden, and traumatic experience, and many survivors have posttraumatic stress that can lead to posttraumatic stress disorder. Survivors leave the intensive care unit with new functional impairments that drive depression, and they frequently experience anxiety. Amidst the stress of understanding the trauma of an intensive care unit admission, survivors can grow in their world views, relationships, and sense of self. Understanding posttraumatic growth in intensive care unit survivors will inform health care providers on how to help survivors understand their new difficulties after an intensive care unit stay and facilitate growth. This article is a conceptual review of posttraumatic growth, identifiers of posttraumatic growth, and how the tenets of the posttraumatic growth theory apply to intensive care unit survivors. Health care professionals, specifically nurses, can incorporate practices into their care during and after the intensive care unit stay that encourage understanding and positive accommodation of new difficulties brought on by the intensive care unit hospitalization to support survivor growth. Opportunities for research include incorporating posttraumatic growth assessments into post-intensive care unit clinics, self-help materials, and various programs or therapies. Outcomes associated with posttraumatic growth are listed to suggest directions for research questions concerning posttraumatic growth in intensive care unit survivors.
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Affiliation(s)
- Abigail C Jones
- Abigail C. Jones is a research assistant, School of Nursing, Vanderbilt University and the Critical Illness, Brain Dysfunction, and Survivorship Center at Vanderbilt, Nashville, Tennessee
| | - Rachel Hilton
- Rachel Hilton is a research assistant, School of Nursing, Vanderbilt University
| | - Blair Ely
- Blair Ely is a research assistant, Critical Illness, Brain Dysfunction, and Survivorship Center at Vanderbilt
| | - Lovemore Gororo
- Lovemore Gororo is an intensive care unit survivor and former patient at Vanderbilt University Hospital, Nashville, Tennessee
| | - Valerie Danesh
- Valerie Danesh is an assistant professor, School of Nursing, University of Texas at Austin, Austin, Texas, and a research scientist, Center for Applied Health Research, Baylor Scott & White Health, Dallas, Texas
| | - Carla M Sevin
- Carla M. Sevin is an assistant professor, Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University School of Medicine and the Critical Illness, Brain Dysfunction, and Survivorship Center at Vanderbilt
| | - James C Jackson
- James C. Jackson is a professor of medicine, Division of Allergy, Pulmonary, and Critical Care Medicine and Center for Health Services Research, Department of Medicine, Vanderbilt University School of Medicine; a professor, Geriatric Research, Education and Clinical Center Service and Clinical Research Center of Excellence, Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System; and a professor, Department of Psychiatry, Vanderbilt Medical Center
| | - Leanne M Boehm
- Leanne M. Boehm is an assistant professor, School of Nursing, Vanderbilt University, and the Critical Illness, Brain Dysfunction, and Survivorship Center at Vanderbilt
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27
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Suire KB, Kavookjian J, Feiss R, Wadsworth DD. Motivational Interviewing for Weight Management Among Women: a Meta-Analysis and Systematic Review of RCTs. Int J Behav Med 2020; 28:403-416. [PMID: 33083891 DOI: 10.1007/s12529-020-09934-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Motivational interviewing (MI) is a communication skill set used by clinicians to help facilitate adherence to numerous health behaviors. Currently, MI's evidence supports its use among adults in various realms; however, clarity is needed regarding weight management among females. The purpose of this systematic review and meta-analysis is to synthesize the literature examining the use of MI and its impact on anthropometric measures among adult females. METHOD The authors conducted a modified Cochrane method of systematic search and review in several relevant databases to explore and report evidence and gaps in the literature for MI in weight management among females in addition to meta-analyses for weight and BMI. Criteria for retention included randomized controlled trials with open inclusion of studies with varied settings, methods, interventionists, target behaviors, and outcomes. RESULTS Of the 3289 references initially identified, 10 intervention arms met the criteria across review tiers. Seven of 10 intervention groups reported significant anthropometric changes compared with a control group, as well as significant changes in non-anthropometric outcomes related to weight management. Using a random-effects model, the effect size of MI on reduction in body weight (kg) was 0.19 (95% CI - 0.13, 0.26; p < 0.01), and the effect size of MI on reduction in BMI was 0.35 (95% CI 0.12, 0.58; p < 0.01). CONCLUSIONS Results suggest that MI interventions are useful for weight management among females. Future studies would enhance the current base of literature by utilizing advanced anthropometric outcomes, including sex-specific results, and including more diverse and larger sample sizes.
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Affiliation(s)
- Kameron B Suire
- School of Kinesiology, Auburn University, 301 Wire Rd, Auburn, AL, 36849, US.
| | - Jan Kavookjian
- Harrison School of Pharmacy, Auburn University, Auburn, AL, US
| | - Robyn Feiss
- School of Kinesiology, Auburn University, 301 Wire Rd, Auburn, AL, 36849, US
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28
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Gower BA, Fowler LA. Obesity in African-Americans: The role of physiology. J Intern Med 2020; 288:295-304. [PMID: 32350924 DOI: 10.1111/joim.13090] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 02/18/2020] [Accepted: 03/02/2020] [Indexed: 12/18/2022]
Abstract
The disproportionate obesity in African American (AA) women has a physiologic basis and can be explained by the interactive effects of insulin secretion, insulin clearance, insulin sensitivity and the glycaemic load of the diet. This review will present data supporting a physiologic basis for obesity propensity in obesity-prone AA women that resides in their unique metabolic/endocrine phenotype: high beta-cell responsiveness, low hepatic insulin extraction and relatively high insulin sensitivity, which together result in a high exposure of tissues and organs to insulin. When combined with a high-glycaemic (HG) diet (that stimulates insulin secretion), this underlying propensity to obesity becomes manifest, as ingested calories are diverted from energy production to storage. Our data indicate that both weight loss and weight loss maintenance are optimized with low-glycaemic (LG) vs HG diet in AA. Whether greater obesity in AA is mechanistically related to their greater prevalence of type 2 diabetes is debatable. This review provides data indicating that obesity is not strongly related to insulin resistance in AA. Rather, insulin resistance in AA is associated with relatively low adipose tissue in the leg, consistent with a genetic predisposition to impaired lipid storage. Greater bioenergetic efficiency has been reported in AA and, via resultant oxidative damage, could plausibly contribute to insulin resistance. In summary, it is proposed here that a subset of AA women are predisposed to obesity due to a specific metabolic/endocrine phenotype. However, greater diabetes risk in AA has an independent aetiology based on impaired lipid storage and mitochondrial efficiency/oxidative stress.
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Affiliation(s)
- B A Gower
- From the, Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
| | - L A Fowler
- From the, Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
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Teeter BS, Thomas JL, Curran GM, Balamurugan A. Classifying intervention modifications in the community pharmacy context: A demonstration study. J Am Pharm Assoc (2003) 2020; 60:e230-e235. [PMID: 32839135 DOI: 10.1016/j.japh.2020.07.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 07/21/2020] [Accepted: 07/27/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The objectives of this study were to apply the Stirman and colleagues' framework to identify modifications made to a motivational interviewing (MI)-based intervention for medication nonadherence and to determine whether the locally modified intervention affected expected patient medication adherence outcomes in community pharmacies. METHODS Pharmacists at 4 pharmacies were trained to provide a brief MI intervention to 50 patients per pharmacy who were nonadherent to antihypertensive medications. The training included a 3-hour online course in MI and in-pharmacy training on patient identification and documentation. Semistructured interviews were conducted to determine modifications to the patient identification processes, MI interventions, and documentation of interventions. Directed content analysis was guided by the Stirman and colleagues' framework. Preintervention and 6 months postintervention adherence rates for the patients who received the intervention were calculated. Paired samples t tests were used to assess the impact of the intervention on adherence rates. RESULTS Modifications were made to the context of the intervention (e.g., via telephone instead of in-pharmacy). Additionally, content modifications included "loosening the structure" (e.g., reordering intervention steps), "drifting or departing" (e.g., too busy to attempt), "adding elements" (e.g., reminder cards), and "repeating elements" (e.g., patient identification). There were statistically significant improvements in adherence from preintervention to 6 months postintervention (74.1% to 84.5%; P < 0.05) at each pharmacy regardless of the modifications applied. CONCLUSION Modifications made during intervention implementation were classified using Stirman and colleagues' framework. Despite the modifications, adherence rates improved and were consistent with expectations based on prior studies of similar interventions. These findings support previous implementation research on adaptability and suggest that the ability to tailor, modify, or refine an intervention to meet the needs of the provider or setting may allow for intervention success. Future research on the impact of specific modifications will help determine which are detrimental or beneficial to patient outcomes and sustainability of services.
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Bailey JE, Surbhi S, Gatwood J, Butterworth S, Coday M, Shuvo SA, Dashputre AA, Brooks IM, Binkley BL, Riordan CJ, Steinberg HO, Gutierrez ML, Haley LE, Leak CL, Tolley EA. The management of diabetes in everyday life study: Design and methods for a pragmatic randomized controlled trial comparing the effectiveness of text messaging versus health coaching. Contemp Clin Trials 2020; 96:106080. [PMID: 32653539 DOI: 10.1016/j.cct.2020.106080] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 06/15/2020] [Accepted: 07/06/2020] [Indexed: 01/13/2023]
Abstract
Background African American patients with uncontrolled diabetes living in medically underserved areas need effective clinic-based interventions to improve self-care behaviors. Text messaging (TM) and health coaching (HC) are among the most promising low-cost population-based approaches, but little is known about their comparative effectiveness in real-world clinical settings. Objective Use a pragmatic randomized controlled trial design to determine the comparative effectiveness of TM and HC with enhanced usual care (EC) in African American adults with uncontrolled diabetes and multiple chronic health conditions. Methods/design The Management of Diabetes in Everyday Life (MODEL) study is randomizing 646 patients (n = 581with anticipated 90% retention) to 3 intervention arms: TM, HC, and EC. Participants are African American adults living in medically underserved areas of the Mid-South, age ≥ 18, with uncontrolled diabetes (A1c ≥ 8), one or more additional chronic conditions, and who have a phone with texting and voicemail capability. Primary outcome measures: the general diet, exercise, and medication adherence subscales of the revised Summary of Diabetes Self-Care Activities questionnaire assessed at one year. Secondary outcomes: diabetes-specific quality of life, primary care engagement, and average blood sugar (A1c). The study will also assess heterogeneity of treatment effects by six key baseline participant characteristics. Conclusions We describe the design and methods of the MODEL study along with design revisions required during implementation in a pragmatic setting. This trial, upon its conclusion, will allow us to compare the effectiveness of two promising low-cost primary care-based strategies for supporting self-care behaviors among African Americans individuals with uncontrolled diabetes. ClinicalTrials.gov registration number: NCT02957513.
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Affiliation(s)
- James E Bailey
- Center for Health System Improvement, University of Tennessee Health Science Center, Memphis, TN, United States of America; Division of General Internal Medicine, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, United States of America; Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, United States of America.
| | - Satya Surbhi
- Center for Health System Improvement, University of Tennessee Health Science Center, Memphis, TN, United States of America; Division of General Internal Medicine, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, United States of America
| | - Justin Gatwood
- Center for Health System Improvement, University of Tennessee Health Science Center, Memphis, TN, United States of America; College of Pharmacy, University of Tennessee Health Science Center, Memphis, TN, United States of America
| | - Susan Butterworth
- Center for Health System Improvement, University of Tennessee Health Science Center, Memphis, TN, United States of America; Q-consult, LLC, St. Petersburg, FL, United States of America
| | - Mace Coday
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, United States of America
| | - Sohul A Shuvo
- Center for Health System Improvement, University of Tennessee Health Science Center, Memphis, TN, United States of America; Institute for Health Outcomes and Policy, College of Graduate Health Sciences, University of Tennessee Health Science Center, Memphis, TN, United States of America
| | - Ankur A Dashputre
- Center for Health System Improvement, University of Tennessee Health Science Center, Memphis, TN, United States of America; Institute for Health Outcomes and Policy, College of Graduate Health Sciences, University of Tennessee Health Science Center, Memphis, TN, United States of America
| | - Ian M Brooks
- Center for Health System Improvement, University of Tennessee Health Science Center, Memphis, TN, United States of America; Department of Surgery, Anne Arundel Medical Center, Annapolis, MD, United States of America
| | - Bonnie L Binkley
- Center for Health System Improvement, University of Tennessee Health Science Center, Memphis, TN, United States of America
| | - Carrie Jo Riordan
- Center for Health System Improvement, University of Tennessee Health Science Center, Memphis, TN, United States of America
| | - Helmut O Steinberg
- Center for Health System Improvement, University of Tennessee Health Science Center, Memphis, TN, United States of America; Division of Endocrinology, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, United States of America
| | - Mary Lou Gutierrez
- Center for Health System Improvement, University of Tennessee Health Science Center, Memphis, TN, United States of America
| | - Lauren E Haley
- Center for Health System Improvement, University of Tennessee Health Science Center, Memphis, TN, United States of America
| | - Cardella L Leak
- Center for Health System Improvement, University of Tennessee Health Science Center, Memphis, TN, United States of America
| | - Elizabeth A Tolley
- Center for Health System Improvement, University of Tennessee Health Science Center, Memphis, TN, United States of America; Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, United States of America
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Toro-Ramos T, Michaelides A, Anton M, Karim Z, Kang-Oh L, Argyrou C, Loukaidou E, Charitou MM, Sze W, Miller JD. Mobile Delivery of the Diabetes Prevention Program in People With Prediabetes: Randomized Controlled Trial. JMIR Mhealth Uhealth 2020; 8:e17842. [PMID: 32459631 PMCID: PMC7381044 DOI: 10.2196/17842] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 04/03/2020] [Accepted: 04/15/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND The Centers for Disease Control and Prevention (CDC) diabetes prevention program (DPP) has formed the foundation for Type 2 Diabetes Mellitus (T2DM) prevention efforts and lifestyle change modifications in multiple care settings. To our knowledge, no randomized controlled trial has verified the efficacy of a fully mobile version of CDC's diabetes prevention program (DPP). OBJECTIVE This study aimed to investigate the long-term weight loss and glycemic efficacy of a mobile-delivered DPP compared with a control group receiving usual medical care. METHODS Adults with prediabetes (N=202) were recruited from a clinic and randomized to either a mobile-delivered, coach-guided DPP (Noom) or a control group that received regular medical care including a paper-based DPP curriculum and no formal intervention. The intervention group learned how to use the Noom program, how to interact with their coach, and the importance of maintaining motivation. They had access to an interactive coach-to-participant interface and group messaging, daily challenges for behavior change, DPP-based education articles, food logging, and automated feedback. Primary outcomes included changes in weight and hemoglobin A1c (HbA1c) levels at 6 and 12 months, respectively. Exploratory secondary outcomes included program engagement as a predictor of changes in weight and HbA1c levels. RESULTS A total of 202 participants were recruited and randomized into the intervention (n=101) or control group (n=99). In the intention-to-treat (ITT) analyses, changes in the participants' weight and BMI were significantly different at 6 months between the intervention and control groups, but there was no difference in HbA1c levels (mean difference 0.004%, SE 0.05; P=.94). Weight and BMI were lower in the intervention group by -2.64 kg (SE 0.71; P<.001) and -0.99 kg/m2 (SE 0.29; P=.001), respectively. These differences persisted at 12 months. However, in the analyses that did not involve ITT, program completers achieved a significant weight loss of 5.6% (SE 0.81; P<.001) at 6 months, maintaining 4.7% (SE 0.88; P<.001) of their weight loss at 12 months. The control group lost -0.15% at 6 months (SE 0.64; P=.85) and gained 0.33% (SE 0.70; P=.63) at 12 months. Those randomized to the intervention group who did not start the program had no meaningful weight or HbA1c level change, similar to the control group. At 1 year, the intervention group showed a 0.23% reduction in HbA1c levels; those who completed the intervention showed a 0.28% reduction. Those assigned to the control group had a 0.16% reduction in HbA1c levels. CONCLUSIONS This novel mobile-delivered DPP achieved significant weight loss reductions for up to 1 year compared with usual care. This type of intervention reduces the risk of overt diabetes without the added barriers of in-person interventions. TRIAL REGISTRATION ClinicalTrials.gov NCT03865342; https://clinicaltrials.gov/ct2/show/NCT03865342.
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Affiliation(s)
| | | | - Maria Anton
- Department of Medicine, Division of Endocrinology & Metabolism, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, United States
| | - Zulekha Karim
- Department of Medicine, Division of Endocrinology & Metabolism, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, United States
| | - Leah Kang-Oh
- Department of Medicine, Division of Endocrinology & Metabolism, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, United States
| | - Charalambos Argyrou
- Department of Medicine, Division of Endocrinology & Metabolism, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, United States
| | - Elisavet Loukaidou
- Department of Medicine, Division of Endocrinology & Metabolism, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, United States
| | - Marina M Charitou
- Department of Medicine, Division of Endocrinology & Metabolism, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, United States
| | - Wilson Sze
- Department of Medicine, Division of Endocrinology & Metabolism, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, United States
| | - Joshua D Miller
- Department of Medicine, Division of Endocrinology & Metabolism, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, United States
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LaRose JG, Gorin AA, Fava JL, Bean MK, Lanoye A, Robinson E, Carey K. Using motivational interviewing to enhance emerging adults' engagement in weight loss: The Live Well RVA pilot randomized clinical trial. Obes Sci Pract 2020; 6:460-472. [PMID: 33082988 PMCID: PMC7556426 DOI: 10.1002/osp4.435] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 05/07/2020] [Accepted: 05/10/2020] [Indexed: 11/15/2022] Open
Abstract
Background Emerging adults (ages 18–25) are at high risk for overweight/obesity, yet traditional adult behavioural weight loss (BWL) interventions do not meet the needs of individuals at this developmental stage. Motivational interviewing (MI) is an evidence‐based approach to promote behaviour change but has not been tested for weight loss in this population. The study aimed to test the feasibility and preliminary efficacy of an MI‐enhanced weight loss programme to promote engagement, retention and weight loss in emerging adults. Methods Emerging adults with overweight/obesity (N = 47, 81% female, 47% racial/ethnic minority, body mass index [BMI] = 33.2 ± 4.6 kg/m2) were randomized to either standard BWL or MI‐enhanced BWL (MIBWL). Weight was assessed objectively at baseline and posttreatment (3 months). Engagement (in‐person session attendance [weeks 1 and 2], online self‐monitoring [weeks 3–12] and online content viewing [weeks 3–12]) was tracked throughout the program. Results Though results did not reach the level of statistical significance, participants in MIBWL demonstrated greater programme engagement (77% vs. 61.0%, p = .11; Cohen d = .48), retention (71% vs. 48.0%, p = .10; Cohen h = .47) and intent‐to‐treat weight loss (−3.3% vs. −2.2%, p = .37; Cohen d = .26) compared with those in BWL. Conclusions Effect sizes suggest that MI might be a viable approach to enhance engagement and retention in weight loss programmes targeting emerging adults. This finding is meaningful, given the documented challenges with engagement and retention in this vulnerable population and the relationship between engagement and better weight loss outcomes. The results of this small pilot study support efforts to replicate these findings within the context of a fully powered trial.
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Affiliation(s)
- Jessica Gokee LaRose
- Department of Health Behavior and Policy Virginia Commonwealth University School of Medicine Richmond Virginia USA
| | - Amy A Gorin
- Department of Psychological Sciences University of Connecticut Mansfield Connecticut USA.,Institute for Collaboration on Health, Intervention, and Policy University of Connecticut Mansfield Connecticut USA
| | - Joseph L Fava
- Weight Control and Diabetes Research Center The Miriam Hospital Providence Rhode Island USA
| | - Melanie K Bean
- Department of Pediatrics Children's Hospital of Richmond at Virginia Commonwealth University Richmond Virginia USA
| | - Autumn Lanoye
- Department of Health Behavior and Policy Virginia Commonwealth University School of Medicine Richmond Virginia USA
| | - Elizabeth Robinson
- Department of Pediatrics Children's Hospital of Richmond at Virginia Commonwealth University Richmond Virginia USA.,Summit Emotional Health Richmond Virginia USA
| | - Kate Carey
- Department of Behavioral and Social Sciences Brown University School of Public Health Providence Rhode Island USA
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Assessing Motivational Stages and Processes of Change for Weight Management Around Bariatric Surgery: a Multicenter Study. Obes Surg 2020; 29:3348-3356. [PMID: 31209830 DOI: 10.1007/s11695-019-04001-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION/PURPOSE The assessment of the patients' motivation as a predictor of behavioral change via five stages (pre-contemplation, contemplation, preparation, action, and maintenance) and four processes (emotional re-evaluation, weight management actions, environmental restructuring, and weight consequences evaluation) of change. MATERIALS/METHODS A total of 542 participants (251 waiting for bariatric surgery (BS), 90 undergoing BS, and 201 controls) completed the Stages (S-Weight) and Processes (P-Weight) of Change in Overweight and Obese People questionnaires in a multicenter cross-sectional study. RESULTS A higher percentage of subjects seeking BS (31.7%) were in the action stage (16.7% of post-BS patients, p < 0.001; 14.9% of controls, p < 0.001). The referred body mass index (BMI) reduction was higher in subjects in active stages (3.6 ± 4.4 kg/m2 in maintenance versus 1.4 ± 1.4 kg/m2 in contemplation, p < 0.001). In the P-Weight questionnaire, patients looking for BS scored significant higher in the four processes of change than controls. In addition, a positive and significantly correlation between BMI and the four processes was observed. In the stepwise multivariate analysis, BMI and the S-Weight allocation were constantly associated with the four processes of change. CONCLUSION Obesity is accompanied by a modifying behavioral stage, suggesting that subjects before BS are seriously thinking about overcoming excess weight. To identify subjects on the waiting list for BS who will be more receptive to weight lost interventions remains a challenge.
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Maula A, Kai J, Woolley AK, Weng S, Dhalwani N, Griffiths FE, Khunti K, Kendrick D. Educational weight loss interventions in obese and overweight adults with type 2 diabetes: a systematic review and meta-analysis of randomized controlled trials. Diabet Med 2020; 37:623-635. [PMID: 31785118 PMCID: PMC7154644 DOI: 10.1111/dme.14193] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/28/2019] [Indexed: 12/31/2022]
Abstract
AIM The worldwide prevalence of type 2 diabetes mellitus is increasing, with most individuals with the disease being overweight or obese. Weight loss can reduce disease-related morbidity and mortality and weight losses of 10-15 kg have been shown to reverse type 2 diabetes. This review aimed to determine the effectiveness of community-based educational interventions for weight loss in type 2 diabetes. METHODS This is a systematic review and meta-analysis of randomized controlled trials (RCT) in obese or overweight adults, aged 18-75 years, with a diagnosis of type 2 diabetes. Primary outcomes were weight and/or BMI. CINAHL, MEDLINE, Embase, Scopus and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched from inception to June 2019. Trials were classified into specified a priori comparisons according to intervention type. A pooled standardized mean difference (SMD) (from baseline to follow-up) and 95% confidence intervals (95% CI) between trial groups (difference-in-difference) were estimated through random-effects meta-analyses using the inverse variance method. Heterogeneity was quantified using I2 and publication bias was explored visually using funnel plots. RESULTS Some 7383 records were screened; 228 full-text articles were assessed and 49 RCTs (n = 12 461 participants) were included in this review, with 44 being suitable for inclusion into the meta-analysis. Pooled estimates of education combined with low-calorie, low-carbohydrate meal replacements (SMD = -2.48, 95% CI -3.59, -1.49, I2 = 98%) or diets (SMD = -1.25, 95% CI -2.11, -0.39, I2 = 95%) or low-fat meal replacements (SMD = -1.15, 95%CI -2.05, -1.09, I2 = 85%) appeared most effective. CONCLUSION Low-calorie, low-carbohydrate meal replacements or diets combined with education appear the most promising interventions to achieve the largest weight and BMI reductions in people with type 2 diabetes.
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Affiliation(s)
- A. Maula
- Division of Primary CareSchool of MedicineThe University of NottinghamNottinghamUK
| | - J. Kai
- Division of Primary CareSchool of MedicineThe University of NottinghamNottinghamUK
| | - A. K. Woolley
- Leicester Diabetes Research CentreUniversity of LeicesterLeicesterUK
| | - S. Weng
- Division of Primary CareSchool of MedicineThe University of NottinghamNottinghamUK
| | - N. Dhalwani
- Leicester Diabetes Research CentreUniversity of LeicesterLeicesterUK
- Real World EvidenceEvideraLondonUK
| | - F. E. Griffiths
- Division of Health SciencesWarwick Medical SchoolUniversity of WarwickCoventryUK
- School of Public HealthUniversity of WitwatersrandJohannesburgSouth Africa
| | - K. Khunti
- Leicester Diabetes Research CentreUniversity of LeicesterLeicesterUK
| | - D. Kendrick
- Division of Primary CareSchool of MedicineThe University of NottinghamNottinghamUK
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Wong MK, Cheng SYR, Chu TK, Lam FY, Lai SK, Wong KC, Liang J. Impact of Motivational Interviewing on Self-Management in Patients With Type 2 Diabetes: Protocol for a Pilot Randomized Controlled Trial. JMIR Res Protoc 2020; 9:e15709. [PMID: 32229475 PMCID: PMC7157490 DOI: 10.2196/15709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 10/28/2019] [Accepted: 02/03/2020] [Indexed: 11/22/2022] Open
Abstract
Background The nonpharmacological approach to diabetic control in patients with diabetes focuses on a healthy diet, physical activity, and self-management. Therefore, to help patients change their habits, it is essential to identify the most effective approach. Many efforts have been devoted to explain changes in or adherence to specific health behaviors. Such efforts have resulted in the development of theories that have been applied in prevention campaigns and include brief advice and counseling services. Within this context, motivational interviewing (MI) has proven to be effective in changing health behaviors for specific cases. However, stronger evidence is needed on the effectiveness of MI in treating chronic pathologies such as diabetes. Objective This study will obtain preliminary data on the impact of a nurse-led MI intervention in improving glycemic control, as well as clinical, psychosocial, and self-care outcomes for individuals with type 2 diabetes mellitus when compared with usual care, with the aim of improving diabetic control in patients with diabetes. Methods An open, two-arm, parallel, randomized controlled, pilot exploratory trial will be performed. Two government outpatient clinics in the New Territories West Cluster in Hong Kong will be involved. In total, 20 to 25 participants will be invited in each arm. Intervention participants will receive face-to-face MI interventions in addition to their usual care from the clinic. Control participants will only receive usual care. Outcomes are assessed at baseline, 6 months, and 12 months. The primary outcome measure is glycated hemoglobin levels. Secondary outcomes include blood pressure, BMI, hip and waist circumference, fasting blood, and psychosocial and self-care measures. Results This study is currently underway with funding support from the Hong Kong College of Family Physician Research Seed Fund 2017. Conclusions MI skills constitute the main strategies primary care nurses use on their patients. Having economical, simple, effective, and applicable techniques is essential for primary care professionals to help their patients change their lifestyle and improve their health. This study will provide scientific evidence on the effectiveness of MI. It will be performed with strict control over the data collection, ensuring the maintenance of therapeutic integrity. Trial Registration Centre for Clinical Research and Biostatistics CUHK_CCRB00614; https://tinyurl.com/v9awzk6 International Registered Report Identifier (IRRID) DERR1-10.2196/15709
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Affiliation(s)
- Man Kin Wong
- Department of Family Medicine and Primary Health Care, Tuen Mun Hospital, New Territories West Cluster, New Territories, Hong Kong
| | - Sai Yip Ronald Cheng
- Department of Family Medicine and Primary Health Care, Tuen Mun Hospital, New Territories West Cluster, New Territories, Hong Kong
| | - Tsun Kit Chu
- Department of Family Medicine and Primary Health Care, Tuen Mun Hospital, New Territories West Cluster, New Territories, Hong Kong
| | - Fung Yee Lam
- Department of Family Medicine and Primary Health Care, Tuen Mun Hospital, New Territories West Cluster, New Territories, Hong Kong
| | - Shiu Kee Lai
- Department of Family Medicine and Primary Health Care, Tuen Mun Hospital, New Territories West Cluster, New Territories, Hong Kong
| | - Kai Chung Wong
- Department of Family Medicine and Primary Health Care, Tuen Mun Hospital, New Territories West Cluster, New Territories, Hong Kong
| | - Jun Liang
- Department of Family Medicine and Primary Health Care, Tuen Mun Hospital, New Territories West Cluster, New Territories, Hong Kong
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Young HM, Miyamoto S, Dharmar M, Tang-Feldman Y. Nurse Coaching and Mobile Health Compared With Usual Care to Improve Diabetes Self-Efficacy for Persons With Type 2 Diabetes: Randomized Controlled Trial. JMIR Mhealth Uhealth 2020; 8:e16665. [PMID: 32130184 PMCID: PMC7076411 DOI: 10.2196/16665] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 12/11/2019] [Accepted: 12/15/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Type 2 diabetes is a growing public health problem amenable to prevention and health promotion. As healthy behaviors have an impact on disease outcomes, approaches to support and sustain diabetes self-management are vital. OBJECTIVE This study aimed to evaluate the effectiveness of a nurse coaching program using motivational interviewing paired with mobile health (mHealth) technology on diabetes self-efficacy and self-management for persons with type 2 diabetes. METHODS This randomized controlled trial compared usual care with an intervention that entailed nurse health coaching and mHealth technology to track patient-generated health data and integrate these data into an electronic health record. The inclusion criteria were as follows: (1) enrolled at 1 of 3 primary care clinics, (2) aged 18 years or above, (3) living with type 2 diabetes, and (4) English-speaking. We collected outcome measures at baseline, 3 months, and 9 months. The primary outcome was diabetes self-efficacy; secondary outcomes were depressive symptoms, perceived stress, physical functioning, and emotional distress and anxiety. Linear regression mixed modeling estimated the population trends and individual differences in change. RESULTS We enrolled 319 participants; 287 participants completed the study (155 control and 132 intervention). The participants in the intervention group had significant improvements in diabetes self-efficacy (Diabetes Empowerment Scale, 0.34; 95% CI -0.15,0.53; P<.01) and a decrease in depressive symptoms compared with usual care at 3 months (Patient Health Questionnaire-9; 0.89; 95% CI 0.01-1.77; P=.05), with no differences in the other outcomes. The differences in self-efficacy and depression scores between the 2 arms at 9 months were not sustained. The participants in the intervention group demonstrated a significant increase in physical activity (from 23,770 steps per week to 39,167 steps per week at 3 months and 32,601 per week at 9 months). CONCLUSIONS We demonstrated the short-term effectiveness of this intervention; however, by 9 months, although physical activity remained above the baseline, the improvements in self-efficacy were not sustained. Further research should evaluate the minimum dose of coaching required to continue progress after active intervention and the potential of technology to provide effective ongoing automated reinforcement for behavior change. TRIAL REGISTRATION ClinicalTrials.gov NCT02672176; https://clinicaltrials.gov/ct2/show/NCT02672176.
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Affiliation(s)
- Heather M Young
- Betty Irene Moore School of Nursing, University of California, Davis, Sacramento, CA, United States
| | - Sheridan Miyamoto
- College of Nursing, The Pennsylvania State University, University Park, PA, United States
| | - Madan Dharmar
- Betty Irene Moore School of Nursing, University of California, Davis, Sacramento, CA, United States
| | - Yajarayma Tang-Feldman
- Betty Irene Moore School of Nursing, University of California, Davis, Sacramento, CA, United States
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Grobe JE, Goggin K, Harris KJ, Richter KP, Resnicow K, Catley D. Race moderates the effects of Motivational Interviewing on smoking cessation induction. PATIENT EDUCATION AND COUNSELING 2020; 103:350-358. [PMID: 31466882 PMCID: PMC7012686 DOI: 10.1016/j.pec.2019.08.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 07/31/2019] [Accepted: 08/17/2019] [Indexed: 05/06/2023]
Abstract
OBJECTIVE Health disparities necessitate exploration of how race moderates response to smoking cessation treatment. Data from a randomized clinical trial of Motivational Interviewing (MI) for smoking cessation induction were used to explore differential treatment response between African American (AA) vs Non-Black (NB) smokers. METHODS Adult tobacco smokers (138 AA vs 66 NB) with low desire to quit were randomly assigned to four sessions of MI or health education (HE). Outcomes (e.g., quit attempts) were assessed 3- and 6-months. RESULTS There was evidence of a Race by Treatment interaction such that MI was less effective than HE in AA smokers. Mean Cohen's d for the interaction effect was -0.32 (95% CI [-0.44, -0.20]). However, the race interaction could be accounted for by controlling for baseline relationship status and communication preference (wants directive approach). CONCLUSIONS MI may be less effective for smoking cessation induction in AA vs NB smokers when compared to another active and more directive therapy. The differential response between races may be explained by psychosocial variables. PRACTICE IMPLICATIONS MI may not be an ideal choice for all African American smokers. Patients' relationship status and preference for a directive counseling approach might explain disparities in response to MI treatment.
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Affiliation(s)
- James E Grobe
- JEGrobe Consulting, 9209 Heatherdale Drive, Dallas, Texas, 75243, United States.
| | - Kathy Goggin
- Division of Health Services and Outcomes Research, Children's Mercy Kansas City Hospitals and Clinics, and Schools of Medicine and Pharmacy, University of Missouri - Kansas City, 2401 Gillham Road, Kansas City, MO, 64108, United States.
| | - Kari Jo Harris
- School of Public and Community Health Sciences, 32 Campus Drive Skaggs Building Room 352, The University of Montana, Missoula, Montana, 406-243-4685, United States.
| | - Kimber P Richter
- Department of Preventive Medicine & Public Health, University of Kansas Medical Center, 3901 Rainbow Boulevard, MS 1008, 4004 Robinson, Kansas City, KS, 66160, United States.
| | - Ken Resnicow
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109-2029, United States.
| | - Delwyn Catley
- Center for Children's Healthy Lifestyles & Nutrition, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO, 64108, United States.
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Nurmi J, Knittle K, Ginchev T, Khattak F, Helf C, Zwickl P, Castellano-Tejedor C, Lusilla-Palacios P, Costa-Requena J, Ravaja N, Haukkala A. Engaging Users in the Behavior Change Process With Digitalized Motivational Interviewing and Gamification: Development and Feasibility Testing of the Precious App. JMIR Mhealth Uhealth 2020; 8:e12884. [PMID: 32003750 PMCID: PMC7055776 DOI: 10.2196/12884] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Revised: 09/26/2019] [Accepted: 10/22/2019] [Indexed: 01/14/2023] Open
Abstract
Background Most adults do not engage in sufficient physical activity to maintain good health. Smartphone apps are increasingly used to support physical activity but typically focus on tracking behaviors with no support for the complex process of behavior change. Tracking features do not engage all users, and apps could better reach their targets by engaging users in reflecting their reasons, capabilities, and opportunities to change. Motivational interviewing supports this active engagement in self-reflection and self-regulation by fostering psychological needs proposed by the self-determination theory (ie, autonomy, competence, and relatedness). However, it is unknown whether digitalized motivational interviewing in a smartphone app engages users in this process. Objective This study aimed to describe the theory- and evidence-based development of the Precious app and to examine how digitalized motivational interviewing using a smartphone app engages users in the behavior change process. Specifically, we aimed to determine if use of the Precious app elicits change talk in participants and how they perceive autonomy support in the app. Methods A multidisciplinary team built the Precious app to support engagement in the behavior change process. The Precious app targets reflective processes with motivational interviewing and spontaneous processes with gamified tools, and builds on the principles of self-determination theory and control theory by using 7 relational techniques and 12 behavior change techniques. The feasibility of the app was tested among 12 adults, who were asked to interact with the prototype and think aloud. Semistructured interviews allowed participants to extend their statements. Participants’ interactions with the app were video recorded, transcribed, and analyzed with deductive thematic analysis to identify the theoretical themes related to autonomy support and change talk. Results Participants valued the autonomy supportive features in the Precious app (eg, freedom to pursue personally relevant goals and receive tailored feedback). We identified the following five themes based on the theory-based theme autonomy support: valuing the chance to choose, concern about lack of autonomy, expecting controlling features, autonomous goals, and autonomy supportive feedback. The motivational interviewing features actively engaged participants in reflecting their outcome goals and reasons for activity, producing several types of change talk and very little sustain talk. The types of change talk identified were desire, need, reasons, ability, commitment, and taking steps toward change. Conclusions The Precious app takes a unique approach to engage users in the behavior change process by targeting both reflective and spontaneous processes. It allows motivational interviewing in a mobile form, supports psychological needs with relational techniques, and targets intrinsic motivation with gamified elements. The motivational interviewing approach shows promise, but the impact of its interactive features and tailored feedback needs to be studied over time. The Precious app is undergoing testing in a series of n-of-1 randomized controlled trials.
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Affiliation(s)
- Johanna Nurmi
- Discipline of Social Psychology, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland.,Behavioural Science Group, Primary Care Unit, University of Cambridge, Cambridge, United Kingdom
| | - Keegan Knittle
- Discipline of Social Psychology, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
| | - Todor Ginchev
- Communications and Networking Department, School of Electrical Engineering, Aalto University, Espoo, Finland
| | - Fida Khattak
- Communications and Networking Department, School of Electrical Engineering, Aalto University, Espoo, Finland
| | - Christopher Helf
- Department of Entertainment Computing, University of Vienna, Vienna, Austria
| | - Patrick Zwickl
- Center For Digital Safety And Security, Austrian Institute of Technology, Vienna, Austria
| | - Carmina Castellano-Tejedor
- Department of Psychiatry, University Hospital Vall d'Hebron, Vall d'Hebron Institute of Research, Barcelona, Spain.,Department of Basic Psychology, Grup de Recerca en Estrès i Salut, Autonomous University of Barcelona, Bellaterra, Spain
| | - Pilar Lusilla-Palacios
- Servicio de Psiquiatría, Hospital Universitari Vall d'Hebron, Departament de Psiquiatria i Medicina Legal, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, Vall d'Hebron Institut de Recerca, Barcelona, Spain
| | - Jose Costa-Requena
- Communications and Networking Department, School of Electrical Engineering, Aalto University, Espoo, Finland
| | - Niklas Ravaja
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Ari Haukkala
- Discipline of Social Psychology, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland.,Helsinki Collegium for Advanced Studies, University of Helsinki, Helsinki, Finland
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Li Z, Chen Q, Yan J, Liang W, Wong WCW. Effectiveness of motivational interviewing on improving Care for Patients with type 2 diabetes in China: A randomized controlled trial. BMC Health Serv Res 2020; 20:57. [PMID: 31973759 PMCID: PMC6979352 DOI: 10.1186/s12913-019-4776-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 11/22/2019] [Indexed: 11/12/2022] Open
Abstract
Background To assess the effects of a motivational interviewing (MI)-based patient empowerment program (PEP) on type 2 diabetes mellitus (DM) patient self-management compared to traditional diabetes health education. Methods Two hundred and twenty-five patients, recruited from community health centers (CHCs) and the family medicine clinic in the University of Hong Kong-Shenzhen Hospital in Shenzhen, were randomly assigned to the intervention or control groups. Patients in the intervention group (n = 117) received a four-session PEP in small groups over 1 month by trained nurses and doctors. The control group (n = 108) received the traditional lecture-style health education on DM. All the patients were followed up for 3 months. Outcomes included problem areas in diabetes (PAID) that measures diabetes-related emotional distress, patient enablement index (PEI), mental health, patient satisfaction respectively as well as lifestyle behaviors were assessed at baseline, post-activity and 3 months. Results At post-intervention and the 3-month follow-up, the PAID score improved significantly in the intervention group (12.7 ± 13.6, 5.8 ± 7.6) compared to the control group (22.7 ± 22.8, 11.7 ± 14.6). No difference was found between groups for changes to exercise, diet, and medication adherence. The PEI score improved significantly at the 3-month follow-up in the MI group (7.27 ± 2.45 vs 5.81 ± 2.97). Conclusion The PEP has a significant effect on improving diabetes-related distress, but MI was not significantly different from the traditional health education programs when it comes to the readiness to change. Trial registration NCT04120844, ClinicalTrials.Gov. Date of registration: October 9th 2019 (Retrospectively registered).
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Affiliation(s)
- Zhe Li
- Family Medicine Department, The University of Hong Kong - Shenzhen Hospital, 1, Haiyuan 1st Road, Futian District, Shenzhen, China
| | - Qingqi Chen
- Family Medicine Department, The University of Hong Kong - Shenzhen Hospital, 1, Haiyuan 1st Road, Futian District, Shenzhen, China
| | - Jingya Yan
- WHO Health Promoting Hospital Office, The University of Hong Kong - Shenzhen Hospital, Shenzhen, China
| | - Wei Liang
- Endocrinology Department, The University of Hong Kong - Shenzhen Hospital, Shenzhen, China
| | - William C W Wong
- Family Medicine Department, The University of Hong Kong - Shenzhen Hospital, 1, Haiyuan 1st Road, Futian District, Shenzhen, China. .,Clinical Associate Professor, Department of Family Medicine and Primary Care, The University of Hong Kong, 1, Haiyuan 1st Road, Futian District, Shenzhen, China.
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Tang X, Andres A, West DS, Lou X, Krukowski RA. Eating behavior and weight gain during pregnancy. Eat Behav 2020; 36:101364. [PMID: 32032810 DOI: 10.1016/j.eatbeh.2020.101364] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 01/02/2020] [Accepted: 01/13/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Little is known about the relationship between eating behavior and weight gain during pregnancy. PURPOSE Our objective was to assess the relationship among self-reported cognitive restraint, disinhibition, and hunger, and excessive gestational weight gain (GWG) as defined by the Institute of Medicine's (IOM) 2009 guidelines. Based on previous research examining eating behaviors and weight gain in non-pregnant women, we hypothesized that excessive GWG would be related to higher cognitive restraint, higher disinhibition, and higher perception of hunger. METHODS 190 pregnant women from the Glowing study completed the Three-Factor Eating Questionnaire (TFEQ) at the enrollment visit, which included subscales assessing restraint, disinhibition, and hunger. Participants' height and weight from <10 weeks through 36 weeks gestation were measured, allowing classification within or in excess of the IOM guidelines adjusted for the week of the final measurement. RESULTS The odds that a participant would gain weight above IOM recommendations was 1.2 times higher (OR = 1.17, 95% CI = 1.05-1.29) for each one-unit increase in the disinhibition subscale in the unadjusted logistic regression. However, after controlling for sociodemographic characteristics and baseline BMI categories, participants' TFEQ scores were not associated with the likelihood of having GWG above IOM guidelines. Eating behaviors subscales were modestly correlated with baseline BMI categories (all rs < 0.50 with p-values ranging from <0.001 to 0.619). CONCLUSIONS Although disinhibition scores had a significant relationship with excessive GWG, the significance of this relationship was not sustained after adjusting for sociodemographic characteristics and baseline BMI categories.
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Affiliation(s)
- Xuyang Tang
- Department of Preventive Medicine, University of Tennessee Health Science Center, United States of America
| | - Aline Andres
- Department of Pediatrics, University of Arkansas for Medical Sciences, United States of America
| | - Delia S West
- Arnold School of Public Health, Department of Exercise Science, University of South Carolina, United States of America
| | - Xiangyang Lou
- Department of Biostatistics, University of Florida, United States of America
| | - Rebecca A Krukowski
- Department of Preventive Medicine, University of Tennessee Health Science Center, United States of America.
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Rosenbaum DL, Clark MH, Convertino AD, Call CC, Forman EM, Butryn ML. Examination of Nutrition Literacy and Quality of Self-monitoring in Behavioral Weight Loss. Ann Behav Med 2019; 52:809-816. [PMID: 30124757 DOI: 10.1093/abm/kax052] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background Few have examined nutrition literacy (i.e., capacity to process and make informed nutritional decisions) in behavioral weight loss. Nutrition literacy (NL) may impact necessary skills for weight loss, contributing to outcome disparities. Purpose The study sets out to identify correlates of NL; evaluate whether NL predicted weight loss, food record completion and quality, and session attendance; and investigate whether the relations of race and education to weight loss were mediated by NL and self-monitoring. Methods This is a secondary analysis of 6-month behavioral weight loss program in which overweight/obese adults (N = 320) completed a baseline measure of NL (i.e., Newest Vital Sign). Participants self-monitored caloric intake via food records. Results NL was lower for black participants (p < .001) and participants with less education (p = .002). Better NL predicted better 6-month weight loss (b = -.63, p = .04) and food record quality (r = .37, p < .001), but not food record completion or attendance (ps > 0.05). Black participants had lower NL, which was associated with poorer food record quality, which adversely affected weight loss. There was no indirect effect of education on weight loss through NL and food record quality. Conclusions Overall, results suggest that lower NL is problematic for weight loss. For black participants, NL may indirectly impact weight loss through quality of self-monitoring. This might be one explanation for poorer behavioral weight loss outcomes among black participants. Additional research should investigate whether addressing these skills through enhanced treatment improves outcomes. Clinical trial information NCT02363010.
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Affiliation(s)
- Diane L Rosenbaum
- Department of Psychology, Drexel University, Philadelphia, PA, USA.,Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Margaret H Clark
- Department of Psychology, Drexel University, Philadelphia, PA, USA
| | | | - Christine C Call
- Department of Psychology, Drexel University, Philadelphia, PA, USA
| | - Evan M Forman
- Department of Psychology, Drexel University, Philadelphia, PA, USA
| | - Meghan L Butryn
- Department of Psychology, Drexel University, Philadelphia, PA, USA
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Heredia NI, Lee M, Hwang KO, Reininger BM, Fernandez ME, McNeill LH. Health coaching to encourage obese adults to enroll in commercially-available weight management programs: The path to health study. Contemp Clin Trials 2019; 83:1-9. [PMID: 31229621 PMCID: PMC6642849 DOI: 10.1016/j.cct.2019.06.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 05/29/2019] [Accepted: 06/19/2019] [Indexed: 11/30/2022]
Abstract
Physicians are recommended to screen and refer obese patients to weight management programs (WMPs). There are often limited referral options for physicians, though commercially-available WMPs could be a potential solution. The purpose of this study (Path to Health) was to evaluate the efficacy of health coaching to promote enrollment in commercially-available WMPs through a two-arm, RCT with obese patients (n = 168) randomly assigned to intervention (n = 84) or control groups (n = 84). Intervention participants received phone health coaching to help them select and enroll in WMPs. We collected data on program enrollment, weight, self-reported physical activity (PA), and fruit and vegetable (FV) intake at baseline, 3- and 6-months. We used logistic regression to assess the intervention effect on enrollment in WMPs and longitudinal regression models to evaluate the effect on weight change, PA and FV intake. The average age was 54.7 years, 59% were female and 43% were Black and 49% were White. At 6 months, 39% of the intervention group (vs. 29% of control) had enrolled in WMPs. We found no longitudinal intervention effect on weight, PA and FV intake. We found that there was more weight loss for those who completed ≥4 calls as compared to those who completed <4 calls. We also found significant dose response relationships for PA and FV intake at 3 months. In this study, we found that phone health coaching was successful in increasing obese adults' enrollment in commercially-available WMPs and that there was a dose response relationship for weight and behavioral outcomes.
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Affiliation(s)
- Natalia I Heredia
- The University of Texas MD Anderson Cancer Center, Health Disparities Research, 1400 Pressler St, Houston, TX 77030, United States.
| | - MinJae Lee
- McGovern Medical School at The University of Texas Health Science Center at Houston, United States
| | - Kevin O Hwang
- McGovern Medical School at The University of Texas Health Science Center at Houston, United States
| | - Belinda M Reininger
- The University of Texas Health Science Center Houston, School of Public Health in Brownsville, United States
| | - Maria E Fernandez
- The University of Texas Health Science Center at Houston, School of Public Health, United States
| | - Lorna H McNeill
- The University of Texas MD Anderson Cancer Center, Health Disparities Research, 1400 Pressler St, Houston, TX 77030, United States
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Oeffinger KC, Ford JS, Moskowitz CS, Chou JF, Henderson TO, Hudson MM, Diller L, McDonald A, Ford J, Mubdi NZ, Rinehart D, Vukadinovich C, Gibson TM, Anderson N, Elkin EB, Garrett K, Rebull M, Leisenring W, Robison LL, Armstrong GT. Promoting Breast Cancer Surveillance: The EMPOWER Study, a Randomized Clinical Trial in the Childhood Cancer Survivor Study. J Clin Oncol 2019; 37:2131-2140. [PMID: 31260642 PMCID: PMC6698920 DOI: 10.1200/jco.19.00547] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The aim of the current study was to increase the uptake of screening mammography among high-risk women who were treated for a childhood cancer with chest radiotherapy. PATIENTS AND METHODS Two hundred four female survivors in the Childhood Cancer Survivor Study who were treated with chest radiotherapy with 20 Gy or greater, age 25 to 50 years, and without breast imaging in the past 24 months were randomly assigned 2:1 to receive a mailed informational packet followed by a tailored telephone-delivered brief motivational interview (intervention) versus an attention control. Primary outcome was the difference in the proportion of participants who completed a screening mammogram by 12 months as evaluated in an intent-to-treat analysis. Stratum-adjusted relative risk (RR) and 95% CI were estimated using the Cochran-Mantel-Haenszel method. Secondary outcomes included the completion of screening breast magnetic resonance imaging (MRI) and barriers to screening and moderating factors. RESULTS Women in the intervention group were significantly more likely than those in the control group to report a mammogram (45 [33.1%] of 136 v 12 [17.6%] of 68; RR, 1.9; 95% CI, 1.1 to 3.3). The intervention was more successful among women age 25 to 39 years (RR, 2.2; 95% CI, 1.1 to 4.7) than among those age 40 to 50 years (RR, 1.4; 95% CI, 0.6 to 3.2). The proportion of women who reported a breast MRI at 12 months was similar between the two groups: 16.2% (intervention) compared with 13.2% (control; RR, 1.2; 95% CI, 0.6 to 2.5). Primary barriers to completing a screening mammogram and/or breast MRI included lack of physician recommendation, deferred action by survivor, cost, and absence of symptoms. CONCLUSION Use of mailed materials followed by telephone-delivered counseling increased mammography screening rates in survivors at high risk for breast cancer; however, this approach did not increase the rate of breast MRI. Cost of imaging and physician recommendation were important barriers that should be addressed in future studies.
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Affiliation(s)
| | - Jennifer S Ford
- 2Hunter College, City University of New York, New York, NY.,3The Graduate Center of the City University of New York, New York, NY
| | | | - Joanne F Chou
- 4Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | - Lisa Diller
- 7Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | | | - James Ford
- 6St Jude Children's Research Hospital, Memphis, TN
| | - Nidha Z Mubdi
- 4Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | | | | | - Elena B Elkin
- 4Memorial Sloan Kettering Cancer Center, New York, NY
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Selçuk‐Tosun A, Zincir H. The effect of a transtheoretical model–based motivational interview on self‐efficacy, metabolic control, and health behaviour in adults with type 2 diabetes mellitus: A randomized controlled trial. Int J Nurs Pract 2019; 25:e12742. [DOI: 10.1111/ijn.12742] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 07/31/2018] [Accepted: 04/14/2019] [Indexed: 11/28/2022]
Affiliation(s)
| | - Handan Zincir
- Faculty of Health SciencesErciyes University Kayseri Turkey
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Jesse CD, Creedy DK, Anderson DJ. Effectiveness of psychological interventions for women with type 2 diabetes who are overweight or obese: a systematic review protocol. JBI DATABASE OF SYSTEMATIC REVIEWS AND IMPLEMENTATION REPORTS 2019; 17:281-289. [PMID: 30451706 DOI: 10.11124/jbisrir-2017-003589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
REVIEW OBJECTIVE/QUESTION The objectives of this review are to.
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Affiliation(s)
- Cecile D Jesse
- School of Nursing, Griffith University, Meadowbrook, Australia
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Carpenter R, DiChiacchio T, Barker K. Interventions for self-management of type 2 diabetes: An integrative review. Int J Nurs Sci 2019; 6:70-91. [PMID: 31406872 PMCID: PMC6608673 DOI: 10.1016/j.ijnss.2018.12.002] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 09/17/2018] [Accepted: 12/14/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Type 2 diabetes mellitus has been identified as one of the most challenging chronic illnesses to manage. Since the management of diabetes is mainly accomplished by patients and families, self-management has become the mainstay of diabetes care. However, a significant proportion of patients fail to engage in adequate self-management. A priority research question is how do interventions affect the self-management behaviors of persons with Type 2 diabetes? PURPOSE/OBJECTIVES The purpose of this integrative review is to provide a summary and critique of interventions that support diabetes self-management in the patient with Type II diabetes mellitus. DESIGN An integrative review design, with a comprehensive methodological approach of reviews, allowing inclusion of experimental and non-experimental studies. PROCEDURES A comprehensive search was conducted via Ebscohost using databases of Academic Search Complete, CINAHL, Health Source: Nursing/Academic Edition, MEDLINE, PsycArtiCLES, and PsycInfo. The final number of papers used for this review were: motivational interviewing (6), peer support/coaching (10), problem solving therapy (3), technology-based interventions (30), lifestyle modification programs (7), patient education (11), mindfulness (3), and cognitive behavioral therapy (5). RESULTS Studies were examined from seventeen countries including a broad range of cultures and ethnicities. While interventions have shown mixed results in all interventional categories, many studies do support small to modest improvements in physiologic, behavioral, and psychological outcome measures. Considerable heterogeneity of interventions exists. The most commonly reported physiologic measure was HbA1c level. Outcome measures were collected mostly at 6 and 12 months. Duration of most research was limited to one year. CONCLUSIONS Research exploring the impact of interventions for self-management has made major contributions to the care of persons with type 2 diabetes, from offering suggestions for improving care, to stimulating new questions for research. However, implications for clinical practice remain inconclusive, and limitations in existing research suggest caution in interpreting results of studies.
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Affiliation(s)
- Roger Carpenter
- West Virginia University School of Nursing, Morgantown, WV, 26506, USA
| | - Toni DiChiacchio
- Faculty Practice & Community Engagement, West Virginia University, Morgantown, WV, 26506, USA
| | - Kendra Barker
- West Virginia University School of Nursing, Morgantown, WV, 26506, USA
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Salgado García FI, Derefinko KJ, Bursac Z, Klesges RC, Ebbert JO, Womack CR, Krukowski RA. Fit & quit: An efficacy trial of two behavioral post-cessation weight gain interventions. Contemp Clin Trials 2019; 76:31-40. [PMID: 30445176 PMCID: PMC6519455 DOI: 10.1016/j.cct.2018.11.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 11/07/2018] [Accepted: 11/12/2018] [Indexed: 12/24/2022]
Abstract
While smoking cessation leads to significant improvements in both mortality and morbidity, post-cessation weight gain partially attenuates this benefit. Even though post-cessation weight gain is small (4.7 kg on average), it is a stated reason to delay cessation attempts and is associated with smoking relapse. Fit & Quit is a randomized, controlled efficacy trial that aims to examine the ability of a weight stability intervention and a weight loss intervention to reduce post-cessation weight gain. For this purpose, Fit & Quit will randomize participants to three conditions: (a) Small Changes, a weight gain prevention intervention; (b) Look AHEAD Intensive Lifestyle Intervention; and (c) a lower-intensity bibliotherapy intervention. All conditions will receive a highly efficacious behavioral (i.e., rate reduction skills, motivational interviewing) and pharmacological (i.e., varenicline) smoking cessation program. A total of 400 participants will be recruited and randomized to the three interventions. Participants will be recruited in waves, with 10 waves of approximately 40 participants per wave. The primary outcomes of this study include post-cessation weight gain and cessation status at 12-month follow-up. Fit & Quit will integrate and adapt the strongest evidence-based interventions available for weight management and smoking cessation. Fit & Quit is highly innovative in the areas of the target population, study design, and use of technology. For these reasons, we expect that Fit & Quit will make a significant public health contribution to curtailing the important cessation barrier of post-cessation weight gain.
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Affiliation(s)
- Francisco I Salgado García
- Department of Preventive Medicine, University of Tennessee Health Science Center, 66 N. Pauline St., Memphis, TN 38163, USA.
| | - Karen J Derefinko
- Department of Preventive Medicine, University of Tennessee Health Science Center, 66 N. Pauline St., Memphis, TN 38163, USA
| | - Zoran Bursac
- Department of Preventive Medicine, University of Tennessee Health Science Center, 66 N. Pauline St., Memphis, TN 38163, USA
| | - Robert C Klesges
- Department of Public Health Sciences, University of Virginia School of Medicine, 560 Ray Hunt Drive, Charlottesville, VA 22911, USA
| | - Jon O Ebbert
- Department of Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905, USA
| | - Catherine R Womack
- Department of Preventive Medicine, University of Tennessee Health Science Center, 66 N. Pauline St., Memphis, TN 38163, USA; Department of Medicine, University of Tennessee Health Science Center, 956 Court Ave., Memphis, TN 38163, USA
| | - Rebecca A Krukowski
- Department of Preventive Medicine, University of Tennessee Health Science Center, 66 N. Pauline St., Memphis, TN 38163, USA
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Moeller LV, Lindhardt CL, Andersen MS, Glintborg D, Ravn P. Motivational interviewing in obese women with polycystic ovary syndrome - a pilot study. Gynecol Endocrinol 2019; 35:76-80. [PMID: 30182773 DOI: 10.1080/09513590.2018.1498832] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Lifestyle intervention is first line treatment in obese women with polycystic ovary syndrome (PCOS). The effect of motivational interviewing (MI) as add on to standard advice (SA) on weight loss and quality of life (QoL) has not been evaluated in obese women with PCOS. We aimed to examine whether MI as add on to SA induced higher weight loss and improved QoL in obese women with PCOS. Thirty-seven obese women with PCOS (BMI ≥30 kg/m2) were randomized to MI + SA (n = 19) vs. SA (n = 18) for six months. Anthropometric measures (BMI, waist) and questionnaires (World Health Organization-5 (WHO-5), Major Depression Index (MDI), Short Form-36 (SF-36) and PCOS-Questionnaire (PCOS-Q)) were performed at baseline and at follow-up, www.clinicaltrials.gov, NCT02924025. Twenty-eight (14 + 14) women completed the study. At baseline, 24/28 women had WHO-5 scores <67 and 12/28 women had MDI scores indicating depression. Changes in weight and QoL were similar between MI + SA vs. SA group. However, WHO-5 (p=.028) and MDI (p=.008) scores improved significantly in the 12/24 women with MDI scores indicating depression. MI as add on to SA did not improve QoL or weight loss. Obese women with PCOS had low QoL.
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Affiliation(s)
| | | | | | - Dorte Glintborg
- b Department of Endocrinology , Odense Universitetshospital , Odense , Denmark
| | - Pernille Ravn
- a Department of Gynecology and Obstetrics , Odense Universitetshospital , Odense , Denmark
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Al-Ozairi E, Ridge K, Taghadom E, de Zoysa N, Tucker C, Stewart K, Stahl D, Ismail K. Diabetes and TelecommunicationS (DATES) study to support self-management for people with type 2 diabetes: a randomized controlled trial. BMC Public Health 2018; 18:1249. [PMID: 30419893 PMCID: PMC6233607 DOI: 10.1186/s12889-018-6136-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 10/19/2018] [Indexed: 11/20/2022] Open
Abstract
Background The increasing prevalence of type 2 diabetes and suboptimal glycaemic control in Kuwait requires novel, wide-reaching, low-cost interventions to motivate and mobilise individuals towards more effective self-management. More than 2 million people in Kuwait own mobile phones. We will test whether automated personalised health text messages based on principles of motivational interviewing and are responsive to biodata delivered remotely is potentially effective in improving glycaemic control compared to usual care. Methods This is a two-arm parallel single-blind randomised controlled trial of 572 individuals with type 2 diabetes in Kuwait. We will develop a culturally appropriate database of text messages supporting positive lifestyle changes in type 2 diabetes. A computer programme will deliver over 400 text messages over a 12-month period using algorithms which provide participants with information on diet and physical activity as well as personalised messages regarding motivators to change behaviours. Individuals aged 18–75 years with established type 2 diabetes who are fluent in Arabic or English and officially resident in Kuwait will be identified via screening of hospital diabetes clinic and primary care practices and invited to participate. A sample of 572 participants will be randomised to usual care or usual care plus the DATES text message intervention. Randomisation will be conducted by an independent Clinical Trials Unit and researchers collecting baseline and outcome data will be blinded to treatment allocation. The primary outcome is change in HbA1c and weight at 12 months in both study arms. Secondary outcomes will include changes in physical activity, fasting lipids and quality of life in both study arms. Discussion The potential of mobile phones in improving diabetes self-care in settings with a high prevalence of diabetes and widespread mobile phone usage has face validity. Mobile phones and text messaging are an understudied virtual communication media which can deliver discrete focused psychological support to motivate and enable diabetes self-care changes. Trial registration ISRCTN10342151. 11/03/2015. Electronic supplementary material The online version of this article (10.1186/s12889-018-6136-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ebaa Al-Ozairi
- Faculty of Medicine, Kuwait University, P. O. Box 24923, 13110, Safat, PO, Kuwait.,Dasman Diabetes Institute, Al Kuwayt, Kuwait
| | - Katie Ridge
- Institute of Psychiatry, Psychology and Neurosciences, King's College London Weston Education Centre, 10 Cutcombe Road, London, SE5 9RJ, UK
| | | | - Nicole de Zoysa
- Institute of Psychiatry, Psychology and Neurosciences, King's College London Weston Education Centre, 10 Cutcombe Road, London, SE5 9RJ, UK
| | - Clare Tucker
- Institute of Psychiatry, Psychology and Neurosciences, King's College London Weston Education Centre, 10 Cutcombe Road, London, SE5 9RJ, UK
| | - Kurtis Stewart
- Institute of Psychiatry, Psychology and Neurosciences, King's College London Weston Education Centre, 10 Cutcombe Road, London, SE5 9RJ, UK
| | - Daniel Stahl
- Institute of Psychiatry, Psychology and Neurosciences, King's College London Weston Education Centre, 10 Cutcombe Road, London, SE5 9RJ, UK
| | - Khalida Ismail
- Institute of Psychiatry, Psychology and Neurosciences, King's College London Weston Education Centre, 10 Cutcombe Road, London, SE5 9RJ, UK.
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Fahey MC, Wayne Talcott G, Cox Bauer CM, Bursac Z, Gladney L, Hare ME, Harvey J, Little M, McCullough D, Hryshko-Mullen AS, Klesges RC, Kocak M, Waters TM, Krukowski RA. Moms fit 2 fight: Rationale, design, and analysis plan of a behavioral weight management intervention for pregnant and postpartum women in the U.S. military. Contemp Clin Trials 2018; 74:46-54. [PMID: 30291998 PMCID: PMC6289301 DOI: 10.1016/j.cct.2018.09.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 09/25/2018] [Accepted: 09/28/2018] [Indexed: 12/16/2022]
Affiliation(s)
- Margaret C Fahey
- Department of Psychology, The University of Memphis, Memphis, TN, USA.
| | - G Wayne Talcott
- Department of Public Health Sciences, University of Virginia, School of Medicine, Charlottesville, VA, USA; Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Callie M Cox Bauer
- Department of Obstetrics and Gynecology, Brooke Army Medical Center, San Antonio, TX, USA
| | - Zoran Bursac
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Leslie Gladney
- Department of Public Health Sciences, University of Virginia, School of Medicine, Charlottesville, VA, USA; Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Marion E Hare
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA; Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Jean Harvey
- Department of Nutrition and Food Sciences, The University of Vermont, Burlington, VT, USA
| | - Melissa Little
- Center for Addition and Prevention Research, University of Virginia, School of Medicine, Charlottesville, VA, USA
| | - Deirdre McCullough
- Department of Obstetrics and Gynecology, Brooke Army Medical Center, San Antonio, TX, USA
| | - Ann S Hryshko-Mullen
- Defense Institute for Medical Operations, Joint Base San Antonio-Lackland Air Force Base, San Antonio, TX, USA
| | - Robert C Klesges
- Department of Public Health Sciences, University of Virginia, School of Medicine, Charlottesville, VA, USA; Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Mehmet Kocak
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Teresa M Waters
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Rebecca A Krukowski
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
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