Using a group medical visit model to promote healthy behaviour change with an underserved population

Abstract Background Models of care are needed to address physical activity, nutrition promotion and weight loss in primary care settings, especially with underserved populations who are disproportionately affected by chronic illness. Group medical visits (GMVs) are one approach that can help overcome some of the barriers to behaviour change in underserved populations, including the amount of time required to care for these patients due to socio-economic stressors and psychosocial complexities (1). GMVs have been shown to improve care in coronary artery disease and diabetes, but more evidence is needed in underserved settings. Objective This project sought to evaluate a GMV incorporating a physical activity component in an underserved patient population, measuring biometric and motivation outcome measures. Methods This project used a pre–post intervention study design through patient surveys at baseline and 12 weeks. We included validated motivational measures along with self-reported demographic information. A GMV intervention promoting physical activity and nutrition to promote weight loss was delivered by an interdisciplinary primary care team and community partners in a Federally Qualified Health Center in Rochester, NY. The intervention consisted of six, 2-hour sessions that occurred every other week at the clinic site. Results Participants lost a significant amount of weight and maintained the weight loss at 6 months. In addition, there was a significant improvement in motivation measures. Conclusion This study provides preliminary evidence that our GMV model can improve weight loss and autonomous motivation in an underserved population. This project has potential for scalability and sustainability.

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A telehealth intervention to promote weight loss and physical activity in overweight primary care patients

Healthcare ◽

10.1016/j.hjdsi.2020.100509 ◽

2021 ◽

Vol 9 (1) ◽

pp. 100509

Author(s):

Ian Hurst ◽

Paul J. Bixenstine ◽

Carlos Casillas ◽

Anna Rasmussen ◽

Sondra Grossman ◽

...

Keyword(s):

Physical Activity ◽

Primary Care ◽

Weight Loss ◽

Promote Weight Loss ◽

Telehealth Intervention ◽

Primary Care Patients

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‘No one ever asked us’: a feasibility study assessing the co-creation of a physical activity programme with adolescent girls

Global Health Promotion ◽

10.1177/1757975919853784 ◽

2019 ◽

Vol 27 (3) ◽

pp. 34-43

Author(s):

Méabh Corr ◽

Elaine Murtagh

Keyword(s):

Physical Activity ◽

Data Collection ◽

Behaviour Change ◽

Adolescent Girls ◽

Retention Rate ◽

Controlled Trial ◽

Activity Level ◽

Health Concern ◽

Post Intervention ◽

Behaviour Change Wheel

Background: Globally, the poor activity level of adolescent girls is a public health concern. Little research has involved adolescents in the design of interventions. This study assessed the feasibility of involving girls in the co-creation of an activity programme. Methods: Thirty-one students (15–17 years old) were recruited from a post-primary school. The Behaviour Change Wheel guided intervention design, providing insights into participants’ capability, opportunity and motivation for change. Step counts and self-reported physical activity levels were recorded pre- and post-intervention. Feasibility benchmarks assessed recruitment, data collection, acceptability and adherence. Results: Activity and educational sessions were delivered for six weeks during physical education class. Average attendance was 87% (benchmark = 80%). Eligibility was 61% (benchmark = 60%). There was a 100% retention rate (benchmark = 90%). All participants ( n = 31) completed baseline measures and 71% ( n = 22) completed post-measures. 54% ( n = 17) of students completed pedometer measurements, with 32% ( n = 10) having complete data. Average daily steps were 13,121 pre-intervention and 14,128 post-intervention ( p > 0.05). Data collection was feasible, receiving a mean score > 4/5 (benchmark > 3.5/5). Conclusions: The Behaviour Change Wheel can be used to co-create an activity programme with adolescent girls. Predetermined benchmarks, except for pedometer recordings, were reached or exceeded, providing evidence for the need of a randomised controlled trial to test effectiveness.

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Session 3 (Joint with the British Dietetic Association): Management of obesity Weight-loss interventions in the treatment of obesity

Proceedings of The Nutrition Society ◽

10.1017/s0029665109991844 ◽

2009 ◽

Vol 69 (1) ◽

pp. 34-38 ◽

Cited By ~ 11

Author(s):

C. R. Hankey

Keyword(s):

Physical Activity ◽

Weight Loss ◽

Energy Expenditure ◽

Energy Intake ◽

Weight Maintenance ◽

Dietary Advice ◽

Excess Body Weight ◽

Lifestyle Interventions ◽

Post Intervention ◽

Weight Losses

Treatments to induce weight loss for the obese patient centre on the achievement of negative energy balance. This objective can theoretically be attained by interventions designed to achieve a reduction in energy intake and/or an increase in energy expenditure. Such ‘lifestyle interventions’ usually comprise one or more of the following strategies: dietary modification; behaviour change; increases in physical activity. These interventions are advocated as first treatment steps in algorithms recommended by current clinical obesity guidelines. Medication and surgical treatments are potentially available to those unable to implement ‘lifestyle interventions’ effectively by achieving losses of between 5 kg and 10 kg. It is accepted that the minimum of 5% weight loss is required to achieve clinically-meaningful benefits. Dietary treatments differ widely. Successful weight loss is most often associated with quantification of energy intake rather than macronutrient composition. Most dietary intervention studies secure a weight loss of between 5 kg and 10 kg after intervention for 6 months, with gradual weight regain at 1 year where weight changes are 3–4 kg below the starting weight. Some dietary interventions when evaluated at 2 and 4 years post intervention report the effects of weight maintenance rather than weight loss. Specific anti-obesity medications are effective adjuncts to weight loss, in most cases doubling the weight loss of those given dietary advice only. Greater physical activity alone increases energy expenditure by insufficient amounts to facilitate clinically-important weight losses, but is useful for weight maintenance. Weight losses of between half and three-quarters of excess body weight are seen at 10 years post intervention with bariatric surgery, making this arguably the most effective weight-loss treatment.

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Testing the feasibility and acceptability of a culturally adapted physical activity intervention for adult Somali women

Translational Behavioral Medicine ◽

10.1093/tbm/ibab064 ◽

2021 ◽

Author(s):

Kate E Murray ◽

Veronica Anne Hellier Villafana ◽

Amina Sheik Mohamed ◽

Sarah Linke ◽

Deborah J Bowen ◽

...

Keyword(s):

Physical Activity ◽

Physical Activity Intervention ◽

Preliminary Evidence ◽

Outcome Evaluation ◽

Community Research ◽

Control Group ◽

Post Intervention ◽

Culturally Adapted ◽

The Usa ◽

Somali Women

Abstract Despite growing numbers in the USA, immigrant populations are underrepresented in existing physical activity (PA) research, in particular Muslim immigrant women. The current study is a pilot evaluation of a culturally adapted evidence-based PA intervention for adult Somali women. Stratified randomization was used to assign participants from a sample of 27 Somali women, aged 18 to 65, to a PA group or a waitlist control group. Bicultural Somali community research team members delivered a 12-week culturally adapted intervention available in English and Somali in a community-based setting. Process and outcome evaluation assessed changes in PA, self-efficacy for PA, access to PA resources, and wellbeing as well as feasibility and satisfaction with the program. Participants in the PA group increased their moderate to vigorous PA significantly more than those from the waitlist group from baseline to post-intervention (2 (SD = 15) to 100 (SD = 53) vs 12 (SD = 21) to 32 (SD = 44) minutes per week). Participants in the PA group had significantly greater scores in wellbeing at post-intervention compared to the waitlist group though there was no significant change from pre- to post-intervention for either group. Participants reported a high level of satisfaction with the program and preliminary evidence supports the general feasibility and acceptability of the program. Findings show that a culturally adapted intervention increased engagement in PA and was feasible and acceptable within a pilot sample of Somali women.

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Quantifying Canadians' use of the Internet as a source of information on behavioural risk factor modifications related to cancer prevention

Chronic Diseases and Injuries in Canada ◽

10.24095/hpcdp.33.3.02 ◽

2013 ◽

Vol 33 (3) ◽

pp. 123-128 ◽

Cited By ~ 3

Author(s):

CG Richardson ◽

LG Hamadani ◽

C Gotay

Keyword(s):

Physical Activity ◽

Weight Loss ◽

Cancer Prevention ◽

Behaviour Change ◽

Healthy Eating ◽

The Internet ◽

Quit Smoking ◽

Key Stakeholders ◽

Internet Searches ◽

Use Of The Internet

Introduction The purpose of this study was to quantify the frequency and timing of Canadians' Internet searches for information on modifying cancer prevention-related behavioural risk factors. Methods We used the Google AdWords Keyword tool to estimate the number of Internet searches in Canada from July 2010 to May 2011 for content associated with the keywords "physical activity / exercise", "healthy eating / weight loss" and "quit smoking". Results For ''physical activity / exercise,'' 663 related keywords resulted in 117 951 699 searches. For ''healthy eating / weight loss,'' 687 related search terms yielded 98 277 954 searches. ''Quit smoking'' was associated with 759 related keywords with 31 688 973 searches. All search patterns noticeably peaked in January 2011. Conclusion Many Canadians are actively searching for information on the Internet to support health behaviour change associated with cancer prevention, especially during the month of January. To take advantage of this opportunity, key stakeholders in cancer prevention need to identify knowledge translation priorities and work with health agencies to develop evidence-based strategies to support Internet-facilitated behaviour change.

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The Obemat2.0 Study: A Clinical Trial of a Motivational Intervention for Childhood Obesity Treatment

Nutrients ◽

10.3390/nu11020419 ◽

2019 ◽

Vol 11 (2) ◽

pp. 419 ◽

Cited By ~ 1

Author(s):

Veronica Luque ◽

Albert Feliu ◽

Joaquín Escribano ◽

Natalia Ferré ◽

Gemma Flores ◽

...

Keyword(s):

Physical Activity ◽

Primary Care ◽

Clinical Trial ◽

Childhood Obesity ◽

Intervention Group ◽

Fat Free Mass ◽

Z Score ◽

Motivational Intervention ◽

Mineral Density ◽

Post Intervention

The primary aim of the Obemat2.0 trial was to evaluate the efficacy of a multicomponent motivational program for the treatment of childhood obesity, coordinated between primary care and hospital specialized services, compared to the usual intervention performed in primary care. This was a cluster randomized clinical trial conducted in Spain, with two intervention arms: motivational intervention group vs. usual care group (as control), including 167 participants in each. The motivational intervention consisted of motivational interviewing, educational materials, use of an eHealth physical activity monitor and three group-based sessions. The primary outcome was body mass index (BMI) z score increments before and after the 12 (+3) months of intervention. Secondary outcomes (pre-post intervention) were: adherence to treatment, waist circumference (cm), fat mass index (z score), fat free mass index (z score), total body water (kg), bone mineral density (z score), blood lipids profile, glucose metabolism, and psychosocial problems. Other assessments (pre and post-intervention) were: sociodemographic information, physical activity, sedentary activity, neuropsychological testing, perception of body image, quality of the diet, food frequency consumption and foods available at home. The results of this clinical trial could open a window of opportunity to support professionals at the primary care to treat childhood obesity. The clinicaltrials.gov identifier was NCT02889406.

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Changes in eating, physical activity and related behaviors in a primary care-based weight loss intervention

International Journal of Obesity ◽

10.1038/ijo.2013.91 ◽

2013 ◽

Vol 37 (S1) ◽

pp. S12-S18 ◽

Cited By ~ 12

Author(s):

S Volger ◽

◽

T A Wadden ◽

D B Sarwer ◽

R H Moore ◽

...

Keyword(s):

Physical Activity ◽

Primary Care ◽

Weight Loss ◽

Weight Loss Intervention

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Feasibility of Audio-Recording Consultations with Pregnant Australian Indigenous Women to Assess Use of Smoking Cessation Behaviour Change Techniques

The Journal of Smoking Cessation ◽

10.1155/2021/6668748 ◽

2021 ◽

Vol 2021 ◽

pp. 1-7

Author(s):

Yael Bar-Zeev ◽

Eliza Skeleton ◽

Michelle Bovill ◽

Maree Gruppetta ◽

Billie Bonevski ◽

...

Keyword(s):

Primary Care ◽

Smoking Cessation ◽

Behaviour Change ◽

Future Research ◽

Behaviour Change Techniques ◽

Health Providers ◽

Post Intervention ◽

Audio Recording ◽

Smoking Cessation Counselling ◽

Audio Recordings

Introduction. Behavioural counselling is an effective method to improve smoking cessation during pregnancy. Audio recordings of consultations have been used previously to assess fidelity in specialized smoking cessation services, but not in primary care. Aims. The study is aimed at assessing the feasibility of audio-recording smoking cessation counselling as part of an intervention in primary care settings and exploring the number and type of behaviour change techniques (BCTs) delivered. Methods. This study was a nested feasibility study within a larger trial. Health providers (HPs) and pregnant women were asked to agree or decline audio recording their smoking-related consultations. Data collected included percentage providing consent, number of recordings performed, HP type, and date (pre/post intervention). Interviews were conducted to assess the trial procedures’ acceptability. Results. Two services provided seven recordings, all pre-intervention. Of the 22 recruited women, 14 consented to being audio recorded (64%) and five provided recordings; of the 23 recruited HPs, 16 agreed (69%), and two provided recordings. Qualitative data suggest that HPs found audio recording difficult to remember. HPs spent on average two minutes discussing smoking and used few BCTs. Conclusions. Audio recordings of smoking-related counselling were not feasible as planned. Future research will need to explore acceptable methods to assess BCT use in primary care.

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A randomized trial to test the effectiveness of two technology-enhanced diabetes prevention programs in primary care: The DiaBEAT-it Study. (Preprint)

10.2196/preprints.29751 ◽

2021 ◽

Author(s):

Fabio Araujo Almeida ◽

Wen You ◽

Fabiana Almeida Brito ◽

Thais Favero Alves ◽

Cody L Goessl ◽

...

Keyword(s):

Physical Activity ◽

Type 2 Diabetes ◽

Primary Care ◽

At Risk ◽

Weight Loss ◽

Small Group ◽

Diabetes Prevention ◽

Action Plan ◽

Activity Class

BACKGROUND Lifestyle interventions targeting physical activity and improved eating habits have demonstrated that modest weight loss can prevent or delay the onset of type-2 diabetes. However, translation of these interventions into typical clinical programs remains a challenge. OBJECTIVE To evaluate the effectiveness of two technology-enhanced interventions for diabetes prevention among adults at risk for developing diabetes in a primary care setting. METHODS The DiaBEAT-it study employed a hybrid 2-group preference (Choice) and 3-group randomized controlled (RCT) design. This paper presents the weight related primary outcomes of the RCT arm. Patients from Southwest Virginia were identified through the Carilion Clinic electronic health records. Eligible participants (18 and older, BMI≥25, no Type 2 Diabetes) were randomized to either Choice (n=264) or RCT (n=334). RCT individuals were further randomized to one of three groups: (1) a 2-hour small group class to help patients develop a personal action plan to prevent diabetes (SC, n=117); (2) a 2-hour small group class plus automated telephone calls using an interactive voice response system (IVR) to help participants initiate weight loss through a healthful diet and regular physical activity (Class/IVR, n=110); or (3) a DVD with same content as the class plus the same IVR calls over a period of 12 months (DVD/IVR, n=107). Height was assessed with a calibrated stadiometer, weight with a calibrated Health-O-Meter stand-on scale. RESULTS Intention to treat analyses, controlling for gender, race, age and baseline BMI, showed that DVD/IVR and Class/IVR led to reductions in BMI at 6 (DVD/IVR -0.94, p<.001; Class/IVR -0.70, p<.01), 12 (DVD/IVR -0.88, p<.001; Class/IVR-0.82, p<.001) and 18 (DVD/IVR -0.78, p<.001; Class/IVR -0.58, p<.01) months. All three groups showed a significant number of participants losing at least 5% of their body weight at 12 months (DVD/IVR 26.87%; Class/IVR 21.62%; SC 16.85%). When comparing groups, DVD/IVR were significantly more likely to decrease BMI at 6 months (p<.05) and maintain the reduction at 18 months (p<.05) when compared to SC. There were no differences between the other groups. CONCLUSIONS These findings suggest that both IVR delivered interventions were effective in reducing and maintaining weight reduction in a group of primary care patients at risk for developing type 2 diabetes. The DiaBEAT-it interventions show promise in responding to the need for scalable, effective methods to manage obesity and prevent diabetes in primary care settings that do not over burden primary care clinics and providers. CLINICALTRIAL clinicaltrials.gov NCT02162901, https://clinicaltrials.gov/ct2/show/NCT02162901 INTERNATIONAL REGISTERED REPORT RR2-doi: 10.1016/j.cct.2014.06.010

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Physical activity goals among patients in a primary care setting

Translational Behavioral Medicine ◽

10.1093/tbm/ibz061 ◽

2019 ◽

Vol 10 (3) ◽

pp. 792-800

Author(s):

Tonya Dodge ◽

Deepti Joshi ◽

Saud Abaalkhail ◽

Brad Moore

Keyword(s):

Physical Activity ◽

Primary Care ◽

Weight Loss ◽

Racial Differences ◽

Stress Reduction ◽

Care Setting ◽

Primary Care Setting ◽

Weight Maintenance ◽

Primary Care Patients ◽

Maintenance Goals

Abstract One approach to increasing physical activity (PA) among adults is to develop interventions targeting PA goals that could be implemented in the primary care setting. However, there is little understanding of the types of goals that individuals bring with them into the primary care setting, which is a necessary first step in building interventions. There were three objectives of the study. One was to identify the types of PA goals held by primary care patients. Another was to examine whether there were racial differences among types of PA goals held by primary care patients. A final objective was to examine the relationship between PA goals and PA behaviors (e.g., meet PA guidelines, number of breaks taken from PA routine). Adults (N = 626; Mage = 51.47, SD = 16.32) were recruited from the waiting room of a primary care clinic over a 30-day span to complete a questionnaire on PA and goals. The most commonly endorsed PA goals included, weight maintenance, overall health benefits, weight loss, well-being, body tone and/or shape, stress reduction, cardiovascular health, and energy level. Black patients were more likely than White patients to report weight loss and weight maintenance goals. Weight maintenance, overall health, and stress reduction are the goals for which the greatest percentage of individuals reported meeting aerobic PA guidelines. Finally, number of breaks taken and average length of breaks were similar across type of PA goal. A relatively small number of goals reflected a majority of the goals pursued by participants in this study. Racial differences in adoption of weight loss and weight maintenance goals highlight the need for further investigation into such differences. Finally, future research should consider the role that goal setting plays in PA adherence, paying particular attention to disparate levels of PA across racial groups.

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