Feasibility of a Nutrition and Lifestyle Focused Shared Medical Appointment Program in a Resource-Challenged Community Setting

Background: In order to address disparities in preventable chronic diseases, we adapted a nutrition and lifestyle focused shared medical appointment (SMA) program to be delivered in an underserved community setting. The objective was to determine the feasibility of the community-based SMA pilot.Methods: The SMA program was a community benefit for community residents regardless of their participation in the research study. We evaluated pre-post changes in wellness indices, biometrics, self-efficacy, and trust in medical researchers. To understand the barriers and facilitators for implementation and scalability, we conducted two participant focus groups and five stakeholder interviews and used content analysis to determine major themes. Key Results: Fifteen participants attended 10 weekly sessions. The majority were older adult, African American women. There were pre-post improvements in mean systolic (-10.5 [7.7] mmHg, p=0.0001) and diastolic (-4.7 [6.7] mmgHg, p=0.17) blood pressures and weight (-5.7 [6.3] pounds, p=0.0034) at 3 months though these were not significant at 6 months. More individuals reported improvements in health status, daily fruit and vegetable intake, and sleep than at baseline. There were no significant pre-post changes in other wellness indices, self-efficacy, trust in medical researchers, hemoglobin A1c, insulin, or LDL cholesterol. Participants discussed positive health changes as a result of the SMA program, program preferences, and facilitators and barriers to continuing program recommendations in focus groups. SMA implementation was facilitated by clinical staff who adjusted content to a low health literacy group and partnership with a trusted community partner. Sustainability barriers include heavy personnel time and in-kind resources to deliver the program. Conclusion: Lifestyle-focused community-based SMAs can be a feasible and acceptable intervention for patients with neighborhood disadvantage, especially in partnership with trusted organizations.