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McVay MA, Jake-Schoffman DE, Leong MC, Lou X. Privacy Concerns in Group Format Lifestyle Interventions for Obesity. Int J Behav Med 2023; 30:693-704. [PMID: 36261768 DOI: 10.1007/s12529-022-10134-1] [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: 10/05/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Group format weight loss interventions have benefits over individual format, but privacy concerns may limit their uptake. METHOD In this study, adults with obesity and interest in losing weight were recruited nationally online and randomly assigned to view one of eight videos describing a hypothetical, group behavioral weight loss intervention. Based on three fully crossed factors, the videos varied on privacy features of intervention (present or not); matching participants to group based on weight loss barriers (matched or not); and intervention format (online or in-person). Participants rated their willingness to join, privacy concerns, and perceived effectiveness of these interventions. They further reported preference for individual or group format interventions and reason for preferences. RESULTS Description of privacy features, matching of participants, and format did not affect willingness to join, privacy concerns, or perceived effectiveness of the intervention. Privacy concerns were associated with lower willingness to join and lower perceived intervention effectiveness, and greater social anxiety and weight stigma. More participants preferred individual over group format (40.1% vs 33.9%; 26% selected neither) and preference for individual format was associated with greater privacy concerns. CONCLUSION Strategies to address privacy concerns in group-based interventions warrant further attention.
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Affiliation(s)
- Megan A McVay
- Department of Health Education and Behavior, College of Health and Human Performance, University of Florida, P.O. Box 118210, Gainesville, FL, 32611, USA.
| | - Danielle E Jake-Schoffman
- Department of Health Education and Behavior, College of Health and Human Performance, University of Florida, P.O. Box 118210, Gainesville, FL, 32611, USA
| | - Man Chong Leong
- Department of Biostatistics, College of Public Health and Health Professions & College of Medicine, University of Florida, University of Florida Health Cancer Center, Gainesville, USA
| | - XiangYang Lou
- Department of Biostatistics, College of Public Health and Health Professions & College of Medicine, University of Florida, University of Florida Health Cancer Center, Gainesville, USA
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2
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Krutilova P, Williams R, Morey R, Field C, Byrth V, Tepe M, McQueen A, Herrick C. Gestational diabetes knowledge improves with interactive online training modules: a pre-post analysis. RESEARCH SQUARE 2023:rs.3.rs-2860961. [PMID: 37398401 PMCID: PMC10312972 DOI: 10.21203/rs.3.rs-2860961/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
Background The risk of developing type 2 diabetes mellitus (T2DM) is up to 50% among women with gestational diabetes mellitus (GDM). GDM also increases risks for pre-term birth, macrosomia, fetal hypoglycemia, and C-section delivery. Education for expectant mothers with GDM about nutrition, exercise, and the risks of developing T2DM after delivery enhances the probability of postpartum diabetes screening. However, the availability of diabetes education is limited. To bridge this gap, our team developed four training modules on GDM tailored for nurses and community health workers. This pilot study assesses changes in knowledge, self-efficacy for providing diabetes education, attitudes, and intentions to recommend diabetes prevention before and after training completion. Methods These interactive online modules, each lasting 45-60 minutes and featuring engaging case studies and integrated knowledge assessment questions, were disseminated through various professional organizations to clinical staff providing care for women with GDM. Optional pre- and post-training surveys were conducted to gauge the effectiveness of the modules. Collected data did not follow a normal distribution pattern. We provided an overview of the baseline characteristics of the population, self-efficacy, attitudes, intentions, and GDM knowledge by calculating the median scores and interquartile ranges. We assessed the changes in scores on self-efficacy, attitudes, intentions, and GDM knowledge before and after training using non-parametric Wilcoxon matched-pair signed rank tests. Results Eighty-two individuals completed baseline evaluation and 20 individuals accessed all modules and completed post-training assessments. Among those completing the training, improvement was noted in GDM knowledge [56.5% (16.0) v. 78.3% (22.0), p < 0.001], Self-efficacy for providing diabetes education [6.60 (2.73) v. 9.33 (0.87), p < 0.001], attitudes toward the value of tight control [4.07 (0.79) v. 4.43 (0.86), p = 0.003], and intentions to recommend diabetes prevention measures [4.81 (0.63) v. 5.00 (0.00), p = 0.009)]. Conclusions Completion of our interactive online modules improved knowledge, intention to recommend diabetes prevention methods, self-efficacy to provide diabetes education, and attitudes toward the value of tight control among individuals caring for women with GDM. Enhanced accessibility to such curricula is crucial to improve access to diabetes education. Trial registration This study was registered at clinicaltrials.gov, identifier: NCT04474795.
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Affiliation(s)
- Petra Krutilova
- Washington University School of Medicine, Metabolism & Lipid Research
| | - Roxann Williams
- Washington University School of Medicine, Metabolism & Lipid Research
| | | | - Carole Field
- Washington University School of Medicine, Metabolism & Lipid Research
| | | | | | | | - Cynthia Herrick
- Washington University School of Medicine, Metabolism & Lipid Research
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3
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Escoffery C, Patel A, Leung J, Anderson M, McGee R, Sajatovic M, Johnson EK, Jobst B, Kiriakopoulos ET, Shegog R, Fraser R, Quarells RC. MEW network self-management program characteristics and lessons learned through the RE-AIM framework. Epilepsy Behav 2023; 140:109111. [PMID: 36804716 PMCID: PMC10941971 DOI: 10.1016/j.yebeh.2023.109111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 12/23/2022] [Accepted: 01/24/2023] [Indexed: 02/18/2023]
Abstract
RATIONALE The promotion of evidence-based self-management support for people living with chronic conditions such as epilepsy is a public health priority. Epilepsy self-management encompasses three general areas: (1) treatment management, (2) seizure management, and (3) lifestyle management. Interventions focusing on self-management have increased quality of life and adherence to treatment. This study assesses and synthesizes the Managing Epilepsy Well Network (MEWN) program implementation experiences using the RE-AIM framework. This research informs the quality and rigor of MEWN program dissemination and implementation efforts to assess whether these programs are being implemented and their scalability. METHODS The study data were derived from a MEWN Self-management Program Survey conducted with currently active MEWN researchers through an online survey and review of program publications and archival documents. Survey data were obtained from either the principal investigator or study team for the UPLIFT, HOBSCOTCH, SMART, MINDSET, TIME, and PACES programs. The survey questionnaire included 6 sections consisting of 68 questions and focused on the RE-AIM dimensions and respondent characteristics. The RE-AIM dimensions included: (1) Reach, (2) Effectiveness, (3) Adoption (number of and type of adopting sites), (4) Implementation (retention rate, barriers to implementation), and (5) Maintenance. RESULTS Across the MEWN programs, participation (44-120 individuals) and delivery methods (community, clinic, or asynchronous; group or individual) ranged with most programs predominantly reaching White or African American participants. Common program outcome measures included clinical outcomes (e.g., depression, quality of life, seizure frequency) and indicators of self-management behaviors (e.g., problem-solving; self-efficacy). Initial efficacy trials suggested programs were effective in changing some of their targeted outcomes (effectiveness). Most programs were implemented in clinical settings and several programs are being replicated or adapted to different geographical (e.g., urban, rural, suburban) or demographic (e.g., race, age) settings (adoption). Program delivery methods involved a mixture of program staff, peer educators, and researchers. Implementation enabling factors included partnerships with local epilepsy organizations and the inclusion of peer educators. Retention rates for all programs averaged 83.6%. Internal barriers included recruitment and lack of sufficient resources for participants. External barriers included clinical staff buy-in, staffing, and insufficient funding for support staff. Despite uncertain funding, all programs offered next steps to sustain their initiatives such as packaging their programs, initiating adoption with regional organizations, and supporting organizational readiness (maintenance). Dissemination efforts included partnering with other organizations, provision of training and technical assistance, and partnering with national organizations on grant opportunities to scale up existing programs. CONCLUSION These data showcase the impact of the MEWN self-management interventions on health and quality of life. These programs are employing training, readiness assessment, technical assistance, and development of partnerships to increase program scalability. Finally, program adaptations are being conducted to expand the interventions to other populations to address health inequalities. The lessons learned are critical for other interventions attempting to increase the translation of their programs to other settings.
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Affiliation(s)
- Cam Escoffery
- Emory University, Rollins School of Public Health, 1518 Clifton Road, Atlanta, GA 30322, United States.
| | - Archna Patel
- Emory University, Rollins School of Public Health, 1518 Clifton Road, Atlanta, GA 30322, United States
| | - Jerik Leung
- Emory University, Rollins School of Public Health, 1518 Clifton Road, Atlanta, GA 30322, United States
| | - Molly Anderson
- Emory University, Rollins School of Public Health, 1518 Clifton Road, Atlanta, GA 30322, United States
| | - Robin McGee
- Emory University, Rollins School of Public Health, 1518 Clifton Road, Atlanta, GA 30322, United States
| | - Martha Sajatovic
- Case Western Reserve University, 10900 Euclid Ave, Cleveland, OH 44106, United States
| | - Erica K Johnson
- University of Washington, Health Promotion Research Center, 1107 NE 45(th) St #200, Seattle, WA 98105, United States
| | - Barbara Jobst
- Dartmouth-Hitchcock Medical Center, 1 Medical Center Dr, Lebanon, NH 03766, United States
| | - Elaine T Kiriakopoulos
- Dartmouth-Hitchcock Medical Center, 1 Medical Center Dr, Lebanon, NH 03766, United States
| | - Ross Shegog
- University of Texas School of Public Health, 7000 Fannin St #1200, Houston, TX 77030, United States
| | - Robert Fraser
- University of Washington, Health Promotion Research Center, 1107 NE 45(th) St #200, Seattle, WA 98105, United States
| | - Rakale C Quarells
- Morehouse School of Medicine, 720 Westview Dr SW, Atlanta, GA 30310, United States
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4
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Madrigal L, Manders OC, Kegler M, Haardörfer R, Piper S, Blais LM, Weber MB, Escoffery C. Inner and outer setting factors that influence the implementation of the National Diabetes Prevention Program (National DPP) using the Consolidated Framework for Implementation Research (CFIR): a qualitative study. Implement Sci Commun 2022; 3:104. [PMID: 36183133 PMCID: PMC9526531 DOI: 10.1186/s43058-022-00350-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 09/19/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Scaling evidence-based interventions are key to impacting population health. The National DPP lifestyle change program is one such intervention that has been scaled across the USA over the past 20 years; however, enrollment is an ongoing challenge. Furthermore, little is known about which organizations are most successful with program delivery, enrollment, and scaling. This study aims to understand more about the internal and external organization factors that impact program implementation and reach. METHODS Between August 2020 and January 2021, data were collected through semi-structured key informant interviews with 30 National DPP delivery organization implementers. This study uses a qualitative cross-case construct rating methodology to assess which Consolidated Framework for Implementation Research (CFIR) inner and outer setting constructs contributed (both in valence and magnitude) to the organization's current level of implementation reach (measured by average participant enrollment per year). A construct by case matrix was created with ratings for each CFIR construct by interviewee and grouped by implementation reach level. RESULTS Across the 16 inner and outer setting constructs and subconstructs, the interviewees with greater enrollment per year provided stronger and more positive examples related to implementation and enrollment of the program, while the lower reach groups reported stronger and more negative examples across rated constructs. Four inner setting constructs/subconstructs (structural characteristics, compatibility, goals and feedback, and leadership engagement) were identified as "distinguishing" between enrollment reach levels based on the difference between groups by average rating, the examination of the number of extreme ratings within levels, and the thematic analysis of the content discussed. Within these constructs, factors such as organization size and administrative processes; program fit with existing organization services and programs; the presence of enrollment goals; and active leadership involvement in implementation were identified as influencing program reach. CONCLUSIONS Our study identified a number of influential CFIR constructs and their impact on National DPP implementation reach. These findings can be leveraged to improve efforts in recruiting and assisting delivery organizations to increase the reach and scale of the National DPP as well as other evidence-based interventions.
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Affiliation(s)
- Lillian Madrigal
- grid.189967.80000 0001 0941 6502Rollins School of Public Health Emory University, 1518 Clifton Rd, Atlanta, GA 30322 USA
| | - Olivia C. Manders
- grid.189967.80000 0001 0941 6502Rollins School of Public Health Emory University, 1518 Clifton Rd, Atlanta, GA 30322 USA
| | - Michelle Kegler
- grid.189967.80000 0001 0941 6502Rollins School of Public Health Emory University, 1518 Clifton Rd, Atlanta, GA 30322 USA
| | - Regine Haardörfer
- grid.189967.80000 0001 0941 6502Rollins School of Public Health Emory University, 1518 Clifton Rd, Atlanta, GA 30322 USA
| | - Sarah Piper
- grid.189967.80000 0001 0941 6502Rollins School of Public Health Emory University, 1518 Clifton Rd, Atlanta, GA 30322 USA
| | - Linelle M. Blais
- grid.189967.80000 0001 0941 6502Rollins School of Public Health Emory University, 1518 Clifton Rd, Atlanta, GA 30322 USA
| | - Mary Beth Weber
- grid.189967.80000 0001 0941 6502Rollins School of Public Health Emory University, 1518 Clifton Rd, Atlanta, GA 30322 USA
| | - Cam Escoffery
- grid.189967.80000 0001 0941 6502Rollins School of Public Health Emory University, 1518 Clifton Rd, Atlanta, GA 30322 USA
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Okpechi IG, Hariramani VK, Sultana N, Ghimire A, Zaidi D, Muneer S, Tinwala MM, Ye F, Sebastianski M, Abdulrahman A, Braam B, Jindal K, Khan M, Klarenbach S, Shojai S, Thompson S, Bello AK. The impact of community-based non-pharmacological interventions on cardiovascular and kidney disease outcomes in remote dwelling Indigenous communities: A scoping review protocol. PLoS One 2022; 17:e0269839. [PMID: 35687551 PMCID: PMC9187124 DOI: 10.1371/journal.pone.0269839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 05/27/2022] [Indexed: 11/26/2022] Open
Abstract
Introduction Indigenous people represent approximately 5% of the world’s population. However, they often have a disproportionately higher burden of cardiovascular disease (CVD) risk and chronic kidney disease (CKD) than their equivalent general population. Several non-pharmacological interventions (e.g., educational) have been used to reduce CVD and kidney disease risk factors in Indigenous groups. The aim of this paper is to describe the protocol for a scoping review that will assess the impact of non-pharmacological interventions carried out in Indigenous and remote dwelling populations to reduce CVD risk factors and CKD. Materials and methods This scoping review will be guided by the methodological framework for conducting scoping studies developed by Arksey and O’Malley. Both empirical (Medline, Embase, Cochrane Library, CINAHL, ISI Web of Science and PsycINFO) and grey literature references will be assessed if they focused on interventions targeted at reducing CVD or CKD among Indigenous groups. Two reviewers will independently screen references in consecutive stages of title/abstract screening and then full-text screening. Impact of interventions used will be assessed using the reach, effectiveness, adoption, implementation, maintenance (RE-AIM) framework. A descriptive overview, tabular summaries, and content analysis will be carried out on the extracted data. Ethics and dissemination This review will collect and analyse evidence on the impact of interventions of research carried out to reduce CVD and CKD among Indigenous populations. Such evidence will be disseminated using traditional approaches that includes open-access peer-reviewed publication, scientific presentations, and a report. Also, we will disseminate our findings to the government and Indigenous leaders. Ethical approval will not be required for this scoping review as the data used will be extracted from already published studies with publicly accessible data.
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Affiliation(s)
- Ikechi G. Okpechi
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa
- Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
| | - Vinash Kumar Hariramani
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Naima Sultana
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Anukul Ghimire
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Deenaz Zaidi
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Shezel Muneer
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Mohammed M. Tinwala
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Feng Ye
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Megan Sebastianski
- Knowledge Translation Platform, Alberta SPOR SUPPORT Unit Department of Pediatrics, University of Alberta, Edmonton, Canada
| | - Abdullah Abdulrahman
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Branko Braam
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Kailash Jindal
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Maryam Khan
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Scott Klarenbach
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Soroush Shojai
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Stephanie Thompson
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Aminu K. Bello
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- * E-mail:
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Williams J, Sachdev N, Kirley K, Moin T, Duru OK, Brunisholz KD, Sill K, Joy E, Aquino GC, Brown AR, O'Connell C, Rea B, Craig-Buckholtz H, Witherspoon PW, Bruett C. Implementation of Diabetes Prevention in Health Care Organizations: Best Practice Recommendations. Popul Health Manag 2022; 25:31-38. [PMID: 34161148 PMCID: PMC8861908 DOI: 10.1089/pop.2021.0044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Approximately 1 in 3 American adults has prediabetes, a condition characterized by blood glucose levels that are above normal, not in the type 2 diabetes ranges, and that increases the risk of developing type 2 diabetes. Evidence-based treatments can be used to prevent or delay type 2 diabetes in adults with prediabetes. The American Medical Association (AMA) has collaborated with health care organizations across the country to build sustainable diabetes prevention strategies. In 2017, the AMA formed the Diabetes Prevention Best Practices Workgroup (DPBP) with representatives from 6 health care organizations actively implementing diabetes prevention. Each organization had a unique strategy, but all included the National Diabetes Prevention Program lifestyle change program as a core evidence-based intervention. DPBP established the goal of disseminating best practices to guide other health care organizations in implementing diabetes prevention and identifying and managing patients with prediabetes. Workgroup members recognized similarities in some of their basic steps and considerations and synthesized their practices to develop best practice recommendations for 3 strategy maturity phases. Recommendations for each maturity phase are classified into 6 categories: (1) organizational support; (2) workforce and funding; (3) promotion and dissemination; (4) clinical integration and support; (5) evaluation and outcomes; (6) and program. As the burden of chronic disease grows, prevention must be prioritized and integrated into health care. These maturity phases and best practice recommendations can be used by any health care organization committed to diabetes prevention. Further research is suggested to assess the impact and adoption of diabetes prevention best practices.
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Affiliation(s)
- Janet Williams
- Improving Health Outcomes, American Medical Association, Chicago, Illinois, USA.,Address correspondence to: Janet Williams, MA, Improving Health Outcomes, American Medical Association, 330 N. Wabash Avenue, Chicago, IL 60611, USA
| | - Neha Sachdev
- Improving Health Outcomes, American Medical Association, Chicago, Illinois, USA.,David Geffen School of Medicine, UCLA and VA, Los Angeles, California, USA
| | - Kate Kirley
- Improving Health Outcomes, American Medical Association, Chicago, Illinois, USA.,David Geffen School of Medicine, UCLA, Los Angeles, California, USA
| | - Tannaz Moin
- David Geffen School of Medicine, UCLA and VA, Los Angeles, California, USA
| | - O. Kenrik Duru
- David Geffen School of Medicine, UCLA, Los Angeles, California, USA
| | | | - Kelly Sill
- Improving Health Outcomes, American Medical Association, Chicago, Illinois, USA
| | - Elizabeth Joy
- Wellness and Nutrition, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Gina C. Aquino
- Henry Ford Macomb Hospital, Clinton Township, Michigan, USA
| | - Ameldia R. Brown
- Faith and Community Health, Henry Ford Health System, Clinton Township, Michigan, USA
| | | | - Brenda Rea
- Department of Family Medicine and Preventive Medicine, Loma Linda University Health, Redlands, California, USA
| | - Holly Craig-Buckholtz
- Diabetes and Outpatient Wound Care Services, Loma Linda University Medical Center, Loma Linda, California, USA
| | | | - Cindy Bruett
- Diabetes Prevention Program, Community Health & Well-Being, Trinity Health, Livonia, Michigan, USA
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Fitzpatrick SL, Mayhew M, Catlin CL, Firemark A, Gruß I, Nyongesa DB, O’Keeffe-Rosetti M, Rawlings AM, Smith DH, Smith N, Stevens VJ, Vollmer WM, Fortmann SP. Evaluating the Implementation of Digital and In-Person Diabetes Prevention Program in a Large, Integrated Health System: Natural Experiment Study Design. Perm J 2021; 26:21-31. [PMID: 35609151 PMCID: PMC9126549 DOI: 10.7812/tpp/21.056] [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: 03/24/2021] [Revised: 07/05/2021] [Accepted: 07/12/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Implementation of a Diabetes Prevention Program (DPP) in both in-person and digital health-care settings has been increasing. The purpose of this article is to describe the protocol of a mixed-methods, natural experiment study designed to evaluate the implementation of DPP in a large, integrated health system. METHODS Kaiser Permanente Northwest patients who were 19 to 75 years with prediabetes (hemoglobin A1c or glycated hemoglobin, 5.7-6.4) and obesity (body mass index ≥ 30 kg/m2) were invited, via the Kaiser Permanente Northwest patient portal, to participate in the digital (n = 4124) and in-person (n = 2669) DPP during 2016 through 2018. Primary (weight) and secondary (hemoglobin A1c or glycated hemoglobin level) outcome data will be obtained from electronic health records. A cost-effectiveness analysis as well as qualitative interviews with patients (enrolled and not enrolled in the DPP) and stakeholders will be conducted to examine further implementation, acceptability, and sustainability. CONCLUSION The mixed-methods, natural experiment design we will use to evaluate Kaiser Permanente Northwest's implementation of the digital and in-person DPP builds on existing evidence related to the effectiveness of these two DPP delivery modes and will contribute new knowledge related to best practices for implementing and sustaining the DPP within large health systems over the long term.
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Affiliation(s)
| | - Meghan Mayhew
- Kaiser Permanente Center for Health Research in Portland, OR
| | - Chris L Catlin
- Kaiser Permanente Center for Health Research in Portland, OR
| | - Alison Firemark
- Kaiser Permanente Center for Health Research in Portland, OR
| | - Inga Gruß
- Kaiser Permanente Center for Health Research in Portland, OR
| | | | | | | | - David H Smith
- Kaiser Permanente Center for Health Research in Portland, OR
| | - Ning Smith
- Kaiser Permanente Center for Health Research in Portland, OR
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8
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Price DW, Davis DA, Filerman GL. "Systems-Integrated CME": The Implementation and Outcomes Imperative for Continuing Medical Education in the Learning Health Care Enterprise. NAM Perspect 2021; 2021:202110a. [PMID: 34901778 PMCID: PMC8654469 DOI: 10.31478/202110a] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- David W Price
- University of Colorado Anschutz School of Medicine and the American Board of Family Medicine
| | - David A Davis
- AXDEV Group, University of Toronto and Mohammed Bin Rashid University of Medicine & the Health Sciences
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9
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Nash DM, Bhimani Z, Rayner J, Zwarenstein M. Learning health systems in primary care: a systematic scoping review. BMC FAMILY PRACTICE 2021; 22:126. [PMID: 34162336 PMCID: PMC8223335 DOI: 10.1186/s12875-021-01483-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 05/10/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Learning health systems have been gaining traction over the past decade. The purpose of this study was to understand the spread of learning health systems in primary care, including where they have been implemented, how they are operating, and potential challenges and solutions. METHODS We completed a scoping review by systematically searching OVID Medline®, Embase®, IEEE Xplore®, and reviewing specific journals from 2007 to 2020. We also completed a Google search to identify gray literature. RESULTS We reviewed 1924 articles through our database search and 51 articles from other sources, from which we identified 21 unique learning health systems based on 62 data sources. Only one of these learning health systems was implemented exclusively in a primary care setting, where all others were integrated health systems or networks that also included other care settings. Eighteen of the 21 were in the United States. Examples of how these learning health systems were being used included real-time clinical surveillance, quality improvement initiatives, pragmatic trials at the point of care, and decision support. Many challenges and potential solutions were identified regarding data, sustainability, promoting a learning culture, prioritization processes, involvement of community, and balancing quality improvement versus research. CONCLUSIONS We identified 21 learning health systems, which all appear at an early stage of development, and only one was primary care only. We summarized and provided examples of integrated health systems and data networks that can be considered early models in the growing global movement to advance learning health systems in primary care.
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Affiliation(s)
- Danielle M Nash
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada. .,ICES, London, ON, Canada.
| | - Zohra Bhimani
- Department of Medicine, London Health Sciences Centre, London, ON, Canada
| | - Jennifer Rayner
- Centre for Studies in Family Medicine, Western University, London, ON, Canada.,Department of Research and Evaluation, Alliance for Healthier Communities, Toronto, ON, Canada
| | - Merrick Zwarenstein
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada.,Centre for Studies in Family Medicine, Western University, London, ON, Canada.,ICES, Toronto, ON, Canada
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10
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Gibson B, Simonsen S, Barton J, Zhang Y, Altizer R, Lundberg K, Wetter DW. Motivation and Problem Solving Versus Mobile 360° Videos to Promote Enrollment in the National Diabetes Prevention Program's Lifestyle Change Program Among People With Prediabetes: Protocol for a Randomized Trial. JMIR Res Protoc 2021; 10:e28884. [PMID: 34125075 PMCID: PMC8240802 DOI: 10.2196/28884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/22/2021] [Accepted: 04/28/2021] [Indexed: 01/20/2023] Open
Abstract
Background More than 88 million Americans are at risk of developing type 2 diabetes mellitus (T2DM). The National Diabetes Prevention Program’s Lifestyle Change Program (DPP LCP) has been shown to be effective in reducing the risk of progressing from prediabetes to T2DM. However, most individuals who could benefit from the program do not enroll. Objective The aim of this trial is to test the real-world efficacy of 3 mobile phone–based approaches to increasing enrollment in the DPP LCP including a best-practice condition and 2 novel approaches. Methods We will conduct a 3-armed randomized clinical trial comparing enrollment and 1-month engagement in the DPP LCP among adults with prediabetes from 2 health care settings. Participants in the best-practice condition will receive SMS-based notifications that they have prediabetes and a link to a website that explains prediabetes, T2DM, and the DPP LCP. This will be followed by a single question survey, “Would you like the DPP LCP to call you to enroll?” Participants in the 2 intervention arms will receive the same best-practice intervention plus either 2 mobile 360° videos or up to 5 brief phone calls from a health coach trained in a motivational coaching approach known as Motivation and Problem Solving (MAPS). We will collect measures of diabetes-related knowledge, beliefs in the controllability of risk for T2DM, risk perceptions for T2DM, and self-efficacy for lifestyle change pre-intervention and 4 weeks later. The primary outcomes of the study are enrollment in the DPP LCP and 4-week engagement in the DPP LCP. In addition, data on the person-hours needed to deliver the interventions as well as participant feedback about the interventions and their acceptability will be collected. Our primary hypotheses are that the 2 novel interventions will lead to higher enrollment and engagement in the DPP LCP than the best-practice intervention. Secondary hypotheses concern the mechanisms of action of the 2 intervention arms: (1) whether changes in risk perception are associated with program enrollment among participants in the mobile 360° video group and (2) whether changes in self-efficacy for lifestyle change are associated with program enrollment among participants in the MAPS coaching group. Finally, exploratory analyses will examine the cost effectiveness and acceptability of the interventions. Results The project was funded in September 2020; enrollment began in February 2021 and is expected to continue through July 2022. Conclusions We are conducting a test of 2 novel, scalable, mobile phone–based interventions to increase enrollment in the DPP LCP. If effective, they have tremendous potential to be scaled up to help prevent T2DM nationwide. Trial Registration ClinicalTrials.gov NCT04746781; https://clinicaltrials.gov/ct2/show/NCT04746781 International Registered Report Identifier (IRRID) DERR1-10.2196/28884
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Affiliation(s)
- Bryan Gibson
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, United States
| | - Sara Simonsen
- College of Nursing, University of Utah, Salt Lake City, UT, United States
| | - Jonathan Barton
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, United States
| | - Yue Zhang
- Division of Epidemiology, University of Utah, Salt Lake City, UT, United States
| | - Roger Altizer
- Entertainment Arts and Engineering, University of Utah, Salt Lake City, UT, United States
| | - Kelly Lundberg
- Department of Psychiatry, University of Utah, Salt Lake City, UT, United States
| | - David W Wetter
- Center for Health Outcomes and Population Equity, Huntsman Cancer Institute, Salt Lake City, UT, United States
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Brunisholz KD, Conroy MB, Belnap T, Joy EA, Srivastava R. Measuring Adherence to U.S. Preventive Services Task Force Diabetes Prevention Guidelines Within Two Healthcare Systems. J Healthc Qual 2021; 43:119-125. [PMID: 32842020 PMCID: PMC7878570 DOI: 10.1097/jhq.0000000000000281] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
ABSTRACT Measuring adherence to the 2015 U.S. Preventive Services Task Force (USPSTF) diabetes prevention guidelines can inform implementation efforts to prevent or delay Type 2 diabetes. A retrospective cohort was used to study patients without a diagnosis of diabetes attributed to primary care clinics within two large healthcare systems in our state to study adherence to the following: (1) screening at-risk patients and (2) referring individuals with confirmed prediabetes to participate in an intensive behavioral counseling intervention, defined as a Center for Disease Control and Prevention (CDC)-recognized Diabetes Prevention Program (DPP). Among 461,866 adults attributed to 79 primary care clinics, 45.7% of patients were screened, yet variability at the level of the clinic ranged from 14.5% to 83.2%. Very few patients participated in a CDC-recognized DPP (0.52%; range 0%-3.53%). These findings support the importance of a systematic implementation strategy to specifically target barriers to diabetes prevention screening and referral to treatment.
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Gibson B, Simonsen S, Jensen JD, Yingling L, Schaefer J, Sundaresh V, Zhang Y, Altizer R. Mobile Virtual reality vs. Mobile 360 Video to Promote Enrollment in the Diabetes Prevention Program Amongst Hispanic Adults (Preprint). JMIR Diabetes 2020; 7:e26013. [PMID: 35297771 PMCID: PMC8972104 DOI: 10.2196/26013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 09/30/2021] [Accepted: 01/23/2022] [Indexed: 11/15/2022] Open
Abstract
Background Hispanic adults are at increased risk of developing type 2 diabetes. The Diabetes Prevention Program (DPP) reduces the risk of developing type 2 diabetes; however, the rate of enrollment is very low. Objective The goal of this pilot project was to determine whether presenting brief motivational mobile videos in virtual reality vs 360° video has differential effects on risk perceptions and enrollment in the DPP. Methods Adults with prediabetes were recruited at a clinic serving a low-income Hispanic community. After consenting, the participants completed a baseline survey that collected information about demographics and risk perceptions. All participants then viewed 2 videos. Per random assignment, the videos were presented either using the participant’s smartphone alone (360° video) or were viewed with their smartphone in a virtual reality (VR) cardboard headset. Two weeks later, a follow-up survey collected measures of enrollment in the DPP, risk perceptions, health literacy, the importance of contextual factors related to the decision of whether to enroll in the DPP (eg, distance to the class), and qualitative feedback on the interventions. We used logistic regression to determine whether enrollment in the DPP differed by intervention mode, while accounting for health literacy and contextual factors related to the DPP. We used unpaired t tests to examine differences in change in risk perceptions between groups. Paired t tests were used to examine within-subject changes in risk perceptions. Results A total of 116 participants provided complete data. Most participants were middle-aged (mean age 44.6 years; SD 11.9) Hispanic (114/116), female (79/116), with low health literacy (mean score 12.3/20; SD 3.4). Enrollment in the DPP was 44/116 (37.9%) overall but did not differ by group (odds ratio for enrolling in VR group 1.78, 95% CI 0.75-4.3; P=.19). Individuals who rated the distance needed to travel to attend the DPP as more important were less likely to enroll in the DPP (odds ratio 0.56, 95% CI 0.33-0.92; P=.03). Risk perceptions did not differ by group (mean change in 360° video group -0.07, mean change in VR group 0.03, t=0.6, P=.54) and did not change within subjects (mean 0.02, t=0.21, P=.83). Participant feedback suggested that the videos are emotionally engaging and educational. Conclusions The videos presented in 360° video and mobile VR had equal efficacy in promoting enrollment in the DPP. Future work to rigorously evaluate this intervention, its mechanism of action, and potential moderators of the efficacy are discussed.
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Affiliation(s)
- Bryan Gibson
- Department of Biomedical Informatics, School of Medicine, University of Utah, Salt Lake City, UT, United States
| | - Sara Simonsen
- College of Nursing, University of Utah, Salt Lake City, UT, United States
| | - Jakob D Jensen
- Department of Communication, University of Utah, Salt Lake City, UT, United States
| | - Leah Yingling
- Department of Biomedical Informatics, School of Medicine, University of Utah, Salt Lake City, UT, United States
| | - Julia Schaefer
- Department of Biomedical Informatics, School of Medicine, University of Utah, Salt Lake City, UT, United States
| | - Vishnu Sundaresh
- Department of Endocrinology, School of Medicine, University of Utah, Salt Lake City, UT, United States
| | - Yue Zhang
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, United States
| | - Roger Altizer
- Therapeutic Games and Applications Lab, University of Utah, Salt Lake City, UT, United States
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McVay MA, Donahue ML, Cheong J, Bacon J, Perri MG, Ross KM. Effects of Intervention Characteristics on Willingness to Initiate a Weight Gain Prevention Program. Am J Health Promot 2020; 34:837-847. [PMID: 32077301 DOI: 10.1177/0890117120905709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To determine characteristics of weight gain prevention programs that facilitate engagement. DESIGN Randomized factorial experiment (5 × 2). SETTING Recruited nationally online. PARTICIPANTS Adults aged 18 to 75 with body mass index ≥25 who decline a behavioral weight loss intervention (n = 498). MEASURES Participants were randomly presented with one of 10 possible descriptions of hypothetical, free weight gain prevention programs that were all low dose and technology-based but differed in regard to 5 behavior change targets (self-weighing only; diet only; physical activity only; combined diet, physical activity, and self-weighing; or choice between diet, physical activity, and self-weighing targets) crossed with 2 financial incentive conditions (presence or absence of incentives for self-monitoring). Participants reported willingness to join the programs, perceived program effectiveness, and reasons for declining enrollment. ANALYSIS Logistic regression and linear regression to test effects of program characteristics offered on willingness to initiate programs and programs' perceived effectiveness, respectively. Content analyses for open-ended text responses. RESULTS Participants offered the self-weighing-only programs were more willing to initiate than those offered the programs targeting all 3 behaviors combined (50% vs 36%; odds ratio [OR] = 1.79; 95% confidence interval [CI], 1.01-3.13). Participants offered the programs with financial incentives were more willing to initiate (50% vs 33%; OR = 2.08; 95% CI, 1.44-2.99) and anticipated greater intervention effectiveness (β = .34, P = .02) than those offered no financial incentives. Reasons for declining to initiate included specific program features, behavior targets, social aspects, and benefits. CONCLUSION Targeting self-weighing and providing financial incentives for self-monitoring may result in greater uptake of weight gain prevention programs. STUDY PREREGISTRATION https://osf.io/b9zfh, June 19, 2018.
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Affiliation(s)
- Megan A McVay
- Department of Health Education and Behavior, College of Health and Human Performance, University of Florida, Gainesville, FL, USA
| | - Marissa L Donahue
- Department of Health Education and Behavior, College of Health and Human Performance, University of Florida, Gainesville, FL, USA
| | - JeeWon Cheong
- Department of Health Education and Behavior, College of Health and Human Performance, University of Florida, Gainesville, FL, USA
| | - Joseph Bacon
- Department of Health Education and Behavior, College of Health and Human Performance, University of Florida, Gainesville, FL, USA
| | - Michael G Perri
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Kathryn M Ross
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
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Coughlin SS, Stewart JL. Toward research-tested mobile health interventions to prevent diabetes and cardiovascular disease among persons with pre-diabetes. ACTA ACUST UNITED AC 2017; 1. [PMID: 29226917 DOI: 10.21037/jhmhp.2017.11.02] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background About 35% of US adults have pre-diabetes and an increased risk of diabetes. Consumer-facing devices such as the Fitbit help users become more physically active and manage their weight which reduces risk of diabetes and cardiovascular disease. Methods In this commentary we provide a summary of healthy lifestyle intervention studies involving persons with pre-diabetes including those conducted in routine clinical practice. We also provide an account of how such interventions might be enhanced through the use of wearable devices linked to smartphone applications. Results In initial trials focusing on overweight and obesity, consumer wearable devices have been shown to increase physical activity and reduce weight. However, the acceptability and effectiveness of these mHealth interventions among persons with impaired glucose tolerance or impaired fasting glucose is unknown; studies involving persons with pre-diabetes have not yet been reported. Conclusions Research is needed to determine the feasibility and efficacy of wearable devices in improving physical activity and weight management in persons with pre-diabetes who are at-risk of diabetes and cardiovascular disease.
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Affiliation(s)
- Steven S Coughlin
- Department of Clinical and Digital Health Sciences, College of Allied Health Sciences, Augusta University, Augusta, GA, USA.,Research Service, Charlie Norwood Veterans Affairs Medical Center, Augusta, GA, USA
| | - Jessica Lynn Stewart
- Department of Clinical and Digital Health Sciences, College of Allied Health Sciences, Augusta University, Augusta, GA, USA
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