Development of a tailored, 5a's-based weight management intervention for veterans within primary care

K F Mateo, S Sikerwar, A Squires, A Kalet, S Sherman, M Jay

Research output: Contribution to journalMeeting Abstract

Abstract

BACKGROUND: Obesity affects 36 % of patients in the Veterans Health Administration. The United States Preventive Services Task Force endorses the use of the 5As framework (Assess, Advise, Agree, Assist, Arrange) to deliver obesity counseling in primary care (PC). This study used qualitative methods to inform the development of a 5As-based weight management intervention to improve obesity care at Veterans Affairs (VA) Medical Centers. METHODS: We conducted a secondary analysis of 6 focus group sessions with Veteran patients and 25 interviews with key VA staff in PC (physicians, nurses, and MOVE! staff) in order to guide intervention development. We asked Veterans and staff to provide feedback on a proposed 5As intervention initially conceived based on prior work and a systematic review of the literature. This proposed intervention would use an online tool to deliver the 5As by assessing health behaviors and barriers (“assess”), providing tailored advice (“advise”), and helping patients set goals (“agree”). Members of the healthcare team would then discuss goals further, focusing on addressing barriers (“assist”) and providing follow-up/referral to more intensive support (“arrange”). Participants were also asked about their experiences with goal setting, weight management, and technology. Focus group and interview sessions were audio-recorded, professionally transcribed, and coded using a rigorous process previously described. To guide intervention development, transcription segments originally coded as “goal-setting,” “proposed intervention,” and/or “technology” were analyzed. The “proposed intervention” code had not been previously analyzed. RESULTS: Both Veterans and VA staff held positive views toward the use of goal setting for healthy behavior change and stressed the importance of social support in achieving goals. Veterans particularly felt the need for someone to hold them accountable for their goals and give them consistent feedback on their progress. VA staff felt that the goals needed to come directly from the patient and that the providers' role was to support the process. Veterans and staff reported mixed attitudes toward technology, acknowledging that some patients were unfamiliar with or distrusting of technology. When asked to give feedback about the proposed intervention, Veterans and staff liked that it would provide individualized counseling and support from the healthcare team to achieve goals. However, some Veterans did not believe a computer could generate individualized advice and did not want technology to replace human support. Most healthcare team members felt that time constraints would be a barrier to implementation and indicated that they could not spend more than 3-5 min on weight management. As a result of these findings, our revised intervention includes the use of a health coach to provide in-person support while using the online tool. The health coach will also provide initial counseling about weight loss and lifestyle goals to allow the healthcare team to focus their time on performing brief counseling to address barriers and endorse the goals. CONCLUSIONS: This study informed the development of a 5As intervention to improve the treatment of obesity in the PC setting. Usability testing of the online tool is currently ongoing, and pilot testing of the intervention will begin soon.
Original languageEnglish (US)
Pages (from-to)S137-S137
JournalJournal of General Internal Medicine
StatePublished - 2015

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Veterans
Primary Health Care
Weights and Measures
Patient Care Team
Counseling
Technology
Obesity
Focus Groups
Interviews
Veterans Health
United States Department of Veterans Affairs
Health Behavior
Health
Primary Care Physicians
Advisory Committees
Social Support
Life Style
Weight Loss
Referral and Consultation
Nurses

Keywords

  • United States
  • behavior change
  • computer
  • counseling
  • feedback system
  • health
  • health behavior
  • health care
  • health care management
  • human
  • information processing
  • internal medicine
  • interview
  • lifestyle
  • nurse
  • obesity
  • patient
  • physician
  • preventive health service
  • primary medical care
  • secondary analysis
  • social support
  • society
  • systematic review
  • technology
  • veteran
  • veterans health
  • weight
  • weight reduction

Cite this

Development of a tailored, 5a's-based weight management intervention for veterans within primary care. / Mateo, K F; Sikerwar, S; Squires, A; Kalet, A; Sherman, S; Jay, M.

In: Journal of General Internal Medicine, 2015, p. S137-S137.

Research output: Contribution to journalMeeting Abstract

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title = "Development of a tailored, 5a's-based weight management intervention for veterans within primary care",
abstract = "BACKGROUND: Obesity affects 36 {\%} of patients in the Veterans Health Administration. The United States Preventive Services Task Force endorses the use of the 5As framework (Assess, Advise, Agree, Assist, Arrange) to deliver obesity counseling in primary care (PC). This study used qualitative methods to inform the development of a 5As-based weight management intervention to improve obesity care at Veterans Affairs (VA) Medical Centers. METHODS: We conducted a secondary analysis of 6 focus group sessions with Veteran patients and 25 interviews with key VA staff in PC (physicians, nurses, and MOVE! staff) in order to guide intervention development. We asked Veterans and staff to provide feedback on a proposed 5As intervention initially conceived based on prior work and a systematic review of the literature. This proposed intervention would use an online tool to deliver the 5As by assessing health behaviors and barriers (“assess”), providing tailored advice (“advise”), and helping patients set goals (“agree”). Members of the healthcare team would then discuss goals further, focusing on addressing barriers (“assist”) and providing follow-up/referral to more intensive support (“arrange”). Participants were also asked about their experiences with goal setting, weight management, and technology. Focus group and interview sessions were audio-recorded, professionally transcribed, and coded using a rigorous process previously described. To guide intervention development, transcription segments originally coded as “goal-setting,” “proposed intervention,” and/or “technology” were analyzed. The “proposed intervention” code had not been previously analyzed. RESULTS: Both Veterans and VA staff held positive views toward the use of goal setting for healthy behavior change and stressed the importance of social support in achieving goals. Veterans particularly felt the need for someone to hold them accountable for their goals and give them consistent feedback on their progress. VA staff felt that the goals needed to come directly from the patient and that the providers' role was to support the process. Veterans and staff reported mixed attitudes toward technology, acknowledging that some patients were unfamiliar with or distrusting of technology. When asked to give feedback about the proposed intervention, Veterans and staff liked that it would provide individualized counseling and support from the healthcare team to achieve goals. However, some Veterans did not believe a computer could generate individualized advice and did not want technology to replace human support. Most healthcare team members felt that time constraints would be a barrier to implementation and indicated that they could not spend more than 3-5 min on weight management. As a result of these findings, our revised intervention includes the use of a health coach to provide in-person support while using the online tool. The health coach will also provide initial counseling about weight loss and lifestyle goals to allow the healthcare team to focus their time on performing brief counseling to address barriers and endorse the goals. CONCLUSIONS: This study informed the development of a 5As intervention to improve the treatment of obesity in the PC setting. Usability testing of the online tool is currently ongoing, and pilot testing of the intervention will begin soon.",
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author = "Mateo, {K F} and S Sikerwar and A Squires and A Kalet and S Sherman and M Jay",
year = "2015",
language = "English (US)",
pages = "S137--S137",
journal = "Journal of General Internal Medicine",
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T1 - Development of a tailored, 5a's-based weight management intervention for veterans within primary care

AU - Mateo, K F

AU - Sikerwar, S

AU - Squires, A

AU - Kalet, A

AU - Sherman, S

AU - Jay, M

PY - 2015

Y1 - 2015

N2 - BACKGROUND: Obesity affects 36 % of patients in the Veterans Health Administration. The United States Preventive Services Task Force endorses the use of the 5As framework (Assess, Advise, Agree, Assist, Arrange) to deliver obesity counseling in primary care (PC). This study used qualitative methods to inform the development of a 5As-based weight management intervention to improve obesity care at Veterans Affairs (VA) Medical Centers. METHODS: We conducted a secondary analysis of 6 focus group sessions with Veteran patients and 25 interviews with key VA staff in PC (physicians, nurses, and MOVE! staff) in order to guide intervention development. We asked Veterans and staff to provide feedback on a proposed 5As intervention initially conceived based on prior work and a systematic review of the literature. This proposed intervention would use an online tool to deliver the 5As by assessing health behaviors and barriers (“assess”), providing tailored advice (“advise”), and helping patients set goals (“agree”). Members of the healthcare team would then discuss goals further, focusing on addressing barriers (“assist”) and providing follow-up/referral to more intensive support (“arrange”). Participants were also asked about their experiences with goal setting, weight management, and technology. Focus group and interview sessions were audio-recorded, professionally transcribed, and coded using a rigorous process previously described. To guide intervention development, transcription segments originally coded as “goal-setting,” “proposed intervention,” and/or “technology” were analyzed. The “proposed intervention” code had not been previously analyzed. RESULTS: Both Veterans and VA staff held positive views toward the use of goal setting for healthy behavior change and stressed the importance of social support in achieving goals. Veterans particularly felt the need for someone to hold them accountable for their goals and give them consistent feedback on their progress. VA staff felt that the goals needed to come directly from the patient and that the providers' role was to support the process. Veterans and staff reported mixed attitudes toward technology, acknowledging that some patients were unfamiliar with or distrusting of technology. When asked to give feedback about the proposed intervention, Veterans and staff liked that it would provide individualized counseling and support from the healthcare team to achieve goals. However, some Veterans did not believe a computer could generate individualized advice and did not want technology to replace human support. Most healthcare team members felt that time constraints would be a barrier to implementation and indicated that they could not spend more than 3-5 min on weight management. As a result of these findings, our revised intervention includes the use of a health coach to provide in-person support while using the online tool. The health coach will also provide initial counseling about weight loss and lifestyle goals to allow the healthcare team to focus their time on performing brief counseling to address barriers and endorse the goals. CONCLUSIONS: This study informed the development of a 5As intervention to improve the treatment of obesity in the PC setting. Usability testing of the online tool is currently ongoing, and pilot testing of the intervention will begin soon.

AB - BACKGROUND: Obesity affects 36 % of patients in the Veterans Health Administration. The United States Preventive Services Task Force endorses the use of the 5As framework (Assess, Advise, Agree, Assist, Arrange) to deliver obesity counseling in primary care (PC). This study used qualitative methods to inform the development of a 5As-based weight management intervention to improve obesity care at Veterans Affairs (VA) Medical Centers. METHODS: We conducted a secondary analysis of 6 focus group sessions with Veteran patients and 25 interviews with key VA staff in PC (physicians, nurses, and MOVE! staff) in order to guide intervention development. We asked Veterans and staff to provide feedback on a proposed 5As intervention initially conceived based on prior work and a systematic review of the literature. This proposed intervention would use an online tool to deliver the 5As by assessing health behaviors and barriers (“assess”), providing tailored advice (“advise”), and helping patients set goals (“agree”). Members of the healthcare team would then discuss goals further, focusing on addressing barriers (“assist”) and providing follow-up/referral to more intensive support (“arrange”). Participants were also asked about their experiences with goal setting, weight management, and technology. Focus group and interview sessions were audio-recorded, professionally transcribed, and coded using a rigorous process previously described. To guide intervention development, transcription segments originally coded as “goal-setting,” “proposed intervention,” and/or “technology” were analyzed. The “proposed intervention” code had not been previously analyzed. RESULTS: Both Veterans and VA staff held positive views toward the use of goal setting for healthy behavior change and stressed the importance of social support in achieving goals. Veterans particularly felt the need for someone to hold them accountable for their goals and give them consistent feedback on their progress. VA staff felt that the goals needed to come directly from the patient and that the providers' role was to support the process. Veterans and staff reported mixed attitudes toward technology, acknowledging that some patients were unfamiliar with or distrusting of technology. When asked to give feedback about the proposed intervention, Veterans and staff liked that it would provide individualized counseling and support from the healthcare team to achieve goals. However, some Veterans did not believe a computer could generate individualized advice and did not want technology to replace human support. Most healthcare team members felt that time constraints would be a barrier to implementation and indicated that they could not spend more than 3-5 min on weight management. As a result of these findings, our revised intervention includes the use of a health coach to provide in-person support while using the online tool. The health coach will also provide initial counseling about weight loss and lifestyle goals to allow the healthcare team to focus their time on performing brief counseling to address barriers and endorse the goals. CONCLUSIONS: This study informed the development of a 5As intervention to improve the treatment of obesity in the PC setting. Usability testing of the online tool is currently ongoing, and pilot testing of the intervention will begin soon.

KW - United States

KW - behavior change

KW - computer

KW - counseling

KW - feedback system

KW - health

KW - health behavior

KW - health care

KW - health care management

KW - human

KW - information processing

KW - internal medicine

KW - interview

KW - lifestyle

KW - nurse

KW - obesity

KW - patient

KW - physician

KW - preventive health service

KW - primary medical care

KW - secondary analysis

KW - social support

KW - society

KW - systematic review

KW - technology

KW - veteran

KW - veterans health

KW - weight

KW - weight reduction

M3 - Meeting Abstract

SP - S137-S137

JO - Journal of General Internal Medicine

JF - Journal of General Internal Medicine

SN - 0884-8734

ER -