Translating an Evidence-Based Lifestyle Intervention Program Into Primary Care

Abstract

Obesity is one of the top health priorities in the United States. Primary care physicians are the designated “gatekeepers” for obesity prevention, detection, and treatment. However, they and the current U.S. health care structure and reimbursement systems are often ill-equipped to implement evidence-based obesity care. The Group Lifestyle Balance™ (GLB) program is a group-delivery adaptation of the predominantly one-on-one lifestyle intervention proven efficacious in the Diabetes Prevention Program (DPP) trial. Participant intervention goals are 7% weight loss and sustained moderate physical activity of 150 minutes or more each week. Sequential instruction and coaching encompasses nutrition, behavior modification, and physical activity principles. The E-LITE (Evaluation of Lifestyle Interventions to Treat Elevated Cardiometabolic Risk in Primary Care) trial evaluates the feasibility and potential effectiveness of delivering the GLB program, supplemented with food tasting and supervised physical activity during each of 12 group sessions, and electronic communication for long-term follow up, in a primary care setting. Benefits and potential areas for improvement in three areas of implementation emerged during the 15-month E-LITE trial: (1) delivery of an established lifestyle intervention program by specialized professionals, (2) integration of a lifestyle intervention program into a primary care clinic, and (3) information technology use in a primary care-based lifestyle intervention program. Our experience shows the feasibility of implementing an evidence-based lifestyle intervention program combining group-delivered nutrition and behavioral counseling, physical activity training, and technology-mediated follow-up in a primary care clinic setting, but challenges remain, and we offer possible solutions to overcome them.

Lessons Learned in the Implementation of HealtheSteps: An Evidence-Based Healthy Lifestyle Program

“…The Health e Steps program supported the development of interprofessional collaborations by requiring teams to work together toward a common goal in order to improve the communities’ lifestyles and reduce type 2 diabetes; nevertheless, a key barrier continually found revolved around administrative processes due to competing interests that often resulted in scheduling issues (Stoutenberg et al, 2015). This reflects similar lessons learned from other programs’ experiences (Blonstein et al, 2013; Green et al, 2012; Josyula & Lyle, 2013; Lewis et al, 2014)—specifically, ensuring adequate facilities and space for programming (Blonstein et al, 2013) as well as dedicated health promotion resources that include personnel and materials for implementation (Green et al, 2012; Josyula & Lyle, 2013; Lewis et al, 2014). Moreover, strong multifunctional teams with diverse functional backgrounds were observed as being pivotal toward program implementation, including the role of centralized support to help move the program forward (Bunderson, 2003).…”

“…Detailing the experience of those delivering these types of programs at different points of care (i.e., family practice, workplace, educational institutions, community centers, fitness centers) and settings (i.e., urban vs. rural and remote) can help us better understand the needs of patients, program administrators, and community health organizations running these programs. Previous research has focused on exploring the experiences of primary care practitioners delivering programs in controlled settings, which may not reflect the multiple avenues where health promotion programs can and are currently being delivered (Blonstein et al, 2013; Green et al, 2012; Josyula & Lyle, 2013; Lee, Hillier, & Weston, 2014). Often literature addressing diabetes prevention in real-world settings underscore their efficacy as a diabetes prevention program rather than establishing and understanding effective strategies for implementation (Dunkley et al, 2014).…”

Integration of chronic disease prevention and management services into primary care: a pragmatic randomized controlled trial (PR1MaC)

“…distress = presence of psychological distress. ing COPD and asthma, 16,48 metabolic syndrome, 49 kidney failure, 20 diabetes, 50 blood pressure control 51 and people with risk factors. 52 Interventions were based on different approaches, mainly self-management support and patient education.…”

Mexican American women’s perspectives on a culturally adapted cognitive-behavioral therapy guided self-help program for binge eating.

“…Second, focus groups provide a safe place to bring forward the voices of those women who have been underrepresented: to validate their everyday experiences, to highlight commonalities, and to enrich each other’s ideas (Wilkinson, 1998). Lastly, there has been an increasing trend for using focus groups as a part of cultural adaptation process and treatment program evaluation (e.g., Blonstein et al, 2013; Grau et al, 2013). Prior to implementing the CBTgsh program, we have conducted preliminary focus groups with a group of Mexican American women diagnosed with binge eating disorders and solicited their feedback on the cultural components that need to be adapted (Shea et al, 2012).…”