Arigo Danielle, Hooker Stephanie, Funderburk Jennifer, Dundon Margaret, Dubbert Patricia, Evans-Hudnall Gina, Catanese Sarah, O'Donohue Jenny, Dickinson Eva-Maria, DeMasi Christine, Downey Sheri, DeSouza Cyrus
1Center for Integrated Healthcare,Syracuse VA Medical Center,Syracuse,NY,USA.
3Department of Psychology,University of Colorado,Denver,CO,USA.
Prim Health Care Res Dev. 2015 Apr;16(2):147-56. doi: 10.1017/S1463423614000139. Epub 2014 Mar 3.
Overweight and obesity are growing problems for primary care. Although effective weight management programs exist, these programs experience significant attrition, which limits effectiveness.
This study examined provider and staff perceptions of attrition from the Veterans Health Administration MOVE!(®) Weight Management Program as an initial step toward understanding attrition from primary care-based programs.
MOVE!(®) clinicians, primary care providers, and other staff members who interacted with patients about participating in MOVE!(®) (n=754) from Department of Veterans Affairs medical centers throughout the United States. Respondents were predominantly female (80.8%), Caucasian (79.2%), and trained as nurses (L.P.N., R.N., or N.P.; 50%).
Participants completed a web-mediated survey; items assessed agreement with personal and programmatic reasons for dropout, and allowed respondents to indicate the number one reason for dropout in an open-ended format. This survey was adapted from an existing tool designed to capture patient perceptions.
Respondents indicated that veterans experienced practical barriers to attendance (eg, transportation and scheduling difficulties) and desire for additions to the program (eg, a live exercise component). Low motivation was the primary factor identified by respondents as associated with dropout, particularly as noted by MOVE!(®) clinicians (versus other providers/staff; P<0.01).
These findings suggest that programmatic changes, such as adding additional meeting times or in-session exercise time, may be of benefit to MOVE!(®). In addition, increasing the use of techniques such as Motivational Interviewing among providers who refer patients to MOVE!(®) may improve participant engagement in MOVE!(®) and other primary care-based weight management programs. Further research is needed to effectively identify those likely to withdraw from weight management programs before achieving their goals, and the reasons for withdrawal.
超重和肥胖问题在初级保健领域日益突出。尽管存在有效的体重管理项目，但这些项目的人员流失率很高，这限制了其效果。
本研究调查了退伍军人健康管理局“行动！”（MOVE!(®)）体重管理项目中提供者和工作人员对人员流失的看法，作为理解基于初级保健项目人员流失的第一步。
来自美国各地退伍军人事务医疗中心的“行动！”（MOVE!(®)）临床医生、初级保健提供者以及与患者就参与“行动！”（MOVE!(®)）项目进行互动的其他工作人员（n = 754）。受访者主要为女性（80.8%）、白种人（79.2%），且接受过护士培训（执照职业护士、注册护士或执业护士；50%）。
参与者完成了一项网络介导的调查；调查项目评估了对退出项目的个人原因和项目原因的认同度，并允许受访者以开放式格式指出退出的首要原因。该调查改编自一个旨在获取患者看法的现有工具。
受访者表示退伍军人在参与项目时遇到实际障碍（如交通和日程安排困难），并希望项目有所增加（如有现场锻炼环节）。低动力是受访者认为与退出相关的主要因素，特别是“行动！”（MOVE!(®)）临床医生指出的（与其他提供者/工作人员相比；P < 0.01）。
这些发现表明，诸如增加额外的会议时间或会议中的锻炼时间等项目调整，可能对“行动！”（MOVE!(®)）项目有益。此外，在将患者转介至“行动！”（MOVE!(®)）项目的提供者中更多地使用动机性访谈等技术，可能会提高参与者对“行动！”（MOVE!(®)）项目及其他基于初级保健的体重管理项目的参与度。需要进一步研究以有效识别那些在实现目标前可能退出体重管理项目的人及其退出原因。
