Klein Jennifer, Brauer Paula, Royall Dawna, Israeloff-Smith Maya, Klein Doug, Tremblay Angelo, Dhaliwal Rupinder, Rheaume Caroline, Mutch David M, Jeejeebhoy Khursheed
Glenrose Rehabilitation Hospital, Edmonton, Canada.
Department of Family Relations & Applied Nutrition, University of Guelph, Guelph, Canada.
BMC Fam Pract. 2018 Aug 31;19(1):148. doi: 10.1186/s12875-018-0837-z.
Patient perspectives on new programs to manage metabolic syndrome (MetS) are critical to evaluate for possible implementation in the primary healthcare system. Participants' perspectives were sought for the Canadian Health Advanced by Nutrition and Graded Exercise (CHANGE) study, which enrolled 293 participants, and demonstrated 19% reversal of MetS after 1 year. The main purpose of this study was to examine participants' perceptions of their experiences with the CHANGE program, enablers and barriers to change.
A convergent parallel mixed methods design combined patients' perspectives collected by questionnaires (n = 164), with insights from focus groups (n = 41) from three sites across Canada. Qualitative data were thematically analyzed using interpretative description. Insights were organized within a socio-ecologic framework.
Key aspects identified by participants included intra-individual factors (personal agency, increased time availability), inter-individual factors (trust, social aspects) and organizational factors (increased mental health support, tailored programs).
Results revealed participants' overall support for the CHANGE program, especially the importance of an extended program under the guidance of a family physician along with a skilled and supportive team. Team delivery of a lifestyle program in primary care or family medicine clinics is a complex intervention and use of a mixed methods design was helpful for exploring patient experiences and key issues on enablers and barriers to health behavior change.
患者对管理代谢综合征（MetS）新方案的看法对于评估其在初级医疗保健系统中可能的实施情况至关重要。在加拿大营养与分级运动促进健康（CHANGE）研究中征求了参与者的看法，该研究招募了293名参与者，并在1年后显示出19%的代谢综合征逆转率。本研究的主要目的是考察参与者对CHANGE项目经历的看法、促成改变的因素和阻碍改变的因素。
采用收敛平行混合方法设计，将通过问卷调查收集的患者观点（n = 164）与来自加拿大三个地点的焦点小组（n = 41）的见解相结合。定性数据采用解释性描述进行主题分析。见解在社会生态框架内进行组织。
参与者确定的关键方面包括个体内因素（个人能动性、时间可用性增加）、个体间因素（信任、社会方面）和组织因素（心理健康支持增加、量身定制的方案）。
结果显示参与者对CHANGE项目总体持支持态度，特别是在家庭医生以及专业且支持性的团队指导下延长项目的重要性。在初级保健或家庭医学诊所团队提供生活方式项目是一项复杂的干预措施，采用混合方法设计有助于探索患者体验以及健康行为改变的促成因素和阻碍因素方面的关键问题。
