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CDA 10-206 – HSR Study

 
CDA 10-206
Improving weight management at the VA: Enhancing the MOVE!23 for primary care
Melanie R. Jay, MD MS
Manhattan Campus of the VA NY Harbor Healthcare System, New York, NY
New York, NY
Funding Period: October 2012 - September 2017
BACKGROUND/RATIONALE:
Veterans shoulder a disproportionate burden of obesity and its co-morbidities. Modest weight loss in obese patients improves health outcomes. The Veterans Affairs (VA) New York Harbor Healthcare System offers the MOVE! program, but only 8% of eligible patients attend. However, Veterans see their primary care providers (PCPs) 3.6 times per year supporting the importance of developing primary care-based interventions. Interactive behavior change technologies utilizing expert system software programs can facilitate behavior change in primary care.

Using rigorous formative methods, we developed the MOVE Towards Your Goals (MTG) intervention. This intervention uses 4 components to deliver 5As counseling within the primary care setting-the MTG online tool, health coach counseling, brief PACT team counseling, and follow-up telephone coaching. The MTG tool is a mobile-friendly software program that can be readily delivered via tablet computers in the clinic setting to facilitate counseling by a health coach and PACT staff. This intervention was developed during the first 2 years of the CDA award by using qualitative data collected from focus groups of Veterans, Key informant interviews of PACT team staff, and Usability testing of the MTG tool (see abstracts 1-12 below, publications 2,3,5,10 below).

To determine the feasibility of conducting an RCT of the MTG weight management intervention compared to Enhanced Usual Care (EUC), we conducted a pilot study.


OBJECTIVE(S):
1)Using qualitative methods, determine optimal goal-setting processes to develop a brief, technology-assisted intervention to treat obesity
2)Determine the feasibility and acceptability of this intervention for urban, obese, VA patients within PACT
3)Explore the impact of this intervention on intermediate, behavioral, and weight loss outcomes at 6 and 12 months post-intervention



METHODS:
Methods:
Veterans with Body Mass Index 30kg/m2 or 25-29.9kg/m2 with comorbidities (N=45) were recruited in two phases and randomized to MTG (n=22) or EUC (n=23). We collected process measures (e.g. number of coaching calls completed, number and types of lifestyle goals, counseling documentation) and written qualitative feedback. Secondary aims included weight and behavioral outcomes.

FINDINGS/RESULTS:
Not yet available.

IMPACT:
We developed and conducted a pilot RCT of a technology-assisted health coaching intervention for weight management. This led to VA and NIH funding to do 2 cluster randomized trials of different versions of the MTG Intervention.

The Goals for Eating and Moving Study: Will test this intervention using student health coaches

The Peer Assisted Lifestyle Weight Management study will test this intervention with Veterans as peer health coaches.

If this intervention later proves to be cost-effective, it could potentially improve obesity care within patient centered medical homes at the VA and other health systems.

External Links for this Project

NIH Reporter

Grant Number: IK2HX000762-01A1
Link: https://reporter.nih.gov/project-details/8398206

Dimensions for VA

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PUBLICATIONS:

Journal Articles

  1. Jay MR, Mateo KM, Horne M, Squires A, Kalet A, Sherman S. "In the military, your body and your life aren't your own": Unique factors influencing health behavior change in overweight and obese veterans. Journal of general internal medicine. 2014 Apr 25; 29(Supplement 1):S3. [view]
  2. Perez HR, Nick MW, Mateo KM, Sherman S, Kalet A, Jay MR. "None of them apply to me": A usability study of the VA's MOVE!23 online weight management software in Latina Women. Journal of general internal medicine. 2014 Apr 23; 29(Supplement 1):S4. [view]
  3. Viglione C, Bouwman D, Rahman N, Fang Y, Beasley JM, Sherman S, Pi-Sunyer X, Wylie-Rosett J, Tenner C, Jay M. A technology-assisted health coaching intervention vs. enhanced usual care for Primary Care-Based Obesity Treatment: a randomized controlled trial. BMC obesity. 2019 Feb 4; 6:4. [view]
  4. Mateo KF, Jay MR. Access to a Behavioral Weight Loss Website With or Without Group Sessions Increased Weight Loss in Statewide Campaign - Article Review. Journal of clinical outcomes management : JCOM. 2014 Jan 1; 21(8):345-8. [view]
  5. Jay M, Stepney C, Wijetunga NA, Akinrinade G, Dorsey K, Bruzzese JM. Accuracy of weight perception among urban early adolescents with uncontrolled asthma and their caregivers. Annals of behavioral medicine : a publication of the Society of Behavioral Medicine. 2013 Apr 1; 45(2):239-48. [view]
  6. Perez HR, Nick MW, Mateo KF, Squires A, Sherman SE, Kalet A, Jay M. Adapting a weight management tool for Latina women: a usability study of the Veteran Health Administration's MOVE!23 tool. BMC medical informatics and decision making. 2016 Oct 5; 16(1):128. [view]
  7. Levine D, Jay MR. Another Win for Veggies - Article Review. Journal of clinical outcomes management : JCOM. 2014 Jan 1; 21(5):207-9. [view]
  8. Creighton S, Jay MR. Are Non-Nutritive Sweetened Beverages Comparable to Water in Weight Loss Trials. Journal of clinical outcomes management : JCOM. 2014 Jan 1; 21(11):490-2. [view]
  9. Jay M, Chintapalli S, Squires A, Mateo KF, Sherman SE, Kalet AL. Barriers and facilitators to providing primary care-based weight management services in a patient centered medical home for Veterans: a qualitative study. BMC family practice. 2015 Nov 14; 16:167. [view]
  10. Gutnick D, Reims K, Davis C, Gainforth H, Jay MR, Cole S. Brief Action Planning to Facilitate Behavior Change and Support Patient Self-Management. Journal of clinical outcomes management : JCOM. 2014 Jan 1; 21(1):17-29. [view]
  11. Mateo KF, Berner NB, Ricci NL, Seekaew P, Sikerwar S, Tenner C, Dognin J, Sherman SE, Kalet A, Jay M. Development of a 5As-based technology-assisted weight management intervention for veterans in primary care. BMC health services research. 2018 Jan 29; 18(1):47. [view]
  12. Perez H, Jay MR. Good Midlife Dietary Habits May Increase Likelihood of Healthy Aging - Article Review. Journal of clinical outcomes management : JCOM. 2014 Jan 1; 21(3):105-9. [view]
  13. Jay MR, Chintapalli S, Oi K, Squires A, Sherman S, Kalet A. Identifying barrier and facilitators to improving the implementation of weight management services within a patient-centered medical home. Journal of general internal medicine. 2014 Apr 25; 29(Supplement 1):S115. [view]
  14. Acosta A, Azzalin A, Emmons CJ, Shuster JJ, Jay M, Lo MC. Improving residents' clinical approach to obesity: impact of a multidisciplinary didactic curriculum. Postgraduate Medical Journal. 2014 Nov 1; 90(1069):630-7. [view]
  15. Jay M, Gutnick D, Squires A, Tagliaferro B, Gerchow L, Savarimuthu S, Chintapalli S, Shedlin MG, Kalet A. In our country tortilla doesn't make us fat: cultural factors influencing lifestyle goal-setting for overweight and obese Urban, Latina patients. Journal of health care for the poor and underserved. 2014 Nov 1; 25(4):1603-22. [view]
  16. Gerchow L, Tagliaferro B, Squires A, Nicholson J, Savarimuthu SM, Gutnick D, Jay M. Latina food patterns in the United States: a qualitative metasynthesis. Nursing Research. 2014 May 1; 63(3):182-93. [view]
  17. Jay M, Mateo KF, Squires AP, Kalet AL, Sherman SE. Military service and other socioecological factors influencing weight and health behavior change in overweight and obese Veterans: a qualitative study to inform intervention development within primary care at the United States Veterans Health Administration. BMC obesity. 2016 Feb 1; 3:5. [view]
  18. Rogers ES, Sherman SE, Malaspina D, Jay M. Prevalence and Predictors of Obesity-Related Counseling Provided by Outpatient Psychiatrists in the United States. Psychiatric services (Washington, D.C.). 2016 Oct 1; 67(10):1156-1159. [view]
  19. Levine DM, Savarimuthu S, Squires A, Nicholson J, Jay M. Technology-assisted weight loss interventions in primary care: a systematic review. Journal of general internal medicine. 2015 Jan 1; 30(1):107-17. [view]
  20. Jay MR, Gillespie CC, Schlair SL, Savarimuthu SM, Sherman SE, Zabar SR, Kalet AL. The impact of primary care resident physician training on patient weight loss at 12 months. Obesity (Silver Spring). 2013 Jan 1; 21(1):45-50. [view]
Conference Presentations

  1. Jay MR, Mateo KF, Horne M, Squires A, Kalet A, Sherman S. "In the military, your body and your life aren’t your own": Unique factors influencing health behavior change in overweight and obese veterans. Presented at: Society of General Internal Medicine Annual Meeting; 2014 Apr 25; San Diego, CA. [view]
  2. Perez HR, Nick MW, Mateo KF, Sherman S, Kalet A, Jay MR. "None of them apply to me": A usability study of the VA’s MOVE!23 online weight management software in Latina Women. Presented at: Society of General Internal Medicine Annual Meeting; 2014 Apr 23; San Diego, CA. [view]
  3. Jay MR, Chintapalli S, Squires A, Sherman S, Kalet A. How communication, roles, and outcome expectancy affect obesity counseling and practices within primary care at the VA (Health Services Research Section Poster Excellence Award). Poster session presented at: Obesity Society Annual Scientific Meeting; 2014 Oct 1; Boston, MA. [view]
  4. Jay MR, Chintapalli S, Oi K, Squires A, Sherman S, Kalet A. Identifying barrier and facilitators to improving the implementation of weight management services within a patient-centered medical home. Presented at: Society of General Internal Medicine Annual Meeting; 2014 Apr 25; San Diego, CA. [view]
  5. Jay MR, Mateo KF, Squires A, Kalet A, Sherman S. Identifying unique factors influencing health behavior change in overweight and obese veterans to inform intervention development in primary care at the VA (Health Services Research Section Poster Excellence Award). Presented at: Obesity Society Annual Scientific Meeting; 2014 Oct 1; Boston, MA. [view]


DRA: Diabetes and Other Endocrine Disorders
DRE: Treatment - Observational, Technology Development and Assessment
Keywords: none
MeSH Terms: none

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