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Provider and staff perceptions of veterans' attrition from a national primary care weight management program.

Arigo D, Hooker S, Funderburk J, Dundon M, Dubbert P, Evans-Hudnall G, Catanese S, O'Donohue J, Dickinson EM, DeMasi C, Downey S, DeSouza C. Provider and staff perceptions of veterans' attrition from a national primary care weight management program. Primary health care research & development. 2015 Apr 1; 16(2):147-56.

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BACKGROUND: Overweight and obesity are growing problems for primary care. Although effective weight management programs exist, these programs experience significant attrition, which limits effectiveness. OBJECTIVES: 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. PARTICIPANTS: 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%). MEASURE: 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. RESULTS: 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). CONCLUSIONS: 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.

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