Provider and staff perceptions of veterans' attrition from a national primary care weight management program
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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!((R)) Weight Management Program as an initial step toward understanding attrition from primary care-based programs. PARTICIPANTS: MOVE!((R)) clinicians, primary care providers, and other staff members who interacted with patients about participating in MOVE!((R)) (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!((R)) 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!((R)). In addition, increasing the use of techniques such as Motivational Interviewing among providers who refer patients to MOVE!((R)) may improve participant engagement in MOVE!((R)) 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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