Project Background Veterans shoulder a disproportionate burden of obesity and its co-morbidities. The VA currently offers an effective weight management program called MOVE!, but the majority of eligible patients do not attend. Since Veterans see their primary care providers (PCPs) on average 3.6 times per year, the primary care (PC) visit is an important opportunity to counsel obese patients about weight management, especially patients who cannot or prefer not to attend the MOVE! program. However, since PCPs often fail to counsel patients, interventions are needed to facilitate weight management counseling within the PACT model of team-based care. Through HSR&D CDA study 10-206, we used rigorous qualitative methods (patient focus groups, key informant interviews with PACT staff, and usability testing of novel software) to develop the MTG intervention that integrates technology-assisted counseling by a health coach and PACT staff to deliver weight management counseling using the 5As framework (assess, advise, agree, assist, arrange) as recommended by the United States Preventive Services Task Force. Project Objectives The objectives of this study are to: (a) test the impact of the MTG intervention on weight change and behavioral/clinical outcomes; (b) identify predictors of weight loss in Veterans participating in the intervention group related to goal setting processes and intervention components; and (c) determine the impact of the MTG intervention on PACT obesity-related counseling practices and attitudes. Project Methods To achieve these objectives, we will conduct a cluster randomized controlled trial of PACTs (randomized at RN Care Manager level) and 392 of their obese Veteran patients at two VA sites (New York and Brooklyn campuses, NY Harbor Healthcare System) to study the impact of the 12-month MTG intervention when compared to Enhanced Usual Care. Patients in the MTG intervention will take the MTG tool, receive health coach counseling, go to their scheduled same-day PC visit, receive brief PACT counseling, and receive follow up telephone coaching from the health coach over 12 months. The MTG tool is a mobile-friendly software program designed to be delivered on tablet computers in the clinic setting to assess lifestyle behaviors and barriers, provide tailored advice and patient education materials, create initial weight loss and behavior change goals, and facilitate counseling by the health coach and PACT staff. Patients in the Enhanced Usual Care arm will receive patient education materials (standard VA Healthy Living Messages) and attend their scheduled same-day PC visit. All patient participants will attend follow-up visits at 3-, 6- and 12-months to assess Body Mass Index, waist circumference, diet and physical activity, and goal attainment. PACT staff and health coach outcomes will include 5As-related competency, as well as quality and frequency of counseling.
Anticipated Impacts on Veterans Health Care This study will evaluate the efficacy of an innovative, technology-assisted weight management intervention designed to treat obesity within primary care at the VA. This intervention, called MOVE! Toward Your Goals (MTG), may enhance the VA?s ability to provide lifestyle-focused obesity treatment within PACT by integrating a novel mobile-friendly tool into practice in order to address barriers to obesity counseling and increase utilization of MOVE! and TeleMOVE!.
