Doctor of Philosophy (PhD)
Health Promotion and Disease Prevention Research
Rural adults are at heightened risk for obesity, yet evidence‐based interventions lack consistent translation into clinical practice. This multi-phase study addresses this gap. First, a systematic review and meta-analysis of rural adult weight loss interventions were conducted to assess overall impact. Though few studies reported participant representativeness, meta‐analyses revealed a significant weight reduction among interventions. Second, 10 focus groups were conducted with primary care (PC) staff to determine the feasibility of implementing a weight-management program through PC. Differences in responses among rural, micropolitan, and metropolitan was also assessed. Thematic analyses revealed rural PC currently lacks the capacity to manage patient weight at a population level. A program to which physicians could refer patients was preferred. These results informed the selection of a digitally-delivered, evidence-based weight loss program to implement through PC while concurrently examining different physician referral and engagement processes for improving program reach. Five PC physicians were randomly assigned a sequence of 4 referral strategies: point of care referral (POC) with/without active telephone follow-up (ATF); electronic health record registry-derived letter with/without ATF. Of 996 potential referrals, 571 were made over 16 weeks; 97 patients enrolled in the program (55% female). Patients receiving ATF were more likely to be screened (49%vs7%; pppF(3,51)=1.93, p=.14) or between participants that did and did not receive ATF (F(1,53)=1.52, p=.22). Cost per participant was $372. Letter referral with ATF appears to be best for enrolling a larger number of patients in a weight-management program, but resource costs may make POC with ATF more attractive to rural clinics.
Porter, Gwenndolyn, "Identifying, Adapting, and Implementing a Weight Management Program in Rural Primary Care" (2020). Theses & Dissertations. 477.
Available for download on Wednesday, August 04, 2021