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BACKGROUND/RATIONALE:
The VA recently developed the Managing Overweight and Obesity in Veterans Everywhere (MOVE) program in response to the growing obesity epidemic. Because the prevalence of obesity in VA patients is even higher than the 65% national average, however, many VA facilities are struggling with enrolling the large number of veterans who are overweight or obese into MOVE. Alternative strategies for delivering the key components of the MOVE program in a timely manner that do not solely rely on relatively time intensive counselor-patient interactions are urgently needed to control the many chronic conditions associated with obesity, many of which are the focus QUERI (e.g., diabetes, heart failure, ischemic heart disease).
OBJECTIVE(S):
The primary focus of this study was to develop feasible telehealth dialogues for use with the MOVE program. The long-term objective was to develop telehealth-based strategies that are evidence-based, patient-centered, and tailored to obese veterans’ individual needs and that enable VHA to disseminate MOVE to larger numbers of veterans. The two specific aims of the study were: 1) to translate dialogues in the MOVE Quick Start Manual that are used by weight management counselors in Level 1 of the MOVE program to telehealth dialogues; and 2) to test the feasibility of this telehealth adjunct to the MOVE program in a sample of overweight and obese veterans.
METHODS:
Written dialogues developed for MOVE that are used to motivate patients to modify eating and exercise activities and to provide education about nutrition and physical activity were translated to a Viterion in-home device. This telehealth technology transmits text messages to patients in their own homes via telephone lines and allows patients to communicate answers to posed questions back to healthcare providers, transmitted over the Internet. A feasibility trial of this process was conducted of 2 groups, each consisting of 10 MOVE participants from the Iowa City VAMC. Each patient received a Viterion device to receive questions about compliance with diet and exercise components of MOVE at home during the first eight weeks of the MOVE Program, every other day. Patients also communicated their weight when prompted once per week. The messages delivered back to patients were tailored to their individual situations, based on the transmitted information. At the end of the trial, patients completed semi-structured interviews to determine satisfaction with the Viterion device and automated dialogues. The percent change in weight between enrollment and study completion after 8 weeks and the percent compliance with the questions delivered via the Viterion device were calculated.
FINDINGS/RESULTS:
MOVE dialogues were successfully translated into text messages and loaded onto the Viterion device. Of the 20 recruited patients into this study, 2 dropped out within the first week and never reported progress via the Viterion device. The remaining 18 found the device was easy to set up (18/18), worked correctly (18/18) and was easy to use (17/18, with the one other patient reporting that it was not easy to use in the beginning but that he learned over time). Of the 28 times the Viterion device prompted each patient to answer questions or enter their weights, participants responded appropriately an average of 11.1 times (39.7%). Two-thirds of patients (12/18) responded at least once per week. About half of the patients reported that the Viterion device helped with weight loss during the 8 week trial. In all, among the 18 patients who completed the trial, 1 participant never entered any data, 1 patient gained 2.2 pounds during the trial, and the remaining 16 patients lost an average of 7.0 pounds (range 0.2-26.4 pounds).
IMPACT:
In addition to helping veterans lose weight, using a telehealth approach may improve associated chronic conditions and reduce the time burden and associated costs of implementing MOVE, in a manner that is easy to use and liked by veteran users.
PUBLICATIONS:
None at this time.
DRA:
Health Services and Systems
DRE:
Prevention
Keywords:
Obesity
MeSH Terms:
none
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