A nutrition and lifestyle-focused shared medical appointment in a resource-challenged community setting: a mixed-methods study

Abstract

Background In order to address disparities in preventable chronic diseases, we adapted a nutrition and lifestyle-focused shared medical appointment (SMA) program to be delivered in an underserved community setting. The objective was to evaluate a community-based nutrition and lifestyle-focused SMA as it relates to acceptability and health and behavior-related outcomes. Methods A mixed-methods study was performed to evaluate pre-post changes in wellness indices, biometrics, self-efficacy, and trust in medical researchers as part of a community-based SMA. To understand program acceptability including barriers and facilitators for implementation and scalability, we conducted two participant focus groups and five stakeholder interviews and used content analysis to determine major themes. Results Fifteen participants attended 10 weekly sessions. The majority were older adult, African American women. There were pre-post improvements in mean [SD] systolic (-10.5 [7.7] mmHg, p = 0.0001) and diastolic (-4.7 [6.7] mmHg, p = 0.17) blood pressures and weight (-5.7 [6.3] pounds, p = 0.003) at 3 months though these were not significant at 6 months. More individuals reported improvements in health status, daily fruit and vegetable intake, and sleep than at baseline. There were no significant pre-post changes in other wellness indices, self-efficacy, trust in medical researchers, hemoglobin A1c, insulin, or LDL cholesterol. Participants discussed positive health changes as a result of the SMA program, program preferences, and facilitators and barriers to continuing program recommendations in focus groups. SMA implementation was facilitated by clinical staff who adjusted content to a low health literacy group and partnership with a trusted community partner. Sustainability barriers include heavy personnel time and in-kind resources to deliver the program. Conclusions Nutrition and lifestyle-focused SMAs in a resource-challenged community setting may be an acceptable intervention for underserved patients.

Transforming care for patients living with diabetes in rural Mexico: a qualitative study of patient and provider experiences and perceptions of shared medical appointments

“…Although this study is unique in exploring the application of SMAs in LMICs, many of the findings are consistent with quantitative research conducted in underserved communities in the US. In particular, some of these studies reported decreased dissatisfaction with diabetes and diabetes distress, as well as improved diabetes-related quality of life, frequency of blood-sugar self-testing, dietary habits, and frequency of exercise among patients participating in SMAs versus those receiving individual care [ 25 , 37 , 38 ]. In other qualitative studies in the US, participants cited a sense of community, improved disease self-management, a sense of empowerment, motivation, increased trust in providers, and gaining knowledge from peers as positive aspects of this model of care delivery [ 18 , 39 , 40 ].…”

“…Regarding healthcare providers, participants in our study highlighted similar benefits of SMAs to those reported in previous qualitative research, such as power-shifting, trust building, better information sharing, improved self-management, peer support, less repetition, and more efficiency than the 1:1 approach [ 18 , 40 ]. One concern raised by practitioners both in our study and in previous SMA interventions, was the administrative workload involved in arranging and facilitating the sessions [ 38 , 40 ]. However, all these comparisons must be considered with caution, as previous SMA interventions were implemented in urban settings in the US and were tailored to those circumstances.…”

There and Back Again: A Forty-Year Perspective on Physician Nutrition Education

“…These opportunities include clinical nutrition innovation and dietary strategies for health within existing payor models, such as the interprofessional Culinary Medicine eConsult [ 101 ]. Prior studies describe group medical care to build patient self-efficacy and behavior change in a feasible and creative context [ [102] , [103] , [104] , [105] ]. Efforts should also include the standard integration of referrals to and reimbursement for RDNs to further support and enhance the nutrition conversations with referring clinicians.…”

An age‐friendly population health dashboard geolocating by clinical and social determinant needs

“…54 This commitment to access can be seen in the creation of multiple patient family advisory councils proposing themes of access, team based care and patient centric communication. 55 The thematic response has been multi‐dimensional: Public health focused shared medical appointment programs for underserved communities 56 ; telemedicine programs promoting mental health 57 ; linkage of thousands to supplies and community resources during the pandemic and federally qualified health center partnerships 58 ; building brand new grocery stores in “food deserts”; internet connectivity in impoverished local neighborhoods. All testament to the continued CCHS focus on access for our most underserved communities.…”