Patient experiences of a lifestyle program for metabolic syndrome offered in family medicine clinics: a mixed methods study

Abstract

BackgroundPatient perspectives on new programs to manage metabolic syndrome (MetS) are critical to evaluate for possible implementation in the primary healthcare system. Participants’ perspectives were sought for the Canadian Health Advanced by Nutrition and Graded Exercise (CHANGE) study, which enrolled 293 participants, and demonstrated 19% reversal of MetS after 1 year. The main purpose of this study was to examine participants’ perceptions of their experiences with the CHANGE program, enablers and barriers to change.MethodsA convergent parallel mixed methods design combined patients’ perspectives collected by questionnaires (n = 164), with insights from focus groups (n = 41) from three sites across Canada. Qualitative data were thematically analyzed using interpretative description. Insights were organized within a socio-ecologic framework.ResultsKey aspects identified by participants included intra-individual factors (personal agency, increased time availability), inter-individual factors (trust, social aspects) and organizational factors (increased mental health support, tailored programs).ConclusionResults revealed participants’ overall support for the CHANGE program, especially the importance of an extended program under the guidance of a family physician along with a skilled and supportive team. Team delivery of a lifestyle program in primary care or family medicine clinics is a complex intervention and use of a mixed methods design was helpful for exploring patient experiences and key issues on enablers and barriers to health behavior change.Electronic supplementary materialThe online version of this article (10.1186/s12875-018-0837-z) contains supplementary material, which is available to authorized users.

Beneficial self‐management support and user involvement in Healthy Life Centres—A qualitative interview study in persons afflicted by overweight or obesity

“…32,51,52 Thus, the importance of trained HPs who possess effective communication skills, and are competent, confident and supportive was highlighted. 32,49,53 In our study, HPs' flexibility and ability to personalize and tailor self-management support and lifestyle intervention to the service users' needs and everyday life was important for their participation and adherence to the intervention programme. Other studies from patient education programmes and lifestyle consultations in primary care confirm that HPs' ability to be observant and individualize and tailor interventions to the service users' values, needs and situation is essential, which underscores the necessity of a person-centred approach.…”

“…Other studies from patient education programmes and lifestyle consultations in primary care confirm that HPs' ability to be observant and individualize and tailor interventions to the service users' values, needs and situation is essential, which underscores the necessity of a person-centred approach. 32,49,53,54 Client-centred therapy emphasizes acknowledgement and a trustful relationship as fundamental in therapy and behavioural change processes. 55 Increased motivation and self-belief through peer support and fellowship is demonstrated by the service users' experience of the value of being included, group affiliation and a common identity.…”

The NHS Diabetes Prevention Programme: an observational study of service delivery and patient experience

“…Whilst previous qualitative studies on patient experiences of other behavioural interventions have provided an in-depth insight into interpersonal factors and participant motivations [ 23 – 25 ], they have not fully addressed the structural factors which are also important for the successful implementation of an intervention. Although the qualitative literature did allude to the fact that having the programme sites in more accessible locations with greater flexibility in session times and days could further improve patient experience [ 23 – 25 ], this has not been extensively researched.…”

“…Whilst previous qualitative studies on patient experiences of other behavioural interventions have provided an in-depth insight into interpersonal factors and participant motivations [23][24][25], they have not fully addressed the structural factors which are also important for the successful implementation of an intervention. Although the qualitative literature did allude to the fact that having the programme sites in more accessible locations with greater flexibility in session times and days could further improve patient experience [23][24][25], this has not been extensively researched. However, such structural features can have a direct influence on the processes and outcomes in programmes, for example, if there is insufficient resources and equipment or sessions cannot be scheduled, this can prohibit patients from accessing the support they require from the programme [26].…”

Development of a patient experience questionnaire to improve lifestyle services in primary care

“…Physicians as a group may or may not have somewhat different priorities than other providers with respect to the most important dimensions of lifestyle programs, although the dimensions of the Wong and Haggerty framework were identified from review of questionnaires directed mainly to physician practice (Wong and Haggerty, 2013). Lack of physician input in the initial discussion was partially mitigated in the pilot testing phase, as several family physicians on the research team reviewed the questionnaire and are co-authors on another paper of patient experience of the CHANGE program (Klein et al , 2017).…”