Scaling a behavioral weight‐loss intervention for individuals with serious mental illness using the enhanced replicating effective programs framework: A preconditions phase proof‐of‐concept study

Abstract

BackgroundGiven the obesity's high prevalence among individuals with serious mental illness (SMI), translating weight‐loss interventions with demonstrated effectiveness is needed. This study describes the initial translation phase of such an intervention using the Enhanced Replicating Effective Programs (REP) Framework for delivery by mental health program staff.MethodsThe Achieving Healthy Lifestyles in Psychiatric Rehabilitation (Achieving Healthy Lifestyles in Psychiatric Rehabilitation) trial intervention was preliminarily adapted to create the ACHIEVE‐Dissemination (ACHIEVE‐D) curriculum. A treatment‐only study was conducted to rapidly evaluate the curriculum using a mixed‐methods approach including surveys and focus groups. A study coach delivered an abbreviated curriculum to individuals with SMI from a single psychiatric program. Among all participants with SMI (n = 17), outcomes were attendance and satisfaction; 14 participated in a focus group. The program staff observed curriculum delivery and participated in a focus group (n = 3).ResultsOverall, 23 group sessions were delivered. Median attendance was 78.6% across participants with SMI; 92.9% would recommend ACHIEVE‐D to others. The staff found the curriculum acceptable, particularly its structured nature, inclusion of weight management and exercise, and integrated goal setting and tracking. These improvements recommended by participants and/or staff were to assess participant readiness‐to‐change prior to enrollment, change the frequency of weigh‐ins, and train staff coaches on anticipated challenges (e.g., exercise engagement, weight fluctuations).ConclusionsDuring this first REP phase, individuals with SMI and program staff were satisfied with ACHIEVE‐D. Additional refinements will aid future implementation and improve participant experience.

Comparing Implementation Strategies for an Evidence-Based Weight Management Program Delivered in Community Mental Health Programs: Protocol for a Pilot Randomized Controlled Trial

“…Given the prevalence of obesity among adults with SMI and its associated increased CVD risk, it is critical to implement effective behavioral weight loss interventions tailored to this population in real-world settings. The ACHIEVE trial demonstrated the efficacy and safety of such a behavioral weight loss intervention [ 11 ], which has been translated into the ACHIEVE-D weight management curriculum appropriate for delivery by community mental health center staff [ 16 ]. We are applying the Enhanced Replicating Effective Programs Framework to increase the acceptability and feasibility of implementing the ACHIEVE-D curriculum in community settings [ 13 , 14 ].…”

“…Table 1 outlines the components of the ACHIEVE-D curriculum, and Multimedia Appendix 2 includes a detailed description of the ACHIEVE-D curriculum. The curriculum has been previously tested in other studies [ 11 , 16 ]. As such, this study will focus on testing implementation interventions to support the delivery of the curriculum by community mental health program staff.…”

“…We modified the schedule and format to support efficient, staff-led delivery but retained the core messages and behavioral strategies. We previously evaluated this adapted curriculum in a proof-of-concept study at a community mental health program (NCT03999892) [ 16 ], which informed further refinements based on feedback from staff observers and participating individuals with SMI. Table 1 outlines this modified weight management curriculum, ACHIEVE-Dissemination (ACHIEVE-D), which will be used in the REP preimplementation stage.…”

Implementing an evidence‐based behavioral weight‐loss program in community mental health centers: A randomized pilot study

“…The pre-conditions phase translated the ACHIEVE intervention into the ACHIEVE-Dissemination (ACHIEVE-D) program. 17,18 In brief, ACHIEVE-D is an adapted 6-month curriculum designed for delivery by mental health center staff, which has weekly, 45-min multi-purpose group sessions structured to include behavioral weight-management lessons and group exercise (26 modules over 6 months) as compared to the 18-month ACHIEVE intervention that included both individual and group sessions delivered by a trained interventionist. A non-randomized proof-ofconcept study was previously conducted at a single PRP in Maryland to determine the acceptability of ACHIEVE-D-study staff delivered the adapted curriculum to clients with SMI, which was observed by mental health center staff.…”

“…A non-randomized proof-ofconcept study was previously conducted at a single PRP in Maryland to determine the acceptability of ACHIEVE-D-study staff delivered the adapted curriculum to clients with SMI, which was observed by mental health center staff. 17 novel training and feedback strategies to address staff logistics and time constraints. 17 Whether performance coaching improved outcomes relative to the standard arm was also examined as a secondary outcome.…”