Implementing lifestyle change interventions to improve health outcomes

University Of Pittsburgh At Pittsburgh, Pittsburgh PA

Investigators

Abstract

Background: Diabetes and obesity collectively impact nearly half of American adults, costing hundreds of billions of dollars per year and contributing to more than 1 in 5 U.S. deaths. Lifestyle change interventions (LCIs) can mitigate the impacts of diabetes, obesity, and other cardiometabolic diseases but have been poorly implemented, despite guidelines supporting their use and data supporting their efficacy and cost-effectiveness. As both a Collaborating Center (Component A) and the LCI Research Network (LCIRN) Coordinating Center (Component B), our team will facilitate collaboration, communication, translation, and dissemination of research activities across LCIRN recipients and their partners through activities organized around eight key activities. We are uniquely positioned for this dual role, offering infrastructure, shared methods, and pragmatic tools to apply implementation science to solve intractable public health problems. LCIRN priorities include understanding patient and provider decision-making around LCIs in the context of newer medications to treat diabetes and obesity (i.e., Glucagon-like peptide-1 alone or in combination with gastric inhibitory polypeptide receptor agonists; GLP1/GIP medications). These medications have revolutionized practice but work best when combined with LCIs, making it critical to understand how to engage patients in LCIs in the context of these increasingly prescribed medications. Aims: 1) Understand the factors that influence healthcare clinician decision-making related to whether to refer patients to an LCI when prescribing GLP1/GIP medications; and 2) Understand the factors that influence patient self-efficacy, motivation, and decision-making related to enrolling in LCIs when being prescribed GLP1/GIP medications. Methods: To accomplish these goals, we will conduct clinician and patient surveys and interviews to understand how to increase LCI referral by clinicians and adoption by patients. Clinicians (n=500) across the US who refer to LCIs will be surveyed about factors associated with referral (based on the Consolidated Framework for Implementation Research), outcomes aligned with the RE-AIM outcomes framework, and implementation strategy (following the Evidence-based Recommendations for Implementing Change taxonomy). Interviews with 32 clinicians will further elucidate these responses. Surveys (n=1000) of and follow-up interviews (n=32) with adults taking GLP1/GIP medications will aim to understand how self-efficacy, motivation, and other factors impact willingness to adopt LCIs. Analysis of these data will apply precision implementation methods to identify data-driven, efficient strategies to increase LCI implementation and adoption. Outcomes/Impact: This research will result in data- driven plans to increase LCI implementation for individuals who are prescribed GLP1/GIP medications (Component A), while our coordinating center will ensure that these findings and other findings across the network are effectively translated to ultimately increase the adoption, implementation, and sustainability of LCIs among and for people with obesity and diabetes. (Component B).