Programs and Communities

Obesity is a significant national public health crisis, affecting one-third of American adults. It is a complex and multifactorial disease that increases the risk of multiple chronic medical conditions including coronary heart disease, diabetes, and even leading to potential premature mortality. Moreover, increased health care utilization and escalating medical costs associated with obesity treatment are overwhelming an already burdened health care system. Obesity is nondiscriminatory, affecting individuals from various demographic and socioeconomic backgrounds, even extending to our unique population of active duty military service members and veterans.

Despite mandatory physical fitness and body composition requirements, active duty service members continue to experience an increasing prevalence of obesity. The obesity epidemic has considerable implications for military readiness, accession, and retention. Limited studies have examined weight-loss interventions including self-paced and provider-led interventions among active duty military service members with varying degrees of success. The purpose of this evidence based doctoral project was to examine the effectiveness of a twelve-week group lifestyle intervention involving education regarding healthy diet, physical activity and behavior change recommendations on weight and body mass index (BMI). The study demonstrated no significant differences in initial and post intervention weight and BMI.

Disease burden is higher in the United States than in comparable countries. The Patient Self Determination Act of 1990 requires healthcare facilities to provide Advance Care Planning (ACP) information to all Medicare patients. The healthcare staffs’ (n=7) commitment to 3-days of ACP training increase ACP rates in the primary care setting. The Medicare Incentive Program is the platform for this initiative. This quantitative project used a valid and reliable pre and posttest design that consisted of 27 items on a Likert-scale. A 3.5-month chart audit (n=91) was conducted to assess the completion rate. Descriptive statistics was used to describe the demographic data.

The results of the two-tailed Wilcoxon signed rank test were significant based on an alpha value of 0.05, V = 0.00, z = -2.37, p = .018. There was a significant increase in the post-readiness to change average scores. A Mann Whitney test was used to analyze the statistically significant difference between the averages in two ACP types and electronic health record documentation (EHR). Staff did not always code (Mdn = 0.00) but they documented in the EHR (Mdn =1.00; 512.00, p = 0.003). ACP discussion was performed 63% of the time during Annual Wellness Visits (AWV), and there was a 49% increase in the EHR documentation. Trained staff are key stakeholders in guiding ACP conversations. They understand the barriers, impact, and consequences related to the lack of advance directives.

This study answers the question, “In Adult Hispanic BMI ≥ 30 (P), how does development of a weight loss program that utilizes Motivational Interviewing (I) compared to counseling and educational materials only (C) affect weight loss over the period of three months (T).” There are limited published systematic reviews and randomized control trials to evaluate the effectiveness of Motivational Interviewing (MI), in conjunction with diet and exercise to promote weight loss. Participants (n = 5) were Latino patients of a local community health care center who were overweight and medically at risk due to unhealthy lifestyles that were determined through a screening test.

The 4-week clinical pathway program used motivational interviewing in one-on-one sessions every other week, and implemented the “Your Heart, Your Life” curriculum the other weeks. One expected outcome included lower anthropometric measurement numbers of participants’ WL, BMI, WC, and BP. Another expected outcome was an increase in physical activity. Participants were also expected to earn a higher score on a post-test about nutrition and healthy living. A paired t-test and power analyses were used to assess its effectiveness.

Results indicated significant decrease in weight loss (t [5] = 3.68, p = .0211, Cohen’s dz=1.647). For heart healthy habits, there were significant increases all three categories: weight management (t [5] = - 3.36, p = .0211), cholesterol and fat (t [5] = - 3.138, p =.035, salt and sodium (t [5] = - 4.899, p = .008). In addition, there was an increase in knowledge (t [5] = - 4.000, p = .016). Every participant showed small gains. Future implications should include more participants, including males, a control group, innovative activities that help to motivate a community of learners and more flexibility in allotted time for interventions.

Purpose: This project examined the effectiveness of an online educational module on basic Motivational Interviewing (MI) techniques for Nurse Practitioners (NPs) providing obesity management to middle-aged women.

Background: Middle-aged women experience distinct physiological and psychosocial factors that contribute to weight gain and make obesity management especially challenging. The evidence supports the use of motivational interviewing (MI) interventions as a highly effective approach to obesity management in combination with standard medical weight loss programs. Educating NPs that provide medical weight loss on basic MI counseling techniques is necessary to facilitate the use of this intervention.

Methods: NP providers at a group of seven medical weight loss clinics in the southwestern United States completed an online MI educational module that was developed for this project. The module content covered basic MI counseling techniques. MI knowledge was assessed using a 6-item pre/post-test. Participants completed an 8-item course evaluation to provide additional feedback.

Results: Ten of the 13 NPs eligible participated in the project. The overall response to the project was positive as demonstrated by high scores on the course evaluation. The average post-test knowledge scores increased after completion of the module, however no statistical significance was noted.

Conclusions: The basic MI education module was beneficial for NPs providing obesity management and future research should focus on developing standardized MI weight loss interventions.

As Baby Boomers age, the number of older homeless patients facing end of life is increasing. Homeless individuals die of the same diseases as their domiciled counterparts, but they have distinct barriers to equitable end-of-life care, such as lack of regular medical care, a higher likelihood of comorbid serious mental illness and substance abuse, alienation from potential healthcare proxies, and specific fears related to dying. Completion of an advance directive (AD) would address many of these barriers, as well as national goals of reducing medical costs associated with end of life care. A review of the literature indicates that homeless individuals, once educated on the purpose and significance of ADs, complete them at a higher rate than non-homeless people. Further, racial and ethnic disparities in document completion are minimized with educational interventions about an AD’s purpose.

King’s Theory of Goal Attainment provides the theoretical basis for the application of such an intervention in the setting of a medical respite center and a day resource center that both serve the homeless. Thirty-seven clients of the two sites and 14 staff members were administered a pre-and post-test measuring attitudes and knowledge relating to ADs on a Likert scale, resulting in an increase in knowledge about one of the two documents that traditionally comprise an AD, while not significantly affecting attitudes. Implications for practice include an inexpensive intervention that does not require a medically trained individual to deliver, enabling a broad application to a variety of settings with the goal of empowering a traditionally disenfranchised population to make health decisions related to the most vulnerable of life passages.