Reducing Obesity Disparities through Primary Care Physicians and - - PowerPoint PPT Presentation

Carolyn M. Tucker, PhD

Reducing Obesity Disparities through Primary Care Physicians and Community Health Workers Implementing Clinic-Based, Culturally Sensitive Interventions to Promote and Sustain Weight Loss among Their Black Women Patients with Obesity

UF Florida Blue Endowed Chair in Health Disparities Research Professor of Psychology and Community Health and Family Medicine September 20, 2019

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Presenter Name: Carolyn M. Tucker, PhD

• Has nothing to disclose.

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What research findings led us to conduct our project?

• Black women have the highest obesity prevalence in the U.S.
• 56% of Black women have obesity, compared to 44.4% of Hispanic women, and 32.8%
• f White women
• A pilot study revealed that only 16% of 25 physicians (80% White) always tracked the

weight of their patients who are overweight or have obesity

• Another pilot study revealed that only 19.8% of 520 patients (42.6% Black; 66.2%

female) said their physicians frequently or very frequently talked to them about their weight

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Who are the project participants and what are the characteristics of their community ?

• Participants
• 680 Black women patients who use community

primary care clinics in Jacksonville, FL

• Community Characteristics
• Obesity and related chronic disease (e.g., diabetes) rates are higher in

Jacksonville, FL than in other parts of Florida

• 30.7% of Jacksonville residents are Black
• Average annual income of a resident in Jacksonville is only $25,496

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What are the major components of this project?

• Integrating community health workers (CHWs) into 20 community primary care clinics
• Implementing our 6-month Health-Smart Weight Loss ProgramTM by trained CHWs
• Conducting Focus Groups with Black women to identify culturally sensitive physician

behaviors when talking with them about weight and obesity

• Implementing one or the other of two physician-implemented 12-month weight-loss

maintenance (WLM) programs at each clinic:

• A motivational interviewing-focused WLM program or a culturally sensitive WLM

program

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What did we do to successfully recruit Black women patient participants?

• Letters prescribing participation were sent by physicians to their Black women patients

with obesity

• Recruitment flyers (that include a picture of Black women) were disseminated by clinic staff
• A large poster about the study was displayed in the waiting room at each clinic
• CHWs personally recruited patients in the waiting room at each clinic
• Patients in the study recruited other patients

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What are we doing to reduce dropout among the Black women patients in our project?

• CHW health empowerment coaches:
• act as attendance cheerleaders
• call patients when they miss 2 health-smart sessions
• encourage patients who have not lost weight
• give surprise small gifts on various days
• arrange attendance to make-up sessions
• Use of a Peer Patient Buddy Support System and a Family Support Person
• Physicians praise their patients for participation in the weight loss maintenance

component of the project

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What are the challenges that we experienced in conducting our project?

• Limited transportation available for many program participants
• Limited safe places for physical activity
• Scheduling medical clearance visits and medical data collection sessions for participants

because of physicians’ busy schedules

• Clearing all project changes with the IRB
• Difficulty reaching participants because of disconnected telephones

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What are key results from CHWs implementing our 6-month Health-Smart Weight Loss ProgramTM with wave 1 participants?

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Patients’ program evaluation:

Values represent percentage of participants endorsing each frequency

Strongly disagree Disagree Neutral Agree Strongly agree The individualized goal-setting session at the beginning of the 6-month weight-loss program was helpful to me. 2 1 3 31 63 The Health-Smart Behavior Resource Guide for Adults was helpful to me. 1 4 37 58 The Family Health Self-Empowerment DVD was helpful to me. 5 1 8 46 40 The 6-month weight-loss program empowered me by increasing my knowledge about managing my weight and health. 1 3 33 63 The 6-month weight-loss program empowered me by increasing my skills to manage my weight and health. 2 4 41 53 I am satisfied with the amount of weight I have lost during the 6-month weight-loss program. 13 23 27 18 19 I was satisfied with my group leader during the 6-month weight-loss program. 3 16 81 My group leader was good at managing our group discussions. 2 2 22 74 The day and time of my group meetings worked well for me. 2 3 8 25 62 The location of my group meetings worked well for me. 2 1 3 27 66 I enjoyed getting to know the other women in my group. 1 2 19 78 Because of the 6-month weight-loss program, I am working on health-smart behaviors. 1 3 44 52 I would recommend the 6-month weight-loss program to other Black women. 1 1 20 78 Overall, I am satisfied with the 6-month weight-loss program. 1 3 6 31 59

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What percentages of wave 1 participants showed clinically meaningful reductions in weight?

37% of the sample experienced body weight reductions of at least 3%

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What percent of participants improved in quality of life?

Perceived overall quality

• f life, health

satisfaction, and psychological health significantly improved Only perceived physical health did not significantly improve

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What are the broader impacts of our project?

• Some CHW coaches got recruited for full-time jobs due to the training in our project
• Recognition by peer researchers that use of focus groups is a culturally sensitive and

effective way to engage Black women patients in identifying ways to promote culturally sensitive health care and thus health care equity

• Development of tools for enabling physicians and medical students in all medical

settings to use in preventing and treating obesity

• Expressed interest from other primary care clinics to have this project implemented

at their sites

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What are lessons learned from conducting our study?

• Patients and community stakeholders need to be trained to advocate for needed transportation

and safe walking areas in their communities

• Physicians are eager to learn specific behaviors and get tools for helping their patients lose

weight and maintain weight loss

• CHWs are ideal health care team members
• Physicians need mental health counseling training to treat obesity and related diseases
• Black women patients are eager to educate physicians about what they need to experience

satisfactory health and health care

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What are opportunities that we identified for future research?

• Evaluation of the impact on patients’ weight and blood pressure of having their

physicians engage in “customized obesity treatment” in which physicians have reviewed each patient’s ratings of the most important physician cultural sensitivity behaviors

• Testing of online delivery of the more effective physician WLM training program/tools
• Identify whether focus groups like those in our current project will yield similar provider

cultural sensitivity behaviors when implemented with Hispanic women

• Evaluate the additional impact of structured family/friend support on weight loss and

weight loss maintenance among Black women with obesity and/or hypertension

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Learn More

• www.pcori.org
• info@pcori.org
• #PCORI2019
• www.people.clas.ufl.edu/cmtucker/
• www.ufhealthdisparities.med.ufl.edu

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Thank You!

• Dr. Carolyn M. Tucker

Program Director September 20, 2019