Feasibility and acceptability of a technology-based, rural weight management intervention in older adults with obesity

We determined the feasibility, acceptability and preliminary outcomes of an integrated technology-based health promotion intervention in rural-living, older adults using remote monitoring and synchronous video-based technology.

Participants video-called with registered dietician nutritionists, were guided by a physical therapist in exercise through a tablet device, and wore a Fitbit. On average, participants lost weight, improved their 30 second sit-to-stand, and at least 41% of participants had at least a 30 meter improvement in 6-min walk. Subjective measures of Late-life function and disability instrument (LLFDI) also noted improvements in total, upper, basic lower, and advanced lower extremity function. In conclusion, this technology-based, video-monitoring and remote monitoring intervention is feasible, acceptable, and demonstrates favorable outcomes by overcoming the limitations of existing geriatric weight-loss trials, overcoming a need for proximity to medical facilities.

John A. Batsis, Curtis L. Petersen, Matthew M. Clark, Summer B. Cook, David Kotz, Tyler L. Gooding, Meredith N. Roderka, Rima I. Al-Nimr, Dawna Pidgeon, Ann Haedrich, K.C. Wright, Christina Aquila, and Todd A. Mackenzie. Feasibility and acceptability of a technology-based, rural weight management intervention in older adults with obesity. BMC Geriatrics, volume 21, article 44, 13 pages. BMC, January 2021. doi:10.1186/s12877-020-01978-x. PMID: 33435877.

Augmenting Traditional User-Centered Design with Natural Language Processing and Sentiment Analysis

This paper includes patient and clinician feedback to better understand treatment progress and increase compliance in resistance-based physical activity to mitigate the effects of age-associated losses in muscle mass and strengths. This study aims to develop a mobile app for a novel device through a user-centered design process with both older adults and clinicians while exploring whether data collected through this process can be used in natural language processing (NLP) and sentiment analysis. We used the Bing sentiment library for a sentiment analysis of interview transcripts and then applied NLP-based latent Dirichlet allocation (LDA) topic modeling to identify differences and similarities in patient and clinician participant interviews. To assess utility, we used quantitative assessment questionnaires—System Usability Scale (SUS) and Usefulness, Satisfaction, and Ease of use (USE). We found a positive association with positive sentiment in an interview and SUS score (ß=1.38; 95% CI 0.37 to 2.39; P=.01), but no significant association between sentiment and the USE score. The LDA analysis found no overlap between patients and clinicians in the 8 identified topics. Involving patients and clinicians allowed us to design and build an app that is user friendly for older adults while supporting compliance. This is the first analysis using NLP and usability questionnaires in the quantification of user-centered design of technology for older adults.

Curtis Lee Petersen, Ryan Halter, David Kotz, Lorie Loeb, Summer Cook, Dawna Pidgeon, Brock C. Christensen, and John A. Batsis. Using Natural Language Processing and Sentiment Analysis to Augment Traditional User-Centered Design: Development and Usability StudyJMIR mHealth and uHealth 8(8), page Article#e16862 (13 pages), August 2020. JMIR Publications. DOI: 10.2196/16862

Willingness to pay for a telemedicine-delivered healthy lifestyle programme

Recent Amulet paper:

Effective weight-management interventions require frequent interactions with specialised multidisciplinary teams of medical, nutritional and behavioural experts. However, barriers that exist in rural areas, such as transportation and a lack of specialised services, can prevent patients from receiving quality care. We recruited patients from the Dartmouth-Hitchcock Weight & Wellness Center into a single-arm, non-randomised study of a remotely delivered 16-week evidence-based healthy lifestyle programme. Every 4 weeks, participants completed surveys that included their willingness to pay for services like those experienced in the intervention based on commute and copay. Overall, those with a travel duration of 31–45 min had a greater willingness to trade in-person visits for telehealth than any other group. Participants who had a travel duration less than 15 min, 16–30 min and 46–60 min experienced a positive trend in willingness to have telehealth visits until Week 8, where there was a general negative trend in willingness to trade in-person visits for virtual. Participants believed that telemedicine was useful and helpful. In rural areas where patients travel 30–45 min a telemedicine-delivered, intensive weight-loss intervention may be a well-received and cost-effective way for both patients and the clinical care team to connect.

Vanessa K. Rauch, Meredith Roderka, Auden C. McClure, Aaron B. Weintraub, Kevin Curtis, David F. Kotz, Richard I. Rothstein, and John A. Batsis. Willingness to pay for a telemedicine-delivered healthy lifestyle programmeJournal of Telemedicine and Telecare, June 2020. Sage. DOI: 10.1177/1357633X20943337

Barriers and facilitators in implementing a pilot, pragmatic, telemedicine-delivered healthy lifestyle program for obesity management in a rural, academic obesity clinic

An Amulet-related paper was published recently.

Few evidence-based strategies are specifically tailored for disparity populations such as rural adults. Two-way video-conferencing using telemedicine can potentially surmount geographic barriers that impede participation in high-intensity treatment programs offering frequent visits to clinic facilities. We aimed to understand barriers and facilitators of implementing a telemedicine-delivered tertiary-care, rural academic weight-loss program for the management of obesity. A single-arm study of a 16-week, weight-loss pilot evaluated barriers and facilitators to program participation, exploratory measures of program adoption, and staff confidence in implementation and intervention delivery. A program was delivered using video-conferencing within an existing clinical infrastructure. Elements of the Consolidated Framework for Implementation Research (CFIR) provided a basis for assessing intervention characteristics, inner and outer settings, and individual characteristics using surveys and semi-structured interview. Using CFIR, the intervention was valuable from a patient participant standpoint; staff equally had positive feelings about using telemedicine as useful for patient care. The RE-AIM framework demonstrated limited reach but willingness to adopt was above average. A significant barrier limiting sustainability was physical space for intervention delivery and privacy and dedicated resources for staff. Scheduling stressors were also a challenge in its implementation. The need to engage staff, enhance organizational culture, and increase reach are major factors for rural health obesity clinics to enhance sustainability of using telemedicine for the management of obesity.

John Batsis, Auden C. McClure, Aaron B. Weintraub, Diane Sette, Sivan Rotenberg, Courtney J. Stevens, Diane Gilbert-Diamond, David F. Kotz, Stephen J. Bartels, Summer B. Cook, and Richard I. Rothstein. Barriers and facilitators in implementing a pilot, pragmatic, telemedicine-delivered healthy lifestyle program for obesity management in a rural, academic obesity clinicImplementation Science Communications 1, page Article#83 (9 pages), September 2020. BMC. DOI: 10.1186/s43058-020-00075-9