title: Provider and staff perceptions of veterans' attrition from a national primary care weight management program.
abstract: BACKGROUND
  Overweight and obesity are growing problems for primary care. Although effective weight management programs exist, these programs experience significant attrition, which limits effectiveness.
  
  
  OBJECTIVE
  This study examined provider and staff perceptions of attrition from the Veterans Health Administration MOVE!(®) Weight Management Program as an initial step toward understanding attrition from primary care-based programs.
  
  
  METHODS
  MOVE!(®) clinicians, primary care providers, and other staff members who interacted with patients about participating in MOVE!(®) (n=754) from Department of Veterans Affairs medical centers throughout the United States. Respondents were predominantly female (80.8%), Caucasian (79.2%), and trained as nurses (L.P.N., R.N., or N.P.; 50%).
  
  
  METHODS
  Participants completed a web-mediated survey; items assessed agreement with personal and programmatic reasons for dropout, and allowed respondents to indicate the number one reason for dropout in an open-ended format. This survey was adapted from an existing tool designed to capture patient perceptions.
  
  
  RESULTS
  Respondents indicated that veterans experienced practical barriers to attendance (eg, transportation and scheduling difficulties) and desire for additions to the program (eg, a live exercise component). Low motivation was the primary factor identified by respondents as associated with dropout, particularly as noted by MOVE!(®) clinicians (versus other providers/staff; P<0.01).
  
  
  CONCLUSIONS
  These findings suggest that programmatic changes, such as adding additional meeting times or in-session exercise time, may be of benefit to MOVE!(®). In addition, increasing the use of techniques such as Motivational Interviewing among providers who refer patients to MOVE!(®) may improve participant engagement in MOVE!(®) and other primary care-based weight management programs. Further research is needed to effectively identify those likely to withdraw from weight management programs before achieving their goals, and the reasons for withdrawal.
authors.affiliation: 1Center for Integrated Healthcare,Syracuse VA Medical Center,Syracuse,NY,USA.
authors.forename: Danielle
authors.initials: D
authors.lastname: Arigo
authors.affiliation: 3Department of Psychology,University of Colorado,Denver,CO,USA.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Hooker
authors.affiliation: 1Center for Integrated Healthcare,Syracuse VA Medical Center,Syracuse,NY,USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Funderburk
authors.affiliation: 1Center for Integrated Healthcare,Syracuse VA Medical Center,Syracuse,NY,USA.
authors.forename: Margaret
authors.initials: M
authors.lastname: Dundon
authors.affiliation: 5South Central VA MIRECC,Jackson,MS,USA.
authors.forename: Patricia
authors.initials: P
authors.lastname: Dubbert
authors.affiliation: 6Michael A. DeBakey VA Medical Center and Baylor College of Medicine,Houston,TX,USA.
authors.forename: Gina
authors.initials: G
authors.lastname: Evans-Hudnall
authors.affiliation: 7Jesse Brown VA Medical Center,Chicago,IL,USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Catanese
authors.affiliation: 7Jesse Brown VA Medical Center,Chicago,IL,USA.
authors.forename: Jenny
authors.initials: J
authors.lastname: O'Donohue
authors.affiliation: 8Stratton VA Medical Center,Albany,NY,USA.
authors.forename: Eva-Maria
authors.initials: EM
authors.lastname: Dickinson
authors.affiliation: 9Omaha VA Medical Center,Omaha,NE,USA.
authors.forename: Christine
authors.initials: C
authors.lastname: DeMasi
authors.affiliation: 9Omaha VA Medical Center,Omaha,NE,USA.
authors.forename: Sheri
authors.initials: S
authors.lastname: Downey
authors.affiliation: 9Omaha VA Medical Center,Omaha,NE,USA.
authors.forename: Cyrus
authors.initials: C
authors.lastname: DeSouza
mesh_terms: D001291:Attitude of Health Personnel; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D050177:Overweight / Q000523:psychology / Q000628:therapy*; D010349:Patient Compliance / Q000523:psychology* / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000379:methods*; D015397:Program Evaluation / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000523:psychology*; D015431:Weight Loss
keywords: weight management