title: Health care provider practices, barriers, and facilitators for weight management for individuals with spinal cord injuries and disorders.
abstract: BACKGROUND
  Even though weight management is essential for the health of individuals with spinal cord injuries and disorders (SCI/D), little is known about current practices, barriers, and facilitators.
  
  
  OBJECTIVE
  To describe weight management delivery in the Veterans Affairs (VA) SCI/D System of Care, including barriers and facilitators experienced by health care providers.
  
  
  METHODS
  Qualitative focus groups were conducted in person at 4 geographically dispersed VA medical facilities delivering care to Veterans with SCI/D. Thirty-two employees involved in weight management efforts participated. Audio-recordings were transcribed and analyzed using qualitative content analysis techniques.
  
  
  RESULTS
  Participants at SCI centers reported that weight management treatment was delivered through the center by a multidisciplinary team using education (eg, written materials) and counseling/consults. Participants at SCI spoke facilities generally depended on facility-level programs (eg, MOVE!) to deliver treatment. Spoke facilities discussed barriers to delivering treatment through their SCI team, including staff shortages and resource and structural issues. MOVE! staff discussed barriers, including limited wheelchair space in classrooms. Staff participants across facilities noted that Veterans with SCI/D were hesitant to use facility-level programs, because of nonspecific SCI-relevant information and discomfort attending sessions with general Veterans. Other barriers, for both centers and spoke facilities, included necessary medications that increase weight, lack of evidence-based guidelines for weight management, safety concerns, and facility layout/accessibility. Facilitators included facility leadership support, provider involvement/prioritization, and community resources.
  
  
  CONCLUSIONS
  Weight management programs delivered through the SCI team, with peers and SCI-relevant content, are likely more acceptable and beneficial to individuals with SCI/D. Program classrooms should provide ample space for individuals with SCI/D.
authors.affiliation: Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, Department of Veterans Affairs (DVA) , Hines, Illinois ; Spinal Cord Injury Quality Enhancement Research Initiative, Hines VA Hospital, DVA , Hines, Illinois.
authors.forename: Sara M
authors.initials: SM
authors.lastname: Locatelli
authors.affiliation: Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, Department of Veterans Affairs (DVA) , Hines, Illinois ; Institute for Health Research and Policy, University of Illinois at Chicago , Chicago, Illinois.
authors.forename: Ben S
authors.initials: BS
authors.lastname: Gerber
authors.affiliation: Spinal Cord Injury Quality Enhancement Research Initiative, Hines VA Hospital, DVA , Hines, Illinois ; SCI Healthcare Group, VA Puget Sound Healthcare System , Seattle, Washington.
authors.forename: Barry
authors.initials: B
authors.lastname: Goldstein
authors.affiliation: Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, Department of Veterans Affairs (DVA) , Hines, Illinois ; Spinal Cord Injury Quality Enhancement Research Initiative, Hines VA Hospital, DVA , Hines, Illinois ; Program in Health Services Research, Stritch School of Medicine, Loyola University , Maywood, Illinois.
authors.forename: Frances M
authors.initials: FM
authors.lastname: Weaver
authors.affiliation: Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, Department of Veterans Affairs (DVA) , Hines, Illinois ; Spinal Cord Injury Quality Enhancement Research Initiative, Hines VA Hospital, DVA , Hines, Illinois ; Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University , Chicago, Illinois.
authors.forename: Sherri L
authors.initials: SL
authors.lastname: LaVela
keywords: United States Department of Veterans Affairs; Veterans; obesity; overweight; weight reduction programs