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.
De Groot S, Post MWM, Postma K, Sluis TA, van der Woude LHV. Prospective analysis of body mass index during and up to 5 years after discharge from inpatient spinal cord injury rehabilitation. J Rehabil Med. 2010;42(10):922–928.
,
Prospective analysis of body mass index during and up to 5 years after discharge from inpatient spinal cord injury rehabilitation
, J Rehabil Med.
, vol. 42
(pg. 922
-928
) Groah SL, Nash MS, Ward EA, et al. Cardiometabolic risk in community-dwelling persons with chronic spinal cord injury. J Cardiopulm Rehab Prev. 2011;31(2):73–80.
,
Cardiometabolic risk in community-dwelling persons with chronic spinal cord injury
, J Cardiopulm Rehab Prev.
, vol. 31
(pg. 73
-80
) Crane DA, Little JW, Burns SP. Weight gain following spinal cord injury: A pilot study. J Spinal Cord Med. 2011;34(2):227–232.
,
Weight gain following spinal cord injury: A pilot study
, J Spinal Cord Med.
, vol. 34
(pg. 227
-232
) Martin Ginis KA, Jörgensen S, Stapleton J. Exercise and sport for persons with spinal cord injury. Phys Med Rehabil. 2012;4(11):894–900.
,
Exercise and sport for persons with spinal cord injury
, Phys Med Rehabil.
, vol. 4
(pg. 894
-900
) Rajan S, McNeely MJ, Hammond M, Goldstein B, Weaver F. Association between obesity and diabetes mellitus in Veterans with spinal cord injuries and disorders. Am J Phys Med Rehabil. 2010;89(5):353–361.
,
Association between obesity and diabetes mellitus in Veterans with spinal cord injuries and disorders
, Am J Phys Med Rehabil.
, vol. 89
(pg. 353
-361
) Stenson KW, Deutsch A, Heinemann AW, Chen D. Obesity and inpatient rehabilitation outcomes for patients with a traumatic spinal cord injury. Arch Phys Med Rehabil. 2011;92(3):384–390.
,
Obesity and inpatient rehabilitation outcomes for patients with a traumatic spinal cord injury
, Arch Phys Med Rehabil.
, vol. 92
(pg. 384
-390
) American Dietetic Association spinal cord injury evidence based nutrition practice guideline, June 2009. http://www.guideline.gov/content.aspx?id=14889. Accessed September 17, 2013. http://www.guideline.gov/content.aspx?id=14889.
Neto FR, Lopes GH. Body composition modifications in people with chronic spinal cord injury after supervised physical activity. J Spinal Cord Med. 2011;34(6):586–593.
,
Body composition modifications in people with chronic spinal cord injury after supervised physical activity
, J Spinal Cord Med.
, vol. 34
(pg. 586
-593
) Cowan RE, Nash MS, Anderson KD. Exercise participation barrier prevalence and association with exercise participation status in individuals with spinal cord injury. Spinal Cord. 2013;51(1):27–32.
,
Exercise participation barrier prevalence and association with exercise participation status in individuals with spinal cord injury
, Spinal Cord.
, vol. 51
(pg. 27
-32
) Chen Y, Henson S, Jackson AB, Richards JS. Obesity intervention in persons with spinal cord injury. Spinal Cord. 2006;44(2):82–91.
,
Obesity intervention in persons with spinal cord injury
, Spinal Cord.
, vol. 44
(pg. 82
-91
) Block P, Vanner EA, Keys CB, Rimmer JH, Skeels SE. Project Shake-It-Up: Using health promotion, capacity building and a disability studies framework to increase self efficacy. Disabil Rehabil. 2010;32(9):741–754.
,
Project Shake-It-Up: Using health promotion, capacity building and a disability studies framework to increase self efficacy
, Disabil Rehabil.
, vol. 32
(pg. 741
-754
) Rimmer JH, Chen M-D, McCubbin JA, Drun C, Peterson J. Exercise intervention research on persons with disability: What we know and where we need to go. Am J Phys Med Rehabil. 2010;89(3):249–263.
,
Exercise intervention research on persons with disability: What we know and where we need to go
, Am J Phys Med Rehabil.
, vol. 89
(pg. 249
-263
) Hicks AL, Martin Ginis KA, Pelletier CA, et al. The effects of exercise training on physical capacity, strength, body composition and functional performance among adults with spinal cord injury: A systematic review. Spinal Cord. 2011;49(11):1103–27.
,
The effects of exercise training on physical capacity, strength, body composition and functional performance among adults with spinal cord injury: A systematic review
, Spinal Cord.
, vol. 49
(pg. 1103
-27
) Zhu DQ, Norman IJ, While AE. The relationship between doctors’ and nurses’ own weight status and their weight management practices: A systematic review. Obesity Rev. 2011;12(6):459–469.
,
The relationship between doctors’ and nurses’ own weight status and their weight management practices: A systematic review
, Obesity Rev.
, vol. 12
(pg. 459
-469
) US Department of Veterans Affairs. VA and spinal cord injury. Fact sheets. January 2009. http://www1.va.gov/opa/publications/factsheets/fs_spinal_cord_ injury.pdf. Accessed September 10, 2013. http://www1.va.gov/opa/publications/factsheets/fs_spinal_cord_ injury.pdf.
US Department of Veterans Affairs. VHA handbook 1176.01: Spinal cord injury and disorders (SCI/D) system of care. February 2011. http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2365. Accessed September 10, 2013. http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2365.
Kinsinger LS, Jones KR, Kahwati L, et al. Design and dissemination of the MOVE! weight-management program for Veterans. Prev Chronic Dis. 2009;6(3):A98.
,
Design and dissemination of the MOVE! weight-management program for Veterans
, Prev Chronic Dis.
, vol. 6
Weiner BJ, Haynes-Maslow L, Kahwati LC, Kinsinger LS, Campbell MK. Implementing the MOVE! weight-management program in the Veterans Health Administration, 2007–2010: A qualitative study. Prev Chronic Dis. 2012;9:E16.
,
Implementing the MOVE! weight-management program in the Veterans Health Administration, 2007–2010: A qualitative study
, Prev Chronic Dis.
, vol. 9
pg. E16
Locatelli SM, Sohn M-W, Spring B, Hadi S, Weaver FM. Participant retention in the Veterans Health Administration’s MOVE! weight management program, 2010. Prev Chron Dis. 2012;9:120056. doi: http://dx.doi.org/10.5888/pcd9.120056
,
Participant retention in the Veterans Health Administration’s MOVE! weight management program, 2010
, Prev Chron Dis.
, vol. 9
pg. 120056
Kahwati LC, Lewis MA, Kane H, et al. Best practices in the Veterans Health Administration’s MOVE! weight management program. Am J Prev Med. 2011;41(5):457–464.
,
Best practices in the Veterans Health Administration’s MOVE! weight management program
, Am J Prev Med.
, vol. 41
(pg. 457
-464
) Damschroder LJ, Aron DC, Keith RE, et al. Fostering implementation of health services research findings into practice: A consolidated framework for advancing implementation science. Impl Sci. 2009;4:50.
,
Fostering implementation of health services research findings into practice: A consolidated framework for advancing implementation science
, Impl Sci.
, vol. 4
Saldaña J. The Coding Manual for Qualitative Researchers. Los Angeles, CA: Sage; 2009.
,
The Coding Manual for Qualitative Researchers.
Krueger RA, Casey MA. Focus Groups: A Practical Guide for Applied Research. 3rd ed. Thousand Oaks, CA: Sage; 2000.
,
Focus Groups: A Practical Guide for Applied Research.
Corbin J, Strauss A. Basics of Qualitative Research Techniques and Procedures for Developing Grounded Theory. 3rd ed. Thousand Oaks, CA: Sage; 2008.
,
Basics of Qualitative Research Techniques and Procedures for Developing Grounded Theory.
Rennie DL. The grounded theory method: Application of a variant of its procedure of constant comparative analysis to psychotherapy research. In: Fischer CT, ed. Qualitative Research Methods for Psychologists: Introduction Through Empirical Studies. San Diego, CA: Elsevier Academic Press; 2006:59–78.
,
The grounded theory method: Application of a variant of its procedure of constant comparative analysis to psychotherapy research.
, Qualitative Research Methods for Psychologists: Introduction Through Empirical Studies.
(pg. 59
-78
) Ndetan H, Evans MW, Bae S, et al. The health care provider’s role and patient compliance to health promotion advice from the user’s perspective: Analysis of the 2006 National Health Interview Survey data. J Manipulative Physiol Ther. 2010;33(6):413–418.
,
The health care provider’s role and patient compliance to health promotion advice from the user’s perspective: Analysis of the 2006 National Health Interview Survey data
, J Manipulative Physiol Ther.
, vol. 33
(pg. 413
-418
) Rose SA, Poynter PS, Anderson JW, Noar SM, Conigliaro J. Physician weight loss advice and patient weight loss behavior change: A literature review and meta-analysis of survey data. Int J Obesity. 2013;37(1):118–128.
,
Physician weight loss advice and patient weight loss behavior change: A literature review and meta-analysis of survey data
, Int J Obesity.
, vol. 37
(pg. 118
-128
) Rao G, Burke LE, Spring BJ, et al. New and emerging weight management strategies for busy ambulatory settings: A scientific statement from the American health Association endorsed by the Society of Behavioral Medicine. Circulation. 2011;124(10):1182–1203.
,
New and emerging weight management strategies for busy ambulatory settings: A scientific statement from the American health Association endorsed by the Society of Behavioral Medicine
, Circulation.
, vol. 124
(pg. 1182
-1203
) Artinian NT, Fletcher GF, Mozaffarian D, et al. Interventions to promote PA and dietary lifestyle changes for cardiovascular risk factor reduction in adults: A scientific statement from the American Heart Association. Circulation. 2010;122(4):406–441.
,
Interventions to promote PA and dietary lifestyle changes for cardiovascular risk factor reduction in adults: A scientific statement from the American Heart Association
, Circulation.
, vol. 122
(pg. 406
-441
) DiLillo V, West DS. Motivational interviewing for weight loss. Psychiatr Clin N Am. 2011;34(4):861–869.
,
Motivational interviewing for weight loss
, Psychiatr Clin N Am.
, vol. 34
(pg. 861
-869
) Molton IR, Jensen MP, Nielson W, Cardenas D, Ehde DM. A preliminary evaluation of the motivational model of pain self-management in persons with spinal cord injury–related pain. J Pain. 2008;9(7):606–612.
,
A preliminary evaluation of the motivational model of pain self-management in persons with spinal cord injury–related pain
, J Pain.
, vol. 9
(pg. 606
-612
) Ciao AC, Latner JD, Durso LE. Treatment seeking and barriers to weight loss treatments of different intensity levels among obese and overweight individuals. Eat Weight Disord. 2012;17(1):e9–e16.
,
Treatment seeking and barriers to weight loss treatments of different intensity levels among obese and overweight individuals
, Eat Weight Disord.
, vol. 17
(pg. e9
-e16
) Davidson KP, Pennebaker JW, Dickerson SS. Who talks? The social psychology of illness support groups. Am Psychol. 2000;55(2):205–217.
,
Who talks? The social psychology of illness support groups
, Am Psychol.
, vol. 55
(pg. 205
-217
) Hetz SP, Latimer AE, Arbour-Nicitopoulos KP, Ginis KAM. Secondary complications and subjective well-being in individuals with chronic spinal cord injury: Associations with self-reported adiposity. Spinal Cord. 2011;49(2):266–272.
,
Secondary complications and subjective well-being in individuals with chronic spinal cord injury: Associations with self-reported adiposity
, Spinal Cord.
, vol. 49
(pg. 266
-272
) Price M. Energy expenditure and metabolism during exercise in persons with a spinal cord injury. Sports Med. 2010;40(8):681–696.
,
Energy expenditure and metabolism during exercise in persons with a spinal cord injury
, Sports Med.
, vol. 40
(pg. 681
-696
) Rycroft-Malone J, Seers K, Chandler J, et al. The role of evidence, context, and facilitation in an implementation trial: Implications for the development of the PARIHS framework. Impl Sci. 2013;8:28.
,
The role of evidence, context, and facilitation in an implementation trial: Implications for the development of the PARIHS framework
, Impl Sci.
, vol. 8
Laughton GE, Buchholz AC, Martin Ginis KA, Goy RE. Lowering body mass index cutoffs better identifies obese persons with spinal cord injury. Spinal Cord. 2009;47(10):757–762.
,
Lowering body mass index cutoffs better identifies obese persons with spinal cord injury
, Spinal Cord.
, vol. 47
(pg. 757
-762
)
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