Lifestyle change program engagement in real-world clinical practice: a mixed-methods analysis

Area of Science:

• Behavioral Science
• Public Health
• Health Psychology

Background:

• Participant engagement is crucial for the success of lifestyle change programs (LCPs) in promoting weight loss.
• Understanding the challenges and facilitators of engagement in LCPs is vital for program improvement.

Purpose of the Study:

• To assess factors associated with participant engagement in real-world LCPs.
• To examine the reasons for withdrawal from LCPs using a mixed-methods approach.

Main Methods:

• A mixed-methods study combining electronic health records (EHR) data and semi-structured interviews.
• Multivariable logistic regression analyzed associations between baseline characteristics and engagement.
• Thematic analysis explored reasons for withdrawal from qualitative interview data.

Main Results:

• Higher engagement in LCPs was linked to older age, higher baseline weight, prior healthcare use, and absence of smoking or depression history.
• Non-Hispanic Black participants showed lower engagement compared to White participants.
• Key withdrawal themes included competing priorities, perceived program effectiveness, program characteristics, and facilitator factors.

Conclusions:

• Motivation and self-efficacy are significant drivers of LCP engagement.
• Future LCPs should offer flexible formats, address competing priorities, and enhance cultural relevance for diverse groups.
• Setting realistic participant goals is recommended to manage expectations and improve outcomes.