--- title: "Lifestyle change program real-world clinical practice | Sutter Health" description: "Lifestyle change program engagement in real-world clinical practice: a mixed-methods analysis" url: "https://www.sutterhealth.org/research/publications/lifestyle-change-program-real-world-clinical-practice-1055312913" --- 1. [Home](https://www.sutterhealth.org/) / 2. [Research](https://www.sutterhealth.org/research) / 3. [Research publications](https://www.sutterhealth.org/research/publications) / 4. Lifestyle change program real-world clinical practice # Lifestyle change program engagement in real-world clinical practice: a mixed-methods analysis _Translational Behavior Medicine_ 2023-01-24 ## Abstract Participant engagement in structured lifestyle change programs (LCPs) is essential for adopting behaviors that promote weight loss; however, the challenges to, and facilitators that promote, engagement with such programs are not well understood. We conducted a mixed-methods study among real-world LCP participants to assess factors associated with program engagement and to examine the reasons for withdrawal. Using electronic health records (EHR), we identified LCP eligible participants between 2010 and 2017. Multivariable logistic regression was used to assess associations between program engagement and baseline characteristics. Semi-structured interviews with LCP participants were conducted and thematically analyzed to examine reasons for withdrawal. A total of 1,813 LCP participants were included. The median number of sessions attended was 10 of 21-25 sessions. Highest LCP engagement was associated with factors potentially related to self-efficacy/motivation, such as older age, higher baseline weight, prior healthcare utilization and an absence of a history of smoking or depression. Engagement was also negatively associated with being Non-Hispanic Black versus White. The qualitative analysis of the interviews revealed four general themes pertaining to participants' withdrawal: competing priorities, perceived program effectiveness, characteristics of the program, and facilitator-related factors. Taken together, results from this mixed-methods study suggest that motivation and self-efficacy are important for program engagement; future LCP enhancements should incorporate flexible formats that may help participants manage competing priorities and maximize personal and cultural relevance for all racial/ethnic groups, especially those who have not benefitted fully. Furthermore, participants should be encouraged to set realistic goals to manage expectations. Keywords:Diabetes prevention program; Lifestyle change; Mixed-method; Program engagement; Program withdrawal. [PubMed abstract](https://pubmed.ncbi.nlm.nih.gov/36694916/) ![Kristen M J Azar, RN, MSN, MPH](https://dyn.mktgcdn.com/p/rFmyR1kiX8JzE5-XNwup0gVC1GRaVTlH7oSDlG0Tr5A/fit=crop,gravity=auto,dpr=2,width=188,height=250,quality=100) Kristen M J Azar, RN, MSN, MPH Principal investigator [View profile](https://www.sutterhealth.org/research/investigators/kristen-m-j-azar-rn-msn-mph-1049680985) ## Research topics - [EHR Data](https://www.sutterhealth.org/research-search-results?query=%22%5C%22EHR+Data%5C%22%22) - [Obesity](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Obesity%5C%22%22) - [Participant Retention](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Participant+Retention%5C%22%22) - [Prevention and Health Maintenance](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Prevention+and+Health+Maintenance%5C%22%22) ## Related publications [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) - Publication ### [Alternatives to monetary incentives for employee weight loss.](https://www.sutterhealth.org/research/publications/non-monetary-incentives-for-employee-wt-loss-1055312646) Lesser LI, Puhl RM. Am J Prev Med. 46(4):429-31. doi: 10.1016/j.amepre.2013.11.017. 2014 Apr 01 - Publication ### [Mobile applications for weight management: theory-based content analysis.](https://www.sutterhealth.org/research/publications/theory-based-content-analysis-of-apps-for-wt-mgmt-1055312668) Azar KM, Lesser LI, Laing BY, Stephens J, Aurora MS, Burke LE, Palaniappan LP. Am J Prev Med. 45(5):583-9. doi: 10.1016/j.amepre.2013.07.005. 2013 Nov 01 - Publication ### [Obesity prevention at the point of purchase.](https://www.sutterhealth.org/research/publications/obesity-prevention-at-point-of-purchase-1055312473) Cohen DA, Lesser LI. Obes Rev. doi: 10.1111/obr.12387. \[Epub ahead of print\] 2016 Feb 22 - Publication ### [Examining paradoxical session attendance and weight loss relationships in a clinic based lifestyle modification intervention](https://www.sutterhealth.org/research/publications/paradoxical-session-attendance-weight-loss-relationships-1055312915) Kristen M. J. Azar, Sylvia Sudat, Qiwen Huang, Alice P. Pressman, Nina K. Szwerinski, Catherine Nasrallah, Elizabeth M. Venditti, Robert J. Romanelli Examining paradoxical session attendance and weight loss relationships in a clinic-based lifestyle modification intervention.Obes Sci Pract. 2023; 2023 Jul 04 - Publication ### [Diabetes prevention and weight loss with a fully automated behavioral intervention by email, web, and mobile phone: a randomized controlled trial among persons with prediabetes.](https://www.sutterhealth.org/research/publications/diabetes-prev-wt-loss-automated-beh-intervention-1055312953) Block G, Azar KM, Romanelli RJ, Block TJ, Hopkins D, Carpenter HA, Dolginsky MS, Hudes ML, Palaniappan LP, Block CH. J Med Internet Res. 17(10):e240. doi: 10.2196/jmir.4897. 2015 Oct 23 [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) ```json {"@context":"https://schema.org","@type":"MedicalOrganization","name":"Sutter Health","@id":"https://www.sutterhealth.org/#medicalorganization","url":"https://www.sutterhealth.org","logo":"https://www.sutterhealth.org/static/images/sutter-health-logo.svg","address":{"@type":"PostalAddress","streetAddress":"2200 River Plaza Drive","addressLocality":"Sacramento","addressRegion":"CA","postalCode":"95833","addressCountry":"US"},"areaServed":{"@type":"AdministrativeArea","name":"California"},"sameAs":["https://www.facebook.com/SutterHealth","https://www.instagram.com/sutterhealth/","https://x.com/SutterHealth","https://www.youtube.com/sutterhealth","https://www.linkedin.com/company/sutter-health","https://en.wikipedia.org/wiki/Sutter_Health"]} ``` ```json {"@context":"https://schema.org","@type":"BreadcrumbList","@id":"https://www.sutterhealth.org/research/publications/lifestyle-change-program-real-world-clinical-practice-1055312913#breadcrumblist","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https://www.sutterhealth.org/"},{"@type":"ListItem","position":2,"name":"Research","item":"https://www.sutterhealth.org/research"},{"@type":"ListItem","position":3,"name":"Research publications","item":"https://www.sutterhealth.org/research/publications"},{"@type":"ListItem","position":4,"name":"Lifestyle change program real-world clinical practice"}]} ``` ```json {"@context":"https://schema.org","@type":"MedicalScholarlyArticle","@id":"https://www.sutterhealth.org/research/publications/lifestyle-change-program-real-world-clinical-practice-1055312913#medicalscholarlyarticle","name":"Lifestyle change program engagement in real-world clinical practice: a mixed-methods analysis","headline":"Lifestyle change program real-world clinical practice","abstract":"Participant engagement in structured lifestyle change programs (LCPs) is essential for adopting behaviors that promote weight loss; however, the challenges to, and facilitators that promote, engagement with such programs are not well understood. We conducted a mixed-methods study among real-world LCP participants to assess factors associated with program engagement and to examine the reasons for withdrawal. Using electronic health records (EHR), we identified LCP eligible participants between 2010 and 2017. Multivariable logistic regression was used to assess associations between program engagement and baseline characteristics. Semi-structured interviews with LCP participants were conducted and thematically analyzed to examine reasons for withdrawal. A total of 1,813 LCP participants were included. The median number of sessions attended was 10 of 21-25 sessions. Highest LCP engagement was associated with factors potentially related to self-efficacy/motivation, such as older age, higher baseline weight, prior healthcare utilization and an absence of a history of smoking or depression. Engagement was also negatively associated with being Non-Hispanic Black versus White. The qualitative analysis of the interviews revealed four general themes pertaining to participants' withdrawal: competing priorities, perceived program effectiveness, characteristics of the program, and facilitator-related factors. Taken together, results from this mixed-methods study suggest that motivation and self-efficacy are important for program engagement; future LCP enhancements should incorporate flexible formats that may help participants manage competing priorities and maximize personal and cultural relevance for all racial/ethnic groups, especially those who have not benefitted fully. Furthermore, participants should be encouraged to set realistic goals to manage expectations. 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