The effect of peer support on knowledge and self-efficacy in weight management: a prospective clinical trial in a mental health setting

Transcription

1 The effect of peer support on knowledge and self-efficacy in weight management: a prospective clinical trial in a mental health setting Ontario Shores Mental Health Conference Tuesday February 27 th 2018

2 Team Member Credentials Institution Claire Hibbert (PI) RD Ontario Shores Emilie Trottier RD Ontario Shores Marlie Boville RN Ontario Shores Dr. Margaret Hahn Psychiatrist, PhD CAMH Alexandra Hernandez PhD Ontario Shores Alifa Siddiqui Research assistant, BScH (candidate) Ontario Shores Acknowledgements: Steve Mann, Melanie Stuckey, Angie Yan Yee Tse, Ontario Shores Research Dpt.

3 What is Metabolic Syndrome? High triglycerides High blood pressure Abdominal Obesity Diabetes Low HDL good cholesterol

4 The Mental Health Metabolic Connection SMI Social Determinants Metabolic Syndrome CVD Biology Symptoms

5 The Metabolic and Weight Management Clinic (MWMC) Who we are and what we do: Minimize the impact of metabolic syndrome on clients with mental illness Focus on modifiable risk factors Self-management approach Staffing and model of care Outcome measures

6 Study Rationale 63 % of clients who have been attending MWMC for at least six months have not achieved and/or maintained 5% weight reduction since their initial enrollment

7 Literature Review What else can we do? There are benefits to group therapy There are also benefits to individual therapy No harms from either modality Frequent follow up is important Follow up for a longer period of time **No literature examines group versus individual therapy for clients with metabolic illness in a mental health setting**

8 Study Design Incorporate peer support groups into existing model of care Two-hour group sessions every 2 weeks for 1 year Prospective clinical trial Within subject, single group pre- & post-test design Grant from the Ontario Shores: 2016 Inter-Professional Clinical Trials Research Seed Grant

9 Study Participants Recruitment o Goal was N = 20 o Initial recruitment N = 19 o Start of study N = 14 Inclusion & exclusion criteria Approved by full board REB at Ontario Shores

10 Intervention - Group Education and Peer Support Sessions Facilitated by RN and RD Review of action plans Education nutrition, physical activity, sleep, managing mood, medication, working with your healthcare team, action planning Healthy snack break Develop new action plans $5 cash per visit

11 Measures Baseline, 3, 6, and 12 months Weight Health-related quality of life (SF-36) Diet Quality (DSQ) Confidence and Conviction (C&C)

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13 Research Objectives Primary: To determine the effects of incorporating frequent group peer support on body weight and C&C Secondary: To examine the relationship between C&C and weight change and maintenance, as well as health-related quality of life and diet quality

14 Hypotheses 1) Group peer support will result in more clients losing and maintaining 5% weight loss in the one-year study period 2) C&C at three months will predict the change in body weight over the one-year study period

15 Results Study Participants Gender 7% 64% 29% Male Female Transgender Age 51.7 ± 12.2 years;

16 Mean Weight (kg) Final Results - Weight Baseline 3 month 6 month 12 month Time Period

17 Weight Change (%) Final Results - Weight % Weight Change at 3, 6 and 12 months months AAA001 AAA002 AAA004 AAA005 AAA006 AAA007 AAA008 AAA009 AAA010 AAA011 AAA013 AAA014 AAA015 AAA016 mean 6 months months -7 Participant -12

18 Mean Conviction Final Results Conviction Baseline 3 month 6 month 12 month Time Period

19 Mean Confidence Final Results Confidence Baseline 3 month 6 month 12 month Time Period

20 Mean Score Final Results SF-36 Medical Outcomes Questionnaire SF Baseline 3 months 6 months 12 months Physical Functioning Physical Health - Role Emotional Health - Role Energy/Fatigue Emotional Well-being Social Functioning Pain General Health Perception Subscales

21 Discussion No significant weight change High C&C scores were maintained Pain improved and physical functioning worsened

22 Barriers and Next Steps Pilot study Logistics Attendance Unanticipated benefits Next steps

23 Contact Information Emilie Trottier, RD (905) ext 6465 Metabolic and Weight Management Clinic Ontario Shores Centre for Mental Health Sciences

24 References 1. Canadian Obesity Network. Obesity and Mental Illness: Addressing a Double Epidemic [Internet] [cited 2016 March 21]. Available from: 2. Public Health Agency of Canada. Obesity in Canada [Internet]. [updated 2011 June 23; cited 2016 March 21]. Available from: 3. Avila C, Holloway AC, Hahn MK, Morrison KM, Restivo M, Anglin R, Taylor VH. An Overview of Links Between Obesity and Mental Health. Curr Obes Rep. 2015; 4(3): doi: /s Sharma AM. Issue #1: Why Obesity is a Chronic Disease. Webinar. [Presented Feb 2016; Accessed 2016 March 24]. Available from: 5. Institute for Healthcare Communication. Choices & Changes Annotated Bibliography. Revised October, Available from: 6. Bandura A, Adams NE, Beyer J. Cognitive processes mediating behavioral change. J Pers Soc Psychol. 1977;35(3): Bandura A. The anatomy of stages of change. Am J Health Promot Sep-Oct;12(1): Keller VF, White MK. Choices and Changes: A New Model for Influencing Patient Health Behavior. JCOM. 1997;4(No.6): Lorig KR, Holman H. Self-management education: history, definition, outcomes, and mechanisms. Ann Behav Med. 2003;26(1): Riediger ND, Clara I. Prevalence of metabolic syndrome in the Canadian adult population. Canadian Medical Association. 2011; 183(15): doi: /cmaj Simon GE, Von Korff M, Saunders K, Miglioretti DL, Crane PK, Van Belle G, et al. Association between obesity and psychiatric disorders in the US adult population. Arch Gen Psychiatry. 2006; 63(7): doi: /archpsyc Gucciardi E, DeMelo M, Lee RN, Grace SL. Assessment of two culturally competent Diabetes education methods: individual versus individual plus group education in Canadian Portuguese adults with Type 2 Diabetes. Ethnicity and Health. 2007; 12(2):

25 References Continued 13. Raz I, Soskolne V, and Stein P. Influence of small-group education sessions on glucose homeostasis in NIDDM. Diabetes Care. 1988; 11(1): Trento M, Passera P, Tomalino M, Bajardi M, Pomero F, Allione A, et al. Group visits improve metabolic control in type 2 diabetes: a 2-year follow-up. Diabetes Care. 2001; 24(6): Rickheim PL, Weaver TW, Flader JL, and Kendall DM. Assessment of group versus individual diabetes education: a randomized study. Diabetes Care. 2002; 25(2): Renjilian DA, Nezu AM, Shermer RL, Perri MG, McKelvey WF, and Anton SD. Individual versus group therapy for obesity: effects of matching participants to their treatment preferences. Journal of Consulting and Clinical Psychology. 2001; 69(4): doi: // X Minniti A, Bissoli L, Di Francesco V, Fantin F, Mandragona R, Oliveieri M, et al. Individual versus group therapy for obesity: comparison of dropout rate and treatment outcome. Eating Weight Disord. 2007; 12(4): Alvarez-Jimenez M, Hetrick SE, Gonzalez-Blanch C, Gleeson JF, McGorry PD. Non-pharmacological management of antipsychotic-induced weight gain: systematic review and meta-analysis of randomised controlled trials. BJ Psych. 2008; 193: doi: /bjp.bp Sunderland, Kim, Mishkin, Wendy, Peer Leadership Group, Mental Health Commission of Canada. Guidelines for the Practice and Training of Peer Support Calgary, AB: Mental Health Commission of Canada. Available from: