ABSTRACT
Background: Adults with metabolic syndrome and obesity who participate in intensive lifestyle Interventions (ILIs) often achieve significant weight loss (>5%), improve activity levels and dietary quality, and reduce their risk for diabetes. STRIDES, the ILI at our safety-net county health system, was delivered in group classes until March 2020, when, due to COVID-19, classes pivoted to a web-based format. STRIDES serves an ethnically and economically diverse population. This project compared participant outcomes and staff work between in-person and web-based STRIDES. Methods: Using the STRIDES program data base, attendance, weight loss, and staff work were evaluated for two in-person class cohorts (2018, 2019) and the web-based class cohort (2020). Attendance at weekly group classes and weight loss were compared for in-person participants to web-based participants. who had monthly in-person weigh-ins. Repeated measures ANOVA was used to test for differences in weight loss over time between the three cohorts after adjusting for baseline weight. Results: The 278 (89, 91,98) participants in three cohorts had: a mean age of 56 yrs.and mean BMI of 41%, and were 90% female and 41% AA.Mean number of classes attended were: 8, 13, and 17 at 3, 6, and 12 months. Dropout, low, medium, and high attendance was 2%, 9%, 23%, and 66% respectively and did not differ between in-person and web-based cohorts. Participant weight loss was 6.3% at 6 mo. with 50% achieving >5% weight loss and did not differ between cohorts. New staff web-based work included: technology on-boarding for participants;>1400 coaching calls/year;set-up/ invites for sessions;delivery of participant materials;monthly in-person weigh-ins;and ongoing log-in support during class. Participants satisfaction with the web-based format was 'good' or 'very good' for 95% and 92% plan to parcticipate again. Conclusions: Diverse ILI participants in the 2020 web-based class format had attendance and weight loss comparable to two prior in-person group class years. Participant satisfaction was high in the web-based format, but may not persist after pandemic conditions. Program delivery required additional work compared to the in-person format. Web-based ILI is promising to improve accessibility to programs that improve cardiometabolic risk, but may have increased costs compared to the in-person format.
ABSTRACT
Background: Intensive lifestyle intervention (ILI) participants often lose weight (>5%) and improve activity levels and dietary quality. STRIDES, the effective ILI at our safety-net county health system that serves diverse adults, pivoted from in-person group classes to a web-based format in March 2020, during the COVID pandemic.This project describes participants' experiences of attending web-based STRIDES (WS) including comparing WS to in-person STRIDES (IPS) for those who attended both. Methods: In May 2021, active WS participants were asked to complete a 48-item survey. The survey assessed the impact of COVID-19 on behaviors, income and employment;satisfaction with the STRIDES program, coaching and in-person weigh-in sessions;preference for future STRIDES delivery;level of group therapeutic factors and self-efficacy for activity and healthy eating. diet. Chi-square tests of independence were performed to examine relationships between WS and IPS and variables representing their experiences. Results: Of 133 invited participants, (74 both WS/IPS, 59 WS only), 118 (89%) completed the survey. Participants' mean age was 59 yrs;mean BMI was 41 kg/m2;98% female;50% white/45% black. Of participants, 90% were satisfied with web-based format;98% had stable internet access, 94% rarely/never had technology related attendance issues;89% found WS class flexible;45% reported they worked, exercised, ran errands or did chores during class. For participants in both WS and IPS, 37% report speaking less in WS than IPS. Group value and self-efficacy were similar for WS and IPS, but catharsis less in WS. Most (89%) prefer a blended model of WS and IPS for future classes. COVID-19 vaccination rate was 77% for participants and 21% of unvaccinated intend to be vaccinated. For many, COVID impacted activity and food;and for some, income. STRIDES felt to help improve weight (89%);diet (92%), and activity (68%) Conclusions: Diverse participants in an effective ILI on a web-based platform during COVID-18 liked the program and its flexibility. They felt it helped with weight loss, activity and healthy eating. WS retained important therapeutic features of in-person group courses. Participants felt STRIDES increased self-efficacy, but COVID-19 negatively impacted activity and diet. Over 75% of participants are vaccinated. Most prefer future classes to blend IPS and WS.