"We need to learn how to encourage participation," she observed.
MOVE! to more health plans?
Ms. Jackson and her coinvestigators see MOVE! as well suited for adoption by other large national health care organizations.
MOVE! differs from the DPP in several key ways. It’s shorter, with 8-12 weekly group sessions largely devoted to nutrition and physical activity, compared with 16 sessions in DPP. The MOVE! classes can be taken in any order, while the DPP program requires sessions to be done in a specific sequence. MOVE! sessions can be run by exercise physiologists, nutritionists, diabetes educators, and other professionals; DPP uses a single coach.
Also, MOVE! is less structured than the DPP in that MOVE! emphasizes individualized, patient-determined goal setting developed through motivational interviewing techniques, while the DPP features fixed, generic goals.
For example, whereas the DPP set a target of 150 minutes of moderate exercise per week, MOVE! is more inclusive. It is open to veterans for whom that exercise goal may not be achievable.
Another important difference: Eligibility for MOVE! is based upon body weight, and many participants already have diabetes. In contrast, DPP participants had to be prediabetic, Ms. Jackson noted.
Future MOVE! analyses will explore the program’s impact upon participants’ health and resource utilization.
The originality of the MOVE! program is that it allows people with or without diabetes to participate, explained session chair Dr. Elbert S. Huang of the department of medicine at the University of Chicago. In contrast, most of the classic diabetes prevention studies had very narrow entry criteria. How is it possible, he asked, for such a wide range of patients in a given class to stay on the same page in terms of goal setting?
"As a practical matter," Ms. Jackson explained, "it’s much easier for the VA system to allow all comers who are obese or overweight with a weight-related health condition to participate. The goals are individualized. The program uses the principles of motivational interviewing to ask veterans, ‘How do you want to change your life?’ "
The Department of Veterans Affairs supported the study. Ms. Jackson reported having no conflicts of interest.