Addressing Diabetes in Primary Care: Hybrid Effectiveness-Implementation Study of Lifestyle Redesign® Occupational Therapy.

IMPORTANCE: Primary health care is rapidly developing as an occupational therapy practice area. Yet, to date, little evidence supports occupational therapy's feasibility and efficacy in primary care settings. OBJECTIVE: To report on the implementation and preliminary clinical outcomes of a Lifestyle Redesign® (LR)-occupational therapy (LR-OT) diabetes management intervention in a primary care clinic. DESIGN: Patients were randomized to be offered LR-OT or to a no-contact comparison group (data not reported). We assessed implementation outcomes using mixed methods. SETTING: Safety-net primary care clinic. PARTICIPANTS: Clinic providers and staff; English- or Spanish-speaking clinic patients ages 18-75 yr with diabetes and a current hemoglobin A1c (HbA1c) ≥ 9.0%. INTERVENTION: Eight 1-hr individual sessions of LR-OT focused on diabetes management. OUTCOMES AND MEASURES: Clinical and health behavior outcomes were assessed via electronic medical record (EMR) review and self-report surveys of patients receiving LR-OT at initial evaluation and discharge. We assessed implementation outcomes (acceptability, appropriateness, feasibility, fidelity, efficiency, and timeliness) using patient and staff surveys, interviews, focus groups, and observations. RESULTS: Seventy-three patients were offered LR-OT: 51 completed one or more sessions, and 38 completed the program. Clinical outcomes among program completers indicate beneficial changes in HbA1c, diabetes self-care, and health status. Implementation challenges included a need for patient and staff education, securing adequate workspace, and establishing a referral process. Factors contributing to implementation success included strong buy-in from clinic leadership, colocation, and shared EMR documentation. CONCLUSIONS AND RELEVANCE: LR-OT is a feasible approach to enhancing service delivery and clinical outcomes in primary care. WHAT THIS ARTICLE ADDS: This study provides insight into factors that may create challenges or contribute to the success of implementing occupational therapy services within primary health care settings. In addition, this study provides preliminary evidence of occupational therapy's effectiveness in improving clinical outcomes among ethnically diverse, low-income patients with diabetes in a safety-net primary care setting.

Worksite physical activity breaks: Perspectives on feasibility of implementation.

BACKGROUND: Worksites offer a unique opportunity to increase physical activity in persons with both active and sedentary lifestyles. OBJECTIVE: The objective of this study was to examine employee and supervisor perspectives on feasibility and acceptability of 10-minute Instant Recess ® physical activity videos in the worksite. METHODS: Convenience sample of public and private worksites in Minneapolis/St. Paul, MN. Employees (n = 187) at 13 worksites were recruited by a one-time email invitation to participate in a group Instant Recess break and complete a 15-question survey. One supervisor per site participated in a one-on-one interview to assess suggestions for feasibility of implementation. Likert-type survey responses were averaged per worksite and overall. Interview results were recorded, transcribed, and coded by two authors. RESULTS: Employees were extremely positive about enjoyment, increased productivity, comfort, and feasibility of doing Instant Recess at the same time and place every day (score = 4.29, 4.17, 4.25, and 4.37 out of 5, respectively). However, they did not feel comfortable leading an Instant Recess break (score = 2.68 out of 5). Supervisors voiced during the one-on-one interviews that they enjoyed Instant Recess (13 out of 13 supervisors), were enthusiastic about Instant Recess as a simple and cost-effective entry into worksite wellness (11 out of 13 supervisors), and felt that Instant Recess could be institutionalized by offering it daily at a set time and place (13 out of 13 supervisors). CONCLUSIONS: Employees and supervisors at various worksites believed that it is feasible and desirable to offer 10-minute physical activity breaks using videos during the workday.