Background

Obesity is a substantial problem in the Veterans Health Administration (VHA). VHA developed and disseminated the MOVE! Weight Management Program for Veterans to its medical facilities but implementation of the program has been variable.

Purpose

The objective was to explore variation in MOVE! program implementation to identify facility structure, policies, and processes associated with larger patient weight-loss outcomes.

Methods

Qualitative comparative analysis (QCA) was used to identify facility conditions or combinations of conditions associated with larger 6-month patient weight-loss outcomes. QCA is a method that allows for systematic cross-case comparison to better understand causal complexity. Eleven sites with larger outcomes and 11 sites with smaller outcomes were identified and data were collected with site interviews, facility-completed program summary forms, and medical record abstraction in 2009 and 2010. Conditions were selected based on theory and experience implementing MOVE! and were calibrated using QCA methods. Configuration patterns were examined to identify necessary conditions (i.e., always present when outcome present, but alone do not guarantee outcome) and sufficient conditions (i.e., presence guarantees outcome) at sites with larger and smaller outcomes. A thematic analysis of site interview data supplemented QCA findings.

Results

No two sites shared the same condition pattern. Necessary conditions included the use of a standard curriculum and group care-delivery format, and they were present at all sites with larger outcomes but at only six sites with smaller outcomes. At the 17 sites with both necessary conditions, four combinations of conditions were identified that accounted for all sites with larger outcomes. These included high program complexity combined with high staff involvement; group care-delivery format combined with low accountability to facility leadership; an active physician champion combined with low accountability to facility leadership; and the use of quality-improvement strategies combined with not using a waiting list.

Conclusions

The use of a standard curriculum delivered with a group care-delivery format is an essential feature of successful VHA facility MOVE! Weight Management Programs, but alone does not guarantee success. Program development and policy will be used to ensure dissemination of the best practices identified in this evaluation.