Why may patients with spinal cord injury be overlooked for obesity screening in the Veterans Health Administration? Qualitative research of the perspectives of patients and healthcare providers

Abstract

Purpose

We sought to describe factors influencing reduced rates of obesity screening for patients with spinal cord injury (SCI) in the United States Veterans Health Administration (VA) and to foster potential solutions.

Materials and Methods

Semi-structured interviews with healthcare providers and patients with SCI who were recruited nationally from diverse VAs. We performed rapid qualitative analysis using content analysis of interview data.

Results

There were 36 providers and 37 patients. We identified provider, patient, and system level barriers to obesity screening for individuals with SCI. Overarching barriers involved provider and patient perceptions that obesity screening is a low priority compared to other health conditions, and body mass index is of low utility. Other obesity screening barriers were related to measuring weight (i.e., insufficient equipment, unknown wheelchair weight, staffing shortages, measurement errors, reduced access to annual screening, insufficient time, patient preference not to be weighed) and measuring height (i.e., insufficient guidance and equipment to this population, measurement errors).

Conclusions

Barriers to obesity screenings exist for patients with SCI receiving care in VA. Healthcare provider and patient interviews suggest possible solutions, including standardizing height and weight measurement processes, ensuring equipment availability in clinics, clarifying guidelines, and offering support to providers and patients.

IMPLICATIONS FOR REHABILITATION

• Individuals with spinal cord injury (SCI) have higher rates of obesity, but are often overlooked for annual obesity screening, even in clinic settings designed to care for individuals with SCI.

• Results may help tailor guidelines/education for healthcare and rehabilitation providers offering them guidance for improving obesity screening for individuals with SCI by standardizing weight and height measurement and documentation. To facilitate this, findings highlight the need for resources, such as ensuring clinics have necessary equipment, and increasing patient access to support and equipment.

• Improving the provision of obesity screening for individuals with SCI is necessary to improve health outcomes and patient satisfaction with care.

Keywords:

• Spinal cord injuries
• obesity
• veterans
• body mass index
• content analyses
• rapid qualitative analysis
• healthcare providers
• prevention

Acknowledgements

The authors thank the Veterans and VA healthcare providers who participated in this study. We also thank the VA Palo Alto Veteran and Family Advisory Council for their helpful feedback throughout the study.

Prior publication

The authors warrant that the article has not received prior publication and is not under consideration for publication elsewhere.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The datasets generated and/or analyzed during the current study are not available due to participant privacy but may be available from the corresponding author on reasonable request.

Additional information

Funding

This study was supported by Merit Review Award number IIR 17-047 (Eisenberg) and Research Career Scientist Award number RCS14-232 (Harris) from the United States (U.S.) Department of Veterans Affairs, Health Services Research and Development Service. The funding source had no involvement in study design, data collection, analysis or interpretation of data. The contents of this manuscript do not necessarily represent the views of the Veterans Health Administration or the United States Government.