A nutrition and lifestyle-focused shared medical appointment in a resource-challenged community setting: a mixed-methods study
Open accessAbstract
Background: In order to address disparities in preventable chronic diseases, we adapted a nutrition and lifestyle-focused shared medical appointment (SMA) program to be delivered in an underserved community setting. The objective was to evaluate a community-based nutrition and lifestyle-focused SMA as it relates to acceptability and health and behavior-related outcomes. Methods: A mixed-methods study was performed to evaluate pre-post changes in wellness indices, biometrics, self-efficacy, and trust in medical researchers as part of a community-based SMA. To understand program acceptability including barriers and facilitators for implementation and scalability, we conducted two participant focus groups and five stakeholder interviews and used content analysis to determine major themes. Results: Fifteen participants attended 10 weekly sessions. The majority were older adult, African American women. There were pre-post improvements in mean [SD] systolic (-10.5 [7.7] mmHg, p = 0.0001) and diastolic (-4.7 [6.7] mmHg, p = 0.17) blood pressures and weight (-5.7 [6.3] pounds, p = 0.003) at 3 months though these were not significant at 6 months. More individuals reported improvements in health status, daily fruit and vegetable intake, and sleep than at baseline. There were no significant pre-post changes in other wellness indices, self-efficacy, trust in medical researchers, hemoglobin A1c, insulin, or LDL cholesterol. Participants discussed positive health changes as a result of the SMA program, program preferences, and facilitators and barriers to continuing program recommendations in focus groups. SMA implementation was facilitated by clinical staff who adjusted content to a low health literacy group and partnership with a trusted community partner. Sustainability barriers include heavy personnel time and in-kind resources to deliver the program. Conclusions: Nutrition and lifestyle-focused SMAs in a resource-challenged community setting may be an acceptable intervention for underserved patients.
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Compared with conventional visits, GMVs have demonstrated improved sleep.
“Compared to conventional visits, GMVs have demonstrated improved dietary habits, improved sleep, greater patient satisfaction, better glycemic and blood pressure control among individuals with diabetes mellitus, modest but significant weight reduction improvement, particularly in females and older adults, and reduced healthcare costs [207, 208, 209, 210].”
From Nutritional priorities to support <scp>GLP</scp> ‐1 therapy for obesity: A joint Advisory from the American College of Lifestyle Medicine, the American Society for Nutrition, the Obesity Medicine Association, and The Obesity Society (2025) · cites this paper as [208]
The Results (Quantitative outcomes; page unavailable) report that more participants slept at least seven hours per night after the program, but the change was not statistically significant. The Discussion (page unavailable) states that the study had no control group, so it cannot support the claimed comparison with conventional visits. (LLM, conf=0.90)
Experimental — accuracy not yet measuredCompared with conventional visits, GMVs have demonstrated reduced healthcare costs.
“Compared to conventional visits, GMVs have demonstrated improved dietary habits, improved sleep, greater patient satisfaction, better glycemic and blood pressure control among individuals with diabetes mellitus, modest but significant weight reduction improvement, particularly in females and older adults, and reduced healthcare costs [207, 208, 209, 210].”
From Nutritional priorities to support <scp>GLP</scp> ‐1 therapy for obesity: A joint Advisory from the American College of Lifestyle Medicine, the American Society for Nutrition, the Obesity Medicine Association, and The Obesity Society (2025) · cites this paper as [208]
The Background describes shared medical appointments as cost-effective healthcare delivery, which supports the general cost claim. It does not establish that they reduce healthcare costs compared with conventional visits. The Discussion also says it is unknown whether this study’s program is cost-effective in low-income settings. (LLM, conf=0.86)
Experimental — accuracy not yet measuredCompared with conventional visits, GMVs have demonstrated improved dietary habits.
“Compared to conventional visits, GMVs have demonstrated improved dietary habits, improved sleep, greater patient satisfaction, better glycemic and blood pressure control among individuals with diabetes mellitus, modest but significant weight reduction improvement, particularly in females and older adults, and reduced healthcare costs [207, 208, 209, 210].”
From Nutritional priorities to support <scp>GLP</scp> ‐1 therapy for obesity: A joint Advisory from the American College of Lifestyle Medicine, the American Society for Nutrition, the Obesity Medicine Association, and The Obesity Society (2025) · cites this paper as [208]
The Results (Qualitative outcomes; page not provided) report participants’ increased water intake and more mindful eating after the shared medical appointment program. But the Discussion states that this was a pre-post study with no control group, so it cannot establish better dietary habits than conventional visits. (LLM, conf=0.88)
Experimental — accuracy not yet measuredCompared with conventional visits, GMVs have demonstrated better glycemic and blood pressure control among individuals with diabetes mellitus.
“Compared to conventional visits, GMVs have demonstrated improved dietary habits, improved sleep, greater patient satisfaction, better glycemic and blood pressure control among individuals with diabetes mellitus, modest but significant weight reduction improvement, particularly in females and older adults, and reduced healthcare costs [207, 208, 209, 210].”
From Nutritional priorities to support <scp>GLP</scp> ‐1 therapy for obesity: A joint Advisory from the American College of Lifestyle Medicine, the American Society for Nutrition, the Obesity Medicine Association, and The Obesity Society (2025) · cites this paper as [208]
The Results > Quantitative outcomes report lower blood pressure after the shared medical appointment program, but no significant improvement in HbA1c. The study reports pre-post changes, not a comparison with conventional visits, and does not establish these outcomes specifically among people with diabetes. (LLM, conf=0.88)
Experimental — accuracy not yet measuredCompared with conventional visits, GMVs have demonstrated modest but significant weight reduction improvement, particularly in females and older adults.
“Compared to conventional visits, GMVs have demonstrated improved dietary habits, improved sleep, greater patient satisfaction, better glycemic and blood pressure control among individuals with diabetes mellitus, modest but significant weight reduction improvement, particularly in females and older adults, and reduced healthcare costs [207, 208, 209, 210].”
From Nutritional priorities to support <scp>GLP</scp> ‐1 therapy for obesity: A joint Advisory from the American College of Lifestyle Medicine, the American Society for Nutrition, the Obesity Medicine Association, and The Obesity Society (2025) · cites this paper as [208]
The Results (Quantitative outcomes; page unavailable) report a modest, statistically significant 5.7-pound weight reduction at three months, but not at six months. The Abstract (Results; page unavailable) says most participants were older women; it does not show greater weight loss specifically among women or older adults. The study reports pre-post changes, not a comparison with conventional visits. (LLM, conf=0.88)
Experimental — accuracy not yet measured
Compared with conventional visits, GMVs have demonstrated greater patient satisfaction.
“Compared to conventional visits, GMVs have demonstrated improved dietary habits, improved sleep, greater patient satisfaction, better glycemic and blood pressure control among individuals with diabetes mellitus, modest but significant weight reduction improvement, particularly in females and older adults, and reduced healthcare costs [207, 208, 209, 210].”
From Nutritional priorities to support <scp>GLP</scp> ‐1 therapy for obesity: A joint Advisory from the American College of Lifestyle Medicine, the American Society for Nutrition, the Obesity Medicine Association, and The Obesity Society (2025) · cites this paper as [208]
In Results > Qualitative outcomes, participants expressed appreciation for the group appointment and some contrasted its explanations with their usual medical care. But the Discussion states that the study had no control group, so it does not establish greater patient satisfaction than conventional visits. Our copy provides no page numbers for these passages. (LLM, conf=0.86)
Experimental — accuracy not yet measured
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- Authors
- Bharmal, N., Beidelschies, M., Alejandro-Rodriguez, M., Alejandro, K., Guo, N., Jones, T., & Bradley, E.
- Affiliations
- Cleveland Clinic (US)
- Corresponding author
- Bharmal, Nazleen
- Venue
- BMC Public Health
- Published
- 2022-03-07
- Volume
- 22
- Issue
- 1
- Pages
- 447-447
- ISSN
- 1471-2458 (ISSN-L)
- PMC
- PMC8900391
- OpenAlex
- W4220677629
- Cited by
- 14
- References
- 27
- Citations by year
- 2026: 3 · 2025: 6 · 2024: 1 · 2023: 2 · 2022: 2
- FWCI
- 3.16
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- BMC Public Health (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
- Health Sciences › Medicine › Epidemiology › Chronic Disease Management Strategies
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
- Keywords
- shared medical appointments, nutrition education, lifestyle intervention, community health programs, underserved populations, African American women, older adults, blood pressure reduction, weight loss, fruit and vegetable intake, sleep, self-efficacy, health disparities, chronic disease prevention, implementation barriers and facilitators, program acceptability, low health literacy
- MeSH terms
- Shared Medical Appointments, Aged, Chronic Disease, Female, Glycated Hemoglobin, Humans, Life Style, Nutritional Status
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