Date of Award


Degree Name

Doctor of Philosophy


Public Health


Leah D. Whigham

Second Advisor

Craig A. Field


The demand for obesity treatment and management cannot be met because of the lack of obesity specialists. Therefore, integrating obesity management tools in primary care is an excellent option for obesity treatment. Also, the importance of DPP as a scalable community-based program and that Small Changes provides a structured dietary approach that we hypothesize will improve weight loss outcomes. These two studies evaluated the implementation of obesity management tools in primary care clinics in the Paso del Norte area and a DPP program in Brownsville, TX. The first study explored the key facilitators and barriers to adopting the CDSS and Small Changes in two primary care facilities in the Paso del Norte region. The key findings from interviews with PCPs included: CDSS was comprehensive, easy to use, and increased self-efficacy with overall obesity treatment. The key findings from interviews with patients included: patients appreciated both the compassion and accountability from their PCP and found Small Changes easy to use and helpful in their weight loss efforts. Additionally, 62.5% of patients lost 5% of their body weight, and 31.25% lost 10% of their body weight. The second study explored the key facilitators and barriers to adopting Small Changes in a community lead DPP program. Interviews with coaches and participants key findings from the interviews were: coaches expressed the need for additional training with Small Changes and perceived conflicting dietary guidelines between DPP and Small Changes. The most prevalent barriers to participants' use of Small Changes were technological, but the program was well-liked for those who did not experience technology barriers. Also, 40% of active participants lost 5% body weight at six months, and 20% lost 7% of their body weight at six months. Lessons learned from these implementation research projects are very valuable as guides for the next steps, helping us to understand how to use technology more effectively to enhance the delivery of weight loss support in both clinical and community settings in a scalable way.




Recieved from ProQuest

File Size


File Format


Rights Holder

Hunter Wayne Turnipseed