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Purpose: To investigate (1) why some participants in a workplace weight management program were more engaged in the program, (2) specific barriers and facilitators for engagement and weight loss, and (3) suggest how workplaces may better engage employees in these programs to improve their effectiveness. Design: Qualitative study (8 focus groups). Setting: A large academic university and medical system. Participants: Twenty-six (5%) of the 550 employees who participated in a weight management program as part of the Steps to Health study. Measures: A trained moderator guided the audio-recorded focus groups. Analysis: Transcripts were analyzed using the directed content analysis approach. Results: Participants faced numerous barriers to engagement in workplace weight management programs, both within and outside the workplace. Participants viewed the coaches positively and reported that the coaches had a strong influence on their engagement in the program. Participants suggested increased frequency and variety of contact by coaches, on-site group exercise classes, and tailored educational materials. Conclusion: Workplace weight management programs may be improved by being more flexible around participants' schedules and changing needs, by increasing access to affordable, convenient exercise facilities, and by implementing institutional changes that encourage healthy eating and physical activity during the workday. Employers should measure program engagement and solicit participant feedback to ensure that the programs are appropriate and delivered in an optimal manner.

Purpose. Physicians are expected to discuss weight loss with overweight and obese patients. Physicians' beliefs, outcome expectancies, and strategies for addressing weight with patients have not been examined. Design. Two focus groups of family physicians and internists included questions about obesity and how physicians discuss weight loss with patients. Setting/Subjects. Family physicians (n = 11) and internists (n = 6) from Duke University Medical Center's Department of Community and Family Medicine and Department of Medicine. Analysis. Qualitative analysis approach using grounded theory methodology. Results. Physicians' responses centered on five key themes: (1) responsibility, (2) barriers, (3) target populations, (4) introducing topic, and (5) ways to talk about obesity. Conclusion. Physicians have many barriers related to discussing weight loss with patients. Given the obesity epidemic, the need to understand how to have these discussions, when to have these discussions, and with whom to have these discussions becomes paramount to providing effective care for patients with obesity. Limited physician training in weight-loss counseling explains why physicians find it challenging to discuss obesity with patients.

Purpose. Although social support has been linked to smoking cessation, no studies have examined whether social support predicts women's late pregnancy cessation. Further, few have included reports from both support recipients and providers. Design. Longitudinal. Subjects. Pregnant couples (n = 394) reported support for cessation in early (13–20 weeks) and late (28 weeks) pregnancy. Measures. Different measures of couples' support were tested for predicting women's late pregnancy cessation. Measures of couples' support that were calculated included: summative (added women's and male partners' support scores, possible range 2–10), difference (subtracted the lower score from the higher, possible range 0–4), strong link (used higher positive or lower negative score, possible range 1–5), weak link (lower positive or higher negative score, possible range 1–5), and female and male reports alone (possible ranges 1–5). Covariate-adjusted odds ratios for the association of these various measures of couples' support with women's late pregnancy cessation were calculated. Results. Of the 12 scores (6 positive, 6 negative), only summative (p = .03) and weak link (p = .05) for positive support predicted women's quitting. Conclusion. Neither women's nor male partners' reports alone predicted women's cessation; only when both scores were considered, either by adding the scores or by taking the lower score, was the positive support score predictive. Future studies of social support should include support recipients' and providers' perspectives.

Background: Hypertension and related complications are major contributors to morbidity and mortality in Nepal. Community health workers have been proposed as promising health cadres to meet the growing healthcare demand for non-communicable disease management in other developing countries.Objective: We aimed to explore existing workflows, needs and challenges for hypertension care coordination and to assess the feasibility of establishing a Female Community Health Volunteer (FCHV)-based hypertension management program in Kavre, Nepal.Design: We conducted one focus group discussion with eight FCHVs and twenty-three in-depth interviews with four FCHVs not attending FGD, nine individuals with hypertension, six health workers, and four health officials in two village development committees of Kavre District, Nepal. Applied thematic analysis was performed using NVivo 12.Results: Health literacy related to hypertension was low among both community members and FCHVs. Delay in treatment initiation and loss to follow-up were common patterns despite anti-hypertensive medication compliance. Major health system-related barriers included underutilization of primary healthcare institutions, communication gaps and lack of grass-roots level educational campaigns. Community pharmacies, monthly health camps and increasing governmental attention to NCDs were favorable for improving hypertension management. This study also supports that FCHVs should be provided with adequate training and financial incentives to promote hypertension education, screening and referral in their catchments.Conclusions: Barriers and facilitators identified in this study provide important implications for future hypertension management in Nepal. We recommend hypertension education and screening across Nepal at a grass-root level through FCHVs. Providing professional training and proper financial incentives for FCHVs are warranted.Highlights:Health literacy related to hypertension was low among both community members and Female Community Health Volunteers in Nepal.Delay in treatment initiation and loss to follow-up were common despite relatively high anti-hypertensive medication compliance.Health system-related barriers in research sites included underutilization of primary healthcare institutions, communication gaps, and lack of grass-roots level educational campaigns.Female Community Health Volunteers should be provided with adequate training and financial incentives to promote hypertension management.