Table 4.
Program adaptations using the FRAME model.
| Adaptation | Description | When? | Program year | Whose need was addressed? | Why was the adaptation made? |
|---|---|---|---|---|---|
| Encourage patient communication outside of the program sooner | Rather than waiting until the end of the program to encourage patients to connect with one another outside of the program, patients are now prompted during session 3 | 2023 | 3 | Patients | Early establishment of an accountability partner and support system to encourage lasting lifestyle change |
| Change program structure | The program structure changed from 4 sessions weekly, 4 sessions every 2 weeks, 4 sessions every 3 weeks, and 4 sessions monthly to 12 sessions weekly. | 2022 | 3 | Patients, Department Administration | Improve attendance |
| Changing reminder method | No longer using email as a reminder method, relying primarily on MyChart messages, text messages and phone calls | 2022 | 3 | Patients, Health Coach/Facilitator | Improve attendance and participation, improve workflow efficiency |
| Changing session times | Removal of 8 a.m. and 4 p.m. sessions in response to attendance data providing insight into optimal session times (see Table 3) | 2022 | 3 | Health Coach/Facilitator | Improve attendance and participation, choose times with better attendance |
| Modified intake visit | Changed intake from 1, hour-long visit to 3, 30-min visits | 2022 | 3 | Physician, Department Administration, | If a patient cancels, only one appointment slot is lost; this gives patients other opportunities to meet with a physician before starting the program and enhances recruitment |
| Expansion of relapse sessions | Information added about Lapse vs. Relapse, addition of slides involving addiction and movement toward recovery | 2021 | 2 | Patients, Health Coach/Facilitator | Improve mental health and motivation |
| Adding information on weight stigma | Information added to better address the weight stigma, to improve patient/participant self-compassion | 2021 | 2 | Patients | Improve motivation, Improve patient self-love |
| Leisure activity moved ahead of physical activity | Leisure activity moved before physical activity to highlight enjoyable forms of movement | 2021 | 2 | Patients | Improve fit of content to patient/participant goals in response to a desire for more and earlier physical activity information |
| Added positive psychology | Added positive psychology pillars like the PERMA (Positive emotion, Engagement, Relationships, Meaning, Accomplishments) model of wellbeing | 2021 | 2 | Patients, Health Coach/Facilitator | Encourage focus on connection, gratitude, and living a meaningful life |
| Moved session on strengths | Moved the session on Strengths earlier in the curriculum | 2021 | 2 | Patients, Health Coach/Facilitator | Encourage strengths-based thinking at the beginning of the program |
| Recommend patients communicate outside of the program | Assigning patient team leaders and maintaining communication through Text/WhatsApp, an effort to improve patient support through communication | 2021 | 2 | Patients | Improve attendance and participation; improve mental health and motivation; improve program comradery |