Medical Student-Created Community Health Initiative Wraps Up Pilot Phase

Healthier Together: A Group-Based Approach to Weight Management and Lifestyle Change, created by two second-year M.D./M.P.H. students in the NextGenMD program at the University of Miami Miller School of Medicine, recently graduated its first cohort of participants.

From left, Lauren Hucko and Margaret Koester
From left, Lauren Hucko and Margaret Koester

The students, Lauren Hucko and Margaret Koester, now plan an array of enhanced features to grow the program, make it more accessible, and optimize outcomes.

Hucko and Koester were initially approached with the idea for a cohort-based educational program to promote positive lifestyle change for low-income adults by Shirin Shafazand, M.D., M.S., professor of medicine and director of the M.D./M.P.H. program. Dr. Shafazand envisioned a longitudinal program encompassing various aspects of nutritional health and behavior change. It was a challenge both students quickly embraced.

“At the beginning of our first year of medical school, Lauren and I connected over our shared interests in nutrition and activity education, community health, and health literacy,” Koester said. “As Dr. Shafazand’s concept aligned so closely with our interests, we didn’t take much convincing.”

Building on Best Practices

Hucko and Koester began with a literature review in December 2020, analyzing public health best practices that would inform the project. The following spring, each received a $2,000 Population Health Scholar Award grant, which helped defray project costs.

As the initiative got under way, Hucko and Koester worked closely with Jackson Health System’s Population Health Department and Jessie Trice Community Health System to recruit and screen potential participants. The first cohort of six was assembled in June 2021.

“We realized early on that, to build the caliber of program we desired, we had to treat this first year as a pilot,” Hucko said. “So we focused on how we could begin on a small scale and make improvements from week to week that were realistic, efficient, and conducive to achieving the program’s goals.”

The initial six-member cohort, varying in gender and in age from 20 to the mid-50s, shared a desire to lose weight, increase nutrition knowledge, and gain confidence and support from a group-based program. For two months, participants took part in weekly group activities, educational sessions, team-building, goal-setting, and reflection, all held at the Miller School free of charge. Participants will then be followed on a monthly basis for one year, with measurement and analysis of combined qualitative and quantitative outcomes such as BMI, blood pressure, and self-efficacy.

“What makes Healthier Together different from traditional dietary counseling is its group-based aspect,” Koester said. “The participants’ ongoing dialogue across the weekly meetings allows them to share strategies that have worked for them in the past, which others may adopt into their daily habits.

“The program’s longitudinal nature allows for a deeper and more thorough dive into participants’ habits and behaviors, which is an essential component of facilitating substantial lifestyle change.”

“Weight bias is pervasive throughout health care,” Hucko said. “We made every effort to develop a program that successfully addresses weight status while minimizing the discrimination and bias that obese patients have historically faced.”

Seeking Sustainability While Scaling Up

More than a year into Healthier Together, Hucko and Koester are following up with members of the first cohort to see if they were able to improve obesity-related health metrics while making lasting lifestyle changes.

They aim to roughly triple the size of the second group while building on what they learned in the pilot run. They also plan to recruit more Miller School medical students to serve as program lifestyle coaches. The ultimate goal is to make the program sustainable and reproducible, creating a template for Healthier Together programs at other medical schools across the country.

The biggest challenge faced by Healthier Together is the recruitment and retention of participants. Though the program is free to low-income individuals, “Inability to take time off work, the cost of transportation, and child care needs are frequent barriers to involvement,” Hucko said. “The Population Health Scholar grants helped cover some of these costs, but we are now seeking more permanent funding sources.”

Hucko and Koester look forward to providing more incentives and rewards to patients through partnerships with area businesses and clinics, grant funding, and implementation of a more intensive follow-up protocol to ensure that participants feel supported in reaching their goals. They also plan to track outcomes to measure the program’s long-term impact and to identify areas of growth and improvement.

“It has been amazing for us to discover that it is possible to work among organizations, individuals, and experts to develop an adjunctive program to patients’ existing primary care services,” Koester said. “This has been a powerful lesson and productive collaboration – one that both of us will carry into our future careers as physicians.”

If you are a health care provider, business owner, or participant interested in participating in or supporting Healthier Together, contact [email protected].

Tags: Department of Public Health Sciences, Jackson Health System, Jessie Trice Community Health System, Lauren Hucko, Margaret Koester, Miller School of Medicine, NextGenMD, population health