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Community-based behavioral and exercise interventions with in-person delivery models were challenged to find a new mode of delivery during the COVID-19 pandemic when access to in-person activities were compromised. These interventions are an essential part of chronic disease patients’ self-management and health promotion efforts. One particularly prevalent chronic disease, knee osteoarthritis (knee OA), is the leading cause of functional decline in older adults and finding a safe way to deliver the intervention during the COVID-19 pandemic provided an opportunity to explore the feasibility, enablers, and barriers to virtual intervention delivery in this population. Access to community-based intervention settings for patients with knee OA remain limited even though it is well known that exercise combined with weight loss via dietary changes can provide clinically significant improvements to a patient’s overall quality of life (QOL). While these meaningful results are well established, further investigation into the delivery of these interventions through online platforms and understanding the patients’ perspective is still needed. By qualitatively capturing the experiences from patients who participated in the Collaborative Lifestyle Intervention Program for Knee Osteoarthritis Patients (CLIP-OA), further understanding can be explored about the feasibility and efficacy of this program to be delivered virtually via a video conferencing platform, such as Zoom, versus the established utility of in-person delivery. An especially important outcome to understand is the intervention’s ability to educate patients in the application of knowledge and skills from the program and gather information about the patient’s confidence to independently maintain the exercise and dietary behavior changes following cessation of the active intervention contacts. As, the pandemic disruption forced both a pause in in-person research activities and subsequent shift to alternate patient contacts, exploring patient perspectives on the enablers and barriers to virtual intervention delivery will expand knowledge of the factors critical to develop and refine this mode of delivery for lifestyle interventions and provide a unique opportunity to capture the experiences of those who lived through the COVID-19 pandemic during the CLIP-OA intervention.Objective: The primary objective of the proposed study is to investigate how effectively the patients are learning, applying, and adhering to their learned skills and knowledge to their daily lives through the completely virtual mode of delivery. The second objective is to understand the enablers and barriers the intervention through this mode of delivery, and specifically with barriers, to understand the novel situation of the pandemic restrictions, and how they may have affected the desired outcomes. Methods: This qualitative study used a mailed, paper survey along with individual and focus group semi-structured interviews. A total of 7 patients were provided with the paper-delivered survey and the opportunity to complete the interviews. A total of 6 patients and 1 community-based instructor agreed to complete the individual semi-structured interviews followed by 4 patients agreeing to complete the patient focus groups.Results: 9 semi-structured interviews were completed. Individual semi-structured interviews were completed by 6 of 7 participants (85.7%), and the one instructor. 4 of the 6 participants (66.7%) who completed the individual interviews continued with the second interview to complete 1 of 2 patient-only, focus group interviews with 2 participants randomized into each group. The mean duration of the individual interviews was 89.43 minutes, and the mean duration of the patient-only focus groups was 101.50 minutes. A thematic analysis showed 7 domains with 13 main themes between them.-Intervention Knowledge and Skills (1a) Self-Regulatory Skills; 2a) Nutrition Guidelines and Skills; 3a) Accumulating Physical Activity; and 4a) Understanding Maintenance).-Intervention Enablers (1b) Intervention Enablers).-Intervention Barriers (1c) Intervention Barriers).-Intervention Perceptions (1d) Enrollment Leads and Interests; 2d) Intervention Overall; 3d) Instruction; and 4d) Group Dynamics).-Intervention Accessibility (1e) Online Accessibility).-Personal Issues and Barriers (Non-Intervention Related) (1f) Personal Issues and Barriers (Non-Intervention Related)).-Pandemic Perceptions (1g) Pandemic Perceptions).Conclusion: The qualitative evaluation of knee OA patients’ perspectives of the enablers and barriers to virtual-delivery of the CLIP-OA lifestyle weight management intervention provided novel data that can advance understanding of how the GMCB model can be applied using the virtual delivery method of videoconferencing within this chronic disease population. These findings can help inform a more accessible, future virtual and/or hybrid approaches to deliver this efficacious weight management intervention and contribute to making it potentially more accessible and cost-effective. Consequently, the findings from this investigation represent an important advance toward efficiently reaching a wider range of the knee OA population with a pressing need for improved access to effective exercise and weight management interventions.

Protecting public health has been an underlying goal of planning since its origin, and planners play a crucial role in creating healthy, sustainable communities by advancing policies that encourage active living and healthy eating. One health issue that has consistently interested planners is obesity. In order to reduce obesity and make our communities healthy, it is necessary to know which factors influence obesity and how planners can have a positive impact on them. There are various social, physical, and behavioral factors (also known as determinants) that affect health. In addition to individual characteristics such as race, income, educational attainment, gender, and age, neighborhood characteristics such as access to healthy food, access to parks, built environment, perceived safety, and social support have also been found to influence health. The primary purpose of this dissertation is to analyze the association between such determinants of health and obesity in Hamilton County, Ohio. Since planners can have a significant impact on the physical environment of a neighborhood, another purpose of this research is to find out if changing the physical environment can change the behavior of people enough to influence health.This work improves on the previous studies as it employs sophisticated and innovative spatial and quantitative analysis to analyze interactions between obesity and its determinants. This study uses three main types of data – qualitative survey data, quantitative data, and spatial data created using Geographical Information System (GIS). After comparing various methodologies and based on the characteristics of the data, log-level regression analysis was used to analyze the weighted data. The raw data was weighted to make it more representative of the Hamilton County population.The results of this research provide an evidence base for directing future planning policy decisions and implementation strategies at local and regional levels. The results are consistent with much of the recent literature analyzing the relationships between obesity and its determinants. As expected, physical activity habits and eating behavior have a strong association with obesity. Similarly, the results show that individual income and race influence obesity, with the regression model suggesting that higher income and White individuals have lower obesity than low-income and Black individuals respectively. However, contrary to the expectations, none of the built environment variables, which were the key variables of interest, had any significant impact on obesity. The results also illustrate that the built environment does not change the individual behavior enough to have any significant impact on health.This study demonstrates that only changing the built environment may not be enough to reduce obesity, and planners should go beyond the physical domain and focus on influencing social and behavioral factors that may be critical in reducing health disparities and achieving health equity.