The lack of onsite educational options, and absence of referral resources, prompted faculty from the USC/California Hospital Family Medicine Residency Program to develop the Take Charge class. The course was designed to promote lifestyle change through a group intervention in an overweight, inner-city minority patient population experiencing a variety of lifestyle-influenced chronic diseases. This paper uses a case study to illustrate the health education program.

Methods
The case study was developed by the course instructors with the assistance of an external researcher using quantitative and qualitative assessments. Information was triangulated to increase the validity of findings.

The course was delivered to 13 cohorts of patients. Weights were collected from cohorts 1 and 2 (n= 31) to measure change before and after the eight week course, as well as at three month follow-up intervals, using one-tailed paired t-tests for significance. Evaluation questionnaires measuring individual perceptions of class content were given to cohorts 4, 5, and 6 on the last day of the course (n= 34: 25 Spanish, 9 English). Long-term follow-up phone interviews were also conducted. External interviewers were used to promote honest responses. The follow-up interviews were designed to control for the temporal dimensions of course acceptance and life-style change. Phone interviews were conducted with cohorts 1, 2, 3 and 5 (n= 49). Average time since graduation was 21 months (range = 12-26). Since the course instructors thought there might be an upward bias in graduation-day evaluation responses, the long-term evaluation sample included both graduates and “drop-outs” and analyses compared the responses of each group.

The Lifestyle Change Intervention
The Take Charge course was developed and facilitated by a Family Physician and a doctor of Public Health. The course consisted of 2-hour sessions held on a weekly basis for eight weeks. Courses were conducted separately in English and Spanish.

California Hospital is home to a Family Medicine residency which operates a primary care Family Practice Center (FPC) across the street from the hospital near the garment district of Los Angeles. For the Take Charge class, faculty members outfitted a large conference room at the FPC, normally used for physician education, with large chairs, some cooking equipment, and educational materials.

FPC patients were referred to the class by their primary care providers. As word of the class spread, patients from neighboring community clinics were also referred. To make the classes more accessible for these outside patients, some sessions were conducted offsite. 124 participants were enrolled in 13 cohorts over four years. The average weight of participants was 237 pounds (95% confidence interval=217-258, range=122-503). This population had multiple related co-morbidities, including: hypertension, coronary artery disease, congestive heart failure, hyperlipidemia, diabetes, arthritis, chronic back pain, depression, and hypothyroidism. Other co-morbidities included: anemia, addiction, blindness, chronic obstructive pulmonary disease, glaucoma, lupus, multiple sclerosis, and seizure disorder.

Participants attending six or more of the eight sessions received graduation certificates. Seventy-four participants graduated and were invited to join alumni activities.