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Sweeney AM, Wilson DK, Zarrett N, Simmons T, Mansfield M, Decker L. Using formative process evaluation to improve program implementation and accessibility of competitive group-based physical activity in the TEAM-PA trial. Int J Behav Nutr Phys Act 2024; 21:88. [PMID: 39138496 PMCID: PMC11321224 DOI: 10.1186/s12966-024-01635-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 07/23/2024] [Indexed: 08/15/2024] Open
Abstract
BACKGROUND This study demonstrates how formative process evaluation was used to assess implementation and improve dose and fidelity in the Together Everyone Achieves More Physical Activity (TEAM-PA) randomized controlled trial. TEAM-PA uses a randomized group cohort design to evaluate the efficacy of a group-based intervention for increasing physical activity among African American women. METHODS Intervention groups met for 10 weeks and were co-led by female African American facilitators, with intervention sessions consisting of group feedback, a health curriculum, group-based physical activity games, and group-based goal-setting. Drawing from a multi-theoretical framework, the intervention targeted social affiliation using collaborative and competitive group strategies, including essential elements focused on group-based behavioral skills, peer-to-peer positive communication, collectivism, optimal challenge, social facilitation, and peer to peer challenges. Formative process evaluation was used to monitor reach, dose, and fidelity, and implement feedback and solutions. RESULTS Across two cohorts, four groups (n = 54) were randomized to the TEAM-PA intervention. On average 84.8% of participants attended each week, which exceeded the a priori criteria. Results from the systematic observations indicated that on average 93% of the dose items were completed in each session and adequate levels of fidelity were achieved at both the facilitator and group-levels. Participants were compliant with wearing the FitBits (6.73 ± 0.42 days/week) and most participants successfully contributed to meeting the group-based goals. The use of open-ended items also revealed the need for additional modifications to the group-based PA games, including allowing for individuals to take breaks, incorporating a broader range of exercises, minimizing activities that required bending/reaching down without assistance, and providing facilitators with additional training for implementing the games. Initial evidence suggests that these changes were successful in increasing participants' comprehension of the games from Cohort 1 (M = 1.83, SD = 0.71) to Cohort 2 (M = 3.33, SD = 0.69). CONCLUSION Findings from this study demonstrated high levels of reach, dose, and fidelity, while also highlighting strategies for implementing competitive group-based PA games that are accessible across physical fitness levels. Formative process evaluation, including open-ended items and collaborative brainstorming, holds tremendous potential for improving future interventions. TRIAL REGISTRATION This study was registered on Clinicaltrials.gov (# NCT05519696) on August 22, 2022 prior to the enrollment of the first participant on September 12, 2022 ( https://clinicaltrials.gov/study/NCT05519696?term=NCT05519696&rank=1 ).
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Affiliation(s)
- Allison M Sweeney
- Department of Biobehavioral Health and Nursing Science, College of Nursing, University of South Carolina, 1601 Greene Street, Columbia, SC, 29201, USA.
| | - Dawn K Wilson
- Department of Psychology, University of South Carolina, Columbia, SC, 29201, USA
| | - Nicole Zarrett
- Department of Psychology, University of South Carolina, Columbia, SC, 29201, USA
| | - Timothy Simmons
- Department of Psychology, University of South Carolina, Columbia, SC, 29201, USA
| | - Makayla Mansfield
- Department of Biobehavioral Health and Nursing Science, College of Nursing, University of South Carolina, 1601 Greene Street, Columbia, SC, 29201, USA
| | - Lindsay Decker
- Department of Biobehavioral Health and Nursing Science, College of Nursing, University of South Carolina, 1601 Greene Street, Columbia, SC, 29201, USA
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Sweeney AM, Wilson DK, Van Horn ML, Zarrett N, Resnicow K, Brown A, Quattlebaum M, Gadson B. Results from "Developing Real Incentives and Volition for Exercise" (DRIVE): A pilot randomized controlled trial for promoting physical activity in African American women. J Consult Clin Psychol 2022; 90:747-759. [PMID: 35834196 PMCID: PMC9669192 DOI: 10.1037/ccp0000740] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Motivation is a barrier to physical activity (PA) among African American (AA) women, but past studies have implemented a "one-size-fits-all" approach and have not addressed differences in autonomous motivation. This pilot randomized controlled trial assessed the preliminary efficacy of "Developing Real Incentives and Volition for Exercise," a community- and theory-based intervention, which evaluated whether a motivationally matched (vs. a nonmatched) intervention increases daily total PA. METHOD In total, 68 AA women (50.72 ± 13.66 years; 86.8% with obesity) were randomized to an 8-week challenge-focused program (targeted toward high autonomous motivation) or rewards-focused program (targeted toward low autonomous motivation). Randomization was stratified by baseline autonomous motivation. FitBits were used during the intervention to promote self-monitoring (both programs) and social connectedness (challenge program only). RESULTS Both programs retained ≥ 80% of participants. Process evaluation revealed high attendance, dose, and fidelity (both programs). However, contrary to expectations, across all motivational levels (low and high autonomous), the challenge-focused intervention resulted in a greater increase in total daily PA (primary outcome), with an average increase of 17.9 min in the challenge-focused intervention versus an average decrease of 8.55 min in the rewards-focused intervention. An exploratory follow-up analysis revealed that engagement with the FitBit mobile app predicted greater PA at postintervention in the challenge-focused program. CONCLUSIONS A team-based approach targeting social connectedness, enjoyment of PA, and positive intragroup competition is a promising approach for promoting PA among AA women. These findings are used to guide a discussion on best practices for engaging AA women in future behavioral interventions. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
| | - Dawn K Wilson
- Department of Psychology, University of South Carolina
| | - M Lee Van Horn
- Department of Education Psychology, University of New Mexico
| | | | - Kenneth Resnicow
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan
| | - Asia Brown
- Department of Psychology, University of South Carolina
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Sun Y, Ji P, Wang Y, Fan H. The Association Between the Subjective Exercise Experience of Chinese Women Participating in Square Dance and Group Cohesion: The Mediating Effect of Income. Front Psychol 2021; 12:700408. [PMID: 34712166 PMCID: PMC8546298 DOI: 10.3389/fpsyg.2021.700408] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 09/07/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Chinese square dance has become well known worldwide in recent years, and most participants are women who dance with a group in their communities. In particular, middle-aged women may have physical and mental health problems, and participating in square dance may increase women's positive subjective well-being and decrease their negative emotions, which may improve their health over the long term. In addition, participating in square dance can promote group cohesion. Our study aimed to examine the relationship between the subjective exercise experience of participating in square dance and group cohesion and whether some variables (e.g., age, education, duration, income level, and work) play a role as mediators in the association with subjective exercise experience and group cohesion. Methods: In total, 1,468 Chinese women from 31 provinces and 82 cities participated in this study by completing an online questionnaire. The questionnaire consisted of a subjective exercise experience questionnaire and a group environment questionnaire. We analyzed the collected data and built a statistical model. Results: (a) Square dance satisfied women's physical and psychological needs partly; (b) positive well-being (PWB) was positively correlated with group cohesion, and fatigue was negatively correlated with group cohesion; and (c) the income level was a partial mediator of the relationship between group cohesion and subjective exercise experience. Conclusion: Chinese women have different motivations for participating in square dance. Because this activity can help meet women's physical and psychological needs, an increasing number of individuals worldwide participate in square dance. As women's subjective well-being increases, group cohesion increases, and vice versa. Moreover, the subjective exercise experience remains a significant predictor of group cohesion after including income level as a mediator, suggesting that the model indicates partial mediation.
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Affiliation(s)
- Yuting Sun
- School of Art, Beijing Sport University, Beijing, China
| | - Peiyao Ji
- School of Psychology, Beijing Sport University, Beijing, China
| | - Yan Wang
- School of Art, Beijing Sport University, Beijing, China
| | - Hongying Fan
- School of Psychology, Beijing Sport University, Beijing, China
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Sokol R, Albanese M, Chew A, Early J, Grossman E, Roll D, Sawin G, Wu DJ, Schuman-Olivier Z. Building a Group-Based Opioid Treatment (GBOT) blueprint: a qualitative study delineating GBOT implementation. Addict Sci Clin Pract 2019; 14:47. [PMID: 31882001 PMCID: PMC6935085 DOI: 10.1186/s13722-019-0176-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 12/11/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Group-Based Opioid Treatment (GBOT) has recently emerged as a mechanism for treating patients with opioid use disorder (OUD) in the outpatient setting. However, the more practical "how to" components of successfully delivering GBOT has received little attention in the medical literature, potentially limiting its widespread implementation and utilization. Building on a previous case series, this paper delineates the key components to implementing GBOT by asking: (a) What are the core components to GBOT implementation, and how are they defined? (b) What are the malleable components to GBOT implementation, and what conceptual framework should providers use in determining how to apply these components for effective delivery in their unique clinical environment? METHODS To create a blueprint delineating GBOT implementation, we integrated findings from a previously conducted and separately published systematic review of existing GBOT studies, conducted additional literature review, reviewed best practice recommendations and policies related to GBOT and organizational frameworks for implementing health systems change. We triangulated this data with a qualitative thematic analysis from 5 individual interviews and 2 focus groups representing leaders from 5 different GBOT programs across our institution to identify the key components to GBOT implementation, distinguish "core" and "malleable" components, and provide a conceptual framework for considering various options for implementing the malleable components. RESULTS We identified 6 core components to GBOT implementation that optimize clinical outcomes, comply with mandatory policies and regulations, ensure patient and staff safety, and promote sustainability in delivery. These included consistent group expectations, team-based approach to care, safe and confidential space, billing compliance, regular monitoring, and regular patient participation. We identified 14 malleable components and developed a novel conceptual framework that providers can apply when deciding how to employ each malleable component that considers empirical, theoretical and practical dimensions. CONCLUSION While further research on the effectiveness of GBOT and its individual implementation components is needed, the blueprint outlined here provides an initial framework to help office-based opioid treatment sites implement a successful GBOT approach and hence potentially serve as future study sites to establish efficacy of the model. This blueprint can also be used to continuously monitor how components of GBOT influence treatment outcomes, providing an empirical framework for the ongoing process of refining implementation strategies.
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Affiliation(s)
- Randi Sokol
- Malden Family Medicine Center, 195 Canal St, Malden, MA 02148 USA
| | - Mark Albanese
- Outpatient Addiction Services, 26 Central St, Somerville, MA 02143 USA
| | - Aaronson Chew
- Malden Family Medicine Center, 195 Canal St, Malden, MA 02148 USA
| | - Jessica Early
- Malden Family Medicine Center, 195 Canal St, Malden, MA 02148 USA
| | - Ellie Grossman
- Somerville Hospital Primary Care, 236 Highland Avenue, Somerville, MA 02143 USA
| | - David Roll
- Revere Care Center, 454 Broadway, Revere, MA 02151 USA
| | - Greg Sawin
- Malden Family Medicine Center, 195 Canal St, Malden, MA 02148 USA
| | - Dominic J. Wu
- Malden Family Medicine Center, 195 Canal St, Malden, MA 02148 USA
| | - Zev Schuman-Olivier
- Center for Mindfulness and Compassion, 1035 Cambridge Street, Suite 21, Cambridge, MA 02141 USA
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McQueen A, Caburnay C, Kreuter M, Sefko J. Improving Adherence to Colorectal Cancer Screening: A Randomized Intervention to Compare Screener vs. Survivor Narratives. JOURNAL OF HEALTH COMMUNICATION 2019; 24:141-155. [PMID: 30924402 PMCID: PMC6459702 DOI: 10.1080/10810730.2019.1587109] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Interventions are needed to increase colorectal cancer screening (CRCS) uptake. Narratives may have advantages over didactic information. We tested different narratives for increasing CRCS intentions and behaviors, and examined their mechanisms of influence. We randomized 477 unscreened adults 50-75 years old to one of three groups: CRCS information only (1) or CRCS information plus a photo and text narrative of a CRC survivor (2) or CRC screener who did not have cancer (3). Photos were tailored on participants' sex, age group, and race/ethnicity. Participants completed online surveys before and after intervention exposure, and 1-, 6-, and 12-months follow-up. Thirty percent of participants completed CRCS. Narrative conditions (vs. information only) were negatively associated with intention, but also positively influenced intentions through greater emotional engagement. Survivor (vs. screener) narratives were positively associated with CRCS, and had mixed effects on intention - positively through emotional engagement and negatively through self-referencing engagement to self-efficacy. Survivor narratives elicited more negative affect, which had positive and negative influences on intention. Continued research using path models to understand the mechanisms of narrative effects will inform theory development and message design. Additional measurement evaluation is needed to adequately capture and then compare the effects of different components of narrative engagement.
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Affiliation(s)
- Amy McQueen
- Washington University in St. Louis, School of Medicine, 4523 Clayton Ave., Campus Box 8005, St. Louis MO 63110
| | - Charlene Caburnay
- Washington University in St. Louis, School of Social Work, 1 Brookings Dr., Campus Box 1196, St. Louis MO 63130
| | - Matthew Kreuter
- Washington University in St. Louis, School of Social Work, 1 Brookings Dr., Campus Box 1196, St. Louis MO 63130
| | - Julianne Sefko
- Washington University in St. Louis, School of Medicine, 4523 Clayton Ave., Campus Box 8005, St. Louis MO 63110
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Valeri L, Sugarman DE, Reilly ME, McHugh RK, Fitzmaurice GM, Greenfield SF. Group therapy for women with substance use disorders: In-session affiliation predicts women's substance use treatment outcomes. J Subst Abuse Treat 2018; 94:60-68. [PMID: 30243419 PMCID: PMC9976621 DOI: 10.1016/j.jsat.2018.08.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 08/20/2018] [Accepted: 08/21/2018] [Indexed: 11/23/2022]
Abstract
In-session affiliation among members is a hypothesized mechanism of action of group therapy for women with substance use disorders (SUDs). We evaluated group affiliation as an independent predictor of SUD treatment outcome in women (n = 100), 18 years or older diagnosed with substance dependence, who were randomized to the single-gender Women's Recovery Group (WRG) or mixed-gender group therapy (Group Drug Counseling; GDC). Affiliative statements made by members in both groups were measured for 39 women in each treatment arm. We studied the relationship between frequency of affiliative statements categorized in quintiles and the trajectory of days of any drug use during 3 months treatment and 6 months post-treatment using a Poisson regression model with estimation via generalized estimating equations. Furthermore, we investigated whether the effect of affiliation on substance use was moderated by group therapy type. The relationship between amount of affiliation and substance use reduction was non-linear. At the end of the treatment phase (3 months), women who experienced the highest level of affiliation (>65 affiliative statements on average) were found to reduce substance use by about 1.75 days more (p-value = 0.02) than women who experienced the lowest level of affiliation (<26). The effects of affiliation persisted 6 months post-treatment and were moderated by therapy group, whereby women enrolled in the single-gender WRG appeared to benefit more from affiliation post-treatment. Training therapists to facilitate verbal affiliation may provide added therapeutic benefit to group therapy for women with SUDs.
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Affiliation(s)
- Linda Valeri
- McLean Hospital, Laboratory for Psychiatric Biostatistics, Belmont, MA 02478, United States; Harvard Medical School, Department of Psychiatry, Boston, MA 02115, United States
| | - Dawn E Sugarman
- Harvard Medical School, Department of Psychiatry, Boston, MA 02115, United States; McLean Hospital, Division of Alcohol and Drug Abuse, Belmont, MA 02478, United States; McLean Hospital, Division of Women's Mental Health, Belmont, MA 02478, United States
| | - Meghan E Reilly
- McLean Hospital, Division of Alcohol and Drug Abuse, Belmont, MA 02478, United States; McLean Hospital, Division of Women's Mental Health, Belmont, MA 02478, United States
| | - R Kathryn McHugh
- Harvard Medical School, Department of Psychiatry, Boston, MA 02115, United States; McLean Hospital, Division of Alcohol and Drug Abuse, Belmont, MA 02478, United States
| | - Garrett M Fitzmaurice
- McLean Hospital, Laboratory for Psychiatric Biostatistics, Belmont, MA 02478, United States; Harvard Medical School, Department of Psychiatry, Boston, MA 02115, United States
| | - Shelly F Greenfield
- Harvard Medical School, Department of Psychiatry, Boston, MA 02115, United States; McLean Hospital, Division of Alcohol and Drug Abuse, Belmont, MA 02478, United States; McLean Hospital, Division of Women's Mental Health, Belmont, MA 02478, United States.
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Collier AF, Daiss S, Temengil E, Russell SC, Miller JC, Renguul FM. Developing an obesity intervention in Micronesia: From needs assessment to planning. EVALUATION AND PROGRAM PLANNING 2018; 69:33-42. [PMID: 29665478 DOI: 10.1016/j.evalprogplan.2018.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 03/04/2018] [Accepted: 04/03/2018] [Indexed: 06/08/2023]
Abstract
Evidence-based obesity reduction programs in the Pacific are scarce to nonexistent. Using a community-based participatory research model (CBPR) we developed a collaboration between our university and a small Pacific Island nation. We established an advisory council of local stakeholders and then conducted an extensive needs assessment with youth, parents, professionals, and lay public. Only 9% of participants had tried a weight loss program. There was a strong tendency to engage in binge-eating cycles; difficulty eating healthy during frequent community celebrations with few healthy food options available in general; and limited traditions that involved physical activity. Participants wanted to learn how to increase their physical activity, make healthier food choices, and learn to reward themselves for healthy behaviors. Diets were most frequently high in energy or protein foods, followed by starch, sugary and fried foods; they ate vegetables and fruits least often. Together, our team then created the culturally relevant Fit Kit Palau©. We highlight lessons learned including how to determine partnerships; manage multiple cultural and geographic barriers; build capacity; and balance program fidelity with responsivity. As the program moves forward, we hope to increase access, engagement, and adherence and provide a model for other PI countries.
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Affiliation(s)
- Ann Futterman Collier
- Department of Psychological Sciences, Northern Arizona University, PO Box 15106, Flagstaff, AZ, 86011, United States.
| | - Suzanne Daiss
- Department of Psychological Sciences, Northern Arizona University, PO Box 15106, Flagstaff, AZ, 86011, United States.
| | - Everlynn Temengil
- Behavioral Health, Ministry of Health, Koror, 96940, Republic of Palau.
| | - Samantha Cody Russell
- Department of Psychological Sciences, Northern Arizona University, PO Box 15106, Flagstaff, AZ, 86011, United States.
| | - Julia Caroline Miller
- Department of Psychological Sciences, Northern Arizona University, PO Box 15106, Flagstaff, AZ, 86011, United States.
| | - Fumiana M Renguul
- Behavioral Health, Ministry of Health, Koror, 96940, Republic of Palau.
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Elliot DL, Goldberg L, MacKinnon DP, Ranby KW, Kuehl KS, Moe EL. Empiric validation of a process for behavior change. Transl Behav Med 2017; 6:449-56. [PMID: 27528533 DOI: 10.1007/s13142-015-0343-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Most behavior change trials focus on outcomes rather than deconstructing how those outcomes related to programmatic theoretical underpinnings and intervention components. In this report, the process of change is compared for three evidence-based programs' that shared theories, intervention elements and potential mediating variables. Each investigation was a randomized trial that assessed pre- and post- intervention variables using survey constructs with established reliability. Each also used mediation analyses to define relationships. The findings were combined using a pattern matching approach. Surprisingly, knowledge was a significant mediator in each program (a and b path effects [p<0.01]). Norms, perceived control abilities, and self-monitoring were confirmed in at least two studies (p<0.01 for each). Replication of findings across studies with a common design but varied populations provides a robust validation of the theory and processes of an effective intervention. Combined findings also demonstrate a means to substantiate process aspects and theoretical models to advance understanding of behavior change.
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Affiliation(s)
- Diane L Elliot
- Division of Health Promotion and Sports Medicine; Department of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road CR110, Portland, OR, 97239-3098, USA.
| | - Linn Goldberg
- Division of Health Promotion and Sports Medicine; Department of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road CR110, Portland, OR, 97239-3098, USA
| | - David P MacKinnon
- Department of Psychology, Arizona State University, Tempe, AZ, 85287-1104, USA
| | - Krista W Ranby
- Department of Psychology, University of Colorado Denver, Denver, CO, 80217-3364, USA
| | - Kerry S Kuehl
- Division of Health Promotion and Sports Medicine; Department of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road CR110, Portland, OR, 97239-3098, USA
| | - Esther L Moe
- Division of Health Promotion and Sports Medicine; Department of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road CR110, Portland, OR, 97239-3098, USA
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Ayala GX, Molina M, Madanat H, Nichols JF, McKenzie TL, Ji M, Holguin M, Cuestas L, Sumek C, Labarca C, Elvira S, Arredondo EM, Elder JP. Intervention Effects on Latinas' Physical Activity and Other Health Indicators. Am J Prev Med 2017; 52:S279-S283. [PMID: 28215381 DOI: 10.1016/j.amepre.2016.10.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 09/02/2016] [Accepted: 10/03/2016] [Indexed: 12/22/2022]
Abstract
INTRODUCTION U.S. Latinas do not engage in sufficient leisure-time physical activity. This study examined whether adding promotor-facilitated healthy lifestyle classes to an exercise intervention would promote exercise session attendance and improve health indicators. METHODS The Familias Sanas y Activas II (Healthy and Active Families II) study used a within-subjects, longitudinal design, with measures at baseline and at 6 and 12 months post-baseline. The intervention was developed by the San Diego Prevention Research Center and implemented between May 2011 and June 2014 in South San Diego County. Three organizations each hired a part-time coordinator and trained volunteer promotores (six to ten per organization) to deliver the intervention in various community locations. A convenience sample of 442 Latinas were in the evaluation cohort. Measured variables included a step test, blood pressure, waist circumference, height, and weight; physical activity was self-reported. RESULTS Attendance at healthy lifestyle classes was positively associated with exercise session attendance (p≤0.001). Mixed effects models showed improvements in systolic and diastolic blood pressure (p≤0.001); waist circumference (p≤0.001); weight (p≤0.05); and BMI (p≤0.05) between baseline and 12 months. At 12 months, fewer participants met clinical guidelines for being hypertensive and having an at-risk waist circumference. Exercise session attendance was associated with improved fitness (p≤0.05) and increased self-reported MET minutes of leisure-time physical activity (p≤0.01). CONCLUSIONS The intervention represents an effective strategy for improving the health status of Latinas, a population with significant health disparities, including high obesity rates. Research efforts are needed to assess methods for scaling up such interventions.
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Affiliation(s)
- Guadalupe X Ayala
- College of Health and Human Services, San Diego State University, San Diego, California; Institute for Behavioral and Community Health, San Diego, California.
| | - Marisa Molina
- Institute for Behavioral and Community Health, San Diego, California
| | - Hala Madanat
- Institute for Behavioral and Community Health, San Diego, California; Graduate School of Public Health, San Diego State University, San Diego, California
| | - Jeanne F Nichols
- Institute for Behavioral and Community Health, San Diego, California; School of Exercise and Nutritional Sciences, San Diego State University, San Diego, California
| | - Thomas L McKenzie
- Institute for Behavioral and Community Health, San Diego, California; School of Exercise and Nutritional Sciences, San Diego State University, San Diego, California
| | - Ming Ji
- Institute for Behavioral and Community Health, San Diego, California; College of Nursing, University of South Florida, Tampa, Florida
| | | | | | - Caryn Sumek
- San Ysidro Health Center, San Ysidro, California
| | - Carolina Labarca
- Institute for Behavioral and Community Health, San Diego, California
| | - Sandra Elvira
- Institute for Behavioral and Community Health, San Diego, California
| | - Elva M Arredondo
- Institute for Behavioral and Community Health, San Diego, California; Graduate School of Public Health, San Diego State University, San Diego, California
| | - John P Elder
- Institute for Behavioral and Community Health, San Diego, California; Graduate School of Public Health, San Diego State University, San Diego, California
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Integrating Physical Activity in Primary Care Practice. Am J Med 2016; 129:1022-9. [PMID: 26953063 DOI: 10.1016/j.amjmed.2016.02.008] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 02/09/2016] [Accepted: 02/09/2016] [Indexed: 01/23/2023]
Abstract
Based on a collaborative symposium in 2014 hosted by the Society of Behavioral Medicine (SBM) and the American College of Sports Medicine (ACSM), this paper presents a model for physical activity counseling for primary care physicians (PCPs). Most US adults do not meet national recommendations for physical activity levels. Socioecological factors drive differences in physical activity levels by geography, sex, age, and racial/ethnic group. The recent Patient Protection and Affordable Care Act incentivizes PCPs to offer patients physical activity counseling. However, PCPs have reported socioecological barriers to physical activity counseling and also patient barriers to physical activity, spanning from the individual to the environmental (eg, lack of safe spaces for physical activity), policy (eg, reimbursement policies), and organizational (eg, electronic medical record protocols, worksite norms/policies) levels. The aims of this paper are to: 1) discuss barriers to PCP counseling for physical activity; 2) provide evidence-based strategies and techniques to help PCPs address these counseling barriers; and 3) suggest practical steps for PCPs to counsel patients on physical activity using strategies and supports from policy, the primary care team, and other support networks.
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Sugarman DE, Wigderson SB, Iles BR, Kaufman JS, Fitzmaurice GM, Hilario EY, Robbins MS, Greenfield SF. Measuring affiliation in group therapy for substance use disorders in the Women's Recovery Group study: Does it matter whether the group is all-women or mixed-gender? Am J Addict 2016; 25:573-80. [PMID: 27647710 DOI: 10.1111/ajad.12443] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 08/05/2016] [Accepted: 09/06/2016] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND OBJECTIVES A Stage II, two-site randomized clinical trial compared the manualized, single-gender Women's Recovery Group (WRG) to mixed-gender group therapy (Group Drug Counseling; GDC) and demonstrated efficacy. Enhanced affiliation and support in the WRG is a hypothesized mechanism of efficacy. This study sought to extend results of the previous small Stage I trial that showed the rate of supportive affiliative statements occurred more frequently in WRG than GDC. METHODS Participants (N = 158; 100 women, 58 men) were 18 years or older, substance dependent, and had used substances within the past 60 days. Women were randomized to WRG (n = 52) or GDC (n = 48). Group therapy videos were coded by two independent raters; Rater 1 coded 20% of videos (n = 74); Rater 2 coded 25% of videos coded by Rater 1 (n = 19). RESULTS The number of affiliative statements made in WRG was 66% higher than in GDC. Three of eight affiliative statement categories occurred more frequently in WRG than GDC: supportive, shared experience, and strategy statements. DISCUSSION AND CONCLUSIONS This larger Stage II trial provided a greater number of group therapy tapes available for analysis. Results extended our previous findings, demonstrating both greater frequency of all affiliative statements, as well as specific categories of statements, made in single-gender WRG than mixed-gender GDC. SCIENTIFIC SIGNIFICANCE Greater frequency of affiliative statements among group members may be one mechanism of enhanced support and efficacy in women-only WRG compared with standard mixed-gender group therapy for substance use disorders. (Am J Addict 2016;25:573-580).
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Affiliation(s)
- Dawn E Sugarman
- Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, Massachusetts.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Sara B Wigderson
- Department of Psychology, University of Miami, Coral Gables, Florida
| | - Brittany R Iles
- Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, Massachusetts
| | | | - Garrett M Fitzmaurice
- Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, Massachusetts.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - E Yvette Hilario
- School of Nursing, The University of Texas at Austin, Austin, Texas
| | | | - Shelly F Greenfield
- Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, Massachusetts. .,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.
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Harden SM, McEwan D, Sylvester BD, Kaulius M, Ruissen G, Burke SM, Estabrooks PA, Beauchamp MR. Understanding for whom, under what conditions, and how group-based physical activity interventions are successful: a realist review. BMC Public Health 2015; 15:958. [PMID: 26404722 PMCID: PMC4582831 DOI: 10.1186/s12889-015-2270-8] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Accepted: 09/14/2015] [Indexed: 11/23/2022] Open
Abstract
Background Participation in group-based physical activity (GBPA) interventions has been found to result in higher levels of exercise adherence and program compliance. However, previous reviews of GBPA programs have provided limited insight regarding ‘for whom’, ‘under what conditions’, and ‘how’ these interventions increase physical activity behavior. Methods A realist review was conducted by following the seven recommended iterative and overlapping steps (J Health Serv Res Policy 10S1:21-34, 2005). The review was limited to group dynamics-based interventions for adults (>17 years of age). The search was conducted in PubMed, PsychInfo, and Web of Science search engines associated with the Science Citation Index Expanded, Social Sciences Citation Index, Arts & Humanities Citation Index, and MEDLINE. Results Using a realist review approach, data from 52 studies were synthesized. Of those, 92 % (n = 48) reported significant increases in participant physical activity. The synthesis resulted in three main observations and recommendations. Discussion GBPA interventions have worked for a variety of populations, including those who are hard to reach; however, more research is needed on moderating factors to determine for whom different GBPA programs may be effective. Second, previous interventions have varied in the duration, frequency, and number of group-based strategies used, and comparative effectiveness research may be necessary to isolate the mechanisms of effect. Third, these interventions have been conducted in a diverse range of settings, using a variety of research designs and analytical approaches. Less information is known about the costs or sustainability of these programs in their intended settings. Conclusion The results of this realist review have important implications for practice, refining trial designs, and replication across diverse populations and settings. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-2270-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Samantha M Harden
- Human Nutrition, Foods and Exercise, Virginia Tech, 1981 Kraft Dr., Room 1009, Blacksburg, VA, 24060, USA. .,University of British Columbia, School of Kinesiology, 6081 University Blvd, Vancouver, BC, V6T 1Z1, USA.
| | - Desmond McEwan
- University of British Columbia, School of Kinesiology, 6081 University Blvd, Vancouver, BC, V6T 1Z1, USA.
| | - Benjamin D Sylvester
- University of British Columbia, School of Kinesiology, 6081 University Blvd, Vancouver, BC, V6T 1Z1, USA.
| | - Megan Kaulius
- University of British Columbia, School of Kinesiology, 6081 University Blvd, Vancouver, BC, V6T 1Z1, USA.
| | - Geralyn Ruissen
- University of British Columbia, School of Kinesiology, 6081 University Blvd, Vancouver, BC, V6T 1Z1, USA.
| | - Shauna M Burke
- School of Health Studies, Western University, 1151 Richmond St, Room 216, HSB, London, ON, N6A 3 K7, USA.
| | - Paul A Estabrooks
- Human Nutrition, Foods and Exercise, Virginia Tech, Family and Community Medicine, Carilion Clinic, 1 Riverside Circle, Roanoke, VA, 24016, USA.
| | - Mark R Beauchamp
- University of British Columbia, School of Kinesiology, 6081 University Blvd, Vancouver, BC, V6T 1Z1, USA.
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The association of binge eating and neighbourhood fast-food restaurant availability on diet and weight status. Public Health Nutr 2014; 18:352-60. [PMID: 24476972 DOI: 10.1017/s1368980013003546] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Fast-food restaurants (FFR) are prevalent. Binge eating is common among overweight and obese women. For women prone to binge eating, neighbourhood FFR availability (i.e. the neighbourhood around one's home) may promote poor diet and overweight/obesity. The present study tested the effects of binge eating and neighbourhood FFR availability on diet (fat and total energy intake) and BMI among African American and Hispanic/Latino women. DESIGN All measures represent baseline data from the Health is Power randomized clinical trial. The numbers of FFR in participants' neighbourhoods were counted and dichotomized (0 or ≥1 neighbourhood FFR). Participants completed measures of binge eating status and diet. Weight and height were measured and BMI calculated. 2 (binge eating status) × 2 (neighbourhood FFR availability) ANCOVA tested effects on diet and BMI while controlling for demographics. SETTING Houston and Austin, TX, USA. SUBJECTS African American and Hispanic/Latino women aged 25-60 years. RESULTS Of the total sample (n 162), 48 % had 1-15 neighbourhood FFR and 29 % were binge eaters. There was an interaction effect on BMI (P = 0·05). Binge eaters with ≥1 neighbourhood FFR had higher BMI than non-binge eaters or binge eaters with no neighbourhood FFR. There were no significant interactions or neighbourhood FFR main effects on total energy or fat intake (P > 0·05). A main effect of binge eating showed that binge eaters consumed more total energy (P = 0·005) and fat (P = 0·005) than non-binge eaters. CONCLUSIONS Binge eaters represented a substantial proportion of this predominantly overweight and obese sample of African American and Hispanic/Latino women. The association between neighbourhood FFR availability and weight status is complicated by binge eating status, which is related to diet.
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