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Canton I, Guzman J, Soto Y, Selzer Ninomiya AL, Morales D, Aguiñaga S. Isotemporal Substitution of Sedentary Time With Physical Activity Among Middle-Aged and Older Latinos: Effects on Episodic Memory. Am J Health Promot 2024; 38:607-614. [PMID: 38352993 DOI: 10.1177/08901171241233404] [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] [Indexed: 04/23/2024]
Abstract
PURPOSE To examine the estimated effects of substituting 30 min of sedentary time with low-light physical activity (LLPA) and high-light physical activity (HLPA) on episodic memory, executive functioning, and working memory among middle-aged and older Latinos. DESIGN A cross-sectional study. SETTING Chicago and Chicagoland suburbs. SUBJECTS Middle-aged and older Latinos (n = 61). MEASURES Accelerometer-assessed physical activity. A cognitive battery was administered to assess episodic memory, executive function, and working memory. ANALYSIS Isotemporal substitution analyses were conducted, where unstandardized coefficients from linear regression models were used to examine the substitution effect of replacing sedentary time with LLPA and HLPA. RESULTS Substitution of sedentary time with LLPA was associated with better episodic memory (Immediate recall, B = .947, P = .008; Delayed recall, B = .857, P = .013). No other significant substitution effects were present. CONCLUSION Middle-aged and older Latinos who replace sedentary time with LLPA may have better episodic memory. Future studies may target light physical activity to address cognition disparities and can inform the development of physical activity interventions that are appealing and accessible for Latinos.
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Affiliation(s)
- Imani Canton
- Department of Kinesiology and Community Health, University of Illinois Urbana Champaign, Champaign, IL, USA
| | | | - Yuliana Soto
- Department of Kinesiology and Community Health, University of Illinois Urbana Champaign, Champaign, IL, USA
| | - Ana Laura Selzer Ninomiya
- Department of Kinesiology and Community Health, University of Illinois Urbana Champaign, Champaign, IL, USA
| | - Diana Morales
- Department of Kinesiology and Community Health, University of Illinois Urbana Champaign, Champaign, IL, USA
| | - Susan Aguiñaga
- Department of Kinesiology and Community Health, University of Illinois Urbana Champaign, Champaign, IL, USA
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Park Y, King J, Eggleston MM, Elias TI. Critical Lessons in Tailoring Interventions: Listening to WISEWOMAN Participants. Am J Health Promot 2024; 38:90-100. [PMID: 37670568 DOI: 10.1177/08901171231200779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
PURPOSE To explore perspectives of participants in the WISEWOMAN program in Pennsylvania (PA-WISE) on challenges and facilitators of reducing cardiovascular disease risk as low-income and un-/under-insured middle-aged women. APPROACH Researchers conducted this 2 year qualitative data collection as one component of a broader, 5 year PA-WISE process and outcome evaluation. SETTING Women from across Pennsylvania, primarily from rural communities. PARTICIPANTS Interviewees were low-income, un-/under-insured women aged 40-64 years who had recently participated in PA-WISE-facilitated health coaching and lifestyle programs (HC/LSPs). METHODS – DATA COLLECTION AND ANALYSIS Researchers conducted individual telephone interviews with 38 women from four discrete samples of PA-WISE participants at 4 time points. Three researchers used grounded theory, and an iterative process of line-by-line coding, data display, and reanalysis to identify emerging themes, sub-themes, and their relationships. RESULTS Participants shared the important benefits of specific PA-WISE program traits. However, participants described significant financial constraints, difficult schedules, caregiving responsibilities, and insufficient social support as persistent challenges in their lives, making lifestyle changes in general, and program participation specifically, difficult. CONCLUSION The challenges that low-income and un-/under-insured women identified amplify the importance of having interventions that offer flexibility, options, and tailoring of supports and resources. The timeless challenges articulated by participants in this study completed just before the COVID-19 pandemic, remain relevant to be addressed through the pandemic and beyond.
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Affiliation(s)
- Yuae Park
- Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - Jennifer King
- Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - Molly M Eggleston
- Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - Thistle I Elias
- Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
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Karran EL, Grant AR, Lee H, Kamper SJ, Williams CM, Wiles LK, Shala R, Poddar CV, Astill T, Moseley GL. Do health education initiatives assist socioeconomically disadvantaged populations? A systematic review and meta-analyses. BMC Public Health 2023; 23:453. [PMID: 36890466 PMCID: PMC9996883 DOI: 10.1186/s12889-023-15329-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 02/27/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Health education interventions are considered critical for the prevention and management of conditions of public health concern. Although the burden of these conditions is often greatest in socio-economically disadvantaged populations, the effectiveness of interventions that target these groups is unknown. We aimed to identify and synthesize evidence of the effectiveness of health-related educational interventions in adult disadvantaged populations. METHODS We pre-registered the study on Open Science Framework https://osf.io/ek5yg/ . We searched Medline, Embase, Emcare, and the Cochrane Register from inception to 5/04/2022 to identify studies evaluating the effectiveness of health-related educational interventions delivered to adults in socio-economically disadvantaged populations. Our primary outcome was health related behaviour and our secondary outcome was a relevant biomarker. Two reviewers screened studies, extracted data and evaluated risk of bias. Our synthesis strategy involved random-effects meta-analyses and vote-counting. RESULTS We identified 8618 unique records, 96 met our criteria for inclusion - involving more than 57,000 participants from 22 countries. All studies had high or unclear risk of bias. For our primary outcome of behaviour, meta-analyses found a standardised mean effect of education on physical activity of 0.05 (95% confidence interval (CI) = -0.09-0.19), (5 studies, n = 1330) and on cancer screening of 0.29 (95% CI = 0.05-0.52), (5 studies, n = 2388). Considerable statistical heterogeneity was present. Sixty-seven of 81 studies with behavioural outcomes had point estimates favouring the intervention (83% (95% CI = 73%-90%), p < 0.001); 21 of 28 studies with biomarker outcomes showed benefit (75% (95%CI = 56%-88%), p = 0.002). When effectiveness was determined based on conclusions in the included studies, 47% of interventions were effective on behavioural outcomes, and 27% on biomarkers. CONCLUSIONS Evidence does not demonstrate consistent, positive impacts of educational interventions on health behaviours or biomarkers in socio-economically disadvantaged populations. Continued investment in targeted approaches, coinciding with development of greater understanding of factors determining successful implementation and evaluation, are important to reduce inequalities in health.
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Affiliation(s)
- E L Karran
- IIMPACT in Health, University of South Australia, GPO Box 2471, Adelaide, South Australia, 5001, Australia.
| | - A R Grant
- IIMPACT in Health, University of South Australia, GPO Box 2471, Adelaide, South Australia, 5001, Australia
| | - H Lee
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal, Sciences, University of Oxford, Oxford, UK.,School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - S J Kamper
- School of Health Sciences, University of Sydney, Sydney, NSW, Australia.,Nepean Blue Mountains Local Health District, Penrith, NSW, Australia
| | - C M Williams
- University of Newcastle, Sydney, NSW, Australia.,Population Health, Hunter New England Local Health District, New Lambton, NSW, Australia
| | - L K Wiles
- IIMPACT in Health, University of South Australia, GPO Box 2471, Adelaide, South Australia, 5001, Australia.,Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia.,South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
| | - R Shala
- IIMPACT in Health, University of South Australia, GPO Box 2471, Adelaide, South Australia, 5001, Australia.,Department of Physiotherapy, Faculty of Medicine, University of Prishtina, Prishtina, Kosovo
| | - C V Poddar
- Sir H. N. Reliance Foundation Hospital and Research Centre, Mumbai, India
| | - T Astill
- Western Sydney University, Sydney, NSW, Australia
| | - G L Moseley
- IIMPACT in Health, University of South Australia, GPO Box 2471, Adelaide, South Australia, 5001, Australia
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Sanz-Remacha M, García-González L, Sevil Serrano J, Aibar Solana A. A Qualitative Evaluation of a Community-Based Intervention on Health-Related Behaviors in Disadvantaged Women. RESEARCH QUARTERLY FOR EXERCISE AND SPORT 2023; 94:272-282. [PMID: 35025722 DOI: 10.1080/02701367.2021.1971149] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 08/13/2021] [Indexed: 06/14/2023]
Abstract
Purpose: Grounded in social ecological model and self-determination theory, the aim of this study was to qualitatively evaluate the first and second year follow-ups of a community-based healthy lifestyle programme on health-related behaviors, and outcomes in disadvantaged adult women. Methods: Eleven disadvantaged adult women (M = 37.72; SD = 8.34) (seven of them from the Roma population) participated in this community-based participatory action research. Discussion groups, semi-structured interviews, and field notes were used to assess the effects of the intervention programme on health-related behaviors and health outcomes through thematic analysis. Results: Women perceived improvements in PA-related variables, healthy eating, and other health-related outcomes throughout two years. Most women mentioned these behavior changes in the first year, while others perceived them in the second year. Conclusions: These findings highlight the importance of developing contextual and culturally tailored interventions that address the specific problems and needs that emerge from ethnic groups. Given that some of these behavior changes were only mentioned by most of these women in the second year, long-term interventions seem to be ideally required in this population.
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Slater K, Colyvas K, Taylor R, Collins CE, Hutchesson M. Primary and secondary cardiovascular disease prevention interventions targeting lifestyle risk factors in women: A systematic review and meta-analysis. Front Cardiovasc Med 2022; 9:1010528. [PMID: 36439996 PMCID: PMC9681924 DOI: 10.3389/fcvm.2022.1010528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 10/25/2022] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND AND AIMS Over seven million women die from cardiovascular disease (CVD) annually. While lifestyle modification is recommended for CVD prevention, there are no systematic reviews evaluating the effectiveness of interventions targeted to women. The primary aim of this systematic review is to determine the efficacy of primary and secondary CVD prevention interventions targeting lifestyle risk factors in women. METHODS Six electronic databases were searched up to January 2022. Eligible studies included randomized controlled trials of primary or secondary CVD prevention interventions targeting CVD lifestyle risk factors (diet, physical activity, sedentary behavior, smoking, alcohol, sleep, and weight management) in women (≥18 years) that reported CVD risk markers or lifestyle risk factors. Meta-analyses were conducted on CVD risk markers and body mass index (BMI), and the level of evidence was applied to the GRADE (Grading of Recommendations Assessment, Development and Evaluation) criteria and reported. RESULTS Thirty-five RCTs were included (24 primary and 11 secondary prevention). Meta-analyses demonstrated that lifestyle CVD prevention interventions achieved statistically significant reductions in BMI at ≤ 6 months (0.95 kg/m2, 95% CI = 0.54 to 1.35, p < 0.0001), 12 months (0.61 kg/m2, 95% CI = 0.07 to 1.16, p = 0.03) and >12 months (0.58 kg/m2, 95% CI = 0.01 to 1.16, p = 0.05), and systolic blood pressure (mmHg) at ≤ 6 months (3.51, p < 0.001). CONCLUSIONS Lifestyle interventions are important for the prevention of CVD in women, specifically to reduce systolic blood pressure in the short term (≤ 6 months) and BMI long term (>12 months). SYSTEMATIC REVIEW REGISTRATION https://osf.io/bkwqm, identifier: osf-registrations-bkwqm-v1.
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Affiliation(s)
- Kaylee Slater
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
- Food and Nutrition Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Kim Colyvas
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
| | - Rachael Taylor
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
- Food and Nutrition Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Clare E. Collins
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
- Food and Nutrition Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Melinda Hutchesson
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
- Food and Nutrition Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
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Evaluating physical activity interventions for socioeconomically disadvantaged adults through the RE-AIM framework: A systematic review of experimental and non–/quasi-experimental trials. Prev Med Rep 2022; 29:101943. [PMID: 36161121 PMCID: PMC9502049 DOI: 10.1016/j.pmedr.2022.101943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 06/30/2022] [Accepted: 08/05/2022] [Indexed: 11/21/2022] Open
Abstract
The review evaluated internal and external validity using the rE-AIM Framework. Results indicate an overall low reporting of validity factors. Information on adoption and maintenance was particularly low. Future studies should improve the reporting across all rE-AIM dimensions. Future studies should consider adaptations during the implementation phase.
The promotion of physical activity in people from lower social strata is a public health priority. Previous reviews of physical activity interventions among socioeconomically disadvantaged adults have focused on intervention effectiveness without considering their translation into practice. This review utilised the RE-AIM framework (Reach, Efficacy/Effectiveness, Adoption, Implementation, Maintenance) to (1) evaluate the extent to which experimental and non–/quasi-experimental trials of interventions to promote physical activity among socioeconomically disadvantaged adults report on issues of internal and external validity and (2) to provide recommendations for future intervention studies. Four databases were searched through June 2021. We included studies published in English or German since 2000 that tested physical activity interventions for socioeconomically disadvantaged adults. Two researchers coded all studies using a validated RE-AIM data extraction tool with 61 indicators referring to internal and external validity. Binary coding (yes = 1/no = 0) was applied to calculate the number and percentage of studies reporting each of the indicators. We included 39 studies of which 22 were non–/quasi-experimental trials. Indicators of reach were most frequently reported (59.2%), followed by implementation (38.9%) and efficacy/effectiveness (28.9%). Dimensions related to external validity were least frequently reported (adoption: 21.9%, maintenance: 17.8%). Few differences were found between experimental and non–/quasi-experimental trials. Analysis showed overall poor reporting of components related to internal and external validity. We recommend that future research should increase attention on reporting indicators of internal and external validity to facilitate their translation and implementation into real world settings. Trial registration: The review was registered with PROSPERO (CRD42021283688).
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Arigo D, Romano KA, Pasko K, Travers L, Ainsworth MC, Jackson DA, Brown MM. A scoping review of behavior change techniques used to promote physical activity among women in midlife. Front Psychol 2022; 13:855749. [PMID: 36211932 PMCID: PMC9534296 DOI: 10.3389/fpsyg.2022.855749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 08/15/2022] [Indexed: 11/13/2022] Open
Abstract
Women in midlife experience health risks that could be mitigated by regular physical activity and reduced sedentary time, but this population rarely achieves physical activity levels that would protect their health. As a result, many behavioral interventions are designed to promote physical activity in this population, which are purportedly guided by theoretical models of health behavior (change) and activate an associated set of behavior change techniques (BCTs). The efficacy and effectiveness of these interventions appear to be limited, however, raising questions about their design and adaptation for women in midlife. Several aspects of these interventions are currently unclear. Specifically, which women they target (i.e., how “midlife” and “sedentary” or “inactive” are defined), which theoretical models or behavior BCTs are used, and how BCTs are activated in such interventions. A synthesis of this information would be useful as an initial step toward improving physical activity interventions for this at-risk group, and thus, represented the goal of the present scoping review. Eligibility required publication in a peer-reviewed journal in English between 2000 and 2021, inclusion of only women in midlife who did not have any medical or other restrictions on their physical activity (e.g., cancer diagnosis), and free-living physical activity or sedentary behavior as the target outcome (with associated assessment). Of the 4,410 initial results, 51 articles met inclusion criteria, and these described 36 unique interventions. More than half of the articles (59%) named an underlying theoretical model and interventions included an average of 3.76 identifiable BCTs (range 1–11). However, descriptions of many interventions were limited and did not provide enough detail to determine whether or how specific BCTs were activated. Interventions also used a wide range of inclusion criteria for age range and starting activity level, which has implications for targeting/tailoring and effectiveness, and many interventions focused on marginalized populations (e.g., women from racial/ethnic minority backgrounds, those un- or under-insured). The present review identifies some strengths and highlights important limitations of existing literature, as well as key opportunities for advancing the design and potential utility of physical activity interventions for women in midlife.
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Affiliation(s)
- Danielle Arigo
- Department of Psychology, Rowan University, Glassboro, NJ, United States
- Department of Family Medicine, Rowan School of Osteopathic Medicine, Stratford, NJ, United States
- *Correspondence: Danielle Arigo
| | - Kelly A. Romano
- Department of Psychology, Old Dominion University, Norfolk, VA, United States
| | - Kristen Pasko
- Department of Psychology, Rowan University, Glassboro, NJ, United States
| | - Laura Travers
- Department of Psychology, Rowan University, Glassboro, NJ, United States
| | - M. Cole Ainsworth
- Department of Psychology, Rowan University, Glassboro, NJ, United States
| | - Daija A. Jackson
- Clinical Psychology Program, Chicago School of Professional Psychology, Washington, DC, United States
| | - Megan M. Brown
- Department of Psychology, Rowan University, Glassboro, NJ, United States
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A Community-Based Participatory Action Research with Women from Disadvantaged Populations: Strengths and Weaknesses of a Multiple Health Behaviour Change Intervention. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116830. [PMID: 35682413 PMCID: PMC9180573 DOI: 10.3390/ijerph19116830] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 05/30/2022] [Accepted: 05/30/2022] [Indexed: 02/04/2023]
Abstract
Disadvantaged populations usually adopt risk behaviours, resulting in obesity and mental health-related disorders. Grounded in the socioecological model and self-determination theory, the aims were firstly to describe and implement a two-year multiple health behaviour change intervention, and secondly, to assess the strengths and weaknesses of the intervention. In total, 11 women from a disadvantaged population participated in this programme, which encompassed 117 sessions. Qualitative techniques were used to collect data and a thematic analysis was conducted. The variety of activities and the group-based intervention were the main strengths, and the decrease in attendance and the programme’s tight schedule were the main weaknesses. This is the first intervention in a disadvantaged population mainly comprised of Roma women. The design described in detail and its assessment provide relevant knowledge to improve their health status and decrease inequalities. The practical implications for future research are useful for replicating interventions in similar contexts.
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Using an Intervention Mapping Approach to Develop a Program for Preventing High Blood Pressure in a Marginalized Afro-Colombian Population: A Community-Based Participatory Research. JOURNAL OF PREVENTION 2022; 43:209-224. [PMID: 35445375 PMCID: PMC8800401 DOI: 10.1007/s10935-022-00668-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/11/2022] [Indexed: 11/04/2022]
Abstract
The prevention of high blood pressure (HBP) is an important public health initiative worldwide, since HBP is the main risk factor for cardiovascular diseases and increases the damage caused by coronavirus disease 2019 (COVID-19). We designed, implemented, and evaluated a program to identify effective and sustainable interventions for preventing HBP in a marginalized black population. Our study was conducted in Quibdó, a city in Colombia with the highest poverty rate and located in the Pacific coast, a subregion in Colombia with the highest prevalence of HBP. We followed an intervention mapping framework using a community-based participatory research approach. Focus groups, photovoice, literature reviews, and cross-sectional quantitative surveys were used for data collection. The community chose the time, place, and type of physical activity; led the physical activities; and strengthened their skills in seeking resources in their community to sustain the program. The evaluation was aimed at determining whether the interventions were able to achieve the program’s primary aim. We used a before (September 2016) and after (December 2017) design for the evaluation. To decrease the selection bias and allow comparisons between homogeneous groups, we used a propensity score matching technique. The steps required to create a self-sustaining physical activity program were provided in detail. The pre-post test showed a decrease of the HBP (systolic, 13.4% points; p = 0.018; diastolic, 6.5% points; p = 0.002). The program may be an effective and self-sustaining intervention, and it can be replicated by policymakers and implemented in other population groups.
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Amiri-Farahani L, Parvizy S, Mohammadi E, Asadi-Lari M, Taghizadeh Z, Pezaro S. Development, implementation and evaluation of the 'BELIEVE' program for improving physical activity among women: a mixed method action research study. BMC Sports Sci Med Rehabil 2021; 13:135. [PMID: 34702341 PMCID: PMC8547091 DOI: 10.1186/s13102-021-00367-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 10/21/2021] [Indexed: 11/10/2022]
Abstract
Background There is insufficient physical activity among women. Yet the implementation of effective, multilevel, and evidence-based interventions may address this. Since the lifestyle of individuals is formed in many different social, physical and cultural contexts, it will be necessary in designing such interventions to involve many stakeholders. Consequently, the present study took a mixed method action research approach in developing, implementing and evaluating a bespoke program to improve physical activity among women.
Methods This study was conducted within the Khoramroudi neighborhood of Tehran between 2013 and 2015 utilizing the four main phases of action research. The Mobilizing for Action through Planning and Partnerships (MAPP) process was used to design the study. During the initial phase, participants were organized into three groups; a core support committee, a steering committee, and a study population. Qualitative and quantitative data were also collected during this first phase. During the second phase, interventions were developed and implemented. In the third phase, an evaluation was carried out using both quantitative (Designing a quasi-experimental study) and qualitative methods. During the fourth phase, an exploration of the structure and process of action research was completed with the aim of providing a conceptual model and descriptions of the context. Results Three strategic interventions were effective in improving physical activity among women: (1) utilization of sports assistants; (2) Local health promotion and the dissemination of an informational, motivational and culturally competent booklet entitled “Educational content for sport assistants" (3) Group-based cognitive behavioral therapy. Quantitative results [Significant difference between the total score of PA before the intervention, and 1 and 3 months after the intervention (P < 0.001)] and the results of qualitative evaluations were shown to improve physical activity among participants. The newly co-created “adjusted MAPP model” was offered within three action cycles. The structure of this was described to capture the impacts of interactions among a variety of stakeholders. Conclusion The comprehensive identification of problems led to the development of collaborative strategies. Strategies of action research can positively affect physical activity among women. To improve physical activity outcomes more generally, the use of MAPP principles and strategies is suggested to meet the specific needs and strengths of all community members.
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Affiliation(s)
- Leila Amiri-Farahani
- Department of Midwifery, Faculty of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran.
| | - Soroor Parvizy
- Department of Pediatric Nursing, Faculty of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Eesa Mohammadi
- Department of Nursing, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Mohsen Asadi-Lari
- Oncopathology Research Centre, Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Ziba Taghizadeh
- Faculty Member of Nursing and Midwifery Care Research Center, Nursing and Midwifery School, Tehran University of Medical Sciences, Tehran, Iran
| | - Sally Pezaro
- Faculty of Health and Life Sciences, Coventry University, Coventry, UK
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Mönninghoff A, Kramer JN, Hess AJ, Ismailova K, Teepe GW, Tudor Car L, Müller-Riemenschneider F, Kowatsch T. Long-term Effectiveness of mHealth Physical Activity Interventions: Systematic Review and Meta-analysis of Randomized Controlled Trials. J Med Internet Res 2021; 23:e26699. [PMID: 33811021 PMCID: PMC8122296 DOI: 10.2196/26699] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/24/2021] [Accepted: 04/02/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Mobile health (mHealth) interventions can increase physical activity (PA); however, their long-term impact is not well understood. OBJECTIVE The primary aim of this study is to understand the immediate and long-term effects of mHealth interventions on PA. The secondary aim is to explore potential effect moderators. METHODS We performed this study according to the Cochrane and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We searched PubMed, the Cochrane Library, SCOPUS, and PsycINFO in July 2020. Eligible studies included randomized controlled trials of mHealth interventions targeting PA as a primary outcome in adults. Eligible outcome measures were walking, moderate-to-vigorous physical activity (MVPA), total physical activity (TPA), and energy expenditure. Where reported, we extracted data for 3 time points (ie, end of intervention, follow-up ≤6 months, and follow-up >6 months). To explore effect moderators, we performed subgroup analyses by population, intervention design, and control group type. Results were summarized using random effects meta-analysis. Risk of bias was assessed using the Cochrane Collaboration tool. RESULTS Of the 2828 identified studies, 117 were included. These studies reported on 21,118 participants with a mean age of 52.03 (SD 14.14) years, of whom 58.99% (n=12,459) were female. mHealth interventions significantly increased PA across all the 4 outcome measures at the end of intervention (walking standardized mean difference [SMD] 0.46, 95% CI 0.36-0.55; P<.001; MVPA SMD 0.28, 95% CI 0.21-0.35; P<.001; TPA SMD 0.34, 95% CI 0.20-0.47; P<.001; energy expenditure SMD 0.44, 95% CI 0.13-0.75; P=.01). Only 33 studies reported short-term follow-up measurements, and 8 studies reported long-term follow-up measurements in addition to end-of-intervention results. In the short term, effects were sustained for walking (SMD 0.26, 95% CI 0.09-0.42; P=.002), MVPA (SMD 0.20, 95% CI 0.05-0.35; P=.008), and TPA (SMD 0.53, 95% CI 0.13-0.93; P=.009). In the long term, effects were also sustained for walking (SMD 0.25, 95% CI 0.10-0.39; P=.001) and MVPA (SMD 0.19, 95% CI 0.11-0.27; P<.001). We found the study population to be an effect moderator, with higher effect scores in sick and at-risk populations. PA was increased both in scalable and nonscalable mHealth intervention designs and regardless of the control group type. The risk of bias was rated high in 80.3% (94/117) of the studies. Heterogeneity was significant, resulting in low to very low quality of evidence. CONCLUSIONS mHealth interventions can foster small to moderate increases in PA. The effects are maintained long term; however, the effect size decreases over time. The results encourage using mHealth interventions in at-risk and sick populations and support the use of scalable mHealth intervention designs to affordably reach large populations. However, given the low evidence quality, further methodologically rigorous studies are warranted to evaluate the long-term effects.
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Affiliation(s)
- Annette Mönninghoff
- Institute for Customer Insight, University of St. Gallen, St. Gallen, Switzerland
- Institute for Mobility, University of St. Gallen, St. Gallen, Switzerland
| | - Jan Niklas Kramer
- Centre for Digital Health Interventions, Institute of Technology Management, University of St. Gallen, St. Gallen, Switzerland
- CSS Insurance, Lucerne, Switzerland
| | - Alexander Jan Hess
- Centre for Digital Health Interventions, Institute of Technology Management, University of St. Gallen, St. Gallen, Switzerland
- Translational Neuromodeling Unit, Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Zurich, Switzerland
| | - Kamila Ismailova
- Centre for Digital Health Interventions, Institute of Technology Management, University of St. Gallen, St. Gallen, Switzerland
| | - Gisbert W Teepe
- Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
| | - Lorainne Tudor Car
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- School of Public Health, Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
| | | | - Tobias Kowatsch
- Centre for Digital Health Interventions, Institute of Technology Management, University of St. Gallen, St. Gallen, Switzerland
- Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- Future Health Technologies Programme, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore-ETH Centre, Singapore, Singapore
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Beyond TTM and ABC: A Practice Perspective on Physical Activity Promotion for Adolescent Females from Disadvantaged Backgrounds. SOCIETIES 2020. [DOI: 10.3390/soc10040080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This paper builds on a growing body of literature on the promise of practice theory in understanding and promoting behavior change in society and develops upon Blue (2017) and Spotswood et al.’s (2019) rationale for evolving theories of practice into the domain of contemporary physical activity research. We begin by considering the intersectional nature of the problem. Statistics reveal that physical activity gradients exist based on gender, as well as socio-economic position. Women, girls, and disadvantaged populations report lower levels of activity than more affluent males and females. More problematic still is what StreetGames (2017) call the “double jeopardy”, where these characteristics intersect, intensifying the negative gradient. Our argument then comprises three parts. First, we provide a critical discussion of intervention studies seeking to transform exercise behavior amongst these populations. The issue we identify is that studies typically rely on behavior change models, such as the Transtheoretical Model (TTM) and the ABC framework. However, these models tend to take insufficient account of the practical and social aspects of behavior change in physical activity, and thus their subjects often succumb to value-action gaps (Shove, 2010). Second, in contrast, we propose that practice theory provides a promising alternative theoretical lens for promoting behavior change in disadvantaged and often resistant populations. Third, the paper highlights a range of conceptual considerations for exploring the relationship between young, disadvantaged women and physical activity, as well as the development of tangible solutions to improve participation.
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Scholes S, Mindell JS. Inequalities in participation and time spent in moderate-to-vigorous physical activity: a pooled analysis of the cross-sectional health surveys for England 2008, 2012, and 2016. BMC Public Health 2020; 20:361. [PMID: 32192444 PMCID: PMC7082987 DOI: 10.1186/s12889-020-08479-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 03/06/2020] [Indexed: 01/03/2023] Open
Abstract
Background Evidence is unclear on whether inequalities in average levels of moderate-to-vigorous physical activity (MVPA) reflect differences in participation, differences in the amount of time spent active, or both. Using self-reported data from 24,882 adults (Health Survey for England 2008, 2012, 2016), we examined gender-specific inequalities in these separate aspects for total and domain-specific MVPA. Methods Hurdle models accommodate continuous data with excess zeros and positive skewness. Such models were used to assess differences between income groups in three aspects: (1) the probability of doing any MVPA, (2) the average hours/week spent in MVPA, and (3) the average hours/week spent in MVPA conditional on participation (MVPA-active). Inequalities were summarised on the absolute scale using average marginal effects (AMEs) after confounder adjustment. Results Inequalities were robust to adjustment in each aspect for total MVPA and for sports/exercise. Differences between adults in high-income versus low-income households in sports/exercise MVPA were 2.2 h/week among men (95% confidence interval (CI): 1.6, 2.8) and 1.7 h/week among women (95% CI: 1.3, 2.1); differences in sports/exercise MVPA-active were 1.3 h/week (95% CI: 0.4, 2.1) and 1.0 h/week (95% CI: 0.5, 1.6) for men and women, respectively. Heterogeneity in associations was evident for the other domains. For example, adults in high-income versus low-income households were more likely to do any walking (men: 13.0% (95% CI: 10.3, 15.8%); women: 10.2% (95% CI: 7.6, 12.8%)). Among all adults (including those who did no walking), the average hours/week spent walking showed no difference by income. Among those who did any walking, adults in high-income versus low-income households walked on average 1 h/week less (men: − 0.9 h/week (95% CI: − 1.7, − 0.2); women: − 1.0 h/week (95% CI: − 1.7, − 0.2)). Conclusions Participation and the amount of time that adults spend in MVPA typically favours those in high-income households. Monitoring inequalities in MVPA requires assessing different aspects of the distribution within each domain. Reducing inequalities in sports/exercise requires policy actions and interventions to move adults in low-income households from inactivity to activity, and to enable those already active to do more. Measures to promote walking should focus efforts on reducing the sizeable income gap in the propensity to do any walking.
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Affiliation(s)
- Shaun Scholes
- Research Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK.
| | - Jennifer S Mindell
- Research Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
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McGuire AM, Seib C, Porter-Steele J, Anderson DJ. The Association Between Web-Based or Face-to-Face Lifestyle Interventions on the Perceived Benefits and Barriers to Exercise in Midlife Women: Three-Arm Equivalency Study. J Med Internet Res 2019; 21:e10963. [PMID: 31436162 PMCID: PMC6724500 DOI: 10.2196/10963] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 11/19/2018] [Accepted: 03/30/2019] [Indexed: 01/14/2023] Open
Abstract
Background Noncommunicable diseases pose a significant threat to women’s health globally, with most diseases being attributed to modifiable risk factors such as physical inactivity. Women perceive a range of benefits and barriers to exercise; however, there is little evidence about the effect of different lifestyle intervention delivery modes on perceptions of exercise. Objective This study aimed to compare the effect of a multiple health behavior change (MHBC) intervention called the Women’s Wellness Program. This intervention was delivered in 3 different modes on perceived exercise benefits, perceived exercise barriers, and actual physical activity and exercise in midlife women. Methods Women aged 45 to 65 years were recruited via the study website. They were assigned in blocks to 3 different treatment groups (A: Web-based independent; B: face-to-face with nurse consultations; and C: Web-based with virtual nurse consultations). All participants received the 12-week intervention that utilizes principles from social-cognitive theory to provide a structured guide to promote healthy lifestyle behaviors with an emphasis on regular exercise and healthy eating. Data were collected using a self-report Web-based questionnaire at baseline (T1) and postintervention (T2) including perceived exercise benefits and barriers and exercise and physical activity. A data analysis examined both within- and between-group changes over time. Results Participants in this study (N=225) had a mean age of 50.9 years (SD 5.9) and most were married or living with a partner (83.3%, 185/225). Attrition was 30.2% with 157 participants completing the final questionnaire. Women in all intervention groups reported a significant increase in positive perceptions of exercise (P<.05); a significant increase in exercise and overall physical activity (P<.01) with moderate-to-large effect sizes noted for overall physical activity (d=0.5 to d=0.87). Participants receiving support from registered nurses in the face-to-face and Web-based groups had a greater magnitude of change in benefit perceptions and physical activity than those in the Web-based independent group. There was no significant change in exercise barrier perceptions within or between groups over time. Conclusions The results of this study suggest that the (MHBC) intervention is effective in increasing exercise benefit perceptions, overall physical activity, and exercise in midlife women. Although Web-based programs are cost-effective and flexible and can be delivered remotely, providing a range of options including face-to-face group delivery and personalized electronic health coaching from registered nurses has the potential to enhance participant engagement and motivation.
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Affiliation(s)
- Amanda Mary McGuire
- Menzies Health Institute Queensland, Griffith University, Southport, Australia
| | - Charrlotte Seib
- Menzies Health Institute Queensland, Griffith University, Southport, Australia
| | - Janine Porter-Steele
- Menzies Health Institute Queensland, Griffith University, Southport, Australia.,Wesley Hospital, Brisbane, Australia
| | - Debra Jane Anderson
- Menzies Health Institute Queensland, Griffith University, Southport, Australia
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Mabweazara SZ, Leach LL, Ley C. Development of a context-sensitive physical activity intervention for persons living with HIV and AIDS of low socioeconomic status using the behaviour change wheel. BMC Public Health 2019; 19:774. [PMID: 31208375 PMCID: PMC6580554 DOI: 10.1186/s12889-019-7091-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 05/31/2019] [Indexed: 01/08/2023] Open
Abstract
Background Regular physical activity (PA) has been recommended for the management of HIV and AIDS. The purpose of this study was to develop a contextualised intervention for promoting PA among women living with HIV and AIDS (WLWHA) of low socioeconomic status (SES). A secondary aim of the study was to optimise the PA intervention using behavioural theory/ frameworks derived from preliminary studies and the literature. Methods The Behaviour Change Wheel (BCW) for designing behaviour change interventions was used. This method was further supplemented by evidence from the literature, systematic literature review (SLR), a concurrent mixed methods study and two cross-sectional studies. The SLR aided in determining the theoretical frameworks to inform the intervention, the specific PA behaviours to be targeted by the intervention, the intervention functions, the intervention policy category and the mode of delivery of the intervention. The concurrent mixed methods study was used to identify key factors that needed to change in order for participants to engage in regular PA. The first cross-sectional study was used to determine the gender to be targeted by the study. The second cross-sectional study was used to determine the domain and intensity of PA to target in the intervention. Results A face-to-face context-sensitive PA intervention employing 14 behavioural change techniques was designed. The PA intervention (a) utilised the Transtheoretical model of behaviour change and the Social Cognitive theory as the underpinning theoretical frameworks (b) included convenient PAs, such as walking, doing simple home-based exercises, engaging in activities of daily living or doing simple exercises at the community centre (c) used education, reward, training in PA, modelling exercise activities and enablement to increase the opportunity to engage in PA as intervention functions (d) used service provision as policy priorities, and (e) used a direct face-to-face mode of delivery. Conclusions The PA intervention emphasises behavioural techniques for increasing PA participation, such as goal-setting, self-monitoring, strategies for overcoming PA barriers, social support and rewards. The intervention employs strategies that highlight low-cost local PA resources and opportunities to help HIV infected women of low SES to participate in PA. The BCW provides a useful and comprehensive framework for the development of evidence and theory-based PA interventions for PLWHA of low SES. The BCW can thus be used in the development of interventions that ‘talk’ to policy by bridging the health inequality gap.
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Affiliation(s)
- S Z Mabweazara
- Department of Sport, Recreation & Exercise Science, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, South Africa
| | - L L Leach
- Department of Sport, Recreation & Exercise Science, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, South Africa
| | - C Ley
- Institute of Sport Science, University of Vienna, Auf der Schmelz 6, 1150, Vienna, Austria. .,Department of Health Sciences, University of Applied Sciences FH Campus Wien, Vienna, Austria.
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The effectiveness of peer-supported interventions for encouraging dietary behaviour change in adults: a systematic review. Public Health Nutr 2018; 22:624-644. [PMID: 30501679 DOI: 10.1017/s1368980018003294] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE There is an urgent need to find effective methods of supporting individuals to make dietary behaviour changes. Peer-supported interventions (PSI) have been suggested as a cost-effective strategy to support chronic disease self-management. However, the effect of PSI on dietary behaviour is unclear. The present systematic review aimed to assess the effectiveness of PSI for encouraging dietary behaviour change in adults and to consider intervention characteristics linked with effectiveness. DESIGN Electronic databases were searched until June 2018 for randomised controlled trials assessing the effectiveness of PSI compared with an alternative intervention and/or control on a dietary related outcome in adults. Following title and abstract screening, two reviewers independently screened full texts and data were extracted by one reviewer and independently checked by another. Results were synthesised narratively. SETTING Randomised controlled trials.ParticipantsAdult studies. RESULTS The fifty-four included studies varied in participants, intervention details and results. More PSI reported a positive or mixed effect on diet than no effect. Most interventions used a group model and were lay-led by peer supporters. Several studies did not report intervention intensity, fidelity and peer training and support in detail. Studies reporting positive effects employed more behaviour change techniques (BCT) than studies reporting no effect; however, heterogeneity between studies was considerable. CONCLUSIONS As evidence was mixed, further interventions need to assess the effect of PSI on dietary behaviour, describe intervention content (theoretical basis, BCT, intensity and peer training/support) and include a detailed process evaluation.
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Bull ER, McCleary N, Li X, Dombrowski SU, Dusseldorp E, Johnston M. Interventions to Promote Healthy Eating, Physical Activity and Smoking in Low-Income Groups: a Systematic Review with Meta-Analysis of Behavior Change Techniques and Delivery/Context. Int J Behav Med 2018; 25:605-616. [PMID: 30003476 PMCID: PMC6244564 DOI: 10.1007/s12529-018-9734-z] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE Healthy eating, physical activity and smoking interventions for low-income groups may have small, positive effects. Identifying effective intervention components could guide intervention development. This study investigated which content and delivery components of interventions were associated with increased healthy behavior in randomised controlled trials (RCTs) for low-income adults. METHOD Data from a review showing intervention effects in 35 RCTs containing 45 interventions with 17,000 participants were analysed to assess associations with behavior change techniques (BCTs) and delivery/context components from the template for intervention description and replication (TIDieR) checklist. The associations of 46 BCTs and 14 delivery/context components with behavior change (measures of healthy eating, physical activity and smoking cessation) were examined using random effects subgroup meta-analyses. Synergistic effects of components were examined using classification and regression trees (meta-CART) analyses based on both fixed and random effects assumptions. RESULTS For healthy eating, self-monitoring, delivery through personal contact, and targeting multiple behaviors were associated with increased effectiveness. Providing feedback, information about emotional consequences, or using prompts and cues were associated with reduced effectiveness. In synergistic analyses, interventions were most effective without feedback, or with self-monitoring excluding feedback. More effective physical activity interventions included behavioral practice/rehearsal or instruction, focussed solely on physical activity or took place in home/community settings. Information about antecedents was associated with reduced effectiveness. In synergistic analyses, interventions were most effective in home/community settings with instruction. No associations were identified for smoking. CONCLUSION This study identified BCTs and delivery/context components, individually and synergistically, linked to increased and reduced effectiveness of healthy eating and physical activity interventions. The identified components should be subject to further experimental study to help inform the development effective behavior change interventions for low-income groups to reduce health inequalities.
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Affiliation(s)
- Eleanor R Bull
- Manchester Metropolitan University, Manchester, UK.
- University of Manchester, Manchester, UK.
| | | | - Xinru Li
- Mathematical Institute, Leiden University, Leiden, the Netherlands
| | | | - Elise Dusseldorp
- Institute of Psychology, Leiden University, Leiden, the Netherlands
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It Takes a Village Coach: Cost-Effectiveness of an Intervention to Improve Diet and Physical Activity Among Minority Women. J Phys Act Health 2018; 15:819-826. [PMID: 30309276 DOI: 10.1123/jpah.2017-0285] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND This study gauged the cost-effectiveness of a community-based health coaching intervention aimed at improving diet and physical activity among women in culturally diverse communities. METHODS The Coalition for a Healthier Community for Utah Women and Girls recruited women from 5 cultural and ethnic groups and randomized them to receive quarterly versus monthly health coaching. Coaching was performed by trained community health workers from the targeted communities. Cost-effectiveness ratios were estimated to gauge the cost-effectiveness of the intervention. RESULTS Estimated quality-adjusted life years gained from both increased physical activity and improved diet were positive. Cost-effectiveness ratios varied by intervention arm, but all ratios fell within the favorable range described in the literature. CONCLUSIONS This culturally adapted health coaching intervention was deemed to be cost-effective. Our findings suggest that to achieve the highest level of cost-effectiveness, programs should focus on enrolling at-risk women who do not meet recommended physical activity standards and/or dietary guidelines.
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McEvoy CT, Moore SE, Appleton KM, Cupples ME, Erwin CM, Hunter SJ, Kee F, McCance D, Patterson CC, Young IS, McKinley MC, Woodside JV. Trial to Encourage Adoption and Maintenance of a Mediterranean Diet (TEAM-MED): Protocol for a Randomised Feasibility Trial of a Peer Support Intervention for Dietary Behaviour Change in Adults at High Cardiovascular Disease Risk. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E1130. [PMID: 30720783 PMCID: PMC6025132 DOI: 10.3390/ijerph15061130] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 05/27/2018] [Accepted: 05/29/2018] [Indexed: 12/22/2022]
Abstract
Adoption of a Mediterranean diet (MD) reduces cardiovascular disease (CVD) risk. However, interventions to achieve dietary behaviour change are typically resource intensive. Peer support offers a potentially low-cost approach to encourage dietary change. The primary objective of this randomised controlled trial is to explore the feasibility of peer support versus a previously tested dietetic-led intervention to encourage MD behaviour change, and to test recruitment strategies, retention and attrition in order to inform the design of a definitive trial. A total of 75 overweight adults at high CVD risk who do not follow a MD (Mediterranean Diet Score (MDS ≤ 3)) will be randomly assigned to either: a minimal intervention (written materials), a proven intervention (dietetic support, written materials and key MD foods), or a peer support intervention (group-based community programme delivered by lay peers) for 12 months. The primary end-point is change in MDS from baseline to 6 months (adoption of MD). Secondary end-points include: change in MDS from 6 to 12 months (maintenance of MD), effects on nutritional biomarkers and CVD risk factors, fidelity of implementation, acceptability and feasibility of the peer support intervention. This study will generate important data regarding the feasibility of peer support for ease of adoption of MD in an 'at risk' Northern European population. Data will be used to direct a larger scale trial, where the clinical efficacy and cost-effectiveness of peer support will be tested.
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Affiliation(s)
- Claire T McEvoy
- Centre for Public Health, Queen's University Belfast, Grosvenor Road, Belfast BT12 6BJ, UK.
| | - Sarah E Moore
- Centre for Public Health, Queen's University Belfast, Grosvenor Road, Belfast BT12 6BJ, UK.
| | - Katherine M Appleton
- Department of Psychology, Faculty of Science and Technology, Bournemouth University, Fern Barrow, Talbot Campus, Bournemouth BH12 5BB, UK.
| | - Margaret E Cupples
- Centre for Public Health, Queen's University Belfast, Grosvenor Road, Belfast BT12 6BJ, UK.
- UK Clinical Research Collaboration, Centre of Excellence for Public Health, Queen's University Belfast, Grosvenor Road, Belfast BT12 6BJ, UK.
| | - Christina M Erwin
- Centre for Public Health, Queen's University Belfast, Grosvenor Road, Belfast BT12 6BJ, UK.
| | - Steven J Hunter
- Belfast Health and Social Care Trust, Diabetes and Endocrinology, Grosvenor Road, Belfast BT12 6BA, UK.
| | - Frank Kee
- Centre for Public Health, Queen's University Belfast, Grosvenor Road, Belfast BT12 6BJ, UK.
- UK Clinical Research Collaboration, Centre of Excellence for Public Health, Queen's University Belfast, Grosvenor Road, Belfast BT12 6BJ, UK.
| | - David McCance
- Belfast Health and Social Care Trust, Diabetes and Endocrinology, Grosvenor Road, Belfast BT12 6BA, UK.
| | - Christopher C Patterson
- Centre for Public Health, Queen's University Belfast, Grosvenor Road, Belfast BT12 6BJ, UK.
- UK Clinical Research Collaboration, Centre of Excellence for Public Health, Queen's University Belfast, Grosvenor Road, Belfast BT12 6BJ, UK.
| | - Ian S Young
- Centre for Public Health, Queen's University Belfast, Grosvenor Road, Belfast BT12 6BJ, UK.
- UK Clinical Research Collaboration, Centre of Excellence for Public Health, Queen's University Belfast, Grosvenor Road, Belfast BT12 6BJ, UK.
| | - Michelle C McKinley
- Centre for Public Health, Queen's University Belfast, Grosvenor Road, Belfast BT12 6BJ, UK.
- UK Clinical Research Collaboration, Centre of Excellence for Public Health, Queen's University Belfast, Grosvenor Road, Belfast BT12 6BJ, UK.
| | - Jayne V Woodside
- Centre for Public Health, Queen's University Belfast, Grosvenor Road, Belfast BT12 6BJ, UK.
- UK Clinical Research Collaboration, Centre of Excellence for Public Health, Queen's University Belfast, Grosvenor Road, Belfast BT12 6BJ, UK.
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The Effect of a Social Cognitive Theory-Based Intervention on Fast Food Consumption Among Students. IRANIAN JOURNAL OF PSYCHIATRY AND BEHAVIORAL SCIENCES 2018. [DOI: 10.5812/ijpbs.10805] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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21
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Simonsen SE, Ralls B, Guymon A, Garrett T, Eisenman P, Villalta J, Tavake-Pasi OF, Mukundente V, Davis FA, Digre K, Hayes S, Alexander S. Addressing Health Disparities from Within the Community: Community-Based Participatory Research and Community Health Worker Policy Initiatives Using a Gender-Based Approach. Womens Health Issues 2017; 27 Suppl 1:S46-S53. [DOI: 10.1016/j.whi.2017.09.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 08/30/2017] [Accepted: 09/07/2017] [Indexed: 01/15/2023]
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Jilcott Pitts SB, Keyserling TC, Johnston LF, Evenson KR, McGuirt JT, Gizlice Z, Whitt OR, Ammerman AS. Examining the Association between Intervention-Related Changes in Diet, Physical Activity, and Weight as Moderated by the Food and Physical Activity Environments among Rural, Southern Adults. J Acad Nutr Diet 2017; 117:1618-1627. [PMID: 28606554 PMCID: PMC5623155 DOI: 10.1016/j.jand.2017.04.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 04/10/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Few studies have been conducted in rural areas assessing the influence of community-level environmental factors on residents' success improving lifestyle behaviors. OBJECTIVE Our aim was to examine whether 6-month changes in diet, physical activity, and weight were moderated by the food and physical activity environment in a rural adult population receiving an intervention designed to improve diet and physical activity. DESIGN We examined associations between self-reported and objectively measured changes in diet, physical activity, and weight, and perceived and objectively measured food and physical activity environments. Participants were followed for 6 months. PARTICIPANTS/SETTING Participants were enrolled in the Heart Healthy Lenoir Project, a lifestyle intervention study conducted in Lenoir County, located in rural southeastern North Carolina. Sample sizes ranged from 132 to 249, depending on the availability of the data. INTERVENTION Participants received four counseling sessions that focused on healthy eating (adapted Mediterranean diet pattern) and increasing physical activity. POTENTIAL MODERATING FACTORS Density of and distance to food and physical activity venues, modified food environment index, Walk Score, crime, and perceived nutrition and physical activity neighborhood barriers were the potential mediating factors. OUTCOME MEASURES Diet quality, physical activity, and weight loss were the outcomes measured. STATISTICAL ANALYSES Statistical analyses included correlation and linear regression and controlling for potential confounders (baseline values of the dependent variables, age, race, education, and sex). RESULTS In adjusted analysis, there was an inverse association between weight change and the food environment, suggesting that participants who lived in a less-healthy food environment lost more weight during the 6-month intervention period (P=0.01). Also, there was a positive association between self-reported physical activity and distance to private gyms (P=0.04) and an inverse association between private gym density and pedometer-measured steps (P=0.03), indicating that those who lived farther from gyms and in areas with lower density of gyms had greater increases in physical activity and steps, respectively. CONCLUSIONS Contrary to our hypotheses, results indicated that those living in less-favorable food and physical activity environments had greater improvements in diet, physical activity, and weight, compared to those living in more favorable environments. Additional research should be undertaken to address these paradoxical findings and, if confirmed, to better understand them.
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Meader N, King K, Wright K, Graham HM, Petticrew M, Power C, White M, Sowden AJ. Multiple Risk Behavior Interventions: Meta-analyses of RCTs. Am J Prev Med 2017; 53:e19-e30. [PMID: 28258777 DOI: 10.1016/j.amepre.2017.01.032] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 12/05/2016] [Accepted: 01/23/2017] [Indexed: 11/17/2022]
Abstract
CONTEXT Multiple risk behaviors are common and associated with developing chronic conditions such as heart disease, cancer, or Type 2 diabetes. A systematic review, meta-analysis, and meta-regression of the effectiveness of multiple risk behavior interventions was conducted. EVIDENCE ACQUISITION Six electronic databases including MEDLINE, EMBASE, and PsycINFO were searched to August 2016. RCTs of non-pharmacologic interventions in general adult populations were selected. Studies targeting specific at-risk groups (such as people screened for cardiovascular risk factors or obesity) were excluded. Studies were screened independently. Study characteristics and outcomes were extracted and risk of bias assessed by one researcher and checked by another. The Behaviour Change Wheel and Oxford Implementation Index were used to code intervention content and context. EVIDENCE SYNTHESIS Random-effects meta-analyses were conducted. Sixty-nine trials involving 73,873 individuals were included. Interventions mainly comprised education and skills training and were associated with modest improvements in most risk behaviors: increased fruit and vegetable intake (0.31 portions, 95% CI=0.17, 0.45) and physical activity (standardized mean difference, 0.25; 95% CI=0.13, 0.38), and reduced fat intake (standardized mean difference, -0.24; 95% CI=-0.36, -0.12). Although reductions in smoking were found (OR=0.78, 95% CI=0.68, 0.90), they appeared to be negatively associated with improvement in other behaviors (such as diet and physical activity). Preliminary evidence suggests that sequentially changing smoking alongside other risk behaviors was more effective than simultaneous change. But most studies assessed simultaneous rather than sequential change in risk behaviors; therefore, comparisons are sparse. Follow-up period and intervention characteristics impacted effectiveness for some outcomes. CONCLUSIONS Interventions comprising education (e.g., providing information about behaviors associated with health risks) and skills training (e.g., teaching skills that equip participants to engage in less risky behavior) and targeting multiple risk behaviors concurrently are associated with small changes in diet and physical activity. Although on average smoking was reduced, it appeared changes in smoking were negatively associated with changes in other behaviors, suggesting it may not be optimal to target smoking simultaneously with other risk behaviors.
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Affiliation(s)
- Nick Meader
- Centre for Reviews and Dissemination, University of York, York, United Kingdom
| | - Kristelle King
- Centre for Reviews and Dissemination, University of York, York, United Kingdom
| | - Kath Wright
- Centre for Reviews and Dissemination, University of York, York, United Kingdom
| | - Hilary M Graham
- Department of Health Sciences, University of York, York, United Kingdom
| | - Mark Petticrew
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Chris Power
- Population, Policy, and Practice, UCL Institute of Child Health, London, United Kingdom
| | - Martin White
- UKCRC Centre for Diet and Activity Research (CEDAR), MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Amanda J Sowden
- Centre for Reviews and Dissemination, University of York, York, United Kingdom.
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Schuette SAP, Cordero E, Slosburg K, Addington EL, Victorson D. A Scoping Review of Positive Lifestyle and Wellness Interventions to Inform the Development of a Comprehensive Health Promotion Program: "HealthPro". Am J Lifestyle Med 2017; 13:336-346. [PMID: 31285713 DOI: 10.1177/1559827617704825] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 03/23/2017] [Accepted: 03/24/2017] [Indexed: 11/17/2022] Open
Abstract
Background. Lifestyle medicine has emerged as a transformational force in mainstream health care. Numerous health promotion and wellness programs have been created to facilitate the adoption of increased positive, modifiable health behaviors to prevent and lessen the effects of chronic disease. This article provides a scoping review of available health promotion interventions that focus on healthy adult populations in the past 10 years. Methods. We conducted a scoping review of the literature searching for health promotion interventions in the past 10 years. Interventions were limited to those conducted among healthy adults that offered a face-to-face, group-based format, with positive results on one or more health outcomes. We then developed a new health promotion intervention that draws on multiple components of included interventions. Results. Fifty-eight articles met our inclusion criteria. Physical activity was the primary focus of a majority (N = 47) of articles, followed by diet/nutrition (N = 40) and coping/social support (N = 40). Conclusions. Efficacious health promotion interventions are critical to address the prevention of chronic disease by addressing modifiable risk factors such as exercise, nutrition, stress, and coping. A new intervention, discussed is this article, provides a comprehensive approaches to health behavior change and may be adapted for future research.
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Affiliation(s)
- Stephanie A P Schuette
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois (SAPS, EC, KS, ELA, DV).,Osher Center for Integrative Medicine at Northwestern, Northwestern Medicine, Chicago, Illinois (SAPS, ELA, DV)
| | - Evelyn Cordero
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois (SAPS, EC, KS, ELA, DV).,Osher Center for Integrative Medicine at Northwestern, Northwestern Medicine, Chicago, Illinois (SAPS, ELA, DV)
| | - Katherine Slosburg
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois (SAPS, EC, KS, ELA, DV).,Osher Center for Integrative Medicine at Northwestern, Northwestern Medicine, Chicago, Illinois (SAPS, ELA, DV)
| | - Elizabeth L Addington
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois (SAPS, EC, KS, ELA, DV).,Osher Center for Integrative Medicine at Northwestern, Northwestern Medicine, Chicago, Illinois (SAPS, ELA, DV)
| | - David Victorson
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois (SAPS, EC, KS, ELA, DV).,Osher Center for Integrative Medicine at Northwestern, Northwestern Medicine, Chicago, Illinois (SAPS, ELA, DV)
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Embree GGR, Samuel-Hodge CD, Johnston LF, Garcia BA, Gizlice Z, Evenson KR, DeWalt DA, Ammerman AS, Keyserling TC. Successful long-term weight loss among participants with diabetes receiving an intervention promoting an adapted Mediterranean-style dietary pattern: the Heart Healthy Lenoir Project. BMJ Open Diabetes Res Care 2017; 5:e000339. [PMID: 28405344 PMCID: PMC5372065 DOI: 10.1136/bmjdrc-2016-000339] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 02/02/2017] [Accepted: 02/20/2017] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE To examine weight change by diabetes status among participants receiving a Mediterranean-style diet, physical activity, and weight loss intervention adapted for delivery in the southeastern USA, where rates of cardiovascular disease (CVD) are disproportionately high. RESEARCH DESIGN AND METHODS The intervention included: Phase I (months 1-6), an individually tailored intervention promoting a Mediterranean-style dietary pattern and increased walking; Phase II (months 7-12), option of a 16-week weight loss intervention for those with BMI≥25 kg/m2 offered as 16 weekly group sessions or 5 group sessions and 10 phone calls, or a lifestyle maintenance intervention; and Phase III (months 13-24), weight loss maintenance intervention for those losing ≥8 pounds with all others receiving a lifestyle maintenance intervention. Weight change was assessed at 6, 12, and 24-month follow-up. RESULTS Baseline characteristics (n=339): mean age 56, 77% female, 65% African-American, 124 (37%) with diabetes; mean weight 103 kg for those with diabetes and 95 kg for those without. Among participants with diabetes, average weight change was -1.2 kg (95% CI -2.1 to -0.4) at 6 months (n=92), -1.5 kg (95% CI -2.9 to -0.2) at 12 months (n=96), and -3.7 kg (95% CI -5.2 to -2.1) at 24 months (n=93). Among those without diabetes, weight change was -0.4 kg (95% CI -1.4 to 0.6) at 24 months (n=154). CONCLUSIONS Participants with diabetes experienced sustained weight loss at 24-month follow-up. High-risk US populations with diabetes may experience clinically important weight loss from this type of lifestyle intervention. TRIAL REGISTRATION NUMBER NCT01433484.
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Affiliation(s)
- Genevieve G R Embree
- Ambulatory Care Physician, Durham VA Medical Center, Durham, North Carolina, USA
| | - Carmen D Samuel-Hodge
- Department of Nutrition, Center for Health Promotion and Disease Prevention, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA; Center for Health Promotion and Disease Prevention, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Larry F Johnston
- Center for Health Promotion and Disease Prevention, University of North Carolina , Chapel Hill, North Carolina , USA
| | - Beverly A Garcia
- Center for Health Promotion and Disease Prevention, University of North Carolina , Chapel Hill, North Carolina , USA
| | - Ziya Gizlice
- Center for Health Promotion and Disease Prevention, University of North Carolina , Chapel Hill, North Carolina , USA
| | - Kelly R Evenson
- Department of Epidemiology , Gillings School of Global Public Health, University of North Carolina , Chapel Hill, North Carolina , USA
| | - Darren A DeWalt
- Division of General Medicine and Clinical Epidemiology , School of Medicine, University of North Carolina , Chapel Hill, North Carolina , USA
| | - Alice S Ammerman
- Department of Nutrition, Center for Health Promotion and Disease Prevention, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA; Center for Health Promotion and Disease Prevention, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Thomas C Keyserling
- Center for Health Promotion and Disease Prevention, University of North Carolina, Chapel Hill, North Carolina, USA; Division of General Medicine and Clinical Epidemiology, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
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Keyserling TC, Samuel-Hodge CD, Pitts SJ, Garcia BA, Johnston LF, Gizlice Z, Miller CL, Braxton DF, Evenson KR, Smith JC, Davis GB, Quenum EL, Elliott NTM, Gross MD, Donahue KE, Halladay JR, Ammerman AS. A community-based lifestyle and weight loss intervention promoting a Mediterranean-style diet pattern evaluated in the stroke belt of North Carolina: the Heart Healthy Lenoir Project. BMC Public Health 2016; 16:732. [PMID: 27495295 PMCID: PMC4975883 DOI: 10.1186/s12889-016-3370-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 07/23/2016] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Because residents of the southeastern United States experience disproportionally high rates of cardiovascular disease (CVD), it is important to develop effective lifestyle interventions for this population. METHODS The primary objective was to develop and evaluate a dietary, physical activity (PA) and weight loss intervention for residents of the southeastern US. The intervention, given in eastern North Carolina, was evaluated in a 2 year prospective cohort study with an embedded randomized controlled trial (RCT) of a weight loss maintenance intervention. The intervention included: Phase I (months 1-6), individually-tailored intervention promoting a Mediterranean-style dietary pattern and increased walking; Phase II (months 7-12), option of a 16-week weight loss intervention for those with BMI ≥ 25 kg/m(2) offered in 2 formats (16 weekly group sessions or 5 group sessions and 10 phone calls) or a lifestyle maintenance intervention; and Phase III (months 13-24), weight loss maintenance RCT for those losing ≥ 8 lb with all other participants receiving a lifestyle maintenance intervention. Change in diet and PA behaviors, CVD risk factors, and weight were assessed at 6, 12, and 24 month follow-up. RESULTS Baseline characteristics (N = 339) were: 260 (77 %) females, 219 (65 %) African Americans, mean age 56 years, and mean body mass index 36 kg/m(2). In Phase I, among 251 (74 %) that returned for 6 month follow-up, there were substantial improvements in diet score (4.3 units [95 % CI 3.7 to 5.0]), walking (64 min/week [19 to 109]), and systolic blood pressure (-6.4 mmHg [-8.7 to -4.1]) that were generally maintained through 24 month follow-up. In Phase II, 138 (57 group only, 81 group/phone) chose the weight loss intervention and at 12 months, weight change was: -3.1 kg (-4.9 to -1.3) for group (N = 50) and -2.1 kg (-3.2 to -1.0) for group/phone combination (N = 75). In Phase III, 27 participants took part in the RCT. At 24 months, weight loss was -2.1 kg (-4.3 to 0.0) for group (N = 51) and -1.1 kg (-2.7 to 0.4) for combination (N = 72). Outcomes for African American and whites were similar. CONCLUSIONS The intervention yielded substantial improvement in diet, PA, and blood pressure, but weight loss was modest. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01433484.
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Affiliation(s)
- Thomas C. Keyserling
- Division of General Medicine and Clinical Epidemiology, Department of Medicine, School of Medicine, CB 7110, University of North Carolina, 5039 Old Clinic Building, Chapel Hill, NC 27599 USA
- Center for Health Promotion and Disease Prevention (a CDC Prevention Research Center), CB 7426, University of North Carolina, Chapel Hill, NC 27599 USA
| | - Carmen D. Samuel-Hodge
- Center for Health Promotion and Disease Prevention (a CDC Prevention Research Center), CB 7426, University of North Carolina, Chapel Hill, NC 27599 USA
- Department of Nutrition, Gillings School of Global Public Health, CB 7461, University of North Carolina, Chapel Hill, NC 27599 USA
| | - Stephanie Jilcott Pitts
- Department of Public Health, Brody School of Medicine, East Carolina University, Lakeside Annex 8, 600 Moye Blvd, MS 660, Greenville, NC 27834 USA
| | - Beverly A. Garcia
- Center for Health Promotion and Disease Prevention (a CDC Prevention Research Center), CB 7426, University of North Carolina, Chapel Hill, NC 27599 USA
| | - Larry F. Johnston
- Center for Health Promotion and Disease Prevention (a CDC Prevention Research Center), CB 7426, University of North Carolina, Chapel Hill, NC 27599 USA
| | - Ziya Gizlice
- Center for Health Promotion and Disease Prevention (a CDC Prevention Research Center), CB 7426, University of North Carolina, Chapel Hill, NC 27599 USA
| | - Cassandra L. Miller
- Center for Health Promotion and Disease Prevention (a CDC Prevention Research Center), CB 7426, University of North Carolina, Chapel Hill, NC 27599 USA
| | - Danielle F. Braxton
- Center for Health Promotion and Disease Prevention (a CDC Prevention Research Center), CB 7426, University of North Carolina, Chapel Hill, NC 27599 USA
- Department of Nutrition, Gillings School of Global Public Health, CB 7461, University of North Carolina, Chapel Hill, NC 27599 USA
| | - Kelly R. Evenson
- Department of Epidemiology, Gillings School of Global Public Health, CB 8050, University of North Carolina, Chapel Hill, NC 27599 USA
| | - Janice C. Smith
- Center for Health Promotion and Disease Prevention (a CDC Prevention Research Center), CB 7426, University of North Carolina, Chapel Hill, NC 27599 USA
| | - Gwen B. Davis
- Center for Health Promotion and Disease Prevention (a CDC Prevention Research Center), CB 7426, University of North Carolina, Chapel Hill, NC 27599 USA
| | - Emmanuelle L. Quenum
- Greene County Health Department, 225 Kingold Blvd, Suite B, Snow Hill, North Carolina 28580 USA
| | - Nadya T. Majette Elliott
- Student Health Services, East Carolina University, 1000 East 5th St, MS 408, Greenville, NC 27858 USA
| | - Myron D. Gross
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN 55455 USA
| | - Katrina E. Donahue
- Department of Family Medicine, School of Medicine, CB 7595, University of North Carolina, Chapel Hill, NC 27599 USA
| | - Jacqueline R. Halladay
- Department of Family Medicine, School of Medicine, CB 7595, University of North Carolina, Chapel Hill, NC 27599 USA
- Cecil G. Sheps Center for Health Services Research, School of Medicine, CB 7590, University of North Carolina, Chapel Hill, NC 27599 USA
| | - Alice S. Ammerman
- Center for Health Promotion and Disease Prevention (a CDC Prevention Research Center), CB 7426, University of North Carolina, Chapel Hill, NC 27599 USA
- Department of Nutrition, Gillings School of Global Public Health, CB 7461, University of North Carolina, Chapel Hill, NC 27599 USA
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Ritten A, Waldrop J, Kitson J. Fit living in progress – fighting lifelong obesity patterns (FLIP-FLOP): A nurse practitioner delivered intervention. Appl Nurs Res 2016; 30:119-24. [DOI: 10.1016/j.apnr.2015.09.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 09/25/2015] [Accepted: 09/27/2015] [Indexed: 10/23/2022]
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Kandula NR, Dave S, De Chavez PJ, Bharucha H, Patel Y, Seguil P, Kumar S, Baker DW, Spring B, Siddique J. Translating a heart disease lifestyle intervention into the community: the South Asian Heart Lifestyle Intervention (SAHELI) study; a randomized control trial. BMC Public Health 2015; 15:1064. [PMID: 26475629 PMCID: PMC4609098 DOI: 10.1186/s12889-015-2401-2] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 10/07/2015] [Indexed: 11/10/2022] Open
Abstract
Background South Asians (Asian Indians and Pakistanis) are the second fastest growing ethnic group in the United States (U.S.) and have an increased risk of atherosclerotic cardiovascular disease (ASCVD). This pilot study evaluated a culturally-salient, community-based healthy lifestyle intervention to reduce ASCVD risk among South Asians. Methods Through an academic-community partnership, medically underserved South Asian immigrants at risk for ASCVD were randomized into the South Asian Heart Lifestyle Intervention (SAHELI) study. The intervention group attended 6 interactive group classes focused on increasing physical activity, healthful diet, weight, and stress management. They also received follow-up telephone support calls. The control group received translated print education materials about ASCVD and healthy behaviors. Primary outcomes were feasibility and initial efficacy, measured as change in moderate/vigorous physical activity and dietary saturated fat intake at 3- and 6-months. Secondary clinical and psychosocial outcomes were also measured. Results Participants’ (n = 63) average age was 50 (SD = 8) years, 63 % were female, 27 % had less than or equal to a high school education, one-third were limited English proficient, and mean BMI was 30 kg/m2 (SD ± 5). There were no significant differences in change in physical activity or saturated fat intake between the intervention and control group. Compared to the control group, the intervention group showed significant weight loss (−1.5 kg, p-value = 0.04) and had a greater sex-adjusted decrease in hemoglobin A1C (−0.43 %, p-value <0.01) at 6 months. Study retention was 100 %. Conclusions This pilot study suggests that a culturally-salient, community-based lifestyle intervention was feasible for engaging medically underserved South Asian immigrants and more effective at addressing ASCVD risk factors than print health education materials. Trial registration NCT01647438, Date of Trial Registration: July 19, 2012 Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-2401-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Namratha R Kandula
- Department of General Internal Medicine, Northwestern University Feinberg School of Medicine, 750 N Lake Shore Drive, 10th Floor, Chicago, IL, 60611, USA. .,Department of Preventive Medicine, Northwestern University, 680 N Lake Shore Drive, Suite 1400, Chicago, IL, 60611, USA.
| | - Swapna Dave
- Department of General Internal Medicine, Northwestern University Feinberg School of Medicine, 750 N Lake Shore Drive, 10th Floor, Chicago, IL, 60611, USA.
| | - Peter John De Chavez
- Department of Preventive Medicine, Northwestern University, 680 N Lake Shore Drive, Suite 1400, Chicago, IL, 60611, USA.
| | - Himali Bharucha
- Metropolitan Asian Family Services, 7541 N Western Avenue, Chicago, IL, 60645, USA.
| | - Yasin Patel
- National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD, USA.
| | - Paola Seguil
- Department of General Internal Medicine, Northwestern University Feinberg School of Medicine, 750 N Lake Shore Drive, 10th Floor, Chicago, IL, 60611, USA.
| | - Santosh Kumar
- Metropolitan Asian Family Services, 7541 N Western Avenue, Chicago, IL, 60645, USA.
| | - David W Baker
- Department of General Internal Medicine, Northwestern University Feinberg School of Medicine, 750 N Lake Shore Drive, 10th Floor, Chicago, IL, 60611, USA.
| | - Bonnie Spring
- Department of Preventive Medicine, Northwestern University, 680 N Lake Shore Drive, Suite 1400, Chicago, IL, 60611, USA.
| | - Juned Siddique
- Department of Preventive Medicine, Northwestern University, 680 N Lake Shore Drive, Suite 1400, Chicago, IL, 60611, USA.
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Amiri Farahani L, Asadi-Lari M, Mohammadi E, Parvizy S, Haghdoost AA, Taghizadeh Z. Community-based physical activity interventions among women: a systematic review. BMJ Open 2015; 5:e007210. [PMID: 25833668 PMCID: PMC4390687 DOI: 10.1136/bmjopen-2014-007210] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Review and assess the effectiveness of community-based physical activity interventions among women aged 18-65 years. DESIGN Systematic review METHODS To find relevant articles, the researcher selected reports published in English between 1 January 2000 and 31 March 2013. Systematic search was to find controlled-trial studies that were conducted to uncover the effect of community-based interventions to promote physical activity among women 18-65 years of age, in which physical activity was reported as one of the measured outcomes. The methodological quality assessment was performed using a critical appraisal sheet. Also, the levels of evidence were assessed for the types of interventions. RESULTS The literature search identified nine articles. Four of the studies were randomised and the others studies had high methodological quality. There was no evidence, on the basis of effectiveness, for social cognitive theory-based interventions and inconclusive evidence of effectiveness for the rest of interventions. CONCLUSIONS There is insufficient evidence to assess the effectiveness of community-based interventions for enhancing physical activity among women. There is a need for high-quality randomised clinical trials with adequate statistical power to determine whether multicomponent and community-based intervention programmes increase physical activity among women, as well as to determine what type of interventions have a more effective and sustainable impact on women's physical activity.
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Affiliation(s)
- Leila Amiri Farahani
- Department of Midwifery, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Asadi-Lari
- DG Int'l Relations Department, MOHME, IR Iran Head- Oncopathology Research Centre, IUMS, Tehran, Iran
| | - Eesa Mohammadi
- Nursing Department, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Soroor Parvizy
- Department of Pediatric Nursing, Nursing and Midwifery Faculty, Iran University of Medical Sciences, Tehran, Iran
- Centre for educational Research in Medical Sciences (CERMS) Iran University of Medical Sciences, Tehran, Iran
| | - Ali Akbar Haghdoost
- The Research Centre for Modelling in Health, Institute for Future Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Ziba Taghizadeh
- Faculty Member of Nursing and Midwifery Care Research Centre, Nursing and Midwifery School, Tehran University of Medical Sciences, Tehran, Iran
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Wilson K, Senay I, Durantini M, Sánchez F, Hennessy M, Spring B, Albarracín D. When it comes to lifestyle recommendations, more is sometimes less: a meta-analysis of theoretical assumptions underlying the effectiveness of interventions promoting multiple behavior domain change. Psychol Bull 2015; 141:474-509. [PMID: 25528345 PMCID: PMC4801324 DOI: 10.1037/a0038295] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
A meta-analysis of 150 research reports summarizing the results of multiple behavior domain interventions examined theoretical predictions about the effects of the included number of recommendations on behavioral and clinical change in the domains of smoking, diet, and physical activity. The meta-analysis yielded 3 main conclusions. First, there is a curvilinear relation between the number of behavioral recommendations and improvements in behavioral and clinical measures, with a moderate number of recommendations producing the highest level of change. A moderate number of recommendations is likely to be associated with stronger effects because the intervention ensures the necessary level of motivation to implement the recommended changes, thereby increasing compliance with the goals set by the intervention, without making the intervention excessively demanding. Second, this curve was more pronounced when samples were likely to have low motivation to change, such as when interventions were delivered to nonpatient (vs. patient) populations, were implemented in nonclinic (vs. clinic) settings, used lay community (vs. expert) facilitators, and involved group (vs. individual) delivery formats. Finally, change in behavioral outcomes mediated the effects of number of recommended behaviors on clinical change. These findings provide important insights that can help guide the design of effective multiple behavior domain interventions.
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Abstract
BACKGROUND Although cardiovascular health has been improving for many Americans, this is not true of those in "vulnerable populations." To address this growing disparity, communities and researchers have worked for decades, and as a result of their work, a growing body of literature supports the use of community engagement as a component of successful interventions. However, little literature synthesizes community-based interventions that address this disparity among a wide range of vulnerable populations. OBJECTIVE This article provides a critical review of community-based cardiovascular disease interventions to improve cardiovascular health behaviors and factors among vulnerable populations based on the American Heart Association's 7 metrics of ideal cardiovascular health. METHODS In February 2011, 4 databases (PubMed, PsychInfo, CINAHL, and Scopus) were searched using the following keywords: vulnerable populations OR healthcare disparities AND cardiovascular disease AND clinical trials OR public health practice AND English. RESULTS This search strategy resulted in the retrieval of 7120 abstracts. Each abstract was reviewed by at least 2 authors, and eligibility for the systematic review was confirmed after reading the full article. Thirty-two studies met eligibility criteria. Education was the most common intervention (41%), followed by counseling or support (38%) and exercise classes (28%). Half of the interventions were multicomponent. Healthcare providers were the most frequent interventionists. Interventions aimed at decreasing blood pressure were the most promising, whereas behavior change interventions were the most challenging. Almost all of the interventions were at the individual level and were proof-of-concept or efficacy trials. CONCLUSIONS This analysis provides a step toward understanding the current literature on cardiovascular interventions for vulnerable population. The next step should be integrating the identified successful interventions into larger health systems and/or social policies.
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Bull ER, Dombrowski SU, McCleary N, Johnston M. Are interventions for low-income groups effective in changing healthy eating, physical activity and smoking behaviours? A systematic review and meta-analysis. BMJ Open 2014; 4:e006046. [PMID: 25432903 PMCID: PMC4248081 DOI: 10.1136/bmjopen-2014-006046] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 10/15/2014] [Accepted: 11/06/2014] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE To conduct a systematic review and meta-analysis examining the effectiveness of behavioural interventions targeting diet, physical activity or smoking in low-income adults. DESIGN Systematic review with random effects meta-analyses. Studies before 2006 were identified from a previously published systematic review (searching 1995-2006) with similar but broader inclusion criteria (including non-randomised controlled trials (RCTs)). Studies from 2006 to 2014 were identified from eight electronic databases using a similar search strategy. DATA SOURCES MEDLINE, EMBASE, PsycINFO, ASSIA, CINAHL, Cochrane Controlled Trials, Cochrane Systematic Review and DARE. ELIGIBILITY CRITERIA FOR SELECTING STUDIES RCTs and cluster RCTs published from 1995 to 2014; interventions targeting dietary, physical activity and smoking; low-income adults; reporting of behavioural outcomes. MAIN OUTCOME MEASURES Dietary, physical activity and smoking cessation behaviours. RESULTS 35 studies containing 45 interventions with 17,000 participants met inclusion criteria. At postintervention, effects were positive but small for diet (standardised mean difference (SMD) 0.22, 95% CI 0.14 to 0.29), physical activity (SMD 0.21, 95% CI 0.06 to 0.36) and smoking (relative risk (RR) of 1.59, 95% CI 1.34 to 1.89). Studies reporting follow-up results suggested that effects were maintained over time for diet (SMD 0.16, 95% CI 0.08 to 0.25) but not physical activity (SMD 0.17, 95% CI -0.02 to 0.37) or smoking (RR 1.11, 95% CI 0.93 to 1.34). CONCLUSIONS Behaviour change interventions for low-income groups had small positive effects on healthy eating, physical activity and smoking. Further work is needed to improve the effectiveness of behaviour change interventions for deprived populations.
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Affiliation(s)
| | - Stephan U Dombrowski
- Division of Psychology, School of Natural Sciences, University of Stirling, Stirling, UK
| | - Nicola McCleary
- Aberdeen Health Psychology Group, Institute of Applied Health Sciences, College of Life Sciences and Medicine, University of Aberdeen, Aberdeen, UK
| | - Marie Johnston
- Aberdeen Health Psychology Group, Institute of Applied Health Sciences, College of Life Sciences and Medicine, University of Aberdeen, Aberdeen, UK
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Agha G, Loucks EB, Tinker LF, Waring ME, Michaud DS, Foraker RE, Li W, Martin LW, Greenland P, Manson JE, Eaton CB. Healthy lifestyle and decreasing risk of heart failure in women: the Women's Health Initiative observational study. J Am Coll Cardiol 2014; 64:1777-85. [PMID: 25443698 PMCID: PMC4254927 DOI: 10.1016/j.jacc.2014.07.981] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 06/28/2014] [Accepted: 07/08/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND The impact of a healthy lifestyle on risk of heart failure (HF) is not well known. OBJECTIVES The objectives of this study were to evaluate the effect of a combination of lifestyle factors on incident HF and to further investigate whether weighting each lifestyle factor has additional impact. METHODS Participants were 84,537 post-menopausal women from the WHI (Women's Health Initiative) observational study, free of self-reported HF at baseline. A healthy lifestyle score (HL score) was created wherein women received 1 point for each healthy criterion met: high-scoring Alternative Healthy Eating Index, physically active, healthy body mass index, and currently not smoking. A weighted score (wHL score) was also created in which each lifestyle factor was weighted according to its independent magnitude of effect on HF. The incidence of hospitalized HF was determined by trained adjudicators using standardized methodology. RESULTS There were 1,826 HF cases over a mean follow-up of 11 years. HL score was strongly associated with risk of HF (multivariable-adjusted hazard ratio [HR] [95% confidence interval (CI)] 0.49 [95% CI: 0.38 to 0.62], 0.36 [95% CI: 0.28 to 0.46], 0.24 [95% CI: 0.19 to 0.31], and 0.23 [95% CI: 0.17 to 0.30] for HL score of 1, 2, 3, and 4 vs. 0, respectively). The HL score and wHL score were similarly associated with HF risk (HR: 0.46 [95% CI: 0.41 to 0.52] for HL score; HR: 0.48 [95% CI: 0.42 to 0.55] for wHL score, comparing the highest tertile to the lowest). The HL score was also strongly associated with HF risk among women without antecedent coronary heart disease, diabetes, or hypertension. CONCLUSIONS An increasingly healthy lifestyle was associated with decreasing HF risk among post-menopausal women, even in the absence of antecedent coronary heart disease, hypertension, and diabetes. Weighting the lifestyle factors had minimal impact.
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Affiliation(s)
- Golareh Agha
- Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts.
| | - Eric B Loucks
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island
| | | | - Molly E Waring
- Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Dominique S Michaud
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island
| | - Randi E Foraker
- Ohio State University, College of Public Health, Columbus, Ohio
| | - Wenjun Li
- Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Lisa W Martin
- George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Philip Greenland
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - JoAnn E Manson
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Charles B Eaton
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island; Department of Family Medicine, Alpert Medical School of Brown University, Providence, Rhode Island
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DeNysschen C, Brown JK, Baker M, Wilding G, Tetewsky S, Cho MH, Dodd MJ. Healthy Lifestyle Behaviors of Breast Cancer Survivors. Clin Nurs Res 2014; 24:504-25. [PMID: 25349070 DOI: 10.1177/1054773814553298] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The purpose of this secondary analysis was to describe the extent to which women with breast cancer, who participated in a randomized control trial on exercise, adopted American Cancer Society (ACS) guidelines for healthy lifestyle behaviors. Women in the study exercised during cancer treatment and for 6 months after completion of treatment. The sample included 106 women, average age 50.7 years (SD = 9.6). Adherence to guidelines for 5 servings of fruits and vegetables ranged from 36% (n = 28) to 39% (n = 36). Adherence with alcohol consumption guidelines was 71% (n = 28) to 83% (n = 30). Adherence with meeting a healthy weight ranged from 52% (n = 33) to 61% (n = 31). Adherence with physical activity guidelines ranged from 13% (n = 30) to 31% (n = 35). Alcohol and healthy weight guidelines were followed by more than half of the participants, but physical activity and dietary guidelines were followed by far fewer women. Further prospective clinical studies are indicated to determine whether interventions are effective in producing a healthy lifestyle in cancer survivors.
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Affiliation(s)
| | | | - Mark Baker
- The State University of New York, Buffalo, USA
| | | | | | - Maria H Cho
- California State University, East Bay, Hayward, USA
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Keyserling TC, Sheridan SL, Draeger LB, Finkelstein EA, Gizlice Z, Kruger E, Johnston LF, Sloane PD, Samuel-Hodge C, Evenson KR, Gross MD, Donahue KE, Pignone MP, Vu MB, Steinbacher EA, Weiner BJ, Bangdiwala SI, Ammerman AS. A comparison of live counseling with a web-based lifestyle and medication intervention to reduce coronary heart disease risk: a randomized clinical trial. JAMA Intern Med 2014; 174:1144-57. [PMID: 24861959 PMCID: PMC4142754 DOI: 10.1001/jamainternmed.2014.1984] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
IMPORTANCE Most primary care clinicians lack the skills and resources to offer effective lifestyle and medication (L&M) counseling to reduce coronary heart disease (CHD) risk. Thus, effective and feasible CHD prevention programs are needed for typical practice settings. OBJECTIVE To assess the effectiveness, acceptability, and cost-effectiveness of a combined L&M intervention to reduce CHD risk offered in counselor-delivered and web-based formats. DESIGN, SETTING, AND PARTICIPANTS A comparative effectiveness trial in 5 diverse family medicine practices in North Carolina. Participants were established patients, aged 35 to 79 years, with no known cardiovascular disease, and at moderate to high risk for CHD (10-year Framingham Risk Score [FRS], ≥10%). INTERVENTIONS Participants were randomized to counselor-delivered or web-based format, each including 4 intensive and 3 maintenance sessions. After randomization, both formats used a web-based decision aid showing potential CHD risk reduction associated with L&M risk-reducing strategies. Participants chose the risk-reducing strategies they wished to follow. MAIN OUTCOMES AND MEASURES The primary outcome was within-group change in FRS at 4-month follow-up. Other measures included standardized assessments of blood pressure, blood lipid levels, lifestyle behaviors, and medication adherence. Acceptability and cost-effectiveness were also assessed. Outcomes were assessed at 4 and 12 months. RESULTS Of 2274 screened patients, 385 were randomized (192 counselor; 193 web): mean age, 62 years; 24% African American; and mean FRS, 16.9%. Follow-up at 4 and 12 months included 91% and 87% of the randomized participants, respectively. There was a sustained reduction in FRS at both 4 months (primary outcome) and 12 months for both counselor-based (-2.3% [95% CI, -3.0% to -1.6%] and -1.9% [95% CI, -2.8% to -1.1%], respectively) and web-based groups (-1.5% [95% CI, -2.2% to -0.9%] and -1.7% [95% CI, -2.6% to -0.8%] respectively). At 4 months, the adjusted difference in FRS between groups was -1.0% (95% CI, -1.8% to -0.1%) (P = .03), and at 12 months, it was -0.6% (95% CI, -1.7% to 0.5%) (P = .30). The 12-month costs from the payer perspective were $207 and $110 per person for the counselor- and web-based interventions, respectively. CONCLUSIONS AND RELEVANCE Both intervention formats reduced CHD risk through 12-month follow-up. The web format was less expensive. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01245686.
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Affiliation(s)
- Thomas C Keyserling
- Division of General Medicine and Clinical Epidemiology, School of Medicine, University of North Carolina, Chapel Hill2Center for Health Promotion and Disease Prevention, University of North Carolina, Chapel Hill
| | - Stacey L Sheridan
- Division of General Medicine and Clinical Epidemiology, School of Medicine, University of North Carolina, Chapel Hill2Center for Health Promotion and Disease Prevention, University of North Carolina, Chapel Hill3Cecil G. Sheps Center for Health Services R
| | - Lindy B Draeger
- Center for Health Promotion and Disease Prevention, University of North Carolina, Chapel Hill
| | - Eric A Finkelstein
- Health Services and Systems Research Program, Duke-National University of Singapore Graduate Medical School, Singapore
| | - Ziya Gizlice
- Center for Health Promotion and Disease Prevention, University of North Carolina, Chapel Hill
| | - Eliza Kruger
- Health Services and Systems Research Program, Duke-National University of Singapore Graduate Medical School, Singapore
| | - Larry F Johnston
- Center for Health Promotion and Disease Prevention, University of North Carolina, Chapel Hill
| | - Philip D Sloane
- Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill5Department of Family Medicine, School of Medicine, University of North Carolina, Chapel Hill
| | - Carmen Samuel-Hodge
- Center for Health Promotion and Disease Prevention, University of North Carolina, Chapel Hill6Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill
| | - Kelly R Evenson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill
| | - Myron D Gross
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis
| | - Katrina E Donahue
- Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill5Department of Family Medicine, School of Medicine, University of North Carolina, Chapel Hill
| | - Michael P Pignone
- Division of General Medicine and Clinical Epidemiology, School of Medicine, University of North Carolina, Chapel Hill3Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill
| | - Maihan B Vu
- Center for Health Promotion and Disease Prevention, University of North Carolina, Chapel Hill
| | | | - Bryan J Weiner
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill
| | - Shrikant I Bangdiwala
- Center for Health Promotion and Disease Prevention, University of North Carolina, Chapel Hill11Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill
| | - Alice S Ammerman
- Center for Health Promotion and Disease Prevention, University of North Carolina, Chapel Hill5Department of Family Medicine, School of Medicine, University of North Carolina, Chapel Hill6Department of Nutrition, Gillings School of Global Public Health, Un
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Wright K, Golder S, Rodriguez-Lopez R. Citation searching: a systematic review case study of multiple risk behaviour interventions. BMC Med Res Methodol 2014; 14:73. [PMID: 24893958 PMCID: PMC4048585 DOI: 10.1186/1471-2288-14-73] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 05/16/2014] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The value of citation searches as part of the systematic review process is currently unknown. While the major guides to conducting systematic reviews state that citation searching should be carried out in addition to searching bibliographic databases there are still few studies in the literature that support this view. Rather than using a predefined search strategy to retrieve studies, citation searching uses known relevant papers to identify further papers. METHODS We describe a case study about the effectiveness of using the citation sources Google Scholar, Scopus, Web of Science and OVIDSP MEDLINE to identify records for inclusion in a systematic review.We used the 40 included studies identified by traditional database searches from one systematic review of interventions for multiple risk behaviours. We searched for each of the included studies in the four citation sources to retrieve the details of all papers that have cited these studies.We carried out two analyses; the first was to examine the overlap between the four citation sources to identify which citation tool was the most useful; the second was to investigate whether the citation searches identified any relevant records in addition to those retrieved by the original database searches. RESULTS The highest number of citations was retrieved from Google Scholar (1680), followed by Scopus (1173), then Web of Science (1095) and lastly OVIDSP (213). To retrieve all the records identified by the citation tracking searching all four resources was required. Google Scholar identified the highest number of unique citations.The citation tracking identified 9 studies that met the review's inclusion criteria. Eight of these had already been identified by the traditional databases searches and identified in the screening process while the ninth was not available in any of the databases when the original searches were carried out. It would, however, have been identified by two of the database search strategies if searches had been carried out later. CONCLUSIONS Based on the results from this investigation, citation searching as a supplementary search method for systematic reviews may not be the best use of valuable time and resources. It would be useful to verify these findings in other reviews.
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Affiliation(s)
- Kath Wright
- Centre for Reviews and Dissemination, A/B Block, Alcuin College, University of York, York YO10 5DD, UK
| | - Su Golder
- Centre for Reviews and Dissemination, A/B Block, Alcuin College, University of York, York YO10 5DD, UK
| | - Rocio Rodriguez-Lopez
- Centre for Reviews and Dissemination, A/B Block, Alcuin College, University of York, York YO10 5DD, UK
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Homan SG, McBride DG, Yun S. The effect of the Missouri WISEWOMAN program on control of hypertension, hypercholesterolemia, and elevated blood glucose among low-income women. Prev Chronic Dis 2014; 11:E74. [PMID: 24784910 PMCID: PMC4008953 DOI: 10.5888/pcd11.130338] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION The Well-Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN) public health program is designed to reduce the risk of heart disease and stroke among low-income, underinsured or uninsured women through clinical screenings, risk factor assessment, and lifestyle interventions. We assessed the effect of the Missouri WISEWOMAN program on the control of high blood pressure, total cholesterol, and blood glucose levels. METHODS We calculated the proportion of participants (N = 1,130) with abnormal blood pressure, total cholesterol, or blood glucose levels at an initial screening visit who gained control at a follow-up visit 11 to 18 months later during a 7-year period from June 30, 2005, to June 29, 2012. We used logistic regression to identify sociodemographic characteristics and other factors associated with achieving control. RESULTS Many WISEWOMAN participants gained control of their blood pressure (41.2%), total cholesterol (24.7%), or blood glucose levels (50.0%). After controlling for sociodemographic factors, smoking status, weight status, medication use, and number of lifestyle interventions, nondiabetic women with stage II hypertension (adjusted odds ratio [AOR] = 0.36, 95% confidence interval [CI] = 0.21-0.60) and diabetic women with stage I (AOR = 0.54, 95% CI = 0.32-0.92) and stage II (AOR = 0.23, 95% CI = 0.07-0.77) hypertension were less likely to achieve control of their blood pressure than nondiabetic women with stage I hypertension. Women aged 45 to 64, women with less than a high school education, women who were obese in the initial visit, women who gained 7% or more of their weight, and women who did not participate in any lifestyle intervention sessions were significantly less likely to achieve total cholesterol control than their counterparts. CONCLUSION The Missouri WISEWOMAN program helps many participants achieve control of blood pressure, total cholesterol, and blood glucose levels; the lifestyle intervention is likely to help participants control total cholesterol. More efforts are needed for women with diabetes and stage II hypertension to achieve blood pressure control.
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Affiliation(s)
- Sherri G Homan
- Missouri Department of Health and Senior Services, Jefferson City, Missouri
| | - David G McBride
- Missouri Department of Health and Senior Services, Jefferson City, Missouri
| | - Shumei Yun
- Missouri Department of Health and Senior Services, Division of Community and Public Health, 920 Wildwood Dr, Jefferson City, MO, 65102-0570. E-mail:
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Lilly CL, Bryant LL, Leary JM, Vu MB, Hill-Briggs F, Samuel-Hodge CD, McMilin CR, Keyserling TC. Evaluation of the effectiveness of a problem-solving intervention addressing barriers to cardiovascular disease prevention behaviors in 3 underserved populations: Colorado, North Carolina, West Virginia, 2009. Prev Chronic Dis 2014; 11:E32. [PMID: 24602586 PMCID: PMC3944947 DOI: 10.5888/pcd11.130249] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION In low-income and underserved populations, financial hardship and multiple competing roles and responsibilities lead to difficulties in lifestyle change for cardiovascular disease (CVD) prevention. To improve CVD prevention behaviors, we adapted, pilot-tested, and evaluated a problem-solving intervention designed to address barriers to lifestyle change. METHODS The sample consisted of 81 participants from 3 underserved populations, including 28 Hispanic or non-Hispanic white women in a western community (site 1), 31 African-American women in a semirural southern community (site 2), and 22 adults in an Appalachian community (site 3). Incorporating focus group findings, we assessed a standardized intervention involving 6-to-8 week group sessions devoted to problem-solving in the fall of 2009. RESULTS Most sessions were attended by 76.5% of participants, demonstrating participant adoption and engagement. The intervention resulted in significant improvement in problem-solving skills (P < .001) and perceived stress (P < .05). Diet, physical activity, and weight remained stable, although 72% of individuals reported maintenance or increase in daily fruit and vegetable intake, and 67% reported maintenance or increase in daily physical activity. CONCLUSION Study results suggest the intervention was acceptable to rural, underserved populations and effective in training them in problem-solving skills and stress management for CVD risk reduction.
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Affiliation(s)
- Christa L Lilly
- West Virginia University School of Public Health, HSC-S PO Box 9214, Morgantown WV 26506.
| | - Lucinda L Bryant
- University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Janie M Leary
- Fairmont State University School of Education, Health, and Human Performance, Fairmont, West Virginia
| | - Maihan B Vu
- The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | | | | | - Thomas C Keyserling
- The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Lane A, Murphy N, Bauman A. An effort to ‘leverage’ the effect of participation in a mass event on physical activity. Health Promot Int 2013; 30:542-51. [DOI: 10.1093/heapro/dat077] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Sheridan SL, Draeger LB, Pignone MP, Sloane PD, Samuel-Hodge C, Finkelstein EA, Gizlice Z, Vu MB, Gitterman DP, Bangdiwala SI, Donahue KE, Evenson K, Ammerman AS, Keyserling TC. Designing and implementing a comparative effectiveness study of two strategies for delivering high quality CHD prevention: methods and participant characteristics for the Heart to Health study. Contemp Clin Trials 2013; 36:394-405. [PMID: 23916919 PMCID: PMC4115064 DOI: 10.1016/j.cct.2013.07.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Revised: 07/25/2013] [Accepted: 07/28/2013] [Indexed: 01/30/2023]
Abstract
BACKGROUND Although lifestyle and medications are effective for coronary heart disease (CHD) risk reduction, few studies have examined the comparative effectiveness of various strategies for delivering high quality CHD risk reduction. In this paper, we report on the design and baseline characteristics of participants for just such a trial. METHODS We conducted a randomized trial of the same lifestyle and medication intervention delivered in two alternate formats: counselor-delivered or web-based. The trial was conducted at 5 diverse practices in a family medicine research network and included men and women age 35-79 who were at high risk of CHD events based on 10-year predicted Framingham risk of ≥10% or a known history of cardiovascular disease. After individual-level randomization, participants in both arms received a decision aid plus four intensive intervention visits and 3 maintenance visits over 12 months. The primary outcome was change in 10-year predicted CHD risk among patients without prior cardiovascular disease. Secondary outcomes, measured among all participants, included changes in CHD risk factors, cost-effectiveness, and acceptability at 4 and 12-month follow-up. RESULTS We randomized 489 eligible patients: 389 without and 100 with a known history of cardiovascular disease. Mean age was 62.3. 75% were white, 25% African-American. 45% had a college education. 88% had health insurance. Mean 10-year predicted CHD risk was 16.9%. CONCLUSION We have successfully recruited a diverse sample of practices and patients that will provide a rich sample in which to test the comparative effectiveness of two strategies to implement high quality CHD prevention.
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Affiliation(s)
- Stacey L Sheridan
- Division of General Medicine and Clinical Epidemiology, CB 7110, University of North Carolina, Chapel Hill, NC 27599, United States; Center for Health Promotion and Disease Prevention, CB 7426, University of North Carolina, Chapel Hill, NC 27599, United States; Cecil G. Sheps Center for Health Services Research, CB 7590, University of North Carolina, Chapel Hill, NC 27599, United States.
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Kandula NR, Patel Y, Dave S, Seguil P, Kumar S, Baker DW, Spring B, Siddique J. The South Asian Heart Lifestyle Intervention (SAHELI) study to improve cardiovascular risk factors in a community setting: design and methods. Contemp Clin Trials 2013; 36:479-87. [PMID: 24060673 DOI: 10.1016/j.cct.2013.09.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Revised: 09/10/2013] [Accepted: 09/16/2013] [Indexed: 01/13/2023]
Abstract
Disseminating and implementing evidence-based, cardiovascular disease (CVD) prevention lifestyle interventions in community settings and in ethnic minority populations is a challenge. We describe the design and methods for the South Asian Heart Lifestyle Intervention (SAHELI) study, a pilot study designed to determine the feasibility and initial efficacy of a culturally-targeted, community-based lifestyle intervention to improve physical activity and diet behaviors among medically underserved South Asians (SAs). Participants with at least one CVD risk factor will be randomized to either a lifestyle intervention or a control group. Participants in both groups will be screened in a community setting and receive a primary care referral after randomization. Intervention participants will receive 6weeks of group classes, followed by 12weeks of individual telephone support where they will be encouraged to initiate and maintain a healthy lifestyle goal. Control participants will receive their screening results and monthly mailings on CVD prevention. Primary outcomes will be changes in moderate/vigorous physical activity and saturated fat intake between baseline, 3-, and 6-month follow-up. Secondary outcomes will be changes in weight, clinical risk factors, primary care visits, self-efficacy, and social support. This study will be one of the first to pilot-test a lifestyle intervention for SAs, one of the fastest growing racial/ethnic groups in the U.S. and one with disparate CVD risk. Results of this pilot study will provide preliminary data about the efficacy of a lifestyle intervention on CVD risk in SAs and inform community-engaged CVD prevention efforts in an increasingly diverse U.S. population.
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Affiliation(s)
- Namratha R Kandula
- Department of General Internal Medicine, Northwestern University Feinberg School of Medicine, 750 N Lake Shore Drive, 10th Floor, Chicago, IL 60611, USA.
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Samuel-Hodge CD, Johnston LF, Gizlice Z, Garcia BA, Lindsley SC, Gold AD, Braxton DF, Keyserling TC. A pilot study comparing two weight loss maintenance interventions among low-income, mid-life women. BMC Public Health 2013; 13:653. [PMID: 23855318 PMCID: PMC3717028 DOI: 10.1186/1471-2458-13-653] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Accepted: 06/25/2013] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Despite high obesity prevalence rates, few low-income midlife women participate in weight loss maintenance trials. This pilot study aims to assess the effectiveness of two weight loss maintenance interventions in this under-represented population. METHODS Low-income midlife women who completed a 16-week weight loss intervention and lost ≥ 8 lbs (3.6 kg) were eligible to enroll in one of two 12-month maintenance programs. The programs were similar in content and had the same number of total contacts, but were different in the contact modality (Phone + Face-to-Face vs. Face-to-Face Only). Two criteria were used to assess successful weight loss maintenance at 12 months: (1) retaining a loss of ≥ 5% of body weight from the start of the weight loss phase and (2) a change in body weight of < 3%, from the start to the end of the maintenance program. Outcome measures of changes in physiologic and psychosocial factors, and evaluations of process measures and program acceptability (measured at 12 months) are also reported. For categorical variables, likelihood ratio or Fisher's Exact (for small samples) tests were used to evaluate statistically significant relationships; for continuous variables, t-tests or their equivalents were used to assess differences between means and also to identify correlates of weight loss maintenance. RESULTS Overall, during the 12-month maintenance period, 41% (24/58) of participants maintained a loss of ≥ 5% of initial weight and 43% (25/58) had a <3% change in weight. None of the comparisons between the two maintenance programs were statistically significant. However, improvements in blood pressure and dietary behaviors remained significant at the end of the 12-month maintenance period for participants in both programs. Participant attendance and acceptability were high for both programs. CONCLUSIONS The effectiveness of two pilot 12-month maintenance interventions provides support for further research in weight loss maintenance among high-risk, low-income women. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT00288301.
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Cleland V, Ball K. What might work? Exploring the perceived feasibility of strategies to promote physical activity among women living in socioeconomically disadvantaged neighbourhoods. HEALTH EDUCATION RESEARCH 2013; 28:205-219. [PMID: 22987863 DOI: 10.1093/her/cys097] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
This study aimed to investigate preferences for, perceived feasibility of and barriers to uptake of hypothetical physical activity promotion strategies among women from socioeconomically disadvantaged neighbourhoods. Semi-structured interviews were conducted with 20 purposively recruited women (18-45 years) living in socioeconomically disadvantaged urban and rural areas of Victoria, Australia. Participants indicated the most and least appealing of nine hypothetical strategies, strategies most likely to use and strategies most likely to increase physical activity. Interviews were digitally recorded and transcribed verbatim. Thematic and interpretive content analyses were used to identify emergent common and contrasting themes. A community centre-based program with free childcare, the provision of a cleaner while physical activity is undertaken and a neighbourhood-based program were the three most popular strategies. Mobile-telephone-delivered text messages, an online interactive diary and subsidized gym memberships were considered least useful. Irrespective of the strategy, components of importance commonly identified were social support; being accountable to someone; having the option of a structured or flexible attendance design; integration of multiple strategies and financial considerations. Issues around trust and privacy and weight loss also emerged as important. The findings provide important insights for the development of physical activity programs targeting socioeconomically disadvantaged women.
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Affiliation(s)
- Verity Cleland
- Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tasmania 7000, Australia.
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Jilcott Pitts SB, Vu MB, Garcia BA, McGuirt JT, Braxton D, Hengel CE, Huff JV, Keyserling TC, Ammerman AS. A community assessment to inform a multilevel intervention to reduce cardiovascular disease risk and risk disparities in a rural community. FAMILY & COMMUNITY HEALTH 2013; 36:135-146. [PMID: 23455684 PMCID: PMC4155752 DOI: 10.1097/fch.0b013e31828212be] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
To complete a formative evaluation to identify community-level assets and barriers to healthy lifestyle choices, we conducted qualitative interviews, community audits, and secondary data analyses. We solicited local leaders' perspectives regarding winnability of obesity prevention policy options. Participants noted that many resources were available, yet a barrier was high cost. There were more parks per capita in low-income areas, but they were of lower quality. The most winnable obesity prevention policy was incentives for use of food from local farms. Results are being used to inform an intervention to reduce cardiovascular disease risk in rural eastern North Carolina.
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Affiliation(s)
- Stephanie B. Jilcott Pitts
- East Carolina University, Department of Public Health, 600 Moye Blvd, MS 660, Greenville, 27834, ; Telephone: (252) 744-5572; Fax: (252) 744-4008
| | - Maihan B. Vu
- University of North Carolina at Chapel Hill, Center for Health Promotion and Disease Prevention, 1700 Martin Luther King Jr Blvd, Campus Box 7426, Chapel Hill, NC 27599-7426, ; Telephone: 919-966-9793; Fax: 919-966-8564
| | - Beverly A. Garcia
- UNC Center for Health Promotion and Disease Prevention, CB# 7426, 1700 MLK Jr. Blvd., Chapel Hill, NC 27599-7426, ; Telephone: 919-966-6088; Fax: 919-966-6264
| | - Jared T. McGuirt
- UNC Center for Health Promotion and Disease Prevention, CB# 7426, 1700 MLK Jr. Blvd., Chapel Hill, NC 27599-7426;
| | - Danielle Braxton
- UNC Center for Health Promotion and Disease Prevention, CB# 7426, 1700 MLK Jr. Blvd., Chapel Hill, NC 27599-7426;
| | - Constance E. Hengel
- Community Programming and Development, Lenoir Memorial Hospital, 100 Airport Road, Kinston, NC 28501, ; Telephone: (252) 522-7028
| | - Joey V. Huff
- Lenoir County Health Department, ; Telephone: (252) 526-4299
| | - Thomas C. Keyserling
- Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, ; Telephone: 919-966-2276; Fax: 919-966-2274
| | - Alice S. Ammerman
- Department of Nutrition, Gillings School of Global Public Health Director, Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, CB# 7426, Chapel Hill, NC 27599-7426, ; Telephone: 919 966-6082, FAX 919 966-3374
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Augedal AW, Hansen KS, Kronhaug CR, Harvey AG, Pallesen S. Randomized controlled trials of psychological and pharmacological treatments for nightmares: a meta-analysis. Sleep Med Rev 2012; 17:143-52. [PMID: 23046846 DOI: 10.1016/j.smrv.2012.06.001] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Revised: 06/01/2012] [Accepted: 06/01/2012] [Indexed: 12/17/2022]
Abstract
A meta-analysis of treatments for nightmares is reported. The studies were identified by database searches and by an inspection of relevant reference lists. The inclusion criteria were: nightmares as a target problem, studies published in English, use of a randomized controlled trials and reporting of nightmare-relevant outcomes. A total of 19 studies, published between 1978 and 2012 were identified, which included 1285 participants. Effect sizes were calculated as Cohen's d. A statistically significant improvement for all studies combined (d = 0.47, 95% CI = 0.33-0.60, fixed effects model; d = 0.49, 95% CI = 0.32-0.66, random effects model) and for psychological treatments alone (d = 0.48, 95% CI = 0.36-0.60, random) and for prazosin alone (d = 0.50, 95% CI = 0.03-0.96, random) was found. Individual therapy format yielded a higher effect size than a self-help format (p = 0.03). Minimal interventions (relaxation, recording) yielded lower overall effect size than studies offering more extensive interventions (p = 0.02). It is concluded that there are both psychological and pharmacological interventions which have documented effects for the treatment of nightmares.
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Yang L, Griffin S, Chapman C, Ogilvie D. The feasibility of rapid baseline objective physical activity measurement in a natural experimental study of a commuting population. BMC Public Health 2012; 12:841. [PMID: 23036074 PMCID: PMC3524024 DOI: 10.1186/1471-2458-12-841] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Accepted: 09/27/2012] [Indexed: 11/17/2022] Open
Abstract
Background Studies of the effects of environmental interventions on physical activity should include valid measures of physical activity before and after the intervention. Baseline data collection can be difficult when the timetable for introduction of an intervention is outside researchers’ control. This paper reports and reflects on the practical issues, challenges and results of rapid baseline objective physical activity measurement using accelerometers distributed by post in a natural experimental study. Methods A sample of working adults enrolling for the Commuting and Health in Cambridge study and expressing willingness to wear an activity monitor was selected to undertake baseline accelerometer assessment. Each selected participant received a study pack by post containing the core study questionnaire and an accelerometer to wear for seven consecutive days, and was asked to return their accelerometer and completed questionnaire in person or by post using the prepaid special delivery envelope provided. If a pack was not returned within two weeks of issue, a reminder was sent to the participant. Each participant received up to five reminders by various methods including letter, email, telephone and letter sent by recorded delivery. Results 95% of participants registering for the study were willing in principle to undertake accelerometer assessment. Using a pool of 221 accelerometers, we achieved a total of 714 issues of accelerometers to participants during a six month period. 116 (16%) participants declined to use the accelerometer after receiving it. Three accelerometers failed, 45 (6% of 714) were lost and many were returned with insufficient data recorded, resulted in 109 (15%) participants re-wearing their accelerometer for a second week of measurement. 550 (77%) participants completed data collection, 478 (87% of 550) to the required standard. A total of 694 reminders were issued to retrieve unreturned accelerometers. More than 90% of accelerometers were retrieved after a maximum of two reminders. Conclusions It is feasible to use accelerometers to collect baseline objective physical activity data by post from a large number of participants in a limited time period. However, a substantial pool of devices is required and researchers need to be prepared to make significant efforts to recover some of the devices.
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Affiliation(s)
- Lin Yang
- MRC Epidemiology Unit, Institute of Metabolic Science, Box 285, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom
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Golin CE, Earp JA, Grodensky CA, Patel SN, Suchindran C, Parikh M, Kalichman S, Patterson K, Swygard H, Quinlivan EB, Amola K, Chariyeva Z, Groves J. Longitudinal effects of SafeTalk, a motivational interviewing-based program to improve safer sex practices among people living with HIV/AIDS. AIDS Behav 2012; 16:1182-91. [PMID: 21964975 DOI: 10.1007/s10461-011-0025-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Programs to help people living with HIV/AIDS practice safer sex are needed to prevent transmission of HIV and other sexually transmitted infections. We sought to assess the impact of SafeTalk, a multicomponent motivational interviewing-based safer sex program, on HIV-infected patients' risky sexual behavior. We enrolled sexually active adult HIV-infected patients from one of three clinical sites in North Carolina and randomized them to receive the 4-session SafeTalk intervention versus a hearthealthy attention-control. There was no significant difference in the proportion of people having unprotected sex between the two arms at enrollment. SafeTalk significantly reduced the number of unprotected sex acts with at-risk partners from baseline, while in controls the number of unprotected sex acts increased. Motivational interviewing can provide an effective, flexible prevention intervention for a heterogeneous group of people living with HIV.
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Affiliation(s)
- Carol E Golin
- Division of General Medicine and Clinical Epidemiology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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Cleland CL, Tully MA, Kee F, Cupples ME. The effectiveness of physical activity interventions in socio-economically disadvantaged communities: a systematic review. Prev Med 2012; 54:371-80. [PMID: 22521997 DOI: 10.1016/j.ypmed.2012.04.004] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Revised: 03/30/2012] [Accepted: 04/04/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Interventions to increase levels of physical activity (PA) in socio-economically disadvantaged communities are needed but little is known about their effectiveness. This review examines the effectiveness of interventions designed to increase PA in these communities and the theoretical frameworks and components used. METHODS Five databases were searched for papers published in English between January 2000 and December 2010 that reported outcomes of PA interventions in socio-economically disadvantaged communities. Studies targeting individuals with pre-existing disease and not reporting a measure of free-living PA were excluded. Two reviewers independently extracted data and evaluated quality of evidence against pre-defined criteria. RESULTS Of 478 publications identified, 27 were included. We found that group-based interventions were effective for adults but not for children; evidence for the effectiveness of interventions targeting individuals was insufficient; limited evidence suggested that community-wide interventions produced small changes in PA. Interventions underpinned by any theoretical framework, compared to none, were more likely to be effective. Several effective interventions included education, PA and social support components. CONCLUSION Compared to other approaches, multi-component adult group-based interventions with theoretical frameworks are most effective in increasing PA in socio-economically disadvantaged communities. More robust evaluations of interventions targeting individuals in these 'hard-to-reach' communities are required.
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Affiliation(s)
- Claire L Cleland
- Centre for Public Health, Queen's University Belfast, Clinical Sciences Block B, Royal Victoria Hospital, Grosvenor Road, Belfast, Northern Ireland, BT12 6BJ, UK
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Jilcott SB, Vu MB, Morgan J, Keyserling TC. Promoting use of nutrition and physical activity community resources among women in a family planning clinic setting. Women Health 2012; 52:55-70. [PMID: 22324358 DOI: 10.1080/03630242.2011.637612] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Research increasingly supports promotion of nutrition and physical activity community resources to support individual-level health promotion interventions. However, even when such resources exist, they are often not well used. In this article, the authors describe the results of formative research regarding patient and health promotion professionals' perspectives on methods to encourage use of community resources among patients accessing family planning services at a local health department in eastern North Carolina. In March through May of 2010, the authors conducted qualitative in-depth interviews with 30 female patients, aged 18-44 years, and five local key informants. Interviews were transcribed verbatim, imported into Atlas Ti for data management, and independently double-coded. Free, easily accessible, and family-friendly resources were most appealing to participants. Key informants offered creative ideas for promoting the use of resources, such as parks and farmers' markets, and included integration of such resources into health care provider prescriptions and taking group trips to resources. Results of this study can guide similar programs attempting to promote the use of resources among hard-to-reach groups.
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Affiliation(s)
- Stephanie B Jilcott
- Department of Public Health, East Carolina University, Greenville, NC 27834, USA.
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The effectiveness of a motivational interviewing primary-care based intervention on physical activity and predictors of change in a disadvantaged community. J Behav Med 2012; 35:318-33. [PMID: 22476812 DOI: 10.1007/s10865-012-9417-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Accepted: 03/19/2012] [Indexed: 10/28/2022]
Abstract
Little research exists on the impact of behavior change interventions in disadvantaged communities. We conducted a prospective study to explore the effectiveness of motivational interviewing on physical activity change within a deprived community and the social- psychological and motivational predictors of change in physical activity including stage of change, self-efficacy, social support, and variables from self-determination theory and the theory of planned behavior. Five motivational interviewing counsellors recruited 207 patients and offered motivational interviewing sessions to support physical activity behavior change. At 6-months there were significant improvements in physical activity, stage of change, and social support. A dose-response relationship was evident; those who attended 2 or more consultations increased their total physical activity, stage of change and family social support more than those who attended just one. Hierarchical regression analyses indicated that number of sessions and change in stage of change predicted 28.4% of the variance in change in total physical activity and, with social support from friends, 21.0% of the variance in change walking time. Change in perceived behavioral control and attitudes, friend social support, and number of sessions predicted 16.8% of the variance in change in vigorous physical activity. Motivational interviewing is an effective approach for promoting physical activity amongst lower socio-economic status groups in the short term. The study demonstrates good translational efficacy, and contributes to a limited number of physical activity interventions targeting low income groups in the UK.
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