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Schmuhl NB, Brow KA, Wise ME, Myers S, Mahoney JE, Brown HW. After the Randomized Trial: Implementation of Community-Based Continence Promotion in the Real World. J Am Geriatr Soc 2020; 68:2668-2674. [PMID: 32803895 DOI: 10.1111/jgs.16771] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 07/01/2020] [Accepted: 07/06/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND/OBJECTIVES Most women aged 65 and older have incontinence, associated with high healthcare costs, institutionalization, and negative quality of life, but few seek care. Mind over Matter: Healthy Bowels, Healthy Bladder (MOM) is a small-group self-management workshop, led by a trained facilitator in a community setting, proven to improve incontinence in older women. DESIGN We used mixed methods to gather information on the real-world adoption, maintenance, and implementation of MOM by community agencies following a randomized controlled trial (RCT) that tested intervention effects on incontinence. SETTING Community agencies serving older adults in six Wisconsin communities. PARTICIPANTS Community agency administrators and facilitators trained to offer MOM for the RCT. MEASUREMENTS Investigators tracked rates of adoption (offering MOM in the 12 months following the RCT) and maintenance (offering MOM more than once in the next 18 months) in six communities. Individual interviews and focus groups (N = 17) generated qualitative data about barriers and facilitators related to adoption and maintenance. Trained observers assessed implementation fidelity (alignment with program protocol) at 42 MOM sessions. RESULTS A total of 67% of communities (four of six) adopted MOM, and 50% (three of six) maintained MOM. No implementation fidelity lapses occurred. Facilitators of adoption and maintenance included MOM's well-organized protocol and lean time commitment, sharing of implementation efforts between partner organizations, staff specifically assigned to health promotion activities, and high community interest in continence promotion. Other than stigma associated with incontinence, barriers were similar to those seen with other community-based programs for older adults: limited funding/staffing, competing organizational priorities, challenges identifying/training facilitators, and difficulty engaging community partners/participants. CONCLUSION Using design for dissemination and community engagement, assessment of implementation outcomes is feasible in conjunction with a clinical RCT. Partner-centered implementation packages can address barriers to adoption and maintenance.
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Affiliation(s)
- Nicholas B Schmuhl
- Department of Obstetrics and Gynecology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Katie A Brow
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
| | - Meg E Wise
- Sonderegger Research Center, University of Wisconsin-Madison School of Pharmacy, Madison, Wisconsin, USA
| | - Shannon Myers
- Wisconsin Institute for Healthy Aging, Madison, Wisconsin, USA
| | - Jane E Mahoney
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Heidi W Brown
- Department of Obstetrics and Gynecology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
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Schwarz AF, Huertas-Delgado FJ, Cardon G, DeSmet A. Design Features Associated with User Engagement in Digital Games for Healthy Lifestyle Promotion in Youth: A Systematic Review of Qualitative and Quantitative Studies. Games Health J 2020; 9:150-163. [PMID: 31923363 DOI: 10.1089/g4h.2019.0058] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
User engagement in digital (serious) games may be important to increase their effectiveness. Insights into how to create engaging games for healthy lifestyle promotion are needed, as despite their potential, not all digital (serious) games are highly engaging. This study systematically reviewed game features that were associated with higher user engagement among youth. A systematic search was conducted in PubMed, Web of Science, CINAHL, and PsycARTICLES databases. Qualitative and quantitative studies were included, if they documented game features associated with youth engagement. Coding of game features was performed using the mechanics-dynamics-aesthetics (MDA) framework. A total of 60 studies met the inclusion criteria and were included in the registered systematic review (No. CRD42018099487). Results showed that various game features were associated with user engagement in digital (serious) games: an attractive storyline, adaptable to gender and age, including diverse (antagonist) characters the user may identify with, high-end realistic graphics, well-defined instructions, which can be skipped, in combination with clear feedback and a balance of educational and fun content. This review underpinned the relevance of investigating engaging game features specifically for youth, as deviations were found with characteristics that are engaging for other populations.
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Affiliation(s)
- Ayla F Schwarz
- Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium
| | - Francisco J Huertas-Delgado
- Department of Didactic of Musical, Plastical and Body Expression, La Inmaculada Teacher Training Centre, University of Granada, Granada, Spain
| | - Greet Cardon
- Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium
| | - Ann DeSmet
- Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium.,Research Foundation Flanders, Brussels, Belgium
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Tabak RG, Schwarz CD, Kemner A, Schechtman KB, Steger-May K, Byrth V, Haire-Joshu D. Disseminating and implementing a lifestyle-based healthy weight program for mothers in a national organization: a study protocol for a cluster randomized trial. Implement Sci 2019; 14:68. [PMID: 31238955 PMCID: PMC6593605 DOI: 10.1186/s13012-019-0916-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 06/10/2019] [Indexed: 11/21/2022] Open
Abstract
Background Excessive weight gain among young adult women age 18–45 years is an alarming and overlooked trend that must be addressed to reverse the epidemics of obesity and chronic disease. During this vulnerable period, women tend to gain disproportionally large amounts of weight compared to men and to other life periods. Healthy Eating and Active Living Taught at Home (HEALTH) is a lifestyle modification intervention developed in partnership with Parents as Teachers (PAT), a national home visiting, community-based organization with significant reach in this population. HEALTH prevented weight gain, promoted sustained weight loss, and reduced waist circumference. PAT provides parent–child education and services free of charge to nearly 170,000 families through up to 25 free home visits per year until the child enters kindergarten. Methods This study extends effectiveness findings with a pragmatic cluster randomized controlled trial to evaluate dissemination and implementation (D&I) of HEALTH across three levels (mother, parent educator, PAT site). The trial will evaluate the effect of HEALTH and the HEALTH training curriculum (implementation strategy) on weight among mothers with overweight and obesity across the USA (N = 252 HEALTH; N = 252 usual care). Parent educators from 28 existing PAT sites (14 HEALTH, 14 usual care) will receive the HEALTH training curriculum through PAT National Center, using PAT’s existing training infrastructure, as a continuing education opportunity. An extensive evaluation, guided by RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance), will determine implementation outcomes (acceptability, adoption, appropriateness, feasibility, fidelity, and adaptation) at the parent educator level. The Conceptual Framework for Implementation Research will characterize determinants that influence HEALTH D&I at three levels: mother, parent educator, and PAT site to enhance external validity (reach and maintenance). Discussion Embedding intervention content within existing delivery channels can help expand the reach of evidence-based interventions. Interventions, which have been adapted, can still be effective even if the effect is reduced and can still achieve population impact by reaching a broader set of the population. The current study will build on this to test not only the effectiveness of HEALTH in real-world PAT implementation nationwide, but also elements critical to D&I, implementation outcomes, and the context for implementation. Trial registration https://ClinicalTrials.gov, NCT03758638. Registered 29 November 2018 Electronic supplementary material The online version of this article (10.1186/s13012-019-0916-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rachel G Tabak
- The Brown School, Washington University in St. Louis, 1 Brookings Dr, St. Louis, MO, 63130, USA.
| | - Cynthia D Schwarz
- The Brown School, Washington University in St. Louis, 1 Brookings Dr, St. Louis, MO, 63130, USA
| | - Allison Kemner
- Research and Quality, Parents as Teachers, 2228 Ball Drive, St. Louis, MO, 63146, USA
| | - Kenneth B Schechtman
- Division of Biostatistics, Washington University School of Medicine, Washington University in St. Louis, 660 S. Euclid Ave., CB 8067, St. Louis, MO, 63110-1093, USA
| | - Karen Steger-May
- Division of Biostatistics, Washington University School of Medicine, Washington University in St. Louis, 660 S. Euclid Ave., CB 8067, St. Louis, MO, 63110-1093, USA
| | - Veronda Byrth
- The Brown School, Washington University in St. Louis, 1 Brookings Dr, St. Louis, MO, 63130, USA
| | - Debra Haire-Joshu
- The Brown School and The School of Medicine, Washington University in St. Louis, 1 Brookings Dr, St. Louis, MO, 63130, USA
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4
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Titze S, Lackinger C, Grossschaedl L, Strehn A, Dorner TE, Niebauer J, Schebesch-Ruf W. How Does Counselling in a Stationary Health Care Setting Affect the Attendance in a Standardised Sports Club Programme? Process Evaluation of a Quasi-Experimental Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15010134. [PMID: 29342896 PMCID: PMC5800233 DOI: 10.3390/ijerph15010134] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 12/22/2017] [Accepted: 01/11/2018] [Indexed: 11/21/2022]
Abstract
Actions in partnership across sectors is one principle for the promotion of health behaviours. The objective of this study was to describe the participation in a sports club-based exercise programme—named JACKPOT—following an intervention in a health care setting. Focus was given to the recruitment into JACKPOT, the attendance level, and whether the different programme elements were implemented as intented. The practicability of the project was also retrospectively rated. Participants were 238 inactive people (50% women) between 30 and 65 years of age who attended a health resort. Of these, 77% were assigned to the intervention group (IG). The recruitment into the 12 JACKPOT sessions and the attendance levels were recorded via attendance lists. The implementation of the intervention standards was assessed with structured interviews and participatory observation. The Pragmatic Explanatory Continuum Indicator Summary (PRECIS)-2 tool served to rate the practicability of the project. Almost 50% of the IG subjects attended JACKPOT sessions at least once and 54% of the attenders visited ≥75% of the 12 sessions. Some of the programme elements were not delivered fully. The process evaluation results showed that the project worked in a real-world setting, and also uncovered potential reasons such as incomplete information delivery for the moderate recruitment and attendance level.
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Affiliation(s)
- Sylvia Titze
- Institute of Sport Science, University of Graz, Mozartgasse 14, 8010 Graz, Austria.
| | - Christian Lackinger
- Department of Health Promotion and Prevention, SPORTUNION Österreich, Falkestrasse 1, 1010 Vienna, Austria.
| | - Lena Grossschaedl
- Social Insurance Authority for Business, Regional Office Styria, Körblergasse 115, 8010 Graz, Austria.
| | - Albert Strehn
- Competence Center Health Promotion, Social Insurance Authority for Business, Osterwiese 2, 7000 Eisenstadt, Austria.
| | - Thomas E Dorner
- Department of Social and Preventive Medicine, Centre for Public Health, Medical University of Vienna, Kinderspitalgasse 15/1, 1090 Vienna, Austria.
| | - Josef Niebauer
- Institute of Sports Medicine, Prevention and Rehabilitation and Research Institute of Molecular Sports and Rehabilitation Medicine, Paracelsus Medical University Salzburg, Lindhofstrasse 20, 5020 Salzburg, Austria.
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5
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Vissenberg C, Nierkens V, Uitewaal PJM, Middelkoop BJC, Stronks K. Recruitment and retention in a 10-month social network-based intervention promoting diabetes self-management in socioeconomically deprived patients: a qualitative process evaluation. BMJ Open 2017; 7:e012284. [PMID: 28751481 PMCID: PMC5577887 DOI: 10.1136/bmjopen-2016-012284] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 08/31/2016] [Accepted: 12/14/2016] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Socioeconomically deprived patients with type 2 diabetes often face challenges with self-management, resulting in more diabetes-related complications. However, these groups are often under-represented in self-management interventions. Evidence on effective recruitment and retention strategies is growing, but lacking for intensive self-management interventions. This study aims to explore recruitment, retention and effective intervention strategies in a 10-month group-based intervention among Dutch, Moroccan, Turkish and Surinamese patients from socioeconomically deprived neighbourhoods. METHODS Participants were recruited through general practitioners (GPs) and participated in a 10-month social network-based intervention (10 groups, n=69): Powerful Together with Diabetes. This intervention also targeted the significant others of participants and aimed to increase social support for self-management and to decrease social influences hindering self-management. A qualitative process evaluation was conducted. Retention was measured using log books kept by group leaders. Further, we conducted 17 in-depth interviews with participants (multiethnic sample) and 18 with group leaders. Interviews were transcribed, coded and analysed using framework analyses. RESULTS The GP's letter and reminder calls, an informational meeting and the intervention's informal nature facilitated recruitment. During the first months, positive group atmosphere, the intervention's perceived usefulness, opportunities to socialise and a reduction in practical barriers facilitated retention. After the first months, conflicting responsibilities and changes in the intervention's nature and planning hindered retention. Calls from group leaders and the prospect of a diploma helped participants overcome these barriers. CONCLUSION To promote retention in lengthy self-management interventions, it seems important that patients feel they are going on an outing to a social gathering that is enjoyable, recreational, useful and easy to attend. However, rewards and intensive personal recruitment and retention strategies remained necessary throughout the entire intervention period. TRIAL REGISTRATION NUMBER Dutch Trial Register NTR1886; Results.
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Affiliation(s)
- Charlotte Vissenberg
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Vera Nierkens
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Paul J M Uitewaal
- Department of Public Health, The Hague's Public Health, The Hague, The Netherlands
| | - Barend J C Middelkoop
- Department of Public Health, Leiden University Medical Centre, Leiden, The Netherlands
| | - Karien Stronks
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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6
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Baron J, Hirani S, Newman S. Challenges in Patient Recruitment, Implementation, and Fidelity in a Mobile Telehealth Study. Telemed J E Health 2016; 22:400-9. [DOI: 10.1089/tmj.2015.0095] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Justine Baron
- Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Shashivadan Hirani
- Institute of Cardiovascular Science, University College London, London, United Kingdom
- Centre for Health Services Research, School of Health Sciences, City University London, London, United Kingdom
| | - Stanton Newman
- Institute of Cardiovascular Science, University College London, London, United Kingdom
- Centre for Health Services Research, School of Health Sciences, City University London, London, United Kingdom
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7
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DeSmet A, Thompson D, Baranowski T, Palmeira A, Verloigne M, De Bourdeaudhuij I. Is Participatory Design Associated with the Effectiveness of Serious Digital Games for Healthy Lifestyle Promotion? A Meta-Analysis. J Med Internet Res 2016; 18:e94. [PMID: 27129447 PMCID: PMC4867751 DOI: 10.2196/jmir.4444] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 07/28/2015] [Accepted: 12/14/2015] [Indexed: 01/21/2023] Open
Abstract
Background Serious digital games can be effective at changing healthy lifestyles, but large differences in their effectiveness exist. The extent of user involvement in game design may contribute to game effectiveness by creating a better fit with user preferences. Participatory design (PD), which represents active user involvement as informant (ie, users are asked for input and feedback) or codesigner (ie, users as equal partners in the design) early on and throughout the game development, may be associated with higher game effectiveness, as opposed to no user involvement or limited user involvement. Objective This paper reports the results of a meta-analysis examining the moderating role of PD in the effectiveness of serious digital games for healthy lifestyle promotion. Methods Four databases were searched for peer-reviewed papers in English that were published or in press before October 2014, using a (group-) randomized controlled trial design. Effectiveness data were derived from another meta-analysis assessing the role of behavior change techniques and game features in serious game effectiveness. Results A total of 58 games evaluated in 61 studies were included. As previously reported, serious digital games had positive effects on healthy lifestyles and their determinants. Unexpectedly, PD (g=0.075, 95% CI 0.017 to 0.133) throughout game development was related to lower game effectiveness on behavior (Q=6.74, P<.05) than when users were only involved as testers (g=0.520, 95% CI 0.150 to 0.890, P<.01). Games developed with PD (g=0.171, 95% CI 0.061 to 0.281, P<.01) were also related to lower game effectiveness on self-efficacy (Q=7.83, P<.05) than when users were not involved in game design (g=0.384, 95% CI 0.283 to 0.485, P<.001). Some differences were noted depending on age group, publication year of the study, and on the specific role in PD (ie, informant or codesigner), and depending on the game design element. Games developed with PD were more effective in changing behavioral determinants when they included users in design elements on game dynamics (beta=.215, 95% CI .075 to .356, P<.01) and, more specifically, as an informant (beta=.235, 95% CI .079 to .329, P<.01). Involving users as informants in PD to create game levels was also related to higher game effectiveness (Q=7.02, P<.01). Codesign was related to higher effectiveness when used to create the game challenge (Q=11.23, P<.01), but to lower game effectiveness when used to create characters (Q=4.36, P<.05) and the game world (Q=3.99, P<.05). Conclusions The findings do not support higher effectiveness of games developed with PD. However, significant differences existed among PD games. More support was found for informant roles than for codesign roles. When PD was applied to game dynamics, levels, and game challenge, this was associated with higher effectiveness than when it was applied to game aesthetics. Since user involvement may have an important influence on reach, adoption, and implementation of the intervention, further research and design efforts are needed to enhance effectiveness of serious games developed with PD.
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Affiliation(s)
- Ann DeSmet
- Ghent University, Department of Movement and Sport Sciences, Ghent, Belgium
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8
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Harden SM, Gaglio B, Shoup JA, Kinney KA, Johnson SB, Brito F, Blackman KCA, Zoellner JM, Hill JL, Almeida FA, Glasgow RE, Estabrooks PA. Fidelity to and comparative results across behavioral interventions evaluated through the RE-AIM framework: a systematic review. Syst Rev 2015; 4:155. [PMID: 26547687 PMCID: PMC4637141 DOI: 10.1186/s13643-015-0141-0] [Citation(s) in RCA: 109] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 10/23/2015] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework was developed to determine potential public health impact of interventions (i.e., programs, policy, and practice). The purpose of this systematic review was to determine (1) comparative results across accurately reported RE-AIM indicators, (2) relevant information when there remains under-reporting or misclassification of data across each dimension, (3) the degree to which authors intervened to improve outcomes related to each dimension, and (4) the number of articles reporting RE-AIM dimensions for a given study. METHODS In April 2013, a systematic search of the RE-AIM framework was completed in PubMed, PSYCHInfo, EbscoHost, Web of Science, and Scopus. Evidence was analyzed until January 2015. RESULTS Eighty-two interventions that included empirical data related to at least one of the RE-AIM dimensions were included in the review. Across these interventions, they reached a median sample size of 320 participants (M = 4894 ± 28,256). Summarizing the effectiveness indicators, we found that: the average participation rate was 45 % (±28 %), 89 % of the interventions reported positive changes in the primary outcome and 11 interventions reported broader outcomes (e.g., quality of life). As for individual-level maintenance, 11 % of studies showed effects ≥6 months post-program. Average setting and staff adoption rates were 75 % (±32 %) and 79 % (±28 %), respectively. Interventions reported being delivered as intended (82 % (±16 %)) and 22 % intervention reported adaptations to delivery. There were insufficient data to determine average maintenance at the organizational level. Data on costs associated with each dimension were infrequent and disparate: four studies reported costs of recruitment, two reported intervention costs per participant, and two reported adoption costs. CONCLUSIONS The RE-AIM framework has been employed in a variety of populations and settings for the planning, delivery, and evaluation of behavioral interventions. This review highlights inconsistencies in the degree to which authors reported each dimension in its entirety as well as inaccuracies in reporting indicators within each dimension. Further, there are few interventions that aim to improve outcomes related to reach, adoption, implementation, and maintenance.
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Affiliation(s)
- Samantha M Harden
- Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA, 24060, USA.
| | - Bridget Gaglio
- Communication and Dissemination Research, Patient-Centered Outcomes Research Institute, Washington, DC, 20036, USA.
| | - Jo Ann Shoup
- School of Public Affairs, University of Colorado, Denver, CO, 80204, USA. .,Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado, US.
| | - Kimberlee A Kinney
- Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA, 24060, USA.
| | - Sallie Beth Johnson
- Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA, 24060, USA.
| | - Fabiana Brito
- Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA, 24060, USA.
| | - Kacie C A Blackman
- Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA, 24060, USA. .,Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90033, USA.
| | - Jamie M Zoellner
- Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA, 24060, USA.
| | - Jennie L Hill
- Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA, 24060, USA.
| | - Fabio A Almeida
- Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA, 24060, USA. .,Family and Community Medicine, Carilion Clinic, Roanoke, VA, 24016, USA.
| | - Russell E Glasgow
- Family Medicine, University of Colorado School of Medicine, Aurora, CO, 80045, USA.
| | - Paul A Estabrooks
- Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA, 24060, USA. .,Family and Community Medicine, Carilion Clinic, Roanoke, VA, 24016, USA.
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Taradash J, Kramer M, Molenaar D, Arena V, Vanderwood K, Kriska AM. Recruitment for a Diabetes Prevention Program translation effort in a worksite setting. Contemp Clin Trials 2015; 41:204-10. [PMID: 25633207 DOI: 10.1016/j.cct.2015.01.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Revised: 01/16/2015] [Accepted: 01/19/2015] [Indexed: 10/24/2022]
Abstract
BACKGROUND The success of the Diabetes Prevention Program (DPP) lifestyle intervention has led to community-based translation efforts in a variety of settings. One community setting which holds promise for the delivery of prevention intervention is the worksite; however, information regarding recruitment in this setting is limited. The current effort describes the initial processes surrounding provision of an adapted DPP lifestyle intervention at a corporate worksite. METHODS Investigators and key management at the worksite collaborated to develop and implement a recruitment plan for the intervention focusing on 1) in-person onsite activities and 2) implementation of a variety of media recruitment tools and methods. RESULTS Adult, non-diabetic overweight/obese employees and family members with pre-diabetes and/or the metabolic syndrome were eligible for the study. Telephone pre-screening was completed for 176 individuals resulting in 171 eligible for onsite screening. Of that number, 160 completed onsite screening, 107 met eligibility criteria, and 89 enrolled in the study. Support from worksite leadership, an invested worksite planning team and a solid recruitment plan consisting of multiple strategies were identified as crucial elements of this effective workplace recruitment effort. CONCLUSION A worksite team successfully developed and implemented a recruitment plan using existing mechanisms appropriate to that worksite in order to identify and enroll eligible individuals. The results of this effort indicate that employee recruitment in a worksite setting is feasible as the first step in offering onsite behavioral lifestyle intervention programs as part of a widespread dissemination plan to prevent diabetes and lower risk for cardiovascular disease.
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Affiliation(s)
- J Taradash
- University of Pittsburgh Graduate School of Public Health, Department of Epidemiology, Pittsburgh, PA, United States; MyoFitness, Pittsburgh, PA, United States
| | - M Kramer
- University of Pittsburgh Graduate School of Public Health, Department of Epidemiology, Pittsburgh, PA, United States.
| | - D Molenaar
- Veterans Health Administration, Department of Medicine, Minneapolis, MN, United States
| | - V Arena
- University of Pittsburgh Graduate School of Public Health, Department of Biostatistics, Pittsburgh, PA, United States
| | - K Vanderwood
- University of Pittsburgh Graduate School of Public Health, Department of Epidemiology, Pittsburgh, PA, United States
| | - Andrea M Kriska
- University of Pittsburgh Graduate School of Public Health, Department of Epidemiology, Pittsburgh, PA, United States
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DeSmet A, Van Ryckeghem D, Compernolle S, Baranowski T, Thompson D, Crombez G, Poels K, Van Lippevelde W, Bastiaensens S, Van Cleemput K, Vandebosch H, De Bourdeaudhuij I. A meta-analysis of serious digital games for healthy lifestyle promotion. Prev Med 2014; 69:95-107. [PMID: 25172024 PMCID: PMC4403732 DOI: 10.1016/j.ypmed.2014.08.026] [Citation(s) in RCA: 182] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 08/15/2014] [Accepted: 08/17/2014] [Indexed: 12/14/2022]
Abstract
Several systematic reviews have described health-promoting effects of serious games but so far no meta-analysis has been reported. This paper presents a meta-analysis of 54 serious digital game studies for healthy lifestyle promotion, in which we investigated the overall effectiveness of serious digital games on healthy lifestyle promotion outcomes and the role of theoretically and clinically important moderators. Findings showed that serious games have small positive effects on healthy lifestyles (g=0.260, 95% CI 0.148; 0.373) and their determinants (g=0.334, 95% CI 0.260; 0.407), especially for knowledge. Effects on clinical outcomes were significant, but much smaller (g=0.079, 95% CI 0.038; 0.120). Long-term effects were maintained for all outcomes except for behavior. Serious games are best individually tailored to both socio-demographic and change need information, and benefit from a strong focus on game theories or a dual theoretical foundation in both behavioral prediction and game theories. They can be effective either as a stand-alone or multi-component programs, and appeal to populations regardless of age and gender. Given that effects of games remain heterogeneous, further explorations of which game features create larger effects are needed.
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Affiliation(s)
- Ann DeSmet
- Department of Movement and Sports Sciences, Faculty of Medicine and Health Sciences, Ghent University, Watersportlaan 2, B-9000 Ghent, Belgium.
| | - Dimitri Van Ryckeghem
- Department of Experimental-Clinical and Health Psychology, Ghent University, Belgium
| | - Sofie Compernolle
- Department of Movement and Sports Sciences, Faculty of Medicine and Health Sciences, Ghent University, Watersportlaan 2, B-9000 Ghent, Belgium
| | - Tom Baranowski
- Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Debbe Thompson
- Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Geert Crombez
- Department of Experimental-Clinical and Health Psychology, Ghent University, Belgium
| | - Karolien Poels
- Department of Communication Studies, Faculty of Political and Social Sciences, University of Antwerp, Belgium
| | - Wendy Van Lippevelde
- Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Belgium
| | - Sara Bastiaensens
- Department of Communication Studies, Faculty of Political and Social Sciences, University of Antwerp, Belgium
| | - Katrien Van Cleemput
- Department of Communication Studies, Faculty of Political and Social Sciences, University of Antwerp, Belgium
| | - Heidi Vandebosch
- Department of Communication Studies, Faculty of Political and Social Sciences, University of Antwerp, Belgium
| | - Ilse De Bourdeaudhuij
- Department of Movement and Sports Sciences, Faculty of Medicine and Health Sciences, Ghent University, Watersportlaan 2, B-9000 Ghent, Belgium
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Barrera M, Toobert DJ, Strycker LA. Relative contributions of naturalistic and constructed support: two studies of women with type 2 diabetes. J Behav Med 2014; 37:59-69. [PMID: 23109138 DOI: 10.1007/s10865-012-9465-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Do distinct sources of social support have differential effects on health? Although previous research has contrasted family and friend support (naturalistic support), research on the relative effects of naturalistic support and constructed support (e.g., support groups) is extremely rare. Two studies of women with type 2 diabetes were conducted that assessed the independent effects of naturalistic and constructed support on physical activity and glycosylated hemoglobin (HbA1c). Participants were women diagnosed with type 2 diabetes from the intervention arms of two randomized controlled trials: primarily European American women (Study 1; N = 163) and exclusively Hispanic women (Study 2; N = 142). Measures assessed physical activity, HbA1c, and friend and family support at baseline and at 6 months, as well as group support after 6 months of intervention. In Study 1, only group support was related to increases in physical activity (ΔR(2) = .036). In Study 2, group support and family support showed independent effects on increases in physical activity (ΔR(2) = .047 and .060, respectively). Also, group support was related to decreases in HbA1c in Study 1 (ΔR(2) = .031) and Study 2 (ΔR(2) = .065). Overall, constructed (group) support was related to outcomes most consistently, but naturalistic (family) support showed some independent relation to physical activity improvement.
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Affiliation(s)
- Manuel Barrera
- Department of Psychology, Arizona State University, Box 871104, Tempe, AZ, 85287-1104, USA,
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Adapting and RE-AIMing a heart disease prevention program for older women with diabetes. Transl Behav Med 2013; 2:180-7. [PMID: 24073110 DOI: 10.1007/s13142-012-0118-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Coronary heart disease is a pervasive public health problem with a heavy burden among older women. There is a need for developing effective interventions for addressing this problem and for evaluating the dissemination potential of such interventions. A multiple-behavior-change program originally designed for men with heart disease was adapted for women at high risk of heart disease in two randomized clinical trials-the Mediterranean Lifestyle Program and ¡Viva Bien!. Results from these two trials, including readiness for dissemination, are evaluated using the RE-AIM framework in terms of Reach, Effectiveness, Adoption, Implementation, and Maintenance. Program adaptations produced relative high reach as well as consistent and replicated effectiveness and maintenance, and were adopted by a high percentage of primary care offices and clinicians approached. We discuss key findings, lessons learned, future directions for related research, and use of RE-AIM for program development, adaptation, scale-up, and evaluation.
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Gaglio B, Shoup JA, Glasgow RE. The RE-AIM framework: a systematic review of use over time. Am J Public Health 2013; 103:e38-46. [PMID: 23597377 DOI: 10.2105/ajph.2013.301299] [Citation(s) in RCA: 572] [Impact Index Per Article: 52.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
We provided a synthesis of use, summarized key issues in applying, and highlighted exemplary applications in the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. We articulated key RE-AIM criteria by reviewing the published literature from 1999 to 2010 in several databases to describe the application and reporting on various RE-AIM dimensions. After excluding nonempirical articles, case studies, and commentaries, 71 articles were identified. The most frequent publications were on physical activity, obesity, and disease management. Four articles reported solely on 1 dimension compared with 44 articles that reported on all 5 dimensions of the framework. RE-AIM was broadly applied, but several criteria were not reported consistently.
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Affiliation(s)
- Bridget Gaglio
- Bridget Gaglio is with the Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, MD 20852, USA.
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Fleisher L, Kandadai V, Keenan E, Miller SM, Devarajan K, Ruth KJ, Rodoletz M, Bieber EJ, Weinberg DS. Build it, and will they come? Unexpected findings from a study on a Web-based intervention to improve colorectal cancer screening. JOURNAL OF HEALTH COMMUNICATION 2012; 17:41-53. [PMID: 22217118 PMCID: PMC3257821 DOI: 10.1080/10810730.2011.571338] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Given the extensive use of the Internet for health information, Web-based health promotion interventions are widely perceived as an effective communication channel. The authors conducted this study to determine use of a Web-based intervention intended to improve colorectal cancer screening in a population of women who are at average risk and noncompliant to current screening recommendations. The study was a randomized controlled trial designed to compare the effectiveness of colorectal cancer screening educational materials delivered using the Internet versus a printed format. In 3 years, 391 women seen for routine obstetrics/gynecology follow-up at 2 academic centers provided relevant survey information. Of these, 130 were randomized to the Web intervention. Participants received voluntary access to a password-protected, study-specific Web site that provided information about colorectal cancer and colorectal cancer screening options. The main outcome measures were self-reported and actual Web site use. Only 24.6% of women logged onto the Web site. Age was the only variable that differentiated users from nonusers (p = .03). In contrast, 16% of participants self-reported Web use. There was significant discordance between the veracity of actual and self-reported use (p = .004). Among true users, most (81%) logged on once only. These findings raise questions about how to increase use of important health communication interventions.
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Affiliation(s)
- Linda Fleisher
- Fox Chase Cancer Center, 510 Township Line Road, Cheltenham, PA 19012, USA.
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The effects of education with printed material on glycemic control in patients with diabetes type 2 treated with different therapeutic regimens. VOJNOSANIT PREGL 2011; 68:676-83. [PMID: 21991791 DOI: 10.2298/vsp1108676s] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIM Diabetes mellitus (DM) is considered to be an epidemic, chronic and progressive disease. The treatment of DM reqiures substantial effort from both the diabetes treatment team and a patient. Patient education is one of the treatment elements. The most efficacious form and content of education has not yet been established. However, every DM education must include introduction to a substantial number of facts about diabetes. The aim of our study was to estimate the levels of DM knowledge and glycemic control in Serbian patients with DM type 2 as well as to estimate the effects of education using printed material on the levels of glycemic control and knowledge about DM. Also, the effects of education on glycemic control and the level of knowledge in differently treated patients were estimated. METHODS The patients with DM type 2 (n = 364), aged 40 to 65 years, from three regional health centers, were randomized for the study. After informed consent, patients filled out the questionnaire, and were checked for HbA1c and fasting blood glucose. Finally, booklet "Healthy lifestyle with diabetes mellitus type 2" was given to them. The same procedure was repeated after 3, 6 and 18 months. RESULTS There was a significant improvement in HbA1c levels after 3 months (8.00 +/- 1.66% vs 9.06 +/- 2.23%, p < 0.01) and after 6 months (7.67 +/- 1.75% vs 9.06 +/- 2.23%, p < 0.01). There was no further improvement in HbA1c levels after 18 months (7.88 +/- 1.46% vs 7.67 +/- 1.75%, p > 0.05). There was a significant improvement in the average test score (percent of correct answers per test sheet) after three monts (64.6% vs 55.6%, p < 0.01). There were no further statistically significant changes in the general level of DM knowledge after 6 months (65.0 +/- 32.5% vs 64.5 +/- 33.7%, p > 0.05) and after 18 months (64.8 +/- 32.7 vs 64.5 +/- 33.7%, p > 0.05). There was a significant diffrence in educational intervention response in DM type 2 patients on different therapeutic regimens. CONCLUSION Education with printed material led to improvement in glycemic control and level of DM knowledge in our patients. Education with printed material may be a useful adjunct to DM treatment and should be structured according to the treatment modality.
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Maindal HT, Skriver MV, Kirkevold M, Lauritzen T, Sandbaek A. Comorbidity and lack of education countered participation in a diabetes prevention self-management program. ACTA ACUST UNITED AC 2011. [DOI: 10.1111/j.1752-9824.2011.01103.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Maindal HT, Sandbæk A, Kirkevold M, Lauritzen T. Effect on motivation, perceived competence, and activation after participation in the ''Ready to Act'' programme for people with screen-detected dysglycaemia: a 1-year randomised controlled trial, Addition-DK. Scand J Public Health 2011; 39:262-71. [PMID: 21427147 DOI: 10.1177/1403494811402721] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To investigate the reach of the ''Ready to Act'' programme and the 1-year effects on psychological determinants of healthy behaviour: motivation, perceived competence, and activation level. METHODS A total of 509 adults with dysglycaemia were recruited from general practioners (GPs) in the intensive arm of the Danish Anglo-Danish-Dutch Study of Intensive Treatment in People with Screen-Detected Diabetes in Primary Care (ADDITION) study, a type 2 diabetes screening programme. The participants were randomised to the ''Ready to Act'' programme added on top of GP care (n = 322) or to GP care (n = 187). The core components of the programme were motivation, action experience, informed decision-making, and social involvement conducted in two one-to-one sessions and eight group-meetings (18 hours). The reach of the programme was measured by the proportion of people who signed up. Outcomes were changes in treatment motivation (Treatment Self-Regulation Questionnaire, TSRQ), perceived competence (Perceived Competence Scale, PCS), and activation in chronic care (Patient Activation Measure, PAM). Effect size was the difference between 1-year changes in the randomisation groups analysed by intention-to-treat. RESULTS A total of 142 (44%) of 322 signed up and 123 (87%) of these completed. At 1 year, the difference in autonomous motivation for behavioural treatment (TSRQ) between the randomisation groups was 1.0 (95% CI 0.1 to 2.0), and the difference in perceived competence changes in healthy diet (PCS-d) was 1.5 (95% CI 0.2 to 2.7). No differences were observed for activation (PAM) between the groups. Subgroup analysis revealed men to benefit more from the intervention than women. CONCLUSIONS The programme is a promising health-promoting component in prevention and care for people with screen-detected dysglycaemia, as it attracted four of 10 people and had effects on motivation and perceived competence.
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Affiliation(s)
- Helle Terkildsen Maindal
- Section for General Medical Practice, School of Public Health, Aarhus University, Aarhus, Denmark.
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18
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Toobert DJ, Strycker LA, Barrera M, Glasgow RE. Seven-year follow-up of a multiple-health-behavior diabetes intervention. Am J Health Behav 2010; 34:680-94. [PMID: 20604694 DOI: 10.5993/ajhb.34.6.5] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To examine the long-term effects of multiple health-behavior changes from the Mediterranean Lifestyle Program. METHODS The randomized trial targeted postmenopausal women with type 2 diabetes (N = 279) at high risk for heart disease. The intervention featured a weekend retreat followed by regular meetings over 24 months to enhance healthful eating, physical activity (PA), stress management, and support behaviors. RESULTS Long-term analyses indicated that significant improvements made in the targeted behaviors during the active treatment phase of the study (at 6, 12, and 24 months) were partially maintained during the nontreatment phase of the study, through 5 years postintervention contact for dietary behavior and stress management, and 1-year posttreatment for PA. CONCLUSIONS This moderate-intensity group-based intervention produced health behavior changes that tended to plateau or return to baseline levels 1 to 5 years after treatment.
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Affiliation(s)
- Deborah J Toobert
- Oregon Research Institute, 1715 Franklin Blvd, Eugene, OR 97403-1983, USA.
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Toobert DJ, Strycker LA, Glasgow RE, Osuna D, Doty AT, Barrera M, Geno CR, Ritzwoller DP. Viva bien!: Overcoming recruitment challenges in a multiple-risk-factor diabetes trial. Am J Health Behav 2010; 34:432-41. [PMID: 20218755 DOI: 10.5993/ajhb.34.4.5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES To describe recruitment of Latinas in a randomized clinical trial conducted within 2 health care organizations. METHODS The study relied on project-initiated telephone calls as part of a multifaceted recruitment approach. Chi-square and t tests were conducted to compare participants and nonparticipants on a number of variables. RESULTS From 4045 telephone contacts, 280 Latinas agreed to participate. Most were ineligible due to non-Latino ethnicity (89%). Of eligible candidates, 61% took part. Few significant differences were found on participant vs nonparticipant characteristics. CONCLUSIONS Using appropriate recruitment procedures, a representative sample of Latinas can be obtained.
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Groeneveld IF, Proper KI, van der Beek AJ, Hildebrandt VH, van Mechelen W. Factors associated with non-participation and drop-out in a lifestyle intervention for workers with an elevated risk of cardiovascular disease. Int J Behav Nutr Phys Act 2009; 6:80. [PMID: 19951417 PMCID: PMC3224927 DOI: 10.1186/1479-5868-6-80] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2009] [Accepted: 12/01/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Non-response and drop-out are problems that are commonly encountered in health promotion trials. Understanding the health-related characteristics of non-participants and drop-outs and the reasons for non-participation and drop-out may be beneficial for future intervention trials. METHODS Male construction workers with an elevated risk of cardiovascular disease (CVD) were invited to participate in a lifestyle intervention study. In order to investigate the associations between participation and CVD risk factors, and drop-out and CVD risk factors, crude and multiple logistic regression analyses were performed. The reasons for non-participation and drop-out were assessed qualitatively. RESULTS 20% of the workers who were invited decided to participate; 8.6% of the participants dropped out before the first follow-up measurement. The main reasons for non-participation were 'no interest', 'current (para-)medical treatment', and 'feeling healthy', and for drop-out they were 'lack of motivation', 'current (para-)medical treatment', and 'disappointment'. Participants were 4.2 years older, had a higher blood pressure, higher total cholesterol, and lower HDL cholesterol than non-participants, and were more likely to report 'tiredness and/or stress' and 'chest pain and/or shortness of breath'. After adjusting for age, most risk factors were not significantly associated with participation. Drop-outs were 4.6 years younger than those who completed the study. The prevalence of smoking was higher among non-participants and drop-outs. CONCLUSION Participants had a worse CVD risk profile than non-participants, mainly because of the difference in age. Non-participants and drop-outs were younger and more likely to be smokers. The main reasons for non-participation and drop-out were health-related. Investigators in the field of health promotion should be encouraged to share comparable information. TRIAL REGISTRATION Current Controlled Trials ISRCTN60545588.
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Affiliation(s)
- Iris F Groeneveld
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
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Robbins JM, Thatcher GE, Webb DA, Valdmanis VG. Nutritionist visits, diabetes classes, and hospitalization rates and charges: the Urban Diabetes Study. Diabetes Care 2008; 31:655-60. [PMID: 18184894 PMCID: PMC2423227 DOI: 10.2337/dc07-1871] [Citation(s) in RCA: 128] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We evaluated the association of different types of educational visits for diabetic patients of the eight Philadelphia Health Care Centers (PHCCs) (public safety-net primary care clinics), with hospital admission rates and charges reported to the Pennsylvania Health Care Cost Containment Council. RESEARCH DESIGN AND METHODS The study population included 18,404 patients who had a PHCC visit with a diabetes diagnosis recorded between 1 March 1993 and 31 December 2001 and had at least 1 month follow-up time. RESULTS A total of 31,657 hospitalizations were recorded for 7,839 (42.6%) patients in the cohort. After adjustment for demographic variables, baseline comorbid conditions, hospitalizations before the diabetes diagnosis, and number of other primary care visits, having had any type of educational visit was associated with 9.18 (95% CI 5.02-13.33) fewer hospitalizations per 100 person-years and $11,571 ($6,377 to $16,765) less in hospital charges per person. Each nutritionist visit was associated with 4.70 (2.23-7.16) fewer hospitalizations per 100 person-years and a $6,503 ($3,421 to $9,586) reduction in total hospital charges. CONCLUSIONS Any type of educational visit was associated with lower hospitalization rates and charges. Nutritionist visits were more strongly associated with reduced hospitalizations than diabetes classes. Each nutritionist visit was associated with a substantial reduction in hospital charges, suggesting that providing these services in the primary care setting may be highly cost-effective for the health care system.
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Affiliation(s)
- Jessica M Robbins
- Philadelphia Department of Public Health, Division of Ambulatory Health Services, Philadelphia, PA 19146, USA.
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Gucciardi E, Cameron JI, Liao CD, Palmer A, Stewart DE. Program design features that can improve participation in health education interventions. BMC Med Res Methodol 2007; 7:47. [PMID: 17996089 PMCID: PMC2204023 DOI: 10.1186/1471-2288-7-47] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2007] [Accepted: 11/09/2007] [Indexed: 12/02/2022] Open
Abstract
Background Although there have been reported benefits of health education interventions across various health issues, the key to program effectiveness is participation and retention. Unfortunately, not everyone is willing to participate in health interventions upon invitation. In fact, health education interventions are vulnerable to low participation rates. The objective of this study was to identify design features that may increase participation in health education interventions and evaluation surveys, and to maximize recruitment and retention efforts in a general ambulatory population. Methods A cross-sectional questionnaire was administered to 175 individuals in waiting rooms of two hospitals diagnostic centres in Toronto, Canada. Subjects were asked about their willingness to participate, in principle, and the extent of their participation (frequency and duration) in health education interventions under various settings and in intervention evaluation surveys using various survey methods. Results The majority of respondents preferred to participate in one 30–60 minutes education intervention session a year, in hospital either with a group or one-on-one with an educator. Also, the majority of respondents preferred to spend 20–30 minutes each time, completing one to two evaluation surveys per year in hospital or by mail. Conclusion When designing interventions and their evaluation surveys, it is important to consider the preferences for setting, length of participation and survey method of your target population, in order to maximize recruitment and retention efforts. Study respondents preferred short and convenient health education interventions and surveys. Therefore, brevity, convenience and choice appear to be important when designing education interventions and evaluation surveys from the perspective of our target population.
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Affiliation(s)
- Enza Gucciardi
- School of Nutrition Ryerson University, Toronto, Ontario, Canada.
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Thoolen B, de Ridder D, Bensing J, Gorter K, Rutten G. Who participates in diabetes self-management interventions?: Issues of recruitment and retainment. DIABETES EDUCATOR 2007; 33:465-74. [PMID: 17570877 DOI: 10.1177/0145721707301491] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of this study was to examine reasons for nonparticipation and drop out in a diabetes self-management intervention. METHODS A total of 468 recently screen-detected patients, receiving usual care or intensive pharmacological treatment, were invited and randomized into either a control or intervention condition, consisting of a brief self-management course. A nonresponse survey was conducted, and participants, nonparticipants, and dropouts were compared on sociodemographic variables, diabetes attitudes, and self-care. RESULTS A total of 227 patients consented and were allocated to the control (n=108) or intervention group (n=119). Two hundred forty-one patients declined participation, 41 dropped out, and 78 completed the intervention. Major reasons for refusal and drop out were hesitancy toward research and practical barriers. Nonparticipants were less educated and reported higher self-management, while participation also varied by treatment and disease duration: intensively treated patients were more likely to participate in their first year, and usual-care patients participated more often 2 to 3 years after diagnosis. Dropouts had a lower education level but did not differ on any other measure. CONCLUSION Participants, nonparticipants, and dropouts did not differ in their attitudes toward diabetes, but the intervention did attract patients with lower self-care. Variations in participation by treatment and disease duration suggest that patients prefer self-management interventions at different times depending on their medical treatment. Finally, education appears to be the most important factor determining participation. Alternative strategies are needed to attract and retain patients with low education.
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Affiliation(s)
- Bart Thoolen
- The Department of Clinical and Health Psychology, Utrecht University, Utrecht, the Netherlands (Mr Thoolen, Dr de Ridder, Dr Bensing)
| | - Denise de Ridder
- The Department of Clinical and Health Psychology, Utrecht University, Utrecht, the Netherlands (Mr Thoolen, Dr de Ridder, Dr Bensing)
| | - Jozien Bensing
- The Department of Clinical and Health Psychology, Utrecht University, Utrecht, the Netherlands (Mr Thoolen, Dr de Ridder, Dr Bensing)
- Netherlands Institute for Health Services Research, Utrecht, the Netherlands (Dr Bensing)
| | - Kees Gorter
- The Julius Center for Health Sciences and Primary Care, Utrecht, the Netherlands (Dr Gorter, Dr Rutten)
| | - Guy Rutten
- The Julius Center for Health Sciences and Primary Care, Utrecht, the Netherlands (Dr Gorter, Dr Rutten)
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Shandro JR, Spain DA, Dicker RA. Recruitment Strategies for a Fall Prevention Program: If We Build It, Will They Really Come? ACTA ACUST UNITED AC 2007; 63:142-6. [PMID: 17622882 DOI: 10.1097/ta.0b013e318068428a] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND More than one third of adults over the age of 65 suffer a fall each year, facing morbidity and mortality. Modifiable risk factors for falls have been identified, but specific recruitment strategies for prevention programs have not been evaluated. The purpose of this observational study was to evaluate recruitment strategies for a fall prevention program. METHODS Participants were recruited during an 11-month period at a Level I trauma center. Participants were eligible if >65 years old, living independently, and had a fall. Recruitment modalities included (1) emergency medical services, (2) emergency department (ED), (3) primary care providers, and (4) media exposure leading to self-referral. Data were collected on baseline rate of fall victims seen in the ED, demographics, medical history, and source of referral. RESULTS There were 91 individuals referred, with 61 (67%) enrolled. Enrollment rates were higher among patients referred by self or primary care providers than among those referred by emergency medical services or the ED. There were no significant differences in demographics or medical history among the eligible but not referred ED population, the referred population, and the enrolled population. Reasons for not enrolling included inappropriate referral (33%), no response (17%), other illness (13%), and patients thinking that they do not need the services (37%). CONCLUSIONS These recruitment strategies were successful in enrolling a representative population of patients at risk for recurrent falls, but could be improved to capture more potential participants. Source of referral has a significant effect on rate of enrollment. We outline challenges and solutions to recruitment.
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Glasgow RE. eHealth evaluation and dissemination research. Am J Prev Med 2007; 32:S119-26. [PMID: 17466816 DOI: 10.1016/j.amepre.2007.01.023] [Citation(s) in RCA: 182] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2006] [Revised: 01/26/2007] [Accepted: 01/30/2007] [Indexed: 11/30/2022]
Abstract
This paper reviews key challenges in evaluating eHealth intervention and behavior change programs, and makes recommendations for the types of designs, measures, and methods needed to accelerate the integration of proven eHealth programs into practice. Key issues discussed include evaluation approaches that answer questions that consumers, potential adoptees, and policymakers have. These include measures of participation and representativeness at both patient and healthcare setting levels, consistency of outcomes across different subgroups, tendency of an eHealth program to ameliorate versus exacerbate health disparities, implementation and program adaptation, cost, and quality-of-life outcomes. More practical eHealth trials are needed that use rigorous but creative designs compatible with eHealth interventions and theory. These evaluations should address key dissemination issues, such as appeal, use, and robustness of eHealth programs across different subgroups, settings, conditions, outcomes, and time.
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Affiliation(s)
- Russell E Glasgow
- Clinical Research Unit, Kaiser Permanente Colorado, Denver, Colorado, USA.
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Strycker LA, Duncan SC, Chaumeton NR, Duncan TE, Toobert DJ. Reliability of pedometer data in samples of youth and older women. Int J Behav Nutr Phys Act 2007; 4:4. [PMID: 17306031 PMCID: PMC1810544 DOI: 10.1186/1479-5868-4-4] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2006] [Accepted: 02/17/2007] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Pedometers offer researchers a convenient and inexpensive tool for objective measurement of physical activity. However, many unanswered questions remain about expected values for steps/day for different populations, sources of variation in the data, and reliability of pedometer measurements. METHODS This study documented and compared mean steps/day, demographic predictors of steps/day, and pedometer reliability in two longitudinal investigations, one involving a population-based youth sample (N = 367) and the other targeting postmenopausal women with type 2 diabetes (N = 270). Individuals were asked to wear pedometers (Yamax model SW-701) at the waist for 7 days and record steps/per day. They were also asked to record daily physical activities, duration, and perceived intensity (1 = low/light, 2 = medium/moderate, 3 = high/hard) for the same 7 days. In addition, survey data regarding usual physical activity was collected. Analyses of variance (ANOVA) were conducted to determine whether there were significant differences in pedometer results according to sex, age, and body mass index. Repeated measures ANOVAs were used to examine potential differences in results among differing numbers of days. RESULTS Mean steps/day were 10,365 steps in the youth sample and 4,352 steps in the sample of older women. Girls took significantly fewer steps than boys, older women took fewer steps than younger women, and both youth and women with greater body mass took fewer steps than those with lower body mass. Reliability coefficients of .80 or greater were obtained with 5 or more days of data collection in the youth sample and 2 or more days in the sample of older women. Youth and older women were more active on weekdays than on weekends. Low but significant associations were found between step counts and self-report measures of physical activity in both samples. CONCLUSION Mean steps/day and reliability estimates in the two samples were generally consistent with previously published studies of pedometer use. Based on these two studies, unsealed pedometers were found to offer an easy-to-use and cost-effective objective measure of physical activity in both youth and older adult populations.
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Affiliation(s)
- Lisa A Strycker
- Oregon Research Institute, 1715 Franklin Blvd, Eugene, OR 97403, USA
| | - Susan C Duncan
- Oregon Research Institute, 1715 Franklin Blvd, Eugene, OR 97403, USA
| | - Nigel R Chaumeton
- Oregon Research Institute, 1715 Franklin Blvd, Eugene, OR 97403, USA
| | - Terry E Duncan
- Oregon Research Institute, 1715 Franklin Blvd, Eugene, OR 97403, USA
| | - Deborah J Toobert
- Oregon Research Institute, 1715 Franklin Blvd, Eugene, OR 97403, USA
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Toobert DJ, Glasgow RE, Strycker LA, Barrera M, Ritzwoller DP, Weidner G. Long-term effects of the Mediterranean lifestyle program: a randomized clinical trial for postmenopausal women with type 2 diabetes. Int J Behav Nutr Phys Act 2007; 4:1. [PMID: 17229325 PMCID: PMC1783667 DOI: 10.1186/1479-5868-4-1] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2006] [Accepted: 01/17/2007] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Multiple-risk-factor interventions offer a promising means for addressing the complex interactions between lifestyle behaviors, psychosocial factors, and the social environment. This report examines the long-term effects of a multiple-risk-factor intervention. METHODS Postmenopausal women (N = 279) with type 2 diabetes participated in the Mediterranean Lifestyle Program (MLP), a randomized, comprehensive lifestyle intervention study. The intervention targeted healthful eating, physical activity, stress management, smoking cessation, and social support. Outcomes included lifestyle behaviors (i.e., dietary intake, physical activity, stress management, smoking cessation), psychosocial variables (e.g., social support, problem solving, self-efficacy, depression, quality of life), and cost analyses at baseline, and 6, 12, and 24 months. RESULTS MLP participants showed significant 12- and 24-month improvements in all targeted lifestyle behaviors with one exception (there were too few smokers to analyze tobacco use effects), and in psychosocial measures of use of supportive resources, problem solving, self-efficacy, and quality of life. CONCLUSION The MLP was more effective than usual care over 24 months in producing improvements on behavioral and psychosocial outcomes. Directions for future research include replication with other populations.
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Affiliation(s)
- Deborah J Toobert
- Oregon Research Institute, 1715 Franklin Blvd, Eugene, OR 97403, USA
| | | | - Lisa A Strycker
- Oregon Research Institute, 1715 Franklin Blvd, Eugene, OR 97403, USA
| | - Manuel Barrera
- Psychology Department, Arizona State University, Box 871104 Tempe, AZ 85287, USA
| | - Debra P Ritzwoller
- Kaiser Permanente Colorado, Clinical Research Unit, 580 Mohawk Dr., Boulder, CO 80302, USA
| | - Gerdi Weidner
- Preventive Medicine Research Institute, 900 Bridgeway, Sausalito, California 94965, USA
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Bourbeau J, Collet JP, Schwartzman K, Ducruet T, Nault D, Bradley C. Economic Benefits of Self-Management Education in COPD. Chest 2006; 130:1704-11. [PMID: 17166985 DOI: 10.1378/chest.130.6.1704] [Citation(s) in RCA: 137] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
CONTEXT There is emerging evidence that disease management with self-management education provided by a case manager might benefit COPD patients. OBJECTIVE To determine whether disease management with self-management education is more cost-effective than usual care among previously hospitalized COPD patients. DESIGN Economic analysis in conjunction with a multicenter randomized clinical trial comparing patients conducting self-management with those receiving usual care over a 1-year follow-up period. SETTING Respiratory referral centers. PATIENTS One hundred ninety-one COPD patients who required hospitalization in the year preceding enrollment were recruited from seven respiratory outpatient clinics. INTERVENTION In addition to usual care, patients in the intervention group received standardized education on COPD self-management program called "Living Well with COPD" with ongoing supervision by a case manager. MAIN OUTCOME MEASURES From the perspective of the health-care payer, we compared costs between the two groups and estimated the program cost per hospitalization prevented (incremental cost-effectiveness ratio of the program). We repeated these estimates for several alternate scenarios of patient caseload. RESULTS The additional cost of the self-management program as compared to usual care, $3,778 (2004 Canadian dollars) per patient, exceeded the savings of $3,338 per patient based on the study design with a caseload of 14 patients per case manager. However, through a highly plausible sensitivity analysis, it was showed that if case managers followed up 50 patients per year, the self-management intervention would be cost saving relative to usual care (cost saving of $2,149 per patient; 95% confidence interval, $38 to $4,258). With more realistic potential caseloads of 50 to 70 patients per case manager, estimated program costs would be $1,326 and $1,016 per prevented hospitalization, respectively. CONCLUSION The program of self-management in COPD holds promise for positive economic benefits with increased patient caseload and rising costs of hospitalization.
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Affiliation(s)
- Jean Bourbeau
- Respiratory Epidemiology and Clinical Research Unit, Montréal Chest Institute, Royal Victoria Hospital, McGill University Health Centre, 3650 St. Urbain, Office K1.32, Montréal, QC, Canada H2X 2P4.
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Barrera M, Toobert DJ, Angell KL, Glasgow RE, Mackinnon DP. Social support and social-ecological resources as mediators of lifestyle intervention effects for type 2 diabetes. J Health Psychol 2006; 11:483-95. [PMID: 16774900 DOI: 10.1177/1359105306063321] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A study was conducted to determine if an intervention could change social support and social-ecological resources of post-menopausal women diagnosed with type 2 diabetes, and if those changes mediated the intervention's effects on health behaviors and outcomes. Women (N = 279) were randomly assigned to receive a comprehensive 6-month Mediterranean Lifestyle Program (MLP) or usual care from their physicians (UC). MLP was successful in changing social embeddedness and social-ecological resources, but not a measure of perceived support. Changes in social-ecological resources mediated intervention effects on fat consumption, exercise and glycemic control. The experimental manipulation of mediators and the demonstrated mediation effects support the conclusion that social-ecological resources can contribute to improvements in healthful lifestyles for women with type 2 diabetes.
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Affiliation(s)
- Manuel Barrera
- Department of Psychology, Arizona State University, Tempe, AZ 85287, USA.
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Pischke CR, Marlin RO, Weidner G, Chi C, Ornish D. The Role of Lifestyle in Secondary Prevention of Coronary Heart Disease in Patients With Type 2 Diabetes. Can J Diabetes 2006. [DOI: 10.1016/s1499-2671(06)02007-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Glasgow RE, Toobert DJ, Barrera M, Strycker LA. The Chronic Illness Resources Survey: cross-validation and sensitivity to intervention. HEALTH EDUCATION RESEARCH 2005; 20:402-409. [PMID: 15572438 DOI: 10.1093/her/cyg140] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
There is great interest in, but few instruments to assess, multiple levels of support and community resources from a social-ecological perspective. This study evaluated the psychometric characteristics of the Chronic Illness Resources Survey (CIRS) and its sensitivity to a multifaceted social-ecological intervention to enhance personally relevant community resources supportive of healthful lifestyles. Participants were 293 post-menopausal women having type 2 diabetes who were part of a multiple-behavior lifestyle change program. Key measures included the CIRS, a validated Food Frequency Questionnaire, the Kristal Fat and Fiber Behavior Questionnaire, the CHAMPS Activities Questionnaire for Older Adults, and other measures of social support. Results revealed that the CIRS displayed good psychometric characteristics in this new sample, was significantly correlated as predicted with established measures of social support, was sensitive to intervention, and partially mediated the effects of intervention on both dietary and physical activity outcomes. The 22-item CIRS scale appears useful for assessing multilevel support resources, predicting successful behavior change and detecting social-ecological intervention effects.
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Toobert DJ, Strycker LA, Glasgow RE, Barrera M, Angell K. Effects of the mediterranean lifestyle program on multiple risk behaviors and psychosocial outcomes among women at risk for heart disease. Ann Behav Med 2005; 29:128-37. [PMID: 15823786 PMCID: PMC1557654 DOI: 10.1207/s15324796abm2902_7] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND The Mediterranean Lifestyle Program was evaluated for its effects on multiple behavioral risk factors for coronary heart disease (CHD) among postmenopausal women with diabetes. PURPOSE Our purpose is to test a comprehensive lifestyle management intervention to reduce CHD risk in postmenopausal women with type 2 diabetes. METHODS Participants (N = 279) were randomized to usual care (UC) or Mediterranean Lifestyle Program, a lifestyle change intervention aimed at the behavioral risk factors (eating patterns, physical activity, stress management, and social support) affecting risk for CHD in postmenopausal women with type 2 diabetes. RESULTS In original and intent-to-treat analyses, Mediterranean Lifestyle Program participants showed significantly greater improvement in dietary behaviors, physical activity, stress management, perceived support, and weight loss at 6 months compared to UC. CONCLUSIONS This study demonstrated the effectiveness of the Mediterranean Lifestyle Program in improving self-care among women with type 2 diabetes, showed that postmenopausal women could make comprehensive lifestyle changes, and provided evidence that a program using social-cognitive strategies and peer support can be used to modify multiple lifestyle behaviors.
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Keers JC, Links TP, Bouma J, Gans ROB, ter Maaten JC, Wolffenbuttel BHR, Sluiter WJ, Sanderman R. Do diabetologists recognise self-management problems in their patients? Diabetes Res Clin Pract 2004; 66:157-61. [PMID: 15533583 DOI: 10.1016/j.diabres.2004.02.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2003] [Revised: 02/16/2004] [Accepted: 02/24/2004] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The aim of this study was to determine whether diabetologists recognise patients' needs for additional intensive multidisciplinary care due to glycaemic and diabetes-related psychosocial difficulties. RESEARCH DESIGN AND METHODS We compared 114 participants in a diabetes intervention programme with 201 as yet non-referred outpatients, of whom 54 outpatients were considered eligible for the intervention by their diabetologists; thus, 147 outpatients were considered non-eligible. RESULTS Analysis revealed that the eligible patients had poorer glycaemic control but all other parameters were similar to non-eligible patients. Significantly, 22 (15%) of the 147 non-eligible patients clearly had diabetes distress and could potentially benefit from the intervention. CONCLUSION The results suggest that in regular care, patients' needs with respect to glycaemic control are recognised by their diabetologists, but patients with high psychosocial diabetes-related distress are often overlooked, though they also may be in need of additional care. Integrated monitoring of diabetes-related distress in outpatients could improve this area of diabetes care.
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Affiliation(s)
- J C Keers
- Northern Centre for Healthcare Research, P.O. Box 196, Groningen 9700 AD, The Netherlands.
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Wiesemann A, Ludt S, Szecsenyi J, Scheuermann W, Scheidt R. Cardiovascular risk factors and motivation for a healthy life-style in a German community--results of the GP-based Oestringen study. PATIENT EDUCATION AND COUNSELING 2004; 55:40-47. [PMID: 15476988 DOI: 10.1016/j.pec.2003.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2003] [Revised: 07/24/2003] [Accepted: 07/28/2003] [Indexed: 05/24/2023]
Abstract
This paper explores the motivation of patients towards a healthy life-style in a small community with a special general practice and community-based health education program in order to identify reasons for different motivations and barriers and to improve preventive measures and outcome. The last of six standardised health surveys carried out over 9 years in the five general practices was therefore combined with a questionnaire to explore the attitudes of a sample of patients from these practices (N = 1044) and all attendees of 11 health education courses (N = 153). In addition to the cardiovascular risk factors, data were collected on sociodemographic factors and motivations for health promotion. The results show that, over time, the risk factors of hypertension (P < 0.001) and smoking (P < 0.005) had decreased. Health-promoting activities were not associated with cardiovascular risk factors; the motivations "duty" and "staying young" correlated with gender (P < 0.05). Patients with good health and white collar professions were more active. About 20% specified specific barriers to health-related activities. As expected, the participants of an educational program were more highly motivated by "fun", "fitness" and "meaningfulness". This group was mainly female. Future preventive measures should take into account that motivation for health promotion depends more on psychosocial factors than on risk factors; frequent obstacles should be noticed in the community.
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Affiliation(s)
- Armin Wiesemann
- Department of General Practice and Health Services Research, University of Heidelberg, Heidelberg, Im Neuenheimer Feld 347, Heidelberg D-69120, Germany.
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Amthauer H, Gaglio B, Glasgow RE, Dortch W, King DK. Lessons learned: patient recruitment strategies for a type 2 diabetes intervention in a primary care setting [corrected]. DIABETES EDUCATOR 2003; 29:673-81. [PMID: 13677178 DOI: 10.1177/014572170302900413] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE This study reports on methods and strategies employed to increase participation rates in diabetes interventions and discusses the reach and representativeness of the Diabetes Priority Program. METHODS A passive mail-out procedure was used to contact patients of participating primary care physicians. Patients who did not return the refusal postcard were contacted. Several attempts were made to contact potential participants. Brochures, "wrong number" postcards, posters, and reports for clinic staff were strategies used to increase participation. RESULTS The recruitment process resulted in a participation rate of 83% among patients who were contacted and eligible. These participants appeared to be representative of both nonparticipants and persons with diabetes in Colorado. In contrast, a low percentage of primary care physicians, estimated at 3%, took part in the program despite efforts to make the program brief, nonintrusive, and compatible with usual care. CONCLUSIONS Recruitment is currently challenging and will become even more difficult with the privacy regulations that affect healthcare research and the public distrust of solicitations. To increase participation rates, it is important that the clinic staff promotes and supports the program, and that participant lists are accurate and adequate in size.
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Affiliation(s)
- Hilarea Amthauer
- Kaiser Permanente, Denver, Colorado (Mss Amthauer, Gaglio, and King, and Dr Glasgow)
- Ms Amthauer is now with the Department of Rehabilitation, University of Colorado Health Science Center, Denver
| | - Bridget Gaglio
- Kaiser Permanente, Denver, Colorado (Mss Amthauer, Gaglio, and King, and Dr Glasgow)
| | - Russell E Glasgow
- Kaiser Permanente, Denver, Colorado (Mss Amthauer, Gaglio, and King, and Dr Glasgow)
| | - Wendy Dortch
- The Cooper Institute, Denver, Colorado (Ms Dortch)
| | - Diane K King
- Kaiser Permanente, Denver, Colorado (Mss Amthauer, Gaglio, and King, and Dr Glasgow)
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Toobert DJ, Glasgow RE, Strycker LA, Barrera M, Radcliffe JL, Wander RC, Bagdade JD. Biologic and quality-of-life outcomes from the Mediterranean Lifestyle Program: a randomized clinical trial. Diabetes Care 2003; 26:2288-93. [PMID: 12882850 DOI: 10.2337/diacare.26.8.2288] [Citation(s) in RCA: 167] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Few multiple lifestyle behavior change programs have been designed to reduce the risk of coronary heart disease in postmenopausal women with type 2 diabetes. This study tested the effectiveness of the Mediterranean Lifestyle Program (MLP), a comprehensive lifestyle self-management program (Mediterranean low-saturated fat diet, stress management training, exercise, group support, and smoking cessation), in reducing cardiovascular risk factors in postmenopausal women with type 2 diabetes. RESEARCH DESIGN AND METHODS Postmenopausal women with type 2 diabetes (n = 279) were randomized to either usual care (control) or treatment (MLP) conditions. MLP participants took part in an initial 3-day retreat, followed by 6 months of weekly meetings, to learn and practice program components. Biological end points were changes in HbA(1c), lipid profiles, BMI, blood pressure, plasma fatty acids, and flexibility. Impact on quality of life was assessed. RESULTS Multivariate ANCOVAs revealed significantly greater improvements in the MLP condition compared with the usual care group on HbA(1c), BMI, plasma fatty acids, and quality of life at the 6-month follow-up. Patterns favoring intervention were seen in lipids, blood pressure, and flexibility but did not reach statistical significance. CONCLUSIONS These results demonstrate that postmenopausal women with type 2 diabetes can make comprehensive lifestyle changes that may lead to clinically significant improvements in glycemic control, some coronary heart disease risk factors, and quality of life.
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