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Polak R, Finkelstein A, Budd MA, Gray BE, Robinson H, Silver JK, Faries MD, Tirosh A. Expectations from a Home Cooking Program: Qualitative Analyses of Perceptions from Participants in "Action" and "Contemplation" Stages of Change, before Entering a Bi-Center Randomized Controlled Trial. Nutrients 2023; 15:2082. [PMID: 37432182 PMCID: PMC10181073 DOI: 10.3390/nu15092082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 04/18/2023] [Accepted: 04/21/2023] [Indexed: 07/12/2023] Open
Abstract
Home cooking is an emerging strategy to improve nutrition; however, the literature lacks reports about patient expectations from culinary interventions. Personalized medicine utilizes knowledge about a person's genes; yet, behavioral factors, such as participant "readiness" to make a change, may also impact treatment preferences and outcomes. The purpose is to explore the expectations of participants in different stages of change from a home cooking intervention. Participants were recruited to a randomized controlled trial evaluating the impact of a home cooking intervention on weight. Stage of change assessed by a validated University of Rhode Island Change Assessment scale and expectations through an open-ended questionnaire. Sixteen (21%) participants were in the action stage of change, and 59 (79%) were in the contemplation stage. Participants from both groups shared similar expectations to achieve healthy eating and lifestyle goals and to adopt sustainable change. However, action group expectations also included expanding existing culinary knowledge and change of habits; the contemplation group expectations also included acquiring culinary knowledge, improving self-regulatory skills, and obtaining guidance and support. While action group participants were looking to expand existing knowledge and techniques, contemplation group participants were focusing on acquiring culinary knowledge and skills. This can potentially contribute to developing effective, personalized nutrition interventions.
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Affiliation(s)
- Rani Polak
- Spaulding Rehabilitation Hospital, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA 02129, USA
- Center of Lifestyle Medicine, Sheba Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Hashomer 52621, Israel
| | - Adi Finkelstein
- Department of Nursing, Faculty of Life and Health Sciences, Jerusalem College of Technology, Jerusalem 95483, Israel;
| | - Maggi A. Budd
- Department of Spinal Cord Medicine, VA Boston Healthcare System, Department of Psychiatry, Harvard Medical School, Boston, MA 02130, USA;
| | - Brianna E. Gray
- Translational and Clinical Research Centers, Massachusetts General Hospital, Boston, MA 02114, USA;
| | - Hanni Robinson
- Medical School, University of Nicosia, Nicosia 2408, Cyprus;
| | - Julie K. Silver
- Massachusetts General Hospital, Brigham & Weman’s Hospital, Spaulding Rehabilitation Hospital, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA 02129, USA;
| | - Mark D. Faries
- Texas A&M School of Public Health and College of Medicine, Bryan, TX 77807, USA;
| | - Amir Tirosh
- Division of Endocrinology, Diabetes and Metabolism, Sheba Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Hashomer 5262161, Israel;
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Tlusty K, Jackson M, Riley B, Blase T. Effects of diet education on empowerment for individuals who have an increased risk of developing breast or colon cancer: A pilot study. J Genet Couns 2022; 31:1138-1147. [PMID: 35502599 PMCID: PMC9790378 DOI: 10.1002/jgc4.1584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 04/10/2022] [Accepted: 04/12/2022] [Indexed: 12/30/2022]
Abstract
Strong evidence indicates following a healthy diet reduces cancer risk; however, the impact of diet education on empowerment on individuals with an increased cancer risk has not been evaluated. Study participants included patients who had met with a cancer genetic counselor without a history of cancer. Participants received pre- and post-diet education surveys including questions to measure empowerment and feedback for diet education in relation to cancer risk. Empowerment was measured using a ten-question survey adapted from the Genetic Counseling Outcome Scale. The diet education intervention consisted of viewing an infographic created for this study based on recommendations for diets that reduce cancer risk by the World Cancer Research Fund and American Institute for Cancer Research. Twenty-eight participants completed both surveys and reviewed the diet education intervention. There was no change in empowerment between pre- and post- diet education (mean change = -0.5; p = 0.49). Participants previously learned about the relationship between a healthy diet and cancer risk reduction from several sources including family and friends (25.0%), online (25.0%), and primary care providers (25.0%). Most participants preferred diet education to be delivered online (42.9%), followed by on paper (39.3%), and in-person delivery (17.9%). This pilot study promotes further investigation on the impact of diet or lifestyle education on individuals who have a predisposition to developing cancer. While the results demonstrated no change in empowerment because of diet education, the results established a desire for learning about a healthy diet related to cancer risk and preferences for the modes of delivering education.
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Affiliation(s)
- Kaitlyn Tlusty
- Division of Genetic Counseling EducationCollege of Allied Health ProfessionsUniversity of Nebraska Medical CenterOmahaNebraskaUSA
| | - Mariah Jackson
- Division of Medical Nutrition EducationCollege of Allied Health ProfessionsUniversity of Nebraska Medical CenterOmahaNebraskaUSA
| | | | - Terri Blase
- Munroe‐Meyer Institute for Genetics and RehabilitationUniversity of Nebraska Medical CenterOmahaNebraskaUSA
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Elliott-Wherry AN, Lee JE, Pearlman AM, Wahls TL. The Wahls Behavior Change Model for Complex Chronic Diseases: A Clinician's Guide. Degener Neurol Neuromuscul Dis 2022; 12:111-125. [PMID: 36110247 PMCID: PMC9469801 DOI: 10.2147/dnnd.s370173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 07/19/2022] [Indexed: 12/04/2022] Open
Abstract
Behavior change models are used to understand and intervene on health-related behaviors and outcomes. However, there is a gap in the literature regarding how to create and maintain behavior change in patients with complex chronic diseases such as Multiple Sclerosis (MS). To address this gap, the Wahls Behavior ChangeTM Model (WBCM) (The trademark applies to subsequent mention of the model.) was developed based on existing behavior change theory, empirical evidence, and extensive clinical experience caring for patients with complex chronic diseases. A patient-centered, comprehensive, and multimodal approach, this model provides a framework for understanding and implementing lifestyle behavior change. The overall goals of this paper are to: (1) review existing behavior change theories; (2) introduce the WBCM, including the model's 11 Principles for behavior change in patients with complex chronic diseases; and (3) share how providers can be trained to implement the WBCM. The WBCM can potentially improve short- and longer-term function and quality of life outcomes for people with complex chronic diseases.
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Affiliation(s)
- Alaina N Elliott-Wherry
- Department of Community and Behavioral Health, University of Iowa College of Public Health, Iowa City, IA, USA
| | - Jennifer E Lee
- College of Nursing, The University of Iowa, Iowa City, IA, USA
| | - Amy M Pearlman
- Department of Urology, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Terry L Wahls
- Department of Internal Medicine-General Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
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Bailey-Davis L, Pinto AM, Hanna DJ, Rethorst CD, Still CD, Foster GD. Qualitative inquiry with primary care providers and specialists about adult weight management care and referrals. Transl Behav Med 2022; 12:576-584. [PMID: 35195267 PMCID: PMC9132206 DOI: 10.1093/tbm/ibac006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Obesity is a highly prevalent disease and providers are expected to offer or refer patients for weight management yet increasingly fewer clinical visits address obesity. Challenges to offering care are known but less is known about referrals and how specialists who treat obesity-related comorbidities address care and referrals. This study explored perceptions of primary care providers (PCPs) and specialty providers regarding care and referrals for weight management, specifically referrals to programs in the community setting. A qualitative design was used to interview 33 PCPs (mean age 54 years) and 31 specialists (cardiology, gynecology, endocrinology, and orthopedics [mean age 62 years]) in the USA during 2019. Each interview was conducted by telephone, audio-recorded, and transcribed verbatim. Inductive analysis was used and followed the constant comparative method. Four themes emerged from the data including (a) Clinical guidelines and provider discretion influence obesity care; (b) Facilitators and barriers to discussing weight and small step strategies; (c) Informal referrals are made for weight management in community settings; and (d) Opportunities and challenges for integrating clinical and community services for weight management. Facilitating referrals to effective programs, ideally with a feedback loop could coordinate care and enhance accountability, but education, compliance, and cost issues need addressed. Care may be offered but not be well-aligned with clinical guidelines. Knowledge gaps regarding community programs' offerings and efficacy were evident. Referrals could be systematically promoted, facilitated, and tracked to advance weight management objectives.
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Affiliation(s)
- Lisa Bailey-Davis
- Department of Population Health Sciences, Geisinger, Danville, PA 17822, USA
- Obesity Research Institute, Geisinger, Danville, PA 17822, USA
| | | | - David J Hanna
- Obesity Research Institute, Geisinger, Danville, PA 17822, USA
| | | | | | - Gary D Foster
- WW International, Inc., New York, NY 10010, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
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Hielkema MH, Lund TB. Reducing meat consumption in meat-loving Denmark: Exploring willingness, behavior, barriers and drivers. Food Qual Prefer 2021. [DOI: 10.1016/j.foodqual.2021.104257] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Gupta SK, Lakshmi PVM, Rastogi A, Kaur M. Development and evaluation of self-care intervention to improve self-care practices among people living with type 2 diabetes mellitus: a mixed-methods study protocol. BMJ Open 2021; 11:e046825. [PMID: 34210727 PMCID: PMC8252870 DOI: 10.1136/bmjopen-2020-046825] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 06/02/2021] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION The management of diabetes mellitus (DM) depends on medication adherence, self-care and regular follow-up to prevent complications and premature mortality. This study aims to develop and implement the behavioural change theory and model based diabetes self-care intervention package to improve self-care practices among people living with type 2 DM. METHODS AND ANALYSIS An exploratory sequential mixed-method study design wherein, quantitative follows qualitative will be used to develop, implement and evaluate the effect of diabetes self-care intervention package among people living with type 2 diabetes. The qualitative research method will be used to identify barriers and facilitators for self-care practices among people living with type 2 DM and will also provide the basis for the development of the diabetes self-care intervention package. The quasi-experimental with control study design will be used to evaluate the developed intervention package among 220 randomly selected people living with type 2 diabetes in both intervention and control arms. Baseline, follow-ups and endline data will be collected using same prevalidated and structured questionnaire for each self-care activity. Difference-in-difference analysis will be used to measure for changes in the proportion of people living with type 2 DM doing different component of self-care practices, preintervention and postintervention in both arms. ETHICS AND DISSEMINATION Permission for conducting the study has been taken from Institutional Ethical Committee of PGIMER, Chandigarh (Ref no. NK/4538/PhD/226, Dated 18.08.18). The findings of the trial will be disseminated through publication in peer-reviewed journals. TRIAL REGISTRATION NUMBER CTRI/2018/10/016108; Pre-results.
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Affiliation(s)
- Saurabh Kumar Gupta
- Department of Community Medicine and School of Public Health, PGIMER, Chandigarh, Chandigarh, India
| | - P V M Lakshmi
- Department of Community Medicine and School of Public Health, PGIMER, Chandigarh, Chandigarh, India
| | - Ashu Rastogi
- Department of Endocrinology, PGIMER, Chandigarh, Chandigarh, India
| | - Manmeet Kaur
- Department of Community Medicine and School of Public Health, PGIMER, Chandigarh, Chandigarh, India
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Ng WWM, Wong ASW, Cheung K. A Cluster Randomized Controlled Trial Feasibility Study of a WhatsApp-Delivered Intervention to Promote Healthy Eating Habits in Male Firefighters. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126633. [PMID: 34203034 PMCID: PMC8296461 DOI: 10.3390/ijerph18126633] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 06/15/2021] [Accepted: 06/17/2021] [Indexed: 11/16/2022]
Abstract
This cluster randomized controlled trial (CRCT)-designed study aimed to explore the feasibility of a promotion pamphlet and/or WhatsApp as a suitable mode of delivery to promote healthy eating habits with fruit and vegetables (F&V) among firefighters. Convenience and snowball sampling methods were used. Forty-five firefighters from 23 fire stations were recruited and they all received the printed pamphlet, while the intervention group participants (n = 20) received additional teaching material through WhatsApp every two weeks for eight weeks. Feasibility outcomes included retention, practicality, and implementation. The participants reported high levels of satisfaction with the intervention. There were significant improvements in the mean numbers of days consuming F&V (p = 0.002; p = 0.031) in the intervention group, and for fruit consumption (p = 0.033) in the control group between the baseline (T0) and 3 months after completion of intervention (T1). High levels of participants’ satisfaction with the intervention revealed that a full-scale CRCT of the WhatsApp-delivered intervention promoting healthy eating could be feasible, especially as a means of increasing the numbers of days they consumed F&V and the numbers of servings of these consumed per day.
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Affiliation(s)
- Winnie Wing Man Ng
- Division of Science, Engineering and Health Studies, College of Professional and Continuing Education, No. 8 Hung Lok Road, Hung Hom, Hong Kong, China
- Correspondence: (W.W.M.N.); (K.C.)
| | - Anthony Siu Wo Wong
- Centre for Gerontological Nursing, School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, China;
| | - Kin Cheung
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, China
- Correspondence: (W.W.M.N.); (K.C.)
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Vilamala-Orra M, Vaqué-Crusellas C, Foguet-Boreu Q, Guimerà Gallent M, del Río Sáez R. Applying the Stages of Change Model in a Nutrition Education Programme for the Promotion of Fruit and Vegetable Consumption among People with Severe Mental Disorders (DIETMENT). Nutrients 2021; 13:nu13062105. [PMID: 34205403 PMCID: PMC8235404 DOI: 10.3390/nu13062105] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/14/2021] [Accepted: 06/17/2021] [Indexed: 11/16/2022] Open
Abstract
Despite growing evidence of the benefits of adequate intake of fruit and vegetables (F&V) and the recommendation to consume five servings daily, the adoption of these habits is poor among people with severe mental disorder (SMD). The main aim of the present study is to determine changes in the intake of F&V and motivation to do so among people with SMDs after participating in a food education programme. A community-based randomized controlled trial was conducted in Spain, with the intervention group (IG) participating in a food education programme based on the stages of change model to promote consumption of F&V and the control group (CG) receiving three informative sessions on basic healthy eating. The main outcomes were related to the intake of F&V and stages of change. Data collection was performed at baseline, post intervention, and 12-month follow-up. Seventy-four participants enrolled in the study and sixty completed the 12-month follow-up. An increase in motivation towards the intake of F&V was observed in the IG but not in the CG (McNemar’s test p = 0.016, p = 0.625). No significant difference was observed for the intake of fruit, vegetables, or F&V. Basing food education strategies on the stages of change model shows positive results, increasing the awareness and disposition of people with SMD towards the intake of F&V. More research is needed to identify the most appropriate eating intervention to increase the intake of F&V.
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Affiliation(s)
- Mireia Vilamala-Orra
- Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, University of Vic—Central University of Catalonia, 08500 Vic, Spain;
- Osonament—Osona Psychopedagogical Medical Center Foundation, 08500 Vic, Spain; (M.G.G.); (R.d.R.S.)
| | - Cristina Vaqué-Crusellas
- Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, University of Vic—Central University of Catalonia, 08500 Vic, Spain;
- Correspondence:
| | - Quintí Foguet-Boreu
- Multidisciplinary Research Group in Mental Health, Faculty of Medicine, University Hospital of Vic, University of Vic—Central University of Catalonia, 08500 Vic, Spain;
| | - Marta Guimerà Gallent
- Osonament—Osona Psychopedagogical Medical Center Foundation, 08500 Vic, Spain; (M.G.G.); (R.d.R.S.)
| | - Ruben del Río Sáez
- Osonament—Osona Psychopedagogical Medical Center Foundation, 08500 Vic, Spain; (M.G.G.); (R.d.R.S.)
- Research Group on Mental Health, University of Vic—Central University of Catalonia, 08500 Vic, Spain
- Social Innovation (SaMIS), University of Vic—Central University of Catalonia, 08500 Vic, Spain
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Abstract
Health-promotion behaviors among urban Black women are the forefront of US health policy regarding health disparities. This cross-sectional study explored factors such as health literacy, self-efficacy, and readiness for change with health-promotion behaviors of urban Black women. Although these variables are relevant, urban Black women have identified that spirituality and history of domestic violence were also relevant. The sample consists of 152 participants from outpatient clinics, community events, and grocery stores in one Northeastern US city. The anonymous online survey contained the following Instruments: Newest Vital Sign, New General Self-efficacy Scale, Health Risk Instrument, Daily Spiritual Assessment Scale, FAST Survey, and Health-Promoting Lifestyle Profile II. Univariate statistics and bivariate/simultaneous linear regression identified significant relationships between health-promotion behaviors and the following: eeadiness for change, self-efficacy, and spirituality. Participants who engaged in health-promotion behaviors were ready to change, but these behaviors were negatively associated with spirituality, self-efficacy, and a history of domestic violence.
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Affiliation(s)
- Millie Hepburn
- College of Health Professions, Lienhard School of Nursing, Pace University, Pleasantville, NY, USA
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Woo S, Park KH. Motivating Children and Adolescents in Obesity Treatment. J Obes Metab Syndr 2020; 29:260-269. [PMID: 32843587 PMCID: PMC7789025 DOI: 10.7570/jomes20026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 04/10/2020] [Accepted: 04/26/2020] [Indexed: 12/21/2022] Open
Abstract
Enhancing motivation is a crucial issue in pediatric obesity interventions, as behavioral changes related to food intake and physical exercise are difficult to carry out with an insufficient level of motivation. In the treatment setting, low motivation towards change may lead to early termination or inadequate treatment outcomes. This paper reviews widely-used models of motivation, including the transtheoretical model of change, self-determination theory, and motivational interviewing (MI). We introduce useful strategies based on each theoretical model to enhance motivation, such as an importance and confidence scale and a decisional balance technique. A review of recent MI interventions in children and adolescents is presented to discuss the efficacy of MI-based interventions and considerations for applying MI in pediatric obesity.
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Affiliation(s)
- Sarah Woo
- Major in Biomedical Science, Department of Medical Sciences, Hallym University College of Medicine, Chuncheon, Korea
| | - Kyung Hee Park
- Department of Family Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
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Ng WM, Cheung K. A feasibility study of a WhatsApp-delivered Transtheoretical Model-based intervention to promote healthy eating habits for firefighters in Hong Kong: a cluster randomized controlled trial. Trials 2020; 21:518. [PMID: 32532313 PMCID: PMC7291567 DOI: 10.1186/s13063-020-04258-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 03/15/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Firefighters' health is often affected by a high prevalence of obesity and cardiovascular diseases, which are common risk factors for sudden cardiac death. The aim of this study is to investigate the feasibility of enhancing healthy eating habits in firefighters through an education programme. METHODS This will be a cluster randomized control trial study. The participants will be assigned randomly into either control (health promotion pamphlet) or intervention (health promotion pamphlet and education materials through WhatsApp) groups. Changes in healthy eating habits will be assessed by a self-administered questionnaire and anthropometric measurements at three different time points. DISCUSSION More education is required in order to improve firefighters' eating habits. TRIAL REGISTRATION ISRCTN registry identifier: Registered on 8 April 2019 ISRCTN95472464.
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Affiliation(s)
- Wing Man Ng
- Division of Science, Engineering and Health Studies, College of Professional and Continuing Education, The Hong Kong Polytechnic University, Hung Hom, Hong Kong.
| | - Kin Cheung
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
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A goal-systems perspective on plant-based eating: keys to successful adherence in university students. Public Health Nutr 2020; 24:75-83. [PMID: 32515718 DOI: 10.1017/s1368980020000695] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To explore adherence to a plant-based diet from the perspective of goals- and motivations-based systems. DESIGN A cross-sectional, survey-based study was conducted regarding eating patterns, goals and motivations for current eating habits. SETTING Data were collected using an online survey platform, including the Goal Systems Assessment Battery (GSAB) and other survey tools. PARTICIPANTS University students were recruited, including thirty-three students reporting successful maintenance of a plant-based diet (Adherents) and sixty-three students trying to adhere to a plant-based diet (Non-adherents). RESULTS Using GSAB subscale scores, discriminant function analyses significantly differentiated adherents v. non-adherents, accounting for 49·0 % of between-group variance (χ2 (13) = 42·03, P < 0·000). It correctly classified 72·7 % of adherents and 88·9 % of non-adherents. Constructs including value, self-efficacy, planning/stimulus control and positive affect were significant and included in the discriminant function. Logistic regression results suggested that participants who successfully adhered to a plant-based diet were seventeen times more likely to report 'To manage or treat a medical condition' as motivation and almost seven times more likely to report 'To align with my ethical beliefs' as motivation compared with non-adherents. However, these participants were 94 % less likely to report 'To maintain and/or improve my health' as motivation compared with non-adherents. Controlling for motivations, hierarchical logistic regression showed that only planning as part of the GSAB self-regulatory system predicted adherence to a plant-based diet. CONCLUSIONS Values-based approaches to plant-based diets, including consideration for ethical beliefs, self-efficacy and proper planning, may be key for successful maintenance of this diet long-term.
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The Impact of Mother-Child Dyad Dietary Intervention Using the Transtheoretical Model on Bone Mineral Density in Japanese Female Adolescents. J Pediatr Nurs 2020; 50:e39-e47. [PMID: 31669496 DOI: 10.1016/j.pedn.2019.09.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 09/17/2019] [Accepted: 09/17/2019] [Indexed: 11/21/2022]
Abstract
PURPOSE Peak bone mass, an important determinant of osteoporosis risk, is reached during adolescence. We evaluated the impact of mother-child dyad dietary intervention using the transtheoretical model (TTM) on bone mineral density in Japanese female adolescents. DESIGN AND METHODS The participants were dyads of female adolescents aged 15-16 years and their mothers (who are generally responsible for cooking). We enrolled 92 dyads, with 56 assigned to the intervention group and 36 to the control group. Bone mineral density was measured using quantitative ultrasound parameters (QUS). Nutrient intake and stage of behavioral change were collected via questionnaires. Evaluations were conducted at baseline and seven months later. The intervention group underwent the TTM-based dietary education program for six months. RESULTS After the intervention program, the ratio of change of the quantitative ultrasound parameter-speed of sound (SOS)-was significantly higher in the intervention than the control group (p < 0.001). Finally, we demonstrated that the intervention was found to significantly affect post-test outcomes in terms of SOS according to the result of analysis of covariance (p < 0.05). CONCLUSIONS Dietary intervention for female adolescents and their mothers using the TTM may enhance the bone mineral density in female adolescents. PRACTICE IMPLICATIONS We suggest that dietary intervention for female adolescents and their mothers using the transtheoretical model may enhance the bone mineral density in female adolescents.
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Guertin C, Pelletier L, Pope P. The validation of the Healthy and Unhealthy Eating Behavior Scale (HUEBS): Examining the interplay between stages of change and motivation and their association with healthy and unhealthy eating behaviors and physical health. Appetite 2020; 144:104487. [DOI: 10.1016/j.appet.2019.104487] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 09/12/2019] [Accepted: 10/09/2019] [Indexed: 11/26/2022]
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Chung LMY, Chung JWY, Chan APC. Building Healthy Eating Knowledge and Behavior: An Evaluation of Nutrition Education in a Skill Training Course for Construction Apprentices. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16234852. [PMID: 31810334 PMCID: PMC6926770 DOI: 10.3390/ijerph16234852] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 11/26/2019] [Accepted: 11/27/2019] [Indexed: 12/21/2022]
Abstract
Background: Prior research has found poor health among construction workers is related to poor nutrition and low fruit and vegetable consumption. Promoting nutrition knowledge can improve dietary behaviors, but nutrition education among construction workers is limited. We evaluated the effectiveness of nutrition education on fruit and vegetable consumption among construction apprentices. In this pilot evaluative study, 36 construction apprentices enrolled in skill training programs received two 1.5-hour nutrition classes. Twelve questions addressing healthy eating knowledge and behavior were administered at baseline, after intervention, and at three months follow-up. After intervention, daily fruit consumption improved from baseline (mean (s.d.) =1.42 (0.55)) to post intervention (mean (s.d.) =1.72 (0.70)) (p < 0.05) and to three months follow-up (mean(s.d.) =1.94 (0.83)) (p > 0.05). After intervention, daily vegetable consumption improved from baseline (mean (s.d.) =1.67 (0.59)) to post intervention (mean (s.d.) =1.97 (0.74)) (p < 0.05) and to three months follow-up (mean (s.d.) = 2.19 (0.82)) (p > 0.05). Younger construction apprentices showed better healthy eating knowledge at post intervention and three months follow-up (p > 0.05). Working in normal hours showed better healthy eating knowledge at post intervention but not at three months follow up (p > 0.05). Both age groups and working hours did not show significant differences on healthy eating behaviour. Nutrition education implemented as a three-hour session within skill courses may possibly promote fruit and vegetable consumption among construction apprentices. Further research with control group is required to support the findings in this study.
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Affiliation(s)
- Louisa Ming Yan Chung
- Department of Health and Physical Education, The Education University of Hong Kong, 10 Lo Ping Road, Tai Po, New Territories, Hong Kong, China;
- Correspondence: ; Tel.: +852-2948-8584
| | - Joanne Wai Yee Chung
- Department of Health and Physical Education, The Education University of Hong Kong, 10 Lo Ping Road, Tai Po, New Territories, Hong Kong, China;
| | - Albert P. C. Chan
- Department of Building and Real Estate, Polytechnic University, 11 Yuk Choi Road, Hung Hom, Hong Kong, China;
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Lee S, Lim H. Development of an Evidence-based Nutritional Intervention Protocol for Adolescent Athletes. J Exerc Nutrition Biochem 2019; 23:29-38. [PMID: 31743977 PMCID: PMC6823648 DOI: 10.20463/jenb.2019.0020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 09/28/2019] [Indexed: 01/26/2023] Open
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Bilgiç N, Günay T. Evaluation of effectiveness of peer education on smoking behavior among high school students. Saudi Med J 2018; 39:74-80. [PMID: 29332112 PMCID: PMC5885124 DOI: 10.15537/smj.2018.1.21774] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objectives: To evaluate the effectiveness of peer education on changing the smoking behavior of high schoolage children’s. Methods: In this interventional study; transtheoretical model, which is one of the cognitive-behavioral models was used for application of the peer education. Study was conducted in Izmir during 2011-2012 education period and included 338 students from 2 high schools The independent variable of the study is peer training. Descriptive variables for a student are age, gender, tendecy of friends to smoke inside and outside the school, the age they have first experienced the habit, reasons for nicotine consumption, levels of addiction, chatting about smoking and related harms. Family descriptive variables are education level of parents and whether their smoking tendency is present or not. Results: Approximately 18.3% of the students were current smoker. A positive behavioral change of smoking quitting among smoker students was observed after peer education. The number of students in precontemplation stage was reduced while the number of students in stages of preparation/determination action and maintenance was increased. Conclusion: Peer education was observed to be an effective method in the behavioral change of smoking teens. Authors strongly suggest peer education to be one of the preferred tools in changing the teen behavior in use of tobacco.
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Ramadas A, Chan CKY, Oldenburg B, Hussein Z, Quek KF. Randomised-controlled trial of a web-based dietary intervention for patients with type 2 diabetes: changes in health cognitions and glycemic control. BMC Public Health 2018; 18:716. [PMID: 29884161 PMCID: PMC5994015 DOI: 10.1186/s12889-018-5640-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 05/30/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Increasing prevalence and disease burden has led to an increasing demand of programs and studies focused on dietary and lifestyle habits, and chronic diseases such as type 2 diabetes mellitus (T2DM). We evaluated the effects of a 6-month web-based dietary intervention on Dietary Knowledge, Attitude and Behaviour (DKAB), Dietary Stages of Change (DSOC), fasting blood glucose (FBG) and glycosylated haemoglobin (HbA1c) in patients with uncontrolled HbA1c (> 7.0%) in a randomised-controlled trial (myDIDeA) in Malaysia. METHODS The e-intervention group (n = 62) received a 6-month web-delivered intensive dietary intervention while the control group (n = 66) continued with their standard hospital care. Outcomes (DKAB and DSOC scores, FBG and HbA1c) were compared at baseline, post-intervention and follow-up. RESULTS While both study groups showed improvement in total DKAB score, the margin of improvement in mean DKAB score in e-intervention group was larger than the control group at post-intervention (11.1 ± 0.9 vs. 6.5 ± 9.4,p < 0.001) and follow-up (19.8 ± 1.1 vs. 7.6 ± 0.7,p < 0.001), as compared to the baseline. Although there was no significant difference between intervention and control arms with respect to DSOC score and glycaemic control, the e-intervention group showed improved DSOC score (199.7 ± 18.2 vs193.3 ± 14.6,p = 0.046), FBG (7.9 ± 2.5 mmol/L vs. 8.9 ± 3.9 mmol/L,p = 0.015) and HbA1c (8.5 ± 1.8% vs. 9.1 ± 2.0%,p = 0.004) at follow-up compared to the baseline, whereas such improvement was not seen in the control group. CONCLUSIONS Most important impact of myDIDeA was on the overall DKAB score. This study is one of the first to demonstrate that an e-intervention can be a feasible method for implementing chronic disease management in developing countries. Concerns such as self-monitoring, length of intervention, intense and individualized intervention, adoption of other domains of Transtheoretical Model and health components, and barriers to change have to be taken into consideration in the development of future intervention programs. TRIAL REGISTRATION ClinicalTrials.gov NCT01246687 .
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Affiliation(s)
- Amutha Ramadas
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Jalan Lagoon Selatan, 47500 Bandar Sunway, Selangor Darul Ehsan Malaysia
| | - Carina Ka Yee Chan
- School of Psychology, Australian Catholic University, Brisbane, Australia
| | - Brian Oldenburg
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | | | - Kia Fatt Quek
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Jalan Lagoon Selatan, 47500 Bandar Sunway, Selangor Darul Ehsan Malaysia
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Hepburn M. The Variables Associated With Health Promotion Behaviors Among Urban Black Women. J Nurs Scholarsh 2018; 50:353-366. [DOI: 10.1111/jnu.12387] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Millie Hepburn
- Assistant Professor, Quinnipiac University, North Haven Campus; School of Nursing; North Haven CT USA
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Daivadanam M, Ravindran TKS, Thankappan KR, Sarma PS, Wahlström R. Development of a Tool to Stage Households' Readiness to Change Dietary Behaviours in Kerala, India. PLoS One 2016; 11:e0165599. [PMID: 27861500 PMCID: PMC5115657 DOI: 10.1371/journal.pone.0165599] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 10/16/2016] [Indexed: 11/18/2022] Open
Abstract
Dietary interventions and existing health behaviour theories are centred on individuals; therefore, none of the available tools are applicable to households for changing dietary behaviour. The objective of this pilot study was to develop a practical tool that could be administered by community volunteers to stage households in rural Kerala based on readiness to change dietary behaviour. Such a staging tool, comprising a questionnaire and its algorithm, focusing five dietary components (fruits, vegetables, salt, sugar and oil) and households (rather than individuals), was finalised through three consecutive pilot validation sessions, conducted over a four-month period. Each revised version was tested with a total of 80 households (n = 30, 35 and 15 respectively in the three sessions). The tool and its comparator, Motivational Interviewing (MI), assessed the stage-of-change for a household pertaining to their: 1) fruit and vegetable consumption behaviour; 2) salt, sugar and oil consumption behaviour; 3) overall readiness to change. The level of agreement between the two was tested using Kappa statistics to assess concurrent validity. A value of 0.7 or above was considered as good agreement. The final version was found to have good face and content validity, and also a high level of agreement with MI (87%; weighted kappa statistic: 0.85). Internal consistency testing was performed using Cronbach’s Alpha, with a value between 0.80 and 0.90 considered to be good. The instrument had good correlation between the items in each section (Cronbach’s Alpha: 0.84 (fruit and vegetables), 0.85 (salt, sugar and oil) and 0.83 (Overall)). Pre-contemplation was the most difficult stage to identify; for which efficacy and perceived cooperation at the household level were important. To the best of our knowledge, this is the first staging tool for households. This tool represents a new concept in community-based dietary interventions. The tool can be easily administered by lay community workers and can therefore be used in large population-based studies. A more robust validation process with a larger sample is needed before it can be widely used.
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Affiliation(s)
- Meena Daivadanam
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, 695011, India.,Dept. of Public Health Sciences (Global Health), Tomtebodavagen 18A, Karolinska Institutet, 171 77, Stockholm, Sweden.,Dept. of Food, Nutrition and Dietetics, Uppsala University, Box 560, SE-751 22, Uppsala, Sweden
| | - T K Sundari Ravindran
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, 695011, India
| | - K R Thankappan
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, 695011, India
| | - P S Sarma
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, 695011, India
| | - Rolf Wahlström
- Dept. of Public Health Sciences (Global Health), Tomtebodavagen 18A, Karolinska Institutet, 171 77, Stockholm, Sweden.,Family Medicine and Preventive Medicine, Dept. of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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Assessment of Stages and Processes of Change, Eating Self-Efficacy and Decisional Balance for Weight Loss in Obese Women Attending Nutrition Clinics. ACTA ACUST UNITED AC 2016. [DOI: 10.5812/jjhs-42088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Guess N, Vasantharajah L, Gulliford M, Viberti G, Gnudi L, Karalliedde J, Wijesuriya M. Improvements in stage of change correlate to changes in dietary intake and clinical outcomes in a 5-year lifestyle intervention in young high-risk Sri Lankans. Prev Med 2016; 90:193-200. [PMID: 27404575 DOI: 10.1016/j.ypmed.2016.07.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Revised: 06/02/2016] [Accepted: 07/08/2016] [Indexed: 11/29/2022]
Abstract
The objectives of a stage-matched approach to lifestyle change are that individuals progress forward through the stages of change. It also posits that progression through the stages of change is associated with positive changes in lifestyle behaviours. Measuring the relationship between stage of change and food intake is challenging due to the plurality of dietary behaviours. Furthermore, it is not clear whether changes in behaviour are sustained long-term. In this study we assess the movement through stages of change in the intensive (visits every 3months) and control groups (visits annually) of a large-scale primary prevention study in cardiovascular disease, carried out in 2637 children and young adults in Sri Lanka between 2007 and 2012. We also examine their relationship to dietary behaviours and clinical outcomes. We demonstrate that individuals in both groups continue to progress through stages of change over the course of the study and that measures of dietary behaviours improved from baseline to final follow-up. We also demonstrate that stage of change positively correlates to dietary behaviours including the ratio of recommended:not-recommended items, unpolished:polished starches and low-fat:high-fat food items throughout each year of the study. Finally, participants in the later stages of change at Y2, Y3 and Y4, had a significantly attenuated increase in weight and waist circumference at the final visit in both groups. We therefore demonstrate the usefulness of stage-matched approach in modifying complex dietary behaviours, and that stage of change is a valid measure of dietary behaviours across a large population over time.
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Affiliation(s)
- N Guess
- Diabetes and Nutritional Sciences Division, Kings College London, London, United Kingdom.
| | | | - M Gulliford
- King's College London, Primary Care & Public Health Sciences, London, United Kingdom
| | - G Viberti
- King's College London, Cardiovascular Division, London, United Kingdom
| | - L Gnudi
- King's College London, Cardiovascular Division, London, United Kingdom
| | - J Karalliedde
- King's College London, Cardiovascular Division, London, United Kingdom
| | - M Wijesuriya
- Diabetes Association of Sri Lanka, Colombo, Sri Lanka
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Cunha DB, de Souza BDSN, da Veiga GV, Pereira RA, Sichieri R. Readiness for behavioral change and variation in food consumption among adolescents from a school-based community trial in Duque de Caxias, RJ. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2015; 18:655-65. [PMID: 26247189 DOI: 10.1590/1980-5497201500030011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 12/18/2014] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To investigate the influence of the stage of readiness for changes in food consumption variation among adolescents participating in school-based community trial in Duque de Caxias (RJ), Brazil. METHODS It is a secondary analysis of a one-year randomized community trial to prevent excessive weight gain in students attending the 5th grade in 20 public schools in the municipality of Duque de Caxias. The activities conducted discouraged the consumption of sweetened beverages and cookies and encouraged the consumption of fruits and beans. A food frequency questionnaire was applied at the beginning and at the end of the study. The stages of readiness for behavioral change vary in a scale from (1) "I don't think of changing diet" to (5) "I'm already changing my diet successfully". For the longitudinal analyses, we used generalized linear mixed models. RESULTS There was a greater change in the consumption of fruit and soft drinks among participants in the intervention group who were in the action stage, compared to participants who did not think about changing their diet. CONCLUSION The proposed strategy may be used to identify population groups with motivation for changes in dietary behavior.
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Affiliation(s)
- Diana Barbosa Cunha
- Institute of Social Medicine, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | - Glória Valéria da Veiga
- Institute of Nutrition Josué de Castro, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Rosangela Alves Pereira
- Institute of Nutrition Josué de Castro, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Rosely Sichieri
- Institute of Social Medicine, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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Pérez-Manchón D, Álvarez-García GM, González-López E. Motivación para cambiar estilos de vida no saludables y riesgo cardiovascular. ENFERMERIA CLINICA 2014; 24:351-5. [DOI: 10.1016/j.enfcli.2014.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Revised: 06/02/2014] [Accepted: 06/08/2014] [Indexed: 10/25/2022]
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Kushida O, Murayama N. Effects of environmental intervention in workplace cafeterias on vegetable consumption by male workers. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2014; 46:350-358. [PMID: 24974354 DOI: 10.1016/j.jneb.2014.05.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Revised: 04/20/2014] [Accepted: 05/05/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To assess the effects of an environmental intervention based on the transtheoretical model to increase access to nutritional information about vegetable consumption in workplace cafeterias. DESIGN Nonrandomized controlled trial. SETTING Sixteen workplaces with cafeterias in Niigata, Japan, were assigned to intervention (n = 8) or comparison sites (n = 8). PARTICIPANTS A total of 349 Japanese male workers aged 20-59 years, who visited the cafeterias ≥ 3 times/wk. INTERVENTION For the intervention group, 12 types of table tents containing information on increasing vegetable consumption, based on the transtheoretical model stages and processes of change, were distributed to cafeterias for 24 weeks in 2009. Information was presented according to the sequence suggested by the stages of change. MAIN OUTCOME MEASURES Vegetable consumption in the cafeteria and per day and stage of change were assessed using self-administered questionnaires. ANALYSIS Differences between groups were tested using a generalized linear model adjusted for age, work environment, and position. RESULTS The difference in the stage of change was not statistically significantly different (P = .05), but the intervention group (n = 181) had increased vegetable consumption in the cafeteria (+0.18 servings; P = .01) and per day (+0.32 servings; P = .01) vs the comparison group. CONCLUSIONS AND IMPLICATIONS The findings suggest a beneficial effect of providing access to nutrition information about vegetable consumption as an environmental intervention in workplace cafeterias.
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Affiliation(s)
- Osamu Kushida
- Department of Health and Nutrition, Niigata University of Health and Welfare, Niigata, Japan.
| | - Nobuko Murayama
- Department of Health and Nutrition, Niigata University of Health and Welfare, Niigata, Japan; Department of Health and Nutrition, University of Niigata Prefecture, Niigata, Japan
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Daivadanam M, Wahlström R, Ravindran TKS, Thankappan KR, Ramanathan M. Conceptual model for dietary behaviour change at household level: a 'best-fit' qualitative study using primary data. BMC Public Health 2014; 14:574. [PMID: 24912496 PMCID: PMC4080697 DOI: 10.1186/1471-2458-14-574] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Accepted: 05/23/2014] [Indexed: 11/22/2022] Open
Abstract
Background Interventions having a strong theoretical basis are more efficacious, providing a strong argument for incorporating theory into intervention planning. The objective of this study was to develop a conceptual model to facilitate the planning of dietary intervention strategies at the household level in rural Kerala. Methods Three focus group discussions and 17 individual interviews were conducted among men and women, aged between 23 and 75 years. An interview guide facilitated the process to understand: 1) feasibility and acceptability of a proposed dietary behaviour change intervention; 2) beliefs about foods, particularly fruits and vegetables; 3) decision-making in households with reference to food choices and access; and 4) to gain insights into the kind of intervention strategies that may be practical at community and household level. The data were analysed using a modified form of qualitative framework analysis, which combined both deductive and inductive reasoning. A priori themes were identified from relevant behaviour change theories using construct definitions, and used to index the meaning units identified from the primary qualitative data. In addition, new themes emerging from the data were included. The associations between the themes were mapped into four main factors and its components, which contributed to construction of the conceptual model. Results Thirteen of the a priori themes from three behaviour change theories (Trans-theoretical model, Health Belief model and Theory of Planned Behaviour) were confirmed or slightly modified, while four new themes emerged from the data. The conceptual model had four main factors and its components: impact factors (decisional balance, risk perception, attitude); change processes (action-oriented, cognitive); background factors (personal modifiers, societal norms); and overarching factors (accessibility, perceived needs and preferences), built around a three-stage change spiral (pre-contemplation, intention, action). Decisional balance was the strongest in terms of impacting the process of behaviour change, while household efficacy and perceived household cooperation were identified as ‘markers’ for stages-of-change at the household level. Conclusions This type of framework analysis made it possible to develop a conceptual model that could facilitate the design of intervention strategies to aid a household-level dietary behaviour change process.
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Affiliation(s)
- Meena Daivadanam
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram 695011, India.
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Abstract
OBJECTIVES To evaluate the effectiveness of a wellness program delivered by WellSteps, LLC, aimed at improving employee health behaviors in small companies that lack the resources to independently develop and manage a wellness program. METHODS Analyses are based on 618 employees from five diverse companies that completed an initial personal health assessment. RESULTS Exercise and dietary behaviors significantly improved across the five companies. Significant improvements in health perception and life satisfaction also resulted and were associated with improvements in health behaviors. Three of the five companies, each with fewer than 50 employees, were most effective in influencing positive health behaviors, health perceptions, and life satisfaction. CONCLUSIONS The worksite wellness program effectively improved health behaviors, health perceptions, and life satisfaction.
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Bartels SJ, Pratt SI, Aschbrenner KA, Barre LK, Jue K, Wolfe RS, Xie H, McHugo G, Santos M, Williams GE, Naslund JA, Mueser KT. Clinically significant improved fitness and weight loss among overweight persons with serious mental illness. Psychiatr Serv 2013; 64:729-36. [PMID: 23677386 PMCID: PMC5662189 DOI: 10.1176/appi.ps.003622012] [Citation(s) in RCA: 131] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the effectiveness of a fitness health mentor program (In SHAPE) in improving physical fitness and weight loss among overweight and obese adults with serious mental illness. METHODS A randomized controlled trial was conducted with 133 persons with serious mental illness and a body mass index (BMI) >25 who were assigned either to the In SHAPE program (one year of weekly sessions with a fitness trainer plus a fitness club membership) or to one year of fitness club membership and education. Assessments were conducted at baseline and three, six, nine, and 12 months later. RESULTS Participants had a mean baseline weight of 231.8±54.8 pounds and a mean BMI of 37.6±8.2. At 12-month follow-up, In SHAPE (N=67) compared with fitness club membership and education (N=66) was associated with three times greater fitness club attendance, twice as much participation in physical exercise, greater engagement in vigorous physical activity, and improvement in diet. Twice the proportion of participants (40% versus 20%) achieved clinically significant improvement in cardiorespiratory fitness (>50 m on the six-minute walk test). Weight loss and BMI did not differ between groups. Among In SHAPE participants, 49% achieved either clinically significant increased fitness or weight loss (5% or greater), and 24% achieved both clinically significant improved fitness and weight loss. CONCLUSIONS The In SHAPE program achieved clinically significant reduction in cardiovascular risk for almost one-half of participants at 12 months. Although the intervention showed promise in improving fitness, optimizing weight loss may require additional intensive, multicomponent dietary interventions.
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Affiliation(s)
- Stephen J Bartels
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, 46 Centerra Parkway, Suite 200, Lebanon, NH 03766, USA.
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Horwath CC, Schembre SM, Motl RW, Dishman RK, Nigg CR. Does the transtheoretical model of behavior change provide a useful basis for interventions to promote fruit and vegetable consumption? Am J Health Promot 2013; 27:351-7. [PMID: 23398135 DOI: 10.4278/ajhp.110516-quan-201] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To determine whether Transtheoretical Model (TTM) constructs differ between individuals making successful versus unsuccessful stage transitions for consumption of five or more servings of fruit and vegetables each day and thus provide a useful basis for designing health promotion interventions. DESIGN Longitudinal, observational study. A randomly selected, multiethnic cohort of adults assessed at 6-month intervals over 2 years. SETTING General community, Hawaii. SUBJECTS There were 700 participants (62.6% female; mean = 47 ± 17.1 years; 31.1% Asian, 22.1% Native Hawaiian/Pacific Islander, 35.0% Caucasian; 25.1% participation rate). MEASURES Stage of readiness, experiential and behavioral processes of change, pros, cons, self-efficacy, and self-reported fruit and vegetable consumption. ANALYSIS The study used t-tests to determine which TTM variable scores differed consistently between those making "successful" versus "unsuccessful " stage transitions from precontemplation, preparation, and maintenance. Sample sizes for contemplation and action prohibited similar analyses. RESULTS Compared to those remaining in precontemplation, individuals successfully progressing from precontemplation showed significantly greater use of behavioral processes (collectively and self-liberation) and consciousness raising (p < .001). However, only self-liberation demonstrated significant differences consistently over time. CONCLUSION This longitudinal investigation reveals that TTM behavioral processes, particularly self-liberation, predict successful transition out of precontemplation for adult fruit and vegetable consumption, suggesting that public health messages tailored according to these TTM variables may be effective for this group. However, for adults prepared to adopt or maintain fruit and vegetable consumption, tailoring based on variables from other theories is needed.
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Mays D, Gerfen E, Mosher RB, Shad AT, Tercyak KP. Validation of a milk consumption stage of change algorithm among adolescent survivors of childhood cancer. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2012; 44:464-468. [PMID: 22770832 PMCID: PMC3509362 DOI: 10.1016/j.jneb.2012.04.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Revised: 04/04/2012] [Accepted: 04/16/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To assess the construct validity of a milk consumption Stages of Change (SOC) algorithm among adolescent survivors of childhood cancer ages 11 to 21 years (n = 75). METHODS Baseline data from a randomized controlled trial designed to evaluate a health behavior intervention were analyzed. Assessments included a milk consumption SOC algorithm and hypothesized theoretical and behavioral predictors of SOC. RESULTS Compared with survivors who expressed no readiness to change, those expressing readiness to change behavior for both 2 and 4 daily servings of milk reported more frequent milk consumption (P < .001), greater dietary calcium intake (P = .006), and were more likely to meet age-specific recommendations for daily calcium intake (P = .01). CONCLUSIONS AND IMPLICATIONS Results provide support for the construct validity of the milk consumption SOC algorithm relative to behavioral criteria. Research is needed to further examine algorithm validity with respect to theoretical predictors of SOC.
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Affiliation(s)
- Darren Mays
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC 20007, USA.
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LeCheminant JD, Merrill RM. Improved health behaviors persist over two years for employees in a worksite wellness program. Popul Health Manag 2012; 15:261-6. [PMID: 22823340 DOI: 10.1089/pop.2011.0083] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This study evaluates whether improvements in health behaviors related to a worksite wellness program persist through 2 years. The program was designed to build behavioral capability and self-efficacy by yielding immediately applicable skills and tools and segmenting the behavior change process into weekly, manageable doses. Analyses are based on 267 individuals employed from 2009 through 2011. Significant improvements were observed in the frequency and volume of exercise, and the consumption of vegetables and fruits over 12 and 24 months. Requests for health coaching significantly increased over the study period. Thus, the type of wellness program evaluated in this study produced sustainable health behaviors through 24 months, which likely will translate into future positive health outcomes and improved employee productivity.
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Affiliation(s)
- James D LeCheminant
- Department of Exercise Science, College of Life Sciences, Brigham Young University, Provo, UT 84602, USA.
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Bernardes S, Caramori PRA. Stages of change for fruit and vegetable intake among patients with atherosclerotic disease. Appetite 2011; 57:656-60. [DOI: 10.1016/j.appet.2011.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2010] [Revised: 07/15/2011] [Accepted: 08/02/2011] [Indexed: 10/17/2022]
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Effectiveness of a Worksite Wellness Program on Health Behaviors and Personal Health. J Occup Environ Med 2011; 53:1008-12. [DOI: 10.1097/jom.0b013e3182281145] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Hoek AC, Luning PA, Weijzen P, Engels W, Kok FJ, de Graaf C. Replacement of meat by meat substitutes. A survey on person- and product-related factors in consumer acceptance. Appetite 2011; 56:662-73. [DOI: 10.1016/j.appet.2011.02.001] [Citation(s) in RCA: 263] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2009] [Revised: 12/16/2010] [Accepted: 02/02/2011] [Indexed: 10/18/2022]
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Gillespie ND, Lenz TL. Implementation of a tool to modify behavior in a chronic disease management program. Adv Prev Med 2011; 2011:215842. [PMID: 21991432 PMCID: PMC3169365 DOI: 10.4061/2011/215842] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2010] [Accepted: 01/13/2011] [Indexed: 11/20/2022] Open
Abstract
Chronic diseases like diabetes, hypertension, and dyslipidemia continue to be a significant burden on the US health care system. As a result, many healthcare providers are implementing strategies to prevent the incidence of heart disease and other chronic conditions. Among these strategies are proper drug therapy and lifestyle modifications. Behavior change is often the rate-limiting step in the prevention and maintenance of lifestyle modifications. The purpose of this paper is to describe a tool used to guide the progression and assess the effectiveness of a cardiovascular risk reduction program. The tool uses the Transtheoretical Model of Behavior Change to determine the readiness and confidence to change specific lifestyle behaviors pertinent to cardiovascular health. The tool aids the practitioner in developing a patient-centered plan to implement and maintain lifestyle changes and can be tailored to use in any situation requiring a behavior change on the part of the patient.
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Affiliation(s)
- Nicole D Gillespie
- Community Pharmacy Practice Residency Program, Creighton University, 2500 California Plaza, Omaha, NE 68178, USA
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Kushida O, Murayama N, Iriyama Y, Horikoshi K, Takemi Y, Yoshiike N. An Algorithm for Assessing Changes in Vegetable Intake Behavior in Adult Male in Japan. ACTA ACUST UNITED AC 2011. [DOI: 10.5264/eiyogakuzashi.69.294] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Fruit and vegetables should be targeted separately in health promotion programmes: differences in consumption levels, barriers, knowledge and stages of readiness for change. Public Health Nutr 2010; 14:694-701. [DOI: 10.1017/s1368980010001643] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
AbstractObjectiveThe aim of the present study was to investigate whether fruit and vegetables should be treated as separate groups in health promotion programmes by examining consumption levels, barriers, knowledge and the association between stage of change and potential predictors of fruit and vegetable intake.DesignComputer-assisted telephone interview survey of the target population.SettingHunter and New England regions of New South Wales, Australia.SubjectsA total of 1403 parents and carers of primary-school-aged children.ResultsConsumption levels and knowledge of recommended intakes and serving size were greater for fruit than for vegetables. There were some differences in the main barriers to the consumption of fruit compared with those cited for vegetables. There was little congruence between the stages of change for fruit consumption and those for vegetable consumption. For fruit, knowledge of serving size and recommended intake, perceptions of adequate consumption, changes made to family intake and educational attainment were all correlated with stage of change categorisation. For vegetables, knowledge of recommended intake, perceptions of adequate consumption and changes made to family intake were correlated with stage of change categorisation.ConclusionsSignificant differences in consumption levels, barriers, knowledge and stages of readiness for change can be shown when fruit and vegetables are treated as separate groups. Health promotion planners may need to consider interventions that focus on improving vegetable consumption in preference to fruit consumption. Messages about the recommended number of servings and serving size must be simplified and this may be achieved by targeting messages towards vegetable consumption.
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Baranowski T, Watson KB, Bachman C, Baranowski JC, Cullen KW, Thompson D, Siega Riz AM. Self efficacy for fruit, vegetable and water intakes: Expanded and abbreviated scales from item response modeling analyses. Int J Behav Nutr Phys Act 2010; 7:25. [PMID: 20350316 PMCID: PMC3099465 DOI: 10.1186/1479-5868-7-25] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2009] [Accepted: 03/29/2010] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVE To improve an existing measure of fruit and vegetable intake self efficacy by including items that varied on levels of difficulty, and testing a corresponding measure of water intake self efficacy. DESIGN Cross sectional assessment. Items were modified to have easy, moderate and difficult levels of self efficacy. Classical test theory and item response modeling were applied. SETTING One middle school at each of seven participating sites (Houston TX, Irvine CA, Philadelphia PA, Pittsburg PA, Portland OR, rural NC, and San Antonio TX). SUBJECTS 714 6th grade students. RESULTS Adding items to reflect level (low, medium, high) of self efficacy for fruit and vegetable intake achieved scale reliability and validity comparable to existing scales, but the distribution of items across the latent variable did not improve. Selecting items from among clusters of items at similar levels of difficulty along the latent variable resulted in an abbreviated scale with psychometric characteristics comparable to the full scale, except for reliability. CONCLUSIONS The abbreviated scale can reduce participant burden. Additional research is necessary to generate items that better distribute across the latent variable. Additional items may need to tap confidence in overcoming more diverse barriers to dietary intake.
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Affiliation(s)
- Tom Baranowski
- Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, 1100 Bates Street, Houston, Texas 77030-2600, USA.
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Laws RA, Chan BC, Williams AM, Davies GP, Jayasinghe UW, Fanaian M, Harris MF. An efficacy trial of brief lifestyle intervention delivered by generalist community nurses (CN SNAP trial). BMC Nurs 2010; 9:4. [PMID: 20175932 PMCID: PMC2841173 DOI: 10.1186/1472-6955-9-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2010] [Accepted: 02/23/2010] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Lifestyle risk factors, in particular smoking, nutrition, alcohol consumption and physical inactivity (SNAP) are the main behavioural risk factors for chronic disease. Primary health care (PHC) has been shown to be an effective setting to address lifestyle risk factors at the individual level. However much of the focus of research to date has been in general practice. Relatively little attention has been paid to the role of nurses working in the PHC setting. Community health nurses are well placed to provide lifestyle intervention as they often see clients in their own homes over an extended period of time, providing the opportunity to offer intervention and enhance motivation through repeated contacts. The overall aim of this study is to evaluate the impact of a brief lifestyle intervention delivered by community nurses in routine practice on changes in clients' SNAP risk factors. METHODS/DESIGN The trial uses a quasi-experimental design involving four generalist community nursing services in NSW Australia. Services have been randomly allocated to an 'early intervention' group or 'late intervention' (comparison) group. 'Early intervention' sites are provided with training and support for nurses in identifying and offering brief lifestyle intervention for clients during routine consultations. 'Late intervention site' provide usual care and will be offered the study intervention following the final data collection point. A total of 720 generalist community nursing clients will be recruited at the time of referral from participating sites. Data collection consists of 1) telephone surveys with clients at baseline, three months and six months to examine change in SNAP risk factors and readiness to change 2) nurse survey at baseline, six and 12 months to examine changes in nurse confidence, attitudes and practices in the assessment and management of SNAP risk factors 3) semi-structured interviews/focus with nurses, managers and clients in 'early intervention' sites to explore the feasibility, acceptability and sustainability of the intervention. DISCUSSION The study will provide evidence about the effectiveness and feasibility of brief lifestyle interventions delivered by generalist community nurses as part of routine practice. This will inform future community nursing practice and PHC policy. TRIAL REGISTRATION ACTRN12609001081202.
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Affiliation(s)
- Rachel A Laws
- Centre for Primary Health Care and Equity, School of Public Health and Community Medicine, University of New South Wales, Sydney NSW 2052, Australia
| | - Bibiana C Chan
- Centre for Primary Health Care and Equity, School of Public Health and Community Medicine, University of New South Wales, Sydney NSW 2052, Australia
| | - Anna M Williams
- Centre for Primary Health Care and Equity, School of Public Health and Community Medicine, University of New South Wales, Sydney NSW 2052, Australia
| | - Gawaine Powell Davies
- Centre for Primary Health Care and Equity, School of Public Health and Community Medicine, University of New South Wales, Sydney NSW 2052, Australia
| | - Upali W Jayasinghe
- Centre for Primary Health Care and Equity, School of Public Health and Community Medicine, University of New South Wales, Sydney NSW 2052, Australia
| | - Mahnaz Fanaian
- Centre for Primary Health Care and Equity, School of Public Health and Community Medicine, University of New South Wales, Sydney NSW 2052, Australia
| | - Mark F Harris
- Centre for Primary Health Care and Equity, School of Public Health and Community Medicine, University of New South Wales, Sydney NSW 2052, Australia
| | - the CN SNAP Project Team
- Centre for Primary Health Care and Equity, School of Public Health and Community Medicine, University of New South Wales, Sydney NSW 2052, Australia
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Editorial. Nutr Res Rev 2007; 20:1-2. [PMID: 19079856 DOI: 10.1017/s0954422407764521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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