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Misir A, Viechtbauer W, de Vries H, Mesters I. Twelve Month Efficacy of Computer-Tailored Communication in Boosting Fruit and Vegetable Consumption Among Adults Aged Forty and over: A Three-Level Meta-Analysis and Systematic Review of Randomized Controlled Trials. Adv Nutr 2024; 15:100150. [PMID: 37979693 PMCID: PMC10756964 DOI: 10.1016/j.advnut.2023.100150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 09/29/2023] [Accepted: 11/03/2023] [Indexed: 11/20/2023] Open
Abstract
Computer-tailored health communication (CTC) can enhance fruit and vegetable (F&V) intake and, consequently, health by providing personalized feedback. However, few studies have examined the long-term effects of such interventions in middle-aged and older adults. This research aimed to assess the 12-mo efficacy of CTC in promoting F&V consumption and potentially identify who among middle-aged and older adults changed their diet after the intervention. The protocol was registered at the International Prospective Register of Systematic Reviews (PROSPERO) on 2021-12-09, code CRD42022330491. The research was performed without external funding. We searched 6 databases (MEDLINE via PubMed, EMBASE, Scopus, Web of Science Core Collection, Cochrane Library, and PsycINFO) for randomized controlled trials (RCTs) comparing CTC interventions for increasing F&V intake with usual care/no intervention control in adults aged ≥40, measured 12 mo after the pretest. The search covered the period from 1 January 1990 to 1 January 2022. We selected 16 RCTs with 25,496 baseline participants for the review systematic literature reviews (SLR) and 11 RCTs with 19 measurements for the meta-analysis (MA). We assessed risk of bias with the JBI Critical Appraisal Checklist. The SLR revealed that at 1-y postCTC intervention, most of the treatment groups increased F&V intake more than the control groups. The overall bias in the data set was not high. The MA model on 11 RCTs revealed a significant effect size for F&V consumption in intervention groups compared with control, standardized mean difference of 0.21 (confidence interval [CI]: 0.12, 0.30), P = 0.0004. The evidence suggests that CTC is a suitable strategy for public interventions aiming to increase F&V intake in adults aged ≥40. The design of CTC for public interventions should consider the process of change and stages of change addressing awareness, attitudes, self-efficacy, and social influence as promising concepts for influencing behavior change.
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Affiliation(s)
- Andreja Misir
- Department of Epidemiology, Maastricht University, Maastricht, Netherlands.
| | - Wolfgang Viechtbauer
- Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, Netherlands
| | - Hein de Vries
- Department of Health Promotion, Maastricht University, Maastricht, Netherlands
| | - Ilse Mesters
- Department of Epidemiology, Maastricht University, Maastricht, Netherlands
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Rovito MJ, Gordon TF, Bass SB, DuCette J, Tierney AM, Coles N. Developing the "Control Identity" Typology to Create More Effective Testicular Health Promotional Messaging. Am J Mens Health 2018; 12:546-555. [PMID: 26669773 PMCID: PMC5987963 DOI: 10.1177/1557988315621143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Testicular self-examination (TSE) promotional interventions historically operate without a theoretical framework, which negatively influences their effectiveness. As TSE is critical to the early detection of testicular cancer, this behavior is an essential component to improving overall male well-being. To address this need, the Control Identity personality typology was developed to assist in creating more effective TSE promotional interventions. Four outcome control dispositions were defined a priori based on the dimensions of illusions of control and locus of control. An original 41-item survey, the Control Identity Assessment Scale, was used to assess perceived vulnerability, value of health promotion, and health outcome control among a convenience sample of 300 university males aged 18 to 35 years via a cross-sectional research design. Factor and cluster analyses were employed to extract salient factors in the data and to identify subgroups within the sample. A consistent five-factor structure matrix (~70% explained variance) served as the foundation from which a k-means cluster analysis was employed to classify four types of individuals. Significant differences were detected between clusters on primary variables, including behavioral intentions to conduct TSE. The Control Identity typology aims to provide the needed mechanism for health practitioners to create more effective preventive health messaging to promote TSE. Future implications on employing this typology to segment audiences in order to increase overall effectiveness are offered. Application of this typology could ultimately lead to increasing TSE knowledge retention, behavioral intentions, actual performance, and adherence.
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Teasdale N, Elhussein A, Butcher F, Piernas C, Cowburn G, Hartmann-Boyce J, Saksena R, Scarborough P. Systematic review and meta-analysis of remotely delivered interventions using self-monitoring or tailored feedback to change dietary behavior. Am J Clin Nutr 2018; 107:247-256. [PMID: 29529158 PMCID: PMC5875102 DOI: 10.1093/ajcn/nqx048] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 11/30/2017] [Indexed: 12/15/2022] Open
Abstract
Background Self-monitoring (SM) of diet and tailored feedback (TF) have been suggested as tools for changing dietary behavior. New technologies allow users to monitor behavior remotely, potentially improving reach, adherence, and outcomes. Objective We conducted a systematic literature review and meta-analysis to address the following question: are remotely delivered standalone (i.e., no human contact) interventions that use SM or TF effective in changing eating behaviors? Design Five databases were searched in October 2016 (updated in September 2017). Only randomized controlled trials published after 1990 were included. Trials could include any adult population with no history of disordered eating which delivered an SM or TF intervention without direct contact and recorded actual dietary consumption as an outcome. Three assessors independently screened the search results. Two reviewers extracted the study characteristics, intervention details, and outcomes, and assessed risk of bias using the Cochrane tool. Results were converted to standardized mean differences and incorporated into a 3-level (individuals and outcomes nested in studies) random effects meta-analysis. Results Twenty-six studies containing 21,262 participants were identified. The majority of the studies were judged to be unclear or at high risk of bias. The meta-analysis showed dietary improvement in the intervention group compared to the control group with a standardized mean difference of 0.17 (95% CI: 0.10, 0.24; P < 0.0001). The I2 statistic for the meta-analysis was 0.77, indicating substantial heterogeneity in results. A "one study removed" sensitivity analysis showed that no single study excessively influenced the results. Conclusions Standalone interventions containing self-regulatory methods have a small but significant effect on dietary behavior, and integrating these elements could be important in future interventions. However, there was substantial variation in study results that could not be explained by the characteristics we explored, and there were risk-of-bias concerns with the majority of studies.
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Affiliation(s)
| | - Ahmed Elhussein
- Medical Sciences Divisional Office, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
| | | | - Carmen Piernas
- Department of Primary Health Care Sciences, University of Oxford, Oxford, United Kingdom
| | - Gill Cowburn
- Centre on Population Approaches for Non-Communicable Disease Prevention, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Jamie Hartmann-Boyce
- Department of Primary Health Care Sciences, University of Oxford, Oxford, United Kingdom
| | - Rhea Saksena
- University College London Medical School, University College London, London, United Kingdom
| | - Peter Scarborough
- Centre on Population Approaches for Non-Communicable Disease Prevention, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
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Roblin DW, Cram P, Lou Y, Edmonds SW, Hall SF, Jones MP, Saag KG, Wright NC, Wolinsky FD. Diet and exercise changes following bone densitometry in the Patient Activation After DXA Result Notification (PAADRN) study. Arch Osteoporos 2018; 13:4. [PMID: 29307094 PMCID: PMC7409367 DOI: 10.1007/s11657-017-0402-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 11/13/2017] [Indexed: 02/03/2023]
Abstract
UNLABELLED Calcium and vitamin D intake and exercise are suboptimal among older adults. Following bone densitometry, a letter communicating individualized fracture risk accompanied by an educational brochure improved participants' lifestyle-but no more than existing communication strategies-over 52 weeks. Simple communication strategies are insufficient for achieving optimal levels of bone health behaviors. PURPOSE The Patient Activation After DXA Result Notification (PAADRN) study was designed to evaluate whether a letter with individualized fracture risk and an educational brochure mailed to patients soon after their DXA might improve bone health behaviors (daily calcium intake, vitamin D supplementation, and weekly exercise sessions) compared to slower, less individualized communication characterizing usual care. METHODS Participants ≥ 50 years were recruited, at three sites, following their DXA and randomized with 1:1 allocation to intervention and control (usual care only) groups. Data were collected at enrollment interview and by phone survey at 12 and 52 weeks thereafter. Intention-to-treat analyses were conducted on 7749 of the 20,397 eligible participants who enrolled. Changes in bone health behaviors were compared within and between study groups. Average treatment effects and heterogeneity of treatment effects were estimated with multivariable linear and logistic regression models. RESULTS In unadjusted analyses, calcium intake, vitamin D supplementation, and weekly exercise sessions increased significantly over 52 weeks within both the intervention and control groups (all p < 0.001). In unadjusted analyses and multivariable models, increases in each behavior did not significantly differ between the intervention and control groups. Intervention group participants with a > 20% 10-year fracture risk at enrollment did, however, have a significantly greater increase in calcium intake compared to other study participants (p = 0.031). CONCLUSIONS Bone health behaviors improved, on average, over 52 weeks among all participants following a DXA. Receipt of the PAADRN letter and educational brochure did not directly improve bone health behaviors compared to usual care. TRIAL REGISTRATION The Patient Activation after DXA Result Notification (PAADRN) Study is registered at ClinicalTrials.Gov: NCT01507662, https://clinicaltrials.gov/ct2/show/NCT01507662.
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Affiliation(s)
- Douglas W. Roblin
- Mid-Atlantic Permanente Research Institute, 2101 East Jefferson St., 3 West, Rockville, MD 20852, USA,Center for Clinical and Outcomes Research, Kaiser Permanente, Atlanta, GA, USA
| | - Peter Cram
- Division of General Internal Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA,Faculty of Medicine, University of Toronto, Toronto, Canada,Division of General Internal Medicine and Geriatrics, Mt. Sinai/UHN Hospitals, Toronto, Canada
| | - Yiyue Lou
- Department of Biostatistics, University of Iowa College of Public Health, Iowa City, IA, USA
| | - Stephanie W. Edmonds
- Division of General Internal Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA,College of Nursing, University of Iowa, Iowa City, IA, USA
| | - Sylvie F. Hall
- College of Nursing, University of Iowa, Iowa City, IA, USA
| | - Michael P. Jones
- Department of Biostatistics, University of Iowa College of Public Health, Iowa City, IA, USA
| | - Kenneth G. Saag
- Division of Clinical Immunology and Rheumatology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Nicole C. Wright
- Division of Clinical Immunology and Rheumatology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA,Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Fredric D. Wolinsky
- Division of General Internal Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA,College of Nursing, University of Iowa, Iowa City, IA, USA,Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City, IA, USA
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Effectiveness of brief nutrition interventions on dietary behaviours in adults: A systematic review. Appetite 2018; 120:335-347. [DOI: 10.1016/j.appet.2017.09.017] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 09/19/2017] [Accepted: 09/20/2017] [Indexed: 11/24/2022]
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Muench F, Baumel A. More Than a Text Message: Dismantling Digital Triggers to Curate Behavior Change in Patient-Centered Health Interventions. J Med Internet Res 2017; 19:e147. [PMID: 28550001 PMCID: PMC5466696 DOI: 10.2196/jmir.7463] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 03/06/2017] [Accepted: 03/17/2017] [Indexed: 11/13/2022] Open
Abstract
Digital triggers such as text messages, emails, and push alerts are designed to focus an individual on a desired goal by prompting an internal or external reaction at the appropriate time. Triggers therefore have an essential role in engaging individuals with digital interventions delivered outside of traditional health care settings, where other events in daily lives and fluctuating motivation to engage in effortful behavior exist. There is an emerging body of literature examining the use of digital triggers for short-term action and longer-term behavior change. However, little attention has been given to understanding the components of digital triggers. Using tailoring as an overarching framework, we separated digital triggers into 5 primary components: (1) who (sender), (2) how (stimulus type, delivery medium, heterogeneity), (3) when (delivered), (4) how much (frequency, intensity), and (5) what (trigger's target, trigger's structure, trigger's narrative). We highlighted key considerations when tailoring each component and the pitfalls of ignoring common mistakes, such as alert fatigue and habituation. As evidenced throughout the paper, there is a broad literature base from which to draw when tailoring triggers to curate behavior change in health interventions. More research is needed, however, to examine differences in efficacy based on component tailoring, to best use triggers to facilitate behavior change over time, and to keep individuals engaged in physical and mental health behavior change efforts. Dismantling digital triggers into their component parts and reassembling them according to the gestalt of one's change goals is the first step in this development work.
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Affiliation(s)
| | - Amit Baumel
- Psychiatry, Northwell Health, Great Neck, NY, United States
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Davis SW, Oakley-Girvan I. Achieving value in mobile health applications for cancer survivors. J Cancer Surviv 2017; 11:498-504. [PMID: 28342093 DOI: 10.1007/s11764-017-0608-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 02/16/2017] [Indexed: 01/12/2023]
Abstract
PURPOSE This study aimed to identify appropriate development and testing strategies for mobile health applications for cancer survivors. METHODS In January of 2016, we conducted a PubMed search for mobile applications for cancer survivors. A total of 32 articles were selected for inclusion, including 13 review articles, and 19 articles describing an mHealth application or intervention. We assessed mobile app development and testing strategies and standards as described in these articles. RESULTS We identified seven elements of patient empowerment applications for cancer survivors, strategies for application development that take advantage of smartphone capabilities, issues for consideration in developing new applications, and steps for creating user-centered mobile health applications that provide meaningful value for cancer survivors. However, few mobile health apps implemented empowerment elements, underwent rigorous design approaches, or included assessment of use in the cancer survivor population. CONCLUSIONS There is tremendous potential for mobile health apps to benefit cancer survivors. However, there are specific issues for consideration in developing new applications and steps for creating user-centered applications which are not routinely used. This diminishes the value for the cancer survivor population but could be easily addressed through standardized development and testing procedures. IMPLICATIONS FOR CANCER SURVIVORS Smartphone applications have the potential to improve the cancer survivorship experience, but users should look for evidence that the application was appropriately developed and tested.
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Affiliation(s)
- Sharon Watkins Davis
- Cancer Prevention Institute of California, 2201 Walnut Ave, Ste 300, Fremont, CA, 94538, USA
| | - Ingrid Oakley-Girvan
- Cancer Prevention Institute of California, 2201 Walnut Ave, Ste 300, Fremont, CA, 94538, USA. .,Department of Health Research and Policy, Stanford Cancer Institute and Canary Center at Stanford for Cancer Early Detection, Stanford University School of Medicine, Stanford, CA, 94305, USA.
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Eaton CB, Hartman SJ, Perzanowski E, Pan G, Roberts MB, Risica PM, Gans KM, Jakicic JM, Marcus BH. A Randomized Clinical Trial of a Tailored Lifestyle Intervention for Obese, Sedentary, Primary Care Patients. Ann Fam Med 2016; 14:311-9. [PMID: 27401418 PMCID: PMC4940460 DOI: 10.1370/afm.1952] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 03/22/2016] [Indexed: 12/12/2022] Open
Abstract
PURPOSE The aim of the study was to test a tailored lifestyle intervention for helping obese primary care patients achieve weight loss and increase physical activity. METHODS We conducted a 24-month randomized clinical trial in Rhode Island. Primary care physicians identified obese, sedentary patients motivated to lose weight and increase their moderate to vigorous physical activity. These patients were randomized to 1 of 2 experimental groups: enhanced intervention (EI) or standard intervention (SI). Both groups received 3 face-to-face weight loss meetings. The enhanced intervention group also received telephone counseling calls, individually tailored print materials, and DVDs focused on diet and physical activity. Active intervention occurred in year 1 with a tapered maintenance phase in year 2. RESULTS Two hundred eleven obese, sedentary patients were recruited from 24 primary care practices. Participants were 79% women and 16% minorities. They averaged 48.6 years of age, with a mean body mass index (BMI) of 37.8 kg/m(2), and 21.2 minutes/week of moderate to vigorous physical activity. Significantly more EI participants lost 5% of their baseline weight than SI participants (group by visit, P <.001). The difference was significant during active treatment at 6 months (37.2% EI vs 12.9% SI) and 12 months (47.8% vs 11.6%), but was no longer significant during the maintenance phase at 18 months (31.4% vs 26.7%,) or 24 months (33.3% vs 24.6%). The EI group reported significantly more minutes of moderate to vigorous physical activity over time than the SI group (group by visit, P = 0.04). The differences in minutes per week at 6 months was 95.7 for the EI group vs 68.3 minutes for the SI group; at 12 months, it was 126.1 vs 73.7; at 18 months, 103.7 vs 63.7, and at 24 months, 101.3 vs 75.4. Similar trends were found for absolute weight loss and the percentage reaching national guidelines for physical activity. CONCLUSION A home-based tailored lifestyle intervention in obese, sedentary primary care patients was effective in promoting weight loss and increasing moderate to vigorous physical activity, with the effects peaking at 12 months but waning at 24 months.
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Affiliation(s)
- Charles B Eaton
- Alpert Medical School of Brown University, Providence, Rhode Island Department of Epidemiology, School of Public Health of Brown University, Providence, Rhode Island Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket, Rhode Island
| | - Sheri J Hartman
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California Cancer Prevention and Control, UC San Diego Moores Cancer Center, La Jolla, California
| | - Elizabeth Perzanowski
- Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket, Rhode Island
| | - Guohui Pan
- Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket, Rhode Island
| | - Mary B Roberts
- Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket, Rhode Island
| | - Patricia M Risica
- Department of Epidemiology, School of Public Health of Brown University, Providence, Rhode Island Institute for Community Health Promotion, School of Public Health, Brown University, Providence, Rhode Island
| | - Kim M Gans
- Institute for Community Health Promotion, School of Public Health, Brown University, Providence, Rhode Island Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, Rhode Island Department of Human Development and Family Studies, University of Connecticut, Storrs, Connecticut Center for Health Interventions and Prevention, University of Connecticut, Storrs, Connecticut
| | - John M Jakicic
- Department of Health and Physical Activity, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Bess H Marcus
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California
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Gans KM, Risica PM, Dulin-Keita A, Mello J, Dawood M, Strolla LO, Harel O. Innovative video tailoring for dietary change: final results of the Good for you! cluster randomized trial. Int J Behav Nutr Phys Act 2015; 12:130. [PMID: 26445486 PMCID: PMC4596558 DOI: 10.1186/s12966-015-0282-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 09/11/2015] [Indexed: 11/12/2022] Open
Abstract
Background Effective, low-cost approaches are needed to enhance dietary behavior change. While both video and tailoring technology have been effective interventions to improve diet, these approaches have never been combined to study the effectiveness of tailored videos. The purpose of this paper is to discuss the results of Good For You!, a randomized trial that tested the efficacy of innovative, individually tailored videos in helping worksite employees decrease dietary fat and increase fruit and vegetable (F&V) intake. Methods Worksites were matched on approximate size, type of company and workforce composition and randomized to one of three experimental conditions: Non-Tailored written information (NT) (n = 14), Tailored Written information (TW) (n = 14), or Tailored Written + Tailored Video (TW + TV) (n = 15). Evaluation was conducted at baseline, 4 and 7 months. We used the NCI Fat Screener and an adapted Food Habits Questionnaire (FHQ) to estimate fat intake and fat-related behaviors, the NCI F&V Screener and F&V Habits Questionnaire (FVHQ) to measure F&V intake and behaviors. Generalized linear models were examined for all outcome measurements. Results 2525 worksite employees were recruited. At 4 months, dietary fat intake decreased significantly more for TW (−2.95 %) and TW + TV (−3.14 %) compared with NT (−2.42 %). FHQ scores decreased significantly more for TW + TV than the other two groups. Fruit intake increased the most for TW + TV compared to NT and TW. Both TW (1.30 cups) and TW + TV (1.59 cups) increased F&V intake significantly more than NT (0.78 cups). TW + TV showed the largest increase in F&V behaviors on the FVFQ. At 8 months, dietary fat change continued to be significantly better for TW + TV (−3.48 %) than NT (3.01 %). F&V intake increased significantly more for the TW + TV group (1.38 cups) compared to the NT group (1.04 cups) and FVHQ changes were significantly greater in TW + TV and TW than for NT. Conclusions The tailored intervention participants were more likely to decrease fat and increase F&V intake. The TW + TV group was generally the stronger of the two tailored interventions, especially at the longer term follow-up, demonstrating the promise of tailored video as an intervention to change eating habits. Future studies should explore newer channels and technologies in addition to DVDs for delivering tailored video interventions such as the internet and smart phones. Trial Registration ClinicalTrials.gov identifier: NCT00301678
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Affiliation(s)
- Kim M Gans
- Institute for Community Health Promotion, Brown University School of Public Health, Providence, Rhode Island, 02912, USA. .,Department of Human Development and Family Studies and the Center for Health Interventions and Prevention, University of Connecticut, 348 Mansfield Road, Unit 1058, Room 330, Storrs, Connecticut, 06269, USA.
| | - Patricia Markham Risica
- Institute for Community Health Promotion, Brown University School of Public Health, Providence, Rhode Island, 02912, USA
| | - Akilah Dulin-Keita
- Institute for Community Health Promotion, Brown University School of Public Health, Providence, Rhode Island, 02912, USA
| | - Jennifer Mello
- Institute for Community Health Promotion, Brown University School of Public Health, Providence, Rhode Island, 02912, USA
| | - Mahin Dawood
- Department of Human Development and Family Studies and the Center for Health Interventions and Prevention, University of Connecticut, 348 Mansfield Road, Unit 1058, Room 330, Storrs, Connecticut, 06269, USA
| | - Leslie O Strolla
- Institute for Community Health Promotion, Brown University School of Public Health, Providence, Rhode Island, 02912, USA
| | - Ofer Harel
- Department of Statistics, University of Connecticut, 215 Glenbrook Road Unit 4120, Storrs, CT, 06269, USA
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Melnyk J, Panza G, Zaleski A, Taylor B. Awareness and Knowledge of Cardiovascular Risk Through Blood Pressure and Cholesterol Testing in College Freshmen. AMERICAN JOURNAL OF HEALTH EDUCATION 2015. [DOI: 10.1080/19325037.2015.1023474] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
| | - G. Panza
- Henry Low Heart Center, Hartford Hospital
| | - A. Zaleski
- Henry Low Heart Center, Hartford Hospital
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Hartman SJ, Risica PM, Gans KM, Marcus BH, Eaton CB. Tailored weight loss intervention in obese adults within primary care practice: rationale, design, and methods of Choose to Lose. Contemp Clin Trials 2014; 38:409-19. [PMID: 24937016 DOI: 10.1016/j.cct.2014.06.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 05/29/2014] [Accepted: 06/05/2014] [Indexed: 11/18/2022]
Abstract
Although there are efficacious weight loss interventions that can improve health and delay onset of diabetes and hypertension, these interventions have not been translated into clinical practice. The primary objective of this study is to evaluate the effectiveness and cost effectiveness of a tailored lifestyle intervention in primary care patients. Patients were recruited by their primary care physicians and eligible participants were randomized to an enhanced intervention or standard intervention. All participants met with a lifestyle counselor to set calorie and physical activity goals and to discuss behavioral strategies at baseline, 6 and 12 months. During the first year, enhanced intervention participants receive monthly counseling phone calls to assist in attaining and maintaining their goals. Enhanced intervention participants also receive weekly mailings consisting of tailored and non-tailored print materials and videos focusing on weight loss, physical activity promotion and healthy eating. The second year focuses on maintenance with enhanced intervention participants receiving tailored and non-tailored print materials and videos regularly throughout the year. Standard intervention participants receive five informational handouts on weight loss across the two years. This enhanced intervention that consists of multiple modalities of print, telephone, and video with limited face-to-face counseling holds promise for being effective for encouraging weight loss, increasing physical activity and healthy eating, and also for being cost effective and generalizable for wide clinical use. This study will fill an important gap in our knowledge regarding the translation and dissemination of research from efficacy studies to best practices in clinical settings.
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Affiliation(s)
- Sheri J Hartman
- Program in Public Health, Department of Family and Preventive Medicine, University of California San Diego, San Diego, CA, USA; Cancer Prevention and Control, University of California San Diego Moores Cancer Center, San Diego, CA, USA.
| | - Patricia M Risica
- Institute for Community Health Promotion, Brown University School of Public Health, Providence, RI, USA; Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA
| | - Kim M Gans
- Institute for Community Health Promotion, Brown University School of Public Health, Providence, RI, USA; Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI, USA
| | - Bess H Marcus
- Program in Public Health, Department of Family and Preventive Medicine, University of California San Diego, San Diego, CA, USA
| | - Charles B Eaton
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA; Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket, RI, USA; Department of Family Medicine, Alpert Medical School of Brown University, Providence, RI, USA
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De Leon E, Fuentes LW, Cohen JE. Characterizing periodic messaging interventions across health behaviors and media: systematic review. J Med Internet Res 2014; 16:e93. [PMID: 24667840 PMCID: PMC3978550 DOI: 10.2196/jmir.2837] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Revised: 11/01/2013] [Accepted: 01/23/2014] [Indexed: 12/12/2022] Open
Abstract
Background Periodic prompts serve as tools for health behavior interventions to encourage and maintain behavior changes. Past literature reviews have examined periodic messages targeting specific behaviors (smoking, physical activity, diet, etc) or media (telephone, email, face-to-face, newsletter, etc) and have found them to be effective in impacting health behavior in the short term. Objective Our goal was to review the literature related to periodic messaging and prompts in order to explore typical characteristics, assess the role of prompt timing, identify common theoretical models used, and identify characteristics associated with the effectiveness of periodic prompts. Methods Electronic searches of PubMed, PsycINFO, CINAHL, and Web of Science were conducted in October 2012 and May 2013. Database search terms included variant terms for periods, prompts, interventions, media, and health behaviors. Results Forty-two of the 55 included research articles found that prompts resulted in significant positive behavioral outcomes for participants. Prompts were delivered via text messages, email, mailed communications, and in a few instances via phone. Generally, the provision of feedback and specific strategies to accomplish behavior change appears to be important for the success of periodic prompts. Rationale for prompt timing was rarely provided, although some studies did organize message content around days of the week or times perceived to be high risk for particular behaviors. Smoking cessation interventions tended to be organized around quit date. Among studies using theoretical models to inform their interventions, the transtheoretical model was most common. Conclusions Periodic messaging interventions yield positive results for short-term health behavior changes. Interventions including feedback and prompts that included strategies were more likely to report significantly positive outcomes. Work remains to better understand elements that make periodic prompts successful and whether they are effective in producing long-term outcomes.
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Affiliation(s)
- Elaine De Leon
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
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Garrett K, Okuyama S, Jones W, Barnes D, Tran Z, Spencer L, Lewis K, Maroni P, Chesney M, Marcus A. Bridging the transition from cancer patient to survivor: pilot study results of the Cancer Survivor Telephone Education and Personal Support (C-STEPS) program. PATIENT EDUCATION AND COUNSELING 2013; 92:266-72. [PMID: 23647980 PMCID: PMC4687454 DOI: 10.1016/j.pec.2013.04.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Revised: 03/17/2013] [Accepted: 04/05/2013] [Indexed: 05/11/2023]
Abstract
OBJECTIVE To develop a feasibility study of a theory-driven telephone counseling program to enhance psychosocial and physical well-being for cancer survivors after treatment. METHODS Participants (n=66) were recruited from two Colorado hospitals with self-administered questionnaires at baseline and two weeks post-intervention. The one group, intervention only design included up to six thematic telephone counseling sessions over three months. Topics included nutrition, physical activity, stress management, and medical follow-up. Primary outcomes were cancer-specific distress, self-reported fruit and vegetable consumption and physical activity. RESULTS Of 66 subjects, 46 completed at least one counseling module and the follow-up assessment (70% retention rate). Mean satisfaction was 9 out of 10, and all participants would recommend C-STEPS to other survivors. Cancer-specific distress (Impact of Event Scale - Intrusion subscale) decreased for entire study population (p<0.001) and stress management session participants (p<0.001). Fruit and vegetable consumption increased for nutrition and exercise session participants (p=0.02) and the entire sample (p=NS). Physical activity increased in the entire group (p=0.006) and for nutrition and exercise session participants (p=0.01). CONCLUSION AND PRACTICE IMPLICATIONS C-STEPS is a feasible telephone counseling program that transcends geographic barriers, demonstrating the potential to decrease distress and promote coping and healthy lifestyles among cancer survivors.
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Affiliation(s)
- Kathleen Garrett
- University of Colorado at Denver, Department of Cancer Prevention and Control, USA.
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Broekhuizen K, Kroeze W, van Poppel MNM, Oenema A, Brug J. A systematic review of randomized controlled trials on the effectiveness of computer-tailored physical activity and dietary behavior promotion programs: an update. Ann Behav Med 2013; 44:259-86. [PMID: 22767052 PMCID: PMC3442159 DOI: 10.1007/s12160-012-9384-3] [Citation(s) in RCA: 179] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background A review update is necessary to document evidence regarding the effectiveness of computer-tailored physical activity and nutrition education. Purpose The purpose of this study was to summarize the latest evidence on the effectiveness of computer-tailored physical activity and nutrition education, and to compare the results to the 2006 review. Methods Databases were searched for randomized controlled trials evaluating computer-tailored physical activity and nutrition education aimed at primary prevention in adults, published from September 2004 through June 2011. Results Compared to the findings in 2006, a larger proportion of studies found positive effects for computer-tailored programs compared to generic or no information, including those for physical activity promotion. Effect sizes were small and generally at short- or medium-term follow-up. Conclusions The results of the 2006 review were confirmed and reinforced. Future interventions should focus on establishing larger effect sizes and sustained effects and include more generic health education control groups and objective measurements of dietary behavior. Electronic supplementary material The online version of this article (doi:10.1007/s12160-012-9384-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Karen Broekhuizen
- EMGO+ Institute for Health and Care Research, Amsterdam, Netherlands.
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Purnell JQ, Kreuter MW, Eddens KS, Ribisl KM, Hannon P, Williams RS, Fernandez ME, Jobe D, Gemmel S, Morris M, Fagin D. Cancer control needs of 2-1-1 callers in Missouri, North Carolina, Texas, and Washington. J Health Care Poor Underserved 2012; 23:752-67. [PMID: 22643622 DOI: 10.1353/hpu.2012.0061] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Innovative interventions are needed to connect underserved populations to cancer control services. With data from Missouri, North Carolina, Texas, and Washington this study a) estimated the cancer control needs of callers to 2-1-1, an information and referral system used by underserved populations, b) compared rates of need with state and national data, and c) examined receptiveness to needed referrals. From October 2009 to March 2010 callers' (N=1,408) cancer control needs were assessed in six areas: breast, cervical, and colorectal cancer screening, HPV vaccination, smoking, and smoke-free homes using Behavioral Risk Factor Surveillance System (BRFSS) survey items. Standardized estimates were compared with state and national rates. Nearly 70% of the sample had at least one cancer control need. Needs were greater for 2-1-1 callers than for state and national rates, and callers were receptive to referrals. 2-1-1 could be a key partner in efforts to reduce cancer disparities.
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Affiliation(s)
- Jason Q Purnell
- Washington University in St. Louis, St. Louis, MO 63130, USA.
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David P, Henry A, Srivastava J, Orcena J, Thrush J. Reactance to a tailored multimedia intervention encouraging teachers to promote cover-the-cough. JOURNAL OF HEALTH COMMUNICATION 2012; 17:915-928. [PMID: 22578305 DOI: 10.1080/10810730.2011.650826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Teachers were presented tailored multimedia messages encouraging them to offer cover-the-cough instruction to their students. Messages were tailored by grade level (elementary, higher grade) and stage of change (preaction, action). Among teachers in the action stages, message tailoring did not make a difference. Among teachers in the preaction stages, tailored messages were rated lower than were nontailored messages. The lower ratings of the tailored messages, seemingly a reactance response, did not carry over to postintervention self-efficacy. The intervention was effective in improving self-efficacy in elementary school teachers, particularly among those in the preaction stages.
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Affiliation(s)
- Prabu David
- Edward R Murrow College of Communication, Washington State University, Pullman, Washington 99164, USA.
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Harrington NG, Noar SM. Reporting standards for studies of tailored interventions. HEALTH EDUCATION RESEARCH 2012; 27:331-342. [PMID: 22156230 DOI: 10.1093/her/cyr108] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Message tailoring is a promising innovative approach to persuasive communication that involves designing messages to meet a person's psychological, behavioral and/or demographic characteristics. Although the tailored intervention literature has many strengths, a weakness is inconsistency in reporting information related to intervention development, implementation and evaluation. The objective of this manuscript is to report recommendations for studies of tailored interventions. As part of ongoing original empirical and meta-analytical research, we reviewed the tailoring literature and identified inconsistencies in reporting. We compared these inconsistencies with existing reporting standards and developed recommendations specific to tailored interventions. An advisory board of preeminent tailoring researchers provided feedback on draft and final recommendations. This paper offers the resulting seven recommendations for reporting studies of tailored interventions. If we are to build a cumulative science of tailoring, both for theory development and research translation, then we should establish standards in the conduct and reporting of the science.
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Rippe JM, Waite MA. Implementing Heart Healthy Dietary Guidelines. Am J Lifestyle Med 2012. [DOI: 10.1177/1559827611428744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Over recent decades, abundant scientific evidence has led to authoritative dietary guidelines and recommendations for heart healthy eating and lifestyle behaviors. But most children and adults do not regularly achieve these goals. Consequently, our focus must now be on helping individual patients and our communities implement these guidelines in everyday life. This article reviews current evidence for insights and practical techniques that can help individuals move from ideal goals to real practice of heart healthy nutrition and lifestyle behaviors.
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Affiliation(s)
- James M. Rippe
- Rippe Lifestyle Institute, Shrewsbury, Massachusetts (JMR)
- Center for Lifestyle Medicine, University of Central Florida, Orlando, Florida (JMR)
- Tufts University School of Medicine, Boston, Massachusetts (JMR)
- Atlanta, Georgia (MAW)
| | - Mary Abbott Waite
- Rippe Lifestyle Institute, Shrewsbury, Massachusetts (JMR)
- Center for Lifestyle Medicine, University of Central Florida, Orlando, Florida (JMR)
- Tufts University School of Medicine, Boston, Massachusetts (JMR)
- Atlanta, Georgia (MAW)
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Clarke P, Evans SH, Hovy EH. Indigenous message tailoring increases consumption of fresh vegetables by clients of community pantries. HEALTH COMMUNICATION 2011; 26:571-582. [PMID: 21512926 DOI: 10.1080/10410236.2011.558337] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
This study tested whether message tailoring of recipes and food-use tips for low-income households is superior to providing a generic version of the material. The field experiment was conducted in the busy conditions found at community food pantries, and included 10 food distributions at each of six sites. We analyzed the consumption of fresh vegetables 6 days following distributions, and retention of print materials 6 weeks later. Self-determination and reactance theories guided the development of tailoring in an indigenous fashion, allowing each pantry client to choose recipes and food tips thought personally useful. This contrasted against paternalistic tailoring, common in health communication, where a motivational theory is used to regulate the health messages given to recipients. Results demonstrated benefits of tailoring over both generic and control conditions and uncovered the degree of tailoring that produced the largest effects. As suggested by construal level theory, the intervention addressed recipients' immediate and concrete decisions about healthy eating, instead of distant or abstract goals like prevention of illnesses. We documented per-client costs of tailored information. Results also suggested that benefits from social capital at sites offering a health outreach may exceed the impact of message tailoring on outcomes of interest.
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Affiliation(s)
- Peter Clarke
- Annenberg School for Communication and Journalism, and Department of Preventive Medicine, University of Southern California, Los Angeles, CA 90089-0281, USA.
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Kroeze W, Dagnelie PC, Heymans MW, Oenema A, Brug J. Biomarker evaluation does not confirm efficacy of computer-tailored nutrition education. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2011; 43:323-330. [PMID: 21906546 DOI: 10.1016/j.jneb.2010.09.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2009] [Revised: 09/14/2010] [Accepted: 09/17/2010] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To evaluate the efficacy of computer-tailored nutrition education with objective outcome measures. DESIGN A 3-group randomized, controlled trial with posttests at 1 and 6 months post-intervention. SETTING Worksites and 2 neighborhoods in the urban area of Rotterdam. PARTICIPANTS A convenience sample of healthy Dutch adults (n = 442). INTERVENTIONS A computer-tailored intervention delivered on CD-ROM; a computer-tailored intervention delivered in print; and a generic information condition. MAIN OUTCOME MEASURES Blood lipids (total, high-density lipoprotein, and low-density lipoprotein cholesterol, and triacylglycerol) were measured by analyzing venous blood samples. ANALYSIS Linear mixed model procedure. RESULTS There were no significant differences among the 3 intervention groups in total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triacylglycerol. CONCLUSIONS AND IMPLICATIONS Contrary to results based on self-report data, no effects of the computer-tailored interventions were found based on objective outcomes. This contradiction calls for a critical reflection on the use of computer-tailored nutrition education interventions and the need to improve those interventions. Furthermore, this study indicates that feasible methods are needed to objectively assess the impact of computer-tailored nutrition education interventions in free-living subjects.
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Affiliation(s)
- Willemieke Kroeze
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands.
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Bensley RJ, Anderson JV, Brusk JJ, Mercer N, Rivas J. Impact of internet vs traditional Special Supplemental Nutrition Program for Women, Infants, and Children nutrition education on fruit and vegetable intake. ACTA ACUST UNITED AC 2011; 111:749-55. [PMID: 21515124 DOI: 10.1016/j.jada.2011.02.010] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2010] [Accepted: 11/05/2010] [Indexed: 11/29/2022]
Abstract
The purpose of this project was to compare the impact of Internet nutrition education to traditional nutrition education on Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participant fruit and vegetable consumption. Interventions were delivered at 15 WIC clinics after normal WIC clinic operations or delivered online. A total of 692 and 872 participants from eight WIC agencies self-enrolled into two phases. A quasi-experimental design using an interrupted time series to determine the impact of two methods of nutrition education and follow-up nutrition counseling was used. Data were collected online and at Michigan WIC clinics during 2005-2007 at 3-month intervals during a 9-month period (per phase). Two Internet nutrition education modules were compared to WIC traditional nutrition education, which included either group classes or a self-guided nutrition education information mall. All interventions were based on the same program learning objectives. Optional motivational negotiation counseling followed 3 months post-intervention. Stage of change progression, belief in ability to change, and fruit and vegetable consumption were measured at baseline, immediately after the intervention, and 3 and 6 months post-intervention. Significance (P<0.05) was analyzed using independent samples t tests, χ(2) distribution, and sample tests for differences in binomial proportions. The Internet group experienced substantial positive differences in stage of change progression, perception that the intervention was helpful and easy to use, and fruit and vegetable consumption. Traditional nutrition education required follow-up counseling to achieve fruit and vegetable consumption levels similar to the Internet nutrition education group. Based on these findings, this study supports Internet nutrition education as a viable alternative to traditional nutrition education for increasing fruit and vegetable consumption in some WIC clients.
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Affiliation(s)
- Robert J Bensley
- Department of Health, Physical Education and Recreation, Western Michigan University, 4025 SRC, Kalamazoo, MI 49008, USA.
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Latimer AE, Rench TA, Rivers SE, Katulak NA, Materese SA, Cadmus L, Hicks A, Hodorowski JK, Salovey P. Promoting participation in physical activity using framed messages: An application of prospect theory. Br J Health Psychol 2010; 13:659-81. [DOI: 10.1348/135910707x246186] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Cobiac LJ, Vos T, Veerman JL. Cost-effectiveness of interventions to promote fruit and vegetable consumption. PLoS One 2010; 5:e14148. [PMID: 21152389 PMCID: PMC2994753 DOI: 10.1371/journal.pone.0014148] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2010] [Accepted: 11/09/2010] [Indexed: 11/19/2022] Open
Abstract
Background Fruits and vegetables are an essential part of the human diet, but many people do not consume the recommended serves to prevent cardiovascular disease and cancer. In this research, we evaluate the cost-effectiveness of interventions to promote fruit and vegetable consumption to determine which interventions are good value for money, and by how much current strategies can reduce the population disease burden. Methods/Principal Findings In a review of published literature, we identified 23 interventions for promoting fruit and vegetable intake in the healthy adult population that have sufficient evidence for cost-effectiveness analysis. For each intervention, we model the health impacts in disability-adjusted life years (DALYs), the costs of intervention and the potential cost-savings from averting disease treatment, to determine cost-effectiveness of each intervention over the lifetime of the population, from an Australian health sector perspective. Interventions that rely on dietary counselling, telephone contact, worksite promotion or other methods to encourage change in dietary behaviour are not highly effective or cost-effective. Only five out of 23 interventions are less than an A$50,000 per disability-adjusted life year cost-effectiveness threshold, and even the most effective intervention can avert only 5% of the disease burden attributed to insufficient fruit and vegetable intake. Conclusions/Significance We recommend more investment in evaluating interventions that address the whole population, such as changing policies influencing price or availability of fruits and vegetables, to see if these approaches can provide more effective and cost-effective incentives for improving fruit and vegetable intake.
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Affiliation(s)
- Linda J Cobiac
- School of Population Health, The University of Queensland, Herston, Queensland, Australia.
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Abstract
Tailored health communication research represents a very promising line of inquiry that has the potential to produce major impacts on lifestyle behaviors. This study defines tailoring and discusses how tailored interventions operate, including comparing/ contrasting different tailoring channels. Next, the authors review the literature on tailored interventions to change lifestyle behaviors, with a focus on smoking cessation, dietary change, and physical activity, as well as interventions that address multiple lifestyle behaviors. Finally, future directions for tailoring research are discussed. To date, a large literature has amassed showing the promise of tailored programs delivered via print, Internet, local computer/kiosk, telephone, and interpersonal channels. Numerous studies demonstrate that these programs are capable of significant impacts on smoking cessation, dietary change, physical activity, and multiple behavior change. It is concluded that the potential of tailoring will be more fully realized as (a) the field builds a more cumulative science of tailoring and (b) greater dissemination of efficacious tailored programs takes place.
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25
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Terry PE, Seaverson ELD, Staufacker MJ, Gingerich SB. A Comparison of the Effectiveness of a Telephone Coaching Program and a Mail-Based Program. HEALTH EDUCATION & BEHAVIOR 2010; 37:895-912. [DOI: 10.1177/1090198110367876] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Many health promotion interventions have been developed and tested in recent years. Practitioners and researchers must continue to explore how various program delivery modalities can be used effectively and efficiently to optimize program outcomes. A sample of 6,055 participants was drawn from 10 large employers. Participants self-selected into a mail or telephone intervention. This study compared the demographics of those who selected each modality and assessed differences in program success relative to the modalities chosen. Telephone participants were more likely to be older, female, and salaried. Telephone participants were also more ready, confident, and motivated to make a behavior change, when compared to those in the mail program. Researchers found both the telephone and mail programs to be effective in reducing participants’ health risk status, though the telephone program was slightly more effective. These findings demonstrate the importance of offering a variety of interventions when promoting healthy changes. More research is needed to investigate the role of participant choice and the combinations of learning experiences that best facilitate sustainable behavior change.
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Krebs P, Prochaska JO, Rossi JS. A meta-analysis of computer-tailored interventions for health behavior change. Prev Med 2010; 51:214-21. [PMID: 20558196 PMCID: PMC2939185 DOI: 10.1016/j.ypmed.2010.06.004] [Citation(s) in RCA: 509] [Impact Index Per Article: 36.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2009] [Revised: 06/04/2010] [Accepted: 06/05/2010] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Computer-tailored interventions have become increasingly common for facilitating improvement in behaviors related to chronic disease and health promotion. A sufficient number of outcome studies from these interventions are now available to facilitate the quantitative analysis of effect sizes, permitting moderator analyses that were not possible with previous systematic reviews. METHOD The present study employs meta-analytic techniques to assess the mean effect for 88 computer-tailored interventions published between 1988 and 2009 focusing on four health behaviors: smoking cessation, physical activity, eating a healthy diet, and receiving regular mammography screening. Effect sizes were calculated using Hedges g. Study, tailoring, and demographic moderators were examined by analyzing between-group variance and meta-regression. RESULTS Clinically and statistically significant overall effect sizes were found across each of the four behaviors. While effect sizes decreased after intervention completion, dynamically tailored interventions were found to have increased efficacy over time as compared with tailored interventions based on one assessment only. Study effects did not differ across communication channels nor decline when up to three behaviors were identified for intervention simultaneously. CONCLUSION This study demonstrates that computer-tailored interventions have the potential to improve health behaviors and suggests strategies that may lead to greater effectiveness of these techniques.
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Affiliation(s)
- Paul Krebs
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
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Campbell MK, Carr C, Devellis B, Switzer B, Biddle A, Amamoo MA, Walsh J, Zhou B, Sandler R. A randomized trial of tailoring and motivational interviewing to promote fruit and vegetable consumption for cancer prevention and control. Ann Behav Med 2010; 38:71-85. [PMID: 20012809 DOI: 10.1007/s12160-009-9140-5] [Citation(s) in RCA: 112] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Healthful dietary patterns, including eating fruits and vegetables (F&V) and avoiding obesity, may decrease the risk of cancer and other chronic diseases. In addition to promoting health for the general population, a cancer diagnosis may provide a "teachable moment," facilitating the adoption of more healthful eating habits and leading to lower risk of chronic disease and better overall health. PURPOSE This study was designed to test the effectiveness of two health communication interventions in increasing F&V consumption and physical activity in a sample of older adults (average age of 66 years), including both colorectal cancer (CRC) survivors and noncolorectal cancer-affected (N-CRC) individuals. METHODS CRC survivors and N-CRC individuals were recruited from a population-based case-control study and randomly assigned to four conditions using a 2 x 2 design. We tested two different methods of communicating and promoting health behavior change alone or in combination: tailored print communication (TPC) and brief telephone-based motivational interviewing (TMI). RESULTS A significant increase in F&V consumption was found for the combined intervention group in the entire sample (p < 0.05). When stratified by cancer survivor status, the effect was concentrated in the N-CRC subset (p < 0.01) versus CRC survivors. The combined intervention was also found to be most cost-effective for the N-CRC group, with TPC more cost-effective than TMI. For physical activity, none of the interventions produced statistically significant improvements. CONCLUSIONS This study indicates that combining tailoring and motivational interviewing may be an effective and cost-effective method for promoting dietary behavior change among older healthy adults. More research is needed to identify the optimal dose and timing for intervention strategies to promote dietary and physical activity change among both CRC survivors and the general population.
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Affiliation(s)
- Marci Kramish Campbell
- Department of Nutrition, UNC Gillings School of Global Public Health, Chapel Hill, NC, USA.
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Kim Y, Pike J, Adams H, Cross D, Doyle C, Foreyt J. Telephone intervention promoting weight-related health behaviors. Prev Med 2010; 50:112-7. [PMID: 20006642 DOI: 10.1016/j.ypmed.2009.12.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2009] [Revised: 11/19/2009] [Accepted: 12/06/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Recent national surveys have documented that the majority of adults in the United States do not meet the recommended levels of healthy lifestyle-related behaviors. The Nutrition and Physical Activity (NuPA) study was designed to promote fruit and vegetable consumption, physical activity, and weight management for a working population. METHOD Data were collected nationwide, USA, from 2005 to 2007 and analyzed in 2008. A total of 2470 employed participants were randomized into the self-help (SH: n=1191) or self-help plus telephone counseling (SH+C: n=1279) group. The SH+C group received nine structured telephone counseling sessions in addition to the print materials. RESULTS A series of hierarchical regression analyses for each of the health behavior outcomes in the present-at-follow-up subsample (n=1098-1148) revealed that the SH+C was effective in increasing fruit and vegetable consumption. Among the overweight and obese participants, weight loss was significant in both the SH and SH+C groups. CONCLUSION Using a theory-based behavioral change counseling technique and targeting multiple health behaviors among employed individuals, our findings demonstrate that the addition of telephone counseling to mailed self-help materials is effective in promoting healthy diet and weight management.
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Affiliation(s)
- Youngmee Kim
- Behavioral Research Center, American Cancer Society, Atlanta, GA, USA.
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A computerised tailored intervention for increasing intakes of fruit, vegetables, brown bread and wholegrain cereals in adolescent girls. Public Health Nutr 2010; 13:1271-8. [PMID: 20059794 DOI: 10.1017/s1368980009992953] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of a computer-generated tailored intervention leaflet compared with a generic leaflet aimed at increasing brown bread, wholegrain cereal, fruit and vegetable intakes in adolescent girls. DESIGN Clustered randomised controlled trial. Dietary intake was assessed via three 24 h dietary recalls. SETTING Eight secondary schools in areas of low income and/or high ethnic diversity, five in London and three in the West Midlands, UK. SUBJECTS Girls aged 12-16 years participated (n 823) and were randomised by school class to receive either the tailored intervention (n 406) or a generic leaflet (n 417). RESULTS At follow-up 637 (77 %) participants completed both baseline and follow-up dietary recalls. The tailored intervention leaflet had a statistically significant effect on brown bread intake (increasing from 0.39 to 0.51 servings/d) with a smaller but significant increase in the control group also (increasing from 0.28 to 0.35 servings/d). The intervention group achieved 0.05 more servings of brown bread daily than the control group (P < 0.05), which is equivalent to 0.35 servings/week. For the other foods there were no significant effects of the tailored intervention. CONCLUSIONS The intervention group consumed approximately 0.35 more servings of brown bread weekly than the control group from baseline. Although this change between groups was statistically significant the magnitude was small. Evaluation of the intervention was disappointing but the tailored leaflet was received more positively in some respects than the control leaflet. More needs to be done to increase motivation to change dietary intake in adolescent girls.
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Eyles HC, Mhurchu CN. Does tailoring make a difference? A systematic review of the long-term effectiveness of tailored nutrition education for adults. Nutr Rev 2009; 67:464-80. [PMID: 19674343 DOI: 10.1111/j.1753-4887.2009.00219.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Tailoring individualizes information to the receiver and provides a potential strategy for improving dietary intakes. The present systematic review summarizes evidence for the long-term (> or =6 months) effectiveness of tailored nutrition education for adults and includes priority population groups. Key electronic databases and relevant bibliographies were searched for trials measuring the following outcomes: nutrition-related health behaviors (e.g., dietary intake and food purchases) and anthropometric measures. Data synthesis was comprised of meta-analysis (for 15 trials including all population groups) and narrative review (for five trials of priority population groups). Overall, the quality of the studies was moderate to good. Tailored nutrition education was found to be a promising strategy for improving the diets of adults (including those in priority population groups) over the long term. However, future studies should ensure adequate reporting of research design and methods and reduce the chances of false-positive findings by using more objective measures of diet, clearly identifying the primary study outcome, and concentrating on outcomes most relevant to nutrition-related disease.
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Affiliation(s)
- Helen C Eyles
- Clinical Trials Research Unit, School of Population Health, University of Auckland, New Zealand.
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Williams-Piehota P, Latimer AE, Katulak NA, Cox A, Silvera SAN, Mowad L, Salovey P. Tailoring messages to individual differences in monitoring-blunting styles to increase fruit and vegetable intake. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2009; 41:398-405. [PMID: 19879495 PMCID: PMC2807207 DOI: 10.1016/j.jneb.2008.06.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2008] [Revised: 06/04/2008] [Accepted: 06/05/2008] [Indexed: 05/03/2023]
Abstract
OBJECTIVE To examine whether messages matched to individuals' monitoring-blunting coping styles (MBCS) are more effective in increasing fruit and vegetable intake than mismatched messages. MBCS refers to the tendency to either attend to and amplify, or distract oneself from and minimize threatening information. DESIGN/SETTING Randomly assigned messages were tailored to resonate with either monitors or blunters and delivered at baseline, 1 week, 2 months, and 3 months later. Surveys were conducted at baseline and 2 and 4 months later. PARTICIPANTS 531 callers to a cancer information hotline who did not meet the 5 A Day guideline. INTERVENTION A brief telephone-delivered message and 3 mailings of booklets and promotional items encouraging fruit and vegetable intake, tailored for either monitors or blunters. MAIN OUTCOME MEASURE Fruit and vegetable intake 2 and 4 months post-baseline. ANALYSIS Hierarchical regression modeling. RESULTS Messages matched to MBCS were more effective than mismatched messages, particularly for the monitor message, in increasing intake at 2 months but not at 4 months. CONCLUSIONS AND IMPLICATIONS These minimal interventions influenced fruit and vegetable intake. MBCS may be a promising target for developing tailored messages aimed at increasing intake, although additional research is needed to verify the robustness of these findings.
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Gans KM, Risica PM, Strolla LO, Fournier L, Kirtania U, Upegui D, Zhao J, George T, Acharyya S. Effectiveness of different methods for delivering tailored nutrition education to low income, ethnically diverse adults. Int J Behav Nutr Phys Act 2009; 6:24. [PMID: 19416525 PMCID: PMC2688475 DOI: 10.1186/1479-5868-6-24] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2008] [Accepted: 05/05/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Computer-tailored written nutrition interventions have been shown to be more effective than non-tailored materials in changing diet, but continued research is needed. Your Healthy Life/Su Vida Saludable (YHL-SVS) was an intervention study with low income, ethnically diverse, English and Spanish-speaking participants to determine which methods of delivering tailored written nutrition materials were most effective in lowering fat and increasing fruit and vegetable (F&V) intake. METHODS YHL-SVS was a randomized controlled trial with four experimental conditions: 1) Nontailored (NT) comparison group; 2) Single Tailored (ST) packet; 3) Multiple Tailored (MT) packet mailed in four installments; 4) Multiple Re-Tailored (MRT) MT packets re-tailored between mailings via brief phone surveys. A baseline telephone survey collected information for tailoring as well as evaluation. Follow-up evaluation surveys were collected 4- and 7-months later. Primary outcomes included F&V intake and fat related behaviors. Descriptive statistics, paired t-test and ANOVA were used to examine the effectiveness of different methods of delivering tailored nutrition information. RESULTS Both the ST and MT groups reported significantly higher F&V intake at 4-months than the NT and MRT groups. At 7 months, only the MT group still had significantly higher F&V intake compared to the NT group. For changes in fat-related behaviors, both the MT and MRT groups showed more change than NT at 4 months, but at 7 months, while these differences persisted, they were no longer statistically significant. There was a significant interaction of experimental group by education for change in F&V intake (P = .0085) with the lowest educational group demonstrating the most change. CONCLUSION In this study, tailored interventions were more effective than non-tailored interventions in improving the short-term dietary behaviors of low income, ethnically diverse participants. Delivery of information in multiple smaller doses over time appeared to improve effectiveness. Future studies should determine which variables are mediators of dietary change and whether these differ by participant demographics. Moreover, future research should differentiate the effects of tailoring vs. cultural adaptation in ethnically diverse populations and study the dissemination of tailored interventions into community-based settings. TRIAL REGISTRATION Current Controlled Trials # NCT00301691.
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Affiliation(s)
- Kim M Gans
- Brown University Institute for Community Health Promotion, Box G S121-8, Providence, RI 02912, USA.
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Kroeze W, Oenema A, Dagnelie PC, Brug J. Examining the minimal required elements of a computer-tailored intervention aimed at dietary fat reduction: results of a randomized controlled dismantling study. HEALTH EDUCATION RESEARCH 2008; 23:880-891. [PMID: 18063650 DOI: 10.1093/her/cym075] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
This study investigated the minimally required feedback elements of a computer-tailored dietary fat reduction intervention to be effective in improving fat intake. In all 588 Healthy Dutch adults were randomly allocated to one of four conditions in an randomized controlled trial: (i) feedback on dietary fat intake [personal feedback (P feedback)], (ii) P feedback and feedback on one's own behavior relative to that of peers [personal-normative feedback (PN feedback)], (iii) PN feedback and practical suggestions on how to change fat intake [personal-normative-action feedback (PNA feedback)] and (iv) generic information. Data on fat intake, awareness of one's own fat intake and intention to change were collected 1 and 6 months post-intervention. Between-group differences were tested with analysis of variance. Among respondents with high fat intakes at baseline (risk consumers) and those who underestimated their fat intake at baseline (underestimators), differences in awareness and (saturated) fat intake were found between the generic and PNA feedback conditions. Compared with generic information P feedback was more effective in changing awareness and intention among the underestimators, and PN feedback was more effective in changing intention among both risk consumers and underestimators. In conclusion, the combination of personal, normative and action feedback is required for inducing change in fat intake and improving awareness of fat intake.
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Affiliation(s)
- Willemieke Kroeze
- Department of Public Health, Erasmus University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
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Kroeze W, Oenema A, Campbell M, Brug J. The efficacy of Web-based and print-delivered computer-tailored interventions to reduce fat intake: results of a randomized, controlled trial. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2008; 40:226-236. [PMID: 18565463 DOI: 10.1016/j.jneb.2007.09.008] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2007] [Revised: 09/13/2007] [Accepted: 09/16/2007] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To test and compare the efficacy of interactive- and print-delivered computer-tailored nutrition education targeting saturated fat intake reduction. DESIGN A 3-group randomized, controlled trial (2003-2005) with posttests at 1 and 6 months post-intervention. SETTING Worksites and 2 neighborhoods in the urban area of Rotterdam. PARTICIPANTS A convenience sample of healthy Dutch adults (n = 442). INTERVENTIONS An interactive, computer-tailored intervention delivered on a CD-ROM (interactive-tailored condition); a print-delivered, computer-tailored intervention (print-tailored condition); and print-delivered, generic information. MAIN OUTCOME MEASURES Total and saturated fat intake (grams/day and percentage-energy) and energy intake per day assessed with validated food frequency questionnaires at 1 and 6 months post-intervention. ANALYSIS Multilevel linear regression analyses. RESULTS Mean total fat, saturated fat, and energy intakes were significantly lower in both tailored conditions compared to the generic condition at 1-month follow-up. These differences were still significant for the print-tailored condition at 6-months follow-up. Effects were most pronounced among participants with unfavorable fat intakes at baseline. There were no significant differences between the 2 tailoring conditions. CONCLUSIONS AND IMPLICATIONS The results indicate that interactive and print-delivered computer-tailored interventions can have similar short-term effects on fat intake and that the effects of the print-delivered tailored feedback are maintained in the longer term.
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Affiliation(s)
- Willemieke Kroeze
- Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
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Buller DB, Woodall WG, Zimmerman DE, Slater MD, Heimendinger J, Waters E, Hines JM, Starling R, Hau B, Burris-Woodall P, Davis GS, Saba L, Cutter GR. Randomized trial on the 5 a day, the Rio Grande Way Website, a web-based program to improve fruit and vegetable consumption in rural communities. JOURNAL OF HEALTH COMMUNICATION 2008; 13:230-49. [PMID: 18569356 PMCID: PMC4376106 DOI: 10.1080/10810730801985285] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
The Internet is a new technology for health communication in communities. The 5 a Day, the Rio Grande Way website intended to increase fruits and vegetables (FV) consumption was evaluated in a rural region enrolling 755 adults (65% Hispanic, 9% Native American, 88% female) in a randomized pretest-posttest controlled trial in 2002-2004. A total of 473 (63%) adults completed a 4-month follow-up. The change in daily intake on a food frequency questionnaire (control: mean = - 0.26 servings; intervention: mean = 0.38; estimated difference = 0.64, SD = 0.52, t(df = 416) = 1.22, p = 0.223) and single item (13.9% eating 5 + servings at pretest, 19.8% posttest for intervention; 17.4%, 13.8% for controls; odds ratio (OR) = 1.84, 95% CI = 1.07, 3.17) was in the expected direction but significant only for the single item. Website use was low and variable (logins: M = 3.3, range = 1 to 39.0; total time: M = 22.2 minutes, range = 0 to 322.7), but it was associated positively with fruit and vegetable intake (total time: Spearman r = 0.14, p = 0.004 for food frequency; Spearman r = 0.135, p = 0.004 for single item). A nutrition website may improve FV intake. The comparison on the food frequency measure may have been undermined by its high variability. Websites may be successful in community settings only when they are used enough by adults to influence them.
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Nitzke S, Kritsch K, Boeckner L, Greene G, Hoerr S, Horacek T, Kattelmann K, Lohse B, Oakland MJ, Beatrice P, White A. A stage-tailored multi-modal intervention increases fruit and vegetable intakes of low-income young adults. Am J Health Promot 2007; 22:6-14. [PMID: 17894257 DOI: 10.4278/0890-1171-22.1.6] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Assess effectiveness of an intervention to improve fruit and vegetable consumption in economically disadvantaged young adults. DESIGN Randomized treatment-control, pre-post design. SETTING Ten states. SUBJECTS Young adults (n = 2024, ages 18-24) were recruited from noncollege venues; 1255 (62%) completed assessment interviews at baseline and at 4 and 12 months. INTERVENTION Treatment participants received a series of mailed materials and two educational calls in 6 months. Controls received a mailed pamphlet. MEASURES Assessment calls determined two measures of fruit and vegetable intakes, demographics and stage of change at baseline, 4 and 12 months, plus treatment participants' decisional balance, processes, and self-efficacy. ANALYSIS Repeated measure analysis of variance, intent-to-treat, chi2, and logistic regression. RESULTS At follow-up, participants in the experimental group had higher intakes of fruit and vegetables than controls (perceived daily intakes of 4.90 vs. 4.60 servings per day, F = 3.49, p < .05 and 4.31 vs. 3.92 servings/day via 5-A-Day Screener, F= 4.78, p < .01) and greater progression to action or maintenance stages (66% progress in fruitfor intervention vs. 55% progress in fruit for controls; 47% vs. 32% progress for vegetables, p = .0080 and .0001, respectively). Lower education, non-White ethnicity, male gender, living with children, and experimental group assignment predicted attrition (chi2(6df) = 288, p < .001, Cox R2 = .132). CONCLUSIONS Tailored educational messages and research-extension partnerships are advantageous for improving fruit and vegetable intakes of young adults.
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Affiliation(s)
- Susan Nitzke
- University of Wisconsin Hospital and Clinics, Madison, Wisconsin, USA.
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Joseph G, Kaplan CP, Pasick RJ. Recruiting low-income healthy women to research: an exploratory study. ETHNICITY & HEALTH 2007; 12:497-519. [PMID: 17978946 PMCID: PMC4497777 DOI: 10.1080/13557850701616961] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVE The study goals were (1) to assess the feasibility of using an existing telephone health information and referral service for low-income, ethnically diverse women to recruit women for research participation; (2) to assess the feasibility of recruiting low-income, African American and Latino men into health research through the women callers to the telephone service; and (3) to describe the challenges women face and the strategies they use when talking to men about the men's health and research participation. DESIGN We recruited women for individual semi-structured qualitative interviews via the Every Woman Counts (EWC) telephone information and referral service, a California Department of Health Services Cancer Detection Program. This paper describes our eligibility and recruitment assessment, and our qualitative data from 23 interviews with low-income African American and Latino women who called EWC. RESULTS We found that it was feasible to recruit women, but not to recruit men through women who call this telephone service. Almost 50% (113) of women demographically eligible for recruitment, completed our screening questionnaire, despite calling EWC for a different purpose. Some 48% (54) of those women were eligible for an interview. Of interview-eligible women, 58% (10) of African Americans and 35% (13) of Latinos completed an interview. Only 17% (4) of women referred a man for participation in an interview for our study. Several themes emerged from our analysis of interview data: (1) women's role in men's health can be significant but is often uneasy; (2) challenges when talking to men about their health include health access, gender dynamics, and men's fear of health care; (3) women's understanding of research may be limited; (4) women use a range of strategies to address and overcome men's resistance to taking care of their health and participating in research. CONCLUSIONS The challenges women face when talking with men about their health affect their ability to effectively speak to men about research participation. However, EWC and similar telephone health services may be an effective means for recruiting low-income women to chemoprevention and other studies requiring healthy participants.
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Affiliation(s)
- Galen Joseph
- University of California, Comprehensive Cancer Center and Institute for Health Policy Studies, San Francisco, CA 94143-0981, USA.
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Latimer AE, Williams-Piehota P, Cox A, Katulak NA, Salovey P, Mowad L. Encouraging Cancer Patients to Talk to Their Physicians About Clinical Trials: Considering Patients' Information Needs. ACTA ACUST UNITED AC 2007. [DOI: 10.1111/j.1751-9861.2008.00020.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Spittaels H, De Bourdeaudhuij I, Vandelanotte C. Evaluation of a website-delivered computer-tailored intervention for increasing physical activity in the general population. Prev Med 2007; 44:209-17. [PMID: 17197015 DOI: 10.1016/j.ypmed.2006.11.010] [Citation(s) in RCA: 133] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2006] [Revised: 11/13/2006] [Accepted: 11/14/2006] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To examine if a website-delivered physical activity intervention, that provides participants with computer-tailored feedback, can improve physical activity in the general population. METHODS Healthy adults (n=434), recruited from parents and staff of 14 primary and secondary schools in Belgium in the spring of 2005, were allocated into one of two intervention groups (receiving intervention with or without repeated feedback) or a no-intervention control group. Physical activity-levels were self-reported at baseline and at 6 months (n=285), using a computerized long version of the International Physical Activity Questionnaire online. Repeated measures analysis of co-variances were used to examine differences between the three groups. RESULTS Intent-to-treat analysis showed significant time by group interaction effects in favor of both intervention groups compared with the control group. Significant increases were found for active transportation (+20, +24, +11 min/week respectively) and leisure-time physical activity (+26, +19, -4 min/week respectively); a significant decrease for minutes sitting on weekdays (-22, -34, +4 min/day respectively). No significant differences were found between both intervention groups. CONCLUSION A website-delivered intervention, including computer-tailoring, was able to increase physical activity when compared to a no-intervention control group. High drop-out rate and the low number of participants who received repeated feedback indicated that engagement and retention are important challenges in e-health studies.
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Affiliation(s)
- Heleen Spittaels
- Policy Research Centre Sport, Physical Activity and Health, Belgium
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Marcus AC, Heimendinger J, Berman E, Strecher V, Bright MA, Allen AR, Davis SW, Julesberg K, Mowad LZ, Nguyen LH, Perocchia R, Thomsen C. A case study in dissemination: lessons learned from a pilot study involving the National Cancer Institute's Cancer Information Service. JOURNAL OF HEALTH COMMUNICATION 2005; 10 Suppl 1:219-33. [PMID: 16377609 DOI: 10.1080/10810730500257689] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
The Cancer Information Service Research Consortium (CISRC) was funded by the National Cancer Institute to disseminate as a pilot study a longitudinally tailored print intervention to promote the 5 A Day for Better Health program among callers to the National Cancer Institute's Cancer Information Service (CIS). Using a one-group (intervention-only) study design, 1,022 eligible CIS callers were enrolled to receive the intervention consisting of four mailings of tailored print materials over a 3-month period. Program evaluation focused on process and implementation evaluation, including adherence to the baseline interviews by CIS information specialists based on live-call monitoring (n = 55 eligible callers), and the timeliness of the intervention mailouts (4,088 scheduled mailouts). Adherence to the baseline interviews by CIS information specialists was extremely high, exceeding 90% for all indicators of quality control. Of the 4,088 intervention mailings, 75% occurred on or before the target date, while 95% occurred within 21 days of the target date. All delays in the scheduled mailouts occurred in the first mailing, due to changes made in the production process (batch printing of all tailored print materials at baseline). This change required additional system upgrades and more intensive and time-consuming quality control than originally anticipated, which was exacerbated by the faster-than-expected accrual of eligible participants. Based on this pilot study, the CIS is now positioned for widespread dissemination of the 5 A Day tailored print intervention. Several key lessons learned are also identified to facilitate the transition from research to dissemination.
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Marcus AC, Morra ME, Bright MA, Fleisher L, Kreps G, Perocchia R. The CIS model for collaborative research in health communications: a brief retrospective from the current generation of research. JOURNAL OF HEALTH COMMUNICATION 2005; 10 Suppl 1:235-45. [PMID: 16377610 DOI: 10.1080/10810730500263612] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
The Cancer Information Service (CIS) of the National Cancer Institute (NCI) is the premiere organization for providing cancer information to the nation. The CIS provides a stellar example of how a service organization dedicated to health communications also can serve as a laboratory for research. This journey by the CIS into health communication research is described briefly, along with the current generation of research summarized in this issue of the Journal of Health Communication (JHC). The CIS model for collaborative research is presented as an exemplar that other service organizations might embrace as a strategic tool for quality improvement in health communications.
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Miller SM, Fleisher L, Roussi P, Buzaglo JS, Schnoll R, Slater E, Raysor S, Popa-Mabe M. Facilitating informed decision making about breast cancer risk and genetic counseling among women calling the NCI's Cancer Information Service. JOURNAL OF HEALTH COMMUNICATION 2005; 10 Suppl 1:119-36. [PMID: 16377604 DOI: 10.1080/07366290500265335] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Despite increased interest among the public in breast cancer genetic risk and genetic testing, there are limited services to help women make informed decisions about genetic testing. This study, conducted with female callers (N = 279) to the National Cancer Institute's (NCI's) Atlantic Region Cancer Information Service (CIS), developed and evaluated a theory-based, educational intervention designed to increase callers' understanding of the following: (a) the kinds of information required to determine inherited risk; (b) their own personal family history of cancer; and (c) the benefits and limitations of genetic testing. Callers requesting information about breast/ovarian cancer risk, risk assessment services, and genetic testing were randomized to either: (1) standard care or (2) an educational intervention. Results show that the educational intervention reduced intention to obtain genetic testing among women at average risk and increased intention among high-risk women at 6 months. In addition, high monitors, who typically attend to and seek information, demonstrated greater increases in knowledge and perceived risk over the 6-month interval than low monitors, who typically are distracted from information. These findings suggest that theoretically designed interventions can be effective in helping women understand their cancer risk and appropriate risk assessment options and can be implemented successfully within a service program like the CIS.
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