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Fu E, Farland G, Cohen D, Gerstler C, Margolies P, Pope L, Rotter M, Compton MT. A Group-Based, Six-Lesson Healthy Eating Curriculum for Individuals With Serious Mental Illnesses: Development and Implementation. Community Ment Health J 2024; 60:1352-1363. [PMID: 38865032 DOI: 10.1007/s10597-024-01291-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 05/10/2024] [Indexed: 06/13/2024]
Abstract
As part of an intervention tailored to individuals with serious mental illnesses in residential settings that aimed to increase dietary intake of fresh vegetables and fruits, we developed and implemented a nutrition and cooking curriculum. To develop the curriculum, we assembled a Workgroup that consisted of professionals from multiple fields. The Workgroup held weekly discussions before drafting what would become the Workbook. Residential staff at partnering housing agencies taught the curriculum to residents. The curriculum Workbook contains six lessons, which are organized around two field trips to a mobile farmers market and a grocery store, and four cooking methods. The Workbook also includes instructions on using FreshConnect Checks at mobile farmers markets. The new curriculum distinguishes itself from other nutrition and culinary literacy curricula in that it delivers knowledge about fresh produce and skills in preparing fruits and vegetables in a way that is tailored to individuals with serious mental illnesses.
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Affiliation(s)
- En Fu
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, 722 W. 168th Street, Room R249, New York, NY, 10032, USA
| | - Gabriella Farland
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, 722 W. 168th Street, Room R249, New York, NY, 10032, USA
| | - Dana Cohen
- New York, State Office of Mental Health, Albany, NY, USA
| | | | - Paul Margolies
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, 722 W. 168th Street, Room R249, New York, NY, 10032, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Leah Pope
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, 722 W. 168th Street, Room R249, New York, NY, 10032, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Merrill Rotter
- New York, State Office of Mental Health, Albany, NY, USA
| | - Michael T Compton
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, 722 W. 168th Street, Room R249, New York, NY, 10032, USA
- New York State Psychiatric Institute, New York, NY, USA
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2
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Redvers N, Larson S, Rajpathy O, Olson D. American Indian and Alaska Native recruitment strategies for health-related randomized controlled trials: A scoping review. PLoS One 2024; 19:e0302562. [PMID: 38687762 PMCID: PMC11060564 DOI: 10.1371/journal.pone.0302562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 04/08/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Significant health disparities exist among American Indian and Alaska Natives (AI/ANs), yet AI/ANs are substantially underrepresented within health-related research, including randomized controlled trials (RCTs). Although research has previously charted representation inequities, there is however a gap in the literature documenting best practice for recruitment techniques of AI/ANs into RCTs. Therefore, the aim of this review was to systematically gather and analyze the published literature to identify common strategies for AI/AN participant recruitment for RCTs in the US. METHODS A scoping review methodology was engaged with a systematic search operationalized within relevant databases to February 19, 2022, with an additional updated search being carried out up until January 1, 2023: PubMed, Embase, Web of Science, PsycINFO, CINAHL, and Google Scholar. A two-stage article review process was engaged with double reviewers using Covidence review software. Content analysis was then carried out within the included articles by two reviewers using NVivo software to identify common categories within the data on the topic area. RESULTS Our review identified forty-one relevant articles with the main categories of recruitment strategies being: 1) recruitment methods for AI/ANs into RCTs (passive advertising recruitment approaches, individual-level recruitment approaches, relational methods of recruitment); 2) recruitment personnel used within RCTs; and, 3) relevant recruitment setting. The majority of the included studies used a culturally relevant intervention, as well as a community-involved approach to operationalizing the research. CONCLUSION Increasing AI/AN representation in RCTs is essential for generating evidence-based interventions that effectively address health disparities and improve health outcomes. Researchers and funding agencies should prioritize the engagement, inclusion, and leadership of AI/AN communities throughout the RCT research process. This includes early community involvement in study design, implementation of culturally tailored recruitment strategies, and dissemination of research findings in formats accessible to AI/AN communities.
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Affiliation(s)
- Nicole Redvers
- Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
- Department of Indigenous Health, School of Medicine & Health Sciences, University of North Dakota, Grand Forks, ND, United States of America
| | - Sarah Larson
- Department of Indigenous Health, School of Medicine & Health Sciences, University of North Dakota, Grand Forks, ND, United States of America
| | - Olivia Rajpathy
- Department of Population Health, School of Medicine & Health Sciences, University of North Dakota, Grand Forks, ND, United States of America
| | - Devon Olson
- Library Resources, School of Medicine & Health Sciences, University of North Dakota, Grand Forks, ND, United States of America
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Silva P, Araújo R, Lopes F, Ray S. Nutrition and Food Literacy: Framing the Challenges to Health Communication. Nutrients 2023; 15:4708. [PMID: 38004102 PMCID: PMC10674981 DOI: 10.3390/nu15224708] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/20/2023] [Accepted: 11/03/2023] [Indexed: 11/26/2023] Open
Abstract
Nutrition and food literacy are two important concepts that are often used interchangeably, but they are not synonymous. Nutrition refers to the study of how food affects the body, while food literacy refers to the knowledge, skills, and attitudes necessary to make informed decisions about food and its impact on health. Despite the growing awareness of the importance of food literacy, food illiteracy remains a global issue, affecting people of all ages, backgrounds, and socioeconomic status. Food illiteracy has serious health implications as it contributes to health inequities, particularly among vulnerable populations. In addition, food literacy is a complex and multidisciplinary field, and there are numerous challenges to health communication that must be addressed to effectively promote food literacy and improve health outcomes. Addressing food illiteracy and the challenges to health communication is essential to promote health equity and improve health outcomes for all populations.
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Affiliation(s)
- Paula Silva
- Laboratory of Histology and Embryology, Department of Microscopy, School of Medicine and Biomedical Sciences (ICBAS), University of Porto (U.Porto), Rua Jorge Viterbo Ferreira 228, 4050-313 Porto, Portugal
- iNOVA Media Lab, ICNOVA-NOVA Institute of Communication, NOVA School of Social Sciences and Humanities, Universidade NOVA de Lisboa, 1069-061 Lisbon, Portugal
| | - Rita Araújo
- Departamento de Artes e Humanidades, Escola Superior de Comunicação, Administração e Turismo, Instituto Politécnico de Bragança, Campus do Cruzeiro—Avenida 25 de Abril, Cruzeiro, Lote 2, Apartado 128, 5370-202 Mirandela, Portugal;
| | - Felisbela Lopes
- Centro de Estudos de Comunicação e Sociedade, Instituto de Ciências Sociais, Universidade do Minho, Campus de Gualtar, 4710-057 Braga, Portugal;
| | - Sumantra Ray
- NNEdPro Global Institute for Food, Nutrition & Health, Cambridge CB4 0WS, UK;
- School of Biomedical Sciences, Ulster University at Coleraine, Coleraine BT52 1SA, UK
- Fitzwilliam College, University of Cambridge, Cambridge CB3 0DG, UK
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Taniguchi T, Haslam A, Sun W, Sisk M, Hayman J, Jernigan VBB. Impact of a Farm-to-School Nutrition and Gardening Intervention for Native American Families from the FRESH Study: A Randomized Wait-List Controlled Trial. Nutrients 2022; 14:nu14132601. [PMID: 35807781 PMCID: PMC9268191 DOI: 10.3390/nu14132601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 06/21/2022] [Accepted: 06/21/2022] [Indexed: 02/08/2023] Open
Abstract
Establishing healthy eating habits during childhood is critical to prevent chronic diseases that develop in adulthood. Tribally owned Early Childhood and Education (ECE) programs signify fundamental influence in childhood obesity disparities. A strategy to improve diet is the use of school gardens; however, few studies have used rigorous methods to assess diet and health outcomes. The purpose of this manuscript is to describe results from the six-month Food Resource Equity for Sustainable Health (FRESH) study among Native American families. We aimed to recruit 176 families of children attending Osage Nation ECE programs in four communities. Two communities received the intervention and two served as wait-list controls. Outcomes included change in dietary intake, body mass index, health status, systolic blood pressure (adults only), and food insecurity in children and parents. There were 193 children (n = 106 intervention; n = 87 control) and 170 adults (n = 93 intervention; n = 77 control) enrolled. Vegetable intake significantly increased in intervention children compared to controls for squash (p = 0.0007) and beans (p = 0.0002). Willingness to try scores increased for beans in intervention children (p = 0.049) and tomatoes in both groups (p = 0.01). FRESH is the first study to implement a farm-to-school intervention in rural, tribally owned ECEs. Future interventions that target healthy dietary intake among children should incorporate a comprehensive parent component in order to support healthy eating for all household members.
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Affiliation(s)
- Tori Taniguchi
- Center for Indigenous Health Research and Policy, Oklahoma State University Center for Health Sciences, Tulsa, OK 74135, USA;
- Correspondence:
| | - Alyson Haslam
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA 94143, USA;
| | - Wenjie Sun
- Department of Rural Health, Oklahoma State University Center for Health Sciences, Tulsa, OK 74135, USA;
| | - Margaret Sisk
- Osage Nation, Harvest Land, Pawhuska, OK 74056, USA; (M.S.); (J.H.)
| | - Jann Hayman
- Osage Nation, Harvest Land, Pawhuska, OK 74056, USA; (M.S.); (J.H.)
| | - Valarie Blue Bird Jernigan
- Center for Indigenous Health Research and Policy, Oklahoma State University Center for Health Sciences, Tulsa, OK 74135, USA;
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5
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Haslam A, Love C, Taniguchi T, Williams MB, Wetherill MS, Sisson S, Weedn AE, Jacob T, Jernigan VBB. Development and Implementation of a Hybrid Online and In-Person Food Sovereignty and Nutrition Education Curriculum for Native American Parents: The FRESH Study. HEALTH EDUCATION & BEHAVIOR 2022; 50:430-440. [PMID: 34991400 PMCID: PMC9981305 DOI: 10.1177/10901981211067168] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The Food Resource Equity and Sustainability for Health ("FRESH") study is an Indigenous-led intervention to increase vegetable and fruit intake among Native American children. As part of this study, we developed a hybrid (online and in-person) food sovereignty and nutrition education curriculum for the parents of these children. This 16-week curriculum was developed to promote household- and community-level healthy eating and food sovereignty practices to parents of preschool-aged children residing in Osage Nation, Oklahoma. A total of 81 parent/caregivers participated in the curriculum component of the FRESH study, with a median age of 34 years (range: 23-54 years). Most study participants were female (88.9%) and less than half (45.7%) had an annual household income of more than US$50,000. Most were married or had a significant other (76.5%) and worked full-time (65.4%). The median total number of children in the home <18 years of age was three (range: 1-8). Participation among the 94 parents was 56% during the first week and was 12% in the final week. Having some college or technical training (vs. having a college degree) and having an annual household income of US$20,000-US$50,000 (vs. more than US$50,000) were associated with fewer sessions attended (p = 0.004 and 0.02, respectively) Being married (vs. not) was associated with higher attendance (p < .0001). Participation in a hybrid food sovereignty and nutrition education curriculum for parents was generally low, but income, education, and marital status were associated with curriculum participation. Our research adds to the literature by describing the development and implementation of this curriculum and recommendations for future research incorporating Indigenous approaches to health.
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Affiliation(s)
- Alyson Haslam
- University of California, San Francisco, San Francisco, CA, USA
| | | | | | | | | | - Susan Sisson
- The University of Oklahoma—Tulsa, Tulsa, OK, USA
| | | | - Tvli Jacob
- Oklahoma State University, Tulsa, OK, USA
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Delaney T, Mclaughlin M, Hall A, Yoong SL, Brown A, O’Brien K, Dray J, Barnes C, Hollis J, Wyse R, Wiggers J, Sutherland R, Wolfenden L. Associations between Digital Health Intervention Engagement and Dietary Intake: A Systematic Review. Nutrients 2021; 13:nu13093281. [PMID: 34579158 PMCID: PMC8470016 DOI: 10.3390/nu13093281] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/09/2021] [Accepted: 09/15/2021] [Indexed: 11/23/2022] Open
Abstract
There has been a proliferation of digital health interventions (DHIs) targeting dietary intake. Despite their potential, the effectiveness of DHIs are thought to be dependent, in part, on user engagement. However, the relationship between engagement and the effectiveness of dietary DHIs is not well understood. The aim of this review is to describe the association between DHI engagement and dietary intake. A systematic search of four electronic databases and grey literature for records published before December 2019 was conducted. Studies were eligible if they examined a quantitative association between objective measures of engagement with a DHI (subjective experience or usage) and measures of dietary intake in adults (aged ≥18 years). From 10,653 citations, seven studies were included. Five studies included usage measures of engagement and two examined subjective experiences. Narrative synthesis, using vote counting, found mixed evidence of an association with usage measures (5 of 12 associations indicated a positive relationship, 7 were inconclusive) and no evidence regarding an association with subjective experience (both studies were inconclusive). The findings provide early evidence supporting an association between measures of usage and dietary intake; however, this was inconsistent. Further research examining the association between DHI engagement and dietary intake is warranted.
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Affiliation(s)
- Tessa Delaney
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia; (M.M.); (A.H.); (S.L.Y.); (A.B.); (K.O.); (J.D.); (C.B.); (J.H.); (R.W.); (J.W.); (R.S.); (L.W.)
- Hunter New England Population Health, Wallsend, NSW 2287, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
- Priority Research Centre for Heath Behavior, University of Newcastle, Callaghan, NSW 2308, Australia
- Correspondence: ; Tel.: +612-49246-499
| | - Matthew Mclaughlin
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia; (M.M.); (A.H.); (S.L.Y.); (A.B.); (K.O.); (J.D.); (C.B.); (J.H.); (R.W.); (J.W.); (R.S.); (L.W.)
- Hunter New England Population Health, Wallsend, NSW 2287, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
- Priority Research Centre for Heath Behavior, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Alix Hall
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia; (M.M.); (A.H.); (S.L.Y.); (A.B.); (K.O.); (J.D.); (C.B.); (J.H.); (R.W.); (J.W.); (R.S.); (L.W.)
- Hunter New England Population Health, Wallsend, NSW 2287, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
- Priority Research Centre for Heath Behavior, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Sze Lin Yoong
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia; (M.M.); (A.H.); (S.L.Y.); (A.B.); (K.O.); (J.D.); (C.B.); (J.H.); (R.W.); (J.W.); (R.S.); (L.W.)
- Hunter New England Population Health, Wallsend, NSW 2287, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
- Priority Research Centre for Heath Behavior, University of Newcastle, Callaghan, NSW 2308, Australia
- Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, VIC 3122, Australia
| | - Alison Brown
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia; (M.M.); (A.H.); (S.L.Y.); (A.B.); (K.O.); (J.D.); (C.B.); (J.H.); (R.W.); (J.W.); (R.S.); (L.W.)
- Hunter New England Population Health, Wallsend, NSW 2287, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
- Priority Research Centre for Heath Behavior, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Kate O’Brien
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia; (M.M.); (A.H.); (S.L.Y.); (A.B.); (K.O.); (J.D.); (C.B.); (J.H.); (R.W.); (J.W.); (R.S.); (L.W.)
- Hunter New England Population Health, Wallsend, NSW 2287, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
- Priority Research Centre for Heath Behavior, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Julia Dray
- School of Psychology, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Courtney Barnes
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia; (M.M.); (A.H.); (S.L.Y.); (A.B.); (K.O.); (J.D.); (C.B.); (J.H.); (R.W.); (J.W.); (R.S.); (L.W.)
- Hunter New England Population Health, Wallsend, NSW 2287, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
- Priority Research Centre for Heath Behavior, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Jenna Hollis
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia; (M.M.); (A.H.); (S.L.Y.); (A.B.); (K.O.); (J.D.); (C.B.); (J.H.); (R.W.); (J.W.); (R.S.); (L.W.)
- Hunter New England Population Health, Wallsend, NSW 2287, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
- Priority Research Centre for Heath Behavior, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Rebecca Wyse
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia; (M.M.); (A.H.); (S.L.Y.); (A.B.); (K.O.); (J.D.); (C.B.); (J.H.); (R.W.); (J.W.); (R.S.); (L.W.)
- Hunter New England Population Health, Wallsend, NSW 2287, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
- Priority Research Centre for Heath Behavior, University of Newcastle, Callaghan, NSW 2308, Australia
| | - John Wiggers
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia; (M.M.); (A.H.); (S.L.Y.); (A.B.); (K.O.); (J.D.); (C.B.); (J.H.); (R.W.); (J.W.); (R.S.); (L.W.)
- Hunter New England Population Health, Wallsend, NSW 2287, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
- Priority Research Centre for Heath Behavior, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Rachel Sutherland
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia; (M.M.); (A.H.); (S.L.Y.); (A.B.); (K.O.); (J.D.); (C.B.); (J.H.); (R.W.); (J.W.); (R.S.); (L.W.)
- Hunter New England Population Health, Wallsend, NSW 2287, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
- Priority Research Centre for Heath Behavior, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Luke Wolfenden
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia; (M.M.); (A.H.); (S.L.Y.); (A.B.); (K.O.); (J.D.); (C.B.); (J.H.); (R.W.); (J.W.); (R.S.); (L.W.)
- Hunter New England Population Health, Wallsend, NSW 2287, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
- Priority Research Centre for Heath Behavior, University of Newcastle, Callaghan, NSW 2308, Australia
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Enhancing Planning Behavior during Retirement: Effects of a Time Perspective Based Training Intervention. SOCIAL SCIENCES 2021. [DOI: 10.3390/socsci10080306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Time perspective is a psychological construct that reflects the way people view time. Two schools of thought exist that theorize how this temporal mindset affects behavior—dominant and balanced. We applied dominant and balanced time perspective frameworks separately to two versions of an online intervention that aimed to promote goal-setting and accumulation of essential retirement resources (health, physical, social, cognitive and emotional) and compared effects with a control group. The effectiveness of the intervention was tested with 109 US retirees using a 4-wave design over a 6-month period. Linear mixed models showed an increase in health goal striving for the balanced group at posttraining and gains were maintained at the 3-month time point. Both training groups demonstrated an increase in the number and specificity of goals at posttraining and 3-months. Applying a time perspective framework to an online planning intervention for retirees shows promise in promoting planning for retirement resources. Practical implications, limitations, and suggestions for developing future interventions are discussed.
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Stotz S, Hebert LE, Brega AG, Lockhart S, Henderson JN, Roubideaux Y, DeSanto K, Moore KR. Technology-based Health Education Resources for Indigenous Adults: A Scoping Review. J Health Care Poor Underserved 2021; 32:318-346. [PMID: 36111137 PMCID: PMC9473312 DOI: 10.1353/hpu.2021.0066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Indigenous peoples experience a disparate burden of chronic diseases and lower access to health education resources compared with other populations. Technology can increase access to health education resources, potentially reducing health inequities in these vulnerable populations. Although many Indigenous communities have limited access to the Internet, this barrier is decreasing as tribes and Indigenous-serving organizations work to improve TechQuity. Using Arksey and O'Malley's framework, we conducted a scoping literature review to identify technology-based health education interventions designed for Indigenous adults. We searched multiple databases, limiting papers to those written in English, describing interventions for participants 18 years of age or older, and published between 1999-2020. The review yielded 229 articles, nine of which met eligibility criteria. Findings suggest a paucity of technology-based health education interventions designed for Indigenous peoples and limited testing of the existing resources. Future health disparity research should focus on development and rigorous testing of such interventions.
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Affiliation(s)
- Sarah Stotz
- Centers for American Indian and Alaska Native Health at the Colorado School of Public Health at The University of Colorado Anschutz Medical Campus
| | - Luciana E Hebert
- Institute for Research and Education Advancing Community Health (IREACH) at the Elson S. Floyd College of Medicine at Washington State University
| | - Angela G Brega
- Centers for American Indian and Alaska Native Health at the Colorado School of Public Health at The University of Colorado Anschutz Medical Campus
| | - Steven Lockhart
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS) at the Children's Hospital Colorado at The University of Colorado Anschutz Medical Campus
| | - J Neil Henderson
- Memory Keepers Medical Discovery Team at the Department of Family Medicine and Biobehavioral Health at The University of Minnesota Medical School
| | | | | | - Kelly R Moore
- Centers for American Indian and Alaska Native Health at the Colorado School of Public Health at The University of Colorado Anschutz Medical Campus
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9
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Cheng C, Beauchamp A, Elsworth GR, Osborne RH. Applying the Electronic Health Literacy Lens: Systematic Review of Electronic Health Interventions Targeted at Socially Disadvantaged Groups. J Med Internet Res 2020; 22:e18476. [PMID: 32788144 PMCID: PMC7453328 DOI: 10.2196/18476] [Citation(s) in RCA: 87] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/30/2020] [Accepted: 06/03/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Electronic health (eHealth) has the potential to improve health outcomes. However, eHealth systems need to match the eHealth literacy needs of users to be equitably adopted. Socially disadvantaged groups have lower access and skills to use technologies and are at risk of being digitally marginalized, leading to the potential widening of health disparities. OBJECTIVE This systematic review aims to explore the role of eHealth literacy and user involvement in developing eHealth interventions targeted at socially disadvantaged groups. METHODS A systematic search was conducted across 10 databases for eHealth interventions targeted at older adults, ethnic minority groups, low-income groups, low-literacy groups, and rural communities. The eHealth Literacy Framework was used to examine the eHealth literacy components of reviewed interventions. The results were analyzed using narrative synthesis. RESULTS A total of 51 studies reporting on the results of 48 interventions were evaluated. Most studies were targeted at older adults and ethnic minorities, with only 2 studies focusing on low-literacy groups. eHealth literacy was not considered in the development of any of the studies, and no eHealth literacy assessment was conducted. User involvement in designing interventions was limited, and eHealth intervention developmental frameworks were rarely used. Strategies to assist users in engaging with technical systems were seldom included in the interventions, and accessibility features were limited. The results of the included studies also provided inconclusive evidence on the effectiveness of eHealth interventions. CONCLUSIONS The findings highlight that eHealth literacy is generally overlooked in developing eHealth interventions targeted at socially disadvantaged groups, whereas evidence about the effectiveness of such interventions is limited. To ensure equal access and inclusiveness in the age of eHealth, eHealth literacy of disadvantaged groups needs to be addressed to help avoid a digital divide. This will assist the realization of recent technological advancements and, importantly, improve health equity.
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Affiliation(s)
- Christina Cheng
- Centre for Global Health and Equity, Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, Australia.,Deakin University, School of Health and Social Development, Faculty of Health, Burwood, Australia
| | - Alison Beauchamp
- Department of Rural Health, Monash University, Melbourne, Australia.,Department of Medicine - Western Health, The University of Melbourne, Melbourne, Australia.,Australian Institute for Musculoskeletal Science, Sunshine Hospital, St Albans, Australia
| | - Gerald R Elsworth
- Centre for Global Health and Equity, Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, Australia
| | - Richard H Osborne
- Centre for Global Health and Equity, Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, Australia
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Rodriguez Rocha NP, Kim H. eHealth Interventions for Fruit and Vegetable Intake: A Meta-Analysis of Effectiveness. HEALTH EDUCATION & BEHAVIOR 2019; 46:947-959. [PMID: 31347403 DOI: 10.1177/1090198119859396] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. An adequate intake of fruits and vegetables (FVI) has shown benefits for reduced risk of manifesting chronic diseases. Thus, development of effective interventions to promote FVI is paramount. Aim. To assess the effectiveness of eHealth interventions for FVI targeted to healthy population, in comparison with control groups, and identify the moderators contributing to their effectiveness. Method. A database search was conducted in April 2016 and July 2018 using MEDLINE, PsycINFO, ERIC, Google Scholar, SciELO, and RISS, yielding 19 eligible studies. Risk of bias was assessed using Cochrane's Risk of Bias Tool. Random-effects model was used to calculate effect sizes (ES) by weighted standardized mean differences. Results. This meta-analysis includes 19 studies and 6,894 participants. The most common eHealth tool used was Internet-based interventions (n = 10). Most of studies were conducted in adults (n = 11), followed by children (n = 4), and adolescents (n = 4). The minimum number of behavior change techniques (BCTs) used was one, and the maximum seven. The overall ES was small (0.26, p < .001), favoring eHealth interventions. The between-studies heterogeneity was large (I2 = 62.77%, p < .001). Subgroup analyses showed that the components with larger ES were tailored interventions (0.27, p < .001), computer-based interventions (0.44, p < .001), and use of ≥7 BCTs (0.42, p < .001). Discussion. All studies showed a positive ES favoring interventions. Large heterogeneity could be explained in part by the number of BCTs and type of eHealth tool used. Nonetheless, more concrete evidence regarding other intervention components effectiveness was limited by small sample size. Conclusion. The use of eHealth tools for the improvement of FVI showed to be more effective compared with nonintervention and interventions not using these technologies. Nonetheless, more research is needed to determine the specific combination of intervention components that could translate into larger effectiveness.
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Beintner I, Görlich D, Berger T, Ebert DD, Zeiler M, Herrero Camarano R, Waldherr K, Jacobi C. Interrelations between participant and intervention characteristics, process variables and outcomes in online interventions: A protocol for overarching analyses within and across seven clinical trials in ICare. Internet Interv 2019; 16:86-97. [PMID: 30775268 PMCID: PMC6364443 DOI: 10.1016/j.invent.2018.05.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 05/23/2018] [Accepted: 05/23/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND It is well known that web-based interventions can be effective treatments for various conditions. Less is known about predictors, moderators, and mediators of outcome and especially interrelations between participant and interventions characteristics, process variables and outcomes in online interventions. Clinical trials often lack statistical power to detect variables that affect intervention effects and their interrelations. Within ICare, we can investigate the interrelation of potential predictor and process variables in a large sample. METHOD The ICare consortium postulated a model of interrelations between participant and intervention characteristics, process variables and outcomes in online interventions. We will assess general and disorder-specific interrelations between characteristics of the intervention, characteristics of the participants, adherence, working alliance, early response, and intervention outcomes in a sample of over 7500 participants from seven clinical trials evaluating 15 online interventions addressing a range of mental health conditions and disorders, using an individual participant data meta-analyses approach. DISCUSSION/CONCLUSION Existing research tends to support the efficacy of online mental health interventions, but the knowledge base regarding factors that affect intervention effects needs to be expanded. The overarching analyses using data from the ICare intervention trials will add considerably to the evidence.
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Affiliation(s)
- Ina Beintner
- Technische Universität Dresden, School of Science, Department of Psychology, Chair of Clinical Psychology and E-Mental-Health, Dresden, Germany
| | - Dennis Görlich
- Westfälische Wilhelms-Universität Münster, Institut für Biometrie und Klinische Forschung, Schmedingstraße 56, Münster, Germany
| | - Thomas Berger
- Universität Bern, Department of Clinical Psychology and Psychotherapy, Bern, Switzerland
| | - David Daniel Ebert
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Department of Clinical Psychology and Psychotherapy, Nägelsbachstr 25a, Erlangen, Germany
| | - Michael Zeiler
- Medizinische Universität Wien, Department for Child and Adolescent Psychiatry, Waehringer Guertel 18-20, Vienna, Austria
| | | | - Karin Waldherr
- Ferdinand PorscheFernFH Distance-Learning University of Applied Sciences, Wien, Austria
| | - Corinna Jacobi
- Technische Universität Dresden, School of Science, Department of Psychology, Chair of Clinical Psychology and E-Mental-Health, Dresden, Germany
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Banna J, Bersamin A. Community involvement in design, implementation and evaluation of nutrition interventions to reduce chronic diseases in indigenous populations in the U.S.: a systematic review. Int J Equity Health 2018; 17:116. [PMID: 30103753 PMCID: PMC6090789 DOI: 10.1186/s12939-018-0829-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 07/24/2018] [Indexed: 11/19/2022] Open
Abstract
Background Indigenous peoples of the United States disproportionately experience chronic diseases associated with poor nutrition, including obesity and diabetes. While chronic disease related health disparities among Indigenous people are well documented, it is unknown whether interventions adequately address these health disparities. In addition, it is unknown whether and to what extent interventions are culturally adapted or tailored to the unique culture, worldview and nutrition environments of Indigenous people. The aim of this review was to identify and characterize nutrition interventions conducted with Indigenous populations in the US, and to determine whether and to what degree communities are involved in intervention design, implementation and evaluation. Methods Peer-reviewed articles were identified using MEDLINE. Articles included were published in English in a refereed journal between 2000 and 2015, reported on a diet-related intervention in Indigenous populations in the US, and reported outcome data. Data extracted were program objectives and activities, target population, geographic region, formative research to inform design and evaluation, partnership, capacity building, involvement of the local food system, and outcomes. Narrative synthesis of intervention characteristics and the degree and type of community involvement was performed. Results Of 1060 records identified, 49 studies were included. Overall, interventions were successful in producing changes in knowledge, behavior or health (79%). Interventions mostly targeted adults in the Western region and used a pre-test, post-test design. Involvement of communities in intervention design, implementation, and evaluation varied from not at all to involvement at all stages. Of programs reporting significant changes in outcomes, more than half used at least three strategies to engage communities. However, formative research to inform the evaluation was not performed to a great degree, and fewer than half of the programs identified described involvement of the local food system. Conclusions The extent of use of strategies to promote community engagement in programs reporting significant outcomes is notable. In planning interventions in Indigenous groups, researchers should consider ways to involve the community in intervention design, execution and evaluation. There is a particular need for studies focused on Indigenous youth in diverse regions of the US to further address diet-related chronic conditions.
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Affiliation(s)
- Jinan Banna
- Department of Human Nutrition, Food and Animal Sciences at the University of Hawai'i at Mānoa, Honolulu, USA.
| | - Andrea Bersamin
- Center for Alaska Native Health Research, Institute of Arctic Biology at the University of Alaska Fairbanks, Fairbanks, USA
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Nakamura S, Inayama T, Harada K, Arao T. Reduction in Vegetable Intake Disparities With a Web-Based Nutrition Education Intervention Among Lower-Income Adults in Japan: Randomized Controlled Trial. J Med Internet Res 2017; 19:e377. [PMID: 29175810 PMCID: PMC5722979 DOI: 10.2196/jmir.8031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Revised: 08/16/2017] [Accepted: 09/23/2017] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND No existing Web-based nutrition education interventions have been evaluated in light of socioeconomic status just in Japan. OBJECTIVE The aim was to investigate the effect of a Web-based intervention program on reducing vegetable intake disparities between low- and middle-income Japanese adults. METHODS In this randomized controlled trial, participants were assessed at three time points-baseline, postintervention (5 weeks later), and a follow-up after 3 months-from October 2015 to March 2016. We collected data via a Japanese online research service company from 8564 adults aged 30 to 59 years. Participants were stratified according to national population statistics for gender and age, and randomly selected. They were then randomly allocated into intervention (n=900) and control (n=600) groups such that both groups contained an equal number of individuals with low and middle income. The intervention program encouraged behavior change using behavioral theories and techniques tailored to their assumed stage of change. The outcome was vegetable intake servings per day (1 serving being approximately 70 g). RESULTS Out of 900 participants who started, 450 were from the middle income group (of which 386 or 85.7% completed the intervention), and 450 were from the low income group (of which 371 or 82.4% completed). In the intervention group, vegetable intake increased in the low-income participants from baseline to postintervention (0.42 servings, 95% CI 0.11-0.72). A two-way analysis of variance showed that low-income participants had significant main effects of group (η2=0.04, P=.01) and time (η2=0.01, P<.001), and a significant interaction (η2=0.01, P=.009). Middle-income participants also had a significant main effect of time (η2=0.01, P=.006) and a significant interaction (η2=0.01, P=.046). CONCLUSIONS This Web-based nutritional education intervention could fill the vegetable intake gap between low- and middle-income adults in Japan, and is expected to prevent noncommunicable and lifestyle-related diseases. Further intervention program improvements are necessary to maintain and increase vegetable intake for other groups. TRIAL REGISTRATION Current Controlled Trials (UMIN-ICDR): UMIN000019376; https://upload.umin.ac.jp/cgi-open-bin/ icdr_e/ctr_view.cgi?recptno=R000022404 (Archived by WebCite at http://www.webcitation.org/6u9wihBZU).
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Affiliation(s)
- Saki Nakamura
- Department of Health Promotion Sciences, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan.,Research Fellow of Japan Society for the Promotion of Science, Tokyo, Japan
| | - Takayo Inayama
- Department of Health Promotion Sciences, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
| | - Kazuhiro Harada
- Graduate School of Human Development and Environment, Kobe University, Hyogo, Japan
| | - Takashi Arao
- Faculty of Sport Sciences, Waseda University, Saitama, Japan
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Bissonnette-Maheux V, Dumas AA, Provencher V, Lapointe A, Dugrenier M, Straus S, Gagnon MP, Desroches S. Women's Perceptions of Usefulness and Ease of Use of Four Healthy Eating Blog Characteristics: A Qualitative Study of 33 French-Canadian Women. J Acad Nutr Diet 2017; 118:1220-1227.e3. [PMID: 29107587 DOI: 10.1016/j.jand.2017.08.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 08/10/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Healthy eating blogs are knowledge translation tools used by nutrition and dietetics practitioners for helping people improve their health behaviors and food choices. OBJECTIVE Our aim was to explore women's perceptions of the usefulness and ease of use of healthy eating blog (HEB) characteristics that might increase potential users' intention to use them as tools to improve their dietary habits. DESIGN We conducted qualitative research using semi-structured individual interviews. PARTICIPANTS Thirty-three women (mean age of 44 years; range=27 to 61 years) living in the Quebec City, Canada, metropolitan area were studied. INTERVENTION Four existing HEBs, written by French-Canadian registered dietitians (RDs) whose main objective was the promotion of a healthy diet, were explored by women during individual interviews. A standardized open-ended interview questionnaire based on the Technology Acceptance Model was used to identify women's perceptions about characteristics of type of blog content delivery, RD blogger's delivery of information, blog layout, and blog design. MAIN OUTCOME MEASURES Women's perceptions toward the contribution of HEB characteristics to the usefulness and ease of use of those tools to improve their dietary habits were measured. ANALYSES PERFORMED Interviews were audiorecorded, transcribed verbatim, coded, and analyzed through an inductive content analysis using NVivo software. RESULTS The most useful characteristics of type of blog content delivery identified by women were recipes, hyperlinks, and references. Among characteristics of RD blogger's delivery of information, most women reported that interaction between blog readers and the RD blogger created a sense of proximity and of connection that was helpful for improving their dietary behaviors. Women's perceptions toward various characteristics of blog layout and design were also discussed. CONCLUSIONS Incorporating specific characteristics when designing HEBs should be considered by RDs and future research to promote the use of those tools to support dietary behavior change efforts of internet users.
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Meng J, Peng W, Shin SY, Chung M. Online Self-Tracking Groups to Increase Fruit and Vegetable Intake: A Small-Scale Study on Mechanisms of Group Effect on Behavior Change. J Med Internet Res 2017; 19:e63. [PMID: 28264793 PMCID: PMC5359417 DOI: 10.2196/jmir.6537] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 01/04/2017] [Accepted: 02/08/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Web-based interventions with a self-tracking component have been found to be effective in promoting adults' fruit and vegetable consumption. However, these interventions primarily focus on individual- rather than group-based self-tracking. The rise of social media technologies enables sharing and comparing self-tracking records in a group context. Therefore, we developed an online group-based self-tracking program to promote fruit and vegetable consumption. OBJECTIVE This study aims to examine (1) the effectiveness of online group-based self-tracking on fruit and vegetable consumption and (2) characteristics of online self-tracking groups that make the group more effective in promoting fruit and vegetable consumption in early young adults. METHODS During a 4-week Web-based experiment, 111 college students self-tracked their fruit and vegetable consumption either individually (ie, the control group) or in an online group characterized by a 2 (demographic similarity: demographically similar vs demographically diverse) × 2 (social modeling: incremental change vs ideal change) experimental design. Each online group consisted of one focal participant and three confederates as group members or peers, who had their demographics and fruit and vegetable consumption manipulated to create the four intervention groups. Self-reported fruit and vegetable consumption were assessed using the Food Frequency Questionnaire at baseline and after the 4-week experiment. RESULTS Participants who self-tracked their fruit and vegetable consumption collectively with other group members consumed more fruits and vegetables than participants who self-tracked individually (P=.01). The results did not show significant main effects of demographic similarity (P=.32) or types of social modeling (P=.48) in making self-tracking groups more effective in promoting fruit and vegetable consumption. However, additional analyses revealed the main effect of performance discrepancy (ie, difference in fruit and vegetable consumption between a focal participant and his/her group members during the experiment), such that participants who had a low performance discrepancy from other group members had greater fruit and vegetable consumption than participants who had a high performance discrepancy from other group members (P=.002). A mediation test showed that low performance discrepancy led to greater downward contrast (b=-0.78, 95% CI -2.44 to -0.15), which in turn led to greater fruit and vegetable consumption. CONCLUSIONS Online self-tracking groups were more effective than self-tracking alone in promoting fruit and vegetable consumption for early young adults. Low performance discrepancy from other group members lead to downward contrast, which in turn increased participants' fruit and vegetable consumption over time. The study highlighted social comparison processes in online groups that allow for sharing personal health information. Lastly, given the small scale of this study, nonsignificant results with small effect sizes might be subject to bias.
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Affiliation(s)
- Jingbo Meng
- Michigan State University, Department of Communication, East Lansing, MI, United States
| | - Wei Peng
- Michigan State University, Department of Media and Information, East Lansing, MI, United States
| | - Soo Yun Shin
- Michigan State University, Department of Communication, East Lansing, MI, United States
| | - Minwoong Chung
- Michigan State University, Department of Communication, East Lansing, MI, United States
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Mosdøl A, Lidal IB, Straumann GH, Vist GE. Targeted mass media interventions promoting healthy behaviours to reduce risk of non-communicable diseases in adult, ethnic minorities. Cochrane Database Syst Rev 2017; 2:CD011683. [PMID: 28211056 PMCID: PMC6464363 DOI: 10.1002/14651858.cd011683.pub2] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Physical activity, a balanced diet, avoidance of tobacco exposure, and limited alcohol consumption may reduce morbidity and mortality from non-communicable diseases (NCDs). Mass media interventions are commonly used to encourage healthier behaviours in population groups. It is unclear whether targeted mass media interventions for ethnic minority groups are more or less effective in changing behaviours than those developed for the general population. OBJECTIVES To determine the effects of mass media interventions targeting adult ethnic minorities with messages about physical activity, dietary patterns, tobacco use or alcohol consumption to reduce the risk of NCDs. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL, ERIC, SweMed+, and ISI Web of Science until August 2016. We also searched for grey literature in OpenGrey, Grey Literature Report, Eldis, and two relevant websites until October 2016. The searches were not restricted by language. SELECTION CRITERIA We searched for individual and cluster-randomised controlled trials, controlled before-and-after studies (CBA) and interrupted time series studies (ITS). Relevant interventions promoted healthier behaviours related to physical activity, dietary patterns, tobacco use or alcohol consumption; were disseminated via mass media channels; and targeted ethnic minority groups. The population of interest comprised adults (≥ 18 years) from ethnic minority groups in the focal countries. Primary outcomes included indicators of behavioural change, self-reported behavioural change and knowledge and attitudes towards change. Secondary outcomes were the use of health promotion services and costs related to the project. DATA COLLECTION AND ANALYSIS Two authors independently reviewed the references to identify studies for inclusion. We extracted data and assessed the risk of bias in all included studies. We did not pool the results due to heterogeneity in comparisons made, outcomes, and study designs. We describe the results narratively and present them in 'Summary of findings' tables. We judged the quality of the evidence using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) methodology. MAIN RESULTS Six studies met the inclusion criteria, including three RCTs, two cluster-RCTs and one ITS. All were conducted in the USA and comprised targeted mass media interventions for people of African descent (four studies), Spanish-language dominant Latino immigrants (one study), and Chinese immigrants (one study). The two latter studies offered the intervention in the participants' first language (Spanish, Cantonese, or Mandarin). Three interventions targeted towards women only, one pregnant women specifically. We judged all studies as being at unclear risk of bias in at least one domain and three studies as being at high risk of bias in at least one domain.We categorised the findings into three comparisons. The first comparison examined mass media interventions targeted at ethnic minorities versus an equivalent mass media intervention intended for the general population. The one study in this category (255 participants of African decent) found little or no difference in effect on self-reported behavioural change for smoking and only small differences in attitudes to change between participants who were given a culturally specific smoking cessation booklet versus a booklet intended for the general population. We are uncertain about the effect estimates, as assessed by the GRADE methodology (very low quality evidence of effect). No study provided data for indicators of behavioural change or adverse effects.The second comparison assessed targeted mass media interventions versus no intervention. One study (154 participants of African decent) reported effects for our primary outcomes. Participants in the intervention group had access to 12 one-hour live programmes on cable TV and received print material over three months regarding nutrition and physical activity to improve health and weight control. Change in body mass index (BMI) was comparable between groups 12 months after the baseline (low quality evidence). Scores on a food habits (fat behaviours) and total leisure activity scores changed favourably for the intervention group (very low quality evidence). Two other studies exposed entire populations in geographical areas to radio advertisements targeted towards African American communities. Authors presented effects on two of our secondary outcomes, use of health promotion services and project costs. The campaign message was to call smoking quit lines. The outcome was the number of calls received. After one year, one study reported 18 calls per estimated 10,000 targeted smokers from the intervention communities (estimated target population 310,500 persons), compared to 0.2 calls per estimated 10,000 targeted smokers from the control communities (estimated target population 331,400 persons) (moderate quality evidence). The ITS study also reported an increase in the number of calls from the target population during campaigns (low quality evidence). The proportion of African American callers increased in both studies (low to very low quality evidence). No study provided data on knowledge and attitudes for change and adverse effects. Information on costs were sparse.The third comparison assessed targeted mass media interventions versus a mass media intervention plus personalised content. Findings are based on three studies (1361 participants). Participants in these comparison groups received personal feedback. Two of the studies recorded weight changes over time. Neither found significant differences between the groups (low quality evidence). Evidence on behavioural changes, and knowledge and attitudes typically found some effects in favour of receiving personalised content or no significant differences between groups (very low quality evidence). No study provided data on adverse effects. Information on costs were sparse. AUTHORS' CONCLUSIONS The available evidence is inadequate for understanding whether mass media interventions targeted toward ethnic minority populations are more effective in changing health behaviours than mass media interventions intended for the population at large. When compared to no intervention, a targeted mass media intervention may increase the number of calls to smoking quit line, but the effect on health behaviours is unclear. These studies could not distinguish the impact of different components, for instance the effect of hearing a message regarding behavioural change, the cultural adaptation to the ethnic minority group, or increase reach to the target group through more appropriate mass media channels. New studies should explore targeted interventions for ethnic minorities with a first language other than the dominant language in their resident country, as well as directly compare targeted versus general population mass media interventions.
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Affiliation(s)
- Annhild Mosdøl
- Norwegian Institute of Public HealthKnowledge Centre for the Health ServicesPO BOX 4404 NydalenOsloNorway
| | - Ingeborg B Lidal
- Norwegian Institute of Public HealthKnowledge Centre for the Health ServicesPO BOX 4404 NydalenOsloNorway
- Sunnaas Rehabilitation HospitalTRS National Resource Centre for Rare DisordersNesoddtangenNorway1450
| | - Gyri H Straumann
- Norwegian Institute of Public HealthKnowledge Centre for the Health ServicesPO BOX 4404 NydalenOsloNorway
| | - Gunn E Vist
- Norwegian Knowledge Centre for the Health ServicesPrevention, Health Promotion and Organisation UnitPO Box 7004St Olavs PlassOsloNorway0130
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Nakamura S, Inayama T, Arao T. A randomized-controlled trial focusing on socio-economic status for promoting vegetable intake among adults using a web-based nutrition intervention programme: study protocol. BMC Public Health 2017; 17:74. [PMID: 28086921 PMCID: PMC5237162 DOI: 10.1186/s12889-016-3907-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 12/06/2016] [Indexed: 11/24/2022] Open
Abstract
Background Web-based nutritional education programmes appear to be comparable to those delivered face-to-face. However, no existing web-based nutrition education or similar programme has yet been evaluated with consideration of socio-economic status. The objective of a nutritional education programme of promoting vegetable intake designed a randomized controlled trial (RCT) is to evaluate the results of intervention and to determine how socio-economic status influences the programme effects. Methods/Design Participants will be randomly sampled individuals (aged 30–59) stratified according national population statistics for sex, age, and household income. Participants were consented to survey participation (n = 1500), and will be randomly divided into intervention and control groups. The intervention period is 5 weeks with one step of diet-related education per week. The main outcome of the programme is dietary behaviour as eating vegetable (350 g per day, five small bowl). To encourage behavioural changes, the programme contents are prepared using behavioural theories and techniques tailored to the assumed group stages of behavioural change. In the first step, we employ the health belief model to encourage a shift from the pre-contemplative to the contemplative phase; in the second and third steps, social cognitive theory is used to encourage transition to the preparatory phase; in the fourth step, social cognitive theory and strengthening social support are used to promote progression to the execution phase; finally, in the fifth step, strengthening social capital and social support are used to promote the shift to the maintenance phase. The baseline, post intervention and follow-up survey was assessed using a self-administered questionnaire. For process evaluation, we use five items relating to programme participation and satisfaction. A follow-up survey of participants will be carried out 3 months after intervention completion. Discussion The fact that this study is an RCT with an established control group is a strong advantage. Information and communications technology is not limited by time or place. If we could show this web-based nutrition education programmes has a positive effect, it may be an appropriate tool for reaching individuals in lower socio-economic state. Trial registration Current Controlled Trials UMIN-ICDR UMIN 000019376 (Registered October 16, 2015).
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Affiliation(s)
- Saki Nakamura
- Department of Health Promotion Sciences, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Minami-Osawa 1-1, Hachioji, Tokyo, 192-0397, Japan.,Research Fellow of Japan Society for the Promotion of Science, Kojimachi Business Center Building, 5-3-1, Kojimachi, Chiyoda-ku, Tokyo, 102-0083, Japan
| | - Takayo Inayama
- Department of Health Promotion Sciences, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Minami-Osawa 1-1, Hachioji, Tokyo, 192-0397, Japan.
| | - Takashi Arao
- Faculty of Sports Sciences, Waseda University, Mikajima 2-579-15, Tokorozawa, Saitama, 359-1192, Japan
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Nkengfack GN, Torimiro JN, Ngogang J, Binting S, Roll S, Tinnemann P, Englert H. Effects of an HIV-Care-Program on immunological parameters in HIV-positive patients in Yaoundé, Cameroon: a cluster-randomized trial. Int J Public Health 2014; 59:509-17. [PMID: 24589725 DOI: 10.1007/s00038-014-0547-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 01/24/2014] [Accepted: 02/10/2014] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES To measure the effects of an HIV-Care-Program, focusing on nutrition and lifestyle, which can be provided at scale to HIV-infected patients, on clinical and anthropometrical parameters, and health status. METHODS A cluster-randomized trial, including 5 health facilities randomized to intervention n = 100 (HIV-Care-Program) or control n = 101 (Usual-Care). The HIV-Care-Program consisted of counseling lessons for 6 months, on: nutrition, hygiene, coping with stigma and discrimination, embedded in practical activities. Outcome variables were CD4 count after 6 months and time to antiretroviral therapy (ARV) initiation, using analysis of covariance and Kaplan-Meier method, respectively. RESULTS After 6 months, CD4 count dropped by 46.3 cells (7.7%) (intervention) and 129 (23%) (control) (p = 0.003). Mean time to ARV; 5.9 months 95% CI (5.9, 6.0) (intervention); 4.9 months 95% CI (4.7, 5.2) (control) (p < 0.004). There was a partial correlation between CD4 count and initial viral load (r = -0.190, p = 0.017). CONCLUSIONS The intervention provides a low-cost alternative improving health status, slowing down CD4 cell decline, delaying initiation of ARV and thus freeing local ARV capacities for patients in urgent need.
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Affiliation(s)
- Germaine N Nkengfack
- Institute for Social Medicine, Epidemiology and Health Economics, Charité, Universitätsmedizin Berlin Center, Berlin, Germany,
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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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Marcus AC, Diefenbach MA, Stanton AL, Miller SM, Fleisher L, Raich PC, Morra ME, Perocchia RS, Tran ZV, Bright MA. Cancer patient and survivor research from the cancer information service research consortium: a preview of three large randomized trials and initial lessons learned. JOURNAL OF HEALTH COMMUNICATION 2013; 18:543-62. [PMID: 23448232 PMCID: PMC4242510 DOI: 10.1080/10810730.2012.743629] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
The authors describe 3 large randomized trials from the Cancer Information Service Research Consortium. Three web-based multimedia programs are being tested to help newly diagnosed prostate (Project 1) and breast cancer patients (Project 2) make informed treatment decisions and breast cancer patients prepare for life after treatment (Project 3). Project 3 also tests a telephone callback intervention delivered by a cancer information specialist. All participants receive standard print material specific to each project. Preliminary results from the 2-month follow-up interviews are reported for the initial wave of enrolled participants, most of whom were recruited from the Cancer Information Service (1-800-4-CANCER) telephone information program (Project 1: n =208; Project 2: n =340; Project 3: n =792). Self-reported use of the multimedia program was 51%, 52%, and 67% for Projects 1, 2, and 3, respectively. Self-reported use of the print materials (read all, most, or some) was 90%, 85%, and 83% for Projects 1, 2, and 3, respectively. The callback intervention was completed by 92% of Project 3 participants. Among those using the Cancer Information Service Research Consortium interventions, perceived usefulness and benefit was high, and more than 90% reported that they would recommend them to other cancer patients. The authors present 5 initial lessons learned that may help inform future cancer communications research.
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Affiliation(s)
- Alfred C Marcus
- University of Colorado Cancer Center, University of Colorado, Denver, 12474 E. 19th Avenue, Mail Stop F427, Room 141, Aurora, CO 80045, USA.
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Kelders SM, Kok RN, Ossebaard HC, Van Gemert-Pijnen JEWC. Persuasive system design does matter: a systematic review of adherence to web-based interventions. J Med Internet Res 2012; 14:e152. [PMID: 23151820 PMCID: PMC3510730 DOI: 10.2196/jmir.2104] [Citation(s) in RCA: 759] [Impact Index Per Article: 63.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2012] [Revised: 05/27/2012] [Accepted: 06/27/2012] [Indexed: 11/13/2022] Open
Abstract
Background Although web-based interventions for promoting health and health-related behavior can be effective, poor adherence is a common issue that needs to be addressed. Technology as a means to communicate the content in web-based interventions has been neglected in research. Indeed, technology is often seen as a black-box, a mere tool that has no effect or value and serves only as a vehicle to deliver intervention content. In this paper we examine technology from a holistic perspective. We see it as a vital and inseparable aspect of web-based interventions to help explain and understand adherence. Objective This study aims to review the literature on web-based health interventions to investigate whether intervention characteristics and persuasive design affect adherence to a web-based intervention. Methods We conducted a systematic review of studies into web-based health interventions. Per intervention, intervention characteristics, persuasive technology elements and adherence were coded. We performed a multiple regression analysis to investigate whether these variables could predict adherence. Results We included 101 articles on 83 interventions. The typical web-based intervention is meant to be used once a week, is modular in set-up, is updated once a week, lasts for 10 weeks, includes interaction with the system and a counselor and peers on the web, includes some persuasive technology elements, and about 50% of the participants adhere to the intervention. Regarding persuasive technology, we see that primary task support elements are most commonly employed (mean 2.9 out of a possible 7.0). Dialogue support and social support are less commonly employed (mean 1.5 and 1.2 out of a possible 7.0, respectively). When comparing the interventions of the different health care areas, we find significant differences in intended usage (p = .004), setup (p < .001), updates (p < .001), frequency of interaction with a counselor (p < .001), the system (p = .003) and peers (p = .017), duration (F = 6.068, p = .004), adherence (F = 4.833, p = .010) and the number of primary task support elements (F = 5.631, p = .005). Our final regression model explained 55% of the variance in adherence. In this model, a RCT study as opposed to an observational study, increased interaction with a counselor, more frequent intended usage, more frequent updates and more extensive employment of dialogue support significantly predicted better adherence. Conclusions Using intervention characteristics and persuasive technology elements, a substantial amount of variance in adherence can be explained. Although there are differences between health care areas on intervention characteristics, health care area per se does not predict adherence. Rather, the differences in technology and interaction predict adherence. The results of this study can be used to make an informed decision about how to design a web-based intervention to which patients are more likely to adhere.
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Affiliation(s)
- Saskia M Kelders
- Center for eHealth Research and Disease Management, Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands.
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Geraghty AWA, Torres LD, Leykin Y, Pérez-Stable EJ, Muñoz RF. Understanding attrition from international Internet health interventions: a step towards global eHealth. Health Promot Int 2012; 28:442-52. [PMID: 22786673 DOI: 10.1093/heapro/das029] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Worldwide automated Internet health interventions have the potential to greatly reduce health disparities. High attrition from automated Internet interventions is ubiquitous, and presents a challenge in the evaluation of their effectiveness. Our objective was to evaluate variables hypothesized to be related to attrition, by modeling predictors of attrition in a secondary data analysis of two cohorts of an international, dual language (English and Spanish) Internet smoking cessation intervention. The two cohorts were identical except for the approach to follow-up (FU): one cohort employed only fully automated FU (n = 16 430), while the other cohort also used 'live' contact conditional upon initial non-response (n = 1000). Attrition rates were 48.1 and 10.8% for the automated FU and live FU cohorts, respectively. Significant attrition predictors in the automated FU cohort included higher levels of nicotine dependency, lower education, lower quitting confidence and receiving more contact emails. Participants' younger age was the sole predictor of attrition in the live FU cohort. While research on large-scale deployment of Internet interventions is at an early stage, this study demonstrates that differences in attrition from trials on this scale are (i) systematic and predictable and (ii) can largely be eliminated by live FU efforts. In fully automated trials, targeting the predictors we identify may reduce attrition, a necessary precursor to effective behavioral Internet interventions that can be accessed globally.
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Rosenbloom ST, Daniels TL, Talbot TR, McClain T, Hennes R, Stenner S, Muse S, Jirjis J, Purcell Jackson G. Triaging patients at risk of influenza using a patient portal. J Am Med Inform Assoc 2012; 19:549-54. [PMID: 22140208 PMCID: PMC3384102 DOI: 10.1136/amiajnl-2011-000382] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Accepted: 11/12/2011] [Indexed: 11/04/2022] Open
Abstract
Vanderbilt University has a widely adopted patient portal, MyHealthAtVanderbilt, which provides an infrastructure to deliver information that can empower patient decision making and enhance personalized healthcare. An interdisciplinary team has developed Flu Tool, a decision-support application targeted to patients with influenza-like illness and designed to be integrated into a patient portal. Flu Tool enables patients to make informed decisions about the level of care they require and guides them to seek timely treatment as appropriate. A pilot version of Flu Tool was deployed for a 9-week period during the 2010-2011 influenza season. During this time, Flu Tool was accessed 4040 times, and 1017 individual patients seen in the institution were diagnosed as having influenza. This early experience with Flu Tool suggests that healthcare consumers are willing to use patient-targeted decision support. The design, implementation, and lessons learned from the pilot release of Flu Tool are described as guidance for institutions implementing decision support through a patient portal infrastructure.
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Affiliation(s)
- S Trent Rosenbloom
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
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Heuman AN, Scholl JC, Wilkinson K. Rural Hispanic populations at risk in developing diabetes: sociocultural and familial challenges in promoting a healthy diet. HEALTH COMMUNICATION 2012; 28:260-274. [PMID: 22716086 DOI: 10.1080/10410236.2012.680947] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Type II diabetes affects Hispanic populations disproportionately and is the fifth leading cause of death for Hispanic people in the United States ( Smith & Barnett, 2005 ). Risk of diabetes is of great concern throughout the United States and is clearly of epidemic proportions for regions such as the Southwest and Texas where the primary minority populations are Mexican American. We conducted four focus groups with a total of 49 Hispanic participants (23 adults and 26 adolescents) from rural West Texas communities to gain insights about participants' eating habits, knowledge of diabetes, and potential barriers to preventive care. From the data, we identified a three-tiered predisposition or vulnerability to diabetes-heredity; preferences for unhealthy, culturally based food; and temptations from U.S. mainstream fast food culture. These vulnerabilities added to the sociocultural concerns that participants identified-importance of parental and familial modeling; challenges to healthy eating based on a culturally based diet and mainstream fast food culture; and a lack of support from the larger sociocultural networks such as teachers, community leaders, and the media. From these data, we have a better understanding of familial and sociocultural factors that need to be addressed in the development of preventive public awareness and educational plans. We outline implications for practitioners and educators from an integrated cultural biomedical approach.
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Affiliation(s)
- Amy N Heuman
- Department of Communication Studies, Texas Tech University, Lubbock, TX 79409-3080, USA.
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Relationship of fruit, vegetable, and fat consumption to binge eating symptoms in African American and Hispanic or Latina women. Eat Behav 2012; 13:179-82. [PMID: 22365808 PMCID: PMC3304303 DOI: 10.1016/j.eatbeh.2012.01.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Revised: 12/19/2011] [Accepted: 01/17/2012] [Indexed: 11/22/2022]
Abstract
African American (AA) and Hispanic or Latina (HL) women have the highest rates of overweight and obesity of any gender and ethnic groups. Binge eating disorder (BED) is the most common eating disorder in the United States and is linked to overweight and obesity. Traditional treatments for BED may not be appropriate or viable for AA and HL women, because they are less likely than whites to seek treatment for psychological conditions and may have less access to healthcare. Improving dietary habits in those with BED or subthreshold BED may reduce binge eating symptoms. The current study investigated the association of fruit, vegetable, and fat consumption to binge eating symptoms in AA and HL women. AA and HL women in the Health Is Power (HIP) study (N=283) reported fruit and vegetable intake, fat intake, and binge eating symptoms. Women were middle aged (M=45.8 years, SD=9.2) and obese (M BMI=34.5 kg/m(2), SD=7.5). Greater fat consumption was correlated with lower fruit and vegetable consumption (r(s)=-0.159, p<0.01). Higher BMI (r(s)=0.209, p<0.01), and greater fat consumption (r(s)=0.227, p<0.05) were correlated with increased binge eating symptoms. Multiple regression analysis demonstrated that for HL women (β=0.130, p=0.024), higher BMI (β=0.148, p=0.012), and greater fat consumption (β=0.196, p=0.001) were associated with increased binge eating symptoms (R(2)=0.086, F(3,278)=8.715, p<0.001). Findings suggest there may be a relationship between fat consumption and binge eating symptoms, warranting further study to determine whether improving dietary habits may serve as a treatment for BED in AA and HL women.
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Ramadurai V, Sharf BF, Sharkey JR. Rural food insecurity in the United States as an overlooked site of struggle in health communication. HEALTH COMMUNICATION 2012; 27:794-805. [PMID: 22329342 DOI: 10.1080/10410236.2011.647620] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
This article indicates the need for health communication scholars to attend to the growing national problem of rural food insecurity. A review of the health communication literature reveals that food insecurity and rural health overall are research issues that have been overlooked. Using the Culture-Centered Approach ( Dutta, 2008 ), while simultaneously searching for community assets as well as problems, we explore aspects of rural residents' food environments, culture, and institutional structures that empower and constrain their communities. Twelve focus groups (n = 86), segmented by race/ethnicity, were conducted in rural central Texas. Results were analyzed using grounded theory methodology. Our findings outline problems and personal obstacles described by participants, as well as creative solutions and coping mechanisms illustrative of individual agency and social capital inherent in their rural culture. We conclude by providing suggestions for future research that will aid health communication scholars to further the conversation on rural food insecurity.
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Affiliation(s)
- Vandhana Ramadurai
- Department of Communication, Texas A & M University, College Station, TX 77843, USA.
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Lee RE, Mama SK, Medina AV, Reese-Smith JY, Banda JA, Layne CS, Baxter M, O'Connor DP, McNeill L, Estabrooks PA. Multiple measures of physical activity, dietary habits and weight status in African American and Hispanic or Latina women. J Community Health 2011; 36:1011-23. [PMID: 21519867 PMCID: PMC4535354 DOI: 10.1007/s10900-011-9403-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Compared measures of physical activity and dietary habits used in the Health Is Power (HIP) study, and described the associations of physical activity and dietary habits among African American and Hispanic or Latino women, adjusted for weight status. Cross-sectional baseline data were compared for community dwelling, healthy African American (N = 262) and Hispanic or Latina women (N = 148) who participated in HIP. Physical activity was measured using the International Physical Activity Questionnaire (IPAQ) long form, the Check And Line Questionnaire (CALQ) log and accelerometry. Dietary habits were measured using NCI 24-h recall screeners, vegetable and fruit (VF) logs and the NCI Diet History Questionnaire (DHQ). Differences in physical activity and dietary habits were assessed using simultaneous 2 (ethnicity) × 3 (weight status) ANCOVAs adjusted for age and socioeconomic status. Women (M age = 44.4 ± 10.9 years) were obese (M = 34.0 ± 9.7 kg/m(2)), did not meet physical activity guidelines as measured by accelerometry (M = 19.4 ± 19.1 min MVPA/day) and ate few VF (M = 2.8 ± 2.7 servings/day). DHQ variables differed by weight status. IPAQ was associated with CALQ, and CALQ with accelerometry (P < .05). IPAQ was not associated with accelerometry. Regardless of ethnicity, normal weight women did more physical activity, reported more VF consumption, and consumed more fat calories than overweight and obese women (Ps < .05). African American women did more MVPA than Hispanic or Latino women (P < .001). Relationships between behaviors and weight status suggest accelerometry and DHQ are preferable, regardless of ethnicity; and studies may capture different domains of physical activity and dietary habits depending on measure used.
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Affiliation(s)
- Rebecca E Lee
- Department of Health and Human Performance, Texas Obesity Research Center, University of Houston, 3855 Holman St., Garrison Rm 104, Houston, TX 77204-6015, USA.
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Maon S, Edirippulige S, Ware R, Batch J. The use of web-based interventions to prevent excessive weight gain. J Telemed Telecare 2011; 18:37-41. [PMID: 22101608 DOI: 10.1258/jtt.2011.110306] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We reviewed web-based interventions for overweight and obesity prevention. A literature search was conducted using seven electronic databases. Manually searched articles were also included. Thirty studies fulfilled the inclusion criteria. Of these, 13 studied physical activity, eight studied dietary practices and nine studied a combination of physical activity and dietary practice. Twenty-eight of the studies (93%) reported positive changes in moderate to vigorous physical activity level, fruit and vegetable intake and psychological factors. A meta-analysis showed there were improvements, though not significant, in fruit and vegetable consumption (standardised mean difference, SMD = 0.61; 95% CI =-0.13 to 1.35) and physical activity (SMD = 0.15; 95% CI =-0.06 to 0.35). The review suggests that web-based interventions are a useful educational tool for increasing awareness and making healthy behaviour changes in relation to an excessive weight gain problem.
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Affiliation(s)
- Siti Maon
- Centre for Online Health, University of Queensland, Brisbane, Australia.
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Buller DB, Bettinghaus EP, Helme D, Young WF, Borland R, Maloy JA, Cutter GR, Andersen PA, Walther JB. Supporting Tobacco Control. Health Promot Pract 2011; 12:186S-94S. [DOI: 10.1177/1524839911414563] [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]
Abstract
A large and growing literature confirms that well-designed web-based programs can be effective in preventing or treating several chronic diseases. This study examined how the Internet can deliver information and train community activists and specifically tested the effects of web-based technical assistance on local tobacco control coalitions’ efforts to use media advocacy to advance their agendas. The authors compared a highly interactive, Enhanced website (intervention) to a noninteractive, Basic text-based website (comparison) in Colorado communities. A total of 24 tobacco control coalitions led by local county health departments and nursing services were enrolled in the project and randomly assigned to use either the intervention or comparison website. A total of 73 local daily and weekly newspapers were identified in the service areas of 23 of the 24 coalitions. A posttest assessment of newspaper coverage was conducted to locate all newspaper articles with tobacco control information published between January 1 and April 9, 2004, the last 3 months of the intervention. Although there was no evidence of a treatment effect on the frequency of newspaper articles on tobacco-related issues, there was, however, evidence that newspapers in counties where the coalition had access to the Enhanced website printed more stories focused on local/regional issues and more anti-tobacco local/regional stories than in the counties where coalitions had access to the Basic website. Coalitions can improve their influence on local media for community tobacco control when high-quality online technical assistance, training, and resources are available to them.
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Affiliation(s)
| | | | | | | | - Ron Borland
- Cancer Council Victoria, Carlton, Victoria, Australia
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Mouttapa M, Robertson TP, McEligot AJ, Weiss JW, Hoolihan L, Ora A, Trinh L. The Personal Nutrition Planner: a 5-week, computer-tailored intervention for women. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2011; 43:165-172. [PMID: 21550532 DOI: 10.1016/j.jneb.2010.08.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2009] [Revised: 08/13/2010] [Accepted: 08/23/2010] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To conduct a dietary intervention using the Personal Nutrition Planner (PNP), an on-line nutrition intervention tool. DESIGN Randomized controlled trial with pretest, posttest, and 2-month follow-up self-report assessments. SETTING Web/on-line. PARTICIPANTS Female university staff (n = 307; 59.1% Caucasian) recruited via e-mail. Retention rate was 85.0% (118 treatment; 143 comparison). INTERVENTION PNP on-line produces individualized nutrition feedback based on initial on-line assessment. Intervention lasted 5 weeks and included weekly e-mail reminders. MAIN OUTCOME MEASURES Dietary intake frequencies, weight loss, opinions regarding intervention. ANALYSIS Repeated-measures analysis of variance to determine intervention effects on dietary intake and weight loss (P < .05). RESULTS Relative to the comparison group who received no program, the treatment group increased dairy intake frequency across the 3 assessments (F(2,304) = 3.15; P < .05). Among participants who wanted to lose weight, weight loss in the treatment group was significantly higher than that of the comparison group from pretest to posttest (F(1,92) = 4.50; P < .05). On a scale of 1-5, mean ratings of the PNP program characteristics ranged from 3-4. CONCLUSIONS AND IMPLICATIONS PNP produced significant increases in dairy intake and decreases in weight. Further revisions will tailor PNP to better fit individuals' dietary goals and increase motivation.
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Affiliation(s)
- Michele Mouttapa
- California State University-Fullerton, Department of Health Science, Fullerton, CA 92834, USA.
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Brouwer W, Kroeze W, Crutzen R, de Nooijer J, de Vries NK, Brug J, Oenema A. Which intervention characteristics are related to more exposure to internet-delivered healthy lifestyle promotion interventions? A systematic review. J Med Internet Res 2011; 13:e2. [PMID: 21212045 PMCID: PMC3221341 DOI: 10.2196/jmir.1639] [Citation(s) in RCA: 325] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2010] [Revised: 11/17/2010] [Accepted: 12/03/2010] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The Internet has become a popular medium for the delivery of tailored healthy lifestyle promoting interventions. The actual reach of Internet-delivered interventions seems, however, lower than expected, and attrition from interventions is generally high. Characteristics of an intervention, such as personally tailored feedback and goal setting, are thought to be among the important factors related to of use of and exposure to interventions. However, there is no systematic overview of which characteristics of Internet-delivered interventions may be related to more exposure. OBJECTIVE The present study aims to identify (1) which potentially exposure-promoting methods and strategies are used in existing Internet interventions, (2) which objective outcome measures are used to measure exposure to Internet interventions, and (3) which potentially exposure-promoting methods and strategies are associated with better exposure. METHODS A systematic review of the literature was conducted based on the Cochrane guidelines. Papers published between 1995 and 2009 were searched in the PubMed, PsycINFO, and Web of Science databases. In total, 64 studies were included that reported objective exposure measures such as completion of an initial visit, number of log-ins, and time spent on the website. Information about intervention-related characteristics (ie, interactive behavior change strategies, interactive elements for fun, peer or counsel support, email/phone contact, and regular updates of the website) that could potentially contribute to better exposure and objective exposure outcomes were abstracted from the studies and qualitative systematic descriptive analyses were performed. RESULTS The results showed that a large variety of behavior change techniques and other exposure-promoting elements were used in the interventions and that these methods and strategies varied for the various lifestyle behaviors. Feedback, interactive elements, and email/phone contact were used most often. In addition, there was much variety and a lack of consistency in the exposure measures that were reported. Of all the categories of intervention characteristics that may be associated with better exposure, there were indications that peer and counselor support result in a longer website visit and that email/phone contact and updates of the website result in more log-ins. CONCLUSIONS Results of this qualitative systematic review indicate that of all intervention characteristics that could potentially enhance exposure, only peer support, counselor support, email/phone contact with visitors, and updates of the intervention website were related to better exposure. The diversity of intervention methods used and the inconsistency in the report of exposure measures prevented us from drawing firmer conclusions. More research is needed to identify whether other characteristics of Internet interventions are associated with greater exposure.
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Affiliation(s)
- Wendy Brouwer
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.
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Lee RE, Mama SK, Medina A, Orlando Edwards R, McNeill L. SALSA : SAving Lives Staying Active to Promote Physical Activity and Healthy Eating. J Obes 2011; 2011:436509. [PMID: 21234315 PMCID: PMC3018638 DOI: 10.1155/2011/436509] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2010] [Revised: 10/22/2010] [Accepted: 11/29/2010] [Indexed: 01/22/2023] Open
Abstract
Physical inactivity, poor dietary habits, and obesity are vexing problems among minorities. SAving Lives, Staying Active (SALSA) was an 8-week randomized controlled crossover design, pilot study to promote regular physical activity (PA) and fruit and vegetable (FV) consumption as a means to preventing weight gain among women of color. Participants completed measures of demographics, PA, and dietary habits. Women (N = 50; M = 42 years) who participated were overweight (MBMI = 29.7 kg/m(2); Mbody fat = 38.5%) and reported low levels of leisure time PA (M = 10.7 MET-min/wk) and FV consumption (M = 4.2 servings/day). All were randomized to a four-week (1) semiweekly Latin dance group or (2) internet-based dietary education group. All participants reported a significant increase in weekly leisure time PA from baseline (M = 10.7 MET-min/wk) to follow up (M = 34.0 MET-min/wk, P < .001), and FV consumption increased over time by group (P = .02). Data suggest that Latin dance interventions to improve PA and web-based interventions to improve dietary habits show promise for improving health among women of color.
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Affiliation(s)
- Rebecca E. Lee
- Texas Obesity Research Center, Health and Human Performance Department, University of Houston, 3855 Holman Street, Houston, TX 77204, USA
- *Rebecca E. Lee:
| | - Scherezade K. Mama
- Texas Obesity Research Center, Health and Human Performance Department, University of Houston, 3855 Holman Street, Houston, TX 77204, USA
| | - Ashley Medina
- Texas Obesity Research Center, Health and Human Performance Department, University of Houston, 3855 Holman Street, Houston, TX 77204, USA
| | - Raul Orlando Edwards
- Strictly Street Salsa Dance Company, 1915 Commonwealth Street, Houston, TX 77006-1841, USA
| | - Lorna McNeill
- Department of Health Disparities Research, M.D. Anderson Cancer Center, University of Texas, 1400 Pressler Street, Unit 1440, Houston, TX 77030-3906, USA
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Geraghty AWA, Wood AM, Hyland ME. Attrition from self-directed interventions: investigating the relationship between psychological predictors, intervention content and dropout from a body dissatisfaction intervention. Soc Sci Med 2010; 71:30-7. [PMID: 20400220 DOI: 10.1016/j.socscimed.2010.03.007] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2009] [Revised: 02/22/2010] [Accepted: 03/02/2010] [Indexed: 11/20/2022]
Abstract
The aims of this study were to (a) identify the predictors of attrition from a fully self-directed intervention, and (b) to test whether an intervention to increase gratitude is an effective way to reduce body dissatisfaction. Participants (N=479, from the United Kingdom) aged 18-76 years took part in a self-help study via the Internet and were randomized to receive one of two interventions, gratitude diaries (n=130), or thought monitoring and restructuring (n=118) or a waitlist control (n=231) for a two week body dissatisfaction intervention. The gratitude intervention (n=40) was as effective as monitoring and restructuring (n=22) in reducing body dissatisfaction, and both interventions were significantly more effective than the control condition (n=120). Participants in the gratitude group were more than twice as likely to complete the intervention compared to those in the monitoring and restructuring group. Intervention content, baseline expectancy and internal locus of control significantly predicted attrition. This study shows that a gratitude intervention can be as effective as a technique commonly used in cognitive therapy and is superior in retaining participants. Prediction of attrition is possible from both intervention content and psychological variables.
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Webb TL, Joseph J, Yardley L, Michie S. Using the internet to promote health behavior change: a systematic review and meta-analysis of the impact of theoretical basis, use of behavior change techniques, and mode of delivery on efficacy. J Med Internet Res 2010; 12:e4. [PMID: 20164043 PMCID: PMC2836773 DOI: 10.2196/jmir.1376] [Citation(s) in RCA: 1491] [Impact Index Per Article: 106.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2009] [Revised: 11/12/2009] [Accepted: 11/16/2009] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The Internet is increasingly used as a medium for the delivery of interventions designed to promote health behavior change. However, reviews of these interventions to date have not systematically identified intervention characteristics and linked these to effectiveness. OBJECTIVES The present review sought to capitalize on recently published coding frames for assessing use of theory and behavior change techniques to investigate which characteristics of Internet-based interventions best promote health behavior change. In addition, we wanted to develop a novel coding scheme for assessing mode of delivery in Internet-based interventions and also to link different modes to effect sizes. METHODS We conducted a computerized search of the databases indexed by ISI Web of Knowledge (including BIOSIS Previews and Medline) between 2000 and 2008. Studies were included if (1) the primary components of the intervention were delivered via the Internet, (2) participants were randomly assigned to conditions, and (3) a measure of behavior related to health was taken after the intervention. RESULTS We found 85 studies that satisfied the inclusion criteria, providing a total sample size of 43,236 participants. On average, interventions had a statistically small but significant effect on health-related behavior (d(+) = 0.16, 95% CI 0.09 to 0.23). More extensive use of theory was associated with increases in effect size (P = .049), and, in particular, interventions based on the theory of planned behavior tended to have substantial effects on behavior (d(+) = 0.36, 95% CI 0.15 to 0.56). Interventions that incorporated more behavior change techniques also tended to have larger effects compared to interventions that incorporated fewer techniques (P < .001). Finally, the effectiveness of Internet-based interventions was enhanced by the use of additional methods of communicating with participants, especially the use of short message service (SMS), or text, messages. CONCLUSIONS The review provides a framework for the development of a science of Internet-based interventions, and our findings provide a rationale for investing in more intensive theory-based interventions that incorporate multiple behavior change techniques and modes of delivery.
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Affiliation(s)
- Thomas L Webb
- Department of Psychology, University of Sheffield, Western Bank, Sheffield, UK.
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Pekmezi DW, Neighbors CJ, Lee CS, Gans KM, Bock BC, Morrow KM, Marquez B, Dunsiger S, Marcus BH. A culturally adapted physical activity intervention for Latinas: a randomized controlled trial. Am J Prev Med 2009; 37:495-500. [PMID: 19944914 PMCID: PMC2814545 DOI: 10.1016/j.amepre.2009.08.023] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2009] [Revised: 06/24/2009] [Accepted: 08/01/2009] [Indexed: 11/18/2022]
Abstract
BACKGROUND In the U.S., Latinos report particularly high levels of inactivity and related chronic illnesses and are in need of intervention. Thus, the purpose of the current study was to culturally and linguistically adapt an empirically supported, individually tailored physical activity print intervention for Latinos and then conduct an RCT of the modified program. DESIGN An RCT was conducted. SETTING/PARTICIPANTS The sample included 93 overweight/obese (80%) Latinas with low income and acculturation. INTERVENTION Data were collected in 2007-2008 and analyzed by intent-to-treat in 2009. Participants were randomly assigned to either (1) a culturally and linguistically adapted physical activity intervention (Seamos Activas) or (2) a wellness contact control condition. MAIN OUTCOME MEASURES Self-report physical activity, as measured pre- and post-intervention (6 months, 87% retention) by the 7-Day Physical Activity Recall. RESULTS Moderate-intensity (or greater) physical activity increased from an average of 16.56 minutes/week (SD=25.76) at baseline to 147.27 (SD=241.55) at 6 months in the intervention arm (n=45), and from 11.88 minutes/week (SD=21.99) to 96.79 (SD=118.49) in the wellness contact control arm (n=48). No between-group differences were seen in overall physical activity. Intervention participants reported significantly greater increases in cognitive (F[1, 91]=9.53, p=0.003) and behavioral processes of change (F[1, 91]=8.37, p=0.005) and available physical activity supplies and equipment at home (F[1, 91]=4.17, p=0.04) than control participants. CONCLUSIONS Results supported the hypothesized feasibility, acceptability, and preliminary efficacy of individually tailored physical activity print interventions among Latinas. Although more research is needed to corroborate these findings, such high-reach, low-cost approaches have great potential to positively affect public health. TRIAL REGISTRATION NCT00724165.
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Affiliation(s)
- Dorothy W Pekmezi
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama 35293, USA.
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Abstract
This article provides a review of health promotion research conducted among Latinos. The authors examined 31 intervention studies promoting physical activity and/or healthy diet in Latino samples. Overall, findings suggested that Latinos are responsive to interventions promoting physical activity and healthy diet, despite facing numerous barriers to health promotion. In fact, 12 of the 21 studies that measured physical activity and 19 of the 26 studies that measured dietary behavior reported that the intervention produced significant improvements in those health behaviors. Design strengths of these studies included the high rates of retention and large number of randomized controlled trials. However, there were concerns regarding the lack of diversity in the samples (mostly Mexican American women), limiting the generalizability of the findings and the underutilization of objective measures of physical activity and diet behavior in intervention studies.
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Affiliation(s)
- Dori Pekmezi
- Medical School of Brown University, Centers for Behavioral and Preventive Medicine, Providence, Rhode Island,
| | - Becky Marquez
- Medical School of Brown University, Centers for Behavioral and Preventive Medicine, Providence, Rhode Island
| | - Joshua Marcus-Blank
- Medical School of Brown University, Centers for Behavioral and Preventive Medicine, Providence, Rhode Island
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Webb TL. Commentary on Shahab & McEwen (2009): Understanding and preventing attrition in online smoking cessation interventions: a self-regulatory perspective. Addiction 2009; 104:1805-6. [PMID: 19832784 DOI: 10.1111/j.1360-0443.2009.02751.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Thomas L Webb
- Department of Psychology, University of Sheffield, Western Bank, Sheffield S10 2TN, UK.
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Zimmerman D, Paschal DB. An exploratory usability evaluation of Colorado State University Libraries' digital collections and the Western Waters Digital Library Web sites. JOURNAL OF ACADEMIC LIBRARIANSHIP 2009. [DOI: 10.1016/j.acalib.2009.03.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Woodall WG, Buller DB, Saba L, Zimmerman D, Waters E, Hines JM, Cutter GR, Starling R. Effect of emailed messages on return use of a nutrition education website and subsequent changes in dietary behavior. J Med Internet Res 2007; 9:e27. [PMID: 17942389 PMCID: PMC2047284 DOI: 10.2196/jmir.9.3.e27] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2006] [Revised: 08/03/2007] [Accepted: 08/12/2007] [Indexed: 12/02/2022] Open
Abstract
Background At-risk populations can be reached with Web-based disease prevention and behavior change programs. However, such eHealth applications on the Internet need to generate return usage to be effective. Limited evidence is available on how continued usage can be encouraged. Objective This analysis tested whether routine email notification about a nutrition education website promoted more use of the website. Methods Adults from six rural counties in Colorado and New Mexico, United States (n = 755) participating in a randomized trial and assigned to the intervention group (n = 380) received, over a period of 4 months, email messages alerting them to updates on the website, along with hyperlinks to new content. Update alerts were sent approximately every 5 weeks (each participant received up to 4 messages). Log-ons to the website were the primary outcome for this analysis. Results A total of 23.5% (86/366) of the participants responded to at least one email, and 51.2% (44/86) of these participants responded to half of the email messages by logging on to the website. Significantly more log-ons occurred on email notification days compared to all other days (OR = 3.71, 95% CI = 2.72-5.06). More log-ons also occurred just after the notification but declined each day thereafter (OR = 0.97, 95% CI = 0.96-0.98 one day further from mass email). Non-Hispanics (OR = 0.46, 95% CI = 0.26-0.84), older participants (OR = 1.04, 95% CI = 1.04-1.06), and those using the Internet most recently (OR = 0.62, 95% CI = 0.51-0.77) were more likely to log on. Responders to the messages had a more positive change in fruit and vegetable intake (mean change = +1.69) than nonresponders (+0.05), as measured with a food frequency assessment (adjusted Spearman partial correlation coefficient = 0.14, P = .049). Compared to nonresponders, responders were more likely to be non-Hispanic (P = .01), older (P < .001), and had used the Internet more recently (P < .001). Conclusions Messages sent by email appeared to promote a modest short-lived increase in use of a disease prevention website by some adults. Those who responded to the messages by logging on to the website may have been influenced to improve their diet.
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