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Al-Khudairy L, Akram Y, Watson SI, Kudrna L, Hofman J, Nightingale M, Alidu L, Rudge A, Rawdin C, Ghosh I, Mason F, Perera C, Wright J, Boachie J, Hemming K, Vlaev I, Russell S, Lilford RJ. Evaluation of an organisational-level monetary incentive to promote the health and wellbeing of workers in small and medium-sized enterprises: A mixed-methods cluster randomised controlled trial. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001381. [PMID: 37410723 DOI: 10.1371/journal.pgph.0001381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 05/26/2023] [Indexed: 07/08/2023]
Abstract
We conducted an independent evaluation on the effectiveness of an organisational-level monetary incentive to encourage small and medium-sized enterprises (SMEs) to improve employees' health and wellbeing. This was A mixed-methods cluster randomised trial with four arms: high monetary incentive, low monetary incentive, and two no monetary incentive controls (with or without baseline measurements to examine 'reactivity' The consequence of particpant awareness of being studied, and potential impact on participant behavior effects). SMEs with 10-250 staff based in West Midlands, England were eligible. We randomly selected up to 15 employees at baseline and 11 months post-intervention. We elicited employee perceptions of employers' actions to improve health and wellbeing; and employees' self-reported health behaviours and wellbeing. We also interviewed employers and obtained qualitative data. One hundred and fifty-two SMEs were recruited. Baseline assessments were conducted in 85 SMEs in three arms, and endline assessments in 100 SMEs across all four arms. The percentage of employees perceiving "positive action" by their employer increased after intervention (5 percentage points, pp [95% Credible Interval -3, 21] and 3pp [-9, 17], in models for high and low incentive groups). Across six secondary questions about specific issues the results were strongly and consistently positive, especially for the high incentive. This was consistent with qualitative data and quantitative employer interviews. However, there was no evidence of any impact on employee health behaviour or wellbeing outcomes, nor evidence of 'reactivity'. An organisational intervention (a monetary incentive) changed employee perceptions of employer behaviour but did not translate into changes in employees' self-reports of their own health behaviours or wellbeing. Trial registration: AEARCTR-0003420, registration date: 17.10.2018, retrospectively registered (delays in contracts and identfying a suitable trial registry). The authors confirm that there are no ongoing and related trials for this intervention.
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Affiliation(s)
- Lena Al-Khudairy
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Yasmin Akram
- West Midlands Combined Authority, Birmingham, United Kingdom
| | - Samuel I Watson
- Institue Applied Health Research, University of Birmingham, Edgbaston, United Kingdom
| | - Laura Kudrna
- Institue Applied Health Research, University of Birmingham, Edgbaston, United Kingdom
| | | | | | | | - Andrew Rudge
- West Midlands Combined Authority, Birmingham, United Kingdom
| | - Clare Rawdin
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Iman Ghosh
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Frances Mason
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Chinthana Perera
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Jane Wright
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Joseph Boachie
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Karla Hemming
- West Midlands Combined Authority, Birmingham, United Kingdom
| | - Ivo Vlaev
- Warwick Business School, University of Warwick, Coventry, United Kingdom
| | - Sean Russell
- West Midlands Combined Authority, Birmingham, United Kingdom
| | - Richard J Lilford
- Institue Applied Health Research, University of Birmingham, Edgbaston, United Kingdom
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Valenzuela R, Saadiq S, Cobos S, Salinas JJ. Engagement in Physical Activity Improves after Participation in Pasos Para Prevenir Cancer-An Obesity-Related Cancer Prevention Program in El Paso, Texas. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11607. [PMID: 36141878 PMCID: PMC9517185 DOI: 10.3390/ijerph191811607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/02/2022] [Accepted: 09/08/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND This present study experimentally evaluated the Pasos Para Prevenir Cancer (PPPC) program to determine whether participation was associated with improved physical activity engagement. Evidence suggests that obesity prevention programs improve physical activity (PA) engagement and lead to healthier weights, which substantially impacts cancer and cardiometabolic disease risk. There is a shortage of knowledge on the effectiveness of programs tailored to populations along the U.S.-Mexico border. METHODS We collected demographic, nutrition, and physical activity data at baseline, 6 months, and 12 months using the Research Electronic Data Capture (REDCap) for 209 participants. We analyzed the average metabolic equivalents (METS) per week for all physical activity levels and types and the achievement of the recommended METS per week to determine the demographic characteristics most associated with a change between baseline, 6 months, and 12 months. RESULTS Light activity was the most common activity at all three points, and it slightly increased at 6 months in work settings. Subjects conducted moderate physical activity primarily at home and work, and moderate physical activity increased more compared to vigorous physical activity. CONCLUSIONS Intervention tailoring might improve PA engagement in Mexican Americans residing on the U.S.-Mexico border; however, larger studies that are more diverse are required.
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Affiliation(s)
- Roy Valenzuela
- Department of Molecular and Translational Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX 79905, USA
| | - Stefan Saadiq
- Francis Graduate School of Biomedical Sciences, Texas Tech University Health Sciences Center El Paso, El Paso, TX 79905, USA
| | - Sandra Cobos
- Department of Molecular and Translational Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX 79905, USA
| | - Jennifer J. Salinas
- Department of Molecular and Translational Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX 79905, USA
- Francis Graduate School of Biomedical Sciences, Texas Tech University Health Sciences Center El Paso, El Paso, TX 79905, USA
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3
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Hill A, Alston L, Needham C, Peeters A, LaMontagne AD, Nichols M. Systematic review of the effectiveness of health promotion interventions targeting obesity prevention in school-based staff. Health Promot Int 2022; 37:6631503. [PMID: 35788312 PMCID: PMC9437818 DOI: 10.1093/heapro/daac061] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
School-based employee interventions can benefit the health of staff and have the potential to influence the health of school students through role-modelling. However, interventions within schools typically focus on students, with very few studies addressing obesity and related health behaviours among school staff. A systematic review of the peer-reviewed literature published between January 2000 and May 2020 was undertaken to synthesize the evidence on the impact that school-based obesity prevention programmes have on the staff they employ. Search terms were derived from four major topics: (i) school; (ii) staff; (iii) health promotion and (iv) obesity. Terms were adapted for six databases and three independent researchers screened results. Studies were included if they reported on the outcomes of body weight, dietary behaviours and/or physical activity. Of 3483 papers identified in the search, 13 studies met the inclusion criteria. All 13 studies included an intervention that focussed on improving nutrition, physical activity or both. All included studies demonstrated a positive outcome for either dietary intake, weight or body mass index or physical activity outcomes, however not all results were statistically significant. The included studies showed promising, although limited, impacts on employee health outcomes. This review demonstrated a lack of global focus and investment in interventions targeting school staff, particularly in contrast to the large amount of research on school-based health promotion initiatives focussed on students. There is a need for further research to understand effective interventions to promote health and prevent obesity in this large, diverse and influential workforce.
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Affiliation(s)
- Amy Hill
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Faculty of Health, Deakin University, Geelong 3220, VIC, Australia
| | - Laura Alston
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Faculty of Health, Deakin University, Geelong 3220, VIC, Australia.,Deakin Rural Health, Faculty of Health, Deakin University, Geelong 3220, VIC, Australia.,Colac Area Health, Research, Colac 3250, VIC, Australia
| | - Cindy Needham
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Faculty of Health, Deakin University, Geelong 3220, VIC, Australia
| | - Anna Peeters
- Institute for Health Transformation, Faculty of Health, Deakin University, Geelong 3220, VIC, Australia
| | - Anthony D LaMontagne
- Institute for Health Transformation, Faculty of Health, Deakin University, Geelong 3220, VIC, Australia
| | - Melanie Nichols
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Faculty of Health, Deakin University, Geelong 3220, VIC, Australia
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4
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Systematic review with analysis of bias and quality of interventions in the food environment of the workplace and their impact on the nutritional status of workers. NUTR HOSP 2022; 39:1153-1165. [DOI: 10.20960/nh.04198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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5
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Melián-Fleitas L, Franco-Pérez Á, Caballero P, Sanz-Lorente M, Wanden-Berghe C, Sanz-Valero J. Influence of Nutrition, Food and Diet-Related Interventions in the Workplace: A Meta-Analysis with Meta-Regression. Nutrients 2021; 13:3945. [PMID: 34836200 PMCID: PMC8622081 DOI: 10.3390/nu13113945] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 10/28/2021] [Accepted: 11/02/2021] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE To review the scientific literature on the influence of verified nutrition, food and diet interventions on occupational health. METHOD This study involved a critical analysis of articles retrieved from MEDLINE (via PubMed), Embase, Cochrane Library, PsycINFO, Scopus, Web of Science, Latin American and Caribbean Health Sciences Literature (LILACS) and Medicina en Español (MEDES) using the descriptors "Diet, Food, and Nutrition" and "Occupational Health" and applying the filters "Clinical Trial", "Humans" and "Adult: 19+ years"; the search was conducted on 29 May 2021. RESULTS A total of 401 references were retrieved from the bibliographic databases, with an additional 16 identified through a secondary search; among the studies retrieved, 34 clinical trials were selected after applying the inclusion and exclusion criteria. The interventions were grouped into seven categories: (1) dietary interventions associated with exercise or educational programs; (2) individual environmental interventions or other educational actions; (3) educational interventions oriented toward lifestyle, dietetics, physical activity and stress management; (4) economic incentives; (5) multicomponent interventions (combination of mindfulness, e-coaching and the addition of fruits and vegetables); or dietary interventions (facilitating greater food supply in cafeterias); or interventions focused on physical exercise. CONCLUSIONS Given that most people spend a large part of their time in the workplace and, therefore, eat at least one of their daily meals there, well-planned interventions-preferably including several strategies-have been demonstrated, in general, as useful for combating overweight and obesity. From the meta-regression study, it was observed that the interventions give better results in people who presented high Body Mass Index (BMI) values (obesity). In contrast, intervention 2 (interventions related to workplace environment) would not give the expected results (it would increase the BMI).
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Affiliation(s)
- Liliana Melián-Fleitas
- Nutrition Department, University of Granada, 18012 Granada, Spain;
- Geriatric Service, Insular Hospital, Health Services Management of the Health Area of Lanzarote, 35500 Arrecife, Spain
| | - Álvaro Franco-Pérez
- Playa Blanca Health Center, Health Services Management of the Health Area of Lanzarote, 35580 Playa Blanca, Spain;
| | - Pablo Caballero
- Department of Community Nursing, Preventive Medicine and Public Health and History of Science, University of Alicante, San Vicente del Raspeig, 03690 Alicante, Spain;
| | - María Sanz-Lorente
- Department of Public Health & History of Science, University Miguel Hernandez, 03550 Alicante, Spain;
- Center of Public Health, Consellería of Universal Health and Public Health, 46940 Manises, Spain
| | - Carmina Wanden-Berghe
- Health and Biomedical Research Institute of Alicante, University General Hospital, 03010 Alicante, Spain;
| | - Javier Sanz-Valero
- Department of Public Health & History of Science, University Miguel Hernandez, 03550 Alicante, Spain;
- National School of Occupational Medicine, Carlos III Health Institute, 28029 Madrid, Spain
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6
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Peñalvo JL, Sagastume D, Mertens E, Uzhova I, Smith J, Wu JHY, Bishop E, Onopa J, Shi P, Micha R, Mozaffarian D. Effectiveness of workplace wellness programmes for dietary habits, overweight, and cardiometabolic health: a systematic review and meta-analysis. LANCET PUBLIC HEALTH 2021; 6:e648-e660. [PMID: 34454642 PMCID: PMC8627548 DOI: 10.1016/s2468-2667(21)00140-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 06/02/2021] [Accepted: 06/04/2021] [Indexed: 12/17/2022]
Abstract
Background The workplace offers a unique opportunity for effective health
promotion. We aimed to comprehensively study the effectiveness of
multicomponent worksite wellness programmes for improving diet and
cardiometabolic risk factors. Methods We did a systematic literature review and meta-analysis, following
PRISMA guidelines. We searched PubMed-MEDLINE, Embase, the Cochrane Library,
Web of Science, and Education Resources Information Center, from Jan 1,
1990, to June 30, 2020, for studies with controlled evaluation designs that
assessed multicomponent workplace wellness programmes. Investigators
independently appraised the evidence and extracted the data. Outcomes were
dietary factors, anthropometric measures, and cardiometabolic risk factors.
Pooled effects were calculated by inverse-variance random-effects
meta-analysis. Potential sources of heterogeneity and study biases were
evaluated. Findings From 10 169 abstracts reviewed, 121 studies (82 [68%] randomised
controlled trials and 39 [32%] quasi-experimental interventions) met the
eligibility criteria. Most studies were done in North America (57 [47%]),
and Europe, Australia, or New Zealand (36 [30%]). The median number of
participants was 413·0 (IQR 124·0–904·0), and
median duration of intervention was 9·0 months
(4·5–18·0). Workplace wellness programmes improved
fruit and vegetable consumption (0·27 servings per day [95% CI
0·16 to 0·37]), fruit consumption (0·20 servings per
day [0·11 to 0·28]), body-mass index (−0·22
kg/m2 [−0·28 to −0·17]), waist
circumference (−1·47 cm [−1·96 to
−0·98]), systolic blood pressure (−2·03 mm Hg
[−3·16 to −0·89]), and LDL cholesterol
(−5·18 mg/dL [−7·83 to −2·53]),
and to a lesser extent improved total fat intake (−1·18% of
daily energy intake [−1·78 to −0·58]), saturated
fat intake (−0·70% of daily energy [−1·22 to
−0·18]), bodyweight (−0·92 kg
[−1·11 to −0·72]), diastolic blood pressure
(−1·11 mm Hg [−1·78 to −0·44]),
fasting blood glucose (−1·81 mg/dL [−3·33 to
−0·28]), HDL cholesterol (1·11 mg/dL [0·48 to
1·74]), and triglycerides (−5·38 mg/dL
[−9·18 to −1·59]). No significant benefits were
observed for intake of vegetables (0·03 servings per day [95% CI
−0·04 to 0·10]), fibre (0·26 g per day
[−0·15 to 0·67]), polyunsaturated fat
(−0·23% of daily energy [−0·59 to 0·13]),
or for body fat (−0·80% [−1·80 to 0·21]),
waist-to-hip ratio (−0·00 ratio [−0·01 to
0·00]), or lean mass (1·01 kg [−0·82 to
2·83]). Heterogeneity values ranged from 46·9% to
91·5%. Between-study differences in outcomes were not significantly
explained by study design, location, population, or similar factors in
heterogeneity analyses. Interpretation Workplace wellness programmes are associated with improvements in
specific dietary, anthropometric, and cardiometabolic risk indicators. The
heterogeneity identified in study designs and results should be considered
when using these programmes as strategies to improve cardiometabolic
health.
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Affiliation(s)
- José L Peñalvo
- Non-Communicable Diseases Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium; Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA.
| | - Diana Sagastume
- Non-Communicable Diseases Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Elly Mertens
- Non-Communicable Diseases Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Irina Uzhova
- Department of Health and Nutritional Sciences, Institute of Technology Sligo, Sligo, Ireland
| | - Jessica Smith
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA; Bell Institute of Health and Nutrition, General Mills, Minneapolis, MN, USA
| | - Jason H Y Wu
- George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Eve Bishop
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Jennifer Onopa
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Peilin Shi
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Renata Micha
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA; Department of Food Science and Human Nutrition, University of Thessaly, Thessaly, Greece
| | - Dariush Mozaffarian
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
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7
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Murawski B, Reilly KL, Hope K, Hall AE, Sutherland RL, Trost SG, Yoong SL, McCarthy N, Lecathelinais C, Wolfenden L, Nathan NK. Exploring the effect of a school-based cluster-randomised controlled trial to increase the scheduling of physical activity for primary school students on teachers' physical activity. Health Promot J Austr 2021; 33:373-378. [PMID: 33949031 DOI: 10.1002/hpja.499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 04/30/2021] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND To determine if a school-based physical activity (PA) intervention that supported primary school teachers to schedule PA during school hours impacted their own PA. METHODS A 2x2 factorial group cluster-randomised controlled trial was undertaken in 12 Australian primary schools. The nine-month intervention supported classroom teachers to increase scheduled weekly PA for their class via physical education, sport, Energisers and integrated lessons. Teachers' PA (n = 76) was measured at follow-up only using accelerometers (Actigraph GT3X or GT9X). Linear mixed models were used to estimate between-group differences in teachers' mean minutes of sedentary, light, moderate-to-vigorous-intensity physical activity (MVPA) across the school day and during class-time. RESULTS At follow-up, there were non-significant between-group differences favouring intervention teachers, compared to controls, for light PA (4.9 minutes, 95% CI: -6.3, 16.0; P = .33) and MVPA (0.4 minutes, 95% CI: -10.9, 11.6; P = .94) across the school day; although not favouring the intervention for sedentary behaviour (5.1 minutes, 95% CI: -11.4, 21.7; P = .48). Similar patterns were seen during class-time for light PA and sedentary time, but not for MVPA. CONCLUSIONS Supporting teachers with the scheduling of PA for their class may impact on their own PA. Fully powered studies are needed to better understand the impact of the intervention on teachers' PA. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12616001228471 (http://www.anzctr.org.au/).
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Affiliation(s)
- Beatrice Murawski
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.,Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, Wallsend, NSW, Australia
| | - Kathryn L Reilly
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.,Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, Wallsend, NSW, Australia
| | - Kirsty Hope
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.,Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, Wallsend, NSW, Australia
| | - Alix E Hall
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.,Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, Wallsend, NSW, Australia
| | - Rachel L Sutherland
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.,Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, Wallsend, NSW, Australia
| | - Stewart G Trost
- Institute of Health and Biomedical Innovation at Queensland Centre for Children's Health Research, Queensland University of Technology, Brisbane, QLD, Australia
| | - Sze Lin Yoong
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.,Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, Wallsend, NSW, Australia
| | - Nicole McCarthy
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.,Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, Wallsend, NSW, Australia
| | - Christophe Lecathelinais
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.,Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, Wallsend, NSW, Australia
| | - Luke Wolfenden
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.,Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, Wallsend, NSW, Australia
| | - Nicole K Nathan
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.,Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, Wallsend, NSW, Australia
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8
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Nathan N, Murawski B, Hope K, Young S, Sutherland R, Hodder R, Booth D, Toomey E, Yoong SL, Reilly K, Tzelepis F, Taylor N, Wolfenden L. The Efficacy of Workplace Interventions on Improving the Dietary, Physical Activity and Sleep Behaviours of School and Childcare Staff: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17144998. [PMID: 32664554 PMCID: PMC7400238 DOI: 10.3390/ijerph17144998] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 07/04/2020] [Accepted: 07/06/2020] [Indexed: 01/07/2023]
Abstract
There is a need for effective interventions that improve the health and wellbeing of school and childcare staff. This review examined the efficacy of workplace interventions to improve the dietary, physical activity and/or sleep behaviours of school and childcare staff. A secondary aim of the review was to assess changes in staff physical/mental health, productivity, and students’ health behaviours. Nine databases were searched for controlled trials including randomised and non-randomised controlled trials and quasi-experimental trials published in English up to October 2019. PRISMA guidelines informed screening and study selection procedures. Data were not suitable for quantitative pooling. Of 12,396 records screened, seven articles (based on six studies) were included. Most studies used multi-component interventions including educational resources, work-based wellness committees and planned group practice (e.g., walking groups). Multiple outcomes were assessed, findings were mixed and on average, there was moderate risk of bias. Between-group differences in dietary and physical activity behaviours (i.e., fruit/vegetable intake, leisure-time physical activity) favoured intervention groups, but were statistically non-significant for most outcomes. Some of the studies also showed differences favouring controls (i.e., nutrient intake, fatty food consumption). Additional robust studies testing the efficacy of workplace interventions to improve the health of educational staff are needed.
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Affiliation(s)
- Nicole Nathan
- Hunter New England Population Health, Hunter New England Area Health Service, Longworth Avenue, Wallsend, NSW 2287, Australia; (S.Y.); (R.S.); (R.H.); (S.L.Y.); (K.R.); (F.T.); (L.W.)
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia; (B.M.); (K.H.)
- Priority Research Centre for Health Behaviour, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia
- Correspondence:
| | - Beatrice Murawski
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia; (B.M.); (K.H.)
- Priority Research Centre for Health Behaviour, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
| | - Kirsty Hope
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia; (B.M.); (K.H.)
- Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia
| | - Sarah Young
- Hunter New England Population Health, Hunter New England Area Health Service, Longworth Avenue, Wallsend, NSW 2287, Australia; (S.Y.); (R.S.); (R.H.); (S.L.Y.); (K.R.); (F.T.); (L.W.)
- Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia
| | - Rachel Sutherland
- Hunter New England Population Health, Hunter New England Area Health Service, Longworth Avenue, Wallsend, NSW 2287, Australia; (S.Y.); (R.S.); (R.H.); (S.L.Y.); (K.R.); (F.T.); (L.W.)
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia; (B.M.); (K.H.)
- Priority Research Centre for Health Behaviour, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia
| | - Rebecca Hodder
- Hunter New England Population Health, Hunter New England Area Health Service, Longworth Avenue, Wallsend, NSW 2287, Australia; (S.Y.); (R.S.); (R.H.); (S.L.Y.); (K.R.); (F.T.); (L.W.)
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia; (B.M.); (K.H.)
- Priority Research Centre for Health Behaviour, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia
| | - Debbie Booth
- University Library, Academic Division, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia;
| | - Elaine Toomey
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland, University Road, Galway H91 TK33, Ireland;
| | - Sze Lin Yoong
- Hunter New England Population Health, Hunter New England Area Health Service, Longworth Avenue, Wallsend, NSW 2287, Australia; (S.Y.); (R.S.); (R.H.); (S.L.Y.); (K.R.); (F.T.); (L.W.)
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia; (B.M.); (K.H.)
- Priority Research Centre for Health Behaviour, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia
| | - Kathryn Reilly
- Hunter New England Population Health, Hunter New England Area Health Service, Longworth Avenue, Wallsend, NSW 2287, Australia; (S.Y.); (R.S.); (R.H.); (S.L.Y.); (K.R.); (F.T.); (L.W.)
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia; (B.M.); (K.H.)
- Priority Research Centre for Health Behaviour, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia
| | - Flora Tzelepis
- Hunter New England Population Health, Hunter New England Area Health Service, Longworth Avenue, Wallsend, NSW 2287, Australia; (S.Y.); (R.S.); (R.H.); (S.L.Y.); (K.R.); (F.T.); (L.W.)
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia; (B.M.); (K.H.)
- Priority Research Centre for Health Behaviour, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia
| | - Natalie Taylor
- Cancer Research Division, Cancer Council New South Wales, 153 Dowling St, Woolloomooloo, NSW 2011, Australia;
- School of Health Sciences, University of Sydney, Camperdown, NSW 2006, Australia
| | - Luke Wolfenden
- Hunter New England Population Health, Hunter New England Area Health Service, Longworth Avenue, Wallsend, NSW 2287, Australia; (S.Y.); (R.S.); (R.H.); (S.L.Y.); (K.R.); (F.T.); (L.W.)
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia; (B.M.); (K.H.)
- Priority Research Centre for Health Behaviour, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia
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9
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Mulchandani R, Chandrasekaran AM, Shivashankar R, Kondal D, Agrawal A, Panniyammakal J, Tandon N, Prabhakaran D, Sharma M, Goenka S. Effect of workplace physical activity interventions on the cardio-metabolic health of working adults: systematic review and meta-analysis. Int J Behav Nutr Phys Act 2019; 16:134. [PMID: 31856826 PMCID: PMC6923867 DOI: 10.1186/s12966-019-0896-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Accepted: 12/04/2019] [Indexed: 02/02/2023] Open
Abstract
Background Adults in urban areas spend almost 77% of their waking time being inactive at workplaces, which leaves little time for physical activity. The aim of this systematic review and meta-analysis was to synthesize evidence for the effect of workplace physical activity interventions on the cardio-metabolic health markers (body weight, waist circumference, body mass index (BMI), blood pressure, lipids and blood glucose) among working adults. Methods All experimental studies up to March 2018, reporting cardio-metabolic worksite intervention outcomes among adult employees were identified from PUBMED, EMBASE, COCHRANE CENTRAL, CINAHL and PsycINFO. The Cochrane Risk of Bias tool was used to assess bias in studies. All studies were assessed qualitatively and meta-analysis was done where possible. Forest plots were generated for pooled estimates of each study outcome. Results A total of 33 studies met the eligibility criteria and 24 were included in the meta-analysis. Multi-component workplace interventions significantly reduced body weight (16 studies; mean diff: − 2.61 kg, 95% CI: − 3.89 to − 1.33) BMI (19 studies, mean diff: − 0.42 kg/m2, 95% CI: − 0.69 to − 0.15) and waist circumference (13 studies; mean diff: − 1.92 cm, 95% CI: − 3.25 to − 0.60). Reduction in blood pressure, lipids and blood glucose was not statistically significant. Conclusions Workplace interventions significantly reduced body weight, BMI and waist circumference. Non-significant results for biochemical markers could be due to them being secondary outcomes in most studies. Intervention acceptability and adherence, follow-up duration and exploring non-RCT designs are factors that need attention in future research. Prospero registration number: CRD42018094436.
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Affiliation(s)
- Rubina Mulchandani
- Indian Institute of Public Health-Delhi, Public Health Foundation of India, Gurgaon, India
| | | | | | - Dimple Kondal
- Centre for Chronic Disease Control, New Delhi, India
| | - Anurag Agrawal
- CSIR Institute of Genomics and Integrative Biology, New Delhi, India
| | - Jeemon Panniyammakal
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Government Medical College, Thiruvananthapuram, Kerala, India.,Public Health Foundation of India, Gurgaon, India
| | - Nikhil Tandon
- All India Institute of Medical Sciences, Delhi, India
| | - Dorairaj Prabhakaran
- Centre for Chronic Disease Control, New Delhi, India.,Public Health Foundation of India, Gurgaon, India
| | | | - Shifalika Goenka
- Indian Institute of Public Health-Delhi, Public Health Foundation of India, Gurgaon, India. .,Centre for Chronic Disease Control, New Delhi, India.
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10
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Schwatka NV, Smith D, Weitzenkamp D, Atherly A, Dally MJ, Brockbank CVS, Tenney L, Goetzel RZ, Jinnett K, McMillen J, Newman LS. The Impact of Worksite Wellness Programs by Size of Business: A 3-Year Longitudinal Study of Participation, Health Benefits, Absenteeism, and Presenteeism. Ann Work Expo Health 2019; 62:S42-S54. [PMID: 30212884 DOI: 10.1093/annweh/wxy049] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 05/26/2018] [Indexed: 11/14/2022] Open
Abstract
Objective Worksite wellness programs (WWP) may positively impact employee health, medical expenditures, absenteeism, and presenteeism. However, there has been little research to assess the benefits of WWP in small businesses. The purpose of this study is to prospectively evaluate changes in health, absenteeism, and presenteeism for employees who participated in a WWP. Methods We conducted an observational, 3-year cohort study of 5766 employees from 314 businesses of differing sizes. We followed two cohorts of employees, who completed at least two annual health risk assessments (HRA) between May 2010 and December 2014. Changes from baseline to the first and second follow-up periods were assessed for chronic and non-chronic health conditions, absenteeism, and presenteeism. Results Small business employees were more likely to participate in the WWP than were employees from large businesses. Changes in chronic and non-chronic health conditions varied by size of business, with small business employees showing improvements in stress, overall health, depression, smoking status, vegetable and fruit consumption, and physical activity, and in their perceptions of job health culture. In contrast, large business employees experienced improvements in stress, vegetable consumption, and alcohol use. No changes in absenteeism or presenteeism were observed. Conclusions Small businesses achieve higher employee participation rates and more health improvements when compared to employees from large employers. Findings suggest that small businesses may gain the most from a WWP.
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Affiliation(s)
- Natalie V Schwatka
- Department of Environmental and Occupational Health, Center for Health, Work & Environment, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Derek Smith
- Department of Biostatistics and Informatics, Center for Health, Work and Environment, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - David Weitzenkamp
- Department of Biostatistics and Informatics, Center for Health, Work and Environment, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Adam Atherly
- Department of Health Systems, Management and Policy, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Miranda J Dally
- Department of Environmental and Occupational Health, Center for Health, Work & Environment, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | | | - Liliana Tenney
- Department of Environmental and Occupational Health, Center for Health, Work & Environment, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Ron Z Goetzel
- Institute for Health and Productivity Studies, Johns Hopkins University Bloomberg School of Public Health, Washington, DC, USA.,IBM Watson Health, Bethesda, MD, USA
| | - Kimberly Jinnett
- Center for Workforce Health and Performance, University of California San Francisco, San Francisco, CA, USA.,Institute for Health and Aging, University of California San Francisco, San Francisco, CA, USA
| | | | - Lee S Newman
- Department of Environmental and Occupational Health, Center for Health, Work & Environment, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA.,Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA.,Department of Medicine, School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
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11
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The Centers for Disease Control and Prevention: Findings From The National Healthy Worksite Program. J Occup Environ Med 2018; 59:631-641. [PMID: 28594703 DOI: 10.1097/jom.0000000000001045] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate employers' implementation of evidence-based interventions, and changes in employees' behaviors associated with participating in the national healthy worksite program (NHWP). METHODS NHWP recruited 100 small and mid-sized employers and provided training and support for 18 months. Outcome measures were collected with an employer questionnaire, an employee survey, and biometric data at baseline and 18 months later. RESULTS The 41 employers who completed the NHWP implemented significantly more evidence-based interventions and had more comprehensive worksite health promotion programs after participating. Employees made significant improvements in physical activity and nutritional behaviors, but did not significantly improve employee weight. CONCLUSIONS Training and technical support can help small and mid-sized employers implement evidence-based health interventions to promote positive employee behavior changes. A longer follow up period may be needed to assess whether NHWP led to improvements in clinical outcomes.
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12
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Weerasekara YK, Roberts SB, Kahn MA, LaVertu AE, Hoffman B, Das SK. Effectiveness of Workplace Weight Management Interventions: a Systematic Review. Curr Obes Rep 2016; 5:298-306. [PMID: 27023071 DOI: 10.1007/s13679-016-0205-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
A systematic review was conducted of randomized trials of workplace weight management interventions, including trials with dietary, physical activity, environmental, behavioral, and incentive-based components. Main outcomes were defined as change in weight-related measures. Keywords related to weight management and workplace interventions were used to search relevant databases, and 23 eligible studies were reviewed in detail using a data extraction form and quality assessment checklist. The trials were conducted mainly in the USA and Europe, with four additional countries represented. Interventions were mostly multicomponent and were implemented in both sexes and in a range of employment categories. Intervention effectiveness appeared unrelated to region of the world and was highest in 6-12-month trials. The results ranged widely from clinically significant 8.8-kg weight loss in one trial to less effective than the control treatment in others. Some workplace interventions achieve clinically significant benefits, and further studies are needed to replicate those results in wider sociocultural and geographical contexts.
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Affiliation(s)
- Yasoma Kumari Weerasekara
- Obesity and Energetics Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, 711 Washington Street, Boston, MA, 02111, USA
| | - Susan B Roberts
- Obesity and Energetics Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, 711 Washington Street, Boston, MA, 02111, USA
| | - Mira A Kahn
- Obesity and Energetics Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, 711 Washington Street, Boston, MA, 02111, USA
| | - Amy E LaVertu
- Hirsh Health Sciences Library, Tufts University, Boston, MA, USA
| | - Ben Hoffman
- General Electric Medical Services, GE, Chicago, IL, USA
- University of Texas School of Public Health, San Antonio, TX, USA
| | - Sai Krupa Das
- Obesity and Energetics Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, 711 Washington Street, Boston, MA, 02111, USA.
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13
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Wilson MG, DeJoy DM, Vandenberg R, Padilla H, Davis M. FUEL Your Life: A Translation of the Diabetes Prevention Program to Worksites. Am J Health Promot 2016; 30:188-97. [DOI: 10.4278/ajhp.130411-quan-169] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Purpose. To evaluate the effectiveness of FUEL Your Life, a translation of the Diabetes Prevention Program for worksites. Design. A randomized control group design was conducted in five worksites of a large transportation company. Measures were collected pretest, posttest (6 months), and follow-up (12 months). Setting. Railroad maintenance facilities of Union Pacific Railroad. Subjects. Participants consisted of 362 workers (227 treatment, 135 control). Intervention. FUEL Your Life was translated from the Diabetes Prevention Program to better fit within the context of the worksite. The primary difference was the use of peer health coaches to provide social support and reinforcement and an occupational nurse to provide lesson content (six sessions of 10 minutes) to participants instead of the lifestyle coaches employed by the Diabetes Prevention Program, resulting in a less structured meeting schedule. Measures. The primary outcomes were weight and body mass index (BMI), with secondary outcomes including eating behaviors, physical activity, and social support. Analysis. Latent growth modeling was used to measure changes in the outcomes over time. Results. Participants in the intervention group maintained weight/BMI (–.1 pounds/–.1 BMI), whereas the control participants gained weight/BMI (+2.6 pounds/+.3 BMI), resulting in a statistically significant difference between groups. Fifty-five percent of intervention participants lost some weight, whereas only 35% of the control group lost weight. Conclusions. FUEL Your Life, a low intensity intervention, was not effective for promoting weight loss, but was effective for helping workers maintain weight over a 12-month period.
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14
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Hoffmann KD, Walnoha A, Sloan J, Buddadhumaruk P, Huang HH, Borrebach J, Cluss PA, Burke JG. Developing a Community-Based Tailored Exercise Program for People With Severe and Persistent Mental Illness. Prog Community Health Partnersh 2015; 9:213-27. [PMID: 26412763 DOI: 10.1353/cpr.2015.0045] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND People with severe and persistent mental illness (SPMI) are at a greater risk of medical issues compared with the general population. Exercise has a positive effect on physical and mental health outcomes among this population in community settings. OBJECTIVES To describe community-based participatory research (CBPR) methods used to tailor an exercise program among people with SPMI, demonstrate its impact, and present lessons learned for future research. METHODS The partnership developed a project to explore the feasibility of implementing a physical activity program at a community agency among clients with SPMI. LESSONS LEARNED Data showed improved trends in mood, social support, and physical and mental health outcomes. Facilitators and barriers must be carefully considered for recruitment and retention. CONCLUSIONS A gender-specific, group-based, tailored exercise intervention developed through collaboration with a community agency serving people with SPMI using CBPR methods is feasible.
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15
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Stockdale SE, Tang L, Pudilo E, Lucas-Wright A, Chung B, Horta M, Masongsong Z, Jones F, Belin TR, Sherbourne C, Wells K. Sampling and Recruiting Community-Based Programs Using Community-Partnered Participation Research. Health Promot Pract 2015; 17:254-64. [PMID: 26384926 DOI: 10.1177/1524839915605059] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The inclusion of community partners in participatory leadership roles around statistical design issues like sampling and randomization has raised concerns about scientific integrity. This article presents a case study of a community-partnered, participatory research (CPPR) cluster-randomized, comparative effectiveness trial to examine implications for study validity and community relevance. Using study administrative data, we describe a CPPR-based design and implementation process for agency/program sampling, recruitment, and randomization for depression interventions. We calculated participation rates and used cross-tabulation to examine balance by intervention status on service sector, location, and program size and assessed differences in potential populations served. We achieved 51.5% agency and 89.6% program participation rates. Programs in different intervention arms were not significantly different on service sector, location, or program size. Participating programs were not significantly different from eligible, nonparticipating programs on community characteristics. We reject claims that including community members in research design decisions compromises scientific integrity. This case study suggests that a CPPR process can improve implementation of a community-grounded, rigorous randomized comparative effectiveness trial.
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Affiliation(s)
- Susan E Stockdale
- David Geffen School of Medicine, UCLA, Los Angeles, CA, USA VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Lingqi Tang
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA UCLA Jane and Terry Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
| | - Esmeralda Pudilo
- UCLA Jane and Terry Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
| | - Anna Lucas-Wright
- Healthy African American Families II, Los Angeles, CA, USA Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
| | - Bowen Chung
- David Geffen School of Medicine, UCLA, Los Angeles, CA, USA RAND Corporation, Santa Monica, CA, USA Harbor-UCLA Medical Center, Torrance, CA, USA
| | | | - Zoe Masongsong
- UCLA Jane and Terry Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
| | - Felica Jones
- Healthy African American Families II, Los Angeles, CA, USA
| | - Thomas R Belin
- David Geffen School of Medicine, UCLA, Los Angeles, CA, USA UCLA Jonathan and Karin Fielding School of Public Health, Los Angeles, CA, USA
| | | | - Kenneth Wells
- David Geffen School of Medicine, UCLA, Los Angeles, CA, USA UCLA Jane and Terry Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA RAND Corporation, Santa Monica, CA, USA UCLA Jonathan and Karin Fielding School of Public Health, Los Angeles, CA, USA
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16
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Fernandez ID, Chin NP, Devine CM, Dozier AM, Martina CA, McIntosh S, Thevenet-Morrison K, Yang H. Images of a Healthy Worksite: A Group-Randomized Trial for Worksite Weight Gain Prevention With Employee Participation in Intervention Design. Am J Public Health 2015; 105:2167-74. [PMID: 25790416 DOI: 10.2105/ajph.2014.302397] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We assessed the effects of a worksite multiple-component intervention addressing diet and physical activity on employees' mean body mass index (BMI) and the percentage of employees who were overweight or obese. METHODS This group-randomized trial (n = 3799) was conducted at 10 worksites in the northeastern United States. Worksites were paired and allocated into intervention and control conditions. Within- and between-groups changes in mean BMIs and in the percentage of overweight or obese employees were examined in a volunteer sample. RESULTS Within-group mean BMIs decreased by 0.54 kilograms per meter squared (P = .02) and 0.12 kilograms per meter squared (P = .73) at the intervention and control worksites, respectively, resulting in a difference in differences (DID) decrease of 0.42 kilograms per meter squared (P = .33). The within-group percentage of overweight or obese employees decreased by 3.7% (P = .07) at the intervention worksites and increased by 4.9% (P = .1) at the control worksites, resulting in a DID decline of 8.6% (P = .02). CONCLUSIONS Our findings support a worksite population strategy that might eventually reduce the prevalence of overweight and obesity by minimizing environmental exposures to calorically dense foods and increasing exposures to opportunities for energy expenditure within worksite settings.
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Affiliation(s)
- I Diana Fernandez
- I. Diana Fernandez, Nancy P. Chin, Ann M. Dozier, Camille A. Martina, Scott McIntosh, and Kelly Thevenet-Morrison are with the Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY. Carol M. Devine is with the Division of Nutritional Sciences, Cornell University, Ithaca, NY. Hongmei Yang is with the Department of Biostatistics and Computational Biology, University of Rochester School of Medicine and Dentistry
| | - Nancy P Chin
- I. Diana Fernandez, Nancy P. Chin, Ann M. Dozier, Camille A. Martina, Scott McIntosh, and Kelly Thevenet-Morrison are with the Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY. Carol M. Devine is with the Division of Nutritional Sciences, Cornell University, Ithaca, NY. Hongmei Yang is with the Department of Biostatistics and Computational Biology, University of Rochester School of Medicine and Dentistry
| | - Carol M Devine
- I. Diana Fernandez, Nancy P. Chin, Ann M. Dozier, Camille A. Martina, Scott McIntosh, and Kelly Thevenet-Morrison are with the Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY. Carol M. Devine is with the Division of Nutritional Sciences, Cornell University, Ithaca, NY. Hongmei Yang is with the Department of Biostatistics and Computational Biology, University of Rochester School of Medicine and Dentistry
| | - Ann M Dozier
- I. Diana Fernandez, Nancy P. Chin, Ann M. Dozier, Camille A. Martina, Scott McIntosh, and Kelly Thevenet-Morrison are with the Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY. Carol M. Devine is with the Division of Nutritional Sciences, Cornell University, Ithaca, NY. Hongmei Yang is with the Department of Biostatistics and Computational Biology, University of Rochester School of Medicine and Dentistry
| | - Camille A Martina
- I. Diana Fernandez, Nancy P. Chin, Ann M. Dozier, Camille A. Martina, Scott McIntosh, and Kelly Thevenet-Morrison are with the Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY. Carol M. Devine is with the Division of Nutritional Sciences, Cornell University, Ithaca, NY. Hongmei Yang is with the Department of Biostatistics and Computational Biology, University of Rochester School of Medicine and Dentistry
| | - Scott McIntosh
- I. Diana Fernandez, Nancy P. Chin, Ann M. Dozier, Camille A. Martina, Scott McIntosh, and Kelly Thevenet-Morrison are with the Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY. Carol M. Devine is with the Division of Nutritional Sciences, Cornell University, Ithaca, NY. Hongmei Yang is with the Department of Biostatistics and Computational Biology, University of Rochester School of Medicine and Dentistry
| | - Kelly Thevenet-Morrison
- I. Diana Fernandez, Nancy P. Chin, Ann M. Dozier, Camille A. Martina, Scott McIntosh, and Kelly Thevenet-Morrison are with the Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY. Carol M. Devine is with the Division of Nutritional Sciences, Cornell University, Ithaca, NY. Hongmei Yang is with the Department of Biostatistics and Computational Biology, University of Rochester School of Medicine and Dentistry
| | - Hongmei Yang
- I. Diana Fernandez, Nancy P. Chin, Ann M. Dozier, Camille A. Martina, Scott McIntosh, and Kelly Thevenet-Morrison are with the Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY. Carol M. Devine is with the Division of Nutritional Sciences, Cornell University, Ithaca, NY. Hongmei Yang is with the Department of Biostatistics and Computational Biology, University of Rochester School of Medicine and Dentistry
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17
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Compernolle S, De Cocker K, Lakerveld J, Mackenbach JD, Nijpels G, Oppert JM, Rutter H, Teixeira PJ, Cardon G, De Bourdeaudhuij I. A RE-AIM evaluation of evidence-based multi-level interventions to improve obesity-related behaviours in adults: a systematic review (the SPOTLIGHT project). Int J Behav Nutr Phys Act 2014; 11:147. [PMID: 25480391 PMCID: PMC4266878 DOI: 10.1186/s12966-014-0147-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 11/17/2014] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND This systematic literature review describes the potential public health impact of evidence-based multi-level interventions to improve obesity-related behaviours in adults, using the Reach, Efficacy, Adoption, Implementation and Maintenance (RE-AIM) framework. METHODS Electronic databases (PubMed, Embase, and The Cochrane Library) were searched to identify intervention studies published between January 2000 and October 2013. The following inclusion criteria were used: (1) the study included at least one outcome measure assessing obesity-related behaviours (i.e. diet, physical activity or sedentary behaviour), (2) the study collected data over at least one year and (3) the study's intervention targeted adults, was conducted in a specified geographical area or worksite, and was multi-level (i.e. targeting both individual and environmental level). Evidence of RE-AIM of the selected interventions was assessed. Potential public health impact of an intervention was evaluated if information was provided on at least four of the five RE-AIM dimensions. RESULTS Thirty-five multi-level interventions met the inclusion criteria. RE-AIM evaluation revealed that the included interventions generally had the potential to: reach a large number of people (on average 58% of the target population was aware of the intervention); achieve the assumed goals (89% found positive outcomes); be broadly adopted (the proportion of intervention deliverers varied from 9% to 92%) and be sustained (sixteen interventions were maintained). The highest potential public health impact was found in multi-level interventions that: 1) focused on all levels at the beginning of the planning process, 2) guided the implementation process using diffusion theory, and 3) used a website to disseminate the intervention. CONCLUSIONS Although most studies underreported results within the RE-AIM dimensions, the reported Reach, Effectiveness, Adoption, Implementation and Maintenance were positively evaluated. However, more information on external validity and sustainability is needed in order to take informed decisions on the choice of interventions that should be implemented in real-world settings to accomplish long-term changes in obesity-related behaviours.
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Affiliation(s)
- Sofie Compernolle
- Department of Movement and Sport Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
| | - Katrien De Cocker
- Department of Movement and Sport Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium. .,Research Foundation Flanders (FWO), B-1000, Ghent, Belgium.
| | - Jeroen Lakerveld
- The EMGO Institute for Health and Care Research, Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands.
| | - Joreintje D Mackenbach
- The EMGO Institute for Health and Care Research, Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands.
| | - Giel Nijpels
- The EMGO Institute for Health and Care Research, Department of General Practice and Elderly Care Medicine, VU University Medical Center, Amsterdam, The Netherlands.
| | - Jean-Michel Oppert
- Université Paris 13, Sorbonne Paris Cité - UREN (Unité de Recherche en Epidémiologie Nutritionnelle), U557 Inserm; U1125 Inra; Cnam, Centre for Research on Human Nutrition Ile-de-France (CRNH IdF), Bobigny, France. .,Université Pierre et Marie Curie-Paris 6, Department of Nutrition Pitié-Salpêtrière Hospital (AP-HP), (CRNH IdF), Institute of Cardiometabolism and Nutrition (ICAN), Paris, France.
| | - Harry Rutter
- European Centre on Health of Societies in Transition, London School of Hygiene and Tropical Medicine, London, UK.
| | - Pedro J Teixeira
- Interdisciplinary Center for the Study of Human Performance, Faculty of Human Kinetics, University of Lisbon, Lisbon, Portugal.
| | - Greet Cardon
- Department of Movement and Sport Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
| | - Ilse De Bourdeaudhuij
- Department of Movement and Sport Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
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18
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Roberts SB, Urban LE, Das SK. Effects of dietary factors on energy regulation: Consideration of multiple- versus single-dietary-factor models. Physiol Behav 2014; 134:15-9. [DOI: 10.1016/j.physbeh.2014.04.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Revised: 04/07/2014] [Accepted: 04/08/2014] [Indexed: 11/17/2022]
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19
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Fernandez ID, Becerra A, Chin NP. Worksite Environmental Interventions for Obesity Prevention and Control: Evidence from Group Randomized Trials. Curr Obes Rep 2014; 3:223-34. [PMID: 26626604 DOI: 10.1007/s13679-014-0100-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Worksites provide multiple advantages to prevent and treat obesity and to test environmental interventions to tackle its multiple causal factors. We present a literature review of group-randomized and non-randomized trials that tested worksite environmental, multiple component interventions for obesity prevention and control paying particular attention to the conduct of formative research prior to intervention development. The evidence on environmental interventions on measures of obesity appears to be strong since most of the studies have a low (4/8) and unclear (2/8) risk of bias. Among the studies reviewed whose potential risk of bias was low, the magnitude of the effect was modest and sometimes in the unexpected direction. None of the four studies describing an explicit formative research stage with clear integration of findings into the intervention was able to demonstrate an effect on the main outcome of interest. We present alternative explanation for the findings and recommendations for future research.
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Affiliation(s)
- Isabel Diana Fernandez
- Department of Public Health Sciences, Division of Epidemiology, University of Rochester School of Medicine and Dentistry, 265 Crittenden Blvd., CU 420644, Rochester, NY, 14642-0644, USA.
| | - Adan Becerra
- Department of Public Health Sciences, Division of Epidemiology, University of Rochester School of Medicine and Dentistry, 265 Crittenden Blvd., CU 420644, Rochester, NY, 14642-0644, USA.
| | - Nancy P Chin
- Department of Public Health Sciences, Division of Social and Behavioral Sciences, University of Rochester School of Medicine and Dentistry, 265 Crittenden Blvd., CU 420644, Rochester, NY, 14642-0644, USA.
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Ausburn TF, LaCoursiere S, Crouter SE, McKay T. Review of Worksite Weight Management Programs. Workplace Health Saf 2014. [DOI: 10.3928/21650799-20140219-06] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Ausburn TF, LaCoursiere S, Crouter SE, McKay T. Review of Worksite Weight Management Programs. Workplace Health Saf 2014; 62:122-6; quiz 127. [DOI: 10.1177/216507991406200306] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Accepted: 02/03/2014] [Indexed: 11/17/2022]
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Lemon SC, Wang ML, Wedick NM, Estabrook B, Druker S, Schneider KL, Li W, Pbert L. Weight gain prevention in the school worksite setting: results of a multi-level cluster randomized trial. Prev Med 2014; 60:41-7. [PMID: 24345602 PMCID: PMC3933312 DOI: 10.1016/j.ypmed.2013.12.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Revised: 12/03/2013] [Accepted: 12/07/2013] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To describe the effectiveness, reach and implementation of a weight gain prevention intervention among public school employees. METHOD A multi-level intervention was tested in a cluster randomized trial among 782 employees in 12 central Massachusetts public high schools from 2009 to 2012. The intervention targeted the nutrition and physical activity environment and policies, the social environment and individual knowledge, attitudes and skills. The intervention was compared to a materials only condition. The primary outcome measures were change in weight and body mass index (BMI) at 24-month follow-up. Implementation of physical environment, policy and social environment strategies at the school and interpersonal levels, and intervention participation at the individual level were assessed. RESULTS At 24-month follow-up, there was a net change (difference of the difference) of -3.03 pounds (p=.04) and of -.48 BMI units (p=.05) between intervention and comparison conditions. The majority of intervention strategies were successfully implemented by all intervention schools, although establishing formal policies was challenging. Employee participation in programs targeting the physical and social environment was maintained over time. CONCLUSION This study supports that a multi-level intervention integrated within the organizational culture can be successfully implemented and prevent weight gain in public high school employees.
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Affiliation(s)
- Stephenie C Lemon
- University of Massachusetts Medical School, Division of Preventive and Behavioral Medicine, Department of Medicine, 55 Lake Avenue North, Worcester, MA 01655, USA.
| | - Monica L Wang
- University of Massachusetts Medical School, Division of Preventive and Behavioral Medicine, Department of Medicine, 55 Lake Avenue North, Worcester, MA 01655, USA.
| | - Nicole M Wedick
- University of Massachusetts Medical School, Division of Preventive and Behavioral Medicine, Department of Medicine, 55 Lake Avenue North, Worcester, MA 01655, USA.
| | - Barbara Estabrook
- University of Massachusetts Medical School, Division of Preventive and Behavioral Medicine, Department of Medicine, 55 Lake Avenue North, Worcester, MA 01655, USA.
| | - Susan Druker
- University of Massachusetts Medical School, Division of Preventive and Behavioral Medicine, Department of Medicine, 55 Lake Avenue North, Worcester, MA 01655, USA.
| | - Kristin L Schneider
- Rosalind Franklin University of Medicine and Science, Department of Psychology, 3333 Green Bay Road, North Chicago, IL 60064, USA.
| | - Wenjun Li
- University of Massachusetts Medical School, Division of Preventive and Behavioral Medicine, Department of Medicine, 55 Lake Avenue North, Worcester, MA 01655, USA.
| | - Lori Pbert
- University of Massachusetts Medical School, Division of Preventive and Behavioral Medicine, Department of Medicine, 55 Lake Avenue North, Worcester, MA 01655, USA.
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Mastellos N, Gunn LH, Felix LM, Car J, Majeed A. Transtheoretical model stages of change for dietary and physical exercise modification in weight loss management for overweight and obese adults. Cochrane Database Syst Rev 2014; 2014:CD008066. [PMID: 24500864 PMCID: PMC10088065 DOI: 10.1002/14651858.cd008066.pub3] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Obesity is a global public health threat. The transtheoretical stages of change (TTM SOC) model has long been considered a useful interventional approach in lifestyle modification programmes, but its effectiveness in producing sustainable weight loss in overweight and obese individuals has been found to vary considerably. OBJECTIVES To assess the effectiveness of dietary intervention or physical activity interventions, or both, and other interventions based on the transtheoretical model (TTM) stages of change (SOC) to produce sustainable (one year and longer) weight loss in overweight and obese adults. SEARCH METHODS Studies were obtained from searches of multiple electronic bibliographic databases. We searched The Cochrane Library, MEDLINE, EMBASE and PsycINFO. The date of the last search, for all databases, was 17 December 2013. SELECTION CRITERIA Trials were included if they fulfilled the criteria of randomised controlled clinical trials (RCTs) using the TTM SOC as a model, that is a theoretical framework or guideline in designing lifestyle modification strategies, mainly dietary and physical activity interventions, versus a comparison intervention of usual care; one of the outcome measures of the study was weight loss, measured as change in weight or body mass index (BMI); participants were overweight or obese adults only; and the intervention was delivered by healthcare professionals or trained lay people at the hospital and community level, including at home. DATA COLLECTION AND ANALYSIS Two review authors independently extracted the data, assessed studies for risk of bias and evaluated overall study quality according to GRADE (Grading of Recommendations Assessment, Development and Evaluation). We resolved disagreements by discussion or consultation with a third party. A narrative, descriptive analysis was conducted for the systematic review. MAIN RESULTS A total of three studies met the inclusion criteria, allocating 2971 participants to the intervention and control groups. The total number of participants randomised to the intervention groups was 1467, whilst 1504 were randomised to the control groups. The length of intervention was 9, 12 and 24 months in the different trials. The use of TTM SOC in combination with diet or physical activity, or both, and other interventions in the included studies produced inconclusive evidence that TTM SOC interventions led to sustained weight loss (the mean difference between intervention and control groups varied from 2.1 kg to 0.2 kg at 24 months; 2971 participants; 3 trials; low quality evidence). Following application of TTM SOC there were improvements in physical activity and dietary habits, such as increased exercise duration and frequency, reduced dietary fat intake and increased fruit and vegetable consumption (very low quality evidence). Weight gain was reported as an adverse event in one of the included trials. None of the trials reported health-related quality of life, morbidity, or economic costs as outcomes. The small number of studies and their variable methodological quality limit the applicability of the findings to clinical practice. The main limitations include inadequate reporting of outcomes and the methods for allocation, randomisation and blinding; extensive use of self-reported measures to estimate the effects of interventions on a number of outcomes, including weight loss, dietary consumption and physical activity levels; and insufficient assessment of sustainability due to lack of post-intervention assessments. AUTHORS' CONCLUSIONS The evidence to support the use of TTM SOC in weight loss interventions is limited by risk of bias and imprecision, not allowing firm conclusions to be drawn. When combined with diet or physical activity, or both, and other interventions we found very low quality evidence that it might lead to better dietary and physical activity habits. This systematic review highlights the need for well-designed RCTs that apply the principles of the TTM SOC appropriately to produce conclusive evidence about the effect of TTM SOC lifestyle interventions on weight loss and other health outcomes.
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Affiliation(s)
- Nikolaos Mastellos
- Imperial College LondonGlobal eHealth Unit, Department of Primary Care and Public Health, School of Public HealthSt Dunstans RoadLondonHammersmithUKW6 8RP
| | - Laura H Gunn
- Stetson UniversityIntegrative Health Science421 N Woodland BlvdUnit 8317DeLandFloridaUSA32723
| | - Lambert M Felix
- School of Public Health, Imperial College LondonGlobal eHealth Unit, Department of Primary Care and Public HealthSt Dunstans RoadLondonUKW6 8RP
| | - Josip Car
- Imperial College LondonGlobal eHealth Unit, Department of Primary Care and Public Health, School of Public HealthSt Dunstans RoadLondonHammersmithUKW6 8RP
| | - Azeem Majeed
- Imperial College LondonDepartment of Primary Care and Public HealthThe Reynolds Building, Charing Cross CampusSt Dunstan's RoadLondonUKW6 8RP
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Harris JR, Hannon PA, Beresford SAA, Linnan LA, McLellan DL. Health promotion in smaller workplaces in the United States. Annu Rev Public Health 2014; 35:327-42. [PMID: 24387086 PMCID: PMC10378509 DOI: 10.1146/annurev-publhealth-032013-182416] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Most American workplaces are smaller, with fewer than 1,000 employees. Many of these employees are low-wage earners and at increased risk for chronic diseases. Owing to the challenges smaller workplaces face to offering health-promotion programs, their employees often lack access to health-promotion opportunities available at larger workplaces. Many smaller employers do not offer health insurance, which is currently the major funding vehicle for health-promotion services. They also have few health-promotion vendors to serve them and low internal capacity for, and commitment to, delivery of on-site programs. The programs they offer, whether aimed at health promotion alone or integrated with health protection, are rarely comprehensive and are understudied. Research priorities for health promotion in smaller workplaces include developing programs feasible for the smallest workplaces with fewer than 20 employees. Policy priorities include incentives for smaller workplaces to implement comprehensive programs and an ongoing system for monitoring and evaluation.
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Affiliation(s)
- Jeffrey R Harris
- Department of Health Services, School of Public Health, University of Washington, Seattle, Washington 98105; , ,
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Miranda J, Ong MK, Jones L, Chung B, Dixon EL, Tang L, Gilmore J, Sherbourne C, Ngo VK, Stockdale S, Ramos E, Belin TR, Wells KB. Community-partnered evaluation of depression services for clients of community-based agencies in under-resourced communities in Los Angeles. J Gen Intern Med 2013; 28:1279-87. [PMID: 23670566 PMCID: PMC3785668 DOI: 10.1007/s11606-013-2480-7] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Revised: 02/27/2013] [Accepted: 04/18/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND As medical homes are developing under health reform, little is known regarding depression services need and use by diverse safety-net populations in under-resourced communities. For chronic conditions like depression, primary care services may face new opportunities to partner with diverse community service providers, such as those in social service and substance abuse centers, to support a collaborative care model of treating depression. OBJECTIVE To understand the distribution of need and current burden of services for depression in under-resourced, diverse communities in Los Angeles. DESIGN Baseline phase of a participatory trial to improve depression services with data from client screening and follow-up surveys. PARTICIPANTS Of 4,440 clients screened from 93 programs (primary care, mental health, substance abuse, homeless, social and other community services) in 50 agencies, 1,322 were depressed according to an eight-item Patient Health Questionnaire (PHQ-8) and gave contact information; 1,246 enrolled and 981 completed surveys. Ninety-three programs, including 17 primary care/public health, 18 mental health, 20 substance abuse, ten homeless services, and 28 social/other community services, participated. MAIN MEASURES Comparisons by setting in 6-month retrospective recall of depression services use. KEY RESULTS Depression prevalence ranged from 51.9 % in mental health to 17.2 % in social-community programs. Depressed clients used two settings on average to receive depression services; 82 % used any setting. More clients preferred counseling over medication for depression treatment. CONCLUSIONS Need for depression care was high, and a broad range of agencies provide depression care. Although most participants had contact with primary care, most depression services occurred outside of primary care settings, emphasizing the need to coordinate and support the quality of community-based services across diverse community settings.
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Affiliation(s)
- Jeanne Miranda
- Department of Psychiatry, David Geffen School of Medicine, UCLA, Los Angeles, USA,
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Malik SH, Blake H, Suggs LS. A systematic review of workplace health promotion interventions for increasing physical activity. Br J Health Psychol 2013; 19:149-80. [PMID: 23827053 DOI: 10.1111/bjhp.12052] [Citation(s) in RCA: 187] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Revised: 04/12/2013] [Indexed: 01/28/2023]
Abstract
PURPOSE The benefits of an active lifestyle are widely documented, yet studies show that only a small proportion of adults engage in sufficient levels of physical activity. The workplace presents an ideal avenue for delivering initiatives to promote physical activity, overcoming commonly cited barriers such as a 'lack of time' and providing access to a large intersection of society. The purpose of this study was to (1) explore the types of interventions workplaces implement to promote physical activity among staff, (2) describe the characteristics of those interventions, (3) understand whether these interventions positively impact on activity levels, and (4) assess the methodological quality of studies. METHODS A systematic review of workplace physical activity interventions published up to April 2011 was conducted to identify types of interventions and their outcomes. RESULTS Of the 58 studies included, the majority utilized health promotion initiatives. There were six physical activity/exercise interventions, 13 counselling/support interventions, and 39 health promotion messages/information interventions. Thirty-two of these studies showed a statistically significant increase in a measure of physical activity against a control group at follow-up. CONCLUSIONS While the studies included in this review show some evidence that workplace physical activity interventions can be efficacious, overall the results are inconclusive. Despite the proliferation of research in this area, there is still a need for more well-designed studies to fully determine the effectiveness of workplace interventions for increasing physical activity and to identify the types of interventions that show the most promise.
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To QG, Chen TTL, Magnussen CG, To KG. Workplace Physical Activity Interventions: A Systematic Review. Am J Health Promot 2013; 27:e113-23. [DOI: 10.4278/ajhp.120425-lit-222] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective. To assess the effectiveness of workplace interventions in improving physical activity. Data Source. EBSCO research database (and all subdatabases). Study Inclusion and Exclusion Criteria. Articles were published from 2000 to 2010 in English, had appropriate designs, and measured employees' physical activity, energy consumption, and/or body mass index (BMI) as primary outcomes. Articles that did not meet the inclusion criteria were excluded. Data Extraction. Data extracted included study design, study population, duration, intervention activities, outcomes, and results. Data Synthesis. Data were synthesized into one table. Results of each relevant outcome including p values were combined. Results. Twelve (60%) of 20 selected interventions reported an improvement in physical activity level, steps, or BMI, and there was one slowed step reduction in the intervention group. Among these, 10 were less than 6 months in duration; 9 used pedometers; 6 applied Internet-based approaches; and 5 included activities targeting social and environmental levels. Seven of 8 interventions with pre-posttest and quasi-experimental controlled design showed improvement on at least one outcome. However, 7 of 12 randomized controlled trials (RCTs) did not prove effective in any outcome. Conclusion. Interventions that had less rigorous research designs, used pedometers, applied Internet-based approaches, and included activities at social and environmental levels were more likely to report being effective than those without these characteristics.
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Mehta S, Dimsdale J, Nagle B, Holub CK, Woods C, Barquera S, Elder JP. Worksite interventions: improving lifestyle habits among Latin American adults. Am J Prev Med 2013; 44:538-42. [PMID: 23597820 DOI: 10.1016/j.amepre.2013.01.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2012] [Revised: 01/22/2013] [Accepted: 01/29/2013] [Indexed: 10/27/2022]
Abstract
CONTEXT Worksite-based interventions have been shown to result consistently in significant improvements in weight- and health-related outcomes among the working adult population; however, applicability and effectiveness of studies has often been limited by inadequate reporting of age and ethnicity. This study aimed to examine work-based interventions among Latinos in the U.S. and Latin America. EVIDENCE ACQUISITION Data were abstracted (and analyzed) from "parent" study Guide to Obesity Prevention in Latin American and the U.S. (GOL), between January 2010 and December 2011. Manuscripts from 1965 to 2010 were evaluated according to inclusion criteria for interventions, including a sample population of at least 50% Latinos or results stratified by ethnicity, at least one obesity-related outcome measure evaluated before and after intervention, and worksite setting and comparison of an intervention group to a non-intervention group (including pre-post designs). EVIDENCE SYNTHESIS Of 105 interventions abstracted, five were work-based interventions. The average participant age was 45 years, with an average of 58% women. Four of the five interventions had a pre-post study design that received a fair execution score and lowest design-suitability score, whereas one group RCT intervention had the greatest design suitability and good execution. For two studies, Cohen's d effect sizes ranged from 0.09 to 0.603. Effect sizes could not be calculated for three of the interventions. Three interventions found significant outcomes for BMI, three for weight, two for waist circumference, and one for waist-to-hip ratio. CONCLUSIONS Few studies have focused on work-based interventions specifically aimed at Latinos. This review identified promising strategies for reducing obesity in the workplace.
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Affiliation(s)
- Setoo Mehta
- Institute for Behavioral and Community Health, San Diego State University, San Diego, CA 92123, USA
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Salinardi TC, Batra P, Roberts SB, Urban LE, Robinson LM, Pittas AG, Lichtenstein AH, Deckersbach T, Saltzman E, Das SK. Lifestyle intervention reduces body weight and improves cardiometabolic risk factors in worksites. Am J Clin Nutr 2013; 97:667-76. [PMID: 23426035 PMCID: PMC3607649 DOI: 10.3945/ajcn.112.046995] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Worksites are potentially effective locations for obesity control because they provide opportunities for group intervention and social support. Studies are needed to identify effective interventions in these settings. OBJECTIVE We examined the effects of a multicomponent lifestyle intervention on weight loss and prevention of regain in 4 worksites (2 intervention and 2 control sites). DESIGN Overweight and obese employees (n = 133) enrolled in this pilot worksite-randomized controlled trial with a 0-6-mo weight-loss phase and a 6-12-mo structured weight-maintenance phase. The intervention combined recommendations to consume a reduced-energy, low-glycemic load, high-fiber diet with behavioral change education. Outcome measurements included changes in body weight and cardiometabolic risk factors. RESULTS The mean ± SEM weight loss was substantial in intervention participants, whereas control subjects gained weight (-8.0 ± 0.7 compared with +0.9 ± 0.5 kg, respectively; P < 0.001), and 89% of participants completed the weight-loss phase. Intervention effects were not significant at the 0.05 level but would have been at the 0.10 level (P = 0.08) in a mixed model in which the worksite nested within group was a random factor. There were also significant improvements in cardiometabolic risk factors in intervention compared with control subjects regarding fasting total cholesterol, glucose, systolic blood pressure, and diastolic blood pressure (P ≤ 0.02 for each). No significant weight regain was observed in participants who enrolled in the structured weight-maintenance program (0.5 ± 0.7 kg; P = 0.65), and overweight and obese employees in intervention worksites who were not enrolled in the weight-loss program lost weight compared with subjects in control worksites (-1.3 ± 0.5 compared with +0.7 ± 0.2 kg, respectively; P = 0.02). CONCLUSION Worksites can be effective for achieving clinically important reductions in body weight and improved cardiometabolic risk factors. This trial was registered at clinicaltrials.gov as NCT01470222.
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Affiliation(s)
- Taylor C Salinardi
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA 02111, USA
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DeJoy DM, Padilla HM, Wilson MG, Vandenberg RJ, Davis MA. Worksite translation of the Diabetes Prevention Program: formative research and pilot study results from FUEL Your Life. Health Promot Pract 2012; 14:506-13. [PMID: 23091301 DOI: 10.1177/1524839912461014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article summarizes formative research and pilot study findings from a workplace translation of the Diabetes Prevention Program (DPP). The overarching goal was to devise a relatively straightforward weight management intervention suitable for use in a wide array of work settings. This project was conducted in conjunction with Union Pacific Railroad at one of their locomotive maintenance facilities. Participating employees were predominately male and middle-aged. Formative data were collected through stakeholder interviews, focus groups, and direct observation of the work environment. These results were used to adapt the DPP into a largely self-directed intervention augmented by peer health coaches and the on-site nurse. A small pilot test of the adapted program (n = 67) produced modest but statistically significant weight reductions at both 6 (core intervention period) and 12 months (maintenance period). These results are discussed in terms of the original DPP and other DPP translation studies.
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Affiliation(s)
- David M DeJoy
- College of Public Health, University of Georgia, Athens, GA 30602-6522, USA.
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Lagrosen Y, Lagrosen S. Organisational learning for school quality and health. INTERNATIONAL JOURNAL OF EDUCATIONAL MANAGEMENT 2012. [DOI: 10.1108/09513541211263737] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Roberts SB, Krebs N. Can weight management programs in worksites reduce the obesity epidemic? Adv Nutr 2012; 3:730-1. [PMID: 22983856 PMCID: PMC3648759 DOI: 10.3945/an.112.002634] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Susan B. Roberts
- Energy Metabolism Laboratory at JM USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA,To whom correspondence should be addressed. E-mail:
| | - Nancy Krebs
- Department of Pediatrics, University of Colorado, Denver, CO
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Webber LS, Rice JC, Johnson CC, Rose D, Srinivasan SR, Berenson GS. Cardiovascular risk factors and physical activity behavior among elementary school personnel: baseline results from the ACTION! worksite wellness program. THE JOURNAL OF SCHOOL HEALTH 2012; 82:410-416. [PMID: 22882104 DOI: 10.1111/j.1746-1561.2012.00716.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Although the prevalence of obesity is increasing during adulthood, there have been few assessments of obesity, cardiovascular risk factors, and levels of physical activity among adult elementary school staff. METHODS Data were collected from 745 African-American and White female school personnel in a suburban school district in southeastern Louisiana as part of the baseline assessment before implementation of a program to improve eating and physical activity behaviors. Anthropometry, blood pressure, serum lipids and lipoproteins, and glucose were measured using established protocols. Physical activity was assessed by accelerometry. RESULTS For both White and Black females, 30% were overweight (body mass index [BMI]) ≥25 kg/m(2) but <30 kg/m(2) ). Whereas 37% of White females were obese (BMI ≥ 30 kg/m(2) ), 61% of the Black females were obese. There was a positive association between BMI and other cardiovascular risk factors except for high-density lipoprotein cholesterol, where the association was negative. The mean number of minutes of daily moderate-to-vigorous physical activity was <1 minute per day and was lower for overweight and obese women than for normal weight women. CONCLUSIONS School personnel in the study have adverse cardiovascular risk factors, including high rates of obesity and very low levels of physical activity. Because these individuals are often called upon to promote health for children, they are an important target population for wellness interventions.
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Affiliation(s)
- Larry S Webber
- Department of Biostatistics and Bioinformatics, Tulane School of Public Health and Tropical Medicine, 1440 Canal Street, New Orleans, LA 70112, USA.
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De las Nueces D, Hacker K, DiGirolamo A, Hicks LS. A systematic review of community-based participatory research to enhance clinical trials in racial and ethnic minority groups. Health Serv Res 2012; 47:1363-86. [PMID: 22353031 DOI: 10.1111/j.1475-6773.2012.01386.x] [Citation(s) in RCA: 210] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To examine the effectiveness of current community-based participatory research (CBPR) clinical trials involving racial and ethnic minorities. DATA SOURCE All published peer-reviewed CBPR intervention articles in PubMed and CINAHL databases from January 2003 to May 2010. STUDY DESIGN We performed a systematic literature review. DATA COLLECTION/EXTRACTION METHODS Data were extracted on each study's characteristics, community involvement in research, subject recruitment and retention, and intervention effects. PRINCIPLE FINDINGS We found 19 articles meeting inclusion criteria. Of these, 14 were published from 2007 to 2010. Articles described some measures of community participation in research with great variability. Although CBPR trials examined a wide range of behavioral and clinical outcomes, such trials had very high success rates in recruiting and retaining minority participants and achieving significant intervention effects. CONCLUSIONS Significant publication gaps remain between CBPR and other interventional research methods. CBPR may be effective in increasing participation of racial and ethnic minority subjects in research and may be a powerful tool in testing the generalizability of effective interventions among these populations. CBPR holds promise as an approach that may contribute greatly to the study of health care delivery to disadvantaged populations.
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Affiliation(s)
- Denise De las Nueces
- Commonwealth Fund/Harvard University Fellowship in Minority Health Policy, 164 Longwood Avenue, 2nd Floor, Boston, MA 02115, USA.
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Tuah NA, Amiel C, Qureshi S, Car J, Kaur B, Majeed A. Transtheoretical model for dietary and physical exercise modification in weight loss management for overweight and obese adults. Cochrane Database Syst Rev 2011:CD008066. [PMID: 21975777 DOI: 10.1002/14651858.cd008066.pub2] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Obesity is a global public health threat. The transtheoretical model stages of change (TTM SOC) model has long been considered a useful interventional approach in lifestyle modification programmes, but its effectiveness in producing sustainable weight loss in overweight and obese individuals has been found to vary considerably. OBJECTIVES To assess the effectiveness of dietary and physical activity interventions based on the transtheoretical model, to produce sustainable weight loss in overweight and obese adults. SEARCH STRATEGY Studies were obtained from searches of multiple electronic bibliographic databases. Date of last search for The Cochrane Library was issue 10, 2010, for MEDLINE Dezember 2010, for EMBASE January 2011 and for PSYCHINFO Januar 2011. SELECTION CRITERIA Trials were included if they fulfilled the following criteria: randomised controlled clinical trials using TTM SOC as a model, theoretical framework or guideline in designing lifestyle modification strategies, mainly dietary and physical exercise versus a comparison intervention of usual care; one of the outcome measures of the study was weight loss; and participants were overweight or obese adults. DATA COLLECTION AND ANALYSIS Two researchers independently applied the inclusion criteria to the identified studies and assessed risk of bias. Disagreement was resolved by discussion or by intervention of a third party. Descriptive analysis was conducted for the review. MAIN RESULTS A total of five studies met the inclusion criteria and a total of 3910 participants were evaluated. The total number of participants randomised to intervention groups was 1834 and 2076 were randomised to control groups. Overall risk of bias was high. The trials varied in length of intervention from six weeks to 24 months, with a median length of nine months. The intervention was found to have limited impact on weight loss (about 2 kg or less) and other outcome measures. There was no conclusive evidence for sustainable weight loss. However, TTM SOC and a combination of physical activity, diet and other interventions tended to produce significant outcomes (particularly change in physical activity and dietary intake). TTM SOC was used inconsistently as a theoretical framework for intervention in the trials. Death and weight gain are the two adverse events reported by the included trials. None of the trials reported health-related quality of life, morbidity, and costs as outcomes. AUTHORS' CONCLUSIONS TTM SOC and a combination of physical activity, diet and other interventions resulted in minimal weight loss, and there was no conclusive evidence for sustainable weight loss. The impact of TTM SOC as theoretical framework in weight loss management may depend on how it is used as a framework for intervention and in combination with other strategies like diet and physical activities.
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Affiliation(s)
- Nik Aa Tuah
- Department of Primary Care and Public Health, Faculty of Medicine, Imperial College London, The Reynolds Building, Charing Cross Campus, St. Dunstan's Road, London, UK, W6 8RP
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Thorndike AN. Workplace Interventions to Reduce Obesity and Cardiometabolic Risk. CURRENT CARDIOVASCULAR RISK REPORTS 2010; 5:79-85. [PMID: 22708000 DOI: 10.1007/s12170-010-0138-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The worksite is ideal for implementing interventions to reduce obesity and cardiometabolic risk factors. Although worksite health promotion is not new, employer-sponsored wellness programs have become more widespread due to the rising prevalence and high cost of obesity. Over the past two decades, employers and researchers focused efforts on individual-based programs to change employees' nutrition and exercise behaviors, but more recently, the worksite environment has been targeted. Overall, there is good evidence that individual-based worksite programs can produce modest weight loss, but the evidence for effects on other risk factors and on long-term health outcomes and costs is inconsistent. There is less evidence for the benefit of environmental-based interventions, and more data will be needed to establish conclusions about the benefits of these types of interventions. A major challenge for employers and researchers in the future will be to find the balance between effectiveness and economic viability of worksite wellness programs.
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Affiliation(s)
- Anne N Thorndike
- General Medicine Unit, Massachusetts General Hospital and Harvard Medical School, 50 Staniford Street, 9th floor, Boston, MA 02114, USA
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