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Determinants of consumer acceptance and use of personalized dietary advice: A systematic review. Trends Food Sci Technol 2022. [DOI: 10.1016/j.tifs.2022.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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BAZ S, UYSAL TORAMAN A. Interventions Preventing Osteoporosis in Primary Care: A Systematic Review. CLINICAL AND EXPERIMENTAL HEALTH SCIENCES 2022. [DOI: 10.33808/clinexphealthsci.1019617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective: The aim of this study was to conduct a systematic review to find interventions in primary health care that would increase osteoporosis prevention behaviors.
Methods: Systematic searches of CINAHL, Eric, Medline complete, PsycInfo, Ovid, Web of Science, Cochrane Library (N=1270). A total of 17 published articles met our inclusion criteria. English-language articles published between January 2000-May 2019, in primary care settings, participants with healthy or risk of osteoporosis, investigated osteoporosis preventing behaviors. The data extracted included population characteristics, diagnosis, mean age and setting, intervention and control groups, and outcomes of significance to the review question and specific objectives. In this review, a meta-analysis could not be performed due to the heterogeneity of the data.
Results: The majority of studies have been found to use multiple strategies to prevent osteoporosis. Eight studies focused only on the female gender and seven studies focused only on older adults. Compared to the control groups, it was found that the participants’ osteoporosis knowledge increased significantly (p
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The Effectiveness of the Transtheoretical Model to Improve Physical Activity in Healthy Adults: A Systematic Review. J Phys Act Health 2020; 18:94-108. [PMID: 33260143 DOI: 10.1123/jpah.2020-0334] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 09/29/2020] [Accepted: 10/04/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Despite the known risks of physical inactivity, only 50% of adults meet the recommended guidelines for physical activity (PA). Therefore, numerous interventions have been designed to increase PA across a lifespan. The purpose of this systematic review was to determine the effectiveness of interventions based on the transtheoretical model to improve PA in healthy adults. METHODS Electronic databases (CINAHL, MEDLINE, Psychology & Behavioral Sciences Collection, PsycINFO, Sociological Collection, and SPORTDiscus) were systematically searched from January 2001 to May 2020. RESULTS A total of 11 randomized pretest-posttest studies were included in this review. Ten studies utilized a subjective measurement of PA, and 3 studies included an objective measure. Five studies demonstrated significant improvements in PA for the transtheoretical model-based intervention groups compared with control/comparison groups; however, 6 studies demonstrated no differences between groups. CONCLUSION The findings suggest that there is inconsistent evidence to support the use of interventions based on the transtheoretical model to improve PA in adult populations. Interventions were more successful when materials were delivered via in-person counseling and when study participants were in the precontemplation or contemplation phases at baseline.
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Linton DN, Porteous J, Eatson H, Chepesiuk R, Long T, Inrig TM, Frankel L, Jain R, Sale JEM. Educational booklet reinforces knowledge of osteoporosis and influences intentions to improve bone health in previously diagnosed and treated patients. Osteoporos Int 2020; 31:1703-1711. [PMID: 32333065 DOI: 10.1007/s00198-020-05392-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 03/16/2020] [Indexed: 10/24/2022]
Abstract
UNLABELLED We examined individuals' experiences using an educational booklet developed by the Ontario Osteoporosis Strategy. The booklet appeared to motivate individuals to make changes to their existing management of their bone health and served as a reference tool reaffirming current practices and beliefs for others. INTRODUCTION The purpose of this study was to examine individuals' experiences of the educational booklet and explore the influence of the booklet on individuals' beliefs and actions regarding their bone health. METHODS Eligible individuals were those who had been prescribed medication to treat low bone mass. One-on-one telephone interviews were conducted over an 18-month period. Participants were interviewed for approximately 1 hour and asked to provide their feedback on the booklet, and to discuss what they were doing with respect to the recommendations made in the booklet. RESULTS We interviewed 50 participants who ranged in age from 58 to 89. The overall impression of the booklet was positive. Participants described the language in the booklet as clear and easy to understand. Participants stated that they would have appreciated receiving this tool at the onset of their diagnosis. Forty-two participants had already taken action, or expressed an intention to make changes, to their existing routines to improve their bone health. In contrast, eight participants used the booklet to reaffirm current practices and beliefs. For these individuals, the recommendations made in the booklet were consistent with what they had already been doing. CONCLUSION The booklet can engage patients in discussions about bone health. The booklet appeared to motivate individuals to make changes to their existing routines in an effort to achieve better health outcomes for their bone health. Providing a tool like this to people recently diagnosed with a bone health issue may prove to be beneficial.
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Affiliation(s)
- D N Linton
- Musculoskeletal Health & Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.
| | - J Porteous
- Ontario Osteoporosis Strategy, Osteoporosis Canada, 201-250 Ferrand Drive, Toronto, ON, M3C 3G8, Canada
| | - H Eatson
- Ontario Osteoporosis Strategy, Osteoporosis Canada, 201-250 Ferrand Drive, Toronto, ON, M3C 3G8, Canada
| | - R Chepesiuk
- Ontario Osteoporosis Strategy, Osteoporosis Canada, 201-250 Ferrand Drive, Toronto, ON, M3C 3G8, Canada
| | - T Long
- Ontario Osteoporosis Strategy, Osteoporosis Canada, 201-250 Ferrand Drive, Toronto, ON, M3C 3G8, Canada
| | - T M Inrig
- Musculoskeletal Health & Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - L Frankel
- Musculoskeletal Health & Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - R Jain
- Ontario Osteoporosis Strategy, Osteoporosis Canada, 201-250 Ferrand Drive, Toronto, ON, M3C 3G8, Canada
| | - J E M Sale
- Musculoskeletal Health & Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, 4th Floor, 155 College Street, Toronto, ON, M5T 3M6, Canada
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Murata Y, Scarneo-Miller SE, McMahon LJ, Casa DJ. Adoption of Emergency Action Plans in Secondary Schools: A Study of School Nurses' Knowledge and Behavior. THE JOURNAL OF SCHOOL HEALTH 2020; 90:694-702. [PMID: 32779227 DOI: 10.1111/josh.12930] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 12/16/2019] [Accepted: 01/04/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND The adoption of an emergency action plan for athletics (AEAP) minimizes the consequences of injuries. School nurses may play an important role in the adoption of an AEAP. The purpose of our study was to describe school nurse's knowledge and perceptions related to AEAP adoption. METHODS An online survey, following the Precaution-Adoption Process Model, examining respondents' readiness to act, was distributed to 1228 school nurses to evaluate their knowledge and perception of an AEAP, with N = 131 (10.6%) responding. RESULTS Sixty-one school nurses were unaware of AEAP adoption at their school. A lack of athletic training services at the school was associated with not adopting an AEAP. The most frequently reported barrier to adopting an AEAP related to finances. When nurses reported perceiving more barriers to adopting an AEAP, their schools were less likely to adopt one. CONCLUSIONS A large number of nurses were unaware if their school adopted an AEAP. There is a need to improve nurses' knowledge and perceptions to promote AEAP development.
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Affiliation(s)
- Yuki Murata
- Graduate School of Education and Human Development, Nagoya University, Furo-cho, Chikusa-ku, Nagoya 464-8601, Japan
| | - Samantha E Scarneo-Miller
- Division of Athletic Training, School of Medicine, West Virginia University, 1 Medical Center Drive, 8501A Health Sciences Center South, Morgantown, WV 26506-9225
| | - Liza J McMahon
- Department of Health Sciences and Nursing, University of Hartford, 200 Bloomfield Avenue, West Hartford, CT 06117
| | - Douglas J Casa
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, 2095 Hillside Road U-1110, Storrs, CT 06269-1110
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Ziebart C, McArthur C, Lee L, Papaioannou A, Laprade J, Cheung AM, Jain R, Giangregorio L. "Left to my own devices, I don't know": using theory and patient-reported barriers to move from physical activity recommendations to practice. Osteoporos Int 2018; 29:1081-1091. [PMID: 29441402 DOI: 10.1007/s00198-018-4390-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 01/08/2018] [Indexed: 11/24/2022]
Abstract
UNLABELLED Knowledge exchange with community-dwelling individuals across Ontario revealed barriers to implementation of physical activity recommendations that reflected capability, opportunity, and motivation; barriers unique to individuals with osteoporosis include fear of fracturing, trust in providers, and knowledge of exercise terminology. Using the Behaviour Change Wheel, we identified interventions (training, education, modeling) and policy categories (communication/marketing, guidelines, service provision). INTRODUCTION Physical activity recommendations exist for individuals with osteoporosis; however, to change behavior, we must address barriers and facilitators to their implementation. The purposes of this project are (1) to identify barriers to and facilitators of uptake of disease-specific physical activity recommendations (2) to use the findings to identify behavior change strategies using the Behaviour Change Wheel (BCW). METHODS Focus groups and semi-structured interviews were conducted with community-dwelling individuals attending osteoporosis-related programs or education sessions in Ontario. They were stratified by geographic area, urban/rural, and gender, and transcribed verbatim. Two researchers coded data and identified emerging themes. Using the Behaviour Change Wheel framework, themes were categorized into capability, opportunity, and motivation, and interventions were identified. RESULTS Two hundred forty community-dwelling individuals across Ontario participated (mean ± SD age = 72 ± 8.28). Barriers were as follows: capability: disease-related symptoms hinder exercise and physical activity participation, lack of exercise-related knowledge, low exercise self-efficacy; opportunity: access to exercise programs that meet needs and preferences, limited resources and time, physical activity norms and preferences; motivation: incentives to exercise, fear of fracturing, trust in exercise providers. Interventions selected were training, education, and modeling. Policy categories selected were communication/marketing, guidelines, and service provision. CONCLUSIONS Barriers unique to individuals with osteoporosis included the following: lack of knowledge on key exercise concepts, fear of fracturing, and trust in providers. Behavior change techniques may need tailoring to gender, age, or presence of comorbid conditions.
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Affiliation(s)
- C Ziebart
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
| | - C McArthur
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
| | - L Lee
- Centre for Family Medicine Family Health Team, Kitchener, ON, Canada
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - A Papaioannou
- Department of Health and Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - J Laprade
- Division of Anatomy, University of Toronto, Toronto, ON, Canada
- Ontario Osteoporosis Strategy, Toronto, ON, Canada
- Osteoporosis Canada, Toronto, ON, Canada
| | - A M Cheung
- University Health Network, Toronto, ON, Canada
| | - R Jain
- Ontario Osteoporosis Strategy, Toronto, ON, Canada
- Osteoporosis Canada, Toronto, ON, Canada
| | - L Giangregorio
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada.
- University Health Network, Toronto, ON, Canada.
- Schlegel-UW Research Institute for Aging, Waterloo, ON, Canada.
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Curry M, Marshall B, Crossler RE, Correia J. InfoSec Process Action Model (IPAM). DATA BASE FOR ADVANCES IN INFORMATION SYSTEMS 2018. [DOI: 10.1145/3210530.3210535] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
While much of the extant InfoSec research relies on single assessment models that predict intent to act, this article proposes a multi-stage InfoSec Process Action Model (IPAM) that can positively change individual InfoSec behavior. We believe that this model will allow InfoSec researchers to focus more directly on the process that leads to action and develop better interventions that address problematic security behaviors. Building on successful healthcare efforts that resulted in smoking cessation, regular exercise, and a healthier diet, among others, IPAM is a hybrid predictive process approach to behavioral InfoSec improvement. IPAM formulates the motivational antecedents of intent as separate from the volitional drivers of behavior. Singular fear appeals often seen in InfoSec research are replaced by more nuanced treatments appropriately differentiated to support behavioral change as part of a process; phase-appropriate measures of self-efficacy are employed to more precisely assess the likelihood that a participant will act on good intentions; and decisional balance assessment of pro and con perceptions is monitored over time. These notions better align InfoSec research with both leading security practice and successful comparators in healthcare. We believe IPAM can both help InfoSec research models better explain actual behavior and better inform practical security behavior improvement initiatives.
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Roblin DW, Cram P, Lou Y, Edmonds SW, Hall SF, Jones MP, Saag KG, Wright NC, Wolinsky FD. Diet and exercise changes following bone densitometry in the Patient Activation After DXA Result Notification (PAADRN) study. Arch Osteoporos 2018; 13:4. [PMID: 29307094 PMCID: PMC7409367 DOI: 10.1007/s11657-017-0402-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 11/13/2017] [Indexed: 02/03/2023]
Abstract
UNLABELLED Calcium and vitamin D intake and exercise are suboptimal among older adults. Following bone densitometry, a letter communicating individualized fracture risk accompanied by an educational brochure improved participants' lifestyle-but no more than existing communication strategies-over 52 weeks. Simple communication strategies are insufficient for achieving optimal levels of bone health behaviors. PURPOSE The Patient Activation After DXA Result Notification (PAADRN) study was designed to evaluate whether a letter with individualized fracture risk and an educational brochure mailed to patients soon after their DXA might improve bone health behaviors (daily calcium intake, vitamin D supplementation, and weekly exercise sessions) compared to slower, less individualized communication characterizing usual care. METHODS Participants ≥ 50 years were recruited, at three sites, following their DXA and randomized with 1:1 allocation to intervention and control (usual care only) groups. Data were collected at enrollment interview and by phone survey at 12 and 52 weeks thereafter. Intention-to-treat analyses were conducted on 7749 of the 20,397 eligible participants who enrolled. Changes in bone health behaviors were compared within and between study groups. Average treatment effects and heterogeneity of treatment effects were estimated with multivariable linear and logistic regression models. RESULTS In unadjusted analyses, calcium intake, vitamin D supplementation, and weekly exercise sessions increased significantly over 52 weeks within both the intervention and control groups (all p < 0.001). In unadjusted analyses and multivariable models, increases in each behavior did not significantly differ between the intervention and control groups. Intervention group participants with a > 20% 10-year fracture risk at enrollment did, however, have a significantly greater increase in calcium intake compared to other study participants (p = 0.031). CONCLUSIONS Bone health behaviors improved, on average, over 52 weeks among all participants following a DXA. Receipt of the PAADRN letter and educational brochure did not directly improve bone health behaviors compared to usual care. TRIAL REGISTRATION The Patient Activation after DXA Result Notification (PAADRN) Study is registered at ClinicalTrials.Gov: NCT01507662, https://clinicaltrials.gov/ct2/show/NCT01507662.
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Affiliation(s)
- Douglas W. Roblin
- Mid-Atlantic Permanente Research Institute, 2101 East Jefferson St., 3 West, Rockville, MD 20852, USA,Center for Clinical and Outcomes Research, Kaiser Permanente, Atlanta, GA, USA
| | - Peter Cram
- Division of General Internal Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA,Faculty of Medicine, University of Toronto, Toronto, Canada,Division of General Internal Medicine and Geriatrics, Mt. Sinai/UHN Hospitals, Toronto, Canada
| | - Yiyue Lou
- Department of Biostatistics, University of Iowa College of Public Health, Iowa City, IA, USA
| | - Stephanie W. Edmonds
- Division of General Internal Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA,College of Nursing, University of Iowa, Iowa City, IA, USA
| | - Sylvie F. Hall
- College of Nursing, University of Iowa, Iowa City, IA, USA
| | - Michael P. Jones
- Department of Biostatistics, University of Iowa College of Public Health, Iowa City, IA, USA
| | - Kenneth G. Saag
- Division of Clinical Immunology and Rheumatology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Nicole C. Wright
- Division of Clinical Immunology and Rheumatology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA,Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Fredric D. Wolinsky
- Division of General Internal Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA,College of Nursing, University of Iowa, Iowa City, IA, USA,Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City, IA, USA
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Goulão B, MacLennan G, Ramsay C. The split-plot design was useful for evaluating complex, multilevel interventions, but there is need for improvement in its design and report. J Clin Epidemiol 2017; 96:120-125. [PMID: 29113938 DOI: 10.1016/j.jclinepi.2017.10.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 09/20/2017] [Accepted: 10/30/2017] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To describe the sample size calculation, analysis and reporting of split-plot (S-P) randomized controlled trials in health care (trials that use two units of randomization: one at a cluster-level and one at a level lower than the cluster). STUDY DESIGN AND SETTING We carried out a comprehensive search in the EMBASE database from 1946 to 2016. Health care trials with a S-P design in human subjects were included. Three authors screened and assessed the studies, and the data were extracted on methodology and reporting standards based on CONSORT. RESULTS Eighteen S-P studies were included, with authors using nine different designations to describe them. Units of randomization were unclear in nine abstracts. Explicit rationale for choosing the design was not given. Ten studies presented a sample size calculation accounting for clustering; the analyses were coherent with that. Flow of participant diagrams was presented but was incomplete in 14 articles. CONCLUSION S-P designs can be useful complex designs but challenging to report. Researchers need to clearly describe the rationale, sample size calculation, and participant flow. We provide a suggested CONSORT style participant flow diagram to aid reporting. There is need for more research regarding sample size calculation for S-P.
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Affiliation(s)
- Beatriz Goulão
- Health Services Research Unit, University of Aberdeen, 3rd Floor, Health Sciences Building, Foresterhill, Aberdeen AB25 2ZD, UK.
| | - Graeme MacLennan
- Health Services Research Unit, University of Aberdeen, 3rd Floor, Health Sciences Building, Foresterhill, Aberdeen AB25 2ZD, UK
| | - Craig Ramsay
- Health Services Research Unit, University of Aberdeen, 3rd Floor, Health Sciences Building, Foresterhill, Aberdeen AB25 2ZD, UK
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Tarantino U, Iolascon G, Cianferotti L, Masi L, Marcucci G, Giusti F, Marini F, Parri S, Feola M, Rao C, Piccirilli E, Zanetti EB, Cittadini N, Alvaro R, Moretti A, Calafiore D, Toro G, Gimigliano F, Resmini G, Brandi ML. Clinical guidelines for the prevention and treatment of osteoporosis: summary statements and recommendations from the Italian Society for Orthopaedics and Traumatology. J Orthop Traumatol 2017; 18:3-36. [PMID: 29058226 PMCID: PMC5688964 DOI: 10.1007/s10195-017-0474-7] [Citation(s) in RCA: 115] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The Italian Society for Orthopaedics and Traumatology conceived this guidance-which is primarily addressed to Italian orthopedic surgeons, but should also prove useful to other bone specialists and to general practitioners-in order to improve the diagnosis, prevention, and treatment of osteoporosis and its consequences. MATERIALS AND METHODS Literature reviews by a multidisciplinary team. RESULTS The following topics are covered: the role of instrumental, metabolic, and genetic evaluations in the diagnosis of osteoporosis; appraisal of the risk of fracture and thresholds for intervention; general strategies for the prevention and treatment of osteoporosis (primary and secondary prevention); the pharmacologic treatment of osteoporosis; the setting and implementation of fracture liaison services for tertiary prevention. Grade A, B, and C recommendations are provided based on the main levels of evidence (1-3). Toolboxes for everyday clinical practice are provided. CONCLUSIONS The first up-to-date Italian guidelines for the primary, secondary, and tertiary prevention of osteoporosis and osteoporotic fractures are presented.
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Affiliation(s)
- Umberto Tarantino
- Policlinico Tor Vergata Foundation, Orthopaedics and Traumatology, University of Rome Tor Vergata, Rome, Italy
| | - Giovanni Iolascon
- Department of Medical and Surgical Specialties and Dentistry, Second University of Naples, Naples, Italy
| | - Luisella Cianferotti
- Metabolic Bone Diseases Unit, Department of Surgery and Translational Medicine, University Hospital of Florence, University of Florence, Viale Pieraccini, 6, 50139, Florence, Italy
| | - Laura Masi
- Metabolic Bone Diseases Unit, Department of Surgery and Translational Medicine, University Hospital of Florence, University of Florence, Viale Pieraccini, 6, 50139, Florence, Italy
| | - Gemma Marcucci
- Metabolic Bone Diseases Unit, Department of Surgery and Translational Medicine, University Hospital of Florence, University of Florence, Viale Pieraccini, 6, 50139, Florence, Italy
| | - Francesca Giusti
- Metabolic Bone Diseases Unit, Department of Surgery and Translational Medicine, University Hospital of Florence, University of Florence, Viale Pieraccini, 6, 50139, Florence, Italy
| | - Francesca Marini
- Metabolic Bone Diseases Unit, Department of Surgery and Translational Medicine, University Hospital of Florence, University of Florence, Viale Pieraccini, 6, 50139, Florence, Italy
| | - Simone Parri
- Metabolic Bone Diseases Unit, Department of Surgery and Translational Medicine, University Hospital of Florence, University of Florence, Viale Pieraccini, 6, 50139, Florence, Italy
| | - Maurizio Feola
- Policlinico Tor Vergata Foundation, Orthopaedics and Traumatology, University of Rome Tor Vergata, Rome, Italy
| | - Cecilia Rao
- Policlinico Tor Vergata Foundation, Orthopaedics and Traumatology, University of Rome Tor Vergata, Rome, Italy
| | - Eleonora Piccirilli
- Policlinico Tor Vergata Foundation, Orthopaedics and Traumatology, University of Rome Tor Vergata, Rome, Italy
| | - Emanuela Basilici Zanetti
- Nursing Science, Center of Excellence for Culture and Nursing Research-IPASVI, University of Rome Tor Vergata, Rome, Italy
| | - Noemi Cittadini
- Nursing Science, Center of Excellence for Culture and Nursing Research-IPASVI, University of Rome Tor Vergata, Rome, Italy
| | - Rosaria Alvaro
- Nursing Science, Center of Excellence for Culture and Nursing Research-IPASVI, University of Rome Tor Vergata, Rome, Italy
| | - Antimo Moretti
- Department of Medical and Surgical Specialties and Dentistry, Second University of Naples, Naples, Italy
| | - Dario Calafiore
- Department of Medical and Surgical Specialties and Dentistry, Second University of Naples, Naples, Italy
| | - Giuseppe Toro
- Department of Medical and Surgical Specialties and Dentistry, Second University of Naples, Naples, Italy
| | - Francesca Gimigliano
- Department of Medical and Surgical Specialties and Dentistry, Second University of Naples, Naples, Italy
| | - Giuseppina Resmini
- Section of Orthopaedics and Traumatology, Centre for the Study of Osteoporosis and Metabolic Bone Disease, Treviglio-Caravaggio Hospital, Bergamo, Italy
| | - Maria Luisa Brandi
- Metabolic Bone Diseases Unit, Department of Surgery and Translational Medicine, University Hospital of Florence, University of Florence, Viale Pieraccini, 6, 50139, Florence, Italy.
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Lein DH, Turner L, Wilroy J. Evaluation of Three Osteoporosis Prevention Programs for Young Women: Application of the Health Belief Model. AMERICAN JOURNAL OF HEALTH EDUCATION 2016. [DOI: 10.1080/19325037.2016.1178610] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
This study documented the outcomes of 108 HIV-positive persons receiving vocational rehabilitation services. Over a 12-month follow-up, participants reported significantly decreased odds of any unstable housing [Adjusted Odds Ratio (AOR) = 0.21; 95 % CI 0.05-0.90; p < .05] and increased odds of being employed at least part-time (AOR = 10.19; 95 % CI 2.40-43.21; p < .01). However, reductions in perceived barriers to employment and increases in income were more pronounced among those not receiving disability benefits at baseline. This was consistent with findings from baseline qualitative interviews with 22 participants where those not on disability were subject to bureaucratic hurdles to rapidly accessing benefits and anticipated stigma of being on disability that propelled them to rejoin the workforce. Vocational rehabilitation could address key structural barriers to optimizing HIV treatment as prevention, and novel approaches are needed to improve outcomes among individuals receiving disability benefits.
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Patient acceptance of osteoporosis treatment: Application of the stages of change model. Maturitas 2016; 88:70-5. [PMID: 27105702 DOI: 10.1016/j.maturitas.2016.03.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 03/08/2016] [Accepted: 03/22/2016] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To examine whether a commonly used model of behaviour change, stages of change, is helpful in understanding osteoporosis treatment initiation in a cohort of fragility fracture patients. STUDY DESIGN This longitudinal cohort study used data from a provincial osteoporosis screening program targeting fragility fracture patients age 50 and over. Logistic regression was used to identify baseline factors associated with patients moving from the first, pre-contemplation stage at baseline to the more advanced stages of action/maintenance at follow-up, when treatment is initiated and maintained. MAIN OUTCOME MEASURE Patient's stage-of-change readiness to accept osteoporosis treatment. RESULTS At baseline, 91% of patients were in the pre-contemplation stage. Of these, 74.1% remained at the same stage at follow-up, 2.7% moved to contemplation and preparation while 23.2% moved to action/maintenance. The adjusted analysis showed that those who moved from pre-contemplation to action/maintenance were more likely to have a previous fracture OR 1.5 (1.1-2.0), history of oral steroid use OR 2.1 (1.3-3.5), higher perceived benefits to osteoporosis drug treatment OR 1.2 (1.0-1.3), perception of bones as "thin" OR 2.8 (2.0-4.0) and were less likely to perceive that they were taking too many medications OR 0.6 (0.5-0.9). CONCLUSIONS With the majority of patients in the pre-contemplation and the action/maintenance stages, our results suggest an existence of a two-stage model. The baseline factors that we identified can be used to predict which patients are less likely to initiate treatment, which in turn, can be used to inform post-fracture interventions and facilitate behaviour change.
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Alvaro R, Pennini A, Zannetti EB, Cittadini N, Feola M, Rao C, D'Agostino F, Vellone E, Tarantino U. Bone care nurses and the evolution of the nurse's educational function: the Guardian Angel(®) research project. CLINICAL CASES IN MINERAL AND BONE METABOLISM 2015; 12:43-6. [PMID: 26136795 DOI: 10.11138/ccmbm/2015.12.1.043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Osteoporosis mostly affects females over 50 years old, worldwide. The main osteoporosis complication is fragility fractures that reduce quality of life and cause morbidity and mortality. Most patients who have fragility fractures are treated for the fracture. However, patients' adherence to follow-up treatment plans is poor. Therefore, tailored educational interventions are needed to improve medication adherence and healthy lifestyles. In this context, the role of bone care nurses is important, as they can act at different levels of osteoporosis prevention and fracture liaison services, which are secondary fracture prevention programmes implemented by health care systems to treat osteoporotic patients. In Italy, a research project called Guardian Angel(®) was developed to provide tailored education to osteoporotic women in order to improve their disease management and reduce related complications.
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Affiliation(s)
- Rosaria Alvaro
- Department of Biomedicine and Prevention, "Tor Vergata" University of Rome, Rome, Italy
| | - Annalisa Pennini
- PhD student in Nursing, "Tor Vergata" University of Rome, Rome, Italy
| | | | - Noemi Cittadini
- PhD student in Nursing, "Tor Vergata" University of Rome, Rome, Italy
| | - Maurizio Feola
- Graduate School in Orthopaedics and Traumatology, "Tor Vergata" University of Rome, Rome, Italy
| | - Cecilia Rao
- Graduate School in Orthopaedics and Traumatology, "Tor Vergata" University of Rome, Rome, Italy
| | - Fabio D'Agostino
- Department of Biomedicine and Prevention, "Tor Vergata" University of Rome, Rome, Italy
| | - Ercole Vellone
- Department of Biomedicine and Prevention, "Tor Vergata" University of Rome, Rome, Italy
| | - Umberto Tarantino
- Department of Orthopaedics and Traumatology, "Tor Vergata" University of Rome, Policlinico Tor Vergata Foundation, Rome, Italy
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The 2 × 2 cluster randomized controlled factorial trial design is mainly used for efficiency and to explore intervention interactions: a systematic review. J Clin Epidemiol 2014; 67:1083-92. [DOI: 10.1016/j.jclinepi.2014.06.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 05/26/2014] [Accepted: 06/02/2014] [Indexed: 11/21/2022]
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Hiligsmann M, Boonen A. The need for (cost)-effective interventions to enhance adherence with osteoporosis medications. Curr Med Res Opin 2014; 30:297-9. [PMID: 24102346 DOI: 10.1185/03007995.2013.851660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Mickaël Hiligsmann
- Department of Health Services Research, School for Public Health and Primary Care (CAPHRI), Maastricht University , Maastricht , The Netherlands
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17
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Lein DH, Clark D, Turner LW, Kohler CL, Snyder S, Morgan SL, Schoenberger YMM. Evaluation of a Computer-Tailored Osteoporosis Prevention Intervention in Young Women. AMERICAN JOURNAL OF HEALTH EDUCATION 2014. [DOI: 10.1080/19325037.2013.853003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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18
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Hiligsmann M, Salas M, Hughes DA, Manias E, Gwadry-Sridhar FH, Linck P, Cowell W. Interventions to improve osteoporosis medication adherence and persistence: a systematic review and literature appraisal by the ISPOR Medication Adherence & Persistence Special Interest Group. Osteoporos Int 2013; 24:2907-18. [PMID: 23636230 DOI: 10.1007/s00198-013-2364-z] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Accepted: 03/11/2013] [Indexed: 11/25/2022]
Abstract
This study aims to systematically review, critically appraise and identify from the published literature, the most effective interventions to improve medication adherence in osteoporosis. A literature search using Medline, EMBASE, Cochrane library, and Cumulative Index to Nursing and Allied Health Literature was undertaken to identify prospective studies published between January 1, 1999 and June 30, 2012. We included studies on adult users of osteoporosis medications that tested a patient adherence intervention (e.g., patient education, intensified patient care, different dosing regimens) and reported quantitative results of adherence. The Delphi list was modified to assess the quality of studies. Of 113 articles identified, 20 studies fulfilled the inclusion criteria. The most frequent intervention was education (n = 11) followed by monitoring/supervision (n = 4), drug regimens (n = 2), drug regimens and patient support (n = 1), pharmacist intervention (n = 1), and electronic prescription (n = 1). Although patient education improved medication adherence in four studies, two large-scale randomized studies reported no benefits. Simplification of dosing regimens (with and without patient support program) was found to have a significant clinical impact on medication adherence and persistence. Monitoring/supervision showed no impact on medication persistence while electronic prescription and pharmacist intervention increased medication adherence or persistence. In conclusion, this review found that simplification of dosing regimens, decision aids, electronic prescription, or patient education may help to improve adherence or persistence to osteoporosis medications. We identified wide variation of quality of studies in the osteoporosis area. The efficacy of patient education was variable across studies, while monitoring/supervision does not seem an effective way to enhance medication adherence or persistence.
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Affiliation(s)
- M Hiligsmann
- Department of Health Services Research, School for Public Health and Primary Care (CAPHRI), Maastricht University, P.O. Box 616, 6200 MD, Maastricht, the Netherlands,
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19
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Barcenilla-Wong AL, Chen JS, March LM. Concern and risk perception of osteoporosis and fracture among post-menopausal Australian women: results from the Global Longitudinal Study of Osteoporosis in Women (GLOW) cohort. Arch Osteoporos 2013; 8:155. [PMID: 24105339 DOI: 10.1007/s11657-013-0155-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Accepted: 09/26/2013] [Indexed: 02/03/2023]
Abstract
PURPOSE The purpose of this study is to identify factors associated with concern and perception of risks of osteoporosis and osteoporotic fractures and determine whether bone mineral density (BMD) testing influenced concern and risk perception. METHODS Study subjects (n = 1,082, age 55-94 years) were female Australian participants of the Global Longitudinal Study of Osteoporosis in Women (GLOW). Self-administered questionnaires were sent annually from 2007 to 2010. Study outcomes included 'concern about osteoporosis', 'perception of getting osteoporosis' and 'perception of fracture risk' compared to similar aged women. The closest post-BMD testing or baseline questionnaires were used for women with and without BMD testing, respectively. Multinomial logistic regression was used for the analysis. RESULTS BMD testing, prior fracture after age 45, younger age and lower self-reported general health were significantly associated with being 'very' or 'somewhat concerned' about osteoporosis and having a 'much higher' or 'little higher' risk perception of osteoporosis and fractures. A poorer BMD result was associated with higher concern and higher risk perceptions. The presence of comorbidities, having ≥2 falls in the preceding year and maternal osteoporosis were associated with higher concern. Maternal osteoporosis, presence of comorbidities, weight loss of ≥5 kg in the preceding year and low body mass index were associated with higher perceptions of osteoporosis risk. CONCLUSION Women's concern and risk perception of osteoporosis and osteoporotic fractures were reasonably well founded. However, increasing age, height loss, smoking and drinking were not associated with concern and perception despite being known osteoporosis risk factors. These factors should be considered in planning for education and awareness raising programmes.
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Affiliation(s)
- A L Barcenilla-Wong
- Institute of Bone and Joint Research, Kolling Institute of Medical Research, University of Sydney, Sydney, Australia,
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20
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French MR, Vernace-Inserra F, Hawker GA. A Prospective Study to Identify Factors Affecting Adherence to Recommended Daily Calcium Intake in Women with Low Bone Mineral Density. J Am Coll Nutr 2013; 27:88-95. [DOI: 10.1080/07315724.2008.10719679] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Ryan P, Schlidt A, Ryan C. The impact of osteoporosis prevention programs on calcium intake: a systematic review. Osteoporos Int 2013; 24:1791-801. [PMID: 23314270 DOI: 10.1007/s00198-012-2259-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Accepted: 08/28/2012] [Indexed: 11/25/2022]
Abstract
Little is known about the dimensions of osteoporosis prevention programs essential to changing health behaviors. The purpose of this review was to determine the impact of select characteristics of structured osteoporosis prevention programs on calcium intake in women. This systematic review included 12 experimental and quasi-experimental studies conducted internationally with adult women participants. Studies were more likely to demonstrate differences when they were conducted outside the U.W.; participants had lower baseline calcium intake; and interventions were multi-dimensional and included factual information, skill training, and social contact delivered dynamically over time. The results document extensive variability across participants, programs, and measures. There is a need to document the source (total and sub-total) of calcium intake, to provide the necessary data to calculate effect sizes to enable comparison across studies, and to identify those moderating factors (such as menopausal status) that affect the ability to determine differences between sub-groups. Results indicate health behavior change is more likely to occur when patient-centered interventions designed to increase knowledge and health beliefs, skills and abilities, and social facilitation are delivered over time. There is an urgent need for the development and testing of new health behavior change theories, prevention programs, and delivery media to support and complement health care providers in the prevention and management of this common, debilitating condition.
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Affiliation(s)
- P Ryan
- Froedtert Healthcare, Patient Care Services, Milwaukee, WI, USA.
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Drieling RL, Ma J, Thiyagarajan S, Stafford RS. An Internet-Based Osteoporotic Fracture Risk Program: Effect on Knowledge, Attitudes, and Behaviors. J Womens Health (Larchmt) 2011; 20:1895-907. [DOI: 10.1089/jwh.2010.2515] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Affiliation(s)
- Rebecca L. Drieling
- Program on Prevention Outcomes and Practices, Stanford Prevention Research Center, Stanford School of Medicine, Stanford, California
| | - Jun Ma
- Palo Alto Medical Foundation Research Institute, Palo Alto, California
| | - Sreedevi Thiyagarajan
- Program on Prevention Outcomes and Practices, Stanford Prevention Research Center, Stanford School of Medicine, Stanford, California
| | - Randall S. Stafford
- Program on Prevention Outcomes and Practices, Stanford Prevention Research Center, Stanford School of Medicine, Stanford, California
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Babatunde OT, Himburg SP, Newman FL, Campa A, Dixon Z. Theory-driven intervention improves calcium intake, osteoporosis knowledge, and self-efficacy in community-dwelling older Black adults. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2011; 43:434-440. [PMID: 21531178 DOI: 10.1016/j.jneb.2010.07.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2010] [Revised: 07/09/2010] [Accepted: 07/12/2010] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To assess the effectiveness of an osteoporosis education program to improve calcium intake, knowledge, and self-efficacy in community-dwelling older Black adults. DESIGN Randomized repeated measures experimental design. SETTING Churches and community-based organizations. PARTICIPANTS Men and women (n = 110) 50 years old and older from 3 south Florida counties. INTERVENTION Participants randomly assigned to either of 2 groups: Group 1 (experimental group) or Group 2 (wait-list control group). Group 1 participated in 6 weekly education program sessions immediately following baseline assessment, and Group 2 started the program following Group 1's program completion. A tested curriculum was adapted to meet the needs of the target population. MAIN OUTCOME MEASURES Dietary calcium intake, osteoporosis knowledge, health beliefs, and self-efficacy. ANALYSIS Descriptive and summary statistics, repeated measures analysis of variance, and regression analysis. RESULTS Of the total participants, 84.6% completed the study (mean age = 70.2 years). Overall, an educational program developed with a theoretical background was associated with improvement in calcium intake, knowledge, and self-efficacy, with no effect on most health belief subscales. Assigned group was the major predictor of change in calcium intake. CONCLUSIONS AND IMPLICATIONS A theory-driven approach is valuable in improving behavior to promote bone health in this population. Health professionals should consider using more theory-driven approaches in intervention studies.
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Affiliation(s)
- Oyinlola T Babatunde
- Department of Nutrition Science, College of Human Ecology, East Carolina University, Greenville, NC 27858, 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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Gillespie AI, Abbott KV. The influence of clinical terminology on self-efficacy for voice. LOGOP PHONIATR VOCO 2010; 36:91-9. [DOI: 10.3109/14015439.2010.539259] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Maintenance of activity and eating change after a clinical trial of tailored newsletters with older rural women. Nurs Res 2010; 59:311-21. [PMID: 20697307 DOI: 10.1097/nnr.0b013e3181ed6695] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In the Wellness for Women Project, a randomized-by-site 1-year controlled clinical trial, the efficacy of generic newsletters and newsletters tailored on Health Promotion Model behavior-specific cognitions, eating behavior, and activity behavior were compared among 225 women aged 50 to 69 years. OBJECTIVES The purpose of this study was to compare the maintenance of change in healthy eating and physical activity over the 12 months following the tailored versus generic mailed newsletter intervention. METHODS Outcomes at 18 and 24 months included behavioral markers and biomarkers of physical activity and eating. Data were analyzed using the multivariate approach to repeated measures analysis of variance and generalized estimating equations (alpha <.05). RESULTS At 18 months, the tailored group maintained levels of all eating and activity behaviors, whereas the generic group maintained levels of fruit and vegetable servings, a moderate or greater activity, stretching exercise, lower body strength and flexibility but increased saturated fat intake and declined in weekly strength exercise and cardiorespiratory fitness. At 24 months, both groups maintained or returned to 12-month levels of all eating behaviors,moderate or greater activity, stretching exercise, and flexibility but declined in cardiorespiratory fitness; the tailored group maintained levels of strength exercise and lower body strength, whereas the generic group decreased in both. A greater proportion of women who received tailored newsletters continued to achieve most Healthy People 2010 criteria for eating and activity. DISCUSSION Mailed tailored print newsletters were more efficacious than generic newsletters in facilitating maintenance of change in eating and activity for 6 months postintervention. Both tailored and generic newsletters facilitated the maintenance of change in eating behaviors and in moderate or greater physical activity and stretching exercise, whereas tailored newsletters were more efficacious in maintaining change in strength exercise for 12 months postintervention.
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Krebs P, Prochaska JO, Rossi JS. A meta-analysis of computer-tailored interventions for health behavior change. Prev Med 2010; 51:214-21. [PMID: 20558196 PMCID: PMC2939185 DOI: 10.1016/j.ypmed.2010.06.004] [Citation(s) in RCA: 509] [Impact Index Per Article: 36.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2009] [Revised: 06/04/2010] [Accepted: 06/05/2010] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Computer-tailored interventions have become increasingly common for facilitating improvement in behaviors related to chronic disease and health promotion. A sufficient number of outcome studies from these interventions are now available to facilitate the quantitative analysis of effect sizes, permitting moderator analyses that were not possible with previous systematic reviews. METHOD The present study employs meta-analytic techniques to assess the mean effect for 88 computer-tailored interventions published between 1988 and 2009 focusing on four health behaviors: smoking cessation, physical activity, eating a healthy diet, and receiving regular mammography screening. Effect sizes were calculated using Hedges g. Study, tailoring, and demographic moderators were examined by analyzing between-group variance and meta-regression. RESULTS Clinically and statistically significant overall effect sizes were found across each of the four behaviors. While effect sizes decreased after intervention completion, dynamically tailored interventions were found to have increased efficacy over time as compared with tailored interventions based on one assessment only. Study effects did not differ across communication channels nor decline when up to three behaviors were identified for intervention simultaneously. CONCLUSION This study demonstrates that computer-tailored interventions have the potential to improve health behaviors and suggests strategies that may lead to greater effectiveness of these techniques.
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Affiliation(s)
- Paul Krebs
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
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Eyles HC, Mhurchu CN. Does tailoring make a difference? A systematic review of the long-term effectiveness of tailored nutrition education for adults. Nutr Rev 2009; 67:464-80. [PMID: 19674343 DOI: 10.1111/j.1753-4887.2009.00219.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Tailoring individualizes information to the receiver and provides a potential strategy for improving dietary intakes. The present systematic review summarizes evidence for the long-term (> or =6 months) effectiveness of tailored nutrition education for adults and includes priority population groups. Key electronic databases and relevant bibliographies were searched for trials measuring the following outcomes: nutrition-related health behaviors (e.g., dietary intake and food purchases) and anthropometric measures. Data synthesis was comprised of meta-analysis (for 15 trials including all population groups) and narrative review (for five trials of priority population groups). Overall, the quality of the studies was moderate to good. Tailored nutrition education was found to be a promising strategy for improving the diets of adults (including those in priority population groups) over the long term. However, future studies should ensure adequate reporting of research design and methods and reduce the chances of false-positive findings by using more objective measures of diet, clearly identifying the primary study outcome, and concentrating on outcomes most relevant to nutrition-related disease.
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Affiliation(s)
- Helen C Eyles
- Clinical Trials Research Unit, School of Population Health, University of Auckland, New Zealand.
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Abstract
BACKGROUND Unhealthy diet and lack of physical activity increase rural midlife and older women's risk of chronic diseases and premature death, and they are behind urban residents in meeting Healthy People 2010 objectives. OBJECTIVES The objective of this study was to compare a tailored intervention based on the Health Promotion Model with a generic intervention to increase physical activity and healthy eating among rural women. METHODS In a randomized-by-site, community-based, controlled, clinical trial, Wellness for Women, 225 women aged 50 to 69 years were recruited in two similar rural areas. Over 12 months, women received by mail either 18 generic newsletters or 18 newsletters computer tailored on Health Promotion Model behavior-specific cognitions (benefits, barriers, self-efficacy, and interpersonal support), activity, and eating. Outcomes at 6 and 12 months included behavioral markers and biomarkers of physical activity and eating. Data were analyzed by repeated-measures analysis of variance and chi-square tests (alpha < .05). RESULTS Both groups significantly increased stretching and strengthening exercise and fruit and vegetable servings and decreased percentage of calories from fat, whereas only the tailored group increased moderate or greater intensity activity and decreased percentage of calories from saturated fat from baseline to 6 months. Both groups increased stretching and strengthening exercise, whereas only the tailored group increased moderate or greater intensity activity and fruit and vegetable servings and decreased percentage of calories from fat from baseline to 12 months. Both groups had several changes in biomarkers over the study. A higher proportion of women receiving tailored newsletters met Healthy People 2010 criteria for moderate or greater intensity activity, fruit and vegetable servings, and percentage of calories from fat at 12 months. DISCUSSION Mailed computer-tailored and generic print newsletters facilitated the adoption of change in both activity and eating over 6 months. Tailored newsletters were more efficacious in facilitating change over 12 months.
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Suhonen R, Välimäki M, Leino-Kilpi H. A review of outcomes of individualised nursing interventions on adult patients. J Clin Nurs 2008; 17:843-60. [PMID: 18321285 DOI: 10.1111/j.1365-2702.2007.01979.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES This review describes the outcomes of individualised nursing interventions on adult patients. Background. Although the delivery of individualised nursing interventions is important there is limited evidence about how these interventions enhance patient outcomes. METHODS A computerised search was undertaken using the Cochrane Library, MEDLINE, CINAHL and PsycINFO. The selection criteria chosen were: reports of individualised nursing interventions focusing on adult patients in a variety of health care settings and using experimental designs. These involved randomised controlled trials, clinical controlled trials and pre- and posttest controlled studies. After a four-stage inclusion strategy 31 documents were accepted for the review. RESULTS The studies were mostly focused in preventative arenas such as health promotion and counselling. Others were care of older people in the community and in hospital and patients with chronic diseases. Over half of the nursing interventions (58%) involved educational or counselling activities which seem to be more effective than ordinary, standardised or routine education and counselling. Overall, 81% of the studies reported a positive impact of individualised interventions on patient outcomes showing that there is evidence, though limited, that individualised interventions can produce positive patient outcomes. CONCLUSIONS There is sufficient evidence, especially in specific areas such as patient education and counselling, to acknowledge that individualised interventions are superior to non-individualised interventions. Evidence for this effect within clinical nursing interventions on patient outcomes was limited by the scarcity of research in this area. There is a need for additional intervention studies to determine the effect of individualised interventions in a wide variety of contexts. Relevance to clinical practice. Experience of health is individual. Therefore, nursing interventions should also be individualised to each patient. These findings show some promise that individualised interventions may be useful in delivering positive patient outcomes.
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Estok PJ, Sedlak CA, Doheny MO, Hall R. Structural Model for Osteoporosis Preventing Behavior in Postmenopausal Women. Nurs Res 2007; 56:148-58. [PMID: 17495570 DOI: 10.1097/01.nnr.0000270031.64810.0c] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Osteoporosis prevention behaviors (OPBs) can prevent and delay bone deterioration; dual-energy X-ray absorptiometry (DXA) scan can identify osteoporosis and provide personal osteoporosis risk information that may promote prevention behaviors. OBJECTIVES This study was designed to estimate relationships between receiving personal knowledge of bone mineral density (gained through DXA scan), general knowledge of osteoporosis, health beliefs, and the two OPBs of calcium intake and weight-bearing exercise in healthy postmenopausal women 50 to 65 years. METHODS In this longitudinal, randomized clinical trial (including covariates), receipt of personal DXA information was manipulated by random assignment to the experimental or control group. The remaining antecedent and outcome variable measures were collected by questionnaire at three time points (initial [T1; pre-DXA], 6 months [T2], 12 months [T3]) and by bone density assessment from 203 women over an 18-month period in 2001-2003. RESULTS The experimental manipulation (DXA results) had a direct positive effect (beta = .23, p < .05) on calcium intake at T2, and indirectly at T3 through T2. Women in the experimental group who were informed they had osteopenia or osteoporosis had a greater T1-T2 change in daily calcium intake than those with normal bone density (beta = .23, p < .05). However, providing DXA results did not relate to change in exercise. Health beliefs and general osteoporosis knowledge predicted initial calcium and exercise levels; there was tentative evidence that susceptibility beliefs partially mediate between DXA results and change in calcium intake. DISCUSSION Personal knowledge of DXA results was related significantly to increases in calcium intake in postmenopausal women, but not to exercise. Directions for further study are discussed.
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van den Akker-Scheek I, Zijlstra W, Groothoff JW, van Horn JR, Bulstra SK, Stevens M. Groningen orthopaedic exit strategy: Validation of a support program after total hip or knee arthroplasty. PATIENT EDUCATION AND COUNSELING 2007; 65:171-9. [PMID: 16965889 DOI: 10.1016/j.pec.2006.07.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2006] [Revised: 07/03/2006] [Accepted: 07/12/2006] [Indexed: 05/11/2023]
Abstract
OBJECTIVE Validation of the program theory of the Groningen orthopaedic exit strategy (GOES), a theory-driven program aiming to improve the rehabilitation of total hip and knee arthroplasty patients after shortened hospital stay. First part of the program theory is the action theory, hypothesising that the GOES treatment positively influences the mediating variables (self-efficacy, social support, pain-coping). The second part, the conceptual theory, hypothesis a positive relationship between these variables and the outcome variables (ADL functioning, physical activity behaviour, quality of life). METHODS Patients were randomly assigned to the GOES or control groups. Questionnaires were used to assess mediating and outcome variables in 103 patients (50 GOES, 53 controls) pre-operatively, and 6 and 26 weeks post-operatively. RESULTS No difference was seen between the two groups in terms of changes between pre-operative and post-operative mediating variables (action theory). Moderate-to-large correlations explaining reasonable amount of variance (22%, 25%, 56%) were found between the mediating and outcome variables (conceptual theory). CONCLUSION The conceptual theory is supported; however, as the treatment did not influence the mediating variables (action theory), it has no added value in its current form. PRACTICE IMPLICATIONS The treatment needs to be adjusted; it is discussed that individualised treatment could be more effective.
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MESH Headings
- Academic Medical Centers
- Activities of Daily Living
- Adaptation, Psychological
- Aftercare/organization & administration
- Aftercare/psychology
- Aged
- Arthroplasty, Replacement, Hip/adverse effects
- Arthroplasty, Replacement, Hip/psychology
- Arthroplasty, Replacement, Hip/rehabilitation
- Arthroplasty, Replacement, Knee/adverse effects
- Arthroplasty, Replacement, Knee/psychology
- Arthroplasty, Replacement, Knee/rehabilitation
- Attitude to Health
- Female
- Home Care Services, Hospital-Based/organization & administration
- Humans
- Male
- Middle Aged
- Netherlands
- Outcome Assessment, Health Care
- Pain, Postoperative/etiology
- Pain, Postoperative/prevention & control
- Pain, Postoperative/psychology
- Patient Discharge
- Program Evaluation
- Psychological Theory
- Quality of Life/psychology
- Regression Analysis
- Self Efficacy
- Social Support
- Surveys and Questionnaires
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Affiliation(s)
- Inge van den Akker-Scheek
- Department of Orthopaedics, University Medical Center Groningen, University of Groningen, The Netherlands.
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Abstract
Adherence to osteoporosis medications is relatively poor. Approximately 20-30% of patients taking daily or weekly treatments may suspend their treatment within 6 to 12 months of initiating therapy. Patients with poor adherence increase their risk of osteoporotic fractures and hospitalisation. The majority of patients who discontinue therapy appear to do so because of drug-induced adverse effects. Fear of adverse effects or other health risks is another commonly cited reason for discontinuing therapy. Factors associated with medication adherence include fractures, regular exercise, female sex, fewer non-osteoporosis medications and co-morbidities, early menopause, willingness to take medications, awareness of osteoporosis status based on a diagnostic test, anti-inflammatory therapy and corticosteroid therapy. Factors associated with non-adherence include adverse effects, pain and being unsure about bone mineral density (BMD) test results. Bisphosphonates, a common class of drugs for treating osteoporosis, have specific administration requirements (e.g. fasting, remaining upright and not ingesting other medications concomitantly). Patient surveys indicate that 12-18% of patients report non-compliance with at least one administration rule. Strategies to increase adherence include reducing administration frequency to weekly or monthly, monitoring patients with bone markers and BMD testing, providing adequate instructions, practitioner feedback and support, and educational materials and sessions. Future studies are needed regarding strategies to increase adherence to osteoporosis medications.
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Abstract
OBJECTIVE To update the evidence-based consensus opinion published by The North American Menopause Society (NAMS) in 2001 on the role of calcium in peri- and postmenopausal women. DESIGN NAMS followed the general principles established for evidence-based guidelines to create this document. A panel of clinicians and researchers acknowledged to be experts in the field of calcium and women's health was enlisted to review the previous position statement and data published since then, compile supporting statements, and make recommendations. Their advice was used to assist the NAMS Board of Trustees in publishing this position statement. RESULTS Adequate calcium intake (in the presence of adequate vitamin D status) has been shown to reduce bone loss in peri- and postmenopausal women and reduce fractures in postmenopausal women older than age 60 with low calcium intakes. Adequate calcium is considered a key component of any bone-protective therapeutic regimen. Calcium has also been associated with beneficial effects in several nonskeletal disorders, primarily hypertension, colorectal cancer, obesity, and nephrolithiasis, although the extent of those effects has not been fully elucidated. The calcium requirement rises at menopause. The target calcium intake for most postmenopausal women is 1,200 mg/day. Adequate vitamin D status, defined as 30 ng/mL or more of serum 25-hydroxyvitamin D (usually achieved with a daily oral intake of at least 400 to 600 IU), is required to achieve the nutritional benefits of calcium. The best source of calcium is food, and the best food source is dairy products. High-quality calcium supplements (taken in divided doses) are alternative sources for women unable to consume enough dietary calcium. There are no reported cases of calcium intoxication from food sources, and cases associated with supplements are rare (high intake levels of 2,150 mg/day have resulted in a 17% increase in renal calculi in one recent study, but not others). Because no accurate test to determine calcium deficiency exists, clinicians should focus instead on encouraging women to consume enough calcium to meet the recommended levels. CONCLUSIONS The most definitive role for calcium in peri- and postmenopausal women is in bone health, but, like most nutrients, calcium has beneficial effects in many body systems. Based on the available evidence, there is strong support for the importance of ensuring adequate calcium intake in all women, particularly those in peri- or postmenopause.
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Kroeze W, Werkman A, Brug J. A systematic review of randomized trials on the effectiveness of computer-tailored education on physical activity and dietary behaviors. Ann Behav Med 2006; 31:205-23. [PMID: 16700634 DOI: 10.1207/s15324796abm3103_2] [Citation(s) in RCA: 412] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Although computer-tailored promotion of dietary change and physical activity has been identified as a promising intervention strategy, there is a need for a more systematic evaluation of the evidence. PURPOSE This study systematically reviews the scientific literature on computer-tailored physical activity and nutrition education. METHODS Intervention studies published from 1965 up to September 2004 were identified through a structured search in PubMed, PsycInfo, and Web of Science and an examination of reference lists of relevant publications. Studies were included that applied a pretest-posttest randomized-controlled trial design, were aimed at primary prevention among adults, used computer-tailored interventions to change physical activity and dietary behaviors, and were published in English. The search resulted in 30 publications-11 on physical activity behaviors and 26 on nutrition behaviors, some studies investigated multiple behaviors. RESULTS Three of 11 of the physical activity studies and 20 of 26 of the nutrition studies found significant effects of the tailored interventions. The evidence was most consistent for tailored interventions on fat reduction. CONCLUSIONS Overall, there seems to be potential for the application of computer tailoring for promoting healthy diets, but more research is needed to test computer-tailored interventions against other state-of-the-art intervention techniques and to identify the mechanisms underlying successful computer tailoring.
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Affiliation(s)
- Willemieke Kroeze
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands.
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Spencer L, Adams TB, Malone S, Roy L, Yost E. Applying the transtheoretical model to exercise: a systematic and comprehensive review of the literature. Health Promot Pract 2006; 7:428-43. [PMID: 16840769 DOI: 10.1177/1524839905278900] [Citation(s) in RCA: 130] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Three questions guided a literature review of the transtheoretical model (TTM) as applied to exercise to address the evidence for stage-matched interventions, the description of priority populations, and the identification of valid TTM measurement tools. One-hundredand-fifty studies were reviewed. Results indicate preliminary support for the use of stage-matched exercise interventions. Most studies have focused on White, middle-class, female populations, limiting the generalizability of their findings. Valid and reliable measures exist for stage of change, decisional balance, processes of change, self-efficacy, and temptations to not exercise; however, more research is needed to refine these measures. Evidence for the construct validity of the TTM as applied to exercise is mixed. When designing and implementing TTM-based exercise interventions, practitioners and policy makers are encouraged to clearly define the term exercise, choose a valid and reliable staging tool, and employ all TTM constructs and not just stage membership.
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Winzenberg TM, Shaw K, Fryer J, Jones G. Calcium supplementation for improving bone mineral density in children. Cochrane Database Syst Rev 2006; 2006:CD005119. [PMID: 16625624 PMCID: PMC8865374 DOI: 10.1002/14651858.cd005119.pub2] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Clinical trials have shown that calcium supplementation in children can increase bone mineral density (BMD) although this effect may not be maintained. There has been no quantitative systematic review of this intervention. OBJECTIVES . To determine the effectiveness of calcium supplementation for improving BMD in children. . To determine if any effect varies by sex, pubertal stage, ethnicity or level of physical activity, and if any effect persists after supplementation is ceased. SEARCH STRATEGY We searched CENTRAL, (Cochrane Central Register of Controlled Trials) (Issue 3, 2005), MEDLINE (1966 to 1 April 2005), EMBASE (1980 to 1 April 2005), CINAHL (1982 to 1 April 2005), AMED (1985 to 1 April 2005), MANTIS (1880 to 1 April 2005) ISI Web of Science (1945 to 1 April 2005), Food Science and Technology Abstracts (1969 to 1 April 2005) and Human Nutrition (1982 to 1 April 2005). Conference abstract books (Osteoporosis International, Journal of Bone and Mineral Research) were hand-searched. SELECTION CRITERIA Randomised controlled trials of calcium supplementation (including by food sources) compared with placebo, with a treatment period of at least 3 months in children without co-existent medical conditions affecting bone metabolism. Outcomes had to include areal or volumetric BMD, bone mineral content (BMC), or in the case of studies using quantitative ultrasound, broadband ultrasound attenuation and ultrasonic speed of sound, measured after at least 6 months of follow-up. DATA COLLECTION AND ANALYSIS Two authors independently assessed trial quality and extracted data including adverse events. We contacted study authors for additional information. MAIN RESULTS The 19 trials included 2859 participants, of which 1367 were randomised to supplementation and 1426 to placebo. There was no heterogeneity in the results of the main effects analyses to suggest that the studies were not comparable. There was no effect of calcium supplementation on femoral neck or lumbar spine BMD. There was a small effect on total body BMC (standardised mean difference (SMD) +0.14, 95% CI+0.01, +0.27) and upper limb BMD (SMD +0.14, 95%CI +0.04, +0.24). Only the effect in the upper limb persisted after supplementation ceased (SMD+0.14, 95%CI+0.01, +0.28). This effect is approximately equivalent to a 1.7% greater increase in supplemented groups, which at best would reduce absolute fracture risk in children by 0.1-0.2%per annum. There was no evidence of effect modification by baseline calcium intake, sex, ethnicity, physical activity or pubertal stage. Adverse events were reported infrequently and were minor. AUTHORS' CONCLUSIONS While there is a small effect of calcium supplementation in the upper limb, the increase in BMD which results is unlikely to result in a clinically significant decrease in fracture risk. The results do not support the use of calcium supplementation in healthy children as a public health intervention. These results cannot be extrapolated to children with medical conditions affecting bone metabolism.
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Affiliation(s)
- T M Winzenberg
- University of Tasmania, Menzies Resarch Institute, Private Bag 23, Hobart, TAS, Australia, 7001.
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Winzenberg T, Oldenburg B, Frendin S, De Wit L, Riley M, Jones G. The effect on behavior and bone mineral density of individualized bone mineral density feedback and educational interventions in premenopausal women: a randomized controlled trial [NCT00273260]. BMC Public Health 2006; 6:12. [PMID: 16430773 PMCID: PMC1386726 DOI: 10.1186/1471-2458-6-12] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2005] [Accepted: 01/23/2006] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Limited information is available on ways to influence osteoporosis risk in premenopausal women. This study tested four hypotheses regarding the effects of individualized bone density (BMD) feedback and different educational interventions on osteoporosis preventive behavior and BMD in pre-menopausal women, namely: that women are more likely to change calcium intake and physical activity if their BMD is low; that group education will be more efficacious at changing behavior than an information leaflet; that BMD feedback and group education have independent effects on behavior and BMD; and, that women who improve their physical activity or calcium intake will have a change in bone mass over 2 years that is better than those who do not alter their behavior. METHODS We performed a 2-year randomized controlled trial of BMD feedback according to T-score and either an osteoporosis information leaflet or small group education in a population-based random sample of 470 healthy women aged 25-44 years (response rate 64%). Main outcome measures were dietary calcium intake, calcium supplement use, smoking behavior, physical activity, endurance fitness, lower limb strength and BMD. We used paired t-tests, one-way ANOVA and linear regression techniques for data analysis. RESULTS Women who had feedback of low BMD had a greater increase in femoral neck BMD than those with normal BMD (1.6% p.a. vs. 0.7% p.a., p = 0.0001), but there was no difference in lumbar spine BMD change between these groups (0.1% p.a. vs. 0.08% p.a., p = 0.9). Both educational interventions had similar increases in femoral neck BMD (Leaflet = +1.0% p.a., Osteoporosis self-management course = + 1.3% p.a., p = 0.4). Femoral neck BMD change was only significantly associated with starting calcium supplements (1.3 % p.a, 95%CI +0.49, +2.17) and persistent self-reported change in physical activity levels (0.7% p.a., 95%CI +0.22, +1.22). CONCLUSION Individualized BMD feedback combined with a minimal educational intervention is effective at increasing hip but not spine bone density in premenopausal women. The changes in behavior through which this was mediated are potentially important in the prevention of other diseases, thus measuring BMD at a young age may have substantial public health benefits, particularly if these changes are sustained.
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Affiliation(s)
- Tania Winzenberg
- Menzies Research Institute, University of Tasmania, Hobart, Australia
| | - Brian Oldenburg
- School of Public Health, Queensland University of Technology, Brisbane, Australia
| | - Sue Frendin
- Department of Health and Human Services, Government of Tasmania, Hobart, Australia
| | - Laura De Wit
- Menzies Research Institute, University of Tasmania, Hobart, Australia
| | - Malcolm Riley
- Nutrition and Dietetic Unit, Monash University, Melbourne, Australia
| | - Graeme Jones
- Menzies Research Institute, University of Tasmania, Hobart, Australia
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Guilera M, Fuentes M, Grifols M, Ferrer J, Badia X. Does an educational leaflet improve self-reported adherence to therapy in osteoporosis? The OPTIMA study. Osteoporos Int 2006; 17:664-71. [PMID: 16437191 DOI: 10.1007/s00198-005-0031-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2005] [Accepted: 10/17/2005] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Adherence to treatment in osteoporosis remains poor. The aim of this study was to evaluate the effects of an educational leaflet on adherence to medication and to assess the association between adherence and health-related quality of life (HRQOL). METHODS A naturalistic, observational, multi-center, prospective study of 12 months' follow-up was performed. Consecutive post-menopausal women aged 50 years to 86 years starting treatment with raloxifene according to daily practice were enrolled from 126 primary care offices in Spain. The women were assigned to two study groups. Group A received an educational leaflet with general information about osteoporosis; group B followed current practice. To assess adherence to medication and HRQOL, the Morisky test and the EuroQoL questionnaire were administered. A total of 745 post-menopausal women (group A, n=366; group B n=379), with a mean age of 62 years, were included. RESULTS Most patients in both study groups showed high adherence to raloxifene at the 3-month visit: 56.3% vs 62.7% for groups A and B, respectively; this proportion at the 12-month visit was 47.4% (P=0.15) and 52.5% (P=0.02), respectively. At baseline, "pain/discomfort" was the dimension showing the highest percentage of women reporting problems: 86.4% vs 83.2% in groups A and B, respectively (P=0.22). HRQOL improved in both groups throughout the study, with an overall mean increment in the EuroQoL visual analog scale (EQ VAS) of 9.2 at 12 months (P<0.01). Correlations between adherence and HRQOL were weak. After receiving an educational leaflet, young post-menopausal women suffering osteoporosis did not show improvement in adherence to therapy. HRQOL improved at 12-month follow-up under treatment. CONCLUSION No consistent correlation between adherence and HRQOL was found.
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Affiliation(s)
- M Guilera
- Health Outcomes Research Europe, Av. Diagonal 618, 1- C/D, 08021, Barcelona, Spain.
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Pearson JA, Burkhart E, Pifalo WB, Palaggo-Toy T, Krohn K. A lifestyle modification intervention for the treatment of osteoporosis. Am J Health Promot 2005; 20:28-33. [PMID: 16171158 DOI: 10.4278/0890-1171-20.1.28] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this evaluation was to evaluate the effectiveness of a multidisciplinary educational and exercise program for individuals at risk for osteoporosis-related fractures. METHODS The Highmark Osteoporosis Prevention and Education (HOPE) program is an ongoing, 8-week program with two postintervention follow-up assessments at 6 months and 2 years. Adults (n = 375) with osteoporosis or significant risk factors, most already engaged in healthy behaviors, self-selected for participation. Baseline measures included bone mineral density scans; fitness assessments; and surveys of depression, exercise, and nutrition behaviors. At course end and 6-month follow-up, assessments were repeated for fitness measures, depression, and exercise and nutrition adherence. Two-year postprogram assessments included bone mineral density scans and adherence measures. RESULTS Paired t-tests showed significant improvements at course end in all measures (p < .0001) for the 87% completing the course. A repeated measure analysis of variance after 2 years with 79% retention indicated that adherence to nutrition recommendations was maintained at 2-year follow-up (p < .0001), whereas exercise adherence decreased but continued to exceed baseline measures (p < .0001). At 2 years, participants averaged two strength training sessions and 131 minutes aerobic exercise per week and consumed an average of 97% and 99% of the recommended calcium and vitamin D. CONCLUSIONS Although findings of this nonexperimental study are limited because of lack of a control group, the HOPE program suggests that a comprehensive community-based education and behavior change program can significantly reduce risk factors for osteoporosis and related fractures. Participants maintained lifestyle modifications for a minimum of 2 years despite advancing age.
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Affiliation(s)
- Janine A Pearson
- Highmark Blue Cross Blue Shield, Pittsburgh, Pennsylvania 15222, USA.
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Brug J, Oenema A, Kroeze W, Raat H. The internet and nutrition education: challenges and opportunities. Eur J Clin Nutr 2005; 59 Suppl 1:S130-7; discussion S138-9. [PMID: 16052181 DOI: 10.1038/sj.ejcn.1602186] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To review the possibilities of using the Internet and especially the World Wide Web (WWW) in nutrition education. RESULTS A healthy existence is partly dependent on dietary behaviours. One way to promote health-promoting dietary habits is nutrition education. In the last decades several potentially important new channels for health communication and nutrition education have emerged, with the Internet and its WWW as the most striking example. The introduction and growth of the WWW has enabled swift and inexpensive distribution of nutrition education expertise and materials. Furthermore, the WWW has also been used for tailoring nutrition education to the personal characteristics of the user. Only few studies have investigated the effects of generic web-based nutrition education, while web-based computer-tailored nutrition education has been studied in randomised controlled trials, with promising but mixed results. Two important challenges for web-based nutrition education interventions are to realise sufficient exposure and to ensure sufficient source reliability and credibility. CONCLUSIONS Next to the great opportunities, there are many challenges for web-based nutrition education. Some evidence for effects of web-based computer-tailored nutrition education has been reported, but more research is needed to obtain evidence for the effectiveness in real-life situations.
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Affiliation(s)
- J Brug
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands.
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McIntosh J, Blalock SJ. Effects of media coverage of Women's Health Initiative study on attitudes and behavior of women receiving hormone replacement therapy. Am J Health Syst Pharm 2005; 62:69-74. [PMID: 15658075 DOI: 10.1093/ajhp/62.1.69] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE The effects of media coverage of the Women's Health Initiative (WHI) study on the attitudes and behavior of women regarding hormone replacement therapy (HRT) were studied. METHODS This cross-sectional observational study took place in 12 counties in western North Carolina from 1997 to 1999. Participants were recruited from among women who participated in a previous study, which examined the effects of osteoporosis education on adherence to prevention guidelines. Women in the current study were limited to those previously reporting postmenopausal status and use of HRT. Participants were interviewed by telephone with a 41-item scripted survey. Main outcomes included primary sources of information regarding HRT, perception of the accuracy of information from various sources, and changes in HRT use. RESULTS Every woman in the study (n = 97) reported having heard about the WHI study, and 52% reported that it had affected their use of HRT. Women using estrogen alone were as likely as women using an estrogen-plus-progestin combination to have had their use affected (48% versus 59%, respectively). Women making a change after hearing about the WHI study results were significantly less likely to trust information from their physicians regarding HRT. CONCLUSION A survey of women who had received HRT found that media reports on the WHI study had a significant influence on their use of HRT.
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Affiliation(s)
- Jennifer McIntosh
- Department of Pharmacy, University of North Carolina Hospitals, Chapel Hill, USA
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Tussing L, Chapman-Novakofski K. Osteoporosis prevention education: Behavior theories and calcium intake. ACTA ACUST UNITED AC 2005; 105:92-7. [PMID: 15635352 DOI: 10.1016/j.jada.2004.10.025] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Osteoporosis is a worldwide health concern. Preventing osteoporosis, and subsequent fractures, has become a goal of many health care practitioners, especially dietetics professionals. However, few prevention models have proven effective. The goal of this project was to determine whether an educational, theory-based osteoporosis prevention program would significantly impact calcium intake. This project used a convenience sample of 42 women who participated in an 8-week educational intervention, similarly to a community class. The program included hands-on activities to increase self-efficacy and was based on the Health Belief Model and Theory of Reasoned Action (TRA). The main outcome measures were calcium intake and constructs from the Health Belief Model and TRA. Significant changes in the Health Belief Model and TRA constructs at postintervention included increased perceived susceptibility to osteoporosis ( P <.001), perceived benefits to increasing calcium intake ( P <.001), and increased self-efficacy related to calcium intake ( P </=.003). Statistically significant regression equations were found for all preintervention intentions related to calcium. Postintervention calcium intake significantly increased to 821+/-372 mg/day ( P <.0001). Results of this project can be used as guidelines for dietetics professionals to develop osteoporosis prevention programs for their clientele.
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Affiliation(s)
- Lisa Tussing
- Department of Human Nutrition, University of Illinois at Chicago, USA
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Heimendinger J, O'Neill C, Marcus AC, Wolfe P, Julesburg K, Morra M, Allen A, Davis S, Mowad L, Perocchia RS, Ward JD, Strecher V, Warnecke R, Nowak M, Graf I, Fairclough D, Bryant L, Lipkus I. Multiple tailored messages are effective in increasing fruit and vegetable consumption among callers to the Cancer Information Service. JOURNAL OF HEALTH COMMUNICATION 2005; 10 Suppl 1:65-82. [PMID: 16377601 DOI: 10.1080/10810730500263646] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Results are reported from a large (n = 3,402) four-group randomized trial to increase fruit and vegetable consumption among callers to the National Cancer Institute's (NCI's) Cancer Information Service (CIS) using tailored print materials. Following a baseline telephone interview, which included a brief educational message (BEM), participants were assigned randomly within CIS offices to one of four groups: single untailored (SU) group-one untailored set of materials; single tailored (ST) group-one tailored booklet; multiple tailored (MT) group-four tailored materials; and multiple retailored (MRT) group-four tailored materials with retailoring based on new information obtained at 5 months follow-up. Follow-up telephone interviews were conducted at 5 (n = 2,233) and 12 months (n = 1,927) after baseline. The main outcome measure was self-reported fruit and vegetable consumption using a seven-item food frequency questionnaire. At 12 months follow-up, there was a significant linear trend across groups of 0.21 servings (p = 0.0002). Specific nested hypotheses then were tested and revealed significant mean serving differences between SU (5.07) vs. MT (5.64) (p = 0.002) and SU vs. MRT (5.71; p < 0.001). Although the mean for ST (5.40) was greater than that for SU (5.07), the difference was not statistically significant (p = 0.07), and no difference was found between MT vs. MRT (p = 0.69). A higher proportion of recipients of tailored materials reported reading all of the materials and believing that they were written especially for them. No differences by experimental condition were found for the perceived usefulness or motivational impact of the print materials. In this trial, MT print materials were more effective at increasing fruit and vegetable (FV) consumption than were SU materials. The intervention mechanisms responsible for this effect merit further research. Retailoring did not produce a significant difference when compared with longitudinal baseline tailoring.
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Blalock SJ, Norton LL, Patel RA, Cabral K, Thomas CL. Development and Assessment of a Short Instrument for Assessing Dietary Intakes of Calcium and Vitamin D. J Am Pharm Assoc (2003) 2003; 43:685-93. [PMID: 14717265 DOI: 10.1331/154434503322642615] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To validate a short food frequency screening instrument designed to assess dietary intakes of calcium and vitamin D. DESIGN Cross-sectional surveys and food diaries. PARTICIPANTS Twenty-seven university employees. MAIN OUTCOME MEASURES Calcium and vitamin D intakes of participants were assessed using three instruments: a 7-day food diary, the Block-National Cancer Institute Health Habits and History Questionnaire (HHHQ), and a short screening instrument derived from the HHHQ. The accuracy of participants' reports of calcium and vitamin D intakes on the HHHQ and short screening instrument were checked against the food diaries. The validity of the full survey and the screening instrument were judged according to their correlation with the food diaries. RESULTS Estimates of calcium and vitamin D intakes derived from the 7-day food diary and the short screening instrument were significantly correlated (r = 0.66 and 0.72, respectively, P < .001). The mean differences between estimates derived from the short screening instrument and those derived from the 7-day food diary were 223 mg/day for calcium and 47 IU/day for vitamin D. The positive predictive value of the short screening instrument in identifying individuals with low nutrient intakes, as assessed by the 7-day food diary, was 91.7% for calcium and 100.0% for vitamin D. CONCLUSION The short screening instrument provides reasonably accurate estimates of calcium and vitamin D intakes. Although it cannot replace more comprehensive nutritional assessments, the screening instrument may provide quick assessments of calcium and vitamin D intakes. Given that many individuals consume suboptimal levels of these nutrients, pharmacists may use the screening instrument to evaluate patients' needs for calcium and/or vitamin D supplements and, thus, reduce their risk for developing osteoporosis.
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Affiliation(s)
- Susan J Blalock
- School of Pharmacy, University of North Carolina-Chapel Hill, 27599-7630, USA.
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DataBase: Research and Evaluation Results. Am J Health Promot 2003. [DOI: 10.4278/0890-1171-17.6.404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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