The Art of Health Promotion

Evaluation of a Community-based Health Promotion Program for the Elderly: Lessons from Seniors CAN

Purpose

To evaluate the effects of a community-based educational program designed to promote health by enhancing older adults’ mastery while decreasing loneliness and stress.

Methods

Between 1999 and 2004, 339 older adults who participated in Seniors CAN completed standardized assessments of mastery, loneliness, and stress, prior to and upon completion of the 4–month intervention. Participants’ scores were compared using paired t-tests to measure changes from preintervention to postintervention. Change scores were then subjected to three-way ANOVA to assess the relative effectiveness based upon participants’ sociodemographic characteristics.

Results

Participants demonstrated significant improvements from preintervention to postintervention for mastery, loneliness, and stress. Additional analysis revealed that improvement in loneliness was significantly greater among low-income ethnic minorities and minorities with a high level of formal education, p < .05.

Conclusion

The 16-week intervention resulted in significant improvements in constructs associated with better health and a higher quality of life for independent-living older adults. These findings suggest that a community-based educational intervention can be an effective strategy to reduce risk and promote the health and independence of older adults.

Empathy in medicine: Neuroscience, education and challenges

Empathy is a multifaceted skill and asset for health care providers. This paper uses current neuroscience literature of empathy to generate nuanced theory of how empathy can be blocked by personal stress and aversion among health care professionals. Current training approaches for educating sustainable empathy are reviewed in depth. The final part of the paper provides suggestions on how to spread empathy education farther and wider across medical education.

How Do Stages of Change for Physical Activity Relate to Employee Sign-Up for and Completion of a Worksite Physical Activity Competition?

Introduction. This study evaluated whether stages of change for physical activity (PA) predict sign-up, participation, and completion in a PA competition. Method. Deidentified data were provided to evaluate a PA competition between 16 different institutions from a public university system. Employees who completed a health assessment (HA) prior to the start of the PA competition ( n = 6,333) were included in the study. Participants completed a self-report HA and logged their PA throughout the competition. Multivariable logistic regression models tested whether stages of change predicted PA competition sign-up and completion. An ordinal logistic regression model tested whether stages of change predicted number of weeks of PA competition participation. Results. Stages of change predicted PA competition sign-up and completion, but not weeks of participation. The odds for PA competition sign-up were 1.64 and 1.98 times higher for employees in preparation and action/maintenance (respectively) compared with employees in precontemplation/contemplation. The odds for PA competition completion were 4.17 times higher for employees in action/maintenance compared with employees in precontemplation/contemplation/preparation. Conclusion. The PA competition was more likely to reach employees in preparation, action, or maintenance stages than precontemplation/contemplation. Most of the completers were likely participating in regular PA prior to the competition.

Shedding light on research participation effects in behaviour change trials: a qualitative study examining research participant experiences

Background

The sequence of events in a behaviour change trial involves interactions between research participants and the trial process. Taking part in such a study has the potential to influence the behaviour of the participant, and if it does, this can engender bias in trial outcomes. Since participants’ experience has received scant attention, the aim of this study is thus to generate hypotheses about which aspects of the conduct of behaviour change trials might matter most to participants, and thus have potential to alter subsequent behaviours and bias trial outcomes

Methods

Twenty participants were opportunistically screened for a health compromising behaviour (unhealthy diet, lack of exercise, smoking or alcohol consumption) and recruited if eligible. Semi structured face to face interviews were conducted, after going through the usual processes involved in trial recruitment, baseline assessment and randomisation. Participants were given information on the contents of an intervention or control condition in a behaviour change trial, which was not actually implemented. Three months later they returned to reflect on these experiences and whether they had any effect on their behaviour during the intervening period. Data from the latter interview were analysed thematically using a modified grounded theory approach.

Results

The early processes of trial participation raised awareness of unhealthy behaviours, although most reported having had only fleeting intentions to change their behaviour as a result of taking part in this study, in the absence of interventions. However, careful examination of the accounts revealed evidence of subtle research participation effects, which varied according to the health behaviour, and its perceived social acceptability. Participants’ relationships with the research study were viewed as somewhat important in stimulating thinking about whether and how to make lifestyle changes.

Conclusion

These participants described no dramatic impacts attributable to taking part in this study. This study demonstrates the likely value of well conducted qualitative studies of subtle research participation effects, which may be particularly important to explore for alcohol. Separating unintended influences in trial participation from the effects of behaviour change interventions being evaluated therein is necessary for valid estimates of intervention effects.

Building a foundation for brief motivational interviewing: communication to promote health literacy and behavior change

The use of collaborative communication styles such as motivational interviewing promotes patient engagement, health literacy, self-management, and improved outcomes for individuals with chronic illness. Brief motivational interviewing is an adaptation developed for use with medical populations in time-limited encounters. Inpatient nurses caring for individuals with chronic diagnoses may lack knowledge regarding brief motivational interviewing. This evidence-based quality improvement project used an online approach to introduce continuing education regarding brief motivational interviewing within the constraints of the inpatient setting. Nurses on four units in a community hospital completed a web-based learning module in preparation for context-based skills training. A significant increase in knowledge scores, combined with strong positive attitudes prior to and following the module, indicated a reliable foundation for skills training within the practice setting. Nurses' enhanced ability to recognize the practice of motivational interviewing in scenarios following online education supported the potential value of a hybrid approach to education.

The Role of Incentive Design, Incentive Value, Communications Strategy, and Worksite Culture on Health Risk Assessment Participation

Purpose.

To examine the impact of financial incentives, communications strategy, and worksite culture on health risk assessment (HRA) participation rates.

Design.

A cross-sectional study design was used to examine factors that influence employee participation, including incentive value, incentive design, communications strategy, and worksite culture.

Setting.

Large private-sector and public-sector employers.

Participants.

Thirty-six employers (n = 559,988 employees) that provided financial incentives to promote employee HRA participation.

Intervention.

Organizations implemented the HRA as part of a more comprehensive worksite health promotion strategy that included follow-up interventions and a variety of other components. The primary outcome of interest was employee HRA participation.

Measures.

Information on program design and structure, as well as on HRA eligibility and participation, was collected for each organization via standard client report and semi-structured interviews with account managers. General linear regression models were used to examine the extent to which factors influence HRA participation independently and when controlled for other factors.

Results.

Incentive value (r2 = .433; p < .000), benefits-integrated incentive design (r2 = .184; p = .009), culture (r2 = .113; p = .045), and communications strategy (r2 = .300; p = .001) had positive bivariate associations with HRA participation rates. When all factors were included in the model, incentive value (p = .001) and communications strategy (p = .023) were significantly associated with HRA participation. Variance accounted for by all factors combined was R2 = .584.

Conclusion.

This study suggests that incentive value, incentive type, supportive worksite culture, and comprehensive communications strategy may all play a role in increasing HRA participation.

The 'Women's Lifestyle Study', 2-year randomized controlled trial of physical activity counselling in primary health care: rationale and study design

Background

Physical inactivity is an independent risk factor for diabetes and heart disease. There is evidence that increasing physical activity can reduce the risk of developing these chronic diseases, but less evidence about effective ways to increase adherence to physical activity. Interventions are therefore needed that produce sustained increases in adherence to physical activity, are cost-effective and improve clinical endpoints.

Methods

The Women's Lifestyle Study is a two year randomized controlled trial involving a nurse-led intervention to increase physical activity in 40–74 year old physically inactive women recruited from primary care. Baseline measures were assessed in a face-to-face interview with a primary care nurse. The intervention involved delivery of a 'Lifestyle script' by a primary care nurse followed by telephone counselling for nine months and a face-to-face nurse visit at six months. Outcome measurements are assessed at 12 and 24 months. The primary outcome is physical activity measured using a validated physical activity questionnaire. Secondary outcomes include blood pressure, weight, waist circumference, physical fitness (step test), serum HbA1c, fasting glucose, lipids, insulin, and quality of life (SF36). Costs were measured prospectively to allow a subsequent cost-effectiveness evaluation if the trial is positive.

Discussion

Due to report in 2008, the Women's Lifestyle Study tests the effectiveness of an enhanced low-cost, evidence-based intervention in increasing physical activity, and improving cardiovascular and diabetes risk indicators over two years. If successful in demonstrating improvements in health outcomes, this randomized controlled trial will be the first to demonstrate long-term cardiovascular and diabetes risk health benefit, in addition to improvements in physical activity, from a sustainable physical activity intervention based in primary care.

Trial Registration

Australian Clinical Trials Registry (ACTR), ACTRN012605000490673.

Best practices for an integrated population health management (PHM) program

Large employers are beginning to create much more robust and potentially effective systems of integrated health management interventions. This organization-wide activity is referred to as a "Population Health Management" (PHM) approach. Best practices are also beginning to emerge in this area, and a number of technical developments are helping shape the patterns of response from innovative employers. This initiative is rapidly emerging as a critical part of overall business and health care strategy.

Talking Oneself Into Change: Motivational Interviewing, Stages of Change, and Therapeutic Process

Motivational interviewing (MI) is a directive, person-centered clinical method for helping clients resolve ambivalence and move ahead with change. It can be applied as a preparation for treatment, a freestanding brief intervention, an enduring clinical style, or a fallback approach when motivational obstacles are encountered. A psycholinguistic theory is emerging to account for the efficacy of MI that has been demonstrated in numerous clinical trials. For cognitive therapists, MI provides an evidence-based alternative to direct disputation of client cognitions.