Cholesterol Reduction among Volunteers in a Health Promotion Project

The Use of Behavioral Contracting to Increase Exercise Activity

A cardiovascular risk reduction program used a submaximal treadmill stress test to evaluate physical fitness. Of the 179 individuals who participated in the health education counseling activities which followed testing, 96 signed a behavioral contract to engage in a 12-week aerobic exercise program. Forty-one contractors fully met contract goals, and 21 reported increased activity levels. Analyses examined demographic, risk factor, and attitudinal predictors of contract signing and contract adherence. Contract signing was related to education, smoking, and women's mean body weight. Only women's body weight was related to contract adherence. Attitudes toward exercise were related to neither. Level of contract adherence was significantly related to a decrease in exercising heart rate at the six-month follow-up assessment. These data suggest that contract signing may be a useful device for assessing client motivation and predicting program participation and behavioral change outcomes.

Implementing a public cholesterol screening campaign: the North Coast experience

Several community-based interventions in the United States have indicated that it is possible to economically screen the blood cholesterol levels of large numbers of the population and to assist those with elevated levels to reduce their blood cholesterol. The North Coast Cholesterol Check Campaign was designed to involve existing community health staff and community volunteers in a Health Promotion Campaign to: increase community awareness of the importance of cholesterol levels in relation to coronary heart disease; to offer participants immediate blood cholesterol analysis; and to offer dietary advice to those participants who were above the recommended 5.5 mmol/L level. Fifty-two Cholesterol Check Points were conducted on the North Coast of NSW between 1 September and 15 December, 1987. Each Check Point featured a rapid cholesterol analysis with a finger-prick procedure on the Boehringer-Mannheim Reflotron System and immediate dietary counselling by trained staff for participants with elevated levels. A total of 12,067 persons participated in the Campaign: 43 per cent were found to have cholesterol levels that exceeded the recommended desirable levels set by the Australian National Heart Foundation. A 4-5 month follow up of 61 per cent (3,164) of these individuals indicates that 72 per cent lowered their blood cholesterol levels and 65 per cent reduced their BMI. Mean cholesterol change was 0.65 mmol/L and mean BMI change was 0.51. The results indicate the potential for similar community-based nutrition education programmes to reduce cholesterol levels in Australia. This paper details the rationale for the North Coast Cholesterol Check Campaign and the issues concerned with implementation of the campaign.

Review and analysis of evaluation measures used in nutrition education intervention research

The purpose of this review is to provide a summary of the kinds of evaluation measures used in 265 nutrition education intervention studies conducted between 1980 and 1999 and an analysis of psychometric issues arising from such a review. The data are summarized in terms of tables for interventions with each of six key population groups: preschool children, school-aged children, adults, pregnant women and breast-feeding promotion, older adults, and inservice preparation of professionals and paraprofessionals. Measures evaluating knowledge and skills or behavioral capabilities were most widely used in studies with preschool, school-aged, and inservice populations (50%-85%) and less widely used in studies with the other groups, particularly breast-feeding promotion (5%). Measures of potential psychosocial mediators or correlates of behavior such as outcome expectancies, self-efficacy, or behavioral intention were used in 90% of behaviorally focused studies with school-aged children and in about 20% of studies with adults. Dietary intake measures were used in almost all studies, primarily food recalls, records, and quantitative food frequency questionnaires. Short frequency instruments involving only foods targeted in the intervention such as fruits and vegetables are increasingly being used. Measures of specific observable behaviors are also increasingly being used. Physiologic parameters were used in about 33% of behaviorally focused interventions with school-aged children and adults, 20% with older adults, and 65% with pregnant women and/or their infants. Criterion validity of newly developed intake instruments and content validity of instruments measuring mediating variables were reported in the majority (range 50%-90%) of studies. Reliability and stability of measures of mediating variables were reported in 50% to 75% of studies, with reliability coefficients mostly about .6 to .7. Two major conclusions from this review are that evaluation measures should be appropriate to the purpose, duration, and power of the intervention and that measures should have adequate validity and reliability in relation to both the outcomes and characteristics of the target audience. Major implications are that considerable preliminary work needs to be done before any intervention study to develop and test evaluation instruments so that they are appropriate and have adequate psychometric properties, and cognitive testing of published instruments with each new target audience is essential. We will then be better able to make judgments about the effectiveness of nutrition education.

Use of eating-pattern messages to evaluate changes in eating behaviors in a worksite cholesterol education program

OBJECTIVE

To determine whether eating-pattern messages can effectively be used in a worksite cholesterol education program to change eating behaviors.

SUBJECTS

91 randomly selected participants with initial serum cholesterol levels of 5.2 mmol/L attended the program.

INTERVENTION

Eating-pattern messages were the focus of a successful 8-week worksite cholesterol education program conducted with city employees of Phoenix, Ariz. Participants completed self-administered questionnaires before and after the intervention that asked them to compare their current eating patterns with those addressed in the program. The majority (n = 84) of the participants attended five or more of eight available sessions, led by registered dietitians, which focused on the skills needed to decrease dietary fat.

STATISTICAL ANALYSES PERFORMED

Parametric and nonparametric statistical tests were used to evaluate the direction and magnitude of changes in eating patterns.

RESULTS

Participants made statistically significant changes in 11 of 15 eating patterns linked to messages delivered during the intervention. Changes in eating behaviors were related to improvements in blood lipid profiles. Results from a multiple regression analysis indicated that intervention-related changes in total cholesterol were significantly associated with combined eating-pattern message scores, and total cholesterol decreased 0.33 mmol/L for each unit decrease in the combined eating-pattern message score.

APPLICATIONS/CONCLUSIONS

These findings indicate that eating-pattern messages can be used successfully to evaluate changes in fat-related eating behaviors.

Cholesterol reduction in the workplace and in community settings

Recent emphasis has been placed on the role of serum cholesterol in the development of cardiovascular disease and on reducing high serum cholesterol levels through a screening followed by a behavioral intervention. However, evidence about the effectiveness of this technique in reducing cholesterol has yet to be evaluated. A review of the biomedical and allied health literature was conducted to determine the effectiveness of reducing serum cholesterol levels in the general population through the use of a screening to identify those at risk followed by a behavioral intervention. Only worksite and community based studies published from 1980-89 were reviewed. Seven worksite and four community studies were identified. All studies used total serum cholesterol as the dependent variable while some included other physiological measures. The majority of studies used a multicomponent intervention involving dietary education, exercise, smoking cessation, or weight reduction components. The interventions tested lasted from 14 weeks to five years and varied from low intensity to high intensity. The methods of intervention ranged from face-to-face interaction to mail and telephone counseling. Although many of the studies reviewed contain methodological flaws, certain findings are evident. The studies show that cholesterol can be reduced through a screening followed by a behavioral intervention, the multicomponent program is the most effective intervention, and low intensive interventions are as equally effective as high intensive interventions. Program implications and future research directions are discussed.