The Use of Behavioral Contracting to Increase Exercise Activity

Sport and Exercise in Improving Outcomes After Solid Organ Transplantation: Overview From a UK Meeting

Outcomes after solid organ transplantation continue to improve, but premature loss of life remains a major concern, with death from cerebrovascular disease and cardiovascular disease accounting for around 20% late deaths. There are multiple contributory factors including preexisting, and the posttransplant development of, cardiometabolic conditions (such as hypertension, diabetes mellitus, hyperlipidemia, and obesity). There is accumulating evidence that the regular engagement in exercise is an important factor affecting outcomes before, during, and after transplantation; yet most waitlist candidates and recipients have reduced levels of physical activity. The mechanisms whereby physical activity is associated with better outcomes and a reduction in risk factors for cardiovascular disease are incompletely understood. Attempts to increase physical activity in the transplant population, as in the general population, have had limited success. Use of concepts from Nudge theory provides an evidence-based approach that may help increase physical activity and so reduce premature mortality. Both National and International Transplant Games provide a vehicle for increasing physical activity in this population and may also help to reduce premature death by providing a forum for mutual support for recipients and their families as well as an excellent forum for highlighting the success and impact of organ donation.

Effectiveness of Contingency Contracting

The purpose of this study was to measure weight loss in overweight employees of a large corporation in Western Michigan who all received the same education on how to lose weight, but were randomly assigned to one of three groups: contingency contracting with a partner, contingency contracting alone, or no contingency contracting. A pretest-posttest quasi-experimental design was used and data were collected by a demographic questionnaire and measure of weight at the initial, 10th, and 23rd weeks. A total of 84 subjects completed the 10 week weight loss program and 57 subjects returned for the 23rd week follow up weight. Each group lost a significant amount of weight from pre-program to 10 weeks; however, there were no significant differences across groups. Although the groups were not significantly different from each other, the results support the value of individualizing interventions and offer insight into how demographic variables may affect attrition and methods chosen for weight loss.

Study of participation barriers in family-focused prevention: research issues and preliminary results

There is a growing body of literature which argues for more research on barriers to participation in family-focused interventions, particularly among at-risk families. Following a review of research needs and issues suggested by the literature, this article presents results from a study which 1) evaluates reasons for decisions against participation in a family-focused prevention intervention project and 2) compares characteristics of intervention project participants with those of non-participants. Data on reasons for refusing participation were collected from non-participants during a recruitment telephone interview and via a mail survey. Results indicated that the most frequent reasons given for decisions against participation concerned intervention time demands and research-related requirements such as videotaping. There were no significant differences between participants and non-participants on any sociodemographic variables. Analyses of the relationships between reasons for participation refusal and sociodemographic subgroupings of non-participants, however, suggested that variations exist among these subgroups. Overall, results highlight the feasibility and importance of data collection on intervention project non-participants, both to clarify potential participation barriers and to gather data on sample representativeness.

A brief office intervention is associated with increased days per week of exercise

OBJECTIVE

We hypothesized that a cardiologist-initiated motivational discussion during a routine general cardiology clinic visit that included an exercise 'contract' signed by the patient, physician and a witness, would increase self-reported days per week of exercise.

METHODS

A short-term pilot intervention was provided to forty consecutive general cardiology clinic patients who were enrolled in 2005. They were asked to answer the question "How many days each week do you exercise" prior to the motivational discussion and at routine follow-up. Each participant signed an exercise 'contract' and agreed to exercise for at least 15 min everyday.

RESULTS

Participants had an average follow-up of 3.2 (1.7) months. The initial visit mean days of exercise per week were 3.1 (1.9). At follow-up, mean days of exercise per week were 4.0 (1.8), (p=0.04).

CONCLUSION

This simple rapid intervention was associated with increased self-reported days per week of exercise.

Effective recruitment of parents into family-focused prevention research: A comparison of two strategies

Recent literature highlights the need for more effective recruitment and retention strategies in prevention research. This article reports an investigation of the effectiveness of two recruitment strategies for a family-focused substance abuse prevention study. The first strategy offered prospective participants two points at which they could make a decision about their level of involvement in the research project and required only a limited initial time commitment. The second strategy required an initial commitment to participate in all phases of the project. The investigation was conducted with 208 rural families participating in the pilot phase of a five-year prevention study. There were three primary findings. First, both strategies were effective, yielding higher recruitment rates than would be predicted from relevant literature. Second, the strategy requiring a limited time commitment showed significantly higher rates of recruitment into the pretest, but was associated with significantly lower posttest retention rates. Third, data trends emerged but there were no statistically significant differences between the two recruitment strategy groups across a range of intervention participation indicators.

Training young pediatricians as leaders for the 21st century

OBJECTIVE

To conduct a needs assessment with young pediatricians who participate in a leadership training program and to evaluate the effectiveness of that program.

METHODS

In concert with the Johnson & Johnson Pediatric Institute, LLC, the American Academy of Pediatrics developed a 1-year strategy to train pediatricians who are <40 years old or <5 years in practice in leadership skills. Participants were nominated by American Academy of Pediatrics chapters and/or sections and were required to complete a detailed needs assessment, attend a 3-day training program, and commit to 1 leadership-related behavior change to be implemented within 6 months. A preanalytic/postanalytic design strategy was used.

RESULTS

A total of 56 applicants representing 33 US states participated; 44.6% were male, and more than half (51.8%) were employed at a medical school/hospital. The needs assessment indicated that participants were confident in many of their leadership qualities but desired increased training, particularly in areas of time and priority management and leading "from the middle." Postsurvey instruments (n = 54, 96% response rate) determined that participants positively evaluated the training program and improved in self-reported basic competencies; 87% also reported fully or partially achieving a leadership-related goal identified in a behavior change contract.

CONCLUSIONS

Results demonstrate that young physicians are eager for leadership training and that continuing medical education in this area can be provided with positive results. Core competencies, curriculum, and evaluative tools need to be developed further and training opportunities need to be expanded to other subpopulations of pediatricians and pediatric health care providers.

Health contract calendars: a tool for health professionals with older adults

A modification of the health contract technique was applied by 4 geriatric fellows from the Center on Aging, University of Texas Medical Branch, and 3 family medicine residents from the Department of Family Medicine, University of Texas Medical Branch, to a diverse group of 48 older adults. The innovation, a calendar component to the health contract, allowed for the calculation of specific success rates. Fifteen clients had a 100% success rate, and 21 were highly successful, 8 not too successful, and 4 unsuccessful.

Worksite fitness and exercise programs: a review of methodology and health impact

PURPOSE

To examine the methodology of worksite fitness and exercise programs and to assess their effect on health-related fitness, cardiac risk factors, life satisfaction and well-being, and illness and injury.

SEARCH METHODS

The 52 studies reviewed cover English-language literature for the period from 1972 to 1994, as identified by a search of the Cumulative Index Medicus, Medline, the Canadian Sport Documentation Centre's "Sport Discus," computerized bibliography, and my own files. Reports were divided into five controlled experimental studies, 14 quasi-experimental studies with matched controls (one reported in abstract), and 33 other interventions of varied quality.

SUMMARY

Methodologic problems include difficulty in allowing for Hawthorne effects, substantial sample attrition, and poor definition of the intervention (exercise or broad-based health promotion). Findings are analyzed by specific fitness and health outcomes. Program participants show small but favorable changes in body mass, skinfolds, aerobic power, muscle strength and flexibility, overall risk-taking behavior, systemic blood pressure, serum cholesterol, and cigarette smoking. Claims of improved mood state are based heavily on uncontrolled studies. Quasi-experimental studies suggest reduced rates of illness and injury among participants, but seasonal and year-to-year differences in health weaken possible conclusions.

CONCLUSIONS

Participation in worksite fitness programs can enhance health-related fitness and reduce risk-taking behavior, but population effect is limited by low participation rates.

Consumer-focused data collection in prevention program evaluation. Rationale and illustrations

This article presents a rationale for consumer-focused data collection at multiple points in the process of prevention program evaluation. Recommended procedures include data collection on consumer responses to various recruitment strategies and consumer preferences for specific program delivery features. Following the general rationale for use of these procedures, a summary description of their relationship with existing approaches to program evaluation is presented. Finally, illustrations of consumer-focused data collection procedures applied during several phases of an ongoing program evaluation project are provided.