Community health worker-delivered weight management intervention among public housing residents: A feasibility study

"I Feel Like It Should Be a Big Part of Our Training": Feasibility and Perceptions of a Motivational Interviewing Training for Community Health Workers

Use of community health workers (CHWs) has increased in recent years, with many being tasked with providing motivational interviewing (MI). However, little research exists regarding ideal means of training CHWs in MI. Therefore, the objective of this study was to explore the feasibility and perceptions of a CHW-focused MI training. This feasibility study employed a single-arm pre-post design, with a convenience sample of n = 24 Oklahoma-based CHWs. For MI training, four online asynchronous modules and one in-person session were developed and delivered by a graduate student competent in MI in collaboration with a member of the Motivational Interviewing Network of Trainers and per corresponding recommendations. The following indicators of feasibility were assessed via both pre-post surveys and semi-structured interviews: acceptability, demand, implementation, limited efficacy, and Practicality. Among responding CHWs, both the training and delivery of MI by CHWs as a whole were deemed feasible, including acceptability (e.g., 93% of respondents reported as "Excellent" or "Very Good"), demand (e.g., increase in actual MI use), implementation (e.g., exceeded recruitment goal), limited efficacy (e.g., some increases in knowledge), and practicality (e.g., delivery of MI training in existing systems, yet consistent with existing literature). Primary challenges included completion of data collection procedures and perceptions of overwhelm. These data indicate training CHWs in MI is feasible and in high demand, but there are important considerations, including minimizing data collection burden, delivering training in smaller intervals over longer periods of time, providing more opportunities for practice, and evaluating context-specific opportunities for feedback and coaching to achieve proficiency.

Effectiveness of behavioural interventions with motivational interviewing on physical activity outcomes in adults: systematic review and meta-analysis

OBJECTIVE

To evaluate the effectiveness of behavioural interventions that include motivational interviewing on physical activity outcomes in adults.

DESIGN

Systematic review and meta-analysis.

STUDY SELECTION

A search of seven databases for randomised controlled trials published from inception to 1 March 2023 comparing a behavioural intervention including motivational interviewing with a comparator without motivational interviewing on physical activity outcomes in adults. Outcomes of interest were differences in change in quantitative measures of total physical activity, moderate to vigorous physical activity (MVPA), and sedentary time.

DATA EXTRACTION AND SYNTHESIS

Two reviewers extracted data and assessed risk of bias. Population characteristics, intervention components, comparison groups, and outcomes of studies were summarised. For overall main effects, random effects meta-analyses were used to report standardised mean differences (SMDs) and 95% confidence intervals (CIs). Differential effects based on duration of follow-up, comparator type, intervention duration, and disease or health condition of participants were also examined.

RESULTS

129 papers reporting 97 randomised controlled trials totalling 27 811 participants and 105 comparisons were included. Interventions including motivational interviewing were superior to comparators for increases in total physical activity (SMD 0.45, 95% CI 0.33 to 0.65, equivalent to 1323 extra steps/day; low certainty evidence) and MVPA (0.45, 0.19 to 0.71, equivalent to 95 extra min/week; very low certainty evidence) and for reductions in sedentary time (-0.58, -1.03 to -0.14, equivalent to -51 min/day; very low certainty evidence). Evidence for a difference in any outcome compared with comparators of similar intensity was lacking. The magnitude of effect diminished over time, and evidence of an effect of motivational interviewing beyond one year was lacking. Most interventions involved patients with a specific health condition, and evidence of an effect of motivational interviewing to increase MVPA or decrease sedentary time was lacking in general population samples.

CONCLUSIONS

Certainty of the evidence using motivational interviewing as part of complex behavioural interventions for promoting total physical activity in adults was low, and for MVPA and sedentary time was very low. The totality of evidence suggests that although interventions with motivational interviewing increase physical activity and decrease sedentary behaviour, no difference was found in studies where the effect of motivational interviewing could be isolated. Effectiveness waned over time, with no evidence of a benefit of motivational interviewing to increase physical activity beyond one year.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42020219881.

Prediction of high visceral adipose tissue for sex-specific community residents in Taiwan

Visceral adipose tissue accumulation is strongly linked with numerous chronic diseases; however, the accessibility for visceral adipose tissue measurement is limited. This study employed a cross-sectional design to determine the optimal strongest predictor of high visceral adipose tissue in each sex and identified the optimal cutoff value thereof. Purposive sampling was used to recruit 94 men and 326 women aged ≥40 years in southern Taiwan. Receiver operating characteristic curve analysis was used to explore the optimal predictor of high visceral adipose tissue (defined as ≥135 cm2 for men and ≥100 cm2 for women) in each sex. The waist-to-hip ratio was the strongest predictor for men, with a cutoff value of 0.96 yielding the maximum sensitivity (94.29%) and specificity (93.22%). By contrast, body mass index was the strongest predictor for women, with a cutoff value of 25.45 kg/m2 yielding the maximum sensitivity (87.18%) and specificity (87.55%). The results may serve as a reference for health policy-makers in screening for high visceral adipose tissue to identify individuals at high risk of developing chronic diseases for health promotion.

Understanding the Public Health Role, Motivations, and Perceptions of Community Health Workers Deployed to Low-Income Housing in Richmond, Virginia

BACKGROUND

For the US health indicators to improve to the level of other developed countries, the use of Community Health Workers (CHWs) in vulnerable populations has been indicated as a possible long-term intervention. There are few models of long-term deployment of CHWs as part of the district level public health system in the US.

METHOD

In this study we interviewed CHWs who served as neighborhood-integrated health district staff assigned to low-income housing in Richmond, Virginia for 10 years. Qualitative analyses of their taped and transcribed interviews resulted in 5 themes from the interviews. The themes were Activities, Satisfaction, Strengths, Facilitation/Resources and Challenges. We highlighted quotes from the CHWs interviews for themes and summarized the findings from each theme.

RESULTS

CHWs carried out a variety of activities daily and these were described. The CHWs were generally satisfied with their job because it enabled them to assist others. The strength of their communities was resilience, and the resources they needed more included physical resources, human resources, political support, and more comprehensive programming. Their client's challenges include transportation, mental health, and physical safety and the CHWs challenge to effectively carrying out their work with clients was trust by community members.

CONCLUSION

The information garnered from the CHWs would be useful in designing CHW programs at other health districts.

Community Walks: a cluster randomized controlled trial of a multilevel physical activity intervention for low income public housing residents

BACKGROUND

Physical activity behavioral interventions to change individual-level drivers of activity, like motivation, attitudes, and self-efficacy, are often not sustained beyond the intervention period. Interventions at both environmental and individual levels might facilitate durable change. This community-based study seeks to test a multilevel, multicomponent intervention to increase moderate intensity physical activity among people with low incomes living in U.S. public housing developments, over a 2 year period.

METHODS

The study design is a prospective, cluster randomized controlled trial, with housing developments (n=12) as the units of randomization. In a four-group, factorial trial, we will compare an environmental intervention (E) alone (3 developments), an individual intervention (I) alone (3 developments), an environmental plus individual (E+I) intervention (3 developments), against an assessment only control group (3 developments). The environmental only intervention consists of community health workers leading walking groups and indoor activities, a walking advocacy program for residents, and provision of walking maps/signage. The individual only intervention consists of a 12-week automated telephone program to increase physical activity motivation and self-efficacy. All residents are invited to participate in the intervention activities being delivered at their development. The primary outcome is change in moderate intensity physical activity measured via an accelerometer-based device among an evaluation cohort (n=50 individuals at each of the 12 developments) from baseline to 24-month follow up. Mediation (e.g., neighborhood walkability, motivation) and moderation (e.g., neighborhood stress) of our interventions will be assessed. Lastly, we will interview key informants to assess factors from the Consolidated Framework for Implementation Research domains to inform future implementation.

DISCUSSION

We hypothesize participants living in developments in any of the three intervention groups (E only, I only, and E+I combined) will increase minutes of moderate intensity physical activity more than participants in control group developments. We expect delivery of an intervention package targeting environmental and social factors to become active, combined with the individual level intervention, will improve overall physical activity levels to recommended guidelines at the development level. If effective, this trial has the potential for implementation through other federal and state housing authorities.

TRIAL REGISTRATION

Clinical Trails.gov PRS Protocol Registration and Results System, NCT05147298 . Registered 28 November 2021.

Effectiveness of Motivational Interviewing in Managing Overweight and Obesity : A Systematic Review and Meta-analysis

BACKGROUND

Motivational interviewing (MI) is potentially useful in management of overweight and obesity, but staff training and increased delivery time are barriers, and its effectiveness independent of other behavioral components is unclear.

PURPOSE

To assess the independent contribution of MI as part of a behavioral weight management program (BWMP) in controlling weight and improving psychological well-being.

DATA SOURCES

6 electronic databases and 2 trial registries, searched from database inception through 24 September 2021.

STUDY SELECTION

Randomized controlled trials in adults or adolescents aimed at weight loss or maintenance and comparing programs incorporating MI versus interventions without MI.

DATA EXTRACTION

Two reviewers independently screened studies, extracted data, and assessed risk of bias. Outcomes included weight, anxiety, depression, quality of life, and other aspects of psychological well-being. Pooled mean differences or standardized mean differences were obtained using random- and fixed-effects meta-analyses.

DATA SYNTHESIS

Forty-six studies involving 11 077 participants, predominantly with obesity, were included. At 6 months, BWMPs using MI were more effective than no/minimal intervention (-0.88 [95% CI, -1.27 to -0.48] kg; I ² = 0%) but were not statistically significantly more effective than lower-intensity (-0.88 [CI, -2.39 to 0.62] kg; I ² = 55.8%) or similar-intensity (-1.36 [CI, -2.80 to 0.07] kg; I ² = 18.8%) BWMPs. At 1 year, data were too sparse to pool comparisons with no/minimal intervention, but MI did not produce statistically significantly greater weight change compared with lower-intensity (-1.16 [CI, -2.49 to 0.17] kg; I ² = 88.7%) or similar-intensity (-0.18 [CI, -2.40 to 2.04] kg; I ² = 72.7%) BWMPs without MI. Studies with 18-month follow-up were also sparse; MI did not produce statistically significant benefit in any of the comparator categories. There was no evidence of subgroup differences based on study, participant, or intervention characteristics. Too few studies assessed effects on psychological well-being to pool, but data did not suggest that MI was independently effective.

LIMITATIONS

High statistical heterogeneity among studies, largely unexplained by sensitivity and subgroup analyses; stratification by comparator intensity and follow-up duration resulted in pooling of few studies.

CONCLUSION

There is no evidence that MI increases effectiveness of BWMPs in controlling weight. Given the intensive training required for its delivery, MI may not be a worthwhile addition to BWMPs.

PRIMARY FUNDING SOURCE

National Institute for Health Research Biomedical Research Centre. (PROSPERO: CRD42020177259).

A Case Study of a Community Health Worker Program Located in Low-Income Housing in Richmond, Virginia

We reviewed data from the electronic health data system used by Community Health Workers (CHWs) in the Richmond/Henrico Health District of the Virginia Department of Health from January 1^st 2013 to December 31st 2020, to map the Community Health Workers’ impact on Social Determinants of Health. We also interviewed the CHWs to obtain demographic information and information about the challenges their communities face. Most referrals were for Healthcare Access (48.7%) and Economic Stability (38.3%), while Neighborhood and Built Environment (0.09%) was the least used referral in the Social Determinants of Health during the time under review. Community Health Workers also carried out 1367 and 565 Blood Pressure and Blood Sugar measurements respectively during the period. The Community Health workers were all women and their education ranged from High School graduate to Master’s degree graduate and they served as Community Health Workers for time ranging from 1 to 8 years. We found their answers to the questions on the issue plaguing the community they serve to indicate empathy and understanding of the issues of low-income communities. Having CHWs working as part of the public health system to deliver health promotion and provide referrals for social determinants of health could serve as a model for improving health access and impacting Social Determinants of Health positively for low-income populations across the country.