1
|
Milan FJ, Knight CJ, de Oliveira LM, Ciampolini V, Milistetd M. An integrative review of parent education approaches in sport: Considerations for program planning and evaluation. Scand J Med Sci Sports 2024; 34:e14620. [PMID: 38581216 DOI: 10.1111/sms.14620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 03/12/2024] [Accepted: 03/21/2024] [Indexed: 04/08/2024]
Abstract
In recent years, there has been an increase in the delivery and evaluation of parent education programs within youth sport. Subsequently, some recent reviews of these programs have been conducted. However, one consistent issue across many of the programs and associated review papers is the lack of an appropriate evaluation framework to guide the planning or associated reporting of the outcomes of the interventions. This has limited understanding of the overall impact of sport parenting interventions. Thus, the purposes of the current study were as follows: (a) to identify commonalities in the reporting and evaluation of parent education programs; (b) to identify gaps in the reporting and evaluation of parent education programs; (c) to draw these insights together to provide suggestions regarding how the RE-AIM could be used to enhance planning and evaluation of evidence-based programs for parent education in sport. Specifically, utilizing the RE-AIM framework to provide insights into pertinent evaluation metrics, this integrative review aimed to identify commonalities and gaps in the reporting of parent education programs. The RE-AIM framework considers the essential elements to assess the external and internal validity of interventions through five dimensions: Reach, Effectiveness, Adoption, Implementation, and Maintenance (Am J Public Health. 1999;89(9):1322-1327). Subsequently, the review aimed to provide suggestions regarding strategies to enhance the planning and evaluation of evidence-based programs for parent education in sport. Overall, the analysis demonstrated that most studies presented some pertinent evaluation information related to the RE-AIM framework, such as the number of participants and contacts made, the measures used, and the program level. However, the studies also lacked information on participant exclusion criteria, the method used to select the delivery agent (e.g., parents engaged in the program), and cost measures. Overall, the current study identified various areas where programs could be enhanced, specifically related to reporting procedural elements (e.g., program design, target population, and costs) pertaining to the implementation of parent education programs.
Collapse
Affiliation(s)
- Fabrício João Milan
- Department of Physical Education, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Camilla J Knight
- Department of Sport and Exercise Sciences, Swansea University, Swansea, UK
- Department of Physical Education and Sport, University of Adger, Kristiansand, Norway
| | | | - Vitor Ciampolini
- Department of Physical Education, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Michel Milistetd
- Department of Physical Education, Federal University of Santa Catarina, Florianópolis, Brazil
| |
Collapse
|
2
|
McVay MA, Jake-Schoffman DE, Leong MC, Lou X. Privacy Concerns in Group Format Lifestyle Interventions for Obesity. Int J Behav Med 2023; 30:693-704. [PMID: 36261768 DOI: 10.1007/s12529-022-10134-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Group format weight loss interventions have benefits over individual format, but privacy concerns may limit their uptake. METHOD In this study, adults with obesity and interest in losing weight were recruited nationally online and randomly assigned to view one of eight videos describing a hypothetical, group behavioral weight loss intervention. Based on three fully crossed factors, the videos varied on privacy features of intervention (present or not); matching participants to group based on weight loss barriers (matched or not); and intervention format (online or in-person). Participants rated their willingness to join, privacy concerns, and perceived effectiveness of these interventions. They further reported preference for individual or group format interventions and reason for preferences. RESULTS Description of privacy features, matching of participants, and format did not affect willingness to join, privacy concerns, or perceived effectiveness of the intervention. Privacy concerns were associated with lower willingness to join and lower perceived intervention effectiveness, and greater social anxiety and weight stigma. More participants preferred individual over group format (40.1% vs 33.9%; 26% selected neither) and preference for individual format was associated with greater privacy concerns. CONCLUSION Strategies to address privacy concerns in group-based interventions warrant further attention.
Collapse
Affiliation(s)
- Megan A McVay
- Department of Health Education and Behavior, College of Health and Human Performance, University of Florida, P.O. Box 118210, Gainesville, FL, 32611, USA.
| | - Danielle E Jake-Schoffman
- Department of Health Education and Behavior, College of Health and Human Performance, University of Florida, P.O. Box 118210, Gainesville, FL, 32611, USA
| | - Man Chong Leong
- Department of Biostatistics, College of Public Health and Health Professions & College of Medicine, University of Florida, University of Florida Health Cancer Center, Gainesville, USA
| | - XiangYang Lou
- Department of Biostatistics, College of Public Health and Health Professions & College of Medicine, University of Florida, University of Florida Health Cancer Center, Gainesville, USA
| |
Collapse
|
3
|
Bajraktari S, Zingmark M, Pettersson B, Rosendahl E, Lundin-Olsson L, Sandlund M. Reaching Older People With a Digital Fall Prevention Intervention in a Swedish Municipality Context-an Observational Study. Front Public Health 2022; 10:857652. [PMID: 35548075 PMCID: PMC9082637 DOI: 10.3389/fpubh.2022.857652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 03/21/2022] [Indexed: 11/14/2022] Open
Abstract
Background There is robust evidence that falls in old age can be prevented by exercise programs that include balance training, functional exercises, and strength training. For the interventions to have a population health impact, outreach to the population of focus with suitable interventions is needed. While digital interventions are promising there is limited knowledge on the characteristics of who is reached. The aim of this study was to describe the recruitment process, estimate reach rate at the population level and to describe participants characteristics and representativeness in a digital fall prevention intervention study. Methods In a municipality-based observational study, reach of a digital fall prevention intervention was evaluated. The intervention included a digital exercise programme (Safe Step) and optional supportive strategies, complemented with a range of recruitment strategies to optimize reach. Recruitment during a period of 6 months was open to people 70 years or older who had experienced a fall or a decline in balance the past year. Reach was based on data from the baseline questionnaire including health and demographic characteristics of participants. Representativeness was estimated by comparing participants to a sample of older people from the Swedish National Public Health Survey. Results The recruitment rate was 4.7% (n = 173) in relation to the estimated population of focus (n = 3,706). Most participants signed up within the first month of the intervention (n = 131). The intervention attracted primarily women, older people with high education, individuals who used the internet or digital applications almost every day and those perceiving their balance as fair or poor. Safe step participants lived more commonly alone and had higher education and better walking ability in comparison to the Swedish National Public Health Survey. Conclusions With a range of recruitment strategies most participants were recruited to a digital fall intervention during the first month. The intervention attracted primarily highly educated women who frequently used the internet or smart technologies. In addition to digital fall prevention interventions, a higher diversity of intervention types (digital and non-digital) is more likely to reach a larger group of older people with different needs. Clinical Trial Registration ClinicalTrials.gov, NCT04161625 (Retrospectively registered), https://clinicaltrials.gov/ct2/show/NCT04161625.
Collapse
Affiliation(s)
- Saranda Bajraktari
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Magnus Zingmark
- Municipality of Östersund, Health and Social Care Administration, Östersund, Sweden.,Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Beatrice Pettersson
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Erik Rosendahl
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Lillemor Lundin-Olsson
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Marlene Sandlund
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| |
Collapse
|
4
|
You W, Yuan Y, Boyle KJ, Michaud TL, Parmeter C, Seidel RW, Estabrooks PA. Examining Ways to Improve Weight Control Programs' Population Reach and Representativeness: A Discrete Choice Experiment of Financial Incentives. PHARMACOECONOMICS - OPEN 2022; 6:193-210. [PMID: 34757584 PMCID: PMC8864042 DOI: 10.1007/s41669-021-00310-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/12/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Both theoretical and empirical evidence supports the potential of modest financial incentives to increase the reach of evidence-based weight control programs. However, few studies exist that examine the best incentive design for achieving the highest reach and representativeness at the lowest cost and whether or not incentive designs may be valued differentially by subgroups that experience obesity-related health disparities. METHODS A discrete choice experiment was conducted (n = 1232 participants; over 90% of them were overweight/obese) to collect stated preference towards different financial incentive attributes, including reward amount, program location, reward contingency, and payment form and frequency. Mixed logit and conditional logit models were used to determine overall and subgroup preference ranking of attributes. Using the National Health and Nutrition Examination Survey data sample weights and the estimated models, we predicted US nationally representative participation rates by subgroups and examined the effect of offering more than one incentive design. External validity was checked by using a completed cluster randomized control trial. RESULTS There were significant subgroup differences in preference toward incentive attributes. There was also a sizable negative response to larger incentive amounts among African Americans, suggesting that higher amounts would reduce participation from this population. We also find that offering participants a menu of incentive designs to choose from would increase reach more than offering higher reward amounts. CONCLUSIONS We confirmed the existence of preference heterogeneity and the importance of subgroup-targeted incentive designs in any evidence-based weight control program to maximize population reach and reduce health disparities.
Collapse
Affiliation(s)
- Wen You
- Department of Public Health Science, School of Medicine, University of Virginia, University of Virginia Cancer Center, Charlottesville, VA USA
| | | | - Kevin J. Boyle
- Department of Agricultural and Applied Economics, Willis Blackwood Real Estate, Virginia Tech, Blacksburg, VA USA
| | - Tzeyu L. Michaud
- Department of Health Promotion, University of Nebraska Medical Center, Omaha, NE USA
| | - Chris Parmeter
- Department of Economics, University of Miami, Miami, FL USA
| | - Richard W. Seidel
- Department of Psychiatry and Behavioral Medicine, Virginia Tech Carilion School of Medicine, Roanoke, VA USA
| | - Paul A. Estabrooks
- Department of Health Promotion, University of Nebraska Medical Center, Omaha, NE USA
| |
Collapse
|
5
|
Reininger BM, Mitchell-Bennett LA, Lee M, Yeh PG, Davé AC, Park SK, Xu T, Ochoa-Del Toro AG. Scaling a Community-Wide Campaign Intervention to Manage Hypertension and Weight Loss. Front Med (Lausanne) 2021; 8:661353. [PMID: 34881250 PMCID: PMC8645688 DOI: 10.3389/fmed.2021.661353] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 11/01/2021] [Indexed: 12/14/2022] Open
Abstract
Public health impacts can be achieved when evidence-based interventions are implemented to those most in need. Too often implementation never or slowly occurs. The community-wide campaign intervention Tu Salud ¡Si Cuenta! has evidence of improving health outcomes related to chronic disease among low-income, Latinos. Using the RE-AIM Framework, this study examined if the scaled-up version of the intervention is associated with improvements in hypertension and obesity in 12 locations. Each element of the RE-AIM framework was examined. For "Effectiveness," we examined outcomes overall and by implementing location. We used linear and logistic regression to assess if exposure in the intervention was associated with improvement in hypertension and weight loss. Participants were stratified into "low exposure" (2-3 outreach visits) vs. "high exposure" (4-5 outreach visits). Based on the RE-AIM Framework, the intervention "reached" its intended population of low-income Latinos, demonstrated "effectiveness" in improving hypertension and obesity, was "adopted" at a high level in all but one site, was "implemented" with fidelity to the intervention model with moderate success across locations, and showed high "maintenance" over time. For effectiveness specifically, we found that out of 5,019 participants, 2,508 (50%) had a baseline hypertensive blood pressure (BP) reading. Of the 2,508, 1,245 (49.9%) recovered to normal blood pressure or pre-hypertension stage by last follow-up. After adjusting for baseline BP and potential confounders in multivariable linear regression models, the high exposure group had significantly more reduction in systolic BP (adjusted mean difference in % change = -0.96; p = 0.002) and diastolic BP (adjusted mean difference in % change = -1.61; p < 0.0001) compared to the low exposure group. After controlling for baseline weight and other confounders, the high exposure group had significantly greater decrease in weight compared to the low exposure group (adjusted mean difference in % change = -1.28; p < 0.0001). Results from the multivariable logistic regression models indicated that compared to the low exposure group the high exposure group was more likely to achieve a clinically significant minimum 5% weight loss [adjusted odds ratio (OR) = 2.97; p < 0.0001). This study contributes evidence that a Community-Wide Campaign model holds promise for addressing hypertension and obesity among low-income Latinos.
Collapse
Affiliation(s)
- Belinda M. Reininger
- Health Promotion and Behavioral Sciences, Hispanic Health Research Center, University of Texas School of Public Health in Brownsville, Brownsville, TX, United States
| | - Lisa A. Mitchell-Bennett
- Health Promotion and Behavioral Sciences, Hispanic Health Research Center, University of Texas School of Public Health in Brownsville, Brownsville, TX, United States
| | - MinJae Lee
- Division of Biostatistics, Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, United States
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Paul G. Yeh
- Health Promotion and Behavioral Sciences, Hispanic Health Research Center, University of Texas School of Public Health in Brownsville, Brownsville, TX, United States
- Department of Physician Assistant Studies, College of Health Professions, University of Texas Rio Grande Valley, Edinburg, TX, United States
| | - Amanda C. Davé
- Health Promotion and Behavioral Sciences, Hispanic Health Research Center, University of Texas School of Public Health in Brownsville, Brownsville, TX, United States
| | - Soo Kyung Park
- Department of Biostatistics and Data Science, University of Texas Health Science Center, University of Texas School of Public Health at Houston, Houston, TX, United States
| | - Tianlin Xu
- Department of Biostatistics and Data Science, University of Texas Health Science Center, University of Texas School of Public Health at Houston, Houston, TX, United States
| | - Alma G. Ochoa-Del Toro
- Health Promotion and Behavioral Sciences, Hispanic Health Research Center, University of Texas School of Public Health in Brownsville, Brownsville, TX, United States
| |
Collapse
|
6
|
Crane MM, Seburg EM, Levy RL, Jeffery RW, Sherwood NE. Using targeting to recruit men and women of color into a behavioral weight loss trial. Trials 2020; 21:537. [PMID: 32546253 PMCID: PMC7298816 DOI: 10.1186/s13063-020-04500-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 06/10/2020] [Indexed: 12/26/2022] Open
Abstract
Background The majority of participants in weight loss trials are non-Hispanic White women, while men and women of color are underrepresented. This study presents data obtained from non-targeted and targeted recruitment approaches in a trial of behavioral weight loss programs to (1) describe the yields from each approach and (2) compare the demographics, weight control histories, and study involvement of samples recruited by each approach. Methods Data for this observational study include source of recruitment, demographic information, weight loss experiences (e.g., lifetime weight loss, current weight loss behaviors), and completion of the 6-month assessment visit. Results Men comprised 14.2% of participants who responded to non-targeted recruitment efforts, while targeted efforts yielded 50.4% men. Similarly, people of color comprised 12.8% of those who responded to non-targeted approaches, whereas targeted recruitment methods yielded 47.2% people of color. Men recruited through targeted methods were younger (p = 0.01) than men recruited through non-targeted means but were otherwise similar. Women of color recruited through targeted methods reported use of fewer weight loss strategies relative to women of color recruited through non-targeted means (p = 0.006) but were otherwise similar. There were no differences by recruitment method on retention to the study. Conclusions Using targeted recruitment methods increased the ethnic and gender diversity of the recruited sample without reducing study retention. This targeting also increased the enrollment of women with less weight loss experience who may not have otherwise sought out a weight loss program. Developing and implementing a targeted recruitment plan should be considered early in the clinical trial development process. Trial registration Clinicaltrials.gov, NCT02368002. Registered on 20 February 2015.
Collapse
Affiliation(s)
- Melissa M Crane
- Department of Preventive Medicine, Rush University Medical Center, 1700 W. Van Buren St., Suite 470, Chicago, IL, 60612, USA.
| | - Elisabeth M Seburg
- HealthPartners Institute, 8170 33rd Ave South, Minneapolis, MN, 55440-1524, USA
| | - Rona L Levy
- School of Social Work, University of Washington, 4101 15th Avenue NE, Seattle, WA, 98105-6250, USA
| | - Robert W Jeffery
- Division of Epidemiology and Community Health, University of Minnesota, 300 West Bank Office Building, 1300 S. 2nd St., Minneapolis, MN, 55454, USA
| | - Nancy E Sherwood
- Division of Epidemiology and Community Health, University of Minnesota, 300 West Bank Office Building, 1300 S. 2nd St., Minneapolis, MN, 55454, USA
| |
Collapse
|
7
|
Tabak RG, Strickland JR, Kirk B, Colvin R, Stein RI, Dart H, Colditz GA, Dale AM, Evanoff BA. Pilot test of an interactive obesity treatment approach among employed adults in a university medical billing office. Pilot Feasibility Stud 2020; 6:57. [PMID: 32355567 PMCID: PMC7187490 DOI: 10.1186/s40814-020-00599-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 04/13/2020] [Indexed: 02/07/2023] Open
Abstract
Background There is a need for workplace programs promoting healthy eating and activity that reach low-wage employees and are scalable beyond the study site. Interventions designed with dissemination in mind aim to utilize minimal resources and to fit within existing systems. Technology-based interventions have the potential to promote healthy behaviors and to be sustainable as well as scalable. We developed an interactive obesity treatment approach (iOTA), to be delivered by SMS text messaging, and therefore accessible to a broad population. The aim of this pilot study was to evaluate participant engagement with, and acceptability of, this iOTA to promote healthy eating and activity behaviors among low-wage workers with obesity. Methods Twenty participants (self-reporting body mass index ≥ 30 kg/m2) of a single workgroup employed by a university medical practice billing office had access to the full intervention and study measures and provided feedback on the experience. Height and weight were measured by trained research staff at baseline. Each participant was offered a quarterly session with a health coach. Measured weight and a self-administered survey, including dietary and activity behaviors, were also collected at baseline, 3, 6, 12, 18, and 24 months. Participant engagement was assessed through responsiveness to iOTA SMS text messages throughout the 24-month pilot. A survey measure was used to assess satisfaction with iOTA at 3 months. Due to the small sample size and pilot nature of the current study, we conducted descriptive analyses. Engagement, weight change, and duration remaining in coaching are presented individually for each study participant. Results The pilot was originally intended to last 3 months, but nearly all participants requested to continue; we thus continued for 24 months. Most (14/20) participants remained in coaching for 24 months. At the 3-month follow-up, eight (47%) of the remaining 17 participants had lost weight; by 24 months, five (36%) of the remaining 14 participants had lost weight (one had bariatric surgery). Participants reported very high satisfaction. Conclusions This pilot provides important preliminary results on acceptability and participant engagement with iOTA, which has significant potential for dissemination and sustainability.
Collapse
Affiliation(s)
- Rachel G Tabak
- 1The Brown School, Washington University in St. Louis, 1 Brookings Dr, St. Louis, MO 63130 USA
| | - Jaime R Strickland
- 2Department of Medicine, Division of General Medical Sciences, Washington University School of Medicine, 4523 Clayton Avenue, Campus Box 8005, St. Louis, MO 63110 USA
| | - Bridget Kirk
- 2Department of Medicine, Division of General Medical Sciences, Washington University School of Medicine, 4523 Clayton Avenue, Campus Box 8005, St. Louis, MO 63110 USA
| | - Ryan Colvin
- 2Department of Medicine, Division of General Medical Sciences, Washington University School of Medicine, 4523 Clayton Avenue, Campus Box 8005, St. Louis, MO 63110 USA
| | - Richard I Stein
- 3Center for Human Nutrition, Department of Medicine, Washington University School of Medicine, 4523 Clayton Avenue, Campus Box 8031, St. Louis, MO 63110 USA
| | - Hank Dart
- 4Division of Public Health Sciences, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8100, St Louis, MO 63110 USA
| | - Graham A Colditz
- 5Division of Public Health Sciences and Alvin J. Siteman Cancer Center, Department of Surgery, Washington University School of Medicine, Washington University in St. Louis, 660 South Euclid Avenue, Campus Box 8100, St. Louis, MO 63110 USA
| | - Ann Marie Dale
- 2Department of Medicine, Division of General Medical Sciences, Washington University School of Medicine, 4523 Clayton Avenue, Campus Box 8005, St. Louis, MO 63110 USA
| | - Bradley A Evanoff
- 2Department of Medicine, Division of General Medical Sciences, Washington University School of Medicine, 4523 Clayton Avenue, Campus Box 8005, St. Louis, MO 63110 USA
| |
Collapse
|
8
|
Stein RI, Strickland JR, Tabak RG, Dale AM, Colditz GA, Evanoff BA. Design of a randomized trial testing a multi-level weight-control intervention to reduce obesity and related health conditions in low-income workers. Contemp Clin Trials 2019; 79:89-97. [PMID: 30664943 PMCID: PMC6521952 DOI: 10.1016/j.cct.2019.01.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 01/15/2019] [Accepted: 01/17/2019] [Indexed: 12/13/2022]
Abstract
Weight-control is a major public health focus for preventing multiple obesity-related health conditions. While clinic-based intensive lifestyle interventions are successful, low-socioeconomic-status (SES) populations, which have a higher burden of obesity, are difficult to reach; thus, the workplace offers a useful setting to target low-SES workers. The current paper presents the design of a study testing a workplace intervention aimed at low-SES employees. Partnering with a large healthcare system and affiliated university, this project will test an innovative multi-level intervention ("Working for You") adapted from existing group- and individual-level intervention models to promote healthy weight among low-wage workers. The individual-level component is an interactive obesity treatment approach (iOTA) program that involves assessment of behavior risks, collaborative goal-setting with a health coach, and interactive SMS text-messages for ongoing support and self-monitoring. This mHealth intervention is embedded in the group-level component, a workplace participatory program that involves worker teams engaged in the design and implementation of interventions to change their workplace environments. These nested interventions are being tested in a group-randomized trial among 22 work groups (~1000 total workers, ~300 workers with obesity). The primary outcome will be program effects on weight at 2-year follow-up, compared to control, and the secondary outcomes will be effects on diet and physical activity; iOTA adherence, process measures, and work environment/support will also be examined. This pragmatic clinical trial will test scalable interventions that can be translated to other work settings to reduce obesity and related health risks among low-SES workers. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02934113.
Collapse
Affiliation(s)
- Richard I Stein
- Washington University School of Medicine, Department of Medicine, Division of Geriatrics and Nutritional Science, 660 S. Euclid, Campus Box 8083, St. Louis, MO 63110, United States.
| | - Jaime R Strickland
- Washington University School of Medicine, Department of Medicine, Division of Geriatrics and Nutritional Science, 660 S. Euclid, Campus Box 8083, St. Louis, MO 63110, United States
| | - Rachel G Tabak
- Washington University School of Medicine, Department of Medicine, Division of Geriatrics and Nutritional Science, 660 S. Euclid, Campus Box 8083, St. Louis, MO 63110, United States
| | - Ann Marie Dale
- Washington University School of Medicine, Department of Medicine, Division of Geriatrics and Nutritional Science, 660 S. Euclid, Campus Box 8083, St. Louis, MO 63110, United States
| | - Graham A Colditz
- Washington University School of Medicine, Department of Medicine, Division of Geriatrics and Nutritional Science, 660 S. Euclid, Campus Box 8083, St. Louis, MO 63110, United States
| | - Bradley A Evanoff
- Washington University School of Medicine, Department of Medicine, Division of Geriatrics and Nutritional Science, 660 S. Euclid, Campus Box 8083, St. Louis, MO 63110, United States
| |
Collapse
|
9
|
Glasgow RE, Harden SM, Gaglio B, Rabin B, Smith ML, Porter GC, Ory MG, Estabrooks PA. RE-AIM Planning and Evaluation Framework: Adapting to New Science and Practice With a 20-Year Review. Front Public Health 2019; 7:64. [PMID: 30984733 PMCID: PMC6450067 DOI: 10.3389/fpubh.2019.00064] [Citation(s) in RCA: 889] [Impact Index Per Article: 177.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 03/05/2019] [Indexed: 01/07/2023] Open
Abstract
The RE-AIM planning and evaluation framework was conceptualized two decades ago. As one of the most frequently applied implementation frameworks, RE-AIM has now been cited in over 2,800 publications. This paper describes the application and evolution of RE-AIM as well as lessons learned from its use. RE-AIM has been applied most often in public health and health behavior change research, but increasingly in more diverse content areas and within clinical, community, and corporate settings. We discuss challenges of using RE-AIM while encouraging a more pragmatic use of key dimensions rather than comprehensive applications of all elements. Current foci of RE-AIM include increasing the emphasis on cost and adaptations to programs and expanding the use of qualitative methods to understand "how" and "why" results came about. The framework will continue to evolve to focus on contextual and explanatory factors related to RE-AIM outcomes, package RE-AIM for use by non-researchers, and integrate RE-AIM with other pragmatic and reporting frameworks.
Collapse
Affiliation(s)
- Russell E. Glasgow
- Dissemination and Implementation Science Program of ACCORDS, Department of Family Medicine, School of Medicine, University of Colorado, Aurora, CO, United States,*Correspondence: Russell E. Glasgow
| | - Samantha M. Harden
- Physical Activity Research and Community Implementation, Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA, United States
| | - Bridget Gaglio
- Patient-Centered Outcomes Research Institute, Washington, DC, United States
| | - Borsika Rabin
- Dissemination and Implementation Science Program of ACCORDS, Department of Family Medicine, School of Medicine, University of Colorado, Aurora, CO, United States,Department of Family Medicine and Public Health, School of Medicine, University of California, San Diego, La Jolla, CA, United States
| | - Matthew Lee Smith
- Center for Population Health and Aging, Texas A&M University, College Station, TX, United States,Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, College Station, TX, United States,Department of Health Promotion and Behavior, College of Public Health, The University of Georgia, Athens, GA, United States
| | - Gwenndolyn C. Porter
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, NE, United States
| | - Marcia G. Ory
- Center for Population Health and Aging, Texas A&M University, College Station, TX, United States,Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, College Station, TX, United States
| | - Paul A. Estabrooks
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, NE, United States
| |
Collapse
|
10
|
Mullane SL, Rydell SA, Larouche ML, Toledo MJL, Feltes LH, Vuong B, Crespo NC, Gaesser GA, Estabrooks PA, Pereira MA, Buman MP. Enrollment Strategies, Barriers to Participation, and Reach of a Workplace Intervention Targeting Sedentary Behavior. Am J Health Promot 2019; 33:225-236. [PMID: 29986592 PMCID: PMC7702267 DOI: 10.1177/0890117118784228] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To review enrollment strategies, participation barriers, and program reach of a large, 2-year workplace intervention targeting sedentary behavior. APPROACH Cross-sectional, retrospective review. SETTING Twenty-four worksites balanced across academic, industry, and government sectors in Minneapolis/Saint Paul (Minnesota) and Phoenix (Arizona) regions. PARTICIPANTS Full-time (≥30+ h/wk), sedentary office workers. METHODS Reach was calculated as the proportion of eligible employees who enrolled in the intervention ([N enrolled/(proportion of eligible employees × N total employees)] × 100). Mean (1 standard deviation) and median worksite sizes were calculated at each enrollment step. Participation barriers and modifications were recorded by the research team. A survey was sent to a subset of nonparticipants (N = 57), and thematic analyses were conducted to examine reasons for nonparticipation, positive impacts, and negative experiences. RESULTS Employer reach was 65% (56 worksites invited to participate; 66% eligible of 56 responses; 24 enrolled). Employee reach was 58% (1317 invited to participate, 83% eligible of 906 responses; 632 enrolled). Postrandomization, on average, 59% (15%) of the worksites participated. Eighteen modifications were developed to overcome participant-, context-, and research-related participation barriers. CONCLUSION A high proportion of worksites and employees approached to participate in a sedentary behavior reduction intervention engaged in the study. Interventions that provide flexible enrollment, graded participant engagement options, and adopt a participant-centered approach may facilitate workplace intervention success.
Collapse
Affiliation(s)
- Sarah L. Mullane
- School of Nutrition and Health Promotion, Arizona State University, Tempe, AZ, USA
| | - Sarah A. Rydell
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Miranda L. Larouche
- School of Nutrition and Health Promotion, Arizona State University, Tempe, AZ, USA
| | | | | | | | - Noe C. Crespo
- Graduate School of Public Health, San Diego State University, San Diego, CA, USA
| | - Glenn A. Gaesser
- School of Nutrition and Health Promotion, Arizona State University, Tempe, AZ, USA
| | - Paul A. Estabrooks
- College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Mark A. Pereira
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Matthew P. Buman
- School of Nutrition and Health Promotion, Arizona State University, Tempe, AZ, USA
| |
Collapse
|
11
|
Tabak RG, Strickland JR, Stein RI, Dart H, Colditz GA, Kirk B, Dale AM, Evanoff BA. Development of a scalable weight loss intervention for low-income workers through adaptation of interactive obesity treatment approach (iOTA). BMC Public Health 2018; 18:1265. [PMID: 30445939 PMCID: PMC6240310 DOI: 10.1186/s12889-018-6176-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 11/01/2018] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Describing how and why an evidence-based intervention is adapted for a new population and setting using a formal evaluation and an adaptation framework can inform others seeking to modify evidence-based weight management interventions for different populations or settings. The Working for You intervention was adapted, to fit a workplace environment, from Be Fit Be Well, an evidence-based intervention that targets weight-control and hypertension in patients at an outpatient clinic. Workplace-based efforts that promote diet and activity behavior change among low-income employees have potential to address the obesity epidemic. This paper aims to explicitly describe how Be Fit Be Well was adapted for this new setting and population. METHODS To describe and understand the worksite culture, environment, and policies that support or constrain healthy eating and activity in the target population, we used qualitative and quantitative methods including key informant interviews, focus groups, and a worker survey; these data informed intervention adaptation. We organized the adaptations made to Be Fit Be Well using an adaptation framework from implementation science. RESULTS The adapted intervention, Working for You, maintains the theoretical premise and evidence-base underpinning Be Fit Be Well. However, it was modified in terms of the means of delivery (i.e., rather than using interactive voice response, Working for You employs automated SMS text messaging), defined as a modification to context by the adaptation framework. The adaptation framework also includes modifications to content; in this case the behavioral goals were modified for the target population based on updated science related to weight loss and to target a workplace population (e.g., a goal to avoiding free food at work). CONCLUSIONS If effective, this scalable and relatively inexpensive intervention can be translated to other work settings to reduce obesity and diabetes risk among low-SES workers, a group with a higher prevalence of these conditions. Using a formal evaluation and framework to guide and organize how and why an evidence-based intervention is adapted for a new population and setting can push the field of intervention research forward. TRIAL REGISTRATION ClinicalTrials.gov: NCT02934113 ; Received: October 12, 2016; Updated: November 7, 2017.
Collapse
Affiliation(s)
- Rachel G. Tabak
- Prevention Research Center in St. Louis, The Brown School, Washington University in St. Louis, 1 Brookings Dr, St. Louis, MO 63130 USA
| | - Jaime R. Strickland
- Division of General Medical Sciences, Department of Medicine, Washington University School of Medicine, 4523 Clayton Avenue, Campus Box 8005, St. Louis, MO 63110 USA
| | - Richard I. Stein
- Center for Human Nutrition, Department of Medicine, Washington University School of Medicine, 4523 Clayton Avenue, Campus Box 8083, St. Louis, MO 63110 USA
| | - Hank Dart
- Division of Public Health Sciences and Alvin J. Siteman Cancer Center, Department of Surgery, Washington University School of Medicine, Washington University in St. Louis, 660 South Euclid Avenue, Campus Box 8100, St. Louis, MO 63110 USA
| | - Graham A. Colditz
- Division of Public Health Sciences and Alvin J. Siteman Cancer Center, Department of Surgery, Washington University School of Medicine, Washington University in St. Louis, 660 South Euclid Avenue, Campus Box 8100, St. Louis, MO 63110 USA
| | - Bridget Kirk
- Division of General Medical Sciences, Department of Medicine, Washington University School of Medicine, 4523 Clayton Avenue, Campus Box 8005, St. Louis, MO 63110 USA
| | - Ann Marie Dale
- Division of General Medical Sciences, Department of Medicine, Washington University School of Medicine, 4523 Clayton Avenue, Campus Box 8005, St. Louis, MO 63110 USA
| | - Bradley A. Evanoff
- Division of General Medical Sciences, Department of Medicine, Washington University School of Medicine, 4523 Clayton Avenue, Campus Box 8005, St. Louis, MO 63110 USA
| |
Collapse
|
12
|
Zoellner J, You W, Almeida F, Blackman KCA, Harden S, Glasgow RE, Linnan L, Hill JL, Estabrooks PA. The Influence of Health Literacy on Reach, Retention, and Success in a Worksite Weight Loss Program. Am J Health Promot 2018; 30:279-82. [PMID: 27404064 DOI: 10.1177/0890117116639558] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To examine if employee health literacy (HL) status moderated reach, retention, and weight outcomes in a worksite weight loss program. DESIGN The study was a two-group cluster randomized controlled weight loss trial. SETTING The study was conducted in 28 worksites. SUBJECTS Subjects comprised 1460 employees with a body mass index >25 kg/m(2). INTERVENTIONS Two 12-month weight loss interventions targeted diet and physical activity behaviors: incentaHEALTH (INCENT; incentivized individually targeted Internet-based intervention) and Livin' My Weigh (LMW; less-intense quarterly newsletters). MEASURES A validated three-item HL screening measure was self-completed at baseline. Weight was objectively assessed with the Health Spot scale at baseline and 12-month follow-up. ANALYSIS The impact of HL on program effectiveness was assessed through fixed-effect parametric models that controlled for individual (i.e., age, gender, race, ethnicity, income, education) and worksite random effects. RESULTS Enrolled employees had significantly higher HL status [13.54 (1.68)] as compared to unenrolled [13.04 (2.17)] (p < .001). This finding was consistent in both interventions. Also, HL moderated weight loss effects (beta = .66; SE = 027; p = .014) and losing >5% weight (beta = -1.53; SE = .77; p < .047). For those with lower baseline HL, the INCENT intervention produced greater weight loss outcomes compared to LMW. The HL level of employees retained was not significantly different from those lost to follow-up. CONCLUSION HL influences reach and moderates weight effects. These findings underscore the need to integrate recruitment strategies and further evaluate programmatic approaches that attend to the needs of low-HL audiences.
Collapse
Affiliation(s)
- Jamie Zoellner
- Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA, USA
| | - Wen You
- Department of Agricultural and Applied Economics, Virginia Tech, Blacksburg, VA, USA
| | - Fabio Almeida
- Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA, USA
| | - Kacie C A Blackman
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Samantha Harden
- Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA, USA
| | - Russell E Glasgow
- Colorado Health Outcomes Program, University of Colorado School of Medicine, Aurora, CO, USA
| | - Laura Linnan
- Gillings School of Global Public Health, University of North Carolina-Chapel Hill, NC, USA
| | - Jennie L Hill
- Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA, USA
| | - Paul A Estabrooks
- Department of Human Nutrition, Foods and Exercise, Virginia Tech Riverside, Roanoke, VA, USA
| |
Collapse
|
13
|
Ingersoll B, Shannon K, Berger N, Pickard K, Holtz B. Self-Directed Telehealth Parent-Mediated Intervention for Children With Autism Spectrum Disorder: Examination of the Potential Reach and Utilization in Community Settings. J Med Internet Res 2017; 19:e248. [PMID: 28701294 PMCID: PMC5529736 DOI: 10.2196/jmir.7484] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 05/04/2017] [Accepted: 05/05/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND There is a significant need for strategies to increase access to evidence-based interventions for children with autism spectrum disorder (ASD). One novel approach is to train parents to use evidence-based interventions for their child with ASD via telehealth. Pilot work examining the efficacy of one such program, ImPACT Online, demonstrated a high rate of parent program engagement, low attrition, and associated gains in parent learning and child social communication. OBJECTIVE The objective of this study was to conduct an open trial of ImPACT Online to better understand its dissemination potential. METHODS We examined the reach and representativeness of families who registered (n=36) compared to families who were referred (n=139) to the open trial for one referral site. We then compared the demographics of all families who enrolled in the open trial (n=112) to families who enrolled in one of two controlled trials of the same program (n=50). We also examined metrics of program engagement for the open and controlled trials, the relationship between program engagement and changes in parents' intervention knowledge, and program evaluation for the participants in the open trial. RESULTS In total, 25.8% (36/139) of the parents who were given information about the program at their child's diagnostic feedback session registered with the program. The parents who enrolled in the open (OT) and controlled trials (CT), respectively, were similar in gender (OT: 84.8% (95/112); CT: 88% (44/50), female), marital status (OT: 80.4% (90/112) ; CT: 69.6% (32/46), married), education (OT: 58.0% (65/112); CT: 54.0% (27/50), college degree or higher), and employment status (OT: 58.0% (65/112); CT: 65.3% (32/49), employed outside the home). The child participants were similar in terms of gender (OT: 83.0% (93/112); CT: 76.0% (38/50), male) and race and ethnicity (OT: 38.4% (43/112); CT: 24.0% (12/50), minority). However, the mean chronological age of the child participants in the open trial group was significantly higher (Mean=60.0 months) than in the controlled trial group (Mean=43.0 months), with t160=5.22, P<.001. Parents in the open trial engaged with the program at a significantly lower rate than the controlled trial, F3,81=21.14, P<.001. Program engagement was significantly associated with gains in parent intervention knowledge across both the groups, beta=.41, t=2.43, P=.02. Participants in the open access trial evaluated the program highly, but several barriers were noted. CONCLUSIONS These data suggest that additional strategies may need to be developed to support families in using telehealth-based parent-mediated intervention in community settings.
Collapse
Affiliation(s)
- Brooke Ingersoll
- Michigan State University, Department of Psychology, East Lansing, MI, United States
| | - Katherine Shannon
- Michigan State University, Department of Psychology, East Lansing, MI, United States
| | - Natalie Berger
- Michigan State University, Department of Psychology, East Lansing, MI, United States
| | - Katherine Pickard
- Michigan State University, Department of Psychology, East Lansing, MI, United States
| | - Bree Holtz
- Michigan State University, Department of Communication and Public Relations, East Lansing, MI, United States
| |
Collapse
|
14
|
A Quasi-Experiment to Assess the Impact of a Scalable, Community-Based Weight Loss Program: Combining Reach, Effectiveness, and Cost. J Gen Intern Med 2017; 32:24-31. [PMID: 28271423 PMCID: PMC5359160 DOI: 10.1007/s11606-016-3971-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Primary care addresses obesity through physician oversight of intensive lifestyle interventions or referral to external programs with demonstrated efficacy. However, limited information exists on community program reach, effectiveness, and costs across different groups of participants. OBJECTIVE To evaluate a scalable, community weight loss program using reach, effectiveness, and cost metrics. DESIGN Longitudinal pre-post quasi-experiment without control. PARTICIPANTS Enrolled participants in Weigh and Win (WAW), a community-based weight loss program. INTERVENTION A 12-month program with daily social cognitive theory-based email and/or text support, online access to health coaches, objective weight assessment through 83 community-based kiosks, and modest financial incentives to increase program reach. MAIN MEASURES Number of participants, representativeness, weight loss achievement (3%, 5% of initial weight lost), and cost of implementation. KEY RESULTS A total of 40,308 adults (79% women; 73% white; BMI = 32.3 ± 7.44, age = 43.9 ± 13.1 years) enrolled in WAW. Women were more likely than men to enroll in the program and continue engagement beyond an initial weigh-in (57% vs. 53%). Based on census data, African Americans were over-represented in the sample. Among participants who engaged in the program beyond an initial weigh-in (n = 19,029), 47% and 34% of participants lost 3% and 5% of their initial body weight, respectively. The average duration for those who achieved 5% weight loss was 1.7 ± 1.3 years. African American participants were more likely to achieve 5% weight loss and remain enrolled in the program longer compared to non-African American participants (2.0 ± 1.3 vs. 1.6 ± 1.2 years). Implementation costs were $2,822,698. Cost per clinically meaningful weight loss for African Americans ($257.97/3% loss; $335.96/5% loss) was lower than that for Hispanics ($318.62; $431.10) and Caucasians ($313.65; $441.87), due to the higher success rate of that subgroup of participants. CONCLUSIONS Weigh and Win is a scalable technology-supported and community-based weight loss program that reaches a large number of participants and may contribute to reducing health disparities.
Collapse
|
15
|
Nobrega S, Champagne N, Abreu M, Goldstein-Gelb M, Montano M, Lopez I, Arevalo J, Bruce S, Punnett L. Obesity/Overweight and the Role of Working Conditions: A Qualitative, Participatory Investigation. Health Promot Pract 2015; 17:127-36. [PMID: 26333770 DOI: 10.1177/1524839915602439] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The rising U.S. prevalence of obesity has generated significant concern and demonstrates striking socioeconomic and racial/ethnic disparities. Most interventions target individual behaviors, sometimes in combination with improving the physical environment in the community but rarely involving modifications of the work environment. With 3.6 million workers earning at or below the federal minimum wage, it is imperative to understand the impact of working conditions on health and weight for lower income workers. To investigate this question, a university-community partnership created a participatory research team and conducted eight focus groups, in English and Spanish, with people holding low-wage jobs in various industries. Analysis of transcripts identified four themes: physically demanding work (illnesses, injuries, leisure-time physical activity), psychosocial work stressors (high demands, low control, low social support, poor treatment), food environment at work (available food choices, kitchen equipment), and time pressure (scheduling, having multiple jobs and responsibilities). Physical and psychosocial features of work were identified as important antecedents for overweight. In particular, nontraditional work shifts and inflexible schedules limited participants' ability to adhere to public health recommendations for diet and physical activity. Workplace programs to address obesity in low-wage workers must include the effect of working conditions as a fundamental starting point.
Collapse
Affiliation(s)
| | | | | | | | - Mirna Montano
- Massachusetts Coalition for Occupational Safety and Health, Boston, MA, USA
| | - Isabel Lopez
- Massachusetts Coalition for Occupational Safety and Health, Boston, MA, USA
| | - Jonny Arevalo
- Massachusetts Coalition for Occupational Safety and Health, Boston, MA, USA
| | | | | |
Collapse
|
16
|
Harden SM, You W, Almeida FA, Hill JL, Linnan LA, Allen KC, Estabrooks PA. Does Successful Weight Loss in an Internet-Based Worksite Weight Loss Program Improve Employee Presenteeism and Absenteeism? HEALTH EDUCATION & BEHAVIOR 2015; 42:769-74. [PMID: 25842385 DOI: 10.1177/1090198115578751] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Certain risk factors associated with overweight and obesity may lead to reduced productivity in the workforce (i.e., increased absenteeism and presenteeism). Participants in a large, Internet-based worksite weight loss intervention, who were present at follow-up (N = 1,030), completed a self-reported productivity measure (World Health Organization's Health and Work Performance Questionnaire) at baseline and postintervention. Twenty-two percent of the participants lost a clinically meaningful amount of weight (≥5% weight loss). There were no statistically significant (p < .05) relationships between weight change from baseline to 12 months and change scores of absolute or relative absenteeism or for absolute or relative presenteeism. Within a modestly successful Internet-based, worksite weight loss intervention, weight loss did not improve self-reported absenteeism or presenteeism. Further studies are needed to explore the sensitivity of the World Health Organization's Health and Work Performance Questionnaire and the long-term effects of weight loss on productivity.
Collapse
Affiliation(s)
| | - Wen You
- Virginia Tech, Blacksburg, VA, USA
| | - Fabio A Almeida
- Virginia Tech, Blacksburg, VA, USA Carilion Clinic, Roanoke, VA, USA
| | | | | | - Kacie C Allen
- Virginia Tech, Blacksburg, VA, USA University of Southern California, Los Angeles, CA, USA
| | - Paul A Estabrooks
- Virginia Tech, Blacksburg, VA, USA Carilion Clinic, Roanoke, VA, USA
| |
Collapse
|
17
|
Almeida FA, You W, Harden SM, Blackman KCA, Davy BM, Glasgow RE, Hill JL, Linnan LA, Wall SS, Yenerall J, Zoellner JM, Estabrooks PA. Effectiveness of a worksite-based weight loss randomized controlled trial: the worksite study. Obesity (Silver Spring) 2015; 23:737-45. [PMID: 25678325 PMCID: PMC4380658 DOI: 10.1002/oby.20899] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 08/18/2014] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To determine the effectiveness of an individually targeted Internet-based intervention with monetary incentives (INCENT) at reducing weight of overweight and obese employees when compared with a less-intensive intervention (Livin' My Weigh [LMW]) 6 months after program initiation. METHODS Twenty-eight worksites were randomly assigned to either INCENT or LMW conditions. Both programs used evidence-based strategies to support weight loss. INCENT was delivered via daily e-mails over 12 months while LMW was delivered quarterly via both newsletters and on-site educational sessions. Generalized linear mixed models were conducted for weight change from baseline to 6 months post-program and using an intention-to-treat analysis to include all participants with baseline weight measurements. RESULTS Across 28 worksites, 1,790 employees (M = 47 years of age; 79% Caucasian; 74% women) participated. Participants lost an average of 2.27 lbs (P < 0.001) with a BMI decrease of 0.36 kg/m(2) (P < 0.001) and 1.30 lbs (P < 0.01) with a BMI decrease of 0.20 kg/m(2) (P < 0.01) in INCENT and LMW, respectively. The differences between INCENT and LMW in weight loss and BMI reduction were not statistically significant. CONCLUSIONS This study suggests that INCENT and a minimal intervention alternative may be effective approaches to help decrease the overall obesity burden within worksites.
Collapse
Affiliation(s)
- Fabio A. Almeida
- Virginia Tech, Department of Human Nutrition, Foods & Exercise
- Fralin Translational Obesity Research Center, Virginia Tech
| | - Wen You
- Fralin Translational Obesity Research Center, Virginia Tech
- Virginia Tech, Department of Agriculture and Applied Economics
| | | | | | - Brenda M. Davy
- Virginia Tech, Department of Human Nutrition, Foods & Exercise
- Fralin Translational Obesity Research Center, Virginia Tech
| | | | - Jennie L. Hill
- Virginia Tech, Department of Human Nutrition, Foods & Exercise
- Fralin Translational Obesity Research Center, Virginia Tech
| | - Laura A. Linnan
- University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center
| | - Sarah S. Wall
- Virginia Tech, Department of Human Nutrition, Foods & Exercise
- Fralin Translational Obesity Research Center, Virginia Tech
| | | | - Jamie M. Zoellner
- Virginia Tech, Department of Human Nutrition, Foods & Exercise
- Fralin Translational Obesity Research Center, Virginia Tech
| | - Paul A. Estabrooks
- Virginia Tech, Department of Human Nutrition, Foods & Exercise
- Fralin Translational Obesity Research Center, Virginia Tech
- Carilion Clinic, Department of Family and Community Medicine
| |
Collapse
|
18
|
The association between worksite physical environment and employee nutrition, and physical activity behavior and weight status. J Occup Environ Med 2015; 56:779-84. [PMID: 24988105 DOI: 10.1097/jom.0000000000000180] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To explore the relationship between worksite physical environment and employee dietary intake, physical activity behavior, and weight status. METHODS Two trained research assistants completed audits (Checklist of Health Promotion Environments at Worksites) at each worksite (n = 28). Employees (n = 6261) completed a brief health survey before participation in a weight loss program. RESULTS Employees' access to outdoor areas was directly associated with lower body mass index (BMI), whereas access to workout facilities within a worksite was associated with higher BMI. The presence of a cafeteria and fewer vending machines was directly associated with better eating habits. Better eating habits and meeting physical activity recommendations were both related to lower BMI. CONCLUSIONS Selected environmental factors in worksites were significantly associated with employee behaviors and weight status, providing additional intervention targets to change the worksite environment and promote employee weight loss.
Collapse
|
19
|
Davy BM, You W, Almeida F, Wall S, Harden S, Comber DL, Estabrooks PA. Impact of individual and worksite environmental factors on water and sugar-sweetened beverage consumption among overweight employees. Prev Chronic Dis 2014; 11:E71. [PMID: 24784907 PMCID: PMC4008951 DOI: 10.5888/pcd11.130207] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Introduction The worksite environment may influence employees’ dietary behaviors. Consumption of water and sugar-sweetened beverages (SSBs) affect weight management; however, little research has evaluated the influence of worksite factors on beverage consumption. Our purpose was to determine whether individual and worksite factors are associated with water and SSB intake among overweight and obese employees. Methods Data were collected as part of baseline assessments for a worksite-based, weight-management intervention trial. Height and weight of participants (N = 1,482; 74% female; mean age = 47 y [standard deviation (SD) = 11y]; mean weight = 208 lbs [SD = 46 lbs]) were assessed, and participants completed a validated beverage intake questionnaire. Environmental characteristics of worksites (N = 28) were audited. A qualitative comparative analysis (QCA) was used to identify worksite conditions that may support healthier beverage intake patterns. Results Most participants were white (75% of sample) with at least some college education or a college degree (approximately 82% of sample). Mean water and SSB intake were 27 fl oz (SD = 18 fl oz) and 17 fl oz (SD = 18 fl oz), respectively; SSB intake (191 kcal [SD = 218 kcal]) exceeded the recommended discretionary energy intake. Statistical models did not identify any significant predictors of water intake. Female sex and increasing level of education and household income were associated with lower SSB intake; baseline body weight and greater number of worksite water coolers and vending machines were associated with higher SSB intake. The QCA identified worksite type (ie, not manual labor) as a condition necessary for healthier beverage consumption; a worksite break policy of 2 or more per day may lead to unhealthy beverage consumption. Lower SSB consumption was noted among older participants, female participants, and among participants with higher education and income levels. Conclusion Workplace factors influence beverage consumption among overweight employees. Limiting vending machine availability and implementing policies that promote weight management may improve employee health.
Collapse
Affiliation(s)
- Brenda M Davy
- Associate Professor, Department of Human Nutrition, Foods and Exercise, Virginia Tech, 338 Wallace Hall, Mail Code, 043, Blacksburg, VA 24061. E-mail:
| | - Wen You
- Virginia Tech, Blacksburg, Virginia
| | | | | | | | - Dana L Comber
- Virginia College of Osteopathic Medicine, Blacksburg, Virginia
| | | |
Collapse
|
20
|
Crane MM, Tate DF, Finkelstein EA, Linnan LA. Motivation for participating in a weight loss program and financial incentives: an analysis from a randomized trial. J Obes 2012; 2012:290589. [PMID: 22577524 PMCID: PMC3345232 DOI: 10.1155/2012/290589] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Revised: 01/20/2012] [Accepted: 02/12/2012] [Indexed: 11/24/2022] Open
Abstract
This analysis investigated if changes in autonomous or controlled motivation for participation in a weight loss program differed between individuals offered a financial incentive for weight loss compared to individuals not offered an incentive. Additionally, the same relationships were tested among those who lost weight and either received or did not receive an incentive. This analysis used data from a year-long randomized worksite weight loss program that randomly assigned employees in each worksite to either a low-intensity weight loss program or the same program plus small financial incentives for weight loss ($5.00 per percentage of initial weight lost). There were no differences in changes between groups on motivation during the study, however, increases in autonomous motivation were consistently associated with greater weight losses. This suggests that the small incentives used in this program did not lead to increases in controlled motivation nor did they undermine autonomous motivation. Future studies are needed to evaluate the magnitude and timing of incentives to more fully understand the relationship between incentives and motivation.
Collapse
Affiliation(s)
- Melissa M. Crane
- Department of Health Behavior, UNC Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, 1700 Martin Luther King Jr. Boulevard, Campus Box 7294, Chapel Hill, NC 27514, USA
- *Melissa M. Crane:
| | - Deborah F. Tate
- Departments of Health Behavior and Nutrition, UNC Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, 1700 Martin Luther King Jr. Boulevard, Campus Box 7294, Chapel Hill, NC 27514, USA
| | | | - Laura A. Linnan
- Department of Health Behavior, UNC Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, 1700 Martin Luther King Jr. Boulevard, Campus Box 7294, Chapel Hill, NC 27514, USA
| |
Collapse
|
21
|
Ajduković D, Pibernik-Okanović M, Šekerija M, Hermanns N. The reach of depression screening preceding treatment: are there patterns of patients' self-selection? Int J Endocrinol 2012; 2012:148145. [PMID: 23209461 PMCID: PMC3502847 DOI: 10.1155/2012/148145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Revised: 09/21/2012] [Accepted: 10/09/2012] [Indexed: 11/17/2022] Open
Abstract
This study evaluated the reach of depression screening followed by treatment programs for subsyndromal depression and explored demographic and clinical characteristics of patients who were reached versus those who were not. A two-item Patient Health Questionnaire-Depression was sent to 4196 type 2 diabetic patients. Positively screened patients were interviewed to assess the severity of depression, and those with subclinical symptoms were invited to treatment groups. The reach of screening procedure was evaluated by the total response rate, proportion of positive depression screenings, and proportion of eligible patients entering treatment programs. Predictors of responsiveness to screening and of participation in treatment were determined using logistic regression. Of the 34% of patients who returned the questionnaire (n = 1442), 40% reported depressive symptoms and a need for professional help (n = 581). Age (OR = 1.06, 95% CI = 1.05-1.08), BMI (OR = 1.02, 95% CI = 1.00-1.04), HbA1C (OR = .92, 95% CI = .86-.99), and LDL-cholesterol (OR = .90, 95% CI = .81-1.00) correlated with response to screening. Willingness to accept treatment was predicted by professional status (OR = 3.24, 95% CI = 1.53-6.87), education (OR = 1.21, 95% CI = 1.05-1.38), and BMI (OR = .91, 95% CI = .85-.98). Older patients with better diabetes control were more likely to be reached by postal screening for depressive symptoms. Professionally inactive, better-educated persons and those with lower BMI were more likely to participate in the intervention for subsyndromal depression.
Collapse
Affiliation(s)
- Dea Ajduković
- Unit for Psychological Medicine, Vuk Vrhovac University Clinic, Merkur Teaching Hospital, Zajčeva 19, 10000 Zagreb, Croatia
| | - Mirjana Pibernik-Okanović
- Unit for Psychological Medicine, Vuk Vrhovac University Clinic, Merkur Teaching Hospital, Zajčeva 19, 10000 Zagreb, Croatia
- *Mirjana Pibernik-Okanović:
| | - Mario Šekerija
- Service for the Epidemiology of Non-Communicable Diseases, Croatian National Institute of Public Health, Rockefellerova 7, 10000 Zagreb, Croatia
| | - Norbert Hermanns
- Forschungsinstitut Diabetes-Akademie Bad Mergentheim (FIDAM GmbH), Diabetes Zentrum Mergentheim, Johann-Hammer-Straße 24, 97980 Bad Mergentheim, Germany
| |
Collapse
|