Home Environment-Focused Intervention Improves Dietary Quality: A Secondary Analysis From the Healthy Homes/Healthy Families Randomized Trial.

OBJECTIVE: Estimate Healthy Homes/Healthy Families (HHHF) intervention efficacy for improving dietary quality. METHODS: Low-income overweight and obese women (n = 349) recruited from rural community health centers were randomized to receive HHHF, a 16-week home environment-focused coaching intervention or health education materials by mail. Healthy Eating Index-2010 scores were calculated from 2 24-hour dietary recalls collected at baseline and 6- and 12-month follow-up. RESULTS: HHHF participants reported greater improvements in Healthy Eating Index-2010 total scores at 6-month follow-up (+3.41 ± 13.43 intervention vs +2.02 ± 12.26 control; P =.009). Subcomponent analysis indicated greater consumption of total vegetables (P = .02) and greens and beans (P = .001), whole grains (P = .02) and reduced consumption of empty calories (P = .03). Standardized intervention effect sizes were 0.16 at 6 months and 0.13 at 12 months of follow-up. CONCLUSIONS AND IMPLICATIONS: The HHHF resulted in short-term improvements in dietary quality, although more research is needed to interpret the clinical significance of effect sizes of this magnitude.

Impact of Improving Home Environments on Energy Intake and Physical Activity: A Randomized Controlled Trial.

OBJECTIVES: We assessed the effectiveness of an intervention targeting home food and activity environments to reduce energy intake and increase physical activity among overweight and obese patients from 3 community health centers in rural Georgia. METHODS: We conducted a randomized controlled trial (n = 349) from 2011 to 2013, with follow-up at 6 and 12 months. Health coaches delivered the 16-week intervention by using tailored home environment profiles showing areas in need of improvement and positive aspects of the home environment, behavioral contracts for healthy actions, and mailed support materials. RESULTS: Participants were mostly African American women (84.8%), with a mean age of 50.2 years and a mean body mass index (weight in kilograms divided by the square of height in meters) of 38.3. Daily energy intake decreased more for the intervention than control group at 6 (-274 vs -69 kcal) and 12 months (-195 vs -76 kcal). We observed no change for either objective or self-reported physical activity. At 12 months, 82.6% of intervention participants had not gained weight compared with 71.4% of control participants. CONCLUSIONS: The intervention was effective in changing home environments and reducing energy intake.

Reported Use of Electronic Health Records to Implement Evidence Based Approaches to Colorectal Cancer Screening in Community Health Centers.

BACKGROUND: Community health centers (CHCs) are critical sources of primary care for medically underserved populations. Electronic health records (EHRs) are important for implementation of evidence-based approaches for cancer control. METHODS: Cross-sectional study of CHCs from the Cancer Prevention Control Research Network's community health center Clinic Characteristics Survey. Proportions of CHCs using EHR data to: 1) measure colorectal cancer screening, 2) deliver reports, and 3) provide patient reminders for colorectal cancer screening. RESULTS: Only 27% of CHCs perceive EHR system's colorectal cancer screening data as very accurate. Over half (57%) of respondent CHCs with EHRs reported it is easy or very easy to do colorectal cancer screening activities using EHR systems. CONCLUSIONS: Poor EHR data quality and cumbersome EHR systems may be significant barriers to implementation of evidence-based approaches to colorectal cancer screening in CHCs.

A qualitative inquiry about weight counseling practices in community health centers.

OBJECTIVE: To use qualitative methods to explore how clinicians approach weight counseling, including who they counsel, how they bring up weight, what advice they provide, and what treatment referral resources they use. METHODS: Thirty primary care physicians, physician assistants, and nurse practitioners from four multi-clinic community health center systems (CHCs) in the state of Georgia (U.S.) completed one-on-one semi-structured interviews. Interviews were digitally recorded, transcribed verbatim, and coded. RESULTS: Clinicians report addressing weight with those who have weight-related chronic conditions, are established patients, or have a change in weight since the previous visit. Most clinicians address weight in the context of managing or preventing chronic conditions. Clinicians report providing detailed dietary advice to patients, including advice about adding or avoiding foods. Many clinicians base advice on their own experiences with weight. Most report no community-based resources to offer patients for weight loss. In the absence of resources, clinicians develop or use existing brochures, refer to in-house weight programs, or use online resources. CONCLUSION: Clinicians use a variety of approaches for addressing weight, many of which are not evidence-based. Linkages with weight loss resources in the health care system or community are not widely reported. IMPLICATIONS FOR PRACTICE: Clinicians and others from the primary care team should continue to offer weight-related counseling to patients with obesity, however, evidence-based treatment approaches for weight loss may need to be adapted or expanded for the CHC practice environment.

Strategies for expanding colorectal cancer screening at community health centers.

Community health centers are uniquely positioned to address disparities in colorectal cancer (CRC) screening as they have addressed other disparities. In 2012, the federal Health Resources and Services Administration, which is the funding agency for the health center program, added a requirement that health centers report CRC screening rates as a standard performance measure. These annually reported, publically available data are a major strategic opportunity to improve screening rates for CRC. The Patient Protection and Affordable Care Act enacted provisions to expand the capacity of the federal health center program. The recent report of the Institute of Medicine on integrating public health and primary care included an entire section devoted to CRC screening as a target for joint work. These developments make this the ideal time to integrate lifesaving CRC screening into the preventive care already offered by health centers. This article offers 5 strategies that address the challenges health centers face in increasing CRC screening rates. The first 2 strategies focus on improving the processes of primary care. The third emphasizes working productively with other medical providers and institutions. The fourth strategy is about aligning leadership. The final strategy is focused on using tools that have been derived from models that work.

Strategies for expanding colorectal cancer screening at community health centers.

Community health centers are uniquely positioned to address disparities in colorectal cancer (CRC) screening as they have addressed other disparities. In 2012, the federal Health Resources and Services Administration, which is the funding agency for the health center program, added a requirement that health centers report CRC screening rates as a standard performance measure. These annually reported, publically available data are a major strategic opportunity to improve screening rates for CRC. The Patient Protection and Affordable Care Act enacted provisions to expand the capacity of the federal health center program. The recent report of the Institute of Medicine on integrating public health and primary care included an entire section devoted to CRC screening as a target for joint work. These developments make this the ideal time to integrate lifesaving CRC screening into the preventive care already offered by health centers. This article offers 5 strategies that address the challenges health centers face in increasing CRC screening rates. The first 2 strategies focus on improving the processes of primary care. The third emphasizes working productively with other medical providers and institutions. The fourth strategy is about aligning leadership. The final strategy is focused on using tools that have been derived from models that work. CA Cancer J Clin 2013. © 2013 American Cancer Society, Inc.

Results from an intervention to improve rural home food and physical activity environments.

BACKGROUND: Ecological models of healthy eating and physical activity emphasize the influence of behavioral settings such as homes and worksites in shaping behavior. Research on home environments suggests that both social and physical aspects of the home may impact physical activity and healthy eating. OBJECTIVE: Using a community-based participatory research (CBPR) approach, the Emory Prevention Research Center (EPRC), Cancer Coalition of South Georgia, and the EPRC's Community Advisory Board (CAB) designed and tested a coach-based intervention to make the home environment more supportive of healthy eating and physical activity for rural adults. METHODS: The 6-week intervention consisted of a tailored home environment profile, goal-setting, and behavioral contracting delivered through two home visits and two telephone calls. The study used a quasi-experimental design with data collected via telephone interviews at baseline, 2 and 4 months post-baseline. Ninety households (n = 90) completed all three telephone interviews. RESULTS: Multilevel models indicated that intervention households reported significant improvements in household food inventories, purchasing of fruit and vegetables, healthier meal preparation, meals with the TV off, and family support for healthy eating, relative to comparison households. Intervention households also reported increased exercise equipment and family support for physical activity relative to comparison households. Percent of fat intake decreased significantly, but no changes were observed for fruit and vegetable intake, physical activity, or weight among intervention relative to comparison households, although trends were generally in a positive direction. CONCLUSION: Coaching combined with a focus on the home environment may be a promising strategy for weight gain prevention in adults.