A randomized trial using motivational interviewing for maintenance of blood pressure improvements in a community-engaged lifestyle intervention: HUB city steps.

Little is known about the effective dose of motivational interviewing for maintaining intervention-induced health outcome improvements. The purpose of this study was to compare effects of two doses of motivational interviewing for maintaining blood pressure improvements in a community-engaged lifestyle intervention conducted with African-Americans. Participants were tracked through a 12-month maintenance phase following a 6-month intervention targeting physical activity and diet. For the maintenance phase, participants were randomized to receive a low (4) or high (10) dose of motivational interviewing delivered via telephone by trained research staff. Generalized linear models were used to test for group differences in blood pressure. Blood pressure significantly increased during the maintenance phase. No differences were apparent between randomized groups. Results suggest that 10 or fewer motivational interviewing calls over a 12-month period may be insufficient to maintain post-intervention improvements in blood pressure. Further research is needed to determine optimal strategies for maintaining changes.

Improvements in blood pressure among undiagnosed hypertensive participants in a community-based lifestyle intervention, Mississippi, 2010.

INTRODUCTION: Effective strategies are needed to reach and treat people who lack awareness of or have uncontrolled hypertension. We used data from a community-based participatory research initiative, Hub City Steps, to quantify the prevalence of undiagnosed hypertension and determine the relationship between hypertension status at baseline and postintervention improvements in blood pressure and health-related quality of life. METHODS: Hub City Steps was a 6-month preintervention-postintervention lifestyle intervention targeting hypertension risk factors. Outcome measures were collected at baseline, 3 months, and 6 months. Generalized linear mixed models were used to test for effects by time and hypertension status. RESULTS: Of the enrolled sample (N = 269), most were overweight or obese (91%), African American (94%), and women (85%). When considering hypertension status, 42% had self-reported diagnosis of hypertension (self-reported subgroup; 84% with antihypertensive medication use); 36% had no self-reported medical history of hypertension, but when blood pressure was measured they had a clinical diagnosis of prehypertension or hypertension (undiagnosed subgroup); and 22% had no self-reported or clinical hypertension diagnosis (no hypertension subgroup). From baseline to 6 months, systolic blood pressure significantly improved for participants with self-reported hypertension [8.2 (SD, 18.2) mm Hg] and undiagnosed hypertension [12.3 (SD, 16.3) mm Hg], with undiagnosed participants experiencing the greatest improvements (P < .001). Effects remained significant after controlling for covariates. Health-related quality of life significantly improved for all 3 hypertension subgroups, with no apparent subgroup differences. CONCLUSION: This study reveals advantages of a culturally appropriate community-based participatory research initiative to reach those with undetected hypertension and effectively improve blood pressure status and health-related quality of life.

Environmental perceptions and objective walking trail audits inform a community-based participatory research walking intervention.

BACKGROUND: Given the documented physical activity disparities that exist among low-income minority communities and the increased focused on socio-ecological approaches to address physical inactivity, efforts aimed at understanding the built environment to support physical activity are needed. This community-based participatory research (CBPR) project investigates walking trails perceptions in a high minority southern community and objectively examines walking trails. The primary aim is to explore if perceived and objective audit variables predict meeting recommendations for walking and physical activity, MET/minutes/week of physical activity, and frequency of trail use. METHODS: A proportional sampling plan was used to survey community residents in this cross-sectional study. Previously validated instruments were pilot tested and appropriately adapted and included the short version of the validated International Physical Activity Questionnaire, trail use, and perceptions of walking trails. Walking trails were assessed using the valid and reliable Path Environmental Audit Tool which assesses four content areas including: design features, amenities, maintenance, and pedestrian safety from traffic. Analyses included Chi-square, one-way ANOVA's, multiple linear regression, and multiple logistic models. RESULTS: Numerous (n = 21) high quality walking trails were available. Across trails, there were very few indicators of incivilities and safety features rated relatively high. Among the 372 respondents, trail use significantly predicted meeting recommendations for walking and physical activity, and MET/minutes/week. While controlling for other variables, significant predictors of trail use included proximity to trails, as well as perceptions of walking trail safety, trail amenities, and neighborhood pedestrian safety. Furthermore, while controlling for education, gender, and income; for every one time per week increase in using walking trails, the odds for meeting walking recommendations increased 1.27 times, and the odds for meeting PA recommendation increased 3.54 times. Perceived and objective audit variables did not predict meeting physical activity recommendations. CONCLUSIONS: To improve physical activity levels, intervention efforts are needed to maximize the use of existing trails, as well as improve residents' perceptions related to incivilities, safety, conditions of trail, and amenities of the walking trails. This study provides important insights for informing development of the CBPR walking intervention and informing local recreational and environmental policies in this southern community.

Using mixed methods to measure the perception of community capacity in an academic-community partnership for a walking intervention.

H.U.B. City Steps is a 5-year community-based participatory research walking intervention designed to help lower blood pressure in a majority African American population in southern Mississippi via community collaboration and capacity building, increased walking, culturally tailored health education sessions, and motivational interviewing. Building community capacity for physical activity is a key component of this intervention. Qualitative and quantitative methods have been used to assess how project stakeholders perceive the community capacity-building efforts of the project. This article illustrates the baseline results of this mixed methods approach from the perspective of three groups of stakeholders: project researchers and staff, community advisory board, and intervention walking coaches. Eight constructs were examined, including leadership, resources, external networking, visibility and recognition, personnel sustainability, ability and commitment to organize, communication with community members, and relationships with influential others. Quantitative results indicated significant differences among stakeholder groups for project leadership and personnel sustainability. Qualitative perspectives provided an opportunity to examine possible reasons for these differences. Overall findings provide direction related to improving intervention outcomes and sustainability.

H.U.B city steps: methods and early findings from a community-based participatory research trial to reduce blood pressure among African Americans.

BACKGROUND: Community-based participatory research (CBPR) has been recognized as an important approach to develop and execute health interventions among marginalized populations, and a key strategy to translate research into practice to help reduce health disparities. Despite growing interest in the CBPR approach, CBPR initiatives rarely use experimental or other rigorous research designs to evaluate health outcomes. This behavioral study describes the conceptual frameworks, methods, and early findings related to the reach, adoption, implementation, and effectiveness on primary blood pressure outcomes. METHODS: The CBPR, social support, and motivational interviewing frameworks are applied to test treatment effects of a two-phased CBPR walking intervention, including a 6-month active intervention quasi experimental phase and 12-month maintenance randomized controlled trial phase to test dose effects of motivational interviewing. A community advisory board helped develop and execute the culturally-appropriate intervention components which included social support walking groups led by peer coaches, pedometer diary self-monitoring, monthly diet and physical activity education sessions, and individualized motivational interviewing sessions. Although the study is on-going, three month data is available and reported. Analyses include descriptive statistics and paired t tests. RESULTS: Of 269 enrolled participants, most were African American (94%) females (85%) with a mean age of 43.8 (SD = 12.1) years. Across the 3 months, 90% of all possible pedometer diaries were submitted. Attendance at the monthly education sessions was approximately 33%. At the 3-month follow-up 227 (84%) participants were retained. From baseline to 3-months, systolic BP [126.0 (SD = 19.1) to 120.3 (SD = 17.9) mmHg; p < 0.001] and diastolic BP [83. 2 (SD = 12.3) to 80.2 (SD = 11.6) mmHg; p < 0.001] were significantly reduced. CONCLUSIONS: This CBPR study highlights implementation factors and signifies the community's active participation in the development and execution of this study. Reach and representativeness of enrolled participants are discussed. Adherence to pedometer diary self-monitoring was better than education session participation. Significant decreases in the primary blood pressure outcomes demonstrate early effectiveness. Importantly, future analyses will evaluate long-term effectiveness of this CBPR behavioral intervention on health outcomes, and help inform the translational capabilities of CBPR efforts.

Development and evaluation of WillTry. An instrument for measuring children's willingness to try fruits and vegetables.

This paper describes the development and evaluation of the WillTry instrument, a psychometric tool designed to measure children's willingness to try fruits and vegetables. WillTry surveys were interviewer-administered to 284 children in an elementary school and summer day camps located in rural Mississippi and Arkansas (United States) communities. Factor analysis was used to determine construct dimensionality. Additional evaluation included internal consistency, test-retest reliability, and predictive validity. Factor analysis suggested a single dimension for the food items. The WillTry food scale had substantial reliability (intraclass correlation coefficients between 0.61 and 0.80) and sufficient internal consistency (Cronbach's alpha > or = 0.70). Results of the regression analysis for percent consumption of foods offered on WillTry response confirmed the predictive validity of the instrument. The results of these analyses provide psychometric evidence for the use of the WillTry instrument as a measure of willingness to try fruits and vegetables in rural, southern US children 5-14 years of age.

Perceptions of factors influencing healthful food consumption behavior in the Lower Mississippi Delta: focus group findings.

OBJECTIVE: To identify perceptions of Lower Mississippi Delta (LMD) residents regarding factors that influence a change in healthful food consumption behavior to assist in planning sustainable nutrition interventions in the LMD. DESIGN: Nine focus groups were conducted with LMD residents in 9 counties in Arkansas, Louisiana, and Mississippi. One focus group was held in each county on the topical area of behavioral change. SETTING: Nine counties in Arkansas, Louisiana, and Mississippi. PARTICIPANTS: The study population included 91 persons, 85 females and 6 males (18-60+ years of age), of whom 71 were African Americans, 17 were Caucasians, and 3 were Hispanics, who participated in the focus group discussions. ANALYSIS: Data analyses were completed by general and specific content coding. Data were reviewed for emerging themes for each topic. The Social Cognitive Theory served as the framework for understanding the determinants of a change in healthful food consumption behavior. RESULTS: The study showed considerable variability in perceptions that are influenced by both personal and external factors. These factors include health concerns, family influence, and need for and availability of nutrition information. Participants were interested in learning about healthful eating, food preparation skills, and portion control. CONCLUSIONS: Focus groups in the LMD identified many important themes relevant to the development of nutrition interventions in these communities. These data will be used to guide the community-based participatory interventions that will be developed and implemented in the LMD. The findings could be applicable to other researchers designing interventions for similar populations.

Maternity Nurses' Knowledge and Practice of Breastfeeding in Mississippi.

BACKGROUND: Mississippi has the lowest rates of breastfeeding of all states at 6 months and at 1 year. Registered nurses working in the maternity setting can be influential in mothers' decision to breastfeed. PURPOSE: The purpose of this study was to examine registered nurses' knowledge and practice related to breastfeeding; and to identify facilitators and barriers to implementing the Ten Steps to Successful Breastfeeding in Mississippi hospitals. METHODS: 302 Registered nurses working in hospital maternity/birthing settings in Mississippi completed a questionnaire. Breastfeeding knowledge and practices overall scores were categorized into: poor and good. Chi-square analysis and Spearman correlations were used to determine correlations among the variables. RESULTS: Overall breastfeeding knowledge and practices of respondents was good. Only 4% earned a perfect score. Most believed they were effective (77%) in meeting the needs of new mothers. Significant positive associations were noted among knowledge and effectiveness, and other variables. Resistance to change and staffing shortages were the main barriers to implementing the Ten Steps; raising awareness about the importance of the Ten Steps and providing a lactation consultant were the main facilitators. CONCLUSION: More research is needed to understand reasons behind low breastfeeding rates in Mississippi.

Breastfeeding Practices and Barriers to Implementing the Ten Steps to Successful Breastfeeding in Mississippi Hospitals.

BACKGROUND: Mississippi has the lowest rates of breastfeeding in the United States at 6 and 12 months. There is growing evidence that the rates and duration of infant breastfeeding improve after hospitals implement the Ten Steps to Successful Breastfeeding; moreover, the Ten Steps approach is considered the standard model for evaluation of breastfeeding practices in birthplaces. Research aim: This study aimed to examine the implementation level of the Ten Steps and identify barriers to implementing the Ten Steps in Mississippi hospitals. METHODS: A cross-sectional self-report survey was used to answer the research aim. Nurse managers of the birthing and maternity units of all 43 Mississippi hospitals that provided birthing and maternity care were recruited. A response rate of 72% ( N = 31) was obtained. Implementation of the Ten Steps in these hospitals was categorized as low, partial, moderate, or high. RESULTS: The researcher classified implementation in 29% of hospitals as moderate and in 71% as partial. The hospital level of implementation was significantly positively associated with the hospital delivery rate along with the hospital cesarean section rate per year. The main barriers for the implementation process of the Ten Steps reported were resistance to new policies, limited financial and human resources, and lack of support from national and state governments. CONCLUSION: Breastfeeding practices in Mississippi hospitals need to be improved. New policies need to be established in Mississippi to encourage hospitals to adopt the Ten Steps policies and practice in the maternity and birthing units.

Predictors of multivitamin supplement use among African-American female students: a prospective study utilizing the theory of planned behavior.

BACKGROUND: Public health officials recommend that women capable of becoming pregnant use folic acid-containing supplements (FAS) to prevent neural tube defects (NTD) in their newborn infants. However, the knowledge about NTD prevention and the prevalence of the use of FAS among women capable of becoming pregnant increased only modestly since the issuing of the recommendation in 1992. Since most commonly available multivitamin supplements (MVS) contain the recommended 400 gg of folic acid, finding out reasons why women take MVS and utilizing these factors in educational campaigns may contribute to increasing the use of FAS. METHODS: The Theory of Planned Behavior variables and the self-reported use of MVS were measured by two separate surveys within one week. A preliminary open-ended questionnaire was utilized to elicit beliefs about MVS. A convenience sample of 100 African-American female college students, mean age 20.99 (SD=1.7) years, participated in this study. RESULTS: Approximately 65% of variance in behavioral intention was explained by attitude, subjective norms, and perceived behavioral control (P<.001). Subjective norms had the greatest influence (3=0.348, P<.001), followed by PBC (3=0.336, P<.001), and attitude (1=0.228, P<.038). Behavioral intention significantly predicted the use of MVS accounting for =59.2% of variance. CONCLUSION: Consistent with the results of the present study, educational campaigns that target African-American female college students to encourage the use of MVS should focus on the impact of physicians, family, and peers.

HUB city steps: a 6-month lifestyle intervention improves blood pressure among a primarily African-American community.

The effectiveness of community-based participatory research (CBPR) efforts to address the disproportionate burden of hypertension among African Americans remains largely untested. The objective of this 6-month, noncontrolled, pre-/post-experimental intervention was to examine the effectiveness of a CBPR intervention in achieving improvements in blood pressure, anthropometric measures, biological measures, and diet. Conducted in 2010, this multicomponent lifestyle intervention included motivational enhancement, social support provided by peer coaches, pedometer diary self-monitoring, and monthly nutrition and physical activity education sessions. Of 269 enrolled participants, 94% were African American and 85% were female. Statistical analysis included generalized linear mixed models using maximum likelihood estimation. From baseline to 6 months, blood pressure decreased significantly: mean (± standard deviation) systolic blood pressure decreased from 126.0 ± 19.1 to 119.6 ± 15.8 mm Hg, P=0.0002; mean diastolic blood pressure decreased from 83.2 ± 12.3 to 78.6 ± 11.1 mm Hg, P<0.0001). Sugar intake also decreased significantly as compared with baseline (by approximately 3 tsp; P<0.0001). Time differences were not apparent for any other measures. Results from this study suggest that CBPR efforts are a viable and effective strategy for implementing nonpharmacologic, multicomponent, lifestyle interventions that can help address the persistent racial and ethnic disparities in hypertension treatment and control. Outcome findings help fill gaps in the literature for effectively translating lifestyle interventions to reach and engage African-American communities to reduce the burden of hypertension.

Examining the diet of post-migrant Hispanic males using the precede-proceed model: predisposing, reinforcing, and enabling dietary factors.

OBJECTIVE: To examine socio-environmental, behavioral, and predisposing, reinforcing, and enabling (PRE) factors contributing to post-migration dietary behavior change among a sample of traditional Hispanic males. DESIGN: In this descriptive study, semistructured interviews, a group interview, and photovoice, followed by group interviews, were used to examine dietary change and contributing factors. The behavioral, environmental, organizational, and educational assessment phases of the PRECEDE-PROCEED model guided the organization of dietary contributing factors for development of a nutrition intervention. SETTING: The southern region of Mississippi. PARTICIPANTS: Traditional Hispanic males (n = 19) were identified from 35 Hispanic males who participated in a larger study. The traditional Hispanic males were identified by the Acculturation Rating Scale for Mexican Americans-II and the Marginality Scale. ANALYSIS: Using the Grounded Theory approach to data analysis, themes and core categories relating to dietary behavior were identified and defined during the analysis process. The constant comparison method was used to identify key themes among coders. RESULTS: Cultural gender role and living structure, as socio-environmental factors, influenced the PRE dietary factors. CONCLUSIONS AND IMPLICATIONS: Multiple factors influence dietary behavior in the target population. The identified socio-environmental factors underlie the PRE factors and, therefore, must first be addressed in nutrition interventions.

Theory of planned behavior and multivitamin supplement use in Caucasian college females.

The objective of this study was to identify predictors of the use of multivitamin supplements (MVS) among Caucasian college females utilizing the Theory of Planned Behavior (TPB). Variables of the TPB and the self-reported use of multivitamin supplements were measured by two separate surveys within 1 week with a convenience sample of 96 Caucasian college student females. Two attitudinal beliefs and one control belief significantly predicted behavioral intention to use multivitamin. A belief that taking multivitamin supplements helps to feel and look good was the most important predictor of the use of multivitamin supplements. EDITORS' STRATEGIC IMPLICATIONS: Findings from this study, although in need of replication, suggest that prevention campaigns would be more successful if messages used to reach these females were consistent with perceived beliefs regarding benefits of using MVS. More broadly, TPB appears to offer a useful framework for understanding or predicting behavior based on psychological constructs theorized to influence behavior.

Conducting needs assessment using the comprehensive participatory planning and evaluation model to develop nutrition and physical activity interventions in a rural community in the Mississippi delta.

BACKGROUND: Members of a Lower Mississippi Delta community and university partners used the Comprehensive Participatory Planning and Evaluation (CPPE) model to assess nutrition and health problems and develop a menu of interventions. OBJECTIVES: We sought to identify and prioritize nutrition and physical activity problems in the community and to identify interventions to address the problems. METHODS: Community members and university partners used the CPPE process to identify and prioritize nutrition and physical activity problems. The participants developed causal models to break down the identified problems to their root causes. They then developed a menu of interventions and criteria to rank the interventions. RESULTS: The identified problems were intake of unhealthy foods, lack of nutrition education, and lack of adequate physical activity. The menu of interventions consisted of seven objectives to address poor nutrition and physical activity as well as a total of 19 interventions to meet these objectives. CONCLUSION: Directly involving community members in identifying health problems and solutions results in the development of interventions that are likely to have greater acceptability with the community.

Fit for life steps: results of a community walking intervention in the rural Mississippi delta.

BACKGROUND: A collaborative community--university--U.S. Department of Agriculture(USDA)/Agricultural Research Service (ARS) partnership developed and implemented a 6-month walking intervention whereby volunteer coaches were trained to lead community walking groups in a rural Mississippi Delta Community. OBJECTIVE: Assess the feasibility of implementing community-based participatory research (CBPR), increase physical activity, and improve anthropometric and biological measures. METHODS: This quasi-experimental design examined body mass index, percent body fat, waist circumference, blood pressure, blood glucose, lipid profile, self-reported walking, stages of change, social support, self-efficacy, and decisional balance at enrollment, 3 months, and 6 months. Participants were primarily African-American (99%) women (97%). Changes were evaluated using repeated measures analysis of variance (ANOVA) and Friedman's test. RESULTS: Community members actively participated in assessing the problem, identifying the intervention, intervention planning, data collection, and evaluation. Of the 83 enrolled participants, 66 (80%) completed the intervention. Participants exhibited significant improvements in waist circumference (-1.4 inches), systolic blood pressure (-4.3 mmHg), and high-density lipoprotein (HDL) cholesterol (+7.9 mg/dL); (PA