Lessons learned from a blended telephone/e-health platform for caregivers in promoting physical activity and nutrition in children with a mobility disability.

BACKGROUND: Children with physical disabilities report higher rates of sedentary lifestyle and unhealthy dietary patterns than non-disabled peers. These behaviors can increase comorbidities, caregiver burden, and healthcare costs. Innovative interventions are needed to assist caregivers of children with physical disabilities improve health behaviors. OBJECTIVE: /Hypothesis: The purpose of this pilot study was to test the usability and preliminary efficacy of an e-health and telecoaching intervention compared to telecoaching alone. METHODS: Parent/child dyads (n = 65) were randomized into either the e-health and telephone group (e-HT) or the telephone only group (TO). All participants received regular calls from a telecoach, and the e-HT group received access to a website with personalized weekly goals for diet and physical activity, and access to resources to meet these goals. At the conclusion of the intervention, participants in the e-HT group were asked to complete a semi-structured interview to discuss the usability of the e-health platform. RESULTS: Fifty of the 65 randomized dyads (77%) completed all baseline measures and had at least one intervention call. Forty families (80% of those that started the intervention) completed the study (50% spina bifida, 24% mobility limitation, diagnosis not reported). Age of the children ranged from 6 to 17 years old. Both groups had high adherence to scheduled phone calls (e-HT (n = 17): 81%, TO (n = 23): 86%); however no significant differences in dietary intake or physical activity were seen within or between groups. Primary themes to emerge from qualitative interviewers were: the platform should target children rather than parents, parents valued the calls more than the website, and schools need to be involved in interventions. CONCLUSIONS: E-health interventions are a promising way to promote healthy behaviors in children with physical disability, but technology must be balanced with ease of use for parents while also engaging the child.

Promotion of physical activity and exercise in multiple sclerosis: Importance of behavioral science and theory.

There is an obvious disconnect between evidence of benefits and rates of participation in exercise and physical activity among people living with multiple sclerosis (MS). We propose that the problem with exercise behavior in MS (i.e. lack of broad or increasing participation by people with MS despite evidence of meaningful benefits) might be ameliorated through the inclusion of behavior change theory in the design of exercise programs and promotion efforts, as has been undertaken in other populations such as breast cancer survivors. This paper reviews Social Cognitive Theory as an example approach for informing interventions for increasing exercise and physical activity behavior outside of MS and provides an overview of current knowledge regarding the application of this theory for physical activity in MS. We then outline future research necessary for informing trials that design, implement, and test theory-based interventions for physical activity promotion in MS. If theories of behavior change are adopted for informing exercise and physical activity research in MS, we can take a major step forward in addressing the problem of exercise and physical activity participation that has plagued the field for more than 25 years.

Self-efficacy as a predictor of weight change and behavior change in the PREMIER trial.

OBJECTIVES: Determine whether self-efficacy independently predicted weight loss in a behavioral intervention and explore factors that influence the path between self-efficacy and weight change. DESIGN: Secondary analysis of the PREMIER trial, a randomized controlled trial testing effects of lifestyle interventions on blood pressure. SETTING: Four academic medical centers. PARTICIPANTS: PREMIER recruited adults (n = 810) with pre-hypertension/stage 1 hypertension, not currently receiving medication. This analysis excluded participants in the control arm, resulting in n = 537. INTERVENTIONS: Participants were randomly assigned to 1 of 3 groups: advice only, established lifestyle recommendations, or established lifestyle recommendations plus Dietary Approaches to Stop Hypertension dietary pattern. MAIN OUTCOME MEASURES: Self-efficacy (dietary self-efficacy [DSE], exercise self-efficacy [ESE]), dietary intake, fitness. ANALYSIS: Pearson correlations, 1-way analysis of variance, mediation analyses. RESULTS: Despite an overall decrease in DSE/ESE, change in DSE/ESE significantly predicted weight change at 6 (ß = -.21, P < .01; ß = -.19, P < .01, respectively) and 18 months (ß = -.19, P < .01; ß = -.35, P < .01). Change in percent calories from fat partially mediated the DSE/weight change relationship at 6 months. Change in fitness partially mediated the ESE/weight change relationship at 18 months. CONCLUSIONS AND IMPLICATIONS: Changes in DSE/ESE were not associated with behavior change as hypothesized. Additional research is needed to identify mediators between self-efficacy and adoption of behaviors that influence weight loss.

Using formative research to develop a worksite health promotion program for African American women.

OBJECTIVES: To describe the development of a culturally appropriate worksite health promotion program (WHPP) designed to promote increased physical activity and improved nutrition in a high risk group of African American women. METHODS: The program was based on EatRight, which is a lifestyle-oriented weight control program that focuses on food volume, rather than calories. Formative research included four nominal group technique (NGT) sessions conducted with 14 African American women from the selected worksite to gather input on job factors that affected their weight and daily life factors that affected their amount of physical activity. Their responses were used to adapt existing EatRight materials to target areas of special need for this unique group. RESULTS: Themes emerged from the NGT sessions that indicated stress at work and an environment of unhealthy eating, in addition to social eating and lack of social support for healthy eating added to unhealthy eating patterns at work. In response to physical activity, the primary themes included lack of time to exercise, stress of multiple family roles and responsibilities, and perceived physical barriers to physical activity. DISCUSSION: Based on the NGT themes, EatRight materials were adapted and additional topics (e.g., increasing social support, overcoming limitations, and time management) were included to develop a WHPP that addressed issues that the participants identified as relevant for their work and home lives. Conducting the NGT sessions and EatRight classes in the work environment, we were able to provide a convenient, familiar environment which fostered social support among participants. We believe that a culturally appropriate modification of EatRight holds great promise in addressing health disparities seen among African American women by offering education on lifestyle changes that will decrease weight through nutrition and physical activity.