Black men's health-related quality of life: A qualitative study to understand community-identified perception and needs.

OBJECTIVE: Health-related quality of life (HRQoL) is a multidimensional indicator of overall health associated with premature mortality. Black men score low on measures of HRQoL, but it is unclear how Black men conceptualize HRQoL and whether there have been efforts to promote HRQoL among these men. The present qualitative study to understand Black men's conceptualization of HRQoL and strategies to improve HRQoL was based in community-based participatory research and the social-ecological model of health. METHOD: A community advisory board (CAB) was established, and the need for an effort to promote HRQoL promotion among Black men was assessed and supported. A focus group protocol was developed in conjunction with the CAB and a group of barbers. Seven focus groups were conducted consisting of 56 Black men in the Southeastern United States. The mean age of participants was 45 years. Two reviewers coded each focus group. Reliability ranged from 71% to 76%. A thematic analysis was conducted, and the findings were confirmed with the CAB. RESULTS: Three themes emerged: (a) a holistic conceptualization of health that includes spiritual functioning among Black men; (b) a state of HRQoL among Black men predominately marked by mental health concerns, in addition to physical and social health concerns; and (c) multilevel determinants of HRQoL among Black men. This last theme consisted of three subthemes related to community-level, interpersonal, and intrapersonal determinants of HRQoL. CONCLUSIONS: Findings from this study can help inform the development of strategies to improve HRQoL and reduce health disparities among Black men. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Results from "Developing Real Incentives and Volition for Exercise" (DRIVE): A pilot randomized controlled trial for promoting physical activity in African American women.

OBJECTIVE: Motivation is a barrier to physical activity (PA) among African American (AA) women, but past studies have implemented a "one-size-fits-all" approach and have not addressed differences in autonomous motivation. This pilot randomized controlled trial assessed the preliminary efficacy of "Developing Real Incentives and Volition for Exercise," a community- and theory-based intervention, which evaluated whether a motivationally matched (vs. a nonmatched) intervention increases daily total PA. METHOD: In total, 68 AA women (50.72 ± 13.66 years; 86.8% with obesity) were randomized to an 8-week challenge-focused program (targeted toward high autonomous motivation) or rewards-focused program (targeted toward low autonomous motivation). Randomization was stratified by baseline autonomous motivation. FitBits were used during the intervention to promote self-monitoring (both programs) and social connectedness (challenge program only). RESULTS: Both programs retained ≥ 80% of participants. Process evaluation revealed high attendance, dose, and fidelity (both programs). However, contrary to expectations, across all motivational levels (low and high autonomous), the challenge-focused intervention resulted in a greater increase in total daily PA (primary outcome), with an average increase of 17.9 min in the challenge-focused intervention versus an average decrease of 8.55 min in the rewards-focused intervention. An exploratory follow-up analysis revealed that engagement with the FitBit mobile app predicted greater PA at postintervention in the challenge-focused program. CONCLUSIONS: A team-based approach targeting social connectedness, enjoyment of PA, and positive intragroup competition is a promising approach for promoting PA among AA women. These findings are used to guide a discussion on best practices for engaging AA women in future behavioral interventions. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The Results of the "Positive Action for Today's Health" (PATH) Trial for Increasing Walking and Physical Activity in Underserved African-American Communities.

BACKGROUND: The "Positive Action for Today's Health" (PATH) trial tested an environmental intervention to increase walking in underserved communities. METHODS: Three matched communities were randomized to a police-patrolled walking plus social marketing, a police-patrolled walking-only, or a no-walking intervention. The 24-month intervention addressed safety and access for physical activity (PA) and utilized social marketing to enhance environmental supports for PA. African-Americans (N=434; 62% females; aged 51±16 years) provided accelerometry and psychosocial measures at baseline and 12, 18, and 24 months. Walking attendance and trail use were obtained over 24 months. RESULTS: There were no significant differences across communities over 24 months for moderate-to-vigorous PA. Walking attendance in the social marketing community showed an increase from 40 to 400 walkers per month at 9 months and sustained ~200 walkers per month through 24 months. No change in attendance was observed in the walking-only community. CONCLUSIONS: Findings support integrating social marketing strategies to increase walking in underserved African-Americans (ClinicalTrials.gov #NCT01025726).

Qualitative developmental research among low income African American adults to inform a social marketing campaign for walking.

BACKGROUND: This study describes the development of a social marketing campaign for increasing walking in a low income, high crime community as part of the Positive Action for Today's Health (PATH) trial. METHODS: Focus groups were conducted with 52 African American adults (ages 18 to 65 yrs), from two underserved communities to develop themes for a social marketing campaign to promote walking. Participants responded to questions concerning social marketing principles related to product, price, place, promotion, and positioning for increasing neighbourhood walking. RESULTS: Focus group data informed the development of the campaign objectives that were derived from the "5 Ps" to promote physical and mental health, social connectedness, safety, and confidence in walking regularly. Focus group themes indicated that physical and mental health benefits of walking were important motivators. Walking for social reasons was also important for overcoming barriers to walking. Police support from trusted officers while walking was also essential to promoting safety for walking. Print materials were developed by the steering committee, with a 12-month calendar and door hangers delivered to residents' homes to invite them to walk. Pride Stride walks empowered community walkers to serve as peer leaders for special walking events to engage new walkers. CONCLUSIONS: Essential elements for developing culturally tailored social marketing interventions for promoting walking in underserved communities are outlined for future researchers.

Formative process evaluation for implementing a social marketing intervention to increase walking among African Americans in the Positive Action for Today's Health trial.

OBJECTIVES: Evaluating programs targeting physical activity may help to reduce disparate rates of obesity among African Americans. We report formative process evaluation methods and implementation dose, fidelity, and reach in the Positive Action for Today's Health trial. METHODS: We applied evaluation methods based on an ecological framework in 2 community-based police-patrolled walking programs targeting access and safety in underserved African American communities. One program also targeted social connectedness and motivation to walk using a social marketing approach. Process data were systematically collected from baseline to 12 months. RESULTS: Adequate implementation dose was achieved, with fidelity achieved but less stable in both programs. Monthly walkers increased to 424 in the walking-plus-social marketing program, indicating expanding program reach, in contrast to no increase in the walking-only program. Increased reach was correlated with peer-led Pride Strides (r = .92; P < .001), a key social marketing component, and program social interaction was the primary reason for which walkers reported participating. CONCLUSIONS: Formative process evaluation demonstrated that the walking programs were effectively implemented and that social marketing increased walking and perceived social connectedness in African American communities.

An overview of the "Positive Action for Today's Health" (PATH) trial for increasing walking in low income, ethnic minority communities.

BACKGROUND: Ethnic minorities and lower-income adults have among the highest rates of obesity and lowest levels of regular physical activity (PA). The Positive Action for Today's Health (PATH) trial compares three communities that are randomly assigned to different levels of an environmental intervention to improve safety and access for walking in low income communities. DESIGN AND SETTING: Three communities matched on census tract information (crime, PA, ethnic minorities, and income) were randomized to receive either: an intervention that combines a police-patrolled-walking program with social marketing strategies to promote PA, a police-patrolled-walking only intervention, or no-walking intervention (general health education only). Measures include PA (7-day accelerometer estimates), body composition, blood pressure, psychosocial measures, and perceptions of safety and access for PA at baseline, 6, 12, 18, and 24 months. INTERVENTION: The police-patrolled walking plus social marketing intervention targets increasing safety (training community leaders as walking captains, hiring off-duty police officers to patrol the walking trail, and containing stray dogs), increasing access for PA (marking a walking route), and utilizes a social marketing campaign that targets psychosocial and environmental mediators for increasing PA. MAIN HYPOTHESES/OUTCOMES: It is hypothesized that the police-patrolled walking plus social marketing intervention will result in greater increases in moderate-to-vigorous PA as compared to the police-patrolled-walking only or the general health intervention after 12 months and that this effect will be maintained at 18 and 24 months. CONCLUSIONS: Implications of this community-based trial are discussed.