Examining relationships between multiple health risk behaviors, well-being, and productivity.

Traditionally, the concept of health promotion has emphasized the reduction of health risk behaviors to reduce disease and impairment. Well-being research expands this focus to include positive constructs such as thriving, productivity, life-evaluation, and emotional and physical health. The objective of the present study was to examine the relationships between health risk behaviors and specific measures of individual well-being. Participants (N = 790) from 49 states completed a one-time online assessment that included the Life-Evaluation Index, Emotional and Physical Health Ladders, the Health Risk Intervention Assessment, and the Work Productivity and Activity Improvement Questionnaire for General Health. Life Evaluation and physical and emotional health were all inversely related to the number of health risk behaviors, with higher well-being scores associated with lower number of risk behaviors. Across the three Life Evaluation categories (Suffering, Struggling, and Thriving) the number of health risk behaviors decreased, productivity loss decreased, and emotional and physical health increased. The results add to previous research on how reducing multiple health risk behaviors can be combined with well-being, i.e., an emphasis on increasing life-evaluation, emotional and physical health, better functioning, and productivity.

Results of a multi-media multiple behavior obesity prevention program for adolescents.

BACKGROUND: This study reports on effectiveness trial outcomes of Health in Motion, a computer tailored multiple behavior intervention for adolescents. METHODS: Using school as level of assignment, students (n=1800) from eight high schools in four states (RI, TN, MA, and NY) were stratified and randomly assigned to no treatment or a multi-media intervention for physical activity, fruit and vegetable consumption, and limited TV viewing between 2006 and 2007. RESULTS: Intervention effects on continuous outcomes, on movement to action and maintenance stages, and on stability within action and maintenance stages were evaluated using random effects modeling. Effects were most pronounced for fruit and vegetable consumption and for total risks across all time points and for each behavior immediately post intervention. Co-variation of behavior change occurred within the treatment group, where individuals progressing to action or maintenance for one behavior were 1.4-4.2 times more likely to make similar progress on another behavior. CONCLUSION: Health in Motion is an innovative, multiple behavior obesity prevention intervention relevant for all adolescents that relies solely on interactive technology to deliver tailored feedback. The outcomes of the effectiveness trial demonstrate both an ability to initiate behavior change across multiple energy balance behaviors simultaneously and feasibility for ease of dissemination.

Workplace Well-Being Factors That Predict Employee Participation, Health and Medical Cost Impact, and Perceived Support.

PURPOSE: This study tested relationships between health and well-being best practices and 3 types of outcomes. DESIGN: A cross-sectional design used data from the HERO Scorecard Benchmark Database. SETTING: Data were voluntarily provided by employers who submitted web-based survey responses. SAMPLE: Analyses were limited to 812 organizations that completed the HERO Scorecard between January 12, 2015 and October 2, 2017. MEASURES: Independent variables included organizational and leadership support, program comprehensiveness, program integration, and incentives. Dependent variables included participation rates, health and medical cost impact, and perceptions of organizational support. ANALYSIS: Three structural equation models were developed to investigate the relationships among study variables. RESULTS: Model sample size varied based on organizationally reported outcomes. All models fit the data well (comparative fit index > 0.96). Organizational and leadership support was the strongest predictor (P < .05) of participation (n = 276 organizations), impact (n = 160 organizations), and perceived organizational support (n = 143 organizations). Incentives predicted participation in health assessment and biometric screening (P < .05). Program comprehensiveness and program integration were not significant predictors (P > .05) in any of the models. CONCLUSION: Organizational and leadership support practices are essential to produce participation, health and medical cost impact, and perceptions of organizational support. While incentives influence participation, they are likely insufficient to yield downstream outcomes. The overall study design limits the ability to make causal inferences from the data.

Development and Validity of a Workplace Health Promotion Best Practices Assessment.

OBJECTIVE: To explore the factor structure of the HERO Health and Well-being Best Practices Scorecard in Collaboration with Mercer (HERO Scorecard) to develop a reduced version and examine the reliability and validity of that version. METHODS: A reduced version of the HERO Scorecard was developed through formal statistical analyses on data collected from 845 organizations that completed the original HERO Scorecard. RESULTS: The final factors in the reduced Scorecard represented content pertaining to organizational and leadership support, program comprehensiveness, program integration, and incentives. All four implemented practices were found to have a strong, statistically significant effect on perceived effectiveness. Organizational and leadership support had the strongest effect (ß = 0.56), followed by incentives (ß = 0.23). CONCLUSION: The condensed version of the HERO Scorecard has the potential to be a promising tool for future research on the extent to which employers are adopting best practices in their health and well-being (HWB) initiatives.

Resistance among domestic violence offenders: measurement development and initial validation.

Batterers' resistance to traditional intervention programs has been well documented. Within a Transtheoretical Model of Change (stage of change) framework, a measure of processes of resistance was developed and administered to 346 adult male domestic violence offenders in treatment. The study yielded a 38-item measure that assesses eight dimensions of resistance: (a) System Blaming, (b) Problems with Partner, (c) Problems with Alliance, (d) Social Justification, (e) Hopelessness, (f) Isolation, (g) Psychological Reactance, and (h) Passive Reactance. The relationship between resistance and stage of change, time in treatment, and partner aggression are reported. Results suggest that we look beyond the most common forms of resistance (e.g., denial and victim-blaming) to identify and address other forms of resistance that may be more internally based and difficult to detect. The processes of resistance measure provides a tool for measuring those types of resistance.

Using mHealth to Deliver Behavior Change Interventions Within Prenatal Care at Community Health Centers.

PURPOSE: To test an iPad-delivered multiple behavior tailored intervention (Healthy Pregnancy: Step by Step) for pregnant women that addresses smoking cessation, stress management, and fruit and vegetable consumption. DESIGN: A randomized 2 × 5 factorial repeated measures design was employed with randomization on the individual level stratified on behavior risk. Women completed three sessions during pregnancy and two postpartum at postdelivery months 1 and 4. SETTING: Women were recruited from six locations of federally funded health centers across three states. SUBJECTS: Participants (N = 335) were English- and Spanish-speaking women at up to 18 weeks gestation. INTERVENTION: The treatment group received three interactive sessions focused on two priority health behavior risks. The sessions offered individually tailored and stage-matched change strategies based on the transtheoretical model of behavior change. The usual care group received March of Dimes brochures. MEASURES: The primary outcome was the number of behavior risks. Stage of change and continuous measures for all behaviors also were assessed. ANALYSIS: Data were analyzed across all time points using generalized estimating equations examining repeated measures effects. RESULTS: Women in the treatment group reported significantly fewer risks than those in usual care at 1 month (.85 vs. 1.20, odds ratio [OR] = .70) and 4 months postpartum (.72 vs. .91, OR = .81). CONCLUSION: Healthy Pregnancy is an evidence-based and personalized program that assists pregnant women with reducing behavior risks and sustaining healthy lifestyle behaviors.

The effect of physician continuing medical education on patient-reported outcomes for identifying and optimally managing obstructive sleep apnea.

STUDY OBJECTIVE: To evaluate the effect of continuing medical education (CME) activities on patient reported outcomes with regard to (1) screening for excessive sleepiness (ES) and obstructive sleep apnea (OSA) and (2) appropriate referral and treatment. METHODS: A total of 725 patients were recruited from 75 providers who either participated or did not participate in Transtheoretical Model (TTM)-based OSA CME activities. Patient reported outcomes from participating (n = 36) and non-participating providers (n = 39) were compared using generalized estimating equations examining random effects of provider as unit of assignment. RESULTS: Patients' reports demonstrate that participating physicians were 1.7 times more likely to initiate discussion of sleep problems than non-participating physicians (t1,411 = 3.71, p = 0.05) and 2.25-2.86 times more likely to administer validated measures for OSA (Epworth Sleepiness Scale and STOP-BANG). Patient reports also indicated that participating clinicians (79.9%) were significantly more likely to recommend seeing a sleep specialist compared to non-participating clinicians (60.7%; t1,348 = 9.1, p < 0.01, OR = 2.6). Furthermore, while 89.4% of participating clinicians recommended a sleep study, only 73.2% of the non-participating physicians recommended one (t1,363 = 11.46, p < 0.001, OR = 3.1). CONCLUSIONS: Participation in TTM-based OSA CME activities was associated with improved patient reported outcomes compared to the non-participating clinicians.

The Functional Well-Being Scale: a measure of functioning loss due to well-being-related barriers.

The objective of this study was to develop the Pro-Change Functional Well-Being Scale, a measure that provides an informative evaluation of general functioning loss due to well-being-related barriers. Exploratory and confirmatory analyses on data from 642 individuals supported a one-factor solution with good model fit. A strong positive correlation existed between the Pro-Change Functional Well-Being Scale and Well-Being Assessment for Productivity. Initial construct validity was demonstrated by predictable relationships between functioning loss and other measures of health and well-being. This initial psychometric evidence suggests that the Pro-Change Functional Well-Being Scale is a reliable and valid assessment of functioning loss due to common well-being-related barriers.

The well-being 5: development and validation of a diagnostic instrument to improve population well-being.

Building upon extensive research from 2 validated well-being instruments, the objective of this research was to develop and validate a comprehensive and actionable well-being instrument that informs and facilitates improvement of well-being for individuals, communities, and nations. The goals of the measure were comprehensiveness, validity and reliability, significant relationships with health and performance outcomes, and diagnostic capability for intervention. For measure development and validation, questions from the Well-being Assessment and Wellbeing Finder were simultaneously administered as a test item pool to over 13,000 individuals across 3 independent samples. Exploratory factor analysis was conducted on a random selection from the first sample and confirmed in the other samples. Further evidence of validity was established through correlations to the established well-being scores from the Well-Being Assessment and Wellbeing Finder, and individual outcomes capturing health care utilization and productivity. Results showed the Well-Being 5 score comprehensively captures the known constructs within well-being, demonstrates good reliability and validity, significantly relates to health and performance outcomes, is diagnostic and informative for intervention, and can track and compare well-being over time and across groups. With this tool, well-being deficiencies within a population can be effectively identified, prioritized, and addressed, yielding the potential for substantial improvements to the health status, performance, and quality of life for individuals and cost savings for stakeholders.

Evaluation of a Stage-Based, Computer-Tailored Adjunct to Usual Care for Domestic Violence Offenders.

OBJECTIVE: Research assessing the efficacy of court-mandated domestic violence treatment continues to yield inconsistent results. The current study examined whether Journey to Change, a Transtheoretical Model of Behavior Change-based treatment adjunct that consists of three computer-administered sessions and a print guide, could improve outcomes. METHOD: 492 male domestic violence offenders attending court-mandated batterer treatment were assigned to Usual Care (UC) or Usual Care + Journey to Change (UC + Journey). RESULTS: Compared to UC, participants receiving UC + Journey were significantly more likely to be in the Action stage at the end of treatment, and to seek help and services outside of group. Based on victim reports, the UC + Journey group was significantly less likely than UC to engage in physical violence during the 12-month follow-up. Both groups were equally likely to drop out of court-mandated treatment and to have further domestic violence-related police involvement. However, among participants with police involvement, the UC + Journey group had lower rates of documented violence and physical injury. CONCLUSIONS: The pattern of findings across the multiple outcomes suggests that the Journey to Change program holds promise for improving some outcomes for domestic violence offenders in treatment, and warrants further investigation.

Enhancing multiple domains of well-being by decreasing multiple health risk behaviors: a randomized clinical trial.

Tailored behavior change programs have proven effective at decreasing health risk factors, but the impact of such programs on participant well-being has not been tested. This randomized trial evaluated the impact of tailored telephone coaching and Internet interventions on health risk behaviors and individual well-being. Exercise and stress management were the primary health risks of interest; improvements in other health risk behaviors were secondary outcomes. A sample of 3391 individuals who reported health risk in the areas of exercise and stress management were randomly assigned to 3 groups: telephonic coaching that applied Transtheoretical Model (TTM) tailoring for exercise and minimal tailoring (stage of change) for stress management; an Internet program that applied TTM tailoring for stress management and minimal tailoring for exercise; or a control group that received an assessment only. Participants were administered the Well-Being Assessment and, at baseline, had relatively low well-being scores (mean, 60.9 out of 100 across all groups). At 6 months, a significantly higher percentage of both treatment groups progressed to the Action stage for exercise, stress management, healthy diet, and total number of health risks, compared to the control group. Both treatment groups also demonstrated significantly greater improvements on overall well-being and the domains of emotional health, physical health, life evaluation, and healthy behaviors. There were no differences between the groups for 2 well-being domains: basic access to needs and work environment. These results indicate that scalable, tailored behavior change programs can effectively reduce health risk and accrue to improved well-being for participants.

The well-being assessment for productivity: a well-being approach to presenteeism.

OBJECTIVE: To develop a presenteeism assessment, the Well-Being Assessment for Productivity (WBA-P), that provides an informative evaluation of job performance loss due to well-being related barriers. METHOD: The WBA-P was developed using exploratory and confirmatory factor analysis using survey data from 1827 employed individuals. Evidence of criterion-related validity was established using multivariate analysis of variance across measures of health and well-being. RESULTS: A hierarchical, two-factor model demonstrated good fit and included factors capturing productivity loss from personal reasons (WBA-PP) and work environment (WBA-PW). Significant interactions existed between these and previously validated presenteeism measures with respect to physical and emotional health, risk factors, and life evaluation. CONCLUSIONS: This initial psychometric evidence suggests that the WBA-P and its subscales are valid measures of presenteeism that capture actionable well-being-related performance barriers.