Adaptations of an Effective Evidence-Based Pediatric Weight Management Intervention.

Current childhood obesity treatment programs do not address medically underserved populations or settings where all members of an interdisciplinary team may not exist-either within one organization or within the community. In this paper, we describe the use of a community-academic partnership to iteratively adapt Epstein's Traffic Light Diet (TLD), into Building Healthy Families (BHF), a community-placed evidence-based pediatric weight management intervention (PWMI) and evaluate its effectiveness in reducing BMI z scores. Nine cohorts of families completed BHF. Participants included children aged 6-12 years with obesity (M = 9.46, SD = 1.74). The Framework for Reporting Adaptations and Modifications-Expanded guided our classification of modifications across BHF cohorts. Using the FRAME reporting structure, the changes that were documented were (1) planned and occurred pre-implementation, (2) based on decisions from local stakeholders (e.g., school administrator, members of the implementation team), and (3) specific to changes in content and context-with a focus on implementation and potential for local scale-up. The nature of the adaptations included adding elements (whole of family approach), removing elements (calorie counting), and substituting elements (steps for minutes of physical activity). Across 9 cohorts, 84 families initiated the BHF program, 69 families successfully completed the 12-week program, and 45 families returned for 6-month follow-up assessments. Results indicated that the BMI z score in children was reduced by 0.31 ± 0.17 at 6 months across all cohorts. Reduction in BMI z score ranged from 0.41 in cohort 4 to 0.13 in cohort 5. Iterative adaptations to BHF were completed to improve the fit of BHF to the setting and participants and have contributed to a sustained community PWMI that adheres to the underlying principles and core elements of other evidence-based PWMIs. Monitoring adaptations and related changes to outcomes can play a role in long-term sustainability and effectiveness.

Does worksite social capital enhance retention into a worksite weight-loss programme?

OBJECTIVE: To determine if worksite social capital predicted retention in a worksite-based weight-loss programme using structural equation modelling. A secondary aim was to determine if worksite social capital was related to changes in weight at 6 months. METHODS: Overweight or obese employees from 28 worksites enrolled in a larger 12-month worksite weight-loss trial. Workplace social capital was assessed using an eight-item scale specific to the workplace. Weight was measured using a HealthSpottm, and change in weight was computed from weigh-ins at baseline and 6 months and reported as pounds (lbs) lost. Retention was defined as those employees who completed a weigh-in at 6 months. RESULTS: Across the trial, N = 1,790; age = 46.6 ± 11; 73% women; 73% White overweight or obese employees participated. The odds of participant attrition were 1.12 times greater with each unit decrease in social capital score at baseline (p < 0.05), and while the model testing the direct effect of social capital at baseline on weight loss at 6 months demonstrated acceptable fit, social capital was not a significant predictor of weight loss (p > 0.05). CONCLUSIONS: Increased worksite social capital was predictive of retention in a worksite weight-loss programme. To maximize return on investments for employee wellness and weight-loss programmes, employers may benefit from understanding the facets of the 'social' environment such as social capital that may increase the likelihood of sustained participation.

The impact of health literacy on rural adults' satisfaction with a multi-component intervention to reduce sugar-sweetened beverage intake.

SIPsmartER is a 6-month behavioral intervention designed using a health literacy universal precautions approach that has been found effective at reducing sugary beverage intake in rural, low socioeconomic adults. The purpose of this mixed-methods study is to determine if health literacy status influenced participants' satisfaction and perceptions of each intervention component: small group classes, interactive-voice response (IVR) calls, personal action plans and self-monitoring logs. Of the 155 participants enrolled in SIPsmartER, 105 (68%) completed an interview-administered summative evaluation including 68 high and 37 low health literate participants. The quantitative findings show participant satisfaction with each intervention component was high (i.e. classes = 9.6, IVR calls = 8.1, action plans = 8.9-9.1, logs = 8.7 on a 10-point scale) and similar across both health literacy groups. The majority of qualitative responses were positive (81.8%) and code counts were comparable between literacy groups with a few exceptions. As compared with high health literacy respondents, low health literacy respondents more frequently mentioned liking the content and length of IVR calls, liking the motivational aspects of the personal action plans, and identified numeracy issues with the self-monitoring logs. Overall, applying a health literacy universal precautions approach is an effective and acceptable strategy for both high and low health literacy groups.

Validation of the stages of change with mild, moderate, and strenuous physical activity behavior, intentions, and self-efficacy.

The stages of change construct of the Transtheoretical Model (TTM) has been proposed for examining exercise adoption. Studies investigating the construct validity of the stages of change for exercise have used physical activity of moderate or higher intensity as operationalization criterion. Since it has been shown that physical activity of lower intensity also provides health benefits, we investigated whether the stages of change appropriately address lower intensity physical activity. Data with respect to the stages of change as well as behavior, intention and self-efficacy associated with mild, moderate, and strenuous exercise were collected in a sample of 467 males and females aged 20 - 85. Results show that the stages of change can be distinguished by moderate and strenuous but are not consistent with mild exercise. Implications for future research utilizing the stage of change conceptualization are discussed and development of new stage assessment instruments for mild exercise is recommended.

Sustaining exercise participation through group cohesion.

The general hypothesis to be examined by this article is that increased group cohesion leads to an increase in adherence to an exercise program over time. Although preliminary research is promising, there is a need for further research aimed at examining the model of group development in exercise classes, the impact of group cohesion on both group and individual exercise behavior, and the measurement of group cohesion.

Group cohesion in older adult exercisers: prediction and intervention effects.

Two studies were conducted to examine the relationship between class cohesion and exercise adherence in older adult exercisers. Study 1 examined the predictive ability of four dimensions of cohesion on exercise participation at 1, 6, and 12 months following the initial assessment of cohesion. Study 2 examined the effectiveness of a team-building intervention, designed to enhance class cohesion (and based on Study 1 results), on improving exercise adherence and return rates. Participants were assigned to a team-building, placebo, or control condition. Study 1 showed that three measures of cohesion, Individual attractions to the group-social, Group integration-social, and Group integration-task, were all significantly related to exercise class attendance following a 1-month interval. Group integration-task was significantly related to class attendance following a 6- and a 12-month interval. Study 2 showed that participants in the team-building condition (a) attended more classes than the control and placebo conditions and (b) had a higher return rate following a 10-week hiatus than the control condition. It was concluded that (a) class cohesion plays a significant role in exercise class participation, both short- and long-term, and (b) samples of older adult exercisers are appropriate groups for interventions based on developing class cohesion.

Maintaining attendance at a fitness center: an application of the decision balance sheet.

The effect of a decision balance sheet intervention on attendance at a university fitness facility was examined. Facility members were randomly assigned to control, placebo, and experimental conditions. The control condition received no intervention, whereas the placebo and experimental conditions were called by telephone and asked to complete either an irrelevant (smoking) or relevant (exercising at the fitness facility) decision balance sheet. Attendance was monitored surreptitiously for 4 weeks baseline and 8 weeks post intervention. Statistical analyses indicated that the control and placebo conditions showed a significant decrease in attendance from baseline to intervention, whereas those in the experimental condition maintained attendance levels. Discussion focused on broadening the application of the decision balance sheet, determining its theoretical boundaries, and the necessity and appropriateness of decision alternatives for the decision balance sheet in the exercise domain.

A simple reinforcement strategy for increasing attendance at a fitness facility.

The purpose of the present study was to examine the effect of a previously untested reinforcement strategy (i.e., 1 month's free membership) on attendance at a fitness facility. Participants were paying members of a fitness facility randomly assigned to control (n = 100), placebo (n = 100), and reinforcement (n = 100) conditions. The control condition received no intervention; the placebo condition received a letter by mail; and the reinforcement condition received the same letter by mail, except that it included an additional paragraph instructing them that they could earn 1 month's free membership if they attended the fitness facility at least 12 times in the next month. Attendance was monitored for 1 month baseline and postintervention by using the facility's computer system. Analysis of variance, t tests, and chi-square analysis all revealed that the reinforcement condition had the best attendance record during the intervention period. These preliminary results shed some light on increasing attendance at a fitness facility. Discussion highlighted the practical implications of the findings and offered directions for future research.

Effect of a stimulus control intervention on attendance at a university fitness center.

The purpose of the present study was to determine the isolated effects of stimulus control on attendance at a fitness facility. Participants were members of a university fitness club randomly assigned to control (n = 50), placebo (n = 50), and stimulus control (n = 100) conditions. The control condition received no intervention, the placebo condition received a letter by mail, and the stimulus control condition received the same letter by mail plus a complimentary "EXERCISE" key chain, which was to act as the stimulus control. Attendance was monitored surreptitiously for 5 weeks baseline and 8 weeks postintervention by using the facility's computer system. A manipulation check found that 48 of the 100 participants used the key chain. Therefore, analyses were conducted separately for "intention to treat" and "actual treatment" conditions. Repeated measures multivariate analyses of variance revealed no main or interaction effects involving experimental condition in either the "intention to treat" or "actual treatment" analyses. Discussion focused on explanations for why the stimulus control intervention was not successful, and directions for future research were provided.