Physical Activity Behavior and Measurement in Arab American Women: An Integrative Review.

Physical activity (PA) is associated with cardiovascular health; however, in the U.S., only 20% of women are physically active, compared to 28% of men. Arab American women (AAW) experience unique barriers to engaging in the recommended PA. This review examines quantitative PA studies conducted with AAW with a specific focus on how PA outcomes were assessed. Studies were analyzed to explore: (a) types of PA behavior, (b) components of PA interventions/interest (if conducted), (c) PA measurement, and (d) translation of PA tools. After screening titles, abstracts, and a full-text review of articles from five different databases, 12 studies met the inclusion criteria. Leisure-time PA was the most readily used PA measure. Only two out of the 12 studies included women-only participants. There was a total of 10 cross-sectional studies and two quasi-experimental studies. All the studies used a self-report PA questionnaire; one study used a pedometer to measure PA. Six PA questionnaires were translated into Arabic. Future studies must explore the use of reliable and valid translated instruments, objective PA measures, and randomized controlled trial designs.

Wearable Devices and Nurses' Health: Protocol for an Integrative Review.

BACKGROUND: Nurses comprise over half of the global health care workforce, and the nursing care they provide is critical for the global population's health. High patient volumes and increased medical complexity have increased the workload and stress of nurses. As a result, the health of nurses is often negatively impacted. Wearables are used within the health care setting to assess patient outcomes; however, efforts to synthesize the use of wearable devices focusing on nurses' health are limited. OBJECTIVE: The primary objective of our integrative review is to synthesize available data concerning the utility of wearable devices for evaluating or improving (or both) the health of nurses. METHODS: We are conducting an integrative review synthesizing data specific to wearable devices and nurses' health. The research question for this review aims to answer how wearable devices are used to evaluate health outcomes among nurses. We searched the following electronic databases from inception until July 2022: PubMed, Embase, CINAHL, Web of Science, IEEE Explore, and AS&T. Titles and abstracts were imported into Covidence software, where citations were screened and duplicates removed. Title and abstract screening has been completed; however, full-text screening has not been started. Further screening is being conducted independently and in duplicate by 2 teams of 2 reviewers each. These reviewers will extract data independently. RESULTS: Search strategies have been developed, and data were extracted from 6 databases. After the removal of duplicates, we collected 8603 studies for title and abstract screening. Two independent reviewers conducted the title and abstract review, and after resolving conflicts, 277 full-text articles are available for review to determine whether they meet the inclusion criteria. CONCLUSIONS: This integrative review will provide synthesized data to inform nurses and other stakeholders about the extent of wearable device-related work done with nurses and provide direction for future research. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/48178.

DNP-PhD Collaboration in NINR-Funded Physical Activity Trials: A Series of Case Studies.

Collaboration between Doctor of Nursing Practice (DNP) scholars and Doctor of Philosophy (PhD) scholars is crucial to efficiently advance and disseminate nursing science. Also, DNP-PhD collaboration can help achieve priorities outlined in the recent National Institute of Nursing Research (NINR) Strategic Plan. The purpose of this series of case studies is to describe exemplars of ongoing DNP-PhD collaborations across three NINR-funded trials (1 completed, 2 ongoing) testing physical activity interventions for women at risk for cardiovascular disease. In our three physical activity intervention trials for women, we categorized examples of DNP-PhD collaboration by the four phases of the team-based research model (development, conceptualization, implementation, and translation). Across all three trials, DNP and PhD scholars contributed successfully to all phases of research in an iterative manner. Future work should focus on expanding DNP-PhD collaboration in behavioral trials, which can inform adapted, contemporary models of iterative DNP-PhD collaboration.

Physical Activity in South Asian Indians: A Systematic Review of Randomized Controlled Trials.

This review systematically examines the characteristics and effectiveness of randomized controlled trials with aerobic physical activity (PA) interventions tailored to South Asian Indians (SAIs). PubMed/MEDLINE, Scopus, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, CINAHL, and Google Scholar were searched. The search yielded 1,842 studies; 11 met the criteria. The Center for Evidence-Based Medicine's critical appraisal tool was used to assess the quality of studies. Studies that used supervised structured PA sessions, educational material in SAI languages, motivational strategies, and positive reinforcement for goal setting, reported significant improvement in PA (p < .05; Cohen's d ≤ 0.3 to >0.8). Future PA studies in India featuring SAIs would benefit from clinic-based one-on-one structured aerobic PA interventions. In contrast, SAI immigrants in Western countries would benefit from community-based structured aerobic PA interventions that are offered in groups and culturally adapted.

Effects of the COVID-19 pandemic on recruitment for the working women walking program.

The global pandemic of coronavirus disease 2019 (COVID-19) affected many aspects of randomized controlled trials, including recruiting and screening participants. The purpose of this paper is to (a) describe adjustments to recruitment and screening due to COVID-19, (b) compare the proportional recruitment outcomes (not completed, ineligible, and eligible) at three screening stages (telephone, health assessment, and physical activity assessment) pre- and post-COVID-19 onset, and (c) compare baseline demographic characteristics pre- and post-COVID-19 onset in the Working Women Walking program. The design is a cross-sectional descriptive analysis of recruitment and screening data from a 52-week sequential multiple assignment randomized trial (SMART). Participants were women 18-70 years employed at a large urban medical center. Recruitment strategies shifted from in-person and electronic to electronic only post-COVID-19 onset. In-person eligibility screening for health and physical activity assessments continued post-COVID-19 onset with Centers for Disease Control and Prevention precautions. Of those who expressed interest in the study pre- and post-COVID-19 onset (n = 485 & n = 269 respectively), 40% (n = 194) met all eligibility criteria pre-COVID-19 onset, and 45.7% (n = 123) post-COVID-19 onset. Although there were differences in the proportions of participants who completed or were eligible for some of the screening stages, the final eligibility rates did not differ significantly pre-COVID-19 versus post-COVID-19 onset. Examination of differences in participant demographics between pre- and post-COVID-19 onset revealed a significant decrease in the percentage of Black women recruited into the study from pre- to post-COVID-19 onset. Studies recruiting participants into physical activity studies should explore the impact of historical factors on recruitment.

Physical Activity Interventions Among American Indian and Alaska Native Persons: A Systematic Review.

OBJECTIVE: The purpose of this review was to identify and describe physical activity (PA) interventions that have been implemented with American Indian and Alaska Natives (AIANs) in the U.S. and Canada since 2006. DATA SOURCE: Searches were conducted in 8 databases plus grey literature sources. STUDY INCLUSION AND EXCLUSION CRITERIA: Eligible studies: (a) described an intervention designed to increase PA; (b) targeted AIANs residing in the U.S. or Canada, or if a multiethnic population, contained an AIAN subanalysis; (c) were published in 2006 or later; and (d) reported a PA outcome. DATA EXTRACTION: Two reviewers independently extracted data, with conflicts resolved through discussion. DATA SYNTHESIS: Data were synthesized by participant characteristics, intervention strategies, PA outcomes, and impact. RESULTS: We identified 25 eligible studies, most targeting children and youth. Intergenerational, environmental policy, cultural adaptation, and curriculum-based approaches were used. Twenty studies used self-reported PA measures. 80% of studies used an element of cultural adaptation, mostly considering cultural needs in design, not program or outcome evaluation. Sedentary behavior and leisure-time PA were rarely assessed. Significant changes in PA outcomes were achieved post-intervention in 13 studies (52%). CONCLUSION: Future interventions should target AIAN adults to evaluate sedentary behavior and leisure-time PA. Interventions should incorporate psychometrically tested objective measures and prioritize the Native perspective from intervention design through project evaluation.

Development of the Doctor of Nursing Practice Nurse Practitioner Minimum Data Set (DNP NP MDS).

BACKGROUND: While the number of Doctor of Nursing Practice (DNP) programs has grown steadily, there is limited data on how national organizations are collecting data on DNP-prepared nurse practitioners (NPs) and no standard instrument exists to collect data on DNP-prepared NPs. PURPOSE: The purpose of this study was to develop a universal minimum data set (MDS) for the DNP-prepared NP population. METHOD: Instrument development consisted of several sequential stages, including conceptualization and item generation, preliminary evaluation of items, field testing the survey, and analysis of scale development data. FINDINGS: A set of 16 core variables and 19 additional variables were developed to collect standardized data on the demographics, education, and practice patterns of DNP-prepared NPs. Pilot testing revealed high correlations between the activities DNP-prepared NPs are prepared for and typically participate in a typical workweek and in their career. The MDS demonstrated high reliability in our sample. DISCUSSION: The DNP NP MDS can be used for data collection by various stakeholders, including national organizations, to facilitate improved tracking of outcome data for the DNP-prepared NP workforce. It can also provide data-driven support for the need and significance of the DNP degree for NPs.

A Quality Improvement Project to Increase Utilization of an Urgent Care Clinic for Cancer.

BACKGROUND: Nationally, patients with cancer experience high numbers of emergency department (ED) visits. Many ED visits may be prevented using cancer-specific urgent care services. OBJECTIVES: The purpose of this quality improvement initiative was to first assess the reasons that adult patients with cancer used the ED instead of an urgent care clinic for cancer (UCC-C). Second, an education program was developed and implemented to improve UCC-C use. METHODS: Using semistructured interviews pre- and postintervention (education program about ED/UCC-C use), this project described knowledge of adult patients with cancer about using the ED instead of the UCC-C. The project also evaluated the efficacy of the education intervention. FINDINGS: Pre- to postimplementation change showed an increase in patient UCC-C knowledge, patients who said they would present to the UCC-C, and patients who presented to the UCC-C for treatment. In addition, there was a decrease in adult patients with cancer who presented to the ED and were subsequently hospitalized.

Traversing academic rank promotion for nurse practitioner faculty.

ABSTRACT: The relatively rapid increase of nurse practitioner (NP) programs across the United States has necessitated schools and colleges of nursing to hire and support NP faculty through the promotion process to sustain their programs. Nurse practitioner faculty engaged in clinical practice often face barriers in obtaining rank promotion. The purpose of this article was to provide NP faculty an evidence-based pathway to support academic rank promotion. An additional aim was to recognize implicit biases and barriers, while offering guidance for overcoming challenges. Using Boyer (1990) and American Association of Colleges of Nursing (2018) as a foundation, this article outlines a pathway to synergistically highlight and weave clinical practice experiences within academic expectations of promotion. The categories of academic rank promotion identified and highlighted within this article include scholarship, teaching, practice, and service. The Stager & Douglass Pathway to Preparation for Traversing Academic Rank for Clinical Faculty provides steps for a well-developed plan and comprehensive dossier in supporting successful promotion. These steps include understanding institutional promotional guidelines, developing focused priorities, defining the clinical practice role in the progression of promotion, partnering with a mentor, gathering supportive materials early, and developing a comprehensive dossier, leading to a successful academic rank promotion process. Preparing the dossier early leverages time for the NP faculty to strategize with academic leaders and colleague mentors to develop focused priorities. In addition, identified biases and barriers may be mitigated to support successful academic rank promotion.

Physical Activity and Cardiovascular Risk Factor Outcomes in Women with a History of Hypertensive Disorders of Pregnancy: Integrative Review.

BACKGROUND: Hypertensive disorders of pregnancy increase a woman's risk for developing cardiovascular disease, with risk factors manifested as early as one year postpartum. Researchers are examining how physical activity may help to mitigate cardiovascular risk factors in this population. AIM: Review the existing scientific literature on the impact of physical activity in women with a history of hypertensive disorders of pregnancy related to physical activity and cardiovascular risk factor outcomes. METHODS: This integrative review examined research studies addressing physical activity in women with a history of preeclampsia or other hypertensive disorders of pregnancy. Using four databases, the search strategy included published studies through December 31, 2019. Identified studies were assessed using Joanna Briggs Institute critical appraisal tools. RESULTS: The initial search identified 1,166 publications. Seven studies including two observational, four quasi-experimental, and one experimental study were included in the review. Although the studies had limitations, none of these limitations were deemed significant enough to eliminate a study from the review. Studies were conducted in four countries, and participants were predominantly White. Physical activity interventions primarily consisted of delivery of educational content, and data were primarily obtained by self-report. Of the five studies utilizing intervention strategies, three reported positive findings including increased physical activity, enhanced physiologic adaptations, and decreased physical inactivity. One study reported mixed findings of improved physical fitness in both groups, while another reported no change in intent to change exercise behavior associated with the intervention. LINKING EVIDENCE TO ACTION: Physical activity promotion among women with a history of hypertensive disorders of pregnancy has been studied by a small group of researchers. Current literature on the topic is characterized by limited sample diversity, lack of exercise-based interventions, and over reliance on self-report to measure physical activity. It is imperative that further research be conducted to facilitate improved cardiovascular outcomes.

LGBTQ Older Adults in Long-Term Care Settings: An Integrative Review to Inform Best Practices.

OBJECTIVES: To synthesize literature about lesbian, gay, bisexual, transgender, and queer (LGBTQ) older adults in long-term care (LTC) facilities and provide recommendations for best practice guideline development to inform practice, research, and policy. METHODS: Four electronic databases were searched in June 2019 for studies conducted between 2000- 2019 related to caring for LGBTQ older adults in LTC settings. An integrative literature review was conducted on the twenty eligible studies. RESULTS: LGBTQ participants fear discrimination in LTC settings leading to the invisibility of their identities. They recognize a need for increased staff training and the importance of community networks and facility preferences. LTC staff have mixed experiences with inclusive practices and complex views of LGBTQ older adults. LTC staff experience training deficits and require more expansive modalities. CONCLUSIONS: LGBTQ participants and LTC staff both advise that LTC facilities revise forms and policies to ensure all sexual orientations and gender identities are affirmed and protected in addition to providing widespread training. CLINICAL IMPLICATIONS: This review calls to attention the need for LTC settings to uniformly follow best-practices. Clinical recommendations to promote equitable healthcare include: staff training at all levels and communication that does not assume heterosexuality or cisgender identity.

Impact of a nutrition education program on health behaviors in a university workplace wellness program.

BACKGROUND: Obesity is a complex health issue associated with the leading causes of preventable chronic diseases, such as heart disease and type 2 diabetes. As part of an interprofessional team, nurse practitioners can play an integral role in leading worksite interventions to enhance health behavior change. Although worksite nutrition interventions have existed for many years, effective weight management programs are needed in the workplace. PURPOSE: The purpose of this study was to determine the effect of a novel nutrition education program implemented in the workplace on health behaviors (dietary habits and physical activity), motivators and barriers, emotional eating, confidence, and biometrics (body mass index and lipid levels). METHODS: A total of 96 university employees participated in a one-group pre- and postintervention from 2017 to 2019. The intervention included eight weekly face-face education sessions. We assessed dietary habits, physical activity, motivators and barriers of a healthy lifestyle, emotional eating, confidence levels, body mass index, and lipid levels. Descriptive statistics, chi-square test, one-way analysis of variance, and Wilcoxon rank test were performed. RESULTS: The consumption of fruits, vegetables, beans, grains, and physical activity increased significantly. Barriers, body mass index, and triglycerides significantly decreased. There was no significant difference in emotional eating and motivators after the intervention. IMPLICATIONS FOR PRACTICE: Nurse practitioners are positioned to lead an interprofessional team to provide nutrition education to help mitigate risk factors for obesity in various settings, including the workplace.

Strategies to Move Entry-Level Nurse Practitioner Education to the Doctor of Nursing Practice Degree by 2025.

BACKGROUND: The National Organization of Nurse Practitioner Faculties (NONPF) has made the commitment to move all entry-level nurse practitioner (NP) education to the Doctor of Nursing Practice (DNP) degree by 2025. PROBLEM: Although there are more than 250 DNP NP programs throughout the United States, many other NP programs have yet to transition to the doctoral level. APPROACH: Leaders representing licensure, accreditation, certification, education, and practice organizations attended a NONPF 2017 Summit to discuss the DNP degree as entry into NP practice. Summit participants strategized on building collective strengths and addressed barriers to implementation. A solution-oriented discussion with action items has been operationalized for the last 4 years. OUTCOMES: Four workgroups were created to address education, outcomes, capacity, and messaging related to moving all entry-level NP education to the DNP degree. CONCLUSION: Ongoing collaborative efforts are critical to facilitate advancing all NP education programs to the DNP degree by 2025.

BAILAMOS With mHealth Technology! Improving Physical Activity and Well-Being in Middle-Aged and Older Latinxs: A Pre-Post Feasibility Study.

Older Latinxs engage in lower levels of leisure-time physical activity (PA) compared with non-Latinx Whites. Latin dance is a culturally relevant type of leisure-time PA that may engage older Latinx populations, particularly when coupled with mobile health technologies (mHealth). This single group pre-post feasibility study described the PA and health outcomes of middle-aged and older Latinxs participating in BAILA TECH-an intervention that combines the BAILAMOS Latin dance program with mHealth (Fitbit Charge 2, Fitbit app, and motivational text messages). Participants (n = 20, Mage = 67 ± 7.1, female n = 15, 75%) were enrolled in the 16-week BAILA TECH intervention held twice a week. Participants received a Fitbit Charge 2 to assess PA at baseline, during the intervention, and postintervention. An mHealth platform (iCardia) collected Fitbit data and staff delivered weekly motivational and informational text messages. Participants completed questionnaires about PA, sedentary behavior, cardiorespiratory fitness, social support, quality of life, and cognitive function at baseline and postintervention. Paired t tests evaluated change in pre-post measures. There was a significant increase in device-assessed moderate-to-vigorous PA (d = 0.69), self-reported light-leisure (d = 1.91) and moderate-to-vigorous PA (d = 1.05), moderate-to-vigorous leisure PA (d = 1.55), predicted cardiorespiratory fitness (d = 1.10), and PA social support (d = 0.81 [family]; d = 0.95 [friends]) from baseline to postintervention. Although nonsignificant, there was a small effect on physical health-related quality of life (d = 0.32) and executive function (d = 0.29). These data describe an increase in PA levels and health-related outcomes of middle-aged and older Latinxs from participation in an mHealth-infused Latin dance intervention. An adequately powered trial is necessary to establish efficacy.

Medical librarians' knowledge and practices in locating clinical trials for systematic reviews.

OBJECTIVE: In regard to locating clinical trials for a systematic review, limited information is available about how librarians locate clinical trials in biomedical databases, including (1) how much information researchers provide librarians to assist with the development of a comprehensive search strategy, (2) which tools librarians turn to for information about study design methodology, and (3) librarians' confidence levels in their knowledge of study design methodology. A survey was developed to explore these aspects of how a medical librarian locates clinical trials when facilitating systematic reviews for researchers. METHODS: In this cross-sectional study, a 21-question survey was sent to medical librarians via several email listservs during April 2020. Respondents were limited to librarians who make the decisions on search terms for systematic reviews. RESULTS: Responses (n=120) indicated that librarians were often asked to search for various types of clinical trials. However, there was not a consistent method for creating search strategies that locate diverse types of clinical trials. Multiple methods were used for search strategy development, with hedges being the most popular method. In general, these librarians considered themselves to be confident in locating trials. Different resources were used to inform study types, including textbooks, articles, library guides and websites. DISCUSSION: Medical librarians indicated that while they felt confident in their searching skills, they did not have a definitive source of information about the various types of clinical trials, and their responses demonstrated a clear need and desire for more information on study design methodology.

Patient-centered mobile health technology intervention to improve self-care in patients with chronic heart failure: Protocol for a feasibility randomized controlled trial.

This randomized controlled trial aims to determine the feasibility and preliminary efficacy of a patient-centered, mobile health technology intervention (iCardia4HF) in patients with chronic Heart Failure (HF). Participants (n = 92) are recruited and randomized 1:1 to the intervention or control group. The intervention group receives a commercial HF self-care app (Heart Failure Storylines), three connected health devices that interface with the app (Withings weight scale and blood pressure monitor, and Fitbit activity tracker), and a program of individually tailored text-messages targeting health beliefs, self-care self-efficacy, HF-knowledge, and physical activity. The control group receives the same connected health devices, but without the HF self-care app and text messages. Follow-up assessments occur at 30 days and 12 weeks. The main outcome of interest is adherence to HF self-care assessed objectively through time-stamped data from the electronic devices and also via patient self-reports. Primary measures of HF self-care include medication adherence and adherence to daily weight monitoring. Secondary measures of HF self-care include adherence to daily self-monitoring of HF symptoms and blood pressure, adherence to low-sodium diet, and engagement in physical activity. Self-reported HF self-care and health-related quality of life are assessed with the Self-care Heart Failure Index and the Kansas City Cardiomyopathy Questionnaire, respectively. Hospitalizations and emergency room visits are tracked in both groups over 12 weeks as part of our safety protocol. This study represents an important step in testing a scalable mHealth solution that has the potential to bring about a new paradigm in self-management of HF.

Effectiveness of Mobile Health Technology Interventions for Patients With Heart Failure: Systematic Review and Meta-analysis.

BACKGROUND: Heart failure (HF) is a complex and serious condition associated with substantial morbidity, mortality, and health care costs. We conducted a systematic review and meta-analysis to evaluate the effects of mobile health (mHealth) interventions compared with usual care in patients with HF. METHODS: We searched MEDLINE, CENTRAL, CINAHL, and EMBASE databases to identify eligible randomized controlled trials (RCTs) of mHealth interventions. Primary outcomes included: all-cause mortality, cardiovascular mortality, HF-related hospitalizations, and all-cause hospitalizations. Meta-analyses using a random effects model were performed for all outcomes. Risk of bias and quality of evidence were evaluated using the Cochrane Tool and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. RESULTS: Sixteen RCTs involving 4389 patients were included. Compared with usual care, mHealth interventions reduced the risk of all-cause mortality (risk ratio [RR], 0.80; 95% confidence interval [CI], 0.65-0.97; absolute risk reduction [ARR], 2.1%; high-quality evidence), cardiovascular mortality (RR, 0.70; 95% CI, 0.53-0.91; ARR, 2.9%; high-quality evidence), and HF hospitalizations (RR, 0.77; 95% CI, 0.67-0.88; ARR, 5%; high-quality evidence), but had no effect on all-cause hospitalizations. Results were driven by mHealth interventions with remote monitoring and clinical feedback, which were associated with larger reductions than stand-alone mHealth interventions. However, subgroup differences were not statistically significant. CONCLUSIONS: mHealth interventions with remote monitoring and clinical feedback reduce mortality and HF-related hospitalizations, but might not reduce all-cause hospitalizations in patients with HF. Additional studies are needed to determine the efficacy of stand-alone mHealth interventions as well as active features of mHealth that contribute to efficacy.

A Church-based Culturally Sensitive Physical Activity Intervention in African American Women.

The purpose of this pilot study was to test a church-based, culturally sensitive, six-week intervention called GET FIT DON'T QUIT. The intervention aimed to increase knowledge and change beliefs about physical activity, and to improve social facilitation to increase self-regulation, in order to promote physical activity in African-American women. A two-group pretest/posttest, quasi-experimental design was conducted in a convenience sample (N = 37) of African-American women. Participants were randomly assigned to the intervention or control group by church affiliation. The six-week intervention consisted of teaching and roundtable discussions, and email reminders to be physically active. There were significant differences (p < .05) in the level of self-efficacy, self-regulation, and friend social support. There were no significant differences in knowledge of physical activity guidelines, beliefs, and family social support. These pilot study results suggested that multiple factors are associated with physical activity engagement in African-American women.

Supporting Primary Care Access and Use among Homeless Persons.

With the implementation of the Affordable Care Act (ACA), many homeless persons who previously lacked health insurance gained medical coverage. This paper describes the experiences of homeless persons in accessing and using primary care services, post-implementation of the ACA. Twenty-six semi-structured interviews were completed with homeless persons and primary care providers/staff. Via thematic analysis, themes were identified, categorized by: factors which influence primary care access and use patterns, and strategies to promote consistent primary care use. Maintaining insurance and leveraging systems-based strategies to support primary care access and use may address health disparities and promote health equity.

Study protocol for a sequential multiple assignment randomized trial (SMART) to improve physical activity in employed women.

INTRODUCTION: Physical activity monitors, motivational text messages, personal calls, and group meetings, have proven to be efficacious physical activity interventions. However, individual participant response to these interventions varies drastically. A SMART design (sequential multiple assignment randomized trial) provides an effective way to test interventions that start with an initial treatment and then transition to an augmented treatment for non-responders. We describe a SMART to determine the most effective adaptive intervention to increase physical activity (steps, moderate-to-vigorous physical activity) and improve cardiovascular health among employed women who are not regularly physically active. The SMART uses combinations of four treatments: 1) enhanced physical activity monitor (Fitbit wearable activity monitor and mobile app with goal setting and physical activity prescription), 2) text messages, 3) personal calls, and 4) group meetings. METHODS: Participants (N = 312) include women ages 18-70 employed at a large academic medical center. Women will be randomized to an initial intervention, either an enhanced physical activity monitor or enhanced physical activity monitor + text messaging. Non-responders to the initial intervention at 2 months will be randomized to either personal calls or groups meetings for the next 6 months. At 8 months, all participants will return to only an enhanced physical activity monitor until their final 12-month assessment. DISCUSSION: Results of this study will add to the literature on improving physical activity in employed women. This study will identify effective interventions for women who respond to less intensive treatments, while maximizing benefits for those who need a more intensive approach.