RESUMO
PURPOSE: Coalitions can be a successful way to promote healthy initiatives throughout a community. To properly measure the success of coalition-based interventions, it is important to conduct a process evaluation of coalition activities and establish a system for evaluating outcomes. This article describes a process evaluation of a monitoring and feedback system for community coalitions targeting chronic disease risk reduction. METHODS: Community coalitions in six rural, southeast Missouri counties collaborated with the Missouri Department of Health and Saint Louis University to track coalition events using the process described in the Centers for Disease Control and Prevention manual Evaluating Community Efforts to Prevent Cardiovascular Diseases. SUMMARY: First, we describe the methodology used to monitor monthly activities and to evaluate satisfaction with the process. Next, we discuss the data that resulted from the monitoring system and interviews with recorders. Third, we discuss changes made to the monitoring system and lessons learned along the way. Finally, we end with recommendations for incorporating this monitoring system in community practice. CONCLUSIONS: When used properly, this system is an effective way of evaluating and promoting sustainability of community interventions.
Assuntos
Doenças Cardiovasculares/prevenção & controle , Coalizão em Cuidados de Saúde/organização & administração , Promoção da Saúde/organização & administração , Avaliação de Programas e Projetos de Saúde/métodos , Registros , Comportamento Cooperativo , Documentação , Humanos , Entrevistas como Assunto , Auditoria Administrativa/métodos , Missouri , Medicina Preventiva , Fatores de Risco , Saúde da População RuralRESUMO
PURPOSE: Exercise counseling by primary care physicians has been shown to improve physical activity in patients. However, the prevalence and effectiveness of physician counseling is unknown in rural populations that are at increased risk for chronic diseases. METHODS: Using a population-based telephone survey at baseline and again at 1-year follow-up, we assessed physical activity behavior among 1141 adults (75% female, 95% white) living within 12 rural communities of Missouri, Tennessee, and Arkansas. We tested the association between physician counseling and patients meeting current physical activity recommendations using logistic regression analysis controlling for demographic variables. RESULTS: Participants who saw a doctor for regular care were 54% more likely to be physically active (adjusted odds ratio [aOR]=1.54; 95% confidence interval [CI], 1.04-2.28). Overweight adults (body mass index [BMI]=25-29.9 kg/m2) who had been advised by their physician to exercise more were nearly 5 times more likely to meet physical activity recommendations if their doctor helped develop an exercise plan (aOR=4.99; 95% CI, 1.69-14.73). Overweight individuals who received additional follow-up with the exercise plan from their doctor had a 51/2-fold increase in likelihood of meeting physical activity recommendations (P<.05). In the overall sample, patients were significantly more likely to initiate (P=.01) and maintain (P=.002) physical activity when the physician prescribed and followed up on an exercise plan. CONCLUSION: This longitudinal study provides evidence that exercise counseling is most effective when the physician presents the counseling as a plan or prescription and when he or she follows up with the patient on it.
Assuntos
Aconselhamento , Terapia por Exercício , Comportamentos Relacionados com a Saúde , Obesidade/prevenção & controle , População Rural , Adolescente , Adulto , Idoso , Arkansas , Índice de Massa Corporal , Exercício Físico , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Missouri , Relações Médico-Paciente , Prática Profissional , TexasRESUMO
BACKGROUND: Walking is a key focus of public health interventions yet is particularly uncommon in rural residents. This study's purpose was to determine whether a multilevel community intervention affected rates of moderate physical activity, in particular walking. METHODS: A quasi-experimental design examined changes in walking in six rural intervention communities in Missouri and six comparison communities in Arkansas and Tennessee in 2003-2004. Interventions were developed with community input and included individually tailored newsletters; interpersonal activities that stressed social support and health provider counseling; and community-wide events such as fun walks. A dose variable estimated exposure to intervention activities. Primary outcomes were rates of walking and moderate physical activity in the past week. RESULTS: At follow-up (n = 1531), the percentage of respondents who met the recommendation for walking was the same across the intervention and comparison areas. Among the dependent variables, walking showed some evidence of a positive linear trend across dose categories (P = 0.090). After adjusting for covariates and baseline rates, intervention participants in the moderate and high dose categories were about three times more likely to meet recommended guidelines for walking. CONCLUSIONS: Some evidence of effectiveness was shown for a multilevel intervention approach to promote walking.