[show abstract][hide abstract] ABSTRACT: Decision aids offer promise as a practical solution to improve patient decision making about coronary heart disease (CHD) prevention medications and help patients choose medications to which they are likely to adhere. However, little data is available on decision aids designed to promote adherence.
In this paper, we report on secondary analyses of a randomized trial of a CHD adherence intervention (second generation decision aid plus tailored messages) versus usual care in an effort to understand how the decision aid facilitates adherence. We focus on data collected from the primary study visit, when intervention participants presented 45 minutes early to a previously scheduled provider visit; viewed the decision aid, indicating their intent for CHD risk reduction after each decision aid component (individualized risk assessment and education, values clarification, and coaching); and filled out a post-decision aid survey assessing their knowledge, perceived risk, decisional conflict, and intent for CHD risk reduction. Control participants did not present early and received usual care from their provider. Following the provider visit, participants in both groups completed post-visit surveys assessing the number and quality of CHD discussions with their provider, their intent for CHD risk reduction, and their feelings about the decision aid.
We enrolled 160 patients into our study (81 intervention, 79 control). Within the decision aid group, the decision aid significantly increased knowledge of effective CHD prevention strategies (+21 percentage points; adjusted p<.0001) and the accuracy of perceived CHD risk (+33 percentage points; adjusted p<.0001), and significantly decreased decisional conflict (-0.63; adjusted p<.0001). Comparing between study groups, the decision aid also significantly increased CHD prevention discussions with providers (+31 percentage points; adjusted p<.0001) and improved perceptions of some features of patient-provider interactions. Further, it increased participants' intentions for any effective CHD risk reducing strategies (+21 percentage points; 95% CI 5 to 37 percentage points), with a majority of the effect from the educational component of the decision aid. Ninety-nine percent of participants found the decision aid easy to understand and 93% felt it easy to use.
Decision aids can play an important role in improving decisions about CHD prevention and increasing patient-provider discussions and intent to reduce CHD risk.
BMC Medical Informatics and Decision Making 02/2014; 14(1):14. · 1.60 Impact Factor
[show abstract][hide abstract] ABSTRACT: Although lifestyle and medications are effective for coronary heart disease (CHD) risk reduction, few studies have examined the comparative effectiveness of various strategies for delivering high quality CHD risk reduction. In this paper, we report on the design and baseline characteristics of participants for just such a trial.
We conducted a randomized trial of the same lifestyle and medication intervention delivered in two alternate formats: counselor-delivered or web-based. The trial was conducted at 5 diverse practices in a family medicine research network and included men and women age 35-79 who were at high risk of CHD events based on 10-year predicted Framingham risk of ≥10% or a known history of cardiovascular disease. After individual-level randomization, participants in both arms received a decision aid plus four intensive intervention visits and 3 maintenance visits over 12 months. The primary outcome was change in 10-year predicted CHD risk among patients without prior cardiovascular disease. Secondary outcomes, measured among all participants, included changes in CHD risk factors, cost-effectiveness, and acceptability at 4 and 12-month follow-up.
We randomized 489 eligible patients: 389 without and 100 with a known history of cardiovascular disease. Mean age was 62.3. 75% were white, 25% African American. 45% had a college education. 88% had health insurance. Mean 10-year predicted CHD risk was 16.9%.
We have successfully recruited a diverse sample of practices and patients that will provide a rich sample in which to test the comparative effectiveness of two strategies to implement high quality CHD prevention.
[show abstract][hide abstract] ABSTRACT: Despite high obesity prevalence rates, few low-income midlife women participate in weight loss maintenance trials. This pilot study aims to assess the effectiveness of two weight loss maintenance interventions in this under-represented population.
Low-income midlife women who completed a 16-week weight loss intervention and lost >= 8 lbs (3.6 kg) were eligible to enroll in one of two 12-month maintenance programs. The programs were similar in content and had the same number of total contacts, but were different in the contact modality (Phone + Face-to-Face vs. Face-to-Face Only). Two criteria were used to assess successful weight loss maintenance at 12 months: (1) retaining a loss of >= 5% of body weight from the start of the weight loss phase and (2) a change in body weight of < 3%, from the start to the end of the maintenance program. Outcome measures of changes in physiologic and psychosocial factors, and evaluations of process measures and program acceptability (measured at 12 months) are also reported. For categorical variables, likelihood ratio or Fisher's Exact (for small samples) tests were used to evaluate statistically significant relationships; for continuous variables, t-tests or their equivalents were used to assess differences between means and also to identify correlates of weight loss maintenance.
Overall, during the 12-month maintenance period, 41% (24/58) of participants maintained a loss of >= 5% of initial weight and 43% (25/58) had a <3% change in weight. None of the comparisons between the two maintenance programs were statistically significant. However, improvements in blood pressure and dietary behaviors remained significant at the end of the 12-month maintenance period for participants in both programs. Participant attendance and acceptability were high for both programs.
The effectiveness of two pilot 12-month maintenance interventions provides support for further research in weight loss maintenance among high-risk, low-income women.Trial registrationClinicalTrials.gov Identifier: NCT00288301.
BMC Public Health 07/2013; 13(1):653. · 2.08 Impact Factor
[show abstract][hide abstract] ABSTRACT: OBJECTIVE: To translate a behavioral weight loss intervention for mid-life, low-income women in real world settings. DESIGN AND METHODS: In this pragmatic clinical trial, we randomly selected 6 North Carolina county health departments and trained their current staff to deliver a 16-session evidence-based behavioral weight loss intervention (special intervention, SI). SI weight loss outcomes were compared to a delayed intervention (DI) control group. RESULTS: Of 432 women expressing interest, 189 completed baseline measures and were randomized within health departments to SI (N =126) or DI (N = 63). At baseline, average age was 51 years, 53% were African American, mean weight was 100 kg, and BMI averaged 37 kg/m(2) . A total of 96 (76%) SI and 55 (87%) DI participants returned for 5-month follow-up measures. The crude weight change was -3.1 kg in the SI and -0.4 kg in the DI group, for a difference of 2.8 kg (95% CI 1.4 to 4.1, p = .0001). Diet quality and physical activity improved significantly more in the SI group, and estimated intervention costs were $327 per participant. CONCLUSIONS: This pragmatic short-term weight loss intervention targeted to low-income mid-life women yielded meaningful weight loss when translated to the county health department setting.
[show abstract][hide abstract] ABSTRACT: OBJECTIVE: To develop a brief questionnaire to assess dietary fat quality, the Dietary Fat Quality Assessment (DFQA), for use in dietary counseling to reduce heart disease risk. METHODS: A subsample of 120 underserved, midlife women enrolled in a randomized, controlled weight loss trial completed baseline and follow-up telephone surveys. Main outcome measures included dietary fat components (total fat, saturated fat, polyunsaturated fat, monounsaturated fat, omega-3 fatty acids, and cholesterol). RESULTS: Assessments of major dietary fat components using the DFQA and a food frequency questionnaire were significantly correlated, with correlation coefficients of 0.54-0.66 (P < .001). Intra-class correlation coefficients to assess reliability ranged from 0.48 to 0.59 for each of the fat components studied. CONCLUSIONS AND IMPLICATIONS: The DFQA provides a reasonable assessment of dietary fat quality associated with coronary heart disease risk and may prove useful as a brief assessment tool to guide dietary counseling given to reduce heart disease risk.
Journal of nutrition education and behavior. 01/2013;
[show abstract][hide abstract] ABSTRACT: BACKGROUND: Most studies on the local food environment have used secondary sources to describe the food environment, such as government food registries or commercial listings (e.g., Reference USA). Most of the studies exploring evidence for validity of secondary retail food data have used on-site verification and have not conducted analysis by data source (e.g., sensitivity of Reference USA) or by food outlet type (e.g., sensitivity of Reference USA for convenience stores). Few studies have explored the food environment in American Indian communities. To advance the science on measuring the food environment, we conducted direct, on-site observations of a wide range of food outlets in multiple American Indian communities, without a list guiding the field observations, and then compared our findings to several types of secondary data. METHODS: Food outlets located within seven State Designated Tribal Statistical Areas in North Carolina (NC) were gathered from online Yellow Pages, Reference USA, Dun & Bradstreet, local health departments, and the NC Department of Agriculture and Consumer Services. All TIGER/Line 2009 roads (>1,500 miles) were driven in six of the more rural tribal areas and, for the largest tribe, all roads in two of its cities were driven. Sensitivity, positive predictive value, concordance, and kappa statistics were calculated to compare secondary data sources to primary data. RESULTS: 699 food outlets were identified during primary data collection. Match rate for primary data and secondary data differed by type of food outlet observed, with the highest match rates found for grocery stores (97%), general merchandise stores (96%), and restaurants (91%). Reference USA exhibited almost perfect sensitivity (0.89). Local health department data had substantial sensitivity (0.66) and was almost perfect when focusing only on restaurants (0.91). Positive predictive value was substantial for Reference USA (0.67) and moderate for local health department data (0.49). Evidence for validity was comparatively lower for Dun & Bradstreet, online Yellow Pages, and the NC Department of Agriculture. CONCLUSIONS: Secondary data sources both over- and under-represented the food environment; they were particularly problematic for identifying convenience stores and specialty markets. More attention is needed to improve the validity of existing data sources, especially for rural local food environments.
International Journal of Behavioral Nutrition and Physical Activity 11/2012; 9(1):137. · 3.58 Impact Factor
[show abstract][hide abstract] ABSTRACT: Physical activity (PA) is low among African American women despite awareness of its positive impact on health. Learning and Developing Individual Exercise Skills for a Better Life (L.A.D.I.E.S.) compares three strategies for increasing PA among African American women using a cluster randomized, controlled trial. Underactive adult women from 30 churches (n=15 participants/church) were recruited. Churches were randomized to a faith-based intervention, a non-faith based intervention, or an information only control group. Intervention groups will meet 25 times in group sessions with other women from their church over a 10-month period. Control group participants will receive standard educational material promoting PA. All participants will be followed for an additional 12months to assess PA maintenance. Data will be collected at baseline, 10, and 22months. The primary outcome is PA (steps/day, daily moderate-to-vigorous PA). We expect treatment effects indicating that assignment to either of the active interventions is associated with greater magnitude of change in PA compared to the control group. In exploratory analyses, we will test whether changes in the faith-based intervention group are greater than changes in the non-faith-based intervention group. L.A.D.I.E.S. focuses on a significant issue-increasing PA levels-in a segment of the population most in need of successful strategies for improving health. If successful, L.A.D.I.E.S. will advance the field by providing an approach that is successful for initiating and sustaining change in physical activity, which has been shown to be a primary risk factor for a variety of health outcomes, using churches as the point of delivery.
[show abstract][hide abstract] ABSTRACT: OBJECTIVE: To evaluate whether the evidence-based Body & Soul program, when disseminated and implemented without researcher or agency involvement and support, would achieve results similar to those of earlier efficacy and effectiveness trials. DESIGN: Prospective group randomized trial. SETTING: Churches with predominantly African American membership. PARTICIPANTS: A total of 1,033 members from the 15 churches completed baseline surveys. Of these participants, 562 (54.4%) completed the follow-up survey 6 months later. INTERVENTION: Church-based nutrition program for African Americans that included pastoral involvement, educational activities, church environmental changes, and peer counseling. MAIN OUTCOME MEASURE: Daily fruit and vegetable (FV) intake was assessed at pre- and posttest. ANALYSIS: Mixed-effects linear models. RESULTS: At posttest, there was no statistically significant difference in daily servings of FVs between the early intervention group participants compared to control group participants (4.7 vs 4.4, P = .38). Process evaluation suggested that added resources such as technical assistance could improve program implementation. CONCLUSIONS AND IMPLICATIONS: The disseminated program may not produce improvements in FV intake equal to those in the earlier efficacy and effectiveness trials, primarily because of a lack of program implementation. Program dissemination may not achieve public health impact unless support systems are strengthened for adequate implementation at the church level.
Journal of nutrition education and behavior 03/2012; · 1.36 Impact Factor
[show abstract][hide abstract] ABSTRACT: Efficacious strategies for the primary prevention of coronary heart disease (CHD) are underused, and, when used, have low adherence. Existing efforts to improve use and adherence to these efficacious strategies have been so intensive that they are impractical for clinical practice.
We conducted a randomized trial of a CHD prevention intervention (including a computerized decision aid and automated tailored adherence messages) at one university general internal medicine practice. After obtaining informed consent and collecting baseline data, we randomized patients (men and women age 40-79 with no prior history of cardiovascular disease) to either the intervention or usual care. We then saw them for two additional study visits over 3 months. For intervention participants, we administered the decision aid at the primary study visit (1 week after baseline visit) and then mailed 3 tailored adherence reminders at 2, 4, and 6 weeks. We assessed our outcomes (including the predicted likelihood of angina, myocardial infarction, and CHD death over 10 years (CHD risk) and self-reported adherence) between groups at 3 month follow-up. Data collection occurred from June 2007 through December 2009. All study procedures were IRB approved.
We randomized 160 eligible patients (81 intervention; 79 control) and followed 96% to study conclusion. Mean predicted CHD risk at baseline was 11.3%. The intervention increased self-reported adherence to chosen risk reducing strategies by 25 percentage points (95% CI 8% to 42%), with the biggest effect for aspirin. It also changed predicted CHD risk by -1.1% (95% CI -0.16% to -2%), with a larger effect in a pre-specified subgroup of high risk patients.
A computerized intervention that involves patients in CHD decision making and supports adherence to effective prevention strategies can improve adherence and reduce predicted CHD risk.
BMC Health Services Research 12/2011; 11:331. · 1.77 Impact Factor
[show abstract][hide abstract] ABSTRACT: Obesity is common among low-income mid-life women, yet most published weight loss studies have not focused on this population and have been highly resourced efficacy trials. Thus, practical type 2 translational studies are needed to evaluate weight loss interventions for low-income women. In this paper, we present the rationale, study design, and baseline characteristics of a type 2 translational study that evaluates both the processes and outcomes of a weight loss intervention for low-income women given at 6 county health departments in North Carolina. Key features of this study include random selection of study sites, intervention delivery by current staff at study sites, efforts to integrate the intervention with local community resources, a focus on evaluating the processes of translation using the RE-AIM framework, use of an evidence-based weight loss intervention, a detailed description of participant recruitment and representativeness, and a practical randomized trial designed to assess the effectiveness of the intervention. Of 81 health departments invited to participate, 30 (37%) were eligible and willing, and 6 were selected at random to deliver the intervention. Of 432 potential participants screened by phone, 213 (49%) were eligible and of these, 189 (89%) completed baseline measures and were randomized to receive a 5-month weight loss intervention or a delayed intervention. The mean age was 51, mean BMI 37 kg/m(2), 53% were African American, and 43% had no health insurance. The results of this study should be informative to key stakeholders interested in real world weight loss interventions for low-income mid-life women.
[show abstract][hide abstract] ABSTRACT: After colon cancer screening, large numbers of persons discovered with colon polyps may receive post-polypectomy surveillance with multiple colonoscopy examinations over time. Decisions about surveillance interval are based in part on polyp size, histology, and number.
To learn physicians' recommendations for post-polypectomy surveillance from physicians' office charts.
Among 322 physicians performing colonoscopy in 126 practices in N. Carolina, offices of 152 physicians in 55 practices were visited to extract chart data, for each physician, on 125 consecutive persons having colonoscopy in 2003. Subjects included persons with first-time colonoscopy and no positive family history or other indication beyond colonoscopy findings that might affect post-polypectomy surveillance recommendations. Data were extracted about demographics, reason for colonoscopy, family history, symptoms, bowel prep, extent of examination, and features of each polyp including location, size, histology. Recommendations for post-polypectomy surveillance were noted.
Among 10,089 first-time colonoscopy examinations, hyperplastic polyps were found in 4.5% of subjects, in whom follow-up by 4-6 years was recommended in 24%, sooner than recommended in guidelines. Of the 6.6% of persons with only small adenomas, 35% were recommended to return in 1-3 years (sooner than recommended in some guidelines) and 77% by 6 years. Surveillance interval tended to be shorter if colon prep was less than "excellent." Prep quality was not reported for 32% of examinations.
Surveillance intervals after polypectomy of low-risk polyps may be more aggressive than guidelines recommend. The quality of post-polypectomy surveillance might be improved by increased attention to guidelines, bowel prep, and reporting.
Digestive Diseases and Sciences 06/2011; 56(9):2623-30. · 2.26 Impact Factor
[show abstract][hide abstract] ABSTRACT: According to hope theory, hope is defined as goal-directed thinking in which people perceive that they can find routes to desired goals and the motivation to use those routes. The purpose of this study was to explore relationships between hope and body mass index and hope and self-rated health among women completing a community survey conducted in four rural counties in eastern North Carolina. The survey was administered as part of Hope Works, a participatory, community-led intervention program to improve weight, health and hope among low-income women in rural North Carolina. Survey data from 434 women were analyzed. In multivariate models adjusting for age, race, education and income, higher hope was positively related to self-reported health (OR:0.92; 95% CI: 0.89-0.95) and negatively related to BMI (P < 0.01). These results indicated that women who reported better self-rated health also had higher hope scores and women who were heavier had lower hope scores. While these findings are exploratory, they suggest directions for further research. State-based hope is considered to be a characteristic that is malleable and open to development. Future interventions should examine the importance of hope as a construct to examine in weight loss studies. For example, programs could be designed to increase hope by focusing on goal setting and providing support, information and resources to help women work toward their goals.
Journal of Community Health 03/2011; 36(6):919-24. · 1.28 Impact Factor
[show abstract][hide abstract] ABSTRACT: Background Little is known about agreement between patients and physicians on content and outcomes of clinical discussions. A common perception of content and outcomes may be desirable to optimize decision making and clinical care.Objective To determine patient–physician agreement on content and outcomes of coronary heart disease (CHD) prevention discussions.Design Cross-sectional survey nested within a randomized CHD prevention study.Setting and participants University internal medicine clinic; 24 physicians and 157 patients.Methods Following one clinic visit, we surveyed patients and physicians on discussion content, decision making and final decisions about CHD prevention. For comparison, we audio-recorded, transcribed and coded 20 patient–physician visits. We calculated percent agreement between patient/physician reports, patient/transcription reports and physician/transcription reports. We calculated Cohen’s kappas to compare patient/physician perspectives.Results Patients and physicians agreed on whether CHD was discussed in 130 visits (83%; kappa = 0.55; 95% CI 0.40–0.70). When discussions occurred, they agreed about discussion content (pros versus cons) in 53% of visits (kappa = 0.15; 95% CI −0.01–0.30) and physicians’ recommendations in 73% (kappa = 0.44; 95% CI 0.28–0.66). Patients and physicians agreed on final decisions to take medication in 78% (kappa = 0.58; 95% CI 0.45–0.71) and change lifestyle in 69% (kappa = 0.38; 95% CI 0.24–0.53). They agreed less often, 43% (kappa = 0.13; 95% CI −0.11–0.37) about degree of involvement in decision making. Audio-recorded results were similar, but showed very low agreement between transcripts and patients’ and physicians’ self-report on discussion content and decision making.Conclusions Disagreements about clinical discussions and decision making may be common. Future work is needed to determine: how widespread such agreements are; whether they impact clinical outcomes; and the relative importance of the subjective experience versus objective steps of shared decision making.
Health expectations: an international journal of public participation in health care and health policy 02/2011; 14(s1):58 - 72. · 1.80 Impact Factor
[show abstract][hide abstract] ABSTRACT: Most Internet vendors offer tax-free cigarettes making them cheaper than those sold at stores. This undermines the impact that higher prices have upon reducing consumption. Most Internet tobacco sales have violated taxation and youth access laws, which led to landmark voluntary agreements in 2005 with the major credit card companies and major private shippers to ban payment transactions and shipments for all Internet cigarette sales.
To assess whether these bans increased the rate of Internet Cigarette Vendors (ICVs) ceasing online sales, decreased the proportion of vendors offering banned payment and shipping options, and decreased consumer traffic to the most popular ICVs.
Websites in a longitudinal study of ICVs were visited in 2003 (n = 338), 2004 (n = 775), 2005 (n = 664), 2006 (n = 762), and 2007 (n = 497) to assess whether they were in business and monitor their advertised sales practices. The number of unique monthly visitors to the 50 most popular ICVs at baseline was examined for the period one year before and two years after the bans to determine whether the bans altered traffic.
Following the bans, the rate of ICVs ceasing online sales year to year increased, but due to an influx of new vendors, there was a net increase in ICVs. The proportion of vendors accepting banned payment options dropped from 99.2% to 37.4% after the bans, and the proportion offering banned shipping options dropped from 32.2% to 5.6%, but there was a corresponding increase in vendors offering non-banned payment options (e.g., personal checks) and shipping options (e.g., US Postal Service). Following the bans, there was a 3.5 fold decline in traffic to the most popular ICV websites.
This promising approach to controlling the sale of restricted goods online has implications for regulating other products such as alcohol, firearms, quack cures, and medicines sold without a prescription.
PLoS ONE 01/2011; 6(2):e16754. · 3.73 Impact Factor
[show abstract][hide abstract] ABSTRACT: In 2005, 27% of adults reported doctor-diagnosed arthritis, and 14% reported chronic joint symptoms but no doctor-diagnosed arthritis (i.e., possible arthritis). We evaluate the value of including persons classified as having possible arthritis in surveillance of arthritis.
In 2005, Kansas, Oklahoma, North Carolina, and Utah added extra questions to their Behavioral Risk Factor Surveillance System (BRFSS) telephone survey targeted to a subsample of those classified as having possible arthritis.
Persons classified as having possible arthritis (n = 2,884) were younger, more often male, and had less activity limitation than persons with doctor-diagnosed arthritis. Of those classified as having possible arthritis, half had seen a doctor for their symptoms, 12.5% reported arthritis, and 61.9% gave other causes. Of the half who had not seen a doctor, most reported mild symptoms (64.8%).
Only 6.3% of those classified as having possible arthritis had what we considered to be arthritis. Most who did not see a doctor reported mild symptoms and, therefore, would be unlikely to be amenable to medical and public health interventions for arthritis. Although including possible arthritis would slightly improve the sensitivity of detecting arthritis in the population, it would increase false-positives that would interfere with targeting state intervention efforts and burden estimates. The ability to add back questions to the BRFSS survey allows for the reintroduction of possible arthritis in case national surveillance indicates it necessary or if studies document an increased rate at which possible arthritis turns into arthritis. Currently, possible arthritis does not need to be included in state arthritis surveillance efforts, and limited question space on surveys is better spent on other arthritis issues.
[show abstract][hide abstract] ABSTRACT: Traditionally, weight management behavioral research has focused on individual-level influences, with little attention given to interpersonal factors that relate to the family behavioral context.
This research examines the association between baseline family functioning scores and weight loss success in a sample of African Americans and Whites enrolled in a 20-week weight loss program with a weight loss goal of ≥ 4 kg.
Baseline surveys measuring six family functioning constructs were completed by 291 participants in a trial of weight loss maintenance. Analysis was limited to 217 participants in households with at least one other family member, and providing final weight measurements. We evaluated associations of family functioning, family composition, and demographic variables with weight loss success defined as losing ≥ 5% of initial body weight. Baseline predictors of weight loss success were determined using logistic regression analysis.
Participants were on average 61 years of age with BMI of 34 kg/m(2); 57% were female and 75% self-identified as African American. Sixty-two percent lost at least 5% of initial body weight. In bivariate analysis, weight loss success was associated with higher income and education (p < 0.01 and p = 0.05, respectively), ethnicity (p < 0.01), and the presence of a spouse (p = 0.01). After adjusting for socio-demographic covariates in a multivariable model, the odds of weight loss success were independently influenced by a significant interaction between ethnicity and family cohesion (p < 0.01).
These findings suggest that family context factors influence weight loss behaviors.
Annals of Behavioral Medicine 12/2010; 40(3):294-301. · 4.20 Impact Factor
[show abstract][hide abstract] ABSTRACT: Reducing the incidence of obesity requires coordination among primary health care providers. Because of their frequent contact with patients, dentists are positioned to recognize patients at risk of developing obesity. The authors conducted a study to assess dentists' interest in and barriers to providing obesity counseling to patients.
The authors surveyed a random sample of 8,000 American Dental Association members by mail, stratified according to census region (West, Midwest, South, Northeast) and dentist type (general, pediatric). The authors weighted respondents' data to account for the unequal probability of selection and nonresponse rates among regions and dentist types.
In all, 2,965 dentists responded. Overall, 4.8 percent of respondents offered a form of counseling services and 50.5 percent reported that they were interested in offering obesity-related services. More than one-half of the respondents cited fears of offending patients (53.8 percent) and appearing judgmental (52 percent) as major barriers, followed by a paucity of trained personnel (46.3 percent) and patients' rejection of weight-loss advice (45.7 percent). Eighty-two percent of respondents agreed that dentists would be more willing to intervene if obesity were linked definitively to oral disease.
Given continued increases in obesity in the United States and the willingness of dentists to assist in preventive and interventional efforts, experts in obesity intervention, in conjunction with dental educators, should develop models of intervention within the scope of dental practice.
Educating dentists about obesity and counseling may reduce barriers for those interested in addressing obesity in their practices.
Journal of the American Dental Association (1939) 11/2010; 141(11):1307-16. · 1.82 Impact Factor
[show abstract][hide abstract] ABSTRACT: Body & Soul, an evidence-based nutrition program for African Americans churches, is currently being disseminated nationally and free of charge by the National Cancer Institute. For dissemination feasibility, the peer counseling training is done via DVD rather than by live trainers. We describe implementation and process evaluation of the peer counseling component under real world conditions.
The study sample included 11 churches (6 early intervention, 5 delayed intervention) in 6 states. Data sources included training observations, post-training debriefing sessions, coordinator interviews, and church participant surveys. Survey data analysis examined associations between exposure to peer counseling and change in dietary intake. Qualitative data were analyzed using the constant comparative method.
Eight of 11 churches initiated the peer counseling program. Recall of talking with a peer counselor was associated with significantly (p<.02) greater fruit and vegetable intake. Data indicate sub-optimal program execution after peer counselor training.
Inconsistent implementation of the peer counseling intervention is likely to dilute program effectiveness in changing nutrition behaviors.
Disseminating evidence-based programs may require added resources, training, quality control, and technical assistance for improving program uptake. Similar to earlier research phases, systematic efforts at the dissemination phase are needed for program success.
Patient Education and Counseling 10/2010; 81(1):37-42. · 2.37 Impact Factor
[show abstract][hide abstract] ABSTRACT: Experts have called for the inclusion of values clarification (VC) exercises in decision aids (DAs) as a means of improving their effectiveness, but little research has examined the effects of such exercises.
To determine whether adding a VC exercise to a DA on heart disease prevention improves decision-making outcomes.
UNC Decision Support Laboratory.
Adults ages 40 to 80 with no history of cardiovascular disease.
A Web-based heart disease prevention DA with or without a VC exercise.
Pre- and postintervention decisional conflict and intent to reduce coronary heart disease (CHD) risk and postintervention self-efficacy and perceived values concordance.
The authors enrolled 137 participants (62 in DA; 75 in DA + VC with moderate decisional conflict (DA 2.4; DA + VC 2.5) and no baseline differences among groups. After the interventions, they found no clinically or statistically significant differences between groups in decisional conflict (DA 1.8; DA + VC 1.9; absolute difference VC-DA 0.1, 95% confidence interval [CI]: -0.1 to 0.3), intent to reduce CHD risk (DA 98%; DA + VC 100%; absolute difference VC-DA: 2%, 95% CI: -0.02% to 5%), perceived values concordance (DA 95%; DA + VC 92%; absolute difference VC-DA -3%, 95% CI: -11% to +5%), or self-efficacy for risk reduction (DA 97%; DA + VC 92%; absolute difference VC-DA -5%, 95% CI: -13% to +3%). However, DA + VC tended to change some decisions about risk reduction strategies.
Use of a hypothetical scenario; ceiling effects for some outcomes.
Adding a VC intervention to a DA did not further improve decision-making outcomes in a population of highly educated and motivated adults responding to scenario-based questions. Work is needed to determine the effects of VC on more diverse populations and more distal outcomes.
Medical Decision Making 01/2010; 30(4):E28-39. · 2.89 Impact Factor
[show abstract][hide abstract] ABSTRACT: Studies of type 2 translation, the adaption of evidence-based interventions to real-world settings, should include representative study sites and staff to improve external validity. Sites for such studies are, however, often selected by convenience sampling, which limits generalizability. We used an optimized probability sampling protocol to select an unbiased, representative sample of study sites to prepare for a randomized trial of a weight loss intervention.
We invited North Carolina health departments within 200 miles of the research center to participate (N = 81). Of the 43 health departments that were eligible, 30 were interested in participating. To select a representative and feasible sample of 6 health departments that met inclusion criteria, we generated all combinations of 6 from the 30 health departments that were eligible and interested. From the subset of combinations that met inclusion criteria, we selected 1 at random.
Of 593,775 possible combinations of 6 counties, 15,177 (3%) met inclusion criteria. Sites in the selected subset were similar to all eligible sites in terms of health department characteristics and county demographics.
Optimized probability sampling improved generalizability by ensuring an unbiased and representative sample of study sites.