Development and implementation of an integrated, multi-modality, user-centered interactive dietary change program

Kaiser Permanente Colorado, PO Box 378066, Denver, CO 80231, USA.
Health Education Research (Impact Factor: 1.66). 09/2008; 24(3):461-71. DOI: 10.1093/her/cyn042
Source: PubMed


Computer-tailored behavior change programs offer the potential for reaching large populations at a much lower cost than individual
or group-based programs. However, few of these programs to date appear to integrate behavioral theory with user choice, or
combine different electronic modalities. We describe the development of an integrated CD-ROM and interactive voice response
dietary change intervention that combines behavioral problem-solving theory with a high degree of user choice. The program,
WISE CHOICES, is being evaluated as part of an ongoing trial. This paper describes the program development, emphasizing how user preferences
are accommodated, and presents implementation and user satisfaction data. The program was successfully implemented; the linkages
among the central database, the CD-ROM and the automated telephone components were robust, and participants liked the program
almost as well as a counselor-delivered dietary change condition. Multi-modality programs that emphasize the strengths of
each approach appear to be feasible. Future research is needed to determine the program impact and cost-effectiveness compared
with counselor-delivered intervention.

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Available from: Steve Christiansen, Dec 13, 2013
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    • "Collectively, these five dimensions provide necessary information to shift our current system of prenatal care towards an improved system of care. Since the original RE-AIM paper in 1999, there have been approximately 100 publications on RE-AIM by a variety of authors in fields as diverse as aging [25], cancer screening [26], dietary change [27], physical activity [28], health policy [29], environmental change [30], chronic illness self-management [31], well-child care [32], eHealth [33], worksite health promotion [34], women's health [35], smoking cessation [36], and practice-based research [37]. The RE-AIM framework provides valuable framework for evaluating the translation of health care innovations such as CP into clinical settings [38, 39]. "
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    ABSTRACT: Background: Centering Pregnancy (CP) is an effective method of delivering prenatal care, yet providers have been slow to adopt the CP model. Our main hypothesis is that a site's adoption of CP is contingent upon knowledge of the CP, characteristics health care personnel, anticipated patient impact, and system readiness. Methods: Using a matched, pretest-posttest, observational design, 223 people completed pretest and posttest surveys. Our analysis included the effect of the seminar on the groups' knowledge of CP essential elements, barriers to prenatal care, and perceived value of CP to the patients and to the system of care. Results: Before the CP Seminar only 34% of respondents were aware of the model, while knowledge significantly after the Seminar. The three greatest improvements were in understanding that the group is conducted in a circle, the health assessment occurs in the group space, and a facilitative leadership style is used. Child care, transportation, and language issues were the top three barriers. The greatest improvements reported for patients included improvements in timeliness, patient-centeredness and efficiency, although readiness for adoption was influenced by costs, resources, and expertise. Discussion: Readiness to adopt CP will require support for the start-up and sustainability of this model.
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    • "Despite having offered guidelines for writing goals, the authors concluded that participants needed more assistance with goal-setting in order to facilitate behavior change. Goal-setting interventions with no face-to-face interaction need to provide support for setting quality goals either through detailed instructions or through a guided-goal setting tool [18,20,21]. Finally, qualitative research could help to identify both important program processes from the participants’ perspectives and alternative ways of assessing both the quantity and quality of participation with community-based interventions [22]. "
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    ABSTRACT: Few lifestyle interventions have successfully prevented excessive gestational weight gain. Understanding the program processes through which successful interventions achieve outcomes is important for the design of effective programs. The objective of this study was to evaluate the effect of the quantity and quality of participation in a healthy lifestyle intervention on risk of excessive gestational weight gain. Pregnant women (N = 179) received five newsletters about weight, nutrition, and exercise plus postcards on which they were asked to set related goals and return to investigators. The quantity of participation (dose) was defined as low for returning few or some vs. high for many postcards (N = 89, 49.7%). Quality of participation was low for setting few vs. high for some or many appropriate goals (N = 92, 51.4%). Fisher's exact tests and multivariate logistic regression were used to analyze the effect of participation variables on the proportion with excessive weight gain. Quantity and quality of participation alone were each not significantly associated with excessive gestational weight gain, while quality of participation among those with high-levels of participation approached significance (p = 0.07). The odds of gaining excessively was decreased when women had both a high quantity and quality of participation (OR = 0.04, 95% CI = 0.005, 0.30). Both quantity and quality of participation are important program process measures in evaluations of lifestyle interventions to promote healthy weight gain during pregnancy.
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    • "This stage also includes usability testing with subcultural group members to identify and address issues arising from technological components of the intervention (e.g., interactive voice response systems, touch-screen computer kiosks, web-based programs, smart phones; Zimmerman, Akerelrea, Buller, Hau, & Leblanc, 2003). The " think aloud " method, in which participants verbalize their thoughts as they interact with technology procedures, can be useful (Glasgow et al., 2009). "
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