Health Education & Behavior current issue

Practice Notes

2008-09-30

Do the Transtheoretical Processes of Change Predict Transitions in Stages of Change for Fruit Intake?

De Vet, E., De Nooijer, J., De Vries, N. K., Brug, J. — 2008-09-30

In a longitudinal study, it is examined whether the transtheoretical processes of change do predict stage transitions in fruit intake. A random sample of an existing Internet research panel resulted in a cohort of 735 adults, who were examined three times with electronic questionnaires assessing stages of change, processes of change, and fruit intake. Cross-sectional differences were found for the processes of change between precontemplation and all further stages. Experiential as well as behavioral processes increased from precontemplation to action with similar patterns. Both experiential and behavioral processes predicted forward transition out of precontemplation and forward transition into action, whereas only behavioral processes predicted forward transition out of contemplation. The results indicate that the transtheoretical processes of change predict stage transitions for fruit intake, but that the pattern of relevant processes for fruit intake is not as straightforward as outlined by the transtheoretical model of behavior change.

Engaging Parents in Preventive Parenting Groups: Do Ethnic, Socioeconomic, and Belief Match Between Parents and Group Leaders Matter?

Dumas, J. E., Moreland, A. D., Gitter, A. H., Pearl, A. M., Nordstrom, A. H. — 2008-09-30

The authors evaluate the relation of ethnic, socioeconomic status (SES), and belief match between parents and group leaders and engagement in a preventive intervention for parents of preschoolers. Engagement was assessed through attendance, retention, and quality of participation in sessions with 171 parents and 11 group leaders. SES match predicted attendance, retention, and quality of participation. Parents attended more sessions, remained longer in the program, and participated more actively when their group leader came from comparable SES backgrounds. Ethnic match predicted retention only, with parents attending longer when their ethnicity matched their group leader's. Engagement was unrelated to the extent of match across different characteristics, nor was the link between ethnic match and retention mediated by SES or belief match. Results suggest that social, cultural, and belief similarities between parents and group leaders may be less salient in preventive parenting interventions than is assumed. Implications for research and practice are discussed.

The WORD (Wholeness, Oneness, Righteousness, Deliverance): A Faith-Based Weight-Loss Program Utilizing a Community-Based Participatory Research Approach

2008-09-30

Despite multidisciplinary efforts to control the nation's obesity epidemic, obesity has persisted as one of the U.S.'s top public health problems, particularly among African Americans. Innovative approaches to address obesity that are sensitive to the unique issues of African Americans are needed. Thus, a faith-based weight-loss intervention using a community-based participatory research approach was developed, implemented, and evaluated with a rural African American faith community. A two-group, quasi-experimental, delayed intervention design was used, with church as the unit of assignment (treatment n = 2, control n = 2) and individual as the unit of observation (treatment n = 36, control n = 37). Weekly small groups led by trained community members met for 8 weeks and emphasized healthy nutrition, physical activity, and faith's connection with health. The mean weight loss of the treatment group was 3.60 ± 0.64 lbs. compared to the 0.59 ± 0.59-lb loss of the control group.

Empowerment and Sense of Community: Clarifying Their Relationship in Community Organizations

Hughey, J., Peterson, N. A., Lowe, J. B., Oprescu, F. — 2008-09-30

The research reported here tested the factor structure of a measure for sense of community in community organizations, and it evaluated sense of community's potential as an empowering organizational characteristic within an organizational empowerment framework. Randomly selected community organization participants (N = 561) were surveyed as part of a study of a substance abuse prevention initiative located in the northeastern United States. Confirmatory factor analysis verified the putative structure of the sense of community measure tailored to community organizations. Hierarchical regression analyses indicated that community organization sense of community significantly predicted intrapersonal empowerment after controlling for demographics, participation, alienation, and other empowering organizational characteristic. Findings imply that organizational sense of community should be considered as an empowering organizational characteristic in community-based health education.

Seeing in 3-D: Examining the Reach of Diabetes Self-Management Support Strategies in a Public Health Care System

2008-09-30

The authors examined whether tailored self-management support (SMS) strategies reach patients in a safety net system and explored variation by language, literacy, and insurance. English-, Spanish-, and Cantonese-speaking diabetes patients were randomized to weekly automated telephone disease management (ATDM) or monthly group medical visits. The SMS programs employ distinct communication methods but share common objectives, including behavioral "action plans." Reach was measured using three complementary dimensions: (a) participation among clinics, clinicians, and patients; (b) patient representativeness; and (c) patient engagement with SMS. Participation rates were high across all levels and preferentially attracted Spanish-language speakers, uninsured, and Medicaid recipients. Although both programs engaged a significant proportion in action planning, ATDM yielded higher engagement, especially among those with limited English proficiency and limited literacy. These results provide important insights for health communication and translational research with respect to realizing the public health benefits of SMS and can inform system-level planning to reduce health disparities.

Diffusion of Clean Indoor Air Ordinances in the Southwestern United States

Rogers, E. M., Peterson, J. C. — 2008-09-30

The authors investigate the process through which clean indoor air ordinances were considered in 10 communities in the southwestern United States and key factors that influenced diffusion and adoption. Clean indoor air ordinances, which ban smoking in public places, were adopted in approximately 1,409 U.S. communities from 1986 to April 2004. The authors gathered data from 10 communities in New Mexico and Texas by means of face-to-face interview, e-mail, and telephone interviews and by analyzing archival materials. Important influences on the adoption or rejection of clean indoor air ordinances were (a) personal experiences of policy champions, (b) local framing of the ordinance as a public health issue versus as an economic/ business or an individual rights issue, and (c) interpersonal networks connecting a community to previously adopting communities. The policies that were adopted ranged in comprehensiveness, with each community of study reinventing model policies obtained from other communities.

Self-Efficacy and Its Association With Use of Diet-Related Behavioral Strategies and Reported Dietary Intake

Nothwehr, F. — 2008-09-30

The construct of self-efficacy has been widely used in studies of dietary behavior change and is accepted as a helpful process indicator. This study examined associations between self-efficacy and use of specific diet-related behavioral strategies and reported dietary intake over time. Data are from two community surveys of rural adults conducted 1 year apart (n = 354). Results indicate that changes in self-efficacy are positively associated with changes in strategy use but not dietary intake. Strategies may be thought of as leading to a particular level of dietary intake but are not the only influence on intake. Findings therefore confirm hypothesized associations between these components of the behavior change process. By attending to and measuring these specific links in the process, researchers and practitioners can better determine where behavioral interventions are succeeding and where they are breaking down.

Spousal Support and Food-Related Behavior Change in Middle-Aged and Older Adults Living With Type 2 Diabetes

Beverly, E. A., Miller, C. K., Wray, L. A. — 2008-09-30

One of the most challenging diabetes-related behavior changes is adhering to a healthful diet. Drawing on the social cognitive theory and social support literature, this qualitative study explores how spousal support influences dietary changes following a diagnosis of type 2 diabetes in middle-aged and older adults. The purpose of this study was to determine how aspects of the spousal relationship translate into behavior changes, specifically adherence to a healthful diet. Analyses revealed five core themes related to dietary adherence: control over food, dietary competence, commitment to support, spousal communication, and coping with diabetes. The themes can be categorized within two key social cognitive theory constructs: reinforcement and self-efficacy. Implications from the focus group data can inform the development of more effective, targeted nutrition messages and programs to provide specific knowledge and skills.

Osteoporosis Health Beliefs Among Younger and Older Men and Women

Shanthi Johnson, C., McLeod, W., Kennedy, L., McLeod, K. — 2008-09-30

The purpose of this study was to compare osteoporosis health beliefs among different age and gender groups. This study used a cross-sectional design, involved 300 participants that represent both genders and three age groups (18 to 25, 30 to 50, and 50-plus), and assessed osteoporosis health beliefs using the Osteoporosis Health Belief Scale (OHBS). Factor analysis revealed three subscales of OHBS: perceived susceptibility, seriousness of the condition, and health motivation to take preventative actions with acceptable levels of reliability. Significant age and gender differences were observed in the susceptibility scores of the OHBS. The perceived seriousness of the osteoporosis scores was similar across all age and gender groups, as was health motivation. These results highlight the need for osteoporosis awareness programs targeting different aspects of belief perceptions, specifically for younger women and men.