Values and diet among colorectal cancer survivors and non-affected individuals in North Carolina

Individual core values may be important to understanding and predicting behavioral decisions. This dissertation, presented in two manuscripts, examined the relationship between values and fruit and vegetable (FV) intake for colorectal cancer (CRC) survivors and non-affected persons. Hypotheses were tested using data from the North Carolina Strategies for Improving Diet, Exercise, and Screening (NC STRIDES) project, a population-based study of CRC risk prevention. Manuscript One describes the results of logistic regression analyses to evaluate whether values promote FV intake for 234 participants. Manuscript Two describes the results of case-comparison techniques to analyze counseling transcripts from 24 participants doing a values self-confrontation exercise. Findings include: Manuscript One: All participants selected family, health, and God's will as the most frequently endorsed values. Compared to CRC survivors, non-affected persons were more likely to choose the values responsibility and friendship. Race, sex, baseline FV intake, and intervention group were not statistically associated with endorsing a particular value. Being a survivor did not predict selection of health as a value or selection of value type (instrumental values vs. terminal values). Being a nonsurvivor did predict increased FV intake at follow-up. Neither selecting instrumental values nor health predicted increased FV consumption. Selecting instrumental values was not predictive for reporting higher importance or self-efficacy for FV intake. Manuscript Two: The value health functioned to influence diet as: (1) a necessary component for other values, (2) a manifestation of God's will, and (3) a co-requisite value with responsibility for being in good health. Values functioned in both health promoting and limiting ways. For FV adherence, beliefs were more suggestive than categorizing participants based on values, sex, race, and CRC status. While logistic analyses provided no evidence supporting relationships between values and FV intake, case-comparison analyses underscore that values do influence diet. The values self-confrontation served to raise participants' awareness about their value hierarchies and helped establish how values influence diet choices. Future research should explore ascribed meanings to values in tandem with how values relate to the health behavior of interest. Understanding how and which values influence health behavior practices can impact intervention design for cancer preventive behaviors

Variations in meanings of the personal core value “Health”

Preventive health behavior patterns and practices are influenced by many factors. Knowledge about a person’s core values may improve the ability to predict decisions related to behaviors such as healthy eating

Planejamento de educação parental on-line para um estilo de vida de peso saudável em pacientes pediátricos de cuidados primários de 6 a 12 anos

Background: Childhood obesity is a pandemic with immediate and future health risks that demand holistic, personalized, and innovative treatments. Healthcare providers struggle to provide such treatment within the constraints of medical visits. A theoretical and evidence-based eHealth intervention could engage parents and caregivers to improve health behaviors and increase reach to low-income vulnerable families, a high-risk chort often neglected in clinical research. This study aims to identify needs and preferences of potential users of an eHealth intervention. Methods: Focus groups and interviews of ethnically diverse, low-income parents and semi-structured interviews of primary healthcare staff obtained perspectives on the content and structure of a eHealth intervention intended to improve lifestyle habits to reduce childhood obesity. Research team members analyzed the data to identify specific needs and communication strategies for the target population.   Results:  Parents endorsed learning more about healthy eating, physical activity, and the effects of sugar-sweetened beverages on their child’s weight.  Parents reported a preference for bright colors, short texts, videos, summary quizzes, and additional resources to explore on their own and with their child. Healthcare staff reported time limitations during clinical visits and an interest in looping family progress into their EHR. Using an eHealth intervention, parents expect an improved relationship and increased trust with their child’s pediatrician.   Conclusion:  Parents and staff saw value in this tool and provided useful recommendations for its design. This eHealth intervention could create a health alliance between the healthcare provider and family, provide personalized content, and be scaled to address health disparities broadly.Antecedentes. la obesidad infantil es una pandemia con riesgos para la salud inmediatos y futuros que demandan tratamientos holísticos, personalizados e innovadores. Los proveedores de atención médica luchan por brindar dicho tratamiento dentro de las limitaciones de las visitas médicas. Una intervención de eSalud teórica y basada en la evidencia podría involucrar a los padres y cuidadores para mejorar los comportamientos de salud y aumentar el alcance a las familias vulnerables de bajos ingresos, un grupo de alto riesgo que a menudo se descuida en la investigación clínica. Este estudio tiene como objetivo identificar las necesidades y preferencias de los usuarios potenciales de una intervención de eSalud. Métodos. Grupos focales y entrevistas de padres étnicamente diversos y de bajos ingresos y entrevistas semiestructuradas del personal de atención primaria de la salud obtuvieron perspectivas sobre el contenido y la estructura de una intervención de eSalud destinada a mejorar los hábitos de estilo de vida para reducir la obesidad infantil. Los miembros del equipo de investigación analizaron los datos para identificar necesidades específicas y estrategias de comunicación para la población objetivo. Resultados. Los padres aprobaron aprender más sobre alimentación saludable, actividad física y los efectos de las bebidas azucaradas en el peso de sus hijos. Los padres informaron una preferencia por los colores brillantes, los textos breves, los videos, los cuestionarios resumidos y los recursos adicionales para explorar por su cuenta y con sus hijos. El personal de atención médica informó limitaciones de tiempo durante las visitas clínicas y un interés en incluir el progreso de la familia en su EHR. Con una intervención de eSalud, los padres esperan una mejor relación y una mayor confianza con el pediatra de su hijo. Conclusión. Los padres y el personal vieron valor en esta herramienta y brindaron recomendaciones útiles para su diseño. Esta intervención de eSalud podría crear una alianza de salud entre el proveedor de atención médica y la familia, brindar contenido personalizado y ampliarse para abordar las disparidades de salud de manera amplia.Antecedentes. A obesidade infantil é uma pandemia com riscos à saúde imediatos e futuros que demandam tratamentos holísticos, personalizados e inovadores. Os prestadores de cuidados de saúde lutam para fornecer esse tratamento dentro das limitações das consultas médicas. Uma intervenção teórica e baseada em evidências de eSaúde poderia envolver pais e cuidadores para melhorar os comportamentos de saúde e aumentar o alcance de famílias vulneráveis de baixa renda, um grupo de alto risco que muitas vezes é negligenciado em pesquisas clínicas. Este estudo visa identificar as necessidades e preferências dos potenciais utilizadores de uma intervenção de eSaúde. Métodos. Grupos focales y entrevistas de padres étnicamente diversos y de bajos ingresos y entrevistas semiestructuradas del personal de atención primaria de la salud obtuvieron perspectivas sobre el contenido y la estructura de una intervención de eSalud destinada a mejorar los hábitos de estilo de vida para reducir la obesidade infantil. Os membros da equipe de pesquisa analisaram os dados para identificar necessidades específicas e estratégias de comunicação para a população-alvo. Resultados. Os pais aprovaram aprender mais sobre alimentação saudável, atividade física e os efeitos das bebidas açucaradas no peso de seus filhos. Os pais relataram preferência por cores vivas, textos curtos, vídeos, questionários curtos e recursos adicionais para explorar sozinhos e com seus filhos. A equipe de saúde relatou limitações de tempo durante as visitas à clínica e interesse em incluir o progresso da família em seu EHR. Com uma intervenção de eSaúde, os pais esperam um melhor relacionamento e maior confiança com o pediatra de seus filhos. Conclusão. Os pais e funcionários viram valor nesta ferramenta e forneceram recomendações úteis para o seu design. Essa intervenção de eSaúde pode criar uma parceria de saúde entre o profissional de saúde e a família, fornecer conteúdo personalizado e ser ampliada para abordar amplamente as disparidades de saúde

African American Women's Perspectives on Breast Cancer: Implications for Communicating Risk of Basal-like Breast Cancer

African American women suffer a higher burden of basal-like breast cancer, an aggressive subtype that has no targeted therapy. While epidemiologic research has identified key prevention strategies, little is known about how best to communicate risk to this population. This study explored women’s knowledge, beliefs, and attitudes about breast cancer to learn about risk perceptions. Six focus groups with 57 women (ages 18–49) women were conducted in North Carolina. Findings revealed that age, race (especially perceptions of cancer as a “White disease”), and lack of family history of breast cancer contributed to women’s perceptions of low breastcancer susceptibility. Perceptions of low risk were also attributed to conflicting risk information from family, media, and health providers. Women had little knowledge about breast cancer subtypes, but emphasized that health communications should be personally relevant, culturally appropriate, and convenient. These study findings will assist in developing health communication tools that encourage prevention

Trinity Court and Pritchard Park, Chapel Hill, Orange County : a community diagnosis including secondary data analysis and qualitative data collection

In order to meet the needs of an identified community effectively, a service provider must possess a firm understanding of the community she wishes to serve. This understanding encompasses far more than simply acknowledging the existence of a community. Rather, a greater awareness of who or what the community consists of, how the community is organized, how members interact, what informal and formal networks already exist in the community, as well as other features that may not be apparent upon initial examination are necessary for effective program delivery. OVERVIEW OF COMMUNITY DIAGNOSIS The purpose of the community diagnosis (CD) process is fourfold: 1) to learn what it is like to live in a given community; 2) to understand the strengths and needs of a community; 3) to help community members and service providers identify ways of working together to improve the community; and 4) encourage interaction between residents and service providers for future efforts. Understanding these facets of a community enables service providers to more fully meet the prominent, as well as the less obvious, needs of community members. By taking the time to involve oneself in a community, a service provider establishes a genuine relationship with the population she serves as well as an emic view of what the community already possesses as strengths, as well as services from which the community could most benefit. METHODOLOGY Two approaches were used to gain information about the Trinity Court and Pritchard Park public housing communities located in Chapel Hill, North Carolina. Four CD team members engaged in a nine-month exploration into the aspects of community which affect the health and livelihood of Trinity Court and Pritchard Park residents. There were two phases of data collection. First, secondary data were collected to define the Trinity Court and Pritchard Park communities in comparison to standardized, quantitative data reported at the state, county, and local levels. These data were gathered from census data, as well as municipal and other organizational records. The second phase of data collection was qualitative in nature. In an attempt to provide an alternative view, illustrate, emphasize, or compensate for information not sufficient at the secondary data collection level, CD team members gathered anecdotal evidence from service providers and community members themselves during individual interviews. The interview process was approved by the University of North Carolina at Chapel Hill School of Public Health Institutional Review Board, which approves the use of human subjects in research conducted by all student and faculty associated with the School. In August 1998, Marlyn Allicock, Nicole Bates, Julie Cheh, and Jill Fisher, first year Masters students in the Department of Health Behavior and Health Education (HBHE) at the University of North Carolina School of Public Health, began working with the Trinity Court and Pritchard Park communities. The first community members with whom we interacted extensively were the children of Trinity Court and Pritchard Park. Initial efforts to gain entrée into the community were made by simply showing our faces to residents. Participation in organized community events afforded our CD team the opportunity to meet core members of Trinity Court and Pritchard Park. Outside of the communities, our CD team conducted quantitative secondary data analyses to provide a framework for understanding the history, geography, economic outlook, and community profile of Trinity Court and Pritchard Park. Qualitative interviews with service providers began in December 1998. These interviews continued for the next three months. Interviews with community members and advocates occurred between January and March 1999. QUANTITATIVE & QUALITATIVE FINDINGS Whenever possible, data were collected at the community level. However, due to the small size of the communities, few sources of secondary data were available specifically at the Trinity Court and Pritchard Park levels. Trinity Court and Pritchard Park are composed of a total of 137 individuals living in 55 units located in seven buildings. These communities are truly a subset of a still smaller University neighborhood. Often, the most precise standard statistical breakdown available was at the census block and census block group level. Even statistics at these levels accounted for residents outside of the Trinity Court and Pritchard Park communities. As indicated in this document, socioeconomic features such as income, educational attainment, and employment status, as well as health indicators at the state and county level, are quite different from the rates in Trinity Court and Pritchard Park. The age of available statistical data also contributes to the imprecision of the secondary data presented in this document. Because the secondary data analyses for this community diagnosis were completed in the spring of 1999, census data reporting state and county level conditions are outdated by nearly one full decade. Both of these factors should encourage the reader of this document to critically examine the validity of comparisons made across the state, county, and local levels, as well as the dynamic nature of an area such as Chapel Hill, North Carolina. As mentioned above, qualitative data were gathered from interviews conducted with service providers and community members. Data collected at this stage were meant to compensate for any information not available or applicable specifically to Trinity Court or Pritchard Park. A total of 10 service provider and 11 community member interviews (roughly 20% of the total adult population) were completed. Three factors affected the paucity of interviews completed. First, the Family Resource Center (FRC), the main gateway to community members, was closed during a critical interview period. Aside from initiating contact by approaching residents on the street, access to many of the residents without phones, or those who worked regular business hours was hindered. Second, of the 137 residents, 77 are children (not approved to be interviewed for this document). Of the remaining 60 adults, only 11 are males. Though several attempts were made to interview male residents, none of those we approached would agree to an interview, thus leaving a lack of male perspective in these interview data. Finally, with the high concentration of University groups entering the communities for special projects, many residents were understandably reluctant to discuss their personal experiences with students from outside of their communities. However, despite these issues, our CD team gathered rich qualitative information about life in Trinity Court and Pritchard Park from the perspective of the residents and service providers. A great deal of qualitative data were also gathered from FRC Board meetings and numerous informal exchanges with residents. COMMUNITY FORUM On Saturday, March 20, 1999, our CD team presented the results from our extensive exploration into the Trinity Court and Pritchard Park communities during a forum entitled "Trinity Court and Pritchard Park Speak Out." The forum provided a venue in which to give feedback to the community members and service providers who were instrumental in our data collection and who are the primary beneficiaries of our findings. An explanation of the CD process was given. In addition, CD team members presented summaries of major community themes that emerged throughout the CD process. Themes included: Trinity Court and Pritchard Park children; safety issues; the Family Resource Center (FRC); and the sense of community. Grounded in the core of the CD process, the forum concluded with a 25 minute solutions-based discussion of what residents and services providers could do to build on existing community strengths and improve less favorable conditions in the communities. The CD team followed up the forum by delivering a summary of this discussion to community members and service providers. This CD document presents the findings from our community diagnosis of Trinity Court and Pritchard Park in two parts. Chapters one through seven report the secondary data collected during the CD process. These chapters cover the history, geography, economic outlook, community profile, crime, health, and the assets and resources of Trinity Court and Pritchard Park. The remaining chapters summarize the qualitative data collected through interactions with community members and service providers. These theme chapters discuss the most salient issues affecting the communities. Chapter Eight: Sense of Community and Reputation discusses the perceived division between Trinity Court and Pritchard Park; the problems which result from Trinity Court and Pritchard Park being lumped together as one community by service providers; and residents' concerns about the negative reputations of their communities. Chapter Nine: The Family Resource Center explores the important role of the FRC among the residents; the services it provides; and the future of the Center. Chapter Ten: Children - Providing a Strong Foundation describes the priority placed on the youngest members of the communities by residents and service providers, as well as Trinity Court and Pritchard Park's need for a safe and nurturing environment for the children. Chapter Eleven: Safety Concerns - Myth vs. Reality reviews the differing rates of crime in Trinity Court and Pritchard Park, as well as residents' concerns about the Trespass Law and the constant surveillance by police. Chapter Twelve: Competing Perspectives - Preparing for the Future examines the priorities of the communities from the differing perspective of residents and service providers; the challenges faced by service providers; and the need expressed by residents for providers who understand and respect the residents and are more involved in their communities. Finally, Chapter Thirteen: Community Action and Involvement addresses the barriers to community action faced by residents and also looks at past examples of action and strategies for facilitating future action and involvement. CONCLUSION In response to the results presented by the CD team, community members and service providers generated a list of three achievable goals that community members and service providers could perform to improve the communities. First, all agreed that community members should make their expectations, desires, and concerns known to service providers and departments. The intention is to increase and improve service provider community relations and involvement to show the community that there is a true vested interest in the success of the Trinity Court and Pritchard Park communities. Second, all agreed that residents, rather than outside organizations, should serve on the FRC Governing Board so that residents are responsible for the decisions of their communities. Thirdly, and closely linked to the second resolution, community members strongly agreed that there is a need to address non-residents (in the position of service providers, troublemakers, or the general public) who denigrate the community. In response to the large discrepancy in perception held by certain community members, service providers, and other non-residents, community members agreed that by regaining ownership of their communities, Trinity Court and Pritchard Park residents could combat myths and misperceptions.Master of Public Healt

Colorectal Cancer Screening and Physical Activity Promotion Among Obese Women: An Online Evaluation of Targeted Messages

Obese women are at higher risk for several cancers, but are less likely than normal weight women to engage in cancer prevention behaviors such as screening and physical activity. Targeted health messages may help increase healthy behaviors among vulnerable groups such as obese women. Using findings from focus groups with obese women, the authors created targeted messages to promote colorectal cancer screening and physical activity among obese women. The messages addressed psychosocial constructs, such as benefits and barriers to colorectal cancer screening and exercise, which were relevant to the target population. Messages were tested online with women age 50 years and older (N = 181). Participants were stratified by weight (obese vs. nonobese) and randomized to review either 10 targeted (intervention) or 10 generic (control) messages. Study outcomes included elaboration about the messages, message relevance and trustworthiness, and behavioral intentions. The authors used moderation and subgroup analyses to determine whether the intervention messages were better received by certain women. They found no differences in elaboration, behavioral intentions, relevance, or trustworthiness between intervention and control for either weight group. However, exercise intentions increased more (p=.06) among inactive obese women who received intervention messages (+2.9) compared with those who were in the control group (+1.2). Intervention messages also produced more elaboration among women who viewed their weight as a barrier to screening or exercise. Tailoring intervention messages for obese women on the basis of behavior and barriers may improve outcomes more than giving the same messages to all obese women

A randomized trial of a Facebook-based physical activity intervention for young adult cancer survivors

Over half of young adult cancer survivors do not meet physical activity (PA) guidelines. PA interventions can enhance health and quality of life among young adult cancer survivors. However, few exercise interventions have been designed and tested in this population. This study evaluated the feasibility and preliminary efficacy of a 12-week, Facebook-based intervention (FITNET) aimed at increasing moderate-to-vigorous intensity PA compared to a Facebook-based self-help comparison (SC) condition

Exploring Mediators of Physical Activity in Young Adult Cancer Survivors: Evidence from a Randomized Trial of a Facebook-Based Physical Activity Intervention

Purpose: This study examined the effects of a physical activity (PA) intervention for young adult cancer survivors on changes in self-efficacy, social support, and self-monitoring and determined whether changes in these social cognitive theory constructs mediated the relationship between the intervention and changes in PA

Peer Connect for African American breast cancer survivors and caregivers: a train-the-trainer approach for peer support

Racial disparities in breast cancer survivorship are a major concern nationally. How survivors cope with cancer and re-frame their lives is a critical part of survivorship. Community-academic research partnerships may facilitate access to much-needed psychosocial support for African American survivors and caregivers in rural areas, but drivers of successful intervention implementation are not well understood. The purpose of this study was to describe the training and evaluation of Community Coaches and Guides (i.e., peer supporters) using the Peer Connect program for African American breast cancer survivors and caregivers. Community engagement strategies were used to implement the training component of Peer Connect, an evidence-based program grounded in the Diffusion of Innovation Theory utilizing motivational interviewing techniques (MI) and a "train-the-trainer" model. Quantitative and qualitative methods examined implementation outcomes of feasibility, MI fidelity, and acceptability-precursor outcomes that must be achieved before examining intervention impact vis-à-vis changes in support care. Training was feasible to implement and replicable by the trained Community Coaches. Beyond feasibility and replicability, success was modest regarding MI fidelity. Benefits (e.g., serving as role models and having safe sources of support) and lessons learned (e.g., need for additional quality control) were identified as both facilitators and barriers to implementation and as factors that could impact the effectiveness of community-engaged programs to improve survivorship outcomes. Peer Connect, like other programs that employ community-engagement strategies, holds promise to meet the psychosocial support needs of diverse rural cancer survivor populations

Evaluating the Dissemination of Body & Soul, an Evidence-based Fruit and Vegetable Intake Intervention: Challenges for Dissemination and Implementation Research

To evaluate whether the evidence-based Body & Soul program, when disseminated and implemented without researcher or agency involvement and support, would achieve similar results to earlier efficacy and effectiveness trials