Recruitment and cost analysis of screening midlife African-American women for a lifestyle physical activity intervention trial

Session presented on: Thursday, July 25, 2013: Purpose: A challenge for implementing physical activity interventions in underserved communities is successful recruitment of participants. The need for a medical release often excludes women most in need because they don\u27t have a provider or cannot afford the additional cost. The purpose of this presentation is to present: 1) outcomes of the recruitment strategies and 2) cost-analyses of providing an advanced practice nurse (APN) screening health assessment for the Women\u27s Lifestyle Physical Activity Program for African American women. An ecological framework guided recruitment. Methods: This randomized clinical trial is delivered in health settings in six predominantly African American Chicago communities. A group-visit approach and two telephone strategies (person calls and automated calls) are being tested to increase motivation and improve adherence to physical activity. Indirect recruitment strategies, that prompt volunteers to contact the staff without having direct contact, involved social-networking with trusted community leaders and among participants. Direct recruitment strategies, that brought the recruiters in direct contact with volunteers, involved presentations at community gatherings. APNs recorded time to complete screening health assessments. Results: Of the 609 women who contacted the program with interest, 49% were eligible, 27% were lost to attrition, and 23% were ineligible. Indirect recruitment strategies were the most effective in generating inquiries. Twenty-four percent heard about the program through social networking among participants and 23% through social networking with trusted community leaders/members. The screening health assessment took an average of 47.6 minutes per subject, an estimated cost of $34.56 (SD$7.44). It was estimated that without the APN health assessment 143 of the eligible woman would not have been able to participate. Conclusion: Recruitment success was attributed to an engaging recruitment staff who had multiple connections with trusted members in all of the targeted communities and advanced practice nurses who made the program accessible to low to moderate income women

Acculturation and mental health issues for immigrant family caregivers and home care workers

Session presented on: Wednesday, July 24, 2013: Purpose: Nearly one-fifth of the U.S. population is projected to be more than 65 years old by 2030. A proportional increase is expected in the demand for both family and non-family caregivers whose personal and household assistance enables elders to remain in their homes longer. Immigrants, who comprise a critical component of this workforce, are particularly vulnerable to isolation and depression. This study examines correlates of depressed mood among Russian-speaking family caregivers and non-family home care workers (HCWs). Methods: Self-report questionnaires were distributed during in-service education at a Chicago home care agency. The sample includes 134 men and women, aged 24-70 years old, who immigrated after age 15 and lived in the US approximately 1-40 years. Approximately 80% were women and 58% were HCWs. Results: Family caregivers lived in the US longer but did not differ from non-family HCWs on age. Depression scores were high for both groups. The two groups did not differ on number of years they had worked as caregivers, but differed on how many hours a week they worked, with family caregivers reporting significantly more hours. Non-family HCWs reported lower acculturation and higher alienation scores. Resilience, discrimination and social support scores did not differ significantly between the two groups. Multiple regression analysis indicated that when depression was regressed on demographic, acculturation, alienation, resilience, discrimination, and social support measures, significant predictors of depressed mood were years in the US, resilience, social support, and discrimination. Fewer years in the US, lower resilience and social support, and higher discrimination predicted higher depression scores. This model accounted for 34% of the variation in depression. Conclusion: Findings suggest HCWs have fewer opportunities for acculturation and are more isolated from mainstream society. Employment with co-ethnics may serve as transitional social support, but this may delay integration. Implications for targeting and prioritizing proactive interventions will be discussed

Midlife African American women\u27s maintenance of lifestyle physical activity

Purpose: Group interventions combining guidance, self-management, and ongoing support effectively increase physical activity in African-American women, but little is known about long-term maintenance. Maintenance of physical activity is commonly defined as participant achievement of a pre-prescribed level of physical activity at 2 points of time often at the end of the intervention and 6 months later (Kahlert, 2015). Examination of 14 physical activity interventions with African American women revealed only three examined maintenance after cessation of the intervention with all reporting a return toward baseline or low retention. The 48-week Women s Lifestyle Physical Activity program designed to increase adherence to physical activity included six nurse led group meetings guided by Social Cognitive Theory (Wilbur et al., 2016). They were held every five weeks at six community healthcare facilities. In addition, there were three accompanying telephone conditions delivered between group meetings (group meeting + 11 motivation interviewing calls, group meeting + 11 motivational automated calls, group meeting only). Personal calls were brief motivational interviews and automated calls provided motivation tips. Findings showed high retention during the intervention phase (90%) with significant improvement in physical activity measured at 48 weeks. These effects did not differ by condition. The purpose of this study is to determine midlife African American women s maintenance of physical activity one to three years after completion of the Women s Lifestyle Physical Activity program and to determine if maintenance differed by telephone condition. Methods: A longitudinal design was used. During the 48-week intervention phase the three telephone conditions were delivered in groups of 13-17 midlife women (total 18 groups). Assessment of long-term maintenance of adherence to physical activity began 1 year after the first group completed the intervention. Over the following six months long-term assessment was completed for each group in the order in which each group completed the intervention. By doing this data were systematically collected with most women participating in long-term assessment from one to three years after completing the intervention. All 288 women who began the intervention received a follow-up survey that included the self-report Community Healthy Activity Model Program for Seniors (CHAMPS) questionnaire covering minutes per week of reported moderate-vigorous (MV) physical activity, M-V leisure time physical activity and walking. The survey was conducted by mail, phone or in person. Results: 254 women (88.2%) completed the follow-up survey. Linear growth analyses showed that increases in self-reported physical activity were sustained at follow-up across all three measures: total moderate-vigorous physical activity (MV physical activity; p\u3c.001), leisure MV physical activity (p\u3c.001), and walking (p\u3c.001). After a sharp increase between baseline and 24 weeks, level of physical activity remained stable through the remainder of the 48-week intervention as well as during long-term maintenance. Minutes of physical activity changed by less than ±2 minutes per month during long-term maintenance. None of the effects varied by intervention condition. Conclusion: Group meetings are a powerful component of physical activity interventions that have sustained physical activity into an extended maintenance phase. Although increases in physical activity during the intervention were confirmed by objective accelerometer measures, long-term follow outcomes were limited by reliance on self-report measures of physical activity. Future studies should verify these results using objective measures of physical activity

Effectiveness of group-visits in a women\u27s lifestyle physical activity program for African-American women

Session presented on Friday, July 24, 2015: Purpose: Theoretically-based group physical activity interventions have shown to be the most effective means of increasing physical activity in minority populations. Primary care providers, however, must refer patients to outside community resources where these group interventions have been developed and delivered. The group-visit or centering model, used in some primary care settings to provide health services and group interventions simultaneously, may offer a culturally-relevant, cost-effective alteRNive for delivering physical activity behavior change. In a large RCT, we examined the effects of a physical activity group-visit intervention with three different telephone support conditions (group-visit alone, group-visit + personal telephone calls, group-visit + automated outgoing telephone calls) on African American women\u27s adherence to lifestyle physical activity. The purpose of this paper is, for all three study conditions, to: 1) describe the components of a group-visit physical activity intervention based on Social Cognitive Theory that emphasizes behavioral skills to adopt and maintain an active lifestyle, and 2) examine the effect of attendance at the group-visits (dose) on adherence to lifestyle physical activity. Methods: The 12-month Women\u27s Lifestyle Physical Activity Program was developed in collaboration with: a) African American women who attended one of seven focus groups conducted in their communities; b) African American women who participated in one of two follow-up focus groups after participating in a 12-month community-based physical activity intervention; and c) a community advisory board. The Women\u27s Lifestyle Program had 6 African American nurse-led group-visits (lasting 2 hours, delivered every 5 weeks for the first six months, once during the last six months each) with two components: a facilitated group discussion and an individualized physical activity prescription. Women wore a pedometer/accelerometer, entered their steps weekly into an automated telephone response system, and based on an algorithm received feedback and a suggested step goal during the group-visit. Training of the interventionists, using a Group Leader Manual, consisted of a two-day program, monthly meetings with research staff, and yearly retraining. Six study sites (3 community hospitals and 3 community health care centers) were randomly assigned to six different sequences of the intervention conditions to counterbalance the effect of the order of administering the conditions. Eligibility criteria were: African American women, aged 40-65, without cardiovascular symptoms, and without disability related to walking. Results: A total of 288 women (18 group-visit cohorts, 95/96 per condition) enrolled. Fifty-nine percent had hypertension and 15% diabetes. Retention was 94% at six months and 90% at 12 months. Over 80% of the women attended \u3e five group-visits with no difference between study conditions. Satisfaction with group visits was high (M=5.93 on a 7 point scale) with no difference between study conditions. There was a significant relationship between group-visit dose and change in accelerometer steps at 24 weeks (r = .17, p = 0.01). Conclusion: Overall retention and attendance at the group-visits were high. Attendance at the group-visit boosted change in physical activity. This may be an ideal format for patients with chronic health diseases because primary care providers can care for more than one patient in an appointment and patients can interact with others who share their problems