Adapting a Behavioral Weight Loss Intervention for Delivery via Facebook: A Pilot Series Among Low-Income Postpartum Women

BACKGROUND: Efforts to translate evidence-based weight loss interventions, such as the Diabetes Prevention Program (DPP), to low-income postpartum women have resulted in poor intervention attendance and high attrition. Strategies that improve engagement and retention in this population are needed to maximize the reach of evidence-based weight loss interventions. OBJECTIVE: The objective of this study was to adapt a DPP-based weight loss intervention (Fresh Start) for Facebook delivery and to evaluate its feasibility among low-income postpartum women. METHODS: This study comprised 3 single-group pilot studies where feasibility outcomes iteratively informed changes from one pilot to the next. We paralleled the in-person program for Facebook delivery by translating the protocol to a content library of Facebook posts with additional posts from lifestyle coaches. Low-income postpartum women were recruited from Women, Infants, and Children (WIC) clinics in Worcester, Massachusetts. Participants were enrolled into a 16-week weight loss intervention delivered via Facebook. During the first 8 weeks, Facebook intervention posts were delivered 2 times per day, with additional posts from coaches aiming to stimulate interaction among participants or respond to participants\u27 questions and challenges. For the following 8 weeks, posts were delivered once per day without additional coaching. Feasibility outcomes were engagement (defined by number of likes, comments, and posts measured throughout intervention delivery), acceptability, and retention (survey at follow-up and assessment completion rate, respectively). Changes in weight were also assessed at baseline and follow-up. RESULTS: Pilot 1 had a retention rate of 89% (24/27), and on average, 62% (17/27) of women actively engaged with the group each week during the 8-week coached phase. Mean weight loss was 2.6 (SD 8.64) pounds, and 79% (19/27) would recommend the program to a friend. Pilot 2 had a retention rate of 83% (20/24), and on average, 55% (13/24) of women actively engaged with the group weekly during the 8-week coached phase. Mean weight loss was 2.5 (SD 9.23) pounds, and 80% (16/24) would recommend the program to a friend. Pilot 3 had a retention rate of 88% (14/16), and on average, 67% (11/16) of women actively engaged with the group weekly during the 8-week coached phase. Mean weight loss was 7.0 (SD 11.6) pounds, and 100% (16/16) would recommend the program to a friend. CONCLUSIONS: Our findings demonstrated that a Facebook-delivered intervention was acceptable and could be feasibly delivered to low-income postpartum women. Future research is needed to evaluate the efficacy of a Facebook-delivered weight loss intervention

Weight gain prevention in the school worksite setting: Results of a multi-level cluster randomized trial

OBJECTIVE: To describe the effectiveness, reach and implementation of a weight gain prevention intervention among public school employees. METHOD: A multi-level intervention was tested in a cluster randomized trial among 782 employees in 12 central Massachusetts public high schools from 2009 to 2012. The intervention targeted the nutrition and physical activity environment and policies, the social environment and individual knowledge, attitudes and skills. The intervention was compared to a materials only condition. The primary outcome measures were change in weight and body mass index (BMI) at 24-month follow-up. Implementation of physical environment, policy and social environment strategies at the school and interpersonal levels, and intervention participation at the individual level were assessed. RESULTS: At 24-month follow-up, there was a net change (difference of the difference) of -3.03 pounds (p=.04) and of -.48 BMI units (p=.05) between intervention and comparison conditions. The majority of intervention strategies were successfully implemented by all intervention schools, although establishing formal policies was challenging. Employee participation in programs targeting the physical and social environment was maintained over time. CONCLUSION: This study supports that a multi-level intervention integrated within the organizational culture can be successfully implemented and prevent weight gain in public high school employees

Evaluating the Implementation of a Hospital Work-Site Obesity Prevention Intervention: Applying the RE-AIM Framework

Step Ahead was a randomized controlled trial testing ecologically based weight gain prevention interventions in the hospital workplace. The RE-AIM framework is used to assess the intervention\u27s Reach, Effectiveness, Adoption, Implementation, and Maintenance. Some intervention components reached a large percentage of the workforce. Although the intervention was not effective in changing BMI on a population level, a dose response was observed, in which persons who used more of the intervention components and materials were more likely to prevent weight gain. Adoption of the intervention by sites invited was 100%. Implementation of healthy eating interventions in the hospital setting was especially challenging because close collaboration was necessary with hospital employees and contractors, and their mission and priorities often were at odds with the intervention goals. There are some notable instances of intervention maintenance at the institutional level: Farmers markets have been expanded at both sites since the end of the intervention period, and new wellness programs are being adopted and implemented. Implications for practice include the translation of this research into other workplace settings

Factors related to weight loss behavior in a multiracial/ethnic workforce

OBJECTIVES: We examined whether factors associated with attempting to lose weight in a hospital-based employee workforce varied by race/ethnicity. METHODS: We conducted a cross-sectional survey in 6 hospitals in a health system in central Massachusetts. The stratified random sample included 813 employees; men and and non-White employees were oversampled. The primary outcome measure was current evidence-based weight loss attempts. RESULTS: Factors positively associated with attempting to lose weight among non-Hispanic Blacks included self-perceived overweight, female sex, higher education, physician recommendation to lose weight, and having a chronic medical condition. Among Hispanics, body mass index and self-perceived overweight were associated with attempts to lose weight, while working full time and second or third shift were associated with lower likelihood of weight loss attempts. Among non-Hispanic Whites, self-perceived overweight, female sex, higher education, and physician recommendation to lose weight were positively associated with attempting to lose weight, while working full time and working third shift were negatively associated. CONCLUSIONS: Rates of overweight and obesity were high among hospital employees. Findings suggest that factors associated with attempting to lose weight vary across racial and ethnic groups. Workplace-based interventions for weight control should include strategies tailored to these differences

Challenges to Research in Urban Community Health Centers

Community health centers (CHCs) are important settings for research aimed at reducing health disparities. However, CHCs pose many challenges to research at patient, provider, and system levels. We summarized lessons learned from a multimethod, formative study to develop intervention strategies for improving colorectal cancer screening in CHCs, and make recommendations for future research. The call for research in “real world” settings such as CHCs must be matched with greater understanding of the challenges, as well as the resources to meet those challenges

Keeping a Step Ahead: formative phase of a workplace intervention trial to prevent obesity

OBJECTIVE: Ecological interventions hold promise for promoting overweight and obesity prevention in worksites. Given the paucity of evaluative research in the hospital worksite setting, considerable formative work is required for successful implementation and evaluation. This paper describes the formative phases of Step Ahead, a site-randomized controlled trial of a multilevel intervention that promotes physical activity and healthy eating in six hospitals in central Massachusetts. The purpose of the formative research phase was to increase the feasibility, effectiveness, and likelihood of sustainability of the intervention. RESEARCH METHODS AND PROCEDURES: The Step Ahead ecological intervention approach targets change at the organization, interpersonal work environment, and individual levels. The intervention was developed using fundamental steps of intervention mapping and important tenets of participatory research. Formative research methods were used to engage leadership support and assistance and to develop an intervention plan that is both theoretically and practically grounded. This report uses observational data, program minutes and reports, and process tracking data. RESULTS: Leadership involvement (key informant interviews and advisory boards), employee focus groups and advisory boards, and quantitative environmental assessments cultivated participation and support. Determining multiple foci of change and designing measurable objectives and generic assessment tools to document progress are complex challenges encountered in planning phases. DISCUSSION: Multilevel trials in diverse organizations require flexibility and balance of theory application and practice-based perspectives to affect impact and outcome objectives. Formative research is an essential component

Risk and reluctance: understanding impediments to colorectal cancer screening

PURPOSE: Screening to detect and prevent colorectal cancer (CRC) is well below optimal, contributing to needless CRC-related morbidity and mortality. Little detailed information exists explaining why screening technologies are underutilized and why screening adherence rates are low. Prior to the design of an intervention study, we assessed knowledge about CRC among adult women and men with access to health care. We also investigated patterns of perceived risk for CRC, barriers and facilitators to screening, and experience and intentions with regard to both fecal occult blood testing and flexible sigmoidoscopy. METHODS: We analyzed data from semistructured focus group interviews with a small, nonrepresentative sample (n = 39) of community-dwelling adult men and women ages 50 to 64 and 65 plus. RESULTS: CRC-related knowledge is low, and misperceptions are common. Provider practices reinforce low levels of perceived risk. Multiple barriers to screening exist, of which many are remediable. CONCLUSIONS: We are at an early stage in the diffusion of information about CRC. Screening utilization may be improved through development of appropriate public health awareness campaigns and by addressing service factors. Recommendations are provided

Screening for colorectal cancer on the front line

OBJECTIVE: The aim of this study was to assess knowledge, beliefs, and practices of primary care clinicians regarding colorectal cancer screening. METHODS: We surveyed 77 primary care providers in six clinics in central Massachusetts to evaluate several factors related to colorectal cancer screening. RESULTS: Most agreed with guidelines for fecal occult blood test (97%) and sigmoidoscopy (87%), which were reported commonly as usual practice. Although the majority (86%) recommended colonoscopy as a colorectal cancer screening test, it was infrequently reported as usual practice. Also, 36% considered barium enema a colorectal cancer screening option, and it was rarely reported as usual practice. Despite lack of evidence supporting effectiveness, digital rectal examinations and in-office fecal occult blood test were commonly reported as usual practice. However, these were usually reported in combination with a guideline-endorsed testing option. Although only 10% reported that fecal occult blood test/home was frequently refused, 60% reported sigmoidoscopy was. Frequently cited patient barriers to sigmoidoscopy compliance included fear the procedure would hurt and that patients assume symptoms occur if there is a problem. Perceptions of health systems barriers to sigmoidoscopy were less strong. CONCLUSIONS: Most providers recommended guideline-endorsed colorectal cancer screening. However, patient refusal for sigmoidoscopy was common. Results indicate that multiple levels of intervention, including patient and provider education and systems strategies, may help increase prevalence

Mammography screening after breast cancer diagnosis in a first degree female relative: age group differences (United States)

OBJECTIVES: To examine age group differences in predictors of mammography screening in women with a first-degree female relative (FDFR) with recent diagnosis of breast cancer. METHODS: A cohort study of 577 women ages 18 and over with a FDFR diagnosed with incident stage 0-III breast cancer was conducted. Telephone interviews were conducted at baseline, 6 months and 12 months. Logistic regression was used to model factors associated with mammography screening since diagnosis. RESULTS: Mammography rates were 32%, 71% and 75% for women aged 18-39, 40-49 and 50 and above, respectively. Among the youngest group, belief in cancer screening effectiveness, mammography history and MD recommendation predicted mammography. For those 40-49, excellent self-rated health, perceived similarity of personality to the patient and higher intrusive thoughts predicted mammography. Perceived similarity of health care utilization to the patient and higher risk perceptions were associated with mammography among women aged 50 and above. CONCLUSIONS: Mammography rates were high among women aged 40-49 and 50 and above, and considerable among women aged 18-30, even in view of the lack of evidence-based guidelines. Continued attention should be paid to the 25-30% of older women who do not report screening