Using the Ecological Model of Predictors to Address Gaps in Childhood Obesity Prevention Research

Childhood obesity is a public health issue that must be addressed using interventions that increase physical activity, reduce sedentary behaviors and reduce the consumption of unhealthy food and beverages. Although researchers have identified the primary factors that increase a child’s risk for obesity, there is still very little scientific understanding of how context influences the outcomes of childhood obesity prevention interventions. The purpose of this dissertation is to provide additional insight into how researchers and practitioners can strengthen obesity prevention interventions to reach children in multiple contexts. The first study is a systematic literature review that examines the impact of school characteristics, including school climate and school culture, on the adoption, implementation and sustainability of school-based obesity prevention interventions. . Organizational characteristics related to access to resources, staff training/professional development, internal support and organizational values influenced the adoption, implementation and sustainability of school-based obesity prevention interventions. The findings also highlight the need for validated tools to aid researchers in defining and measuring school climate and culture related to health. The second study examines parent encouragement as a moderating variable between parent physical activity and child screen time. Parent encouragement was a moderating variable among White children and for children whose parents reported that it was safe for their child to play in their neighborhood with other children. This study highlights the importance of community and parent perceptions in the delivery of interventions that seek to reduce sedentary behaviors. The final study examines the relationship between organized sports and child physical activity. Multi-level modeling was used to examine the association between school, child/ family characteristics and participation in organized sports. The results of this study suggest that children who participate in organized sports are more active than their peers who do not participate in organized sports. Surprisingly, girls were more likely to report participation in organized sports than boys. Physical activity did not vary between schools or by race/ethnicity or weight status. The findings from this dissertation highlight the importance of researchers exploring the influence of context on childhood obesity risk. Gaining additional insight into how context influences a child’s risk for obesity may assist in the development of obesity prevention interventions that reach children in multiple environments

Factors Related to Implementation and Reach of a Pragmatic Multisite Trial: The My Own Health Report (MOHR) Study

BACKGROUND: Contextual factors relevant to translating healthcare improvement interventions to different settings are rarely collected systematically. This study articulates a prospective method for assessing and describing contextual factors related to implementation and patient reach of a pragmatic trial in primary care. METHODS: In a qualitative case-series, contextual factors were assessed from the My Own Health Report (MOHR) study, focused on systematic health risk assessments and goal setting for unhealthy behaviors and behavioral health in nine primary care practices. Practice staff interviews and observations, guided by a context template were conducted prospectively at three time points. Patient reach was calculated as percentage of patients completing MOHR of those who were offered MOHR and themes describing contextual factors were summarized through an iterative, data immersion process.These included practice members' motivations towards MOHR, practice staff capacity for implementation, practice information system capacity, external resources to support quality improvement, community linkages, and implementation strategy fit with patient populations. CONCLUSIONS: Systematically assessing contextual factors prospectively throughout implementation of quality improvement initiatives helps translation to other health care settings. Knowledge of contextual factors is essential for scaling up of effective interventions

Apps Seeking Theories: Results of a Study on the Use of Health Behavior Change Theories in Cancer Survivorship Mobile Apps

Background Thousands of mobile health apps are now available for use on mobile phones for a variety of uses and conditions, including cancer survivorship. Many of these apps appear to deliver health behavior interventions but may fail to consider design considerations based in human computer interface and health behavior change theories. Objective This study is designed to assess the presence of and manner in which health behavior change and health communication theories are applied in mobile phone cancer survivorship apps. Methods The research team selected a set of criteria-based health apps for mobile phones and assessed each app using qualitative coding methods to assess the application of health behavior change and communication theories. Each app was assessed using a coding derived from the taxonomy of 26 health behavior change techniques by Abraham and Michie with a few important changes based on the characteristics of mHealth apps that are specific to information processing and human computer interaction such as control theory and feedback systems. Results A total of 68 mobile phone apps and games built on the iOS and Android platforms were coded, with 65 being unique. Using a Cohen’s kappa analysis statistic, the inter-rater reliability for the iOS apps was 86.1 (P<.001) and for the Android apps, 77.4 (P<.001). For the most part, the scores for inclusion of theory-based health behavior change characteristics in the iOS platform cancer survivorship apps were consistently higher than those of the Android platform apps. For personalization and tailoring, 67% of the iOS apps (24/36) had these elements as compared to 38% of the Android apps (12/32). In the area of prompting for intention formation, 67% of the iOS apps (34/36) indicated these elements as compared to 16% (5/32) of the Android apps. Conclusions Mobile apps are rapidly emerging as a way to deliver health behavior change interventions that can be tailored or personalized for individuals. As these apps and games continue to evolve and include interactive and adaptive sensors and other forms of dynamic feedback, their content and interventional elements need to be grounded in human computer interface design and health behavior and communication theory and practice.The open access fee for this work was funded through the Texas A&M University Open Access to Knowledge (OAK) Fund

Multilevel Comparisons of Hospital Discharge among Older Adults with a Fall-Related Hospitalization

Objective: We examined multilevel factors associated with hospital discharge status among older adults suffering a fall-related hospitalization. Data Sources: The 2011–2013 (n = 131,978) Texas Inpatient Hospital Discharge Public-Use File was used. Study Design/Methods: Multilevel logistic regression analyses estimated the likelihood of being discharged to institutional settings versus home. Principal Findings: Factors associated with a greater likelihood of being discharged to institutional settings versus home/self-care included being female, white, older, having greater risk of mortality, receiving care in a non-teaching hospital, having Medicare (versus Private) coverage, and being admitted from a non-health care facility (versus clinical referral). Conclusions: Understanding risk factors for costly discharges to institutional settings enables targeted fall-prevention interventions with identification of at-risk groups and allows for identifying policy-related factors associated with discharge status