Live Well Springfield (LWS): Measuring Baseline Usage of the Springfield River Walk

OBJECTIVE: To measure RW usage prior to implementation of a targeted LWS intervention. METHODS: Users were automatically counted by TRAFx infrared trail counters, which were installed at three locations along the RW – Brightwood, Boathouse, and Depot. Data are expressed in counts, not in number of people, because the counters cannot determine user identity. Data represent counts from August through October 2013. RESULTS: The median daily counts for the Brightwood, Boathouse, and Depot locations were 70, 96, 181, respectively; mean counts were 69, 97, 189, respectively; and the range in counts were 39-133, 18-209, and 52-374, respectively. Hourly distributions varied. DISCUSSION: Brightwood had relatively high counts during the 6 PM hour (6:00 to 6:59), suggesting nearby residents using the trail after work. Boathouse counts showed no sharp hourly peaks, suggesting usage is less related to a typical work schedule. Depot counts peaked sharply during the 12 PM and 1 PM hours, suggesting employees from downtown using the trail on their lunch break. The range in counts at each location suggests that weather affected usage overall, while differences between locations suggest that characteristics of each location played a large role in determining counts. CONCLUSION: Results of this study will inform LWS programming and lay the foundation for post-intervention comparisons

Live Well Springfield (LWS) – A Community Transformation Initiative LWS.org Website Evaluation

The Live Well Springfield (LWS) initiative is a collaborative effort comprised of partner organizations in Springfield, Massachusetts. The project promotes healthy living by increasing knowledge and awareness of food and physical activity. A website to communicate this mission is a major strategy being employed by LWS. In addition to event and health information, the website exhibits stories (including multimedia) that depict residents practicing healthy lifestyle choices. These narratives were designed to motivate residents to engage in healthy behaviors. To date, there has been no evaluation of the website’s reach and effect. A mixed-methods approach of an online survey and focus group discussion will be used to collect data. Examining the end-users perceptions of website/content will assess the website’s quality, engagement potential, and appropriateness. Constructs adapted from eHealth evaluation literature and from theoretical models, including Expectation-Confirmation Model (ECM) and Elaboration Likelihood Model (ELM), were used to develop the online survey. The survey will be accessible via the homepage of the LWS website as well as the LWS Facebook page to collect user perceptions as quantitative data. Qualitative data collected by focus groups will explore users’ responses to affective (narratives) versus cognitive (fact-based) messaging. Survey data will be analyzed using frequencies and cross tabulation. Recurrent themes identified from focus group transcripts will be used to assess appropriateness and relevance of website content. Results will inform potential revisions of the LWS website and contribute to the wider, second phase activities of the LWS initiative

Live Well Springfield (LWS) -- A Community Transformation Initiative. Springfield MENU Program Evaluation

Studies have shown that low-income and minority Americans have a poor diet quality, which increases obesity and chronic disease risk. According to the Massachusetts Department of Public Health, Springfield is among the top five poorest cities in the state. To promote healthy eating behaviors among Springfield residents, Mason Square Health Task Force, a Live Well Springfield (LWS) partner, created a 6-session nutrition curriculum, entitled The MENU Program. The goal is to increase overall health awareness and healthy eating behaviors among residents in communities that are being targeted by the LWS initiative. The program was piloted with a group of female Mason Square residents, aged 60-85 years (n=12), at the Dunbar YMCA in Springfield, MA. Pre-and post-surveys were administered at sessions #1 and #6 to assess nutrition-related knowledge, attitudes and behaviors. Brief process evaluations were administered at the end of each 60 to 90 minute session to identify program strengths and limitations. Preliminary analysis reveals that participants increased their vegetable intake by 34% and consumption of fresh/frozen fruits and vegetables (vs. canned) increased by 9% and 18%, respectively. Those who reported “always” or “usually” reading nutrition labels increased from 54% to 72%, and those who reported “always” or “usually” shopping at a farmer’s market increased from 18% to 36%. Process evaluations showed positive responses to most of the material presented, particularly information regarding My Plate, portion control, and nutrition label reading. Further data analysis will inform revision of The MENU Program for use with larger, more diverse groups of Springfield residents

Changes in colorectal cancer screening intention among people aged 18–49 in the United States

Background: To determine whether exposure to a peer-led intervention focused on colorectal cancer (CRC) screening, physical activity, and multi-vitamin intake can lead to increased intentions to be screened for CRC once age eligible among adults under the age of 50. Methods: Participants were residents of low-income housing sites, and CRC screening intentions were assessed at baseline and at follow-up (approximately 2 years later) to determine changes in screening intentions and factors associated with changes in intentions. Results: Participants (n = 692) were 78.4% female, 42.6% Hispanic and 50.8% black. At follow-up, 51% maintained their intention to be screened and 14.6% newly intended to get screened. Individuals newly intending to get screened were more likely to have participated in the intervention, be older, male, and born in Puerto Rico or the United States compared to those who maintained their intention not to get screened (p < 0.05). Conclusion: Exposure to CRC prevention messages before the age of 50 can increase screening intentions among individuals who did not initially intend to get screened. Peer-led interventions to promote CRC screening should include individual less than 50 years of age, as this may contribute to increased screening at the recommended age threshold

Patient Follow-Up After Participating in a Beach-Based Skin Cancer Screening Program

Many skin cancer screenings occur in non-traditional community settings, with the beach being an important setting due to beachgoers being at high risk for skin cancer. This study is a secondary analysis of data from a randomized trial of a skin cancer intervention in which participants (n = 312) had a full-body skin examination by a clinician and received a presumptive diagnosis (abnormal finding, no abnormal finding). Participants’ pursuit of follow-up was assessed post-intervention (n = 283). Analyses examined: (1) participant’s recall of screening results; and (2) whether cognitive and behavioral variables were associated with follow-up being as advised. Just 12% of participants (36/312) did not correctly recall the results of their skin examination. One-third (33%, 93/283) of participants’ follow-up was classified as being not as advised (recommend follow-up not pursued, unadvised follow-up pursued). Among participants whose follow-up was not as advised, 71% (66/93) did not seek recommended care. None of the measured behavioral and cognitive variables were significantly associated with recall of screening examination results or whether follow-up was as advised. Research is needed to determine what factors are associated with follow-up being as advised and to develop messages that increase receipt of advised follow-up care

A randomized comparative effectiveness study of Healthy Directions 2—A multiple risk behavior intervention for primary care

Objective: To evaluate the effectiveness of the Healthy Directions 2 (HD2) intervention in the primary care setting. Methods: HD2 was a cluster randomized trial (conducted 3/09–11/11). The primary sampling unit was provider (n = 33), with secondary sampling of patients within provider (n = 2440). Study arms included: 1) usual care (UC); 2) HD2—a patient self-guided intervention targeting 5 risk behaviors; and 3) HD2 plus 2 brief telephone coaching calls (HD2 + CC). The outcome measure was the proportion of participants with a lower multiple risk behavior (MRB) score by follow-up. Results: At baseline, only 4% of the participants met all behavioral recommendations. Both HD2 and HD2 + CC led to improvements in MRB score, relative to UC, with no differences between the two HD2 conditions. Twenty-eight percent of the UC participants had improved MRB scores at 6 months, vs. 39% and 43% in HD2 and HD2 + CC, respectively (ps ≤ .001); results were similar at 18 months (p ≤ .05). The incremental cost of one risk factor reduction in MRB score was $310 for HD2 and$450 for HD2 + CC. Conclusions: Self-guided and coached intervention conditions had equivalent levels of effect in reducing multiple chronic disease risk factors, were relatively low cost, and thus are potentially useful for routine implementation in similar health settings

Safe To Walk? Neighborhood Safety and Physical Activity Among Public Housing Residents

Garry Bennett and colleagues measured exercise levels and obtained opinions on neighborhood safety. They concluded that residing in a neighborhood perceived to be unsafe at night is a barrier to regular physical activity

Colorectal cancer prevention for low-income, sociodemographically-diverse adults in public housing: baseline findings of a randomized controlled trial

Background: This paper presents the study design, intervention components, and baseline data from Open Doors to Health, a study designed to address social contextual factors in colorectal cancer (CRC) prevention for low-income, racial/ethnic minority populations. Methods: A cluster randomized design with 12 housing sites as the primary sampling units was used: 6 sites were assigned to a Peer-led plus Screening Access (PL) condition, and 6 were assigned to Screening Access only (SCR) condition. Study-related outcomes were CRC screening, physical activity (measured as mean steps/day), and multivitamin use. Results: At baseline (unweighted sample size = 1554), two-thirds self-reported that they were current with screening recommendations for CRC (corrected for medical records validation, prevalence was 52%), with half having received a colonoscopy (54%); 96% had health insurance. Mean steps per day was 5648 (se mean = 224), and on average 28% of the sample reported regular multivitamin use. Residents reported high levels of social support [mean = 4.40 (se = .03)] and moderately extensive social networks [mean = 2.66 (se = .02)]. Conclusion: Few studies have conducted community-based studies in public housing communities; these data suggest areas for improvement and future opportunities for intervention development and dissemination. Findings from the randomized trial will determine the effectiveness of the intervention on our health-related outcomes as well as inform future avenues of research