Evaluation of messages tailored to cancer prevention guidelines

Researchers using tailored messages in cancer prevention intervention studies have not sufficiently studied how best to tailor messages about multiple behaviors. One important question is whether behavioral change strategies and feedback should include only behaviors participants indicate they most want to work on (i.e. a behavioral priority) or behaviors selected on their behalf based on expert evidence of potential disease prevention benefit. Compared to expert-based tailoring, tailoring to participants' behavioral priorities may be of greater relevance, prompting information processing, and ultimately facilitating behavioral changes. This dissertation included three lines of research. First, from six focus groups, we elicited participants' perceptions about components of a healthy lifestyle and used this information to design a tailored feedback graphic. Second, we conducted secondary analyses of data from two large worksite intervention trials, in which subsets of female participants received tailored messages. Results indicated that those who chose the 'healthy eating' priority and received a tailored message increased servings of fruits and vegetables by 1.8-2.0 compared to women who had also chosen 'healthy eating' but did not receive a tailored message. Building from these results, we conducted a randomized web-based trial to directly evaluate tailoring to participant-selected behavioral priorities versus expert-based health behaviors and a non-tailored comparison group. Six cancer prevention guidelines for nutrition and physical activity were targeted. Immediately before and after reading the tailored or non-tailored feedback on-screen, we measured guideline-specific intention, self-efficacy, goal commitment, and goal difficulty. Female college students (n=408), 74% non-Hispanic white, participated. Overall, support for tailoring to behavioral priorities was found for increasing fruits and vegetables and physical activity with statistically significant improvements in self-efficacy, goal commitment, and goal difficulty. Even stronger effects on these variables were found among participants randomized to the expert-tailored group, but only among those who received a message that happened to match their selected behavioral priority. Overall, results from this dissertation support tailoring to behavioral priorities and provide a tool to increase message effectiveness. Tailored health communications effective in facilitating healthful nutrition and physical activity choices have the potential to impact cancer incidence population-wide

Peer coaching through mHealth targeting physical activity in people with Parkinson disease: feasibility study

BACKGROUND: Long-term engagement in exercise and physical activity mitigates the progression of disability and increases quality of life in people with Parkinson disease (PD). Despite this, the vast majority of individuals with PD are sedentary. There is a critical need for a feasible, safe, acceptable, and effective method to assist those with PD to engage in active lifestyles. Peer coaching through mobile health (mHealth) may be a viable approach. OBJECTIVE: The purpose of this study was to develop a PD-specific peer coach training program and a remote peer-mentored walking program using mHealth technology with the goal of increasing physical activity in persons with PD. We set out to examine the feasibility, safety, and acceptability of the programs along with preliminary evidence of individual-level changes in walking activity, self-efficacy, and disability in the peer mentees. METHODS: A peer coach training program and a remote peer-mentored walking program using mHealth was developed and tested in 10 individuals with PD. We matched physically active persons with PD (peer coaches) with sedentary persons with PD (peer mentees), resulting in 5 dyads. Using both Web-based and in-person delivery methods, we trained the peer coaches in basic knowledge of PD, exercise, active listening, and motivational interviewing. Peer coaches and mentees wore FitBit Zip activity trackers and participated in daily walking over 8 weeks. Peer dyads interacted daily via the FitBit friends mobile app and weekly via telephone calls. Feasibility was determined by examining recruitment, participation, and retention rates. Safety was assessed by monitoring adverse events during the study period. Acceptability was assessed via satisfaction surveys. Individual-level changes in physical activity were examined relative to clinically important differences. RESULTS: Four out of the 5 peer pairs used the FitBit activity tracker and friends function without difficulty. A total of 4 of the 5 pairs completed the 8 weekly phone conversations. There were no adverse events over the course of the study. All peer coaches were "satisfied" or "very satisfied" with the training program, and all participants were "satisfied" or "very satisfied" with the peer-mentored walking program. All participants would recommend this program to others with PD. Increases in average steps per day exceeding the clinically important difference occurred in 4 out of the 5 mentees. CONCLUSIONS: Remote peer coaching using mHealth is feasible, safe, and acceptable for persons with PD. Peer coaching using mHealth technology may be a viable method to increase physical activity in individuals with PD. Larger controlled trials are necessary to examine the effectiveness of this approach.This study is supported by Boston Roybal Center for Active Lifestyle Interventions (RALI Boston), Grant #P30 AG048785, and the American Parkinson Disease Association, Massachusetts chapter. The authors would like to thank Nicole Sullivan, SOT, for her assistance with data management and data collection and Nick Wendel, DPT, for his assistance with data collection. Additionally, the authors would like to thank the participants in this study for their time, effort, and insights. (P30 AG048785 - Boston Roybal Center for Active Lifestyle Interventions (RALI Boston); American Parkinson Disease Association, Massachusetts chapter)Accepted manuscrip

The role of attitude, control and intention to explain fruit and vegetable intake among racial/ethnic minority women with low socioeconomic status

OBJECTIVE: Fruit and Vegetable (FV) intake-a modi able risk factor for chronic diseases-is lower among racial/ethnic minorities and low Socio- Economic Status (SES) groups when compared to other populations. The Theory of Planned Behavior (TPB) is one theoretical model studied to explain and in uence individual health behaviors, including FV intake, in middle class populations, but not exclusively in diverse, low SES groups. This cross-sectional study evaluated the utility of select TPB variables to explain intention to consume and intake of FV in this population. DESIGN: Demographics, BMI, select TPB variables, and FV intake were measured via survey. Bivariate analyses were conducted to explore relationships between variables. Hierarchical regression analyses were used to t two models: one to explain intention and one to explain behavior with regard to FV vegetable intake. RESULTS: Participants (n=114) age 25-69 years and were mostly African American/Black and Hispanic (21.9% and 73%, respectively). The TPB variable perceived behavioral control was the only signi cant predictor of intention to consume FV (OR=2.55, 95% CI OR: 1.23, 5.27), and with BMI, FV intake (R2=0.08; F [2,130] =5.72, p=0.0042). CONCLUSION: Perceived behavioral control and BMI are the most signi cant predictors of FV intake but explain only 8% of the variability in intake in our cohort. Our results support prior research which suggests an attenuation of the intention-behavior relationship by SES, and may question the utility of the TPB as it is currently operationalized as a foundational model for future health behavior change research and programs in low SES racial/ethnic minorities

Pilot and feasibility test of an implementation intention intervention to improve fruit and vegetable intake among women with low socioeconomic status

Fruit and vegetable intake (FVI), a modifiable risk factor for chronic diseases, is lower in low socioeconomic status (SES) populations. Implementation intentions (a specific type of planning that extends the Theory of Planned Behavior) has been studied to improve FVI, but not exclusively with low SES groups. Using mixed methods, we evaluated the feasibility, acceptability, and preliminary efficacy of an implementation intention intervention (versus a general plan) to increase FVI in women with low SES. For the pilot randomized controlled trial, demographics, body mass index, attitude, perceived behavioral control, goal intention strength, and FVI were measured at baseline and FVI again 1-month following the intervention. Feasibility data were collected for recruitment, randomization, retention, and assessment procedures and compared to predetermined targets. Semi-structured interview data was analyzed for emergent themes regarding acceptability of the trial. Preliminary efficacy of the intervention to improve FVI was analyzed descriptively. Feasibility targets were met for randomization (100% vs. ≥80% target), retention (93.5% vs. ≥70% target) and the assessment metrics missing data points (2% vs. ≤10% target) and days from intervention to follow up (mean=69.2, sd=42.6 vs.days). Targets for recruitment were not met with the exception of participants giving informed consent (100% vs. ≥70% target). Participants described the intervention as enjoyable and reported behavioral constructs outside of those measured as important to improve FVI. Limited efficacy analysis suggested that both groups increased their FVI (experimental: +0.17 servings per day, 95% CI: -0.85, 1.20; control: +0.50 servings per day, 95% CI: -0.56, 1.58). Further research which examines interventions based upon behavior change models to improve dietary health behaviors in marginalized groups is needed

Theory of Planned Behavior and implementation intentions to improve fruit and vegetable intake in women of low socioeconomic status

Fruit and vegetable intake (FVI) is an important modifiable risk factor for chronic diseases. Low socioeconomic status (SES) populations demonstrate lower FVI and higher rates of chronic diseases than higher SES groups. Theory-based models and interventions like the Theory of Planned Behavior (TPB) and implementation intentions (II) have been used effectively to explain and influence health behaviors, including FVI, in middle class populations, but have not been evaluated in exclusively low SES populations. This research investigates the efficacy, feasibility and acceptability of the TPB and an II intervention to explain and influence FVI in women of low SES.Participants: Adult female residents of Boston Public Housing developments. TPB constructs and FVI were measuredvia survey. We conducted pilot and feasibility randomized controlled and one-group II intervention studies (n=31) to promote FVI and a qualitative analysis of semi-structured interview data (n=8) to evaluate intervention efficacy, feasibility and acceptability.Intervention and control groups did not increase FVI (intervention + 0.26 servings per day, t(17)=0.73,p=0.476; control +0.50 servings per day, t(9)=1.07,p=0.3111) and no difference in FVI between groups t(26)=0.40,p=0.6934). Feasibility goals were met for randomization (100%vs ≥80%), retention(93.5%vs ≥70%), missing data (2%vs <10%), days to follow up (mean=69.27±42.67 vs <180 days), and not for recruitment(38.1% vs≥70%). Interviewed participants characterized the intervention as “beneficial”, and reported autonomy, positive regard and having support facilitated dietary behavior change. Overall, our analysis of an II intervention suggests that simply intervening on TPB variables may not be enough to change dietary behavior and, although acceptable, participants reported constructs not included in the TPB as facilitators of dietary behavior change. Future research is needed to determine how/if the TPB and II can be used as a theoretical foundation and intervention to describe and influence dietary behavior change in women of low SES

Feasibility and acceptability of dietary intake assessment via 24-hour recall and food frequency questionnaire among women with low socioeconomic status

BACKGROUND: Comprehensive evaluation of dietary interventions depends on effective and efficient measurement to quantify behavior change. To date, little is known regarding which self-reported measure of dietary intake is most feasible and acceptable for use in evaluation of the effectiveness of diet intervention studies among underserved populations. OBJECTIVE: This research focused on evaluating feasibility and acceptability of two self-report measures of diet. DESIGN: Cross-sectional. PARTICIPANTS/SETTING: Two interviewer-administered 24-hour recalls and a 110-item food frequency questionnaire (FFQ) were administered to both English- and Spanish-speaking participants (n=36) by native English- and Spanish-speaking research assistants. On completion of both dietary assessments, participants were interviewed regarding their preference of measure. MAIN OUTCOME MEASURES: Feasibility for completion of the dietary assessment measures was determined for contacts and retention. Acceptability of the measures was determined through responses to open- and closed-ended questions. RESULTS: During the 5-month trial, 36 participants were enrolled; 29 completed both intake measures, and 26 completed both measures and the interview. Participants were mainly Hispanic/Latina (72%), with a mean age of 37.0 (±7.6) years. Feasibility targets were met for contacts (1.9, 1.6, 1.8 contact attempts to complete each diet assessment measure with a target of ≤2) and for retention with 89% and 91% completing two 24-hour recalls and the FFQ, respectively. Participants indicated both diet assessment methods were generally acceptable; both positive and negative comments were received for use of the FFQ. CONCLUSION: Dietary assessment with the use of 24-hour recalls or an FFQ can be feasible and acceptable among women with low socioeconomic status, although care should be taken to address cultural appropriateness in the selection of the measurement method. Copyright © 2018 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.IRG 72 001-36 - American Cancer Societ

Pilot and Feasibility Test of an Implementation Intention Intervention to Improve Fruit and Vegetable Intake Among Women with Low Socioeconomic Status

Fruit and vegetable intake (FVI), a modifiable risk factor for chronic diseases, is lower in low socioeconomic status (SES) populations. Implementation intentions (a specific type of planning that extends the Theory of Planned Behavior) has been studied to improve FVI, but not exclusively with low SES groups. Using mixed methods, we evaluated the feasibility, acceptability, and preliminary efficacy of an implementation intention intervention (versus a general plan) to increase FVI in women with low SES. For the pilot randomized controlled trial, demographics, body mass index, attitude, perceived behavioral control, goal intention strength, and FVI were measured at baseline and FVI again 1-month following the intervention. Feasibility data were collected for recruitment, randomization, retention, and assessment procedures and compared to predetermined targets. Semi-structured interview data was analyzed for emergent themes regarding acceptability of the trial. Preliminary efficacy of the intervention to improve FVI was analyzed descriptively. Feasibility targets were met for randomization (100% vs. ≥80% target), retention (93.5% vs. ≥70% target) and the assessment metrics missing data points (2% vs. ≤10% target) and days from intervention to follow up (mean=69.2, sd=42.6 vs.days). Targets for recruitment were not met with the exception of participants giving informed consent (100% vs. ≥70% target). Participants described the intervention as enjoyable and reported behavioral constructs outside of those measured as important to improve FVI. Limited efficacy analysis suggested that both groups increased their FVI (experimental: +0.17 servings per day, 95% CI: -0.85, 1.20; control: +0.50 servings per day, 95% CI: -0.56, 1.58). Further research which examines interventions based upon behavior change models to improve dietary health behaviors in marginalized groups is needed

The effect of a weight gain prevention intervention on moderate-vigorous physical activity among black women: the Shape Program

Background: Rates of physical inactivity are high among Black women living in the United States with overweight or obesity, especially those living in the rural South. This study was conducted to determine if an efficacious weight gain prevention intervention increased moderate-vigorous physical activity (MVPA). Methods: The Shape Program, a weight gain prevention intervention implemented in community health centers in rural North Carolina, was designed for socioeconomically disadvantaged Black women with overweight or obesity. MVPA was measured using accelerometers, and summarized into 1- and 10-min bouts. We employed analyses of covariance (ANCOVA) to assess the relationship between changes in MVPA over 12 months, calculated as a change score, and intervention assignment (intervention versus usual care). Results: Participants completing both baseline and 12-month accelerometer assessments (n = 121) had a mean age of 36.1 (SD = 5.43) years and a mean body mass index of 30.24 kg/m2 (SD = 2.60). At baseline, 38% met the physical activity recommendation (150 min of MVPA/week) when assessed using 10-min bouts, and 76% met the recommendation when assessed using 1-min bouts. There were no significant differences in change in MVPA participation among participants randomized to the intervention from baseline to 12-months using 1-min bouts (adjusted intervention mean [95% CI]: 20.50 [−109.09 to 150.10] vs. adjusted usual care mean [95% CI]: -80.04 [−209.21 to 49.13], P = .29), or 10-min bouts (adjusted intervention mean [95% CI]: 7.39 [−83.57 to 98.35] vs. adjusted usual care mean [95% CI]: -17.26 [−107.93 to 73.40], P = .70). Conclusions: Although prior research determined that the Shape intervention promoted weight gain prevention, MVPA did not increase significantly among intervention participants from baseline to 12 months. The classification of bouts had a marked effect on the prevalence estimates of those meeting physical activity recommendations. More research is needed to understand how to promote increased MVPA in weight gain prevention interventions

Results of a Randomized Trial Testing Messages Tailored to Participant-Selected Topics among Female College Students: Physical Activity Outcomes

A better understanding of identifying tailoring variables would improve message design. Tailoring to a behavior that a participant selects as one they would like to work on may increase message relevance, and thus effectiveness. This trial compared 3 groups: message tailored to physical activity as a participant-selected topic (choice), message tailored to physical activity as an expert-determined topic (expert), or nontailored message (comparison)

Updated Poster Presentation Abstract (n = 58) From 2020 Combined Sections Meeting Of The American Physical Therapy Association: How Well Do Clinical Walking Measures Predict Natural Walking Behavior In Parkinson Disease?

Declines in the amount and intensity of natural walking behavior in people with Parkinson disease (PD) may precede declines in motor behavior, gait, and balance. Physical interventions targeting walking behavior in PD may have the greatest impact on slowing the progression of disability. Despite a lack of supporting evidence, however, clinicians may be more likely to rely on quick performance measures of walking speed, capacity, and balance to make inferences about a patient’s walking health, rather than direct measures of natural walking behavior. Our primary purpose, therefore, was to examine the extent to which clinical walking measures might predict natural walking behavior in early to mid-stage PD. Secondarily we sought to explore differences in the predictive capability of clinical measures between relatively less active and more active participants