Evaluating an Insurance-Sponsored Weight Management Program With the RE-AIM Model, West Virginia, 2004-2008

Introduction: Evaluations of weight management programs in real-world settings are lacking. The RE-AIM model (reach, effectiveness, adoption, implementation, maintenance) was developed to address this deficiency. Our primary objective was to evaluate a 12-week insurance-sponsored weight management intervention by using the RE-AIM model, including short-term and long-term individual outcomes and setting-level implementation factors. Our secondary objective was to critique the RE-AIM model and its revised calculation methods. Methods: We created operational definitions for components of the 5 RE-AIM indices and used standardized effect size values from various statistical procedures to measure multiple components or outcomes within each index. We used chi(2) analysis to compare categorical variables and repeated-measures analysis of variance to assess the magnitude of outcome changes over time. Results: On the basis of data for 1,952 participants and surveys completed by administrators at 23 sites, RE-AIM indices ranging from 0 to 100 revealed low program reach and adoption (5.4 and 8.8, respectively), moderate effectiveness (43.8), high implementation (91.4), low to moderate individual maintenance (21.2), and moderate to high site maintenance (77.8). Median (interquartile range) weight loss was 13 lb (6.5-21.4 lb) among participants who completed phase I (12 weeks; 76.5%) and 15 lb (6.1-30.3 lb) among those who completed phase II (1 year; 45.7%). Conclusion: This program had a significant, positive effect on participants and has been sustainable but needs to be expanded for more public health benefit. The RE-AIM model provided a useful framework to determine program strengths and weaknesses and to present them to the insurance agency and public health decision makers

Physical activity mass media campaigns and their evaluation: a systematic review of the literature 2003–2010

Internationally, mass media campaigns to promote regular moderate-intensity physical activity have increased recently. Evidence of mass media campaign effectiveness exists in other health areas, however the evidence for physical activity is limited. The purpose was to systematically review the literature on physical activity mass media campaigns, 2003–2010. A focus was on reviewing evaluation designs, theory used, formative evaluation, campaign effects and outcomes. Literature was searched resulting in 18 individual adult mass media campaigns, mostly in high-income regions and two in middle-income regions. Designs included: quasi experimental (n = 5); non experimental (n = 12); a mixed methods design (n = 1). One half used formative research. Awareness levels ranged from 17 to 95%. Seven campaigns reported significant increases in physical activity levels. The review found that beyond awareness raising, changes in other outcomes were measured, assessed but reported in varying ways. It highlighted improvements in evaluation, although limited evidence of campaign effects remain. It provides an update on the evaluation methodologies used in the adult literature. We recommend optimal evaluation design should include: (1) formative research to inform theories/frameworks, campaign content and evaluation design; (2) cohort study design with multiple data collection points; (3) sufficient duration; (4) use of validated measures; (5) sufficient evaluation resources

Self-regulation and self-control in exercise: The strength-energy model

Self-regulation is an important component of psychosocial theories of exercise behaviour and lack of self-regulatory skills are associated with low adherence to health-related exercise. This review presents a strength-energy model of self-control as an explanation of self-regulation in exercise contexts. The review will provide impetus for original research aimed at understanding exercise behaviour and help develop recommendations for exercise promotion. In the model, self-control is conceptualized as a global but limited resource. Engaging in actions requiring self-control depletes resources leading to self-regulatory failure. Self-control resource depletion is reduced through rest and frequent training on self-control. The expectation of the need to exert self-control in future leads to a conservation of self-control resources. Proposed mechanisms for self-control resource depletion include changes in physiological markers and blood glucose levels. Based on our review, we propose an integrated model of self-regulation incorporating hypotheses from the strength-energy model with those from traditional psychosocial models of exercise behaviour. Recommendations for future research include incorporating hypotheses from the strength-energy model into theories of self-presentation and interpersonal relations in exercise. Practical recommendations aimed at minimising self-control depletion in exercise include the provision of advice on nutrition and recovery, self-control training and motivational and implementation intention strategies

Does neighbourhood walkability moderate the effects of mass media communication strategies to promote regular physical activity?

Background: Mass media campaigns are widely used in Australia and elsewhere to promote physical activity among adults. Neighbourhood walkability is consistently shown to be associated with walking and total activity. Campaigns may have different effects on individuals living in high and low walkable neighbourhoods. Purpose: The purpose of this study is to compare pre- and post-campaign cognitive and behavioural impacts of the Heart Foundation’s Find Thirty every day® campaign, in respondents living in high and lower walkable neighbourhoods. Methods: Pre- and post-campaign cross-sectional survey data were linked with objectively measured neighbourhood walkability. Cognitive and behavioural impacts were assessed using logistic regression stratified by walkability. Results: Cognitive impacts were significantly higher post-campaign and consistently higher in respondents in high compared with lower walkable neighbourhoods. Post campaign sufficient activity was significantly higher and transport walking significantly lower, but only in residents of lower walkable areas. Conclusions: Cognitive impacts of mass media physical activity campaigns may be enhanced by living in a more walkable neighbourhood

Priority of activity-friendly community issues among key decision makers in Hawaii

The U.S. Community Guide to Preventive Services strongly recommends changes in urban design, land use and accessibility to increase physical activity. To achieve these goals, policy change is often needed. This study assessed attitudes of decision makers in Hawaii to determine if physical activity related issues are among their priorities. Methods: State and county officials (n =179) were mailed surveys. Respondents listed the three most important problems (openended) in Hawaii and rated the importance of 23 specified problems, of which six directly related to physical activity. Results: The survey was completed by 126 (70.4%) respondents. The most frequently mentioned categories for the open-ended questions were affordable housing, environment/sustainability, sprawl/ traffic/population growth, and healthcare. Among the closed-ended physical activity related items, increasing traffic was ranked highest (43.9%) and fourth overall. Less than 12% of decision makers rated other physical activity issues as important. Conclusions: Future work is needed to increase the visibility and importance of physical activity related issues among policymakers

Motivated to walk but nowhere to walk to: Differential effect of a mass media campaign by mix of local destinations.

OBJECTIVE: Built environment attributes are associated with walking but little is known about how the impact of walking campaigns varies across different environments. The objective of this study was to compare the impact of a campaign on changes in walking between respondents with a high versus low mix of local destinations. METHODS: Pre- and post-campaign data from a quasi-experimental study were used to compare changes in walking for residents aged 40-65 with high and low destination mix in a West Virginia community campaign (March-May 2005). RESULTS: Overall samples consisted of 777 intervention community respondents and 388 comparison community respondents with pre- and post-campaign data. Among insufficiently active intervention respondents, those with high destination mix increased their walking by 0.64 days more than those with low mix (p < 0.05). No significant differences were observed among the comparison community. CONCLUSION: The walking response to campaigns in those insufficiently active may be influenced by neighborhood attributes