Church leaders' barriers and facilitators before and after implementing a physical activity and nutrition intervention.

Faith-based health promotion programs have been effective in increasing healthy eating (HE) and physical activity (PA). Very few reports exist regarding church leaders' anticipated and experienced barriers and facilitators to program implementation. Pastors (n = 38, 70%) and program coordinators (n = 54, 100%) from churches (N = 54) who attended a program training answered open-ended questions about anticipated barriers and facilitators to implementing the HE and PA parts of the Faith, Activity, and Nutrition (FAN) program. Twelve months later, pastors (n = 49, 92%) and coordinators (n = 53, 98%) answered analogous questions about their experienced barriers and facilitators to implementing the HE and PA parts of the FAN program. Responses were coded using thematic analysis. Similar themes appeared at baseline and follow-up for anticipated and experienced barriers and facilitators. The most common barriers were no anticipated barriers, resistance to change, church characteristics, and lack of participation/motivation. The most common facilitators were internal support, leadership, and communication. Few differences were found between anticipated and experienced barriers and facilitators. Understanding these perspectives, particularly overcoming resistance to change and church characteristics through strong leadership and internal support from church leaders, will improve future program development, resources, and technical assistance in faith-based and non-faith-based communities alike.

Baseline predictors of physical activity in a sample of adults with arthritis participating in a self-directed exercise program.

OBJECTIVES: To examine baseline predictors of moderate-to-vigorous intensity physical activity (MVPA) at the 12-week follow-up in a sample of adults with arthritis participating in a self-directed, multicomponent exercise program. STUDY DESIGN: Pretest-posttest. Analyses were limited to those randomized to the exercise intervention. METHODS: Participants (n = 152) completed a survey assessing demographic, health-related, and arthritis-related factors, and completed anthropometric and functional measurements at baseline. Self-reported MVPA was assessed at baseline and 12 weeks. Participants were classified as engaging in ≥2.5 or <2.5 h/week of MVPA at the 12-week follow-up. Baseline demographic, health-related, arthritis-related, and functional factors were examined as predictors of engaging in ≥2.5 h of MVPA. RESULTS: At the 12-week follow-up, 66.5% (n = 101) of participants engaged in ≥2.5 h/week of MVPA. Those with a higher body mass index, more days with poor physical health, a greater number of health conditions, self-reported hypertension, self-reported high cholesterol, and greater pain and stiffness were less likely to engage in ≥2.5 h of MVPA at the 12-week follow-up; those with greater arthritis self-efficacy and better performance on the 6 minute walk test were more likely. None of the other factors examined were associated with MVPA. CONCLUSIONS: This study uncovered health-related, arthritis-related, and functional factors associated with MVPA that may help guide intervention strategies. Participants with less severe symptoms, better functional performance and fewer comorbidities at baseline were more likely to achieve the recommended MVPA level at 12 weeks; therefore self-directed PA interventions may be best suited for those with relatively good health status despite arthritis, while those with worse symptoms and health status may benefit more from other intervention delivery modalities such as structured, individualized programs where additional support for managing arthritis symptoms and comorbidity can be addressed.

Evaluating community coalition characteristics and functioning: a summary of measurement tools.

Community coalitions and partnerships are frequently used to promote community health; however, little research to evaluate measurement tools for assessing their effectiveness has been reported. This summary identified measurement tools for coalition or partnership characteristics and functioning. The largest numbers of measures were identified for assessing individual and group characteristics, with impact and outcome measures being the least numerous. Published measures often lacked information regarding validity and reliability, with internal consistency reliability being the most commonly reported statistic. Some measures were well defined, but others lacked conceptual clarity. Valid and reliable tools that can be applied across multiple coalitions are necessary in order to achieve a better understanding of the associations among factors influencing optimal coalition functioning and community health impacts and outcomes.

Assets-oriented community assessment.

Determining how to promote community health requires that community health workers first assess where the community stands. The authors maintain that Healthy Communities initiatives are better served by assets-oriented assessment methods than by standard "problem-focused" or "needs-based" approaches. An assets orientation allows community members to identify, support, and mobilize existing community resources to create a shared vision of change, and encourages greater creativity when community members do address problems and obstacles.

Expanding the criteria for defining success when evaluating weight loss intervention programs.

In order to evaluate outcomes among former participants in a residential weight loss program, attendees were surveyed from 1 to 5 years post-intervention. A total of 187 respondents were studied for weight changes and behavioral practices. Diet practices were assessed by number of servings per day using the Food Guide Pyramid recommendations as a guideline for indicating fruit and vegetable intake. Exercise behaviors were measured in frequency, duration, and intensity, and a weighted score was computed to obtain units for describing physical activity. Maintaining a 10% weight loss from the program entry weight, consuming five or more servings per day of fruits and/or vegetables (5-a-day) and maintaining an "active" level of physical activity were included in criteria for describing intervention success. Those meeting two of the three criteria were categorized as "successful," which included 35.8% of the study population. Because each of these behaviors (5-a-day, active lifestyle, and modest weight loss maintenance) result in independent risk reduction, it is recommended that future weight loss intervention evaluations expand the criteria for describing successful impacts and outcomes to include not only weight maintenance, but also physical activity and diet compliance behaviors.

Gender differences among those exhibiting characteristics of binge eating disorder.

One hundred and eighty-seven former residential weight control participants exhibiting binge eating traits were assessed for gender differences regarding demographics, diet, exercise, weight control techniques, behavior modification techniques and binge eating characteristics. Data were gathered using a 68-item paper pencil questionnaire. Results indicate that there were no significant differences between males and females regarding demographic variables, and the number and types of weight control programs tried since leaving the residential program. Significant differences did exist between males and females in the number of times they had started dieting in the past year. No significant differences were observed among males and females regarding severity, binge emotions and compensatory behaviors. Statistically significant differences did exist regarding post-binge emotions. Results from this study suggest that males and females differ in regard to the diet/binge cycle and additionally, males appear to have a different or less emotional response subsequent to a binge.

Effects of a one-year physical activity intervention for older adults at congregate nutrition sites.

The effects of a physical activity intervention on strength, balance, motor coordination, and mobility were tested in a quasi-experiment at rural congregate nutrition sites. Twice-weekly sessions of low intensity movements were conducted for one year. Logistic regression results showed significant differences between intervention (n = 61) and comparison (n = 49) groups on several performance-based measures. Intervention subjects perceived significantly greater improvements in physical functioning over the previous year than did comparison subjects. A qualitative evaluation revealed perceived program benefits of pain reduction, increased flexibility, muscle strengthening, increased walking speed, and improved mental outlook.

Blood pressure in Hispanic women: the role of diet, acculturation, and physical activity.

The role of diet, acculturation, and physical activity on systolic and diastolic blood pressure was examined among 1,420 Mexican American, 388 Cuban American, and 542 Puerto Rican women who responded to the Hispanic Health and Nutrition Examination Survey collected in 1982-4. Dietary intake measures included sodium, potassium, calcium, magnesium, fiber, ethanol, and total kilocalories as estimated from 24-hour recall data. Serum sodium/potassium ratio was included as a measure of metabolic function. Acculturation was measured using language preference, speaking, reading and writing. Physical activity included recreational and non-recreational activities. Other correlates included age, education, and body composition. Final models indicated that age and body composition were significantly associated with blood pressure across all three Hispanic subgroups. Among Mexican-American women, acculturation had an impact on both systolic and diastolic blood pressure that was independent of diet, body composition, and physical activity. Furthermore, the dietary intake of specific nutrients such as sodium and potassium did not appear to be as important as the way the individual metabolized those nutrients, as indicated by the serum sodium/potassium ratio. The strong association of body mass index with both systolic and diastolic blood pressure among all three ethnic groups reinforces the need to maintain an appropriate body weight.

Functional health status as a predictor of mortality in men and women over 65.

This study evaluated the effect of functional health status on mortality in a sample of community-dwelling older people. White and African-American self-respondents to the 1986 National Health Interview Survey Functional Health Supplement (n = 5, 320) were included in the study. Functional health status was measured by a ten-item unidimensional activities of daily living-instrumental activities of daily living (ADL-IADL) scale and a three-item cognitive ADL scale. Proportional hazards regression was used to evaluate the effect of increasing score on the ten-item ADL-IADL scale on risk of mortality over a 5-year period while controlling for demographic, social, and health status covariates. In both men and women, increasing score on the ADL-IADL scale was predictive of mortality, adjusting for increasing age, poor self-rated health, low body mass index in women, and being an unmarried man. These findings indicate that a unidimensional scale consisting of both ADL and IADL items is useful in predicting mortality, controlling for the effect of covariates in sex-specific models.

Exercise participation in a frail elderly population.

A low-intensity exercise demonstration project was developed jointly by researchers, social service practitioners, and program participants to actively involve frail older people in their own health maintenance. This article describes this collaborative process and its impact on the success of the health promotion program, which was conducted at three senior centers serving a low-income, urban elderly population. Participants were predominantly sedentary women over age 70 with multiple chronic conditions. The program was conducted with peer leaders to facilitate its continuation after the research demonstration phase. In addition to positive health outcomes related to functional mobility, blood pressure maintenance, and overall well-being, this intervention was successful in sustaining active participation in regular physical activity through the use of peer leaders selected by the program participants. The planning, implementation, and outcomes of this project illustrate the benefits and challenges of combining research and practice perspectives in conducting health promotion interventions with older populations.

Measurement of social interaction in change of health behavior.

A social network approach to measuring social interaction related to change of health behavior required 460 participants in a health promotion program to nominate up to five network members and to rate the supportiveness of each person in changing health behavior during the previous year. Exploratory factor analysis of intercorrelations of the eight items suggested two factors representing supportive and negative interaction with internal consistency reliability of .89 and .61, respectively.

The relationship between diet, activity, and other factors, and postpartum weight change by race.

OBJECTIVE: To identify the impact of dietary intake and activity level on postpartum weight change. METHODS: White (n = 121) and black (n = 224) women, 7-12 months postpartum, participating in the Special Supplemental Feeding Program for Women, Infants, and Children were assessed for dietary intake, activity level, body weight, and other maternal characteristics. RESULTS: For both black and white women, the most important variables in predicting postpartum weight loss were pre-pregnancy weight, gestational weight gain, parity, and prenatal exercise. After these factors were controlled, race predicted that black women retained 6.4 lb more than white women. These results may be due to the finding that black women reported significantly higher mean energy intake (2039 versus 1552 kcal, P < .001), higher percent fat in diet (41 versus 38%, P < .001), and significantly lower amounts of prenatal and postpartum activity. CONCLUSION: Higher energy intake and lower activity levels in black postpartum mothers compared with white mothers may contribute to the significantly higher rates of obesity found in black mothers. This study suggests the need for intervention strategies in the prenatal and postpartum periods to help those at risk of retaining weight gained during pregnancy.

Older women and health services: moving from ageism toward empowerment.

Ageism and sexism in health services and research affect the quality of care, patient-provider interaction, patient self-perceptions, and the planning of health education programs for older women. Stereotyping of older women in the health care encounter, although often subtle, can have far-reaching effects on the health status of older women. Prevailing research methodologies are focused on disease processes and neglect older women's subjective experience of illness. Changes at the organizational, community, and individual levels that promote the autonomy and empowerment of older women are discussed.

Adaptation of a general optimism scale for use with older women.

The Life Orientation Test has been widely used with various populations since its development, but its psychometric properties among older adults have not been assessed. This study employed exploratory factor analysis to examine the factor structure of a modified version of the test for 90 frail older women. The results do not support a unidimensional conceptualization of optimism. Internal consistency reliability was lower for the entire scale than for separate factors representing positively versus negatively framed questions. Some support for construct validity was shown by small to moderate correlations with several related constructs. The results were likely to have been affected both by the modification of the test to simplify data collection with an elderly population and by a differing manifestation of the construct among functionally impaired older adults as compared to previous research with younger, healthier samples.

Impact of social support, social cognitive variables, and perceived threat on depression among adults with diabetes.

Tested was a model of social support and cognitive appraisal of self-efficacy, outcome expectancies, and illness threat on depression. Study participants were community-dwelling adults with diabetes who completed a mailed questionnaire (N = 362). Results of structural equation modeling indicated that 52% of the variance in depression was explained by the model--largely by the direct effects of physical functioning, the perceived availability of social support, and the perceived threat of diabetes as well as the indirect paths from perceived support to perceived threat and from physical functioning to perceived support and perceived threat of diabetes. Diabetes-specific social support, self-efficacy, and outcome expectancies were not significant predictors of depression.

Services for persons with dementia and their families: a survey of information and referral agencies in Michigan.

In planning a statewide Dementia Program, Michigan agencies (N = 244) providing geriatric information and referral (I&R) were surveyed to determine service availability, families' needs, and problems providing I&R for persons with dementia and their families. Home-delivered meals, nursing and social work assessments were considered more available. Medical assessment, however, was considered "very available" by only 60%. Respite and adult day care were least available and most needed. Least was known about autopsy and financial services. For several services, non-urban areas reported less availability than urban areas. With additional information and training, existing agencies could provide more available and extensive I&R for persons with dementia and their families, forming a statewide network.

Exercise beliefs and behaviors among older employees: a health promotion trial.

This health promotion trial included university faculty and staff aged 50 to 69 who had completed a health risk screening. Predictors of intention to exercise were education, gender, self-efficacy, outcome expectancy, perceived barriers, and baseline exercise frequency. Baseline exercise frequency was the only predictor of exercise behavior 1 year later.

Comparative effects of bilateral hand splints and an elbow orthosis on stereotypic hand movements and toy play in two children with Rett syndrome.

A single-subject rapidly alternating treatment design was used to compare the effectiveness of bilateral hand splints and an elbow orthosis in decreasing stereotypic hand behaviors and increasing toy play in 2 children with Rett syndrome. The subjects' responses were compared across three treatment conditions: no intervention, hand splints, and elbow orthosis. The order of the treatment phases was randomly selected for each subject. Data were collected in both a free-time condition and a toy-play condition; the outcome measures were stereotypic hand movements and hand-to-toy contact. Both subjects demonstrated a decrease in stereotypic hand movements and a corresponding increase in toy contact with the use of the elbow orthosis. The bilateral hand splints had no obvious treatment effect.

Self-regulation of health behavior: the "take PRIDE" program.

Social cognitive theory, in particular, the construct of self-regulation was the basis for developing an educational program for older adults with heart disease. This paper discusses the theoretical principles utilized and describes the program activities based on them. Data from an evaluation conducted with 246 older heart patients who took part in the education are used to illustrate how social cognitive theory constructs operated empirically.