Perceptions of participants and staff of implementing a physical activity program in rural primary care

Addressing the lack of physical activity (PA) in rural adults is vital because of the role it plays in the risk for many chronic diseases. The purpose of the study was to explore the feasibility of conducting a 12-week intervention utilizing a Fitbit to increase PA behavior in inactive rural adults recruited from a primary care clinic. Semi-structured interviews were conducted with study participants (n=10) and a focus group was held with nurses (n=7) from the primary care clinic. Data were analyzed using the process of immersion/crystallization. Participants and nurses both felt the program had a positive impact on PA and that the program was needed in the community. Study participants most often reported their favorite part of the study was being able to track their activity as well as the goal setting. However, study participants reported barriers to continued participation in PA related to a lack of time and ability to be active in cold weather. Further, nursing staff reported barriers in regard to a lack of resources (staffing and money) These barriers need to be examined further and addressed in order to implement a sustainable PA program that can be maintained through a primary care clinic.     

A theoretically derived model of premarital intervention: The building of a family system

Premarital intervention programs are on the rise in the United States despite the absence of persuasive empirical data that substantiate their effectiveness. In addition to this lack of strong empirical support, many premarital counseling programs fail to articulate any coherent theory of family process or family intervention which serve as conceptual guideposts for formulating program goals and devising program activities. In this article, the authors describe an experimental program that is conceptually grounded in theories of family process and family intervention. The theoretical rationale for each element included in the program is discussed and numerous examples of the program's content and exercises are offered. Finally, the authors discuss a number of issues central to the evaluation of premarital counseling programs.     

Examining the link between program implementation and behavior outcomes in the lifestyle education for activity program (LEAP)

Lifestyle Education for Activity Program (LEAP) was a comprehensive, school-based intervention designed to promote physical activity in high school girls. The intervention focused on changes in instructional practices and the school environment to affect personal, social, and environmental factors related to physical activity. Multiple process evaluation tools and an organizational assessment tool were developed to monitor program implementation from a framework called the LEAP essential elements, which characterized complete and acceptable intervention delivery; secular trends were also monitored. Using process data, LEAP intervention schools were categorized into low- and high-implementing groups and compared with control schools on nine essential elements assessed at the organizational level. The Wilcoxon scores test revealed that low- and high-implementing intervention, and control schools differed significantly on two of nine administrator-reported organizational-level components: having a physical activity team and having a faculty-staff health promotion program. A mixed-model analysis of covariance indicated that, compared to control schools, a greater percentage of girls in high-implementing schools reported engaging in vigorous physical activity. Process evaluation can be used to understand the relationship between level of implementation and successful program outcome.     

A systematic approach to smoking cessation activities in Danish shelters

Introduction: Shelter users have an alarmingly high smoking prevalence; our aim was to develop systematic smoking cessation activities in the shelters. Method: All available (n?=?13) shelters in Copenhagen were included. This Participatory Action Research had a development/test period and an implementation period for the revised intervention. Shelter-staff completed a questionnaire at baseline. Municipal smoking cessation counselors were trained to work with shelter users. Three types of on-site smoking cessation activities were developed and offered. Results: The estimated mean smoking prevalence in shelter users was 79%. Only two shelters ran smoking cessation activities prior to study start. All but one of the shelters implemented group-based intervention activities and approximately 13% of smokers signed-up; 26.6% of those who attended the first session were abstinent after approximately 12 weeks, as confirmed by staff. Conclusion: Smoking cessation activities in shelters are wanted by staff and shelter users, they are feasible and even very vulnerable persons are able to quit. Based on our experiences in Copenhagen shelters, we propose a systematic approach for future smoking cessation initiatives: smoking activities should be driven by the municipality, be pro-active, on-site, tailored and flexible, in addition, free nicotine therapy should be offered and trained smoking cessation counselors should be available.     

Replication of an Intensive Educational Intervention for Youth Pregnancy and STI Prevention: The GIG

The article reports the results of two years of program replication to determine the effectiveness of an innovative intervention which is one component of a program aimed at the prevention of pregnancy and sexually transmitted infection (STI). The GIG is a 6 h intervention which presents prevention information in an entertainment venue employing non-conventional and youth culture oriented educational activities. Statistically significant improvement in knowledge and attitudes with regard to pregnancy and STI was found in both replication samples, demonstrating consistency in the effectiveness of the intervention. Item by item analyses of measure items offer information regarding specific knowledge and attitudes. Implications for further implementation of the intervention and broader applications are offered. STI has replaced STD in medical parlance.     

Peer 2 Peer: Efficacy of a Course-Based Peer Education Intervention to Increase Physical Activity Among College Students

Abstract

There are few physical activity (PA) interventions in higher education, and they have been only minimally effective. Objective: To determine if a course-based, peer education intervention was associated with increases in PA and physical fitness. Participants: Participants were 178 students enrolled in a personal health class during the 2007–2008 academic year. Methods: A quasi-experimental design was used to assess the effect of the intervention. Repeated measures analysis of covariance was employed to test the impact of the intervention on students’ PA, body composition, waist-to-hip ratio, cardiovascular fitness, flexibility, and muscular strength. Results: Women in the treatment group classified as “Inactive” at baseline increased PA, whereas “Inactive” control women had reductions in PA. Women in the treatment group who were “Active” at baseline reduced their waist-to-hip ratio and increased flexibility. There were no differences by treatment group among men. Conclusions: The intervention was effective in improving PA and physical fitness among college women.     

Formative evaluation of a motivational intervention for increasing physical activity in underserved youth

The present study was designed to develop an innovative motivational intervention (based on Self-Determination Theory and Social Cognitive Theory) to increase physical activity (PA) in underserved adolescents. Sixty-four adolescents (35 females, 29 males; 50% minority; 65% on reduced lunch program; ages 11-13 yr) participated in either an 8-week motivational intervention after-school (n = 32) or a typical after-school program (n = 32). The conceptual framework for the intervention targeted the social environment (perceived autonomy, perceived social support, participation, fun), cognitive mediators (perceived choice, self-efficacy, and relatedness/belongingness), and motivational orientation (intrinsic motivation, commitment, positive self-concept). Formative evaluation data was collected by staff through daily forms throughout the 8-week program and through observational data completed by independent objective observers during 2 weeks of the program. The major themes that were identified addressed theoretical concepts regarding the intervention and logistical issues in delivering the intervention. The data revealed information regarding the importance of the cognitive appropriateness of the PA and motivational activities, the environmental climate for promoting nurturing relationships, developing specific strategies for increasing intrinsic rather than extrinsic reinforcement, and developing methods for preventing social "cliques" and gender conflicts to maintain an appropriate level of support in the social climate. Themes for training staff included focusing on team building, leadership, and nurturing. This formative evaluation is being used to formalize a randomized trial to test the effects of a student-centered motivational intervention on increasing PA in underserved 6th graders.     

Project LIFE: a partnership to increase physical activity in elders with multiple chronic illnesses

The authors describe a medical center-based randomized trial aimed at determining the feasibility and effectiveness of partnering patients and primary-care providers with an exercise health counselor. Study participants included 165 veterans age 70 years and older. The primary end point was change in physical activity at 3 and 6 months comparing patients receiving high-intensity physical activity counseling, attention control counseling, and usual care after receiving standardized clinic-based counseling. We noted a significant Group x Time interaction (p = .041) for physical activity frequency and a similar effect for caloric expenditure (p = .054). Participants receiving high-intensity counseling and usual care increased physical activity over the short term, but those with usual care returned to baseline by the end of the study. The intervention was well received by practitioners and patients. We conclude that partnering primary-care providers with specialized exercise counselors for age- and health-appropriate physical activity counseling is effective.     

Tai Chi-based exercise for older adults with Parkinson's disease: a pilot-program evaluation

The primary objective of this study was to provide preliminary evaluation of the feasibility, safety, and efficacy of a newly developed Tai Chi-based exercise program for older adults with Parkinson's disease (PD). Using a one-group pretest-posttest design, 17 community-dwelling adults (mean age 71.51 years) with mild to moderate idiopathic PD (Stage I, II, or III on the Hoehn and Yahr scale) and stable medication use completed a 5-day, 90-min/day Tai Chi exercise-evaluation program. Outcome measures included face-to-face exit interviews on appropriateness and safety and physical performance (i.e., 50-ft speed walk, up-and-go, functional reach). At the end of this brief intervention, exercise adherence was 100% and the program was shown to be safe. Exit interviews indicated that the program was well received by all participants with respect to program appropriateness, participant satisfaction and enjoyment, and intentions to continue. Furthermore, a significant pretest-to-posttest change was observed at the end of the 5-day program in all three physical-performance measures (p < .05). The results of this pilot evaluation suggest that Tai Chi is an appropriate physical activity for older adults with PD and might also be useful as a therapeutic exercise modality for improving and maintaining physical function. These preliminary findings warrant further investigation.     

Care for left-behind children in rural China: A realist evaluation of a community-based intervention

In many countries, large numbers of left-behind children (LBC) grow up experiencing prolonged separation from their migrant worker parents. These children are known to be vulnerable to psychological and developmental problems. Drawing on qualitative interview data as well as ethnographic observations, a realist approach was applied in this study to evaluate the feasibility, acceptance, preliminary outcomes and potential sustainability of a community-based intervention to provide care and support to LBC, in a migrant-sending area of rural China. The intervention program comprised “Children's Clubs” in local communities, in which LBC participate in play and educational activities under the care and supervision of local volunteers. Twelve Clubs in 12 different villages were evaluated for the study. In each village, semi-structured interviews were conducted with three community stakeholders, and children and primary caregivers from two families, to examine their perceptions and experiences with regard to the intervention. Our findings indicated that most Clubs adapted the initial program theory and implementation plan to specific community contexts, particularly the socio-economic situation and the support from village leadership and other community members. Program implementation mechanisms consisted of integrating available resources, engaging local volunteers, and delivering various Club activities. Preliminary outcomes indicated the success in establishing a community care platform to benefit the emotional and behavioral wellbeing of LBC, and to enhance the community support networks. To ensure program sustainability, the Children's Clubs should explore new funding schemes, expand the pool of qualified volunteers, and improve the curricular and activities at the Clubs.     

Effects of a multimodal activation program (SimA-P) in residents of nursing homes

Is it possible to maintain or even enhance functional and cognitive independence in residents of nursing homes? Little is known about the potentials and limits of therapeutic methods designed to maintain independence in elderly people already in need of residential nursing care. The aim of the “Rehabilitation in Nursing Homes” research project was to determine the practicability and effectiveness of a rehabilitative approach targeting residents of nursing homes. The main objectives of the activation program were to maintain and enhance residents’ cognitive and functional autonomy. Data on psychological, functional, and medical variables were obtained from a sample of 294 nursing home residents (age range?=?70–99 years) at three points of measurement over a 12-month period. The intervention approach draws on the theoretical and practical findings of the SimA Study (“Bedingungen der Erhaltung und Förderung von Selbstständigkeit im höheren Lebensalter,” “conditions on maintaining and supporting independent living in old age”; Oswald et al., Z. Gerontopsychol. Psychiatr., 15:61–84, 2002, Z. Gerontopsychol. Psychiatr., 15:13–31, 2002) and incorporates the results of recent therapeutic and rehabilitative studies in the fields of geriatrics and gerontopsychiatry. The intervention involves a combined program of cognitive and physical activation. An alternative program based on biographical information was designed specifically for residents with dementia. Results show that the intervention had significant effects on cognitive and functional parameters. Moreover, transfer effects were observed with respect to activities of daily living and frequency of falls.     

Process evaluation of “Girls on the Run”: Exploring implementation in a physical activity-based positive youth development program

Many positive youth development programs rely on physical activity as a primary program component. Referred to as physical activity-based youth development programs, these program designs have great potential for promoting healthy youth development. This study examined how one such physical activity-based positive youth development program was implemented in order to identify design features critical to maximizing positive youth outcomes. This mixed method, multi-site process evaluation of Girls on the Run (GOTR) utilized focus groups, site visits, and self-report implementation checklists. Implementation scores were calculated to assess implementation fidelity across twenty-nine sites, and qualitative data were inductively analyzed to identify factors influential for implementation. Results reveal variability in how GOTR was implemented. Five themes emerged from the data that represented factors serving as facilitators or barriers to programmatic implementation. These included contextual/environmental factors (e.g., parental involvement, relationships with school personnel), organizational factors (e.g., implementation support and responsiveness of staff), program-specific factors (e.g., curriculum design), coach factors (e.g., existing relationships with participants, responsiveness to participant's needs), and youth factors (e.g., behavioral and discipline issues). Study findings have implications for improving the design of physical activity-based and other positive youth development programs, with relevance to evaluators, program planners, youth development leaders, and others working with children and youth.     

Faculty in the Middle

This study was designed to explore how organizational life in university-affiliated graduate social work education programs in the United States is affected by the stress of heightened caregiving roles. Analysis of data from 69 schools demonstrated deleterious effects of caregiving stress on organizational effectiveness, including missed obligations, feeling overwhelmed, and distracting others by seeking social support for specific problems. The authors identify two variables that provided partial amelioration of caregiver stress and appeared to contribute to increased organizational effectiveness: larger faculty size and on-site child care.     

Addressing Career Success Issues of African Americans in the Workplace: An Undergraduate Business Program Intervention

Career success as measured by the objective, traditional criteria of the composite of high number of promotions, high annual compensation, and high organizational level in corporate America has eluded the majority of African Americans. This article describes an undergraduate business program career success intervention designed to assist African Americans in overcoming the organizational barriers present in corporate America that prevent their upward mobility, examines its effectiveness, and concludes with implications for research and practice in career development and counseling.     

A pilot intervention to promote walking and wellness and to improve the health of college faculty and staff

There is a need to investigate novel interventions that promote worksite physical activity and wellness. OBJECTIVE: The authors' purpose in this study was to evaluate the effectiveness of a 12-week walking program supplemented with a pedometer, computer educational program, and weekly e-mails. METHODS: College faculty and staff participated in a one-group pre-posttest study to determine whether the 12-week walking intervention had an effect on body mass index (BMI), blood pressure, blood glucose, and cholesterol. The authors also determined participant-perceived wellness effects. RESULTS: The authors observed differences between baseline and follow-up in BMI (p = .024), blood glucose (p = .06), and total cholesterol (p = .09). The program had a moderate effect on fitness, mood, health awareness, nutrition, and health. CONCLUSIONS: It is incumbent that experts develop innovative worksite physical activity and wellness programs. A pedometer-monitored walking program is one way that a worksite health initiative can improve the health and wellness of its employees and simultaneously reduce health-care costs.     

The Adaptive Success Identity Plan (ASIP): A Career Intervention for College Students

The Adaptive Success Identity Plan (ASIP) uses the construct of success identity as the core of a career intervention program. Three empirical studies (N > 2,000) explored the success identity construct and its application in a structured career intervention. Study 1 provided reliability and validity evidence of the measures. Study 2 indicated that programming efforts targeting family involvement, self-efficacy, and stress and time management should enhance a number of college outcomes. Study 3 found that students who received the ASIP intervention were more likely to use the success identity construct in defining their role in college success.     

Borderline and antisocial personality scores as mediators between attachment and intimate partner violence

Court-mandated male batterers (n = 192) attending an intervention program completed measures examining adult attachment orientations (anxious and avoidant), personality disorders (borderline and antisocial), type of violence (psychological and physical), and social desirability. Structural equation modeling was used to determine whether there were significant relationships between anxious attachment and physical and psychological violence that are mediated by either borderline or antisocial personality disorders. Social desirability was included in both models as a covariate. Results indicated that personality disorders fully mediated the relationship between avoidant attachment and physical as well as psychological violence. Personality disorders only partially mediated the relationship between anxious attachment and psychological violence. Implications for intervention are discussed.     

Physical activity and hormone-replacement therapy: interactive effects on cognition?

The purpose of this study was to examine the interactive effects of hormone-replacement therapy (HRT) and physical activity (PA) on the cognitive performance of older women. Postmenopausal women (n = 101) were recruited to complete a PA questionnaire, provide demographic information, and perform the digit-symbol substitution task (DSST) and the trail-making tests (TMT). Regression analyses were conducted for participants with complete data for each cognitive test (DSST n = 62; TMT n = 69). For both tasks, results indicated that PA and education were positively related and age was negatively related to cognitive performance. The interaction of HRT with PA did not add to the predicted variance of either measure of cognitive performance. This was true even after limiting the HRT users to women using unopposed estrogen. It is concluded that the beneficial relationship between PA and these two measures of cognitive performance in postmenopausal women exists irrespective of HRT use.     

Process evaluation of the ‘Singapore Physical Activity and Nutrition Study’

IntroductionThe Singapore Physical Activity and Nutrition Study (SPANS) aimed to improve the physical activity (PA) and nutrition behaviours of Singaporean women aged 50 years and over. The SPANS program consisted of PA classes, nutrition workshops, telephone dietary counselling, health booklets, a health calendar and program ambassadors. This study aimed to assess and understand the implementation of the program strategies and gain insight into process evaluation components to inform future programs.MethodsThe evaluation was guided by a process evaluation framework and collected data via questionnaires (n = 209), program ambassador documentation and exit interviews with program completers (n = 13) and non-completers (n = 12).ResultsIn total, 295 participants completed the program (response rate = 84 %). Participants reported high levels of satisfaction with the overall program (99.5 %) and program activities (96.7 %), and also rated program ambassadors highly. Participation rates were highest for telephone dietary counselling sessions. The main reason for not attending program activities was having a ‘busy schedule’ (n = 158). Participants cited a need for improved recreational centre facilities and increased flexibility around program delivery.ConclusionsThe process evaluation showed that the program strategies were implemented as planned and were deemed suitable for supporting behaviour change among Singaporean women aged 50 years and over. The program reached and involved the majority of participants throughout the six months. The combination of practical educational resources and supportive program ambassadors were key strategies that facilitated positive PA and dietary behaviours. However, there needs to be some flexibility in the delivery of programs. The findings of this research may inform other programs in the region.     

A family systems-based model of organizational intervention

Employee assistance professionals are expected to be proficient at intervening in organizations and creating meaningful behavioral change in interpersonal functioning. Because of their training in family systems theories and concepts, marriage and family therapists (MFTs) are well suited to serve organizations as "systems consultants." Unfortunately, the authors were unable to identify any family systems-based models for organizational intervention that have been empirically tested and supported. In this article, the authors present a family systems-based model of intervention that they developed while working in an employee assistance program (EAP). They also present research that was used to refine the model and to provide initial support for its effectiveness.