Recruiting worksites to participate in a health promotion research study

PURPOSE: In this study, the type and size of participating and nonparticipating worksites in a health promotion research trial were examined. DESIGN: In-person and telephone contacts were made with representatives from a random sample of eligible worksites recruited to participate in a research trial to increase fruit and vegetable consumption. SETTING: Worksites that had 250 to 2000 employees and a worksite cafeteria were recruited. SUBJECTS: Eighty-one worksites were contacted. MEASURES: A census of eligible worksites (N = 109) formed the recruitment base, and a random selection of worksites (N = 81) was personally contacted and asked to participate in the research. Information on size, type of worksite, and a worksite representative was obtained from a privately compiled list covering the greater Puget Sound area. Eligibility for the project included the presence of an onsite cafeteria at the worksite as assessed by a brief telephone call. RESULTS: Thirty-six of the contacted worksites (44.5%) agreed to participate. There were no significant differences in participation by type or size of worksite. DISCUSSION: Worksites can be recruited to participate in research trials. No particular type or size of worksite is more likely to participate. Instituting pre-randomization participation conditions may reduce post-randomization dropout by ascertaining compliance with research requirements before randomization.     

Work-site health promotion: the effects of a goal-setting program on nutrition-related behaviors

A Goal Attainment Scaling procedure was used to quantify and evaluate change in nutrition-related behaviors of participants in a work-site wellness program. Goal Attainment Scaling is a procedure for quantifying change over time, in five categories varying from "less than expected" success to "more than expected" success. The sample consisted of 60 enlisted military personnel who had indicated, on a screening questionnaire, their desire to improve dietary practices. The subjects were assigned to three groups but remained unaware throughout the study that nutrition was being investigated. The Goal-Setting/Goal Attainment group (GSGA, no. = 19) received a full 8-week health promotion program, based on goal-setting, fitness information, and skill development (12 sessions). The Goal-Setting group (GS, no. = 19) received only the part of the program that focused on setting goals (two sessions). The control group (no. = 22) received no instruction. Results from analysis of variance indicated that GSGA had significantly higher "Change Scores" in nutrition-related behaviors than the control group (p less than .05); "Change Scores" reflect degree of dietary improvement. Frequency data indicate that dietary improvements were sustained for 84% of the GSGA members, 64% of the GS members, and 37% in the control group. These findings suggest goal-setting skills enhance individuals' capabilities for making and maintaining improvements in nutrition-related behaviors.     

Ethical review of health promotion program evaluation proposals

Some policies state that program evaluation falls within the domain of administrative research that does not require review by an ethics review board. We propose that some health promotion program evaluations include at least one element of research and can be distinguished from quality assurance. Although American and Canadian evaluation societies provide important guidelines and standards for evaluation practitioners, processes for accountability to the public are provided by research ethics boards. The field of health promotion is, by its nature, replete with challenges to existing research ethics boards. Given the dearth of published literature on the ethics of health promotion evaluation or practice, the field could benefit from the open debate that reviews of proposals would encourage.     

Assessing the effects of a health promotion programme for elderly people.

Physical exercise is an increasingly popular health promotion activity for elderly people, although evidence of its effectiveness is limited. We aimed to evaluate the impact of the exercise component of the Look After Yourself (LAY) package promoted by the Health Education Authority in two groups of elderly people attending the 10 weekly sessions which make up the LAY course. Classes 1 and 2 comprised 13 and 18 subjects, aged from 65 to 89 years, and from 58 to 87 years respectively. Class 1 subjects were white with the exception of one Jamaican man, and Class 2 subjects were all Afro-Caribbean. Subjects had measurements of shoulder joint flexibility, grip strength, blood pressure, weight and a self-perceived health questionnaire, the Nottingham Health Profile (NHP) completed at baseline, 10 weeks and at six months. Class 1 showed reductions in grip strength and a deterioration in pain and mobility dimensions of the NHP, whereas Class 2 showed large improvements in shoulder joint flexibility and a small and non-significant trend towards improved self-perceived health. Class 2 subjects felt that they had benefited, and just over half had continued with an exercise programme. These findings suggest that the effect of mild exercise on objective indicators and self-perceived health may depend on the context in which it is done, the type of exercise promoted, and that continued exercise is aided by the provision of further group classes. There is a need for evaluation of the impact of different types of exercise programmes, covering a wider range of indicators of fitness, in larger groups of elderly people.     

Health promotion programs in small worksites: results of a national survey

PURPOSE: This study documents the prevalence of workplace health promotion activities at small worksites with 15 to 99 employees. DESIGN: A random sample of U.S. worksites stratified by size and industry (n = 3628) was drawn using American Business Lists. MEASURES: Each worksite was surveyed using a computer-assisted telephone interview system to document activities related to health promotion and related programs, worksite policies regarding health and safety, health insurance, and philanthropic activities. SUBJECTS: Participation varied by industry and size, with an overall response rate for eligible worksites of 78% for a total sample of 2680 worksites. DATA ANALYSIS: Data were analyzed using SUDAAN statistical software. RESULTS: Approximately 25% of worksites with 15 to 99 employees offered health promotion programs to their employees, compared with 44% of worksites with 100+ employees. As with the larger worksites, the most common programs for worksites with 15 to 99 employees were those related to occupational safety and health, back injury prevention, and CPR. The majority of worksites in both size categories had alcohol, illegal drug, smoking, and occupant protection policies. The majority of both small and large worksites also offered group health insurance to their employees (92% and 98%, respectively), with many of the worksites also extending benefits to family members and dependents (approximately 80% for both business sizes). CONCLUSIONS: The results indicated that small worksites are providing programs to their employees, with a primary focus on job-related hazards. Small worksites also have formal policies regarding alcohol, drug use, smoking, and seatbelt use and offer health insurance to their employees at a rate only slightly lower than that of large worksites.     

A census of economic evaluations in health promotion

While policy makers argue for a greater share of health resources to go to health promotion, action is stalled by, among other things, the perception that little is known about which interventions offer the best health returns. Additionally, what is missing is any sense of what the economic literature in health promotion looks like overall. Where is the economic evidence plentiful and where is it scant? The project described here compiled a census of economic evaluations in health promotion. Studies were classified according to a four-part typology that documented the strategic intent of the intervention, the risk factor being addressed, the population most affected and the setting in which the intervention took place. Since 1990, there have been over 400 economic evaluations of health-promoting interventions in the peer review and grey literatures. Of these, 90% address biological or behavioral determinants of health. Relatively little is known about the economics of population health advocacy or interventions to tackle the social and economic determinants of health. Initiatives are in place to increase the availability of economic evidence. Research is also needed into how to support decision makers' use of imperfect, incomplete and uncertain information.     

The effects of a worksite health promotion program on the wives of fire fighters

One method of increasing the cost-effectiveness of worksite health promotion programs is to develop programs that also have an impact on risk factors of family members and friends of the employees. In this study, 41 wives of fire fighters were interviewed concerning changes the fire fighters and they had made in their health habits--exercise, weight, and consumption of fats, fruits/vegetables, and cereal/whole grain breads--in the previous year. Thirty-two were wives of fire fighters who had received a worksite health promotion program and nine were wives of fire fighters who had not yet received the program. Findings of our exploratory study strongly suggest that wives of fire fighters who received information were more aware of the program (93% vs 56%), had greater exposure to the written diet plan (72% vs 11%) and guide to high fat foods (72% vs 0%) than controls. Furthermore, the intervention led to changes in the fire fighters' health habits that were reported by the wives. No significant changes in the wives' health habits occurred as a result of the intervention, although the changes were in the predicted direction in every category; changes by the wives were, however, related to changes by fire fighters. Involvement of the fire fighters in the preparation of meals and sharing of information from the intervention program by the participant with the wife, were related to change in health habits of the wives.(ABSTRACT TRUNCATED AT 250 WORDS)     

Social capital and health promotion: a review

Interest in social capital and health has emerged at an exciting time. In public health, there is a renewed interest in mechanisms that link social inequalities and health. In epidemiology, there has been a critical interrogation of methods and a call for a more explicit use of theory. In health promotion over the last 20-30 years, social health interventions have been somewhat marginalised in an era dominated by interest in traditional cardiovascular disease risk factors. Now that social hypotheses are being reborn in health, there is a risk that the sophistication that has developed in social health promotion and the literatures that have informed it could be overlooked. In this paper, we present a brief history of social capital and how it has come into recent prominence through the debate linking income inequality and health. We present the background to this, the earlier literatures on social environmental influences on health and the possible processes thought to underlie this relationship. Social capital has relational, material and political aspects. We suggest that, although the relational properties of social capital are important (eg, trust, networks), the political aspects of social capital are perhaps under recognised. The paper also reviews how complex social processes at the community level have come to be operationalised by social theorists and intervention agents in other fields. We suggest that social capital research so far has inadequately captured the underlying constructs, in particular the qualitative difference between the macro/context level and the micro/individual level. While being cautious about the science, we conclude that social capital's power as rhetoric and as a metaphor may be of value. We conclude by suggesting that the coalescence of interests in context-level influences on health now invites a revitalisation of theories and interventions inspired by diverse fields, such as geography and ecological community psychology.     

'Settings' based health promotion: a review.

Over the past 10 years, 'settings' based health promotion has become a central feature of efforts to promote health that recognize the significance of context. Emerging in part from a perception of an over-reliance on individualistic methods, the approach was built on a profound belief in its value and deployed a range of novel theoretical resources, mainly from organizational sociology and psychology. This initial enthusiasm has been maintained within policy directives, in the published literature and, from our own experience, amongst health promotion practitioners. At the same time, with the maturing of the approach, has come a healthy element of critical review. Drawing upon the literature and based upon our experiences within the Health Education Board for Scotland, this paper seeks to bring together a range of perspectives, casting a critical yet constructive eye on current settings theory and practice. The paper first reviews the nature of settings based work, highlighting the varied bases and expectations that underpin it. Similarly, the many factors that influence the ability of health promoters to deliver such activities are considered. In relation to the construction and delivery of such activity, the paper suggests that there needs to be an explicit and detailed assessment of the nature of the setting, the skills of the health promoter and the associated expectations.     

Sustained effects evaluations of a Chapter 1 program

The purpose of this longitudinal study was to examine the sustained effectiveness of the federally-funded Chapter 1 instructional support program and to explore the implications of the findings for the program, schools, and the students selected to receive those services. The sample included six cohorts of educationally disadvantaged students [three in reading and three in mathematics] who received these services between 1988 and 1990 in grades 2, 3, and 4. Student achievement data were derived from the results of norm referenced testing in Spring 1988, 1989, and 1990. The metric of analysis was the Normal Curve Equivalent [NCE]. The analyses were limited to gain score methodology designed for the evaluation of the Chapter 1 program. The findings were [1] the Grade 2 cohorts in reading and mathematics and the Grade 3 cohorts in reading increased their achievement gains at the end of the first year and sustained these gains to the sustained effects testing point; and [2] the Grade 3 cohorts in mathematics and the Grade 4 cohorts in reading and mathematics did not achieve positive gains at the end of the first year but exceeded their baseline scores at the sustained effects testing point. Conclusion: the effectiveness of the Chapter 1 program, as an instructional support, is more evident in the lower grades than it is in the upper grades, and more so in reading than in mathematics. An implication of these results is that further investigation is required to determine the influencing variables in the lower grades and to isolate the problem in the upper grades.     

Assessing food selection in a health promotion program: validation of a brief instrument for American Indian children in the southwest United States

OBJECTIVE: Brief dietary assessment instruments are needed to evaluate behavior changes of participants in dietary intervention programs. The purpose of this project was to design and validate an instrument for children participating in Pathways to Health, a culturally appropriate, cancer prevention curriculum. DESIGN: Validation of a brief food selection instrument, Yesterday's Food Choices (YFC), which contained 33 questions about foods eaten the previous day with response choices of yes, no, or not sure. Reference data for validation were 24-hour dietary recalls administered individually to 120 students selected randomly. SUBJECTS: The YFC and 24-hour dietary recalls were administered to American Indian children in fifth- and seventh-grade classes in the Southwest United States. STATISTICAL ANALYSES PERFORMED: Dietary recalls were coded for food items in the YFC and results were compared for each item using percentage agreement and the kappa statistic. RESULTS: Percentage agreement for all items was greater than 60%; for most items it was greater than 70%, and for several items it was greater than 80%. The amount of agreement beyond that explained by chance (kappa statistic) was generally small. Three items showed substantial agreement beyond chance (kappa > or = 0.6); 2 items showed moderate agreement (kappa = 0.40 to 0.59) most items showed fair agreement (kappa = 0.20 to 0.39). The food items showing substantial agreement were hot or cold cereal, low-fat milk, and mutton or chile stew. Fried or scrambled eggs and deep-fried foods showed moderate agreement beyond chances. CONCLUSIONS: Previous development and validation of brief food selection instruments for children participating in health promotion programs has had limited success. In this study, instrument-related factors that apparently contributed to poor agreement between data from the YFC and 24-hour dietary recall were inclusion of categories of foods vs specific foods; food knowledge, preparation, and vocabulary, item length, and overreporting of attractive foods. Collecting and scoring the 24-hour recall data may also have contributed to poor agreement. Further development of brief instruments for evaluating changes in children's behavior in dietary programs is necessary. Factors related to the YFC that need further development may be issues that are also important in the development of effective, brief dietary assessments for children as individual clients or patients.     

Development and effects of a health promotion program utilizing the mail function of mobile phones

PURPOSE: The purpose of the study was to develop a health education program, named "i-exerM," utilizing the mail function of the mobile phone and affect its effects setting body weight reduction as the achievement target. METHODS: The i-exerM was developed with 136 adults (28 males and 108 females) living or working in Shizuoka Prefecture, and subscribing to the i-mode of NTT DoCoMo orJ-sky of JPHONE (currently Vodafone), who indicated an interest in participating in a body weight reduction twelve week (between July 15th and October 9th, 2003) program. As-one of the special characteristics of the i-exerM, the subjects were informed once every day via mailing to the mobile phone some new items regarding body weight reduction knowledge and practice. By use of a self-monitoring method, the subjects were asked to register the body weight via internet from time to time. Information for each individual at the start and the end of the i-exerM monitoring session was collected with a questionnaire covering physical conditions, lifestyle and program evaluation, without an meeting with the participants during the program. From this trial result, the enforcement potential of healthy education utilizing the mail function of mobile phones was examined. RESULTS: 1) Those who submitted a questionnaire before the i-exerM start and after the end were 14 adult (50%) males and 69 adult (64%) females. 2) A tendency for reduced body weight was found in 63 (46%) of 136 adults who participated in the i-exerM. Furthermore, average body weights were significantly reduced (P < 0.001) from 73.2 kg to 71.1 kg (males), and from 58.8 kg to 57.6 kg (females). 3) The i-exerM program was evaluated positively, 44 adults (32%) indicating that it was "greatly effective" for "stimulating consideration of body reduction and starting concrete efforts." CONCLUSION: The success of the current i-exerM program suggests its possible application for chronic disease states such as hypertension and hyperlipidemia.