Process tracking results from the Treatwell 5-a-Day Worksite Study

PURPOSE: To report findings from Treatwell 5-a-Day process tracking. DESIGN: Worksites were randomly assigned to a minimal intervention control, worksite-only condition, or worksite-plus-family condition. SETTING: Twenty-two small community health centers in Massachusetts. SUBJECTS: Employees of the community health centers. INTERVENTION: Both intervention conditions included the formation of employee advisory boards; activities such as nutrition discussions and taste tests targeting individual behavior change; and point-of-purchase labeling as an environmental strategy. Worksite-plus-family sites incorporated activities such as family contests, campaigns, and picnics. MEASURES: Documentation of the number and type of activities for extent of implementation; number of participants in activities for reach; program awareness and participation from the follow-up employee survey (n = 1306, representing 76% [range, 56%-100%] of the sample); change in fruit and vegetable consumption from a comparison between the follow-up and baseline surveys (n = 1359, representing 87% [range, 75%-100%] of the sample). RESULTS: A higher number of activities per employee was significantly correlated with greater program awareness (.68; p = .006) and greater change in fruit and vegetable consumption (.55; p = .04). Greater participation in activities was significantly correlated with greater awareness (.67; p = .007), higher participation (.61; p = .02), and increase in fruit and vegetable consumption. (.55; p = .04). CONCLUSIONS: These results provide quantitative indicators of a dose-response relationship between the number of intervention activities per employee and higher percentage of employee participation and observed increases in fruit and vegetable consumption.     

Work-site nutrition intervention and employees'' dietary habits: the Treatwell program.

In a randomized, controlled study of the Treatwell work-site nutrition intervention program, which focused on promoting eating patterns low in fat and high in fiber, 16 work sites from Massachusetts and Rhode Island were recruited to participate and randomly assigned to either an intervention or a control condition. The intervention included direct education and environmental programming tailored to each work site; control work sites received no intervention. A cohort of workers randomly sampled from each site was surveyed both prior to and following the intervention. Dietary patterns were assessed using a semiquantitative food frequency questionnaire. Adjusting for work site, the decrease in mean dietary fat intake was 1.1% of total calories more in intervention sites than in control sites (P less than .005). Mean changes in dietary fiber intake between intervention and control sites did not differ. This study provides evidence that a work-site nutrition intervention program can effectively influence the dietary habits of workers.     

Results of employee involvement in planning and implementing the Treatwell 5-a-Day work-site study.

When work-site health promotion programs incorporate theories of community organization, it is likely that employee ownership and participation are enhanced. This article reports quantitative indicators of involvement of Employee Advisory Board (EAB) members in the Treatwell 5-a-Day work-site study and examines relationships between EAB member time spent on project activities and work-site size, with indicators of the extent of implementation and variables associated with behavior change and work-site support. The results reported here indicate that a greater number of EAB member hours spent on program activities was associated with a greater number of events implemented. Smaller work-site size was associated with greater employee awareness of the program and greater participation in project activities as reported on the employee survey. These results suggest that the number of hours employee representatives devote to project activities might be an important consideration in planning employee involvement in work-site health promotion programming.     

Seattle 5-a-Day Work-Site Project: process evaluation.

The Seattle 5-a-Day Work-Site Project developed a community-based intervention to increase fruit and vegetable intake, using both environmental (including cafeteria and work-site-wide events) and individual strategies. The Employee Advisory Board developed its own protocol from a common skeleton and a minimum set of activities. Small work sites and work sites with fewer female employees delivered more displays, posters, and table tents per employee (p < .01 and p < .05, respectively). Dose was neither related to use of the intervention nor to change in fruit and vegetable intake. Use of informational materials increased fruit and vegetable intake in the cohort of employees with both baseline and follow-up data (p = .05). The intervention was associated both with increased employee use of the intervention (activities and materials) and with increased intake of fruit and vegetables. Work sites with medium average baseline intake were the most responsive. These findings can guide the development of more efficient community-based dietary interventions.     

Changing fruit and vegetable consumption among children: the 5-a-Day Power Plus program in St. Paul,Minnesota.

OBJECTIVES: A randomized school based trial sought to increase fruit and vegetable consumption among children using a multicomponent approach. METHODS: The intervention, conducted in 20 elementary schools in St. Paul, targeted a multiethnic group of children who were in the fourth grade in spring 1995 and the fifth grade in fall 1995. The intervention consisted of behavioral curricula in classrooms, parental involvement, school food service changes, and industry support and involvement. Lunchroom observations and 24-hour food recalls measured food consumption. Parent telephone surveys and a health behavior questionnaire measured psychosocial factors. RESULTS: The intervention increased lunchtime fruit consumption and combined fruit and vegetable consumption, lunchtime vegetable consumption among girls, and daily fruit consumption as well as the proportion of total daily calories attributable to fruits and vegetables. CONCLUSIONS: Multicomponent school-based programs can increase fruit and vegetable consumption among children. Greater involvement of parents and more attention to increasing vegetable consumption, especially among boys, remain challenges in future intervention research.     

A dietary education program for hypercholesterolemic children and their parents.

A parent-child autotutorial dietary education program for 4- to 10-year-old, hypercholesterolemic children and their families was developed and pilot tested. The 10-lesson program, designed for weekly use at home, uses a "talking-book" approach (audiotapes with accompanying picture booklet) for the child. Parents are provided with information on ways to make recommended dietary changes, along with hands-on activities to do with the children. To help match the instructional approach to the wide developmental range within the children's age span, materials are divided into three program levels that use different story characters and concept presentations. During program development, evaluation by two children (and their parents) for each of the program levels guided the design and refinement of the lessons. A pilot test among 22 hypercholesterolemic children (whose treatment was limited to diet modification) revealed that children within the 4- to 10-year age range liked the "talking-book" approach and identified positively with the story characters. Parents indicated that their materials were clear and helpful. Between the baseline and 3-month follow-up visits, the children exhibited a significant increase in knowledge of heart healthy foods, a decrease in total fat consumption that approached significance, and a significant decrease in plasma low-density-lipoprotein cholesterol values.     

Stages of change for increasing fruit and vegetable consumption among adults and young adults participating in the national 5-a-Day for Better Health community studies.

Higher fruit and vegetable consumption is associated with a reduced risk of certain cancers and chronic diseases. The 5-a-Day for Better Health community studies are evaluating population-based strategies to achieving dietary behavior change using the stages-of-change model and associated theories. The authors present baseline comparisons of stages of change for fruit and vegetable consumption among adults and young adults in eight study sites representing diverse regions of the United States and diverse populations and settings. Three dominant stages, precontemplation, preparation, and maintenance, were found across sites. Women and those with college degrees were more likely to be in action/maintenance. Fruit and vegetable consumption, self-efficacy, and knowledge of the 5-a-Day recommendation were positively associated with more advanced stages of change in all study sites. The authors discuss the findings in relation to possible limitations of this and other dietary stages-of-change measures and suggest directions for future research.     

The impact of change on family planning services. Implications for health education.

The future looks threatening to district health authority family planning clinics, supportive to general practitioner services, and dismissive of consumer needs. As health education becomes increasingly drawn into the field of Aids and its drug-linked implications, the concern is whether financial priorities will be shifted at the expense of family planning facilities.     

Statewide Dissemination of a Nutrition Program: Show the Way to 5-a-Day

Increasing nutrition education in elementary schools is a goal for all nutrition educators. However, adoption of nutrition programs and curricula by busy teachers is a challenge. The “Show the Way to 5-a-Day” nutrition guide was developed to help young children increase fruit and vegetable consumption by having teachers partner with grocery stores to get produce contributed to the classroom. The guide was based on the principles of Social Cognitive Theory and developed and pilot tested with input from elementary school teachers. The objectives of the current project were to evaluate the systematic, statewide dissemination of this program; determine the importance of teacher training from the state department of health; and determine the factors distinguishing teachers who responded to and/or adopted the program from those who did not. Approximately 50% of teachers accepted a free guide and an additional 50% of these “respondents” reported implementing it. Use of the program was positively influenced by teacher training and, aside from age, there were no significant differences between teachers who adopted the program and those who did not.     

Effect of education on hand hygiene beliefs and practices: a 5-year program.

To evaluate infection control and hand hygiene understanding at 3 public hospitals, we surveyed 4,345 healthcare workers (HCWs) 3 times during a 5-year infection control intervention. The preference for the use of alcohol hand rub for hand hygiene increased dramatically; in nurses, it increased from 14% to 34%; in physicians, 4.3% to 51%; and in allied HCWs, 12% to 44%. Study year, infection control interactive education-session attendance, infection control knowledge, and being a physician or allied HCW independently predicted a preference for alcohol hand rub.     

The family heart dietary intervention program: Community response and characteristics of joining and nonjoining families

A random sample of 501 eligible families was selected from a designated neighborhood in Portland, Oregon, and given the opportunity to join a 5-year intervention program promoting a low-fat and low-cholesterol eating pattern designed to reduce risk for coronary heart disease. Participation entailed three baseline assessments of clinical, dietary, and psychological indices, periodic follow-up measurements, and monthly small group meetings led by psychologists and nutritionists. A prior home health survey allowed comparisons of respondents from joining and nonjoining families in terms of reported health status, health beliefs, health locus of control, knowledge about health and nutrition, and demographic characteristics. Almost half (47%) of all invited families agreed to join this long-term nutrition intervention program and completed the necessary baseline assessments. Factors discriminating joiners and nonjoiners were not generally consistent with the health belief model of preventive health behavior. Joiners were similar to nonjoiners in terms of perceived susceptibility to disease, family health histories, and reports of elevated plasma cholesterol levels in the family. However, families with hypertensive members were less likely to join this heart disease prevention program. Positive predictors of participation included higher occupational status, greater knowledge about heart disease, a more internal health locus of control, and the belief that there are few barriers preventing the adoption of a healthier low-fat eating pattern. These findings indicate that there is widespread community interest in optimal nutrition, and they also provide suggestions as to what motivates the general public to take preventive health actions.