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.     

Worksite and family education for dietary change: the Treatwell 5-a-Day program.

The National Cancer Institute's '5-a-Day for Better Health Campaign is examining the efficacy of interventions in increasing the consumption of fruits and vegetables to five or more servings a day. This paper presents the study design, intervention and baseline survey results of the Treatwell 5-a-Day project, a randomized, controlled worksite-based intervention study. Twenty-two community health centers were randomly assigned to either a Minimal Intervention, Worksite Intervention or Worksite Plus Family Intervention. The Worksite Intervention included participation of employee advisory boards, programs aimed at individual behavior change and programs aimed at changes in the worksite environment. The Worksite Plus Family Intervention incorporated family-focused interventions into the worksite program, including a learn-at-home program, family newsletter, family festival and materials mailings. A self-administered survey was conducted prior to randomization (mean response rate: 87%, n = 1359). Twenty-three percent reported consuming five or more servings of fruits and vegetables a day. Consumption of fruits and vegetables was directly associated with level of household support for healthy eating. The Treatwell 5-a-Day intervention model has the potential to enhance existing worksite-based intervention through incorporation of its family focus, especially given the association of household support with individual eating habits.     

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.     

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.     

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.     

Impact of end user involvement in implementing guidelines on routine pre-operative tests.

OBJECTIVES: To assess the impact of health professionals' involvement in the implementation of practice guidelines aimed at reducing the use of pre-operative tests in patients at low anaesthetic risk undergoing elective surgery. INTERVENTION: A 6 month (September 1997 to February 1998) strategy based upon organization of local meetings involving health professionals from six hospitals of Canton Ticino (Switzerland). DESIGN: Observational study (pre/post) of pre-operative test utilization between March 1996 and December 1998. SUBJECTS AND METHODS: A total of 17,978 patients admitted for elective surgery over the study period. The latter was modelled in six intervals, three before (baseline), one during, and two after (adoption) guidelines implementation, respectively. For each time interval the proportion of patients undergoing pre-operative tests was estimated. Multilevel logistic regression analysis was used to assess patient likelihood [expressed as the odds ratio (OR)] of undergoing a diagnostic test in each period, using the implementation interval as the reference category. MAIN OUTCOME MEASURE: Change in patient probability of undergoing pre-operative tests in the adoption interval. RESULTS: Adoption of the recommendations was associated with 81% [OR = 0.19; 95% confidence interval (CI) 0.15-0.23] reduction of patient probability of undergoing coagulation test, 73% (OR = 0.27; 95% CI 0.23-0.33) for glycaemia, 62% (OR = 0.38; 95% CI 0.33-0.44) for azotaemia, 57% (OR = 0.43; 95% CI 0.36-0.51) for chest X-ray, 49% (OR = 0.51; 95% CI 0.44-0.60) for creatinemia, and 43% (OR = 0.57; 95% CI 0.48-0.69) for ECG. Overall, these findings corresponded to a cost saving of 67,890 Swiss francs (US$42,000) for the last quarter under study. CONCLUSIONS: This study indicates that an implementation strategy based upon direct involvement of end users in the identification of possible barriers to change can be successful in promoting the use of practice guidelines.     

城市区域卫生规划实施中的难点与对策

我国一些地区城市区域卫生规划实施工作在政府牵头、部门配合下已经取得成效。江苏省徐州市企业医院众多,隶属关系复杂,现就我市在城市区域卫生规划实施工作中遇到的难点及对策探讨如下。 1 难点 (1)我市现有医院233所,其中,企业医院占有相当大比例,而且在市区内分布也很不合理:如市一院(三级医院)与口腔医院、公费医院、房管医院、鼓楼医院,市二院(三级医院)与儿童医院、矿一院、建工医院、市六院,市三院与化工医院、电力医院、民政医院、交通医院、粮食医院,市四院(三级医院)与妇幼医院、云龙医院、纺织医院、铁路     

Key factors in planning and implementing interprofessional education in health care settings

Interprofessional education (IPE) is regarded by many health care practitioners (i.e., nurses, occupational therapists, physicians), educators, and policy makers as an important activity to enhance the quality of teamwork and patient care. While the focus on developing an evidence basis for IPE has demonstrated the potential value of IPE for improving collaboration and patient outcomes, exploration of key concepts that underpin IPE has been overlooked. In this commentary, we aim to begin addressing this oversight by identifying and discussing key conceptual factors that are critical for the planning and implementation of IPE. We draw upon our prior IPE curricula development and research experiences, as well as the published literature, to argue that seven interconnecting learner-focused, faculty-focused, and organization-focused factors are key to the successful planning and implementation of IPE. We also argue that IPE planners need to be cognizant of all seven factors and how they interact with one another to help ensure they maximize success in their work.