Carol H. Pullen

Determinants of health-promoting lifestyle behaviors in rural older women.

The purpose of this study was to: (a) describe the health-promoting lifestyle behaviors and attempts at change among 102 community-dwelling rural women aged 65 and older, and (b) determine the extent to which personal influences (demographics, definition of health, and perceived health status) and contextual influences (sources of health information and provider counseling) explain health-promoting lifestyle behaviors and attempts at change among those women. They scored highest on frequency of nutrition behaviors and lowest on frequency of physical activity behaviors. They had attempted change in from zero to five areas of health-promoting lifestyle within the past year. Multiple regression analyses revealed that younger age, living with other(s), defining health as wellness, better perceived mental health, more sources of health information and provider counseling were significantly associated with health-promoting lifestyle behaviors. Only younger age and more sources of health information were significantly associated with attempts at change. These findings provide information that is relevant in designing interventions to enhance health-promoting lifestyle behaviors among rural older women.

Tailored versus standard internet-delivered interventions to promote physical activity in older women.

Purpose: While substantial evidence demonstrates physical activity is effective at reducing risk for cardiovascular and other diseases, the percentage of older women participating in regular activity is low. The Internet offers an alternative method for delivery of a primary prevention intervention. This preliminary study examined the feasibility and effectiveness of using the Internet to deliver behavior change interventions for promoting physical activity in women ages 50‐69 years. Methods: Thirty‐one healthy women (56.1 ± 4.9 years) were randomly assigned to either tailored or standard newsletter groups. Both groups received 3 Internet‐delivered newsletters at baseline, 1 month, and 2 months. Behavioral markers and biomarkers were measured at baseline and postintervention. Post‐testing occurred at 3 months (1 month after delivery of the third newsletter). Results: Repeated measures ANOVAs revealed improvement in measures of flexibility and perceived barriers to exercise for both groups. For the standard group, improvement occurred in % body fat while VO2max declined. Women indicated the newsletters were helpful in influencing behavior change. Conclusion: Internet‐delivered newsletters appeared feasible and promising for favorably influencing perceptions about barriers to physical activity in these women. Selfreported physical activity did not increase although selected biomarkers did improve. Whether tailored or standard messaging was more effective was inconclusive.

Use and Reliability of the World Wide Web Version of the Block Health Habits and History Questionnaire with Older Rural Women

OBJECTIVE To estimate the parallel forms reliability of the paper and pencil and World Wide Web versions of the 1998 Block Health Habits and History Questionnaire (HHHQ) and to examine the feasibility of older women using the Web version. DESIGN Within a 2-week period, participants completed both the paper and pencil and Web versions of the HHHQ and pre- and postsurveys about their comfort level and experience in using the computer. SUBJECTS A convenience sample of 31 white women, aged 58.2 6.3 years, from a rural location were recruited via direct mail, public service announcements, and public posters. VARIABLES MEASURED The parallel forms reliability of the HHHQ administered in two different ways and the perceptions of the women on their computer use were measured. ANALYSIS Dietary data were analyzed using Pearson correlations and paired t tests. Alpha significance level was set at P <or=.05. RESULTS The Web HHHQ had adequate reliability when compared with the paper and pencil version; paired sample correlations approximated acceptable coefficients (r >.70), with only vitamin C (r =.54) and iron (r =.65) falling below the acceptable standard. Eleven women indicated initial discomfort with the computer, but after the study, only three said they were uncomfortable completing the on-line survey. IMPLICATIONS Internet dietary assessment tools could be a feasible assessment tool for older women to self-administer.

Determinants of Older Rural Women’s Activity and Eating

This research examined the relationship of cognitive-perceptual determinants from the Health Promotion Model to physical activity and healthy eating at baseline of a clinical trial among rural women aged 50 to 69. Two multivariate regression analyses with canonical correlation (N = 179) each yielded one interpretable canonical variate that explained similar amounts of variance (21.7% and 22.5%) in sets of activity and eating variables. In both analyses, the determinants set is a linear combination of all four cognitive-perceptual constructs from the model (perceived self-efficacy, benefits, barriers, interpersonal influences). The activity behavior set included caloric expenditure, VO2max, and stretching and strengthening activity, whereas the eating behavior set included daily percentage of calories from fat and servings of fruits and vegetables, meat, and whole grains. As predicted by theory, greater self-efficacy, benefits and interpersonal support, and fewer barriers are associated with desirable healthy lifestyle behaviors.

Clinical trial of tailored activity and eating newsletters with older rural women

Background: Unhealthy diet and lack of physical activity increase rural midlife and older womens risk of chronic diseases and premature death, and they are behind urban residents in meeting Healthy People 2010 objectives. Objectives: The objective of this study was to compare a tailored intervention based on the Health Promotion Model with a generic intervention to increase physical activity and healthy eating among rural women. Methods: In a randomized-by-site, community-based, controlled, clinical trial, Wellness for Women, 225 women aged 50 to 69 years were recruited in two similar rural areas. Over 12 months, women received by mail either 18 generic newsletters or 18 newsletters computer tailored on Health Promotion Model behavior-specific cognitions (benefits, barriers, self-efficacy, and interpersonal support), activity, and eating. Outcomes at 6 and 12 months included behavioral markers and biomarkers of physical activity and eating. Data were analyzed by repeated-measures analysis of variance and chi-square tests (&agr; < .05). Results: Both groups significantly increased stretching and strengthening exercise and fruit and vegetable servings and decreased percentage of calories from fat, whereas only the tailored group increased moderate or greater intensity activity and decreased percentage of calories from saturated fat from baseline to 6 months. Both groups increased stretching and strengthening exercise, whereas only the tailored group increased moderate or greater intensity activity and fruit and vegetable servings and decreased percentage of calories from fat from baseline to 12 months. Both groups had several changes in biomarkers over the study. A higher proportion of women receiving tailored newsletters met Healthy People 2010 criteria for moderate or greater intensity activity, fruit and vegetable servings, and percentage of calories from fat at 12 months. Discussion: Mailed computer-tailored and generic print newsletters facilitated the adoption of change in both activity and eating over 6 months. Tailored newsletters were more efficacious in facilitating change over 12 months.

Feasibility of Internet-delivered weight loss interventions among rural women ages 50-69.

Purpose: The increased availability and use of the Internet by midlife and older women who seek health information may provide an innovative method for delivering weight loss interventions. This preliminary study examined the feasibility and efficacy of web‐based interventions for promoting weight loss among rural overweight and obese women ages 50‐69 (M =55.5 ± 4.9) over a 3‐month period. Methods: Twenty‐one Caucasian women with body mass index of 28‐34.5 (M = 30.69 ± 2.58) were randomly assigned to either a Web site only or Web site augmented with a peer‐led support group. The Web site included recommended approaches to healthy eating and activity, weekly newsletters, and other resources. Body weight, eating, and activity measures were assessed at baseline and postintervention. Data analysis included 2‐way repeated measures ANOVAs with effect sizes reported as appropriate for a pilot study. Results: Sixteen women (76.2%) completed the study; 14 lost from 2% to 10% of their body weight, and 2 gained 2% of their weight. Large effect sizes were found over time for body weight, estimated VO2max, and percentage of calories from fat. For time by group interaction, large effect sizes favoring the Web site plus peer‐led support group were found for body weight, waist circumference, percent body fat, whole grain servings, and both systolic and diastolic blood pressure. Process evaluations indicated that 85.7% of women accessed the Web site weekly. There were a total of 305 hits in the Web site only group versus 658 hits in the peer‐led support groups. Conclusions: Internet delivered interventions appeared feasible for these rural women with weight loss and improvement in selected eating and activity measures after 3 months.

Advancing Symptom Science Through Use of Common Data Elements.

BACKGROUND Use of common data elements (CDEs), conceptually defined as variables that are operationalized and measured in identical ways across studies, enables comparison of data across studies in ways that would otherwise be impossible. Although healthcare researchers are increasingly using CDEs, there has been little systematic use of CDEs for symptom science. CDEs are especially important in symptom science because people experience common symptoms across a broad range of health and developmental states, and symptom management interventions may have common outcomes across populations. PURPOSES The purposes of this article are to (a) recommend best practices for the use of CDEs for symptom science within and across centers; (b) evaluate the benefits and challenges associated with the use of CDEs for symptom science; (c) propose CDEs to be used in symptom science to serve as the basis for this emerging science; and (d) suggest implications and recommendations for future research and dissemination of CDEs for symptom science. DESIGN The National Institute of Nursing Research (NINR)-supported P20 and P30 Center directors applied published best practices, expert advice, and the literature to identify CDEs to be used across the centers to measure pain, sleep, fatigue, and affective and cognitive symptoms. FINDINGS We generated a minimum set of CDEs to measure symptoms. CONCLUSIONS The CDEs identified through this process will be used across the NINR Centers and will facilitate comparison of symptoms across studies. We expect that additional symptom CDEs will be added and the list will be refined in future work. CLINICAL RELEVANCE Symptoms are an important focus of nursing care. Use of CDEs will facilitate research that will lead to better ways to assist people to manage their symptoms.

Maintenance of activity and eating change after a clinical trial of tailored newsletters with older rural women.

Background:In the Wellness for Women Project, a randomized-by-site 1-year controlled clinical trial, the efficacy of generic newsletters and newsletters tailored on Health Promotion Model behavior-specific cognitions, eating behavior, and activity behavior were compared among 225 women aged 50 to 69 years. Objectives:The purpose of this study was to compare the maintenance of change in healthy eating and physical activity over the 12 months following the tailored versus generic mailed newsletter intervention. Methods:Outcomes at 18 and 24 months included behavioral markers and biomarkers of physical activity and eating. Data were analyzed using the multivariate approach to repeated measures analysis of variance and generalized estimating equations (α <.05). Results:At 18 months, the tailored group maintained levels of all eating and activity behaviors, whereas the generic group maintained levels of fruit and vegetable servings, a moderate or greater activity, stretching exercise, lower body strength and flexibility but increased saturated fat intake and declined in weekly strength exercise and cardiorespiratory fitness. At 24 months, both groups maintained or returned to 12-month levels of all eating behaviors,moderate or greater activity, stretching exercise, and flexibility but declined in cardiorespiratory fitness; the tailored group maintained levels of strength exercise and lower body strength, whereas the generic group decreased in both. A greater proportion of women who received tailored newsletters continued to achieve most Healthy People 2010 criteria for eating and activity. Discussion:Mailed tailored print newsletters were more efficacious than generic newsletters in facilitating maintenance of change in eating and activity for 6 months postintervention. Both tailored and generic newsletters facilitated the maintenance of change in eating behaviors and in moderate or greater physical activity and stretching exercise, whereas tailored newsletters were more efficacious in maintaining change in strength exercise for 12 months postintervention.

Implementing common data elements across studies to advance research

Challenges arise in building the knowledge needed for evidence-based practice partially because obtaining clinical research data is expensive and complicated, and many studies have small sample sizes. Combining data from several studies may have the advantage of increasing the impact of the findings or expanding the population to which findings may be generalized. The use of common data elements will allow this combining and, in turn, create big data, which is an important approach that may accelerate knowledge development. This article discusses the philosophy of using common data elements across research studies and illustrates their use by the processes in a developmental center grant funded by the National Institutes of Health. The researchers identified a set of data elements and used them across several pilot studies. Issues that need to be considered in the adoption and implementation of common data elements across pilot studies include theoretical framework, purpose of the common measures, respondent burden, teamwork, managing large data sets, grant writing, and unintended consequences. We describe these challenges and solutions that can be implemented to manage them.

Caregiving demand and difficulty in older adult spousal caregivers after coronary artery bypass surgery

The purpose of this study was to describe the caregiving demands and difficulties for older adult spousal caregivers of coronary artery bypass (CAB) surgery patients. Caregiving demands and difficulties were measured by the Caregiving Burden Scale. The sample size was 35 caregivers of CAB surgery patients who were, on average, 60 years old and 19 days since hospital discharge. Descriptive analysis revealed that the top four most demanding caregiving activities perceived by spousal caregivers were providing transportation, additional household tasks, providing emotional support, and two tied for fourth: monitoring symptoms and additional tasks outside the home. The top four most difficult caregiving tasks were additional household tasks, providing transportation, and two tied for third: additional tasks outside home and managing behavior problems. Also, caregivers reported experiencing more demands than difficulties. Examining the demanding and difficult caregiving tasks provides information from which to develop and test tailored interventions for caregivers of this population.