Christiaan G. Abildso

A Mixed Methods Evaluation of a 12-Week Insurance-Sponsored Weight Management Program Incorporating Cognitive-Behavioral Counseling

Physical activity is critical in healthy weight loss, yet there is still much to be learned about psychosocial mechanisms of physical activity behavior change in weight loss. A sequential mixed methods approach was used to assess the physical and psychosocial impact of a 12-week cognitive—behavioral weight management program and explore factors associated with weight loss. Quantitative data (N = 55) revealed program completion rate and mean percentage weight loss that compare favorably with other interventions, and differential psychosocial impacts on those losing more weight. Telephone interviews (n = 11) revealed four potential mechanisms for these differential impacts: (a) fostering accountability, (b) balancing perceived effort and success, (c) redefining ‘‘success,’’ and (d) developing cognitive flexibility.

Rural Active Living: A Call to Action

Rural residents are less physically active than their urban counterparts and disproportionately affected by chronic diseases and conditions associated with insufficient activity. While the ecological model has been successful in promoting and translating active living research in urban settings, relatively little research has been conducted in rural settings. The resulting research gap prohibits a comprehensive understanding and application of solutions for active living in rural America. Therefore, the purpose of this article was to assess the evidence base for an ecological model of active living for rural populations and outline key scientific gaps that inhibit the development and application of solutions. Specifically, we reexamined the 4 domains conceptualized by the model and suggest that there is a dearth of research specific to rural communities across all areas of the framework. Considering the limited rural-specific efforts, we propose areas that need addressing to mobilize rural active living researchers and practitioners into action.

Predictors of Clinically Significant Weight Loss and Participant Retention in an Insurance-Sponsored Community-Based Weight Management Program

Health insurance providers are a logical partner in providing third-party payment for behavioral weight loss programming, but little evidence of predictors of improved outcomes or retention in large, insurance-sponsored lifestyle programming is available. The purpose was to determine predictors of weight loss and retention in an insurance-sponsored, community-based weight management program. Current and former participants (N = 2,106) were recruited to complete a program evaluation survey. Respondents’ survey and objective outcome data (n = 766) were analyzed using logistic regression procedures to understand the factors predictive of clinically-significant (5%) weight loss and program retention (>6 months). Clinically significant weight loss was predicted by completing more than 6 months of the program, positive ratings of staff interaction, and social support from friends on success. Ratings of positive impact of site hours of operation, nurse calls, and availability of safe places to be active and feeling comfortable at the site were predictive of program retention. Modifiable intervention, social factors, and site-level factors were predictive of clinically significant weight loss and program retention, providing fodder for further study and dissemination to current providers and to a broader network of health promotion professionals.

The importance of being parsimonious: reliability of a brief community walkability assessment instrument.

This research presents the Leyden Walkability Instrument (LWI), a brief survey checklist designed to measure the perceived walkability of a neighborhood or community where a respondent lives. The reliability of this instrument was tested using the intra-class correlation and found to be moderately substantially reliable (Landis-Koch rating) in every survey item (ranging from .54 to .76 and ranging in observed agreement from 72.8% to 93.9% with an overall instrument score of .71 and an observed agreement of 81.6%). The LWI is discussed in the context of other survey instruments designed to measure perceived walkability and found to be a useful addition because of its brevity and ease of use.

Predictors of weight loss maintenance following an insurance-sponsored weight management program.

Intentional weight loss among overweight and obese adults (body mass index ≥ 25 kg/m2) is associated with numerous health benefits, but weight loss maintenance (WLM) following participation in weight management programming has proven to be elusive. Many individuals attempting to lose weight join formal programs, especially women, but these programs vary widely in focus, as do postprogram weight regain results. We surveyed 2,106 former participants in a community-based, insurance-sponsored weight management program in the United States to identify the pre, during, and post-intervention behavioral and psychosocial factors that lead to successful WLM. Of 835 survey respondents (39.6% response rate), 450 met criteria for inclusion in this study. Logistic regression analyses suggest that interventionists should assess and discuss weight loss and behavior change perceptions early in a program. However, in developing maintenance plans later in a program, attention should shift to behaviors, such as weekly weighing, limiting snacking in the evening, limiting portion sizes, and being physically active every day.

Measuring policy and related effects of a health impact assessment related to connectivity

Health Impact Assessments are an important tool to help policymakers perceive the potential positive and negative contributions of decisions to public health. While they have been increasingly used in the United States, studies have not examined intermediate effects. Using key stakeholder interviews, this manuscript examines policy outcomes and other related effects of the HIA 21months after completing a Health Impact Assessment Report around connectivity policy. Further, it reflects on the measurement of these effects as part of the monitoring and evaluation stage of the Health Impact Assessment process.

Motivated to walk but nowhere to walk to: Differential effect of a mass media campaign by mix of local destinations

Objective Built environment attributes are associated with walking but little is known about how the impact of walking campaigns varies across different environments. The objective of this study was to compare the impact of a campaign on changes in walking between respondents with a high versus low mix of local destinations. Methods Pre- and post-campaign data from a quasi-experimental study were used to compare changes in walking for residents aged 40–65 with high and low destination mix in a West Virginia community campaign (March–May 2005). Results Overall samples consisted of 777 intervention community respondents and 388 comparison community respondents with pre- and post-campaign data. Among insufficiently active intervention respondents, those with high destination mix increased their walking by 0.64 days more than those with low mix (p < 0.05). No significant differences were observed among the comparison community. Conclusion The walking response to campaigns in those insufficiently active may be influenced by neighborhood attributes.

Evaluation of an Intimate Partner Violence Training for Home Visitors Using the Theory of Planned Behavior

Introduction. Intimate partner violence (IPV) is a public health issue with recent intervention focus by home visiting programs with at-risk families in the United States. Home visitors are typically required to assess IPV but feel unprepared to do so and desire training. Our aim was to evaluate the impact of a daylong IPV training on the intention to enact three key IPV behaviors (screening, making referrals, and safety planning) using the theory of planned behavior. Method. Survey of 125 home visitors in West Virginia was conducted before and after a daylong IPV training. Results. The IPV training had a positive impact on intention to perform the three behaviors of interest, with the greatest impact on the intention to conduct IPV screenings. Discussion. Results provide important preliminary evidence supporting the effectiveness of professional development as a means of increasing intentions to conduct activities related to IPV. The impact on IPV screening intention is promising because screening is the first step in addressing IPV. Conclusion. The IPV training proved beneficial in increasing intentions and such trainings should be expanded, but further study is needed to link intentions to subsequent behaviors to address IPV with at-risk families.

Impact of an Intimate Partner Violence Training on Home Visitors’ Perceived Knowledge, Skills, and Abilities to Address Intimate Partner Violence Experienced by Their Clients

Aims. The aims of this study were to (1) evaluate the effects of a statewide intimate partner violence (IPV) training on home visitors’ perceived knowledge, skills, and abilities to address IPV experienced by their clients and (2) examine home visitors’ perceived barriers to addressing IPV during client home visits. Methods. In 2015, five equivalent, daylong IPV trainings were held throughout West Virginia. Attendance was mandatory for all home visitors in the state. Pre- and posttraining surveys were administered to every attendee (N = 125). The surveys assessed home visitors’ perceived knowledge, skills, and abilities to address IPV experienced by their clients and perceived barriers to addressing IPV during a client home visit. Results. The results showed (1) home visitors’ knowledge, skills, and abilities significantly improved from pre- to posttraining (all p < .05) and (2) the most commonly reported barriers to addressing IPV were “the partner is present for the visit” (86.2%), “worried that asking may risk my relationship with my client” (30.2%), “not sure how to ask questions without seeming too intrusive” (25.9%), and “worried about upsetting the client” (21.6%). Conclusions. Our findings highlight the immediate positive effects of an IPV training on home visitors’ professional capabilities to address IPV experienced by clients and the most prevalent barriers home visitors face when addressing IPV that should be targeted in future health education interventions.

The Impact of Community Input in Community Health Needs Assessments

Objective: To determine the impact of community participation on nonprofit hospital priorities as outlined in a Community Health Needs Assessment. Design: Using 3 completed Community Health Needs Assessments, we compare key stakeholder survey responses with community survey responses and determine their contribution to the finalized priorities. Setting: Three communities in West Virginia served by nonprofit hospitals (1 metropolitan statistical area, 1 micropolitan statistical area, and 1 rural community). Participants: Key stakeholders and the general population of communities served by the hospital. Main Outcome Measure: Finalized priorities as outlined in the Community Health Needs Assessment. Results: Community participation had an impact on finalized priorities. Conclusion: Community participation is key in identifying unique health needs and should be incorporated into the assessment process by nonprofit hospitals, local health departments, and other public health practitioners. As reforms are considered to the Patient Protection and Affordable Care Act, it will be important to emphasize the importance of community input in identifying ways nonprofit hospitals contribute community benefit. CHNAs without adequate public input may not translate into implementation plans that accurately address pressing health concerns.