Elizabeth G. Eakin

Quality of Life and Associated Characteristics in a Large National Sample of Adults With Diabetes

OBJECTIVE This study investigated the quality of life and the demographic, medical-history, and self-management characteristics associated with it. RESEARCH DESIGN AND METHODS A diabetes self-management survey was sent to 2,800 adults with diabetes throughout the U.S. who were part of a marketing company national sample. The response rate was 73%. The final sample of 2,056 persons was heterogeneous: the average age was 59 years (range, 18–92 years); 53% had high school education or less; 86% had type II diabetes; 62% were female; and 31% reported being on an intensive management plan, such as the one used in the Diabetes Control and Complications Trial. Quality-of-life items included the social, physical, and mental health dimensions of the Short Form (SF-20) of the General Health Survey. RESULTS Overall, respondents reported a moderate to low quality of life, relative to previous studies. Factors related to lower quality of life included: less education, lower income, older age, being female, type of health insurance (no medical insurance or Medicare/Medicaid recipients reported lower quality of life than those with either a health maintenance organization or private insurance), number of diabetes complications, number of comorbid illnesses, and lower levels of physical activity. Multiple regression analyses revealed that the level of self-reported exercise was the only significant self-management behavior to predict the quality of life, after controlling for demographic and medical variables. CONCLUSIONS If the findings regarding physical activity are replicated, it may be that moderate-intensity physical activity programs could be initiated with diabetic individuals at risk of low quality of life. Quality of life is an important and understudied topic in diabetes that appears to be related to demographic, medical-history, and self-management factors.

Physician advice and support for physical activity: Results from a national survey

BACKGROUND It is increasingly well documented that physical activity (PA) is a key preventive behavior and that visits to a physician provide an important opportunity for advice and counseling. This paper reports on physician counseling behaviors regarding PA and other chronic disease risk factors from a national survey. METHODS A diverse sample of U.S. adults (N=1818), with oversampling of lower-income households, was surveyed about their PA level as well as a host of social, environmental, and physician counseling issues. RESULTS Overall, 28% of respondents reported receiving physician advice to increase their PA level. Of those who received advice, only 38% received help formulating a specific activity plan and 42% received follow-up support. Patients who received advice and support were more likely to be older, nonwhite, and to have more chronic illnesses and more contact with their doctor. CONCLUSIONS Physician advice, counseling, and follow-up are important components of the social-environmental supports needed to increase population PA levels. Health system changes, including teaching communication skills, prompts to use those skills, and system changes to support attention to PA, are needed to extend promotion of PA to more patients.

Lymphedema after gynecological cancer treatment - prevalence, correlates, and supportive care needs

Few studies have evaluated lymphedema after gynecological cancer treatment. The aim of this research was to establish prevalence, correlates, and supportive care needs of gynecological cancer survivors who develop lymphedema.

Systematic review of maintenance of behavior change following physical activity and dietary interventions

OBJECTIVE In the past decade, there has been no systematic review of the evidence for maintenance of physical activity and/or dietary behavior change following intervention (follow-up). This systematic review addressed three questions: 1) How frequently do trials report on maintenance of behavior change? 2) How frequently do interventions achieve maintenance of behavior change? 3) What sample, methodologic, or intervention characteristics are common to trials achieving maintenance? DESIGN Systematic review of trials that evaluated a physical activity and/or dietary behavior change intervention among adults, with measurement at preintervention, postintervention, and at least 3 months following intervention completion (follow-up). MAIN OUTCOME MEASURES Maintenance of behavior change was defined as a significant between-groups difference at postintervention and at follow-up, for one or more physical activity and/or dietary outcome. RESULTS Maintenance outcomes were reported in 35% of the 157 intervention trials initially considered for review. Of the 29 trials that met all inclusion criteria, 21 (72%) achieved maintenance. Characteristics common to trials achieving maintenance included those related to sample characteristics (targeting women), study methods (higher attrition and pretrial behavioral screening), and intervention characteristics (longer duration [>24 weeks], face-to-face contact, use of more intervention strategies [>6], and use of follow-up prompts). CONCLUSIONS Maintenance of physical activity and dietary behavior change is not often reported; when it is, it is often achieved. To advance the evidence, the field needs consensus on reporting of maintenance outcomes, controlled evaluations of intervention strategies to promote maintenance, and more detailed reporting of interventions.

A social-ecologic approach to assessing support for disease self-management: the Chronic Illness Resources Survey.

We report on the development and validation of an instrument to assess support and resources for chronic illness management (the Chronic Illness Resources Survey; CIRS). The 64-item full instrument and the 29-item Brief CIRS are based on a social–ecologic model, designed to apply across chronic diseases, and assess support and resources at each of seven levels (e.g., family and friends, physician and health care team, neighborhood/community). A prospective evaluation with 123 patients having heart disease, arthritis, diabetes, and/or COPD revealed that the overall instrument, as well as subscales and the brief instrument, had acceptable internal consistency, moderate to high test–retest reliability, good construct validity, and moderate concurrent and prospective criterion validity. We discuss potential uses of the CIRS for assessment, feedback, tailoring intervention, and evaluation and make recommendations for future research.

Feasibility of Reducing Older Adults' Sedentary Time

BACKGROUND Sedentary time (too much sitting, as distinct from lack of exercise) is a prevalent risk to health among older adults. PURPOSE Examine the feasibility of an intervention to reduce and break up sedentary time in older adults. DESIGN A pre-experimental (pre-post) study. SETTING/PARTICIPANTS A total of 59 participants aged ≥60 years from Brisbane, Australia. Data were collected between May and December 2009 and analyzed in 2010. INTERVENTION One face-to-face goal-setting consultation and one individually tailored mailing providing feedback on accelerometer-derived sedentary time, grounded in social cognitive theory and behavioral choice theory. MAIN OUTCOME MEASURES Program reach and retention; changes in accelerometer-derived sedentary time, light-intensity physical activity (LIPA), and moderate-to-vigorous-intensity physical activity (MVPA) (assessed over 6 days in pre- and post-intervention periods); and participant satisfaction. RESULTS Reach was 87.5% of those screened and eligible; retention was 100%. From pre- to post-intervention, participants decreased their sedentary time [-3.2% (95% CI= -4.18, -2.14), p<0.001], increased their breaks in sedentary time per day [4.0 (1.48, 6.52), p=0.003], and increased their LIPA [2.2% (1.40, 2.99), p<0.001] and MVPA [1.0% (0.55, 1.38), p<0.001]. Significantly greater reductions in sedentary time were made after 10:00am, with significantly greater number of breaks occurring between 7:00pm and 9:00pm. Participants reported high satisfaction with the program (median 9/10). CONCLUSIONS Sedentary time in older adults can be reduced following a brief intervention based on goal setting and behavioral self-monitoring.

Telephone-Delivered Interventions for Physical Activity and Dietary Behavior Change : An Updated Systematic Review

CONTEXT Telephone-delivered interventions targeting physical activity and dietary change have potential for broad population reach and thus have a role to play in addressing increasing rates of lifestyle-related chronic diseases. The purpose of this systematic review is to update the evidence for their potential to inform translation, including effectiveness in promoting maintenance, reporting on implementation, and costs. EVIDENCE ACQUISITION A structured search of PubMed, MEDLINE, and PsycINFO (January 2006 to April 2010) was conducted. Included studies reported on physical activity and/or dietary change in adults, delivered at least 50% of intervention contacts by telephone, and included a control group (except in dissemination studies). Detailed information on study design, intervention features, and behavioral outcomes was extracted, tabulated, and summarized. EVIDENCE SYNTHESIS Twenty-five studies (27 comparisons) were included: 16 for physical activity, two for diet, and seven for combined interventions. Twenty of 27 comparisons found evidence for initiation of behavior change (14 of 17 comparisons for physical activity; two of two for diet; four of eight for combined interventions). Ten of 25 studies evaluated post-intervention maintenance of change, with three reporting that maintenance was achieved for at least 50% of outcomes. Dissemination studies were rare (n=3), as were dose-response (n=2) and cost-effectiveness analyses (n=2). CONCLUSIONS Given the strength of evidence for telephone-delivered physical activity and dietary change interventions, greater emphasis on dissemination studies is warranted.

Reducing occupational sedentary time: a systematic review and meta-analysis of evidence on activity-permissive workstations

Excessive sedentary time is detrimentally linked to obesity, type 2 diabetes, cardiovascular disease and premature mortality. Studies have been investigating the use of activity‐permissive workstations to reduce sedentary time in office workers, a highly sedentary target group. This review systematically summarizes the evidence for activity‐permissive workstations on sedentary time, health‐risk biomarkers, work performance and feasibility indicators in office workplaces. In July 2013, a literature search identified 38 relevant peer‐reviewed publications. Key findings were independently extracted by two researchers. The average intervention effect on sedentary time was calculated via meta‐analysis. In total, 984 participants across 19 field‐based trials and 19 laboratory investigations were included, with sample sizes ranging from n = 2 to 66 per study. Sedentary time, health‐risk biomarkers and work performance indicators were reported in 13, 23 and 23 studies, respectively. The pooled effect size from the meta‐analysis was −77 min of sedentary time/8‐h workday (95% confidence interval = −120, −35 min). Non‐significant changes were reported for most health‐ and work‐related outcomes. Studies with acceptability measures reported predominantly positive feedback. Findings suggest that activity‐permissive workstations can be effective to reduce occupational sedentary time, without compromising work performance. Larger and longer‐term randomized‐controlled trials are needed to understand the sustainability of the sedentary time reductions and their longer‐term impacts on health‐ and work‐related outcomes.

Health behavior changes after a cancer diagnosis: What do we know and where do we go from here?,

Survival rates for certain types of cancer have improved over the past few decades. Changing unhealthy behaviors such as smoking, poor diet, and sedentary life-style among individuals who have been diagnosed with cancer may help to reduce cancer treatment sequelae, possibly reduce risk of recurrence for specific types of cancer, and reduce risk for other common diseases such as cardiovascular disease, obesity, and hypertension. This article reports the prevalence of each of these behaviors among those diagnosed with cancer and reviews interventions that have targeted these risk behaviors. There is considerable variation in the type of research questions asked, the methodologic quality of the research, sample sizes, and the outcomes observed across studies focusing on changing the three health risk behaviors. In the final section, we provide guidelines for researchers in developing health behavior interventions for individuals diagnosed with cancer and highlight challenges that should be addressed.

Reaching those most in need: a review of diabetes self-management interventions in disadvantaged populations.

There has been increased recognition of the importance of developing diabetes self‐management education (DSME) interventions that are effective with under‐served and minority populations. Despite several recent studies in this area, there is to our knowledge no systematic review or synthesis of what has been learned from this research. An electronic literature search identified five formative evaluations and ten controlled DSME intervention trials focused on under‐served (low‐income, minority or aged) populations. The RE‐AIM (Reach, Efficacy, Adoption, Implementation, Maintenance) evaluation framework was used to evaluate the controlled studies on the dimensions of reach, efficacy, adoption, implementation, and maintenance. Fifty percent of the studies identified reported on the percentage of patients who participated, and the percentages were highly variable. The methodological quality of the articles was generally good and the short‐term results were encouraging, especially on behavioral outcomes. Data on adoption (representativeness of settings and clinicians who participate) and implementation were almost never reported. Studies of modalities in addition to group meetings are needed to increase the reach of DSME with under‐served populations. The promising formative evaluation work that has been conducted needs to be extended for more systematic study of the process of intervention implementation and adaptation with special populations. Studies that explicitly address the community context and that address multiple issues related to public health impact of DSME interventions are recommended to enhance long‐term results. Copyright