Erin S. Pearson

Goal setting as a health behavior change strategy in overweight and obese adults: A systematic literature review examining intervention components

OBJECTIVE This paper describes goal setting components used for behavior change specific to diet and physical activity in community-based interventions targeting overweight and obese adults. METHODS A systematic literature review was conducted. Studies were evaluated using the S.T.A.R.T. (Specificity, Timing, Acquisition, Rewards and feedback, and Tools) criteria which were developed for the purposes of this paper in order to elucidate which intervention features elicit optimal health behavior outcomes. RESULTS Eighteen studies were included. Based on the S.T.A.R.T. criteria, it was determined that developing specific goals that are in close proximity, involve the participant in acquisition, and incorporate regular feedback, are common features in this context. CONCLUSION Goal setting can be useful for effecting health behavior changes in this population. However, as different intervention components were often implemented concurrently (e.g., education sessions, self-monitoring records), it was not possible to ascertain which were responsible for positive changes independently. PRACTICE IMPLICATIONS Goal setting shows promise as a tool that can be incorporated into weight reduction programs by health care professionals and researchers. Studies are warranted to identify the specific mechanisms through which individuals with overweight or obesity can apply the S.T.A.R.T. criteria with respect to goal setting for the purposes of weight loss.

The 'how-to' of health behaviour change brought to life: a theoretical analysis of the Co-Active coaching model and its underpinnings in self-determination theory

Self-determination theory (SDT) and Co-Active life coaching (CALC) serve in a complementary capacity whereby both are concerned with investigating the natural growth tendencies of individuals with respect to self-motivation. SDT provides a framework for examining the processes that regulate health behaviours, while the Co-Active model provides the tools necessary to bring desired changes to fruition. Although an increasing amount of empirical support for CALC exists, its motivation-specific underpinnings have yet to be examined theoretically. Given that motivation has been linked to the behaviour change process, the purpose of present paper was to explore the motivational foundations of CALC as they relate to SDT in order to provide theory-based evidence for its effectiveness and validate further, its utility as a viable health behaviour change method. Through deconstructing the techniques inherent in CALC and analysing its three key principles (i.e. fulfilment, balance and process coaching), a protocol for increasing motivation and enhancing self-determination as a function of satisfying SDTs needs for autonomy, competence and relatedness was uncovered. This exploratory analysis provides an important first step in positioning CALC as a theoretically grounded behaviour change method from a motivational perspective. Empirical research is now warranted to confirm these mechanisms with respect to the behaviour change process and treatment outcomes.

Using the RE-AIM framework to evaluate a community-based summer camp for children with obesity: a prospective feasibility study

BackgroundIncreasing rates of childhood overweight and obesity highlight a need for the evaluation of lifestyle interventions. The purpose of the study was to determine the Reach, Effectiveness, Adoption, Implementation and Maintenance of a novel family-focused program targeting children with obesity (i.e., the Children’s Health and Activity Modification Program [C.H.A.M.P.]) using the RE-AIM framework, an evaluation tool for community-based health interventions.MethodsA single-centre, single cohort interventional feasibility study was conducted over the course of two years. Children with obesity and their families completed a 4-week group-based lifestyle intervention in Year 1 (n = 15; Mage = 10.6; 53% female) and/or Year 2 (n = 25; Mage = 10.6; 56% female). Outcome variables were measured pre- and post-intervention, as well as 6- and 12-months following completion of the formal program.ResultsOverall, C.H.A.M.P. had high reach in terms of participant representativeness. In addition, participation in the program was associated with significantly improved standardized body mass index (BMI-z), body fat percentage, lean mass percentage, and child- and parent-proxy reported quality of life (QOL; effectiveness/individual maintenance). Furthermore, a number of community partnerships were built, strengthened, and maintained prior to, during, and following implementation of the two-year program (adoption/setting maintenance, respectively). Finally, the intervention was delivered as intended as evidenced by high adherence to the schedule, attendance rates, and cost effectiveness (implementation).ConclusionsBased on RE-AIM metrics, C.H.A.M.P. appears to be a promising childhood obesity program. The findings reported will inform researchers and practitioners on how to design and implement future community-based programs addressing pediatric obesity.Trial registrationISRCTN Registry, Study ID ISRCTN13143236. Registered 27 March 2015.

Parental perspectives of a 4-week family-based lifestyle intervention for children with obesity.

Objectives: The childhood obesity epidemic is now recognized as one of the most serious public health challenges of the 21st century. Community-based behaviour modification treatment programs involving both children and their families are warranted. The purpose of this study was to explore the experiences of parents whose children participated in the Childrens Health and Activity Modification Program (C.H.A.M.P.): a 4-week lifestyle program delivered as a day-camp for obese children at risk for type II diabetes and their families. Parents were required to attend four half-day education sessions during the intervention period. Methods: Seven focus groups were conducted immediately following the 4-week interventions offered in August 2008 and 2009. The perspectives of 38 parents representing 32 children aged 8-14 with obesity (i.e., body mass index > the 95th percentile) were shared. Results: Overall, parents were pleased with the impact of the program and proud of their childrens accomplishments (e.g., increased physical activity levels, enhanced self-esteem, weight loss). Several facilitators to success (e.g., social support; a positive environment) and barriers to its maintenance (e.g., time management; unsupportive family members) were identified, and recommendations were made for future programs. Although parents found the half-day sessions valuable, post-programmatic bi-monthly booster session adherence declined over the one-year follow-up period. Conclusion: Delivered as a 4-week day-camp, C.H.A.M.P. represents a unique approach to the treatment of childhood obesity. Future family-based interventions should consider avenues for intensifying the parental program component whilst employing strategies to promote parental adherence in service of enhancing long-term sustainability of health behaviour changes.

The CHANGE Program: Comparing an Interactive versus Prescriptive Obesity Intervention on University Students’ Self-Esteem and Quality of Life

BACKGROUND Previous studies incorporating Motivational Interviewing administered via Co-Active Life Coaching tools (MI-via-CALC) have elicited positive results among adults with obesity. However, there is a paucity of this research that includes sufficient power and a comparison group. This studys purpose was to compare MI-via-CALC with a validated obesity intervention among university students. METHODS Participants (n = 45) were randomised to either a telephone-based 12-week: (a) MI-via-CALC program whereby a certified coach worked with subjects to achieve goals through dialogue; or (b) lifestyle modification treatment following the LEARN Program for Weight Management. Participants completed the Rosenberg Self-Esteem Scale and Short Form Functional Health Status Scale (SF-36) at baseline, mid-, and post-treatment, and 3 and 6 months following the program. RESULTS Analyses revealed that both conditions elicited significant time effects between baseline and 6 months for self-esteem and all dimensions of the SF-36 (e.g. overall health). CONCLUSIONS MI-via-CALC compares favorably with LEARN as an obesity treatment. Given that self-esteem and quality of life are essential for promoting behavior change among individuals with obesity, this study offers unique insights into their change processes. Future research should provide both treatments and allow participants to choose based on their personal preferences, learning styles, and needs.

The Children’s Health and Activity Modification Program (C.H.A.M.P.): Participants’ perspectives of a four-week lifestyle intervention for children with obesity

To date, there is a paucity of qualitative research examining the influence of community-based interventions for childhood obesity on the participants themselves. This study explored the experiences of children who participated in the Children’s Health and Activity Modification Program (C.H.A.M.P.), a four-week day camp for children with obesity aged 8–14, in order to uncover key program elements for positive behavior change. Following the intervention, children (n = 36) participated in focus groups where they were asked about their experiences pertaining to physical activity and nutrition, what it was like to be part of a team, and how they felt about themselves. Findings revealed that participants perceived C.H.A.M.P. as helpful (e.g. in making healthier food choices, being more active, and feeling more confident and self-aware). This pilot study offers unique insights into the perspectives of children with obesity. Results are discussed with respect to future program development and research for childhood obesity treatment.

Smoking prevention in children and adolescents: a systematic review of individualized interventions

OBJECTIVE This study systematically reviewed the literature to determine what type of cognitive-behavioral based interventions administered outside of formal school settings effectively prevent smoking initiation among children and adolescents. METHODS Applying the PRISMA guidelines we searched MEDLINE, PsycINFO, CINHAL, Pub Med, SCOPUS, and Sport Discus. Article review, data extraction, and assessment of risk of bias were conducted by two independent reviewers. RESULTS We included 16 studies administered in various settings: seven in health care; four informally during and outside of school hours; three in the home; and two in extra-curricular settings. Positive preventive effects in smoking behavior ranging from 3-months to 4-years were observed in eight studies. Social environmental influences (e.g., parental smoking, friends) are salient contributing factors. CONCLUSIONS Effective approaches involved interventions conducted in health care settings as well as those employing interpersonal communication and support strategies (e.g., via peer leaders, parent support, physicians). PRACTICE IMPLICATIONS Primary health care settings may be optimal for implementing cigarette smoking prevention interventions for children and adolescents. Providing tailored education and facilitating interpersonal discussions between health care providers and families about the risks of smoking/strategies to avoid uptake, as well as capitalizing on technology-based modalities may reduce rates among children and adolescents.

Self-presentation in exercise: Changes over a 12-week cardiovascular programme for overweight and obese sedentary females

Abstract Self-presentational concerns, shown to influence exercise-related cognitions and behaviours, are evaluated frequently in the absence of exercise or following a single bout of physical activity. The purpose of the present study was to examine longitudinally, the extent to which participating in a structured 12-week cardiovascular exercise intervention elicited changes in self-presentational efficacy expectancy (SPEE) and social physique anxiety (SPA). Participants were 80 sedentary women with overweight or obesity (mean body mass index 29.02 kg/m2, SD=4.71) between the ages of 19 and 45 wanting to begin an exercise programme (mean age 33.4 years, SD=7.6). The Self-Presentational Efficacy Scale (SPES) and the Social Physique Anxiety Scale (SPAS) were completed by each participant prior to commencing the study, and at the 6- and 12-week time points. For those who completed the programme, repeated measures ANOVAs indicated significant increases in SPEE between baseline and week 6 (P<0.001, η2=0.37), and week 6 to 12 (P<0.05, η2=0.10), while SPA decreased significantly between baseline and week 6 (P<0.01, η2=0.16). Bivariate correlation analyses revealed that length of participation in the study was positively related to SPEE and negatively related to SPA. Implications of focusing on these variables within a physical activity intervention are discussed with respect to exercise behaviour, programme development and adherence.