Janice M. Phillips

The efficacy of an educational intervention in promoting self-regulation among high-risk older drivers

Visual processing impairment increases crash risk among older drivers. Many older drivers meet the legal requirements for licensing despite having vision impairments that elevate crash risk. In this study, 365 older drivers who were licensed, visually-impaired, and crash-involved in the prior year were randomly assigned to an intervention group or usual-eye-care control group to evaluate the efficacy of an educational intervention that promoted the performance of self-regulatory practices. The educational curriculum was designed to change self-perceptions about vision impairment and how it can impact driver safety and to promote the avoidance of challenging driving situations through self-regulation, leading to reductions in driving exposure. Analyses compared the intervention and control groups at pre-test and 6 months post-test with respect to self-reported perceptions about vision and driving practices. At post-test, drivers who had received the educational intervention were more likely to acknowledge that the quality of their eyesight was less than excellent, report a higher frequency of avoiding challenging driving situations (e.g. left-turns) and report performing more self-regulatory practices (e.g. three right-turns) as compared to controls. Additionally, drivers in the educational intervention group reported significantly fewer days, fewer places and fewer trips made per week as compared to those not receiving the educational intervention. These findings imply that visually-impaired older drivers at higher risk for crash involvement may benefit from educational interventions by reducing their driving exposure and increasing their avoidance of visually challenging driving situations. A critical future step in this research program will be to examine whether this educational intervention has an impact on the safety of these high-risk older drivers by reducing their crash involvement in the years following the educational intervention.

Impact of aging and age-related maculopathy on inactivation of the a-wave of the rod-mediated electroretinogram.

This study examined the impact of aging and age-related maculopathy (ARM) on the inactivation of phototransduction in rod photoreceptors by measuring the recovery of the a-wave using a paired flash electroretinogram technique. Measurements were made on 32 older adults in normal retinal health, 25 with early ARM, 7 with late ARM, and 20 young adults for comparison purposes. ARM presence and severity were defined by the Wisconsin Age-Related Maculopathy Grading System based on grading of fundus photographs. The inactivation of rod phototransduction exhibited an aging-related slowing. Those with early ARM did not exhibit inactivation slowing over and above what would be expected based on normal retinal aging. Persons in the late stages of ARM exhibited dramatic slowing in inactivation kinetics.

Pilot Study Evaluating the Feasibility and Initial Outcomes of a Primary Care Weight Loss Intervention with Peer Coaches

Purpose The purpose of this single-group pilot study was to evaluate the feasibility, acceptability, and initial outcomes of a novel approach to delivering weight loss treatment in primary care using peer coaches and targeting predominantly African American patients with diabetes or prediabetes. Methods Participants (N = 33) were recruited from a family medicine practice for a 6-month lifestyle intervention. Eligible patients were obese adults (body mass index [BMI] ≥30 kg/m2) with ≥1 additional cardiometabolic risk factor(s), including (1) elevated hemoglobin A1C or diagnosed diabetes, (2) elevated blood pressure, (3) elevated triglycerides, and/or (4) low high-density lipoprotein. The intervention included a combination of 12 group-based office visits with health professionals plus 12 individual phone contacts with peer coaches. Outcomes included weight loss, program adherence, and program satisfaction. Results Participants (mean age = 56 ± 10 years; BMI = 42.9 ± 11.0 kg/m2) were predominantly female (88%) and African American (85%). Treatment resulted in a significant mean weight loss of −4.5 ± 7.2 kg, and approximately 27% of participants lost ≥5% of their initial body weight. Participants completed approximately 50% of the group visits and 40% of the telephone calls with peer coaches. Participants rated both components of the intervention favorably. Conclusions Results of this pilot study indicated that a primary care weight management program including group-based visits and peer-delivered telephone contacts achieved significant weight loss among predominantly African American patients with weight-related comorbidities, including diabetes and prediabetes. Additional research is needed to examine the long-term outcomes of this novel approach and to identify program components supporting patients’ success.

Acceptability of Delivering and Accessing Health Information Through Text Messaging Among Community Health Advisors

Background Communication technologies can play a significant role in decreasing communication inequalities and cancer disparities by promoting cancer control and enhancing population and individual health. Studies have shown that technology, such as the mobile phone short message service (SMS) or text messaging, can be an effective health communication strategy that influences individuals’ health-related decisions, behaviors, and outcomes. Objective The purpose of this study was to explore usage of communication technologies, assess the acceptability of mobile technology for delivery and access of health information, and identify cancer and health information needs among Deep South Network for Cancer Control trained Community Health Advisors as Research Partners (CHARPs). Methods A mixed-method design was used, and a triangulation protocol was followed to combine quantitative and qualitative data. Focus groups (4 focus groups; n=37) and self-administered surveys (n=77) were conducted to determine CHARPs mobile phone and text message usage. The objective was to include identification of barriers and facilitators to a mobile phone intervention. Results All participants were African American (37/37, 100%), 11/37 (89%) were women, and the mean age was 53.4 (SD 13.9; focus groups) and 59.9 (SD 8.7; survey). Nearly all (33/37, 89%) of focus group participants reported owning a mobile phone. Of those, 8/33 (24%) owned a smartphone, 22/33 (67%) had a text messaging plan, and 18/33 (55%) and 11/33 (33%) received and sent text messages several times a week or day, respectively. Similar responses were seen among the survey participants, with 75/77 (97%) reporting owning a mobile phone, and of those, 22/75 (30%) owned a smartphone, 39/75 (53%) had a text messaging plan, and 37/75 (50%) received and 27/75 (37%) sent text messages several times a week or day. The benefits of a text messaging system mentioned by focus group participants included alternative form of communication, quick method for disseminating information, and privacy of communication. The main barriers reported by both groups to using mobile technology to receive health information were cost and not knowing how to text message. Ways to overcome barriers were explored with focus group participants, and education was the most proposed solution. Majority of CHARPs were in favor of receiving a weekly text message that would provide cancer/health information. Conclusions The findings from this study indicate that CHARPs are receptive to receiving text messages focusing on cancer/health information and would be likely to engage in mobile health research. These findings represent the first step in the development of an interactive mobile health program designed to provide cancer/health information and a support network for the Deep South Network Community Health Advisors as Research Partners (DSN CHARPs).

Barriers and facilitators to HPV vaccination among rural Alabama adolescents and their caregivers

INTRODUCTION Half of all new human papillomavirus (HPV) infections occur in adolescents and young adults, and this population has poor HPV vaccination rates. Rural areas of the U.S. have high rates of HPV-related diseases and low vaccination rates as well. The purpose of this study was to determine the perceived barriers and facilitators to HPV vaccination among adolescents and their caregivers in rural south Alabama. METHODS Vaccinated and non-vaccinated adolescents ages 11-18 years old and primary caregivers were recruited from three rural counties in south Alabama. Participants completed individual interviews to discuss perceived barriers to vaccination and factors influencing their decision to vaccinate. Discussion groups were held to determine potential solutions to barriers elucidated from the interviews. Interview and discussion group transcripts were analyzed, and themes were identified. RESULTS Approximately 62.5% of adolescents had not initiated the HPV vaccine series. Of those adolescents who started the vaccine series (n = 9, 37.5%), about half completed it (n = 5). Few participants in this study reported speaking with their health care provider (HCP) about the vaccine in the past year. Lack of information about the vaccine, its side effects, and no HCP recommendation were common barriers cited by non-vaccinators. Facilitators to vaccination included cancer prevention, discussion with HCP, and peer testimonials. Potential solutions to barriers were also discussed. CONCLUSIONS Proposed strategies to increase HPV vaccination were similar between vaccinated and non-vaccinated groups. Education about HPV and the HPV vaccine is needed throughout these rural south Alabama communities to ensure informed decisions are made about vaccination and to increase vaccination rates.

Determinants of Obesity in Two Urban Communities: Perceptions and Community-Driven Solutions

Objective In the search of solutions to the rising rates of obesity, community perspectives are important because they highlight areas of need and help determine the level of community support for potential interventions. This study aimed to identify community perceptions of factors associated with obesity in two urban municipalities - one racially mixed and one predominantly African American - and to explore community-driven solutions to the problem of obesity. Methods The study used Photovoice methodology to understand what community members perceived as obesity-promoting factors in their residential environments. Results A total of 96 photographs of factors relevant to obesity were discussed. Most commonly depicted were restaurants, grocery stores, fast food, and fitness centers. In 10 race-stratified focus groups, participants made 592 comments on 12 themes, the most common being restaurants, physical activity, food stores, and proposed solutions. The top three themes - restaurants, physical activity, and food stores - accounted for 58% of all barriers to healthy weight. Proposed solutions ranged from personal efforts and peer support, to educating adults and children, to community action. Conclusions Interventions addressing the immediate food and physical activity environment - restaurants, grocery stores, and resources for physical activity - may have high likelihood of success as they align with community needs and understanding of priorities. Health education and promotion programs that increase food-related knowledge and skills are also needed and likely to receive strong community support.

A weight loss intervention delivered by peer coaches in primary care: Rationale and study design of the PROMISE trial

Primary care offers a familiar and accessible clinical venue for patients with obesity to receive evidence-based lifestyle interventions for weight management. However, there are numerous barriers to the implementation of such programs in primary care, and previous primary care weight loss interventions demonstrate modest and temporary effects. Weight loss treatment delivered within primary care by peer coaches may offer a viable and effective alternative. The purpose of this trial is to test the effects of weight loss treatment that includes ongoing support from a peer coach (i.e., trained, salaried community health workers) as compared to self-directed treatment. Peer coach treatment will be delivered over 18 months and includes a combination of in-person, group-based office visits and individual telephone contacts. This weight loss trial will include 375 adults with obesity (BMI = 30-50 kg/m2) randomized from 10 primary care practices. The primary outcome will be changes in body weight at month 18. Secondary outcomes will include key patient-centered outcomes, including quality-of-life, physical and social functioning, mood, and treatment satisfaction. The cost-effectiveness of the peer coach intervention will also be evaluated. If this novel intervention is effective, it could offer a practical and sustainable approach for the delivery of weight loss treatment in primary care that has the potential to improve clinical outcomes for patients, increase treatment options for primary care providers, and reduce obesity-related healthcare utilization and costs.