Kristen Hammerback

Understanding Older Adults’ Motivators and Barriers to Participating in Organized Programs Supporting Exercise Behaviors

Little is known about older adults’ perceptions of organized programs that support exercise behavior. We conducted semi-structured interviews with 39 older adults residing in King County, Washington, who either declined to join, joined and participated, or joined and then quit a physical activity-oriented program. We sought to explore motivators and barriers to physical activity program participation and to elicit suggestions for marketing strategies to optimize participation. Two programs supporting exercise behavior and targeting older persons were the source of study participants: Enhance®Fitness and Physical Activity for a Lifetime of Success. We analyzed interview data using standard qualitative methods. We examined variations in themes by category of program participant (joiner, decliner, quitter) as well as by program and by race. Interview participants were mostly females in their early 70s. Approximately half were non-White, and about half had graduated from college. The most frequently cited personal factors motivating program participation were enjoying being with others while exercising and desiring a routine that promoted accountability. The most frequent environmental motivators were marketing materials, encouragement from a trusted person, lack of program fees, and the location of the program. The most common barriers to participation were already getting enough exercise, not being motivated or ready, and having poor health. Marketing messages focused on both personal benefits (feeling better, social opportunity, enjoyability) and desirable program features (tailored to individual needs), and marketing mechanisms ranged from traditional written materials to highly personalized approaches. These results suggest that organized programs tend to appeal to those who are more socially inclined and seek accountability. Certain program features also influence participation. Thoughtful marketing that involves a variety of messages and mechanisms is essential to successful program recruitment and continued attendance.

Older Adults' Perceptions of Clinical Fall Prevention Programs: A Qualitative Study

Objective. To investigate motivational factors and barriers to participating in fall risk assessment and management programs among diverse, low-income, community-dwelling older adults who had experienced a fall. Methods. Face-to-face interviews with 20 elderly who had accepted and 19 who had not accepted an invitation to an assessment by one of two fall prevention programs. Interviews covered healthy aging, core values, attributions/consequences of the fall, and barriers/benefits of fall prevention strategies and programs. Results. Joiners and nonjoiners of fall prevention programs were similar in their experience of loss associated with aging, core values they expressed, and emotional response to falling. One difference was that those who participated endorsed that they “needed” the program, while those who did not participate expressed a lack of need. Conclusions. Interventions targeted at a high-risk group need to address individual beliefs as well as structural and social factors (transportation issues, social networks) to enhance participation.

Opportunities for Improving Cancer Prevention at Federally Qualified Health Centers

As the Affordable Care Act unfolds, federally qualified health centers (FQHCs) will likely experience an influx of newly insured, low-income patients at disparate risk for cancer. Cancer-focused organizations are seeking to collaborate with FQHCs and the Primary Care Associations (PCAs) that serve them, to prevent cancer and reduce disparities. To guide this collaboration, we conducted 21 interviews with representatives from PCAs and FQHCs across four western states. We asked about: FQHC priorities, barriers and facilitators to cancer prevention, the PCA–FQHC relationship, and collaboration opportunities for external organizations. FQHC priorities include medical home transformation, electronic health records, and clinical care; prevention efforts must integrate with these. Barriers to cancer prevention include competing priorities, inadequate patient insurance, and lack of reimbursement, while facilitators are the presence of patient navigators and cancer-related performance measures. Collaboration opportunities for external organizations include dissemination of culturally appropriate educational materials and support for patient navigators.

It Could Be a Pearl to You: Exploring Recruitment and Retention of the Program to Encourage Active, Rewarding Lives (PEARLS) With Hard-to-Reach Populations

PURPOSE OF THE STUDY We partnered with 3 social service organizations to identify hard-to-reach populations, barriers to reach, and strategies for improving recruitment and retention for Program to Encourage Active, Rewarding Lives (PEARLS), a home-based depression-care management program for elders. DESIGN AND METHODS We conducted semistructured interviews with staff and former PEARLS participants. All interviews were transcribed verbatim and thematically analyzed. RESULTS Veterans, African Americans, Filipino men, other immigrants and English-language learners, old-older adults, rural communities, and people with limited education were identified as hard to reach. The themes of trust, cultural appropriateness, meet them where they are, and framing and reframing, cut across barriers to participation in PEARLS and approaches for overcoming these barriers. IMPLICATIONS Research findings will be used to inform technical assistance activities with PEARLS providers, changes to PEARLS program and training materials, and future PEARLS research activities.

Development and Pilot Test of the Workplace Readiness Questionnaire, a Theory-Based Instrument to Measure Small Workplaces' Readiness to Implement Wellness Programs

Purpose. To develop a theory-based questionnaire to assess readiness for change in small workplaces adopting wellness programs. Design. In developing our scale, we first tested items via “think-aloud” interviews. We tested the revised items in a cross-sectional quantitative telephone survey. Setting. The study setting comprised small workplaces (20–250 employees) in low-wage industries. Subjects. Decision-makers representing small workplaces in King County, Washington (think-aloud interviews, n = 9), and the United States (telephone survey, n = 201) served as study subjects. Measures. We generated items for each construct in Weiner’s theory of organizational readiness for change. We also measured workplace characteristics and current implementation of workplace wellness programs. Analysis. We assessed reliability by coefficient alpha for each of the readiness questionnaire subscales. We tested the association of all subscales with employers’ current implementation of wellness policies, programs, and communications, and conducted a path analysis to test the associations in the theory of organizational readiness to change. Results. Each of the readiness subscales exhibited acceptable internal reliability (coefficient alpha range, .75–.88) and was positively associated with wellness program implementation (p < .05). The path analysis was consistent with the theory of organizational readiness to change, except change efficacy did not predict change-related effort. Conclusion. We developed a new questionnaire to assess small workplaces’ readiness to adopt and implement evidence-based wellness programs. Our findings also provide empirical validation of Weiner’s theory of readiness for change.

Perspectives on Workplace Health Promotion among Employees in Low-Wage Industries

Purpose. Study goals were to (1) understand the attitudes of employees in low-wage industries toward workplace health promotion, including views on appropriateness of employer involvement in employee health and level of interest in workplace health promotion overall and in specific programs, and (2) determine the potential for extending workplace health promotion to spouses and partners of these employees. Approach. The study used 42 interviews of 60 to 90 minutes. Setting. Interviews were conducted with couples (married or living together) in the Seattle/King County metropolitan area of Washington State. Participants. Study participants were forty-two couples with one or more members working in one of five low-wage industries: accommodation/food services, education, health care/social assistance, manufacturing, and retail trade. Method. The study employed qualitative analysis of interview transcripts using grounded theory to identify themes. Results. Employees consider workplace health promotion both appropriate and desirable and believe it benefits employers through increased productivity and morale. Most have little personal experience with it and doubt their employers would prioritize employee health. Employees are most interested in efforts focused on nutrition and physical activity. Both employees and their partners support extending workplace health promotion to include partners. Conclusion. Employees and their partners are interested in workplace health promotion if it addresses behaviors they care about. Concern over employer involvement in their personal health decisions is minimal; instead, employees view employer interest in their health as a sign that they are valued.

Feasibility of Workplace Health Promotion for Restaurant Workers, Seattle, 2012

Introduction Restaurant workers are a large population at high risk for tobacco use, physical inactivity, and influenza. They are difficult to reach with health care interventions and may be more accessible through workplaces, yet few studies have explored the feasibility of workplace health promotion in this population. This study sought to identify barriers and facilitators to promotion of tobacco cessation, physical activity, and influenza vaccination in restaurants. Methods Moderators conducted 7 focus groups, 3 with restaurant owners and managers, 2 with English-speaking workers, and 2 with Spanish-speaking workers. All groups were recorded, and recordings were transcribed and uploaded to qualitative-analysis software. Two researchers coded each transcript independently and analyzed codes and quotations for common themes. Results Seventy people from the restaurant industry participated. Barriers to workplace health promotion included smoking-break customs, little interest in physical activity outside of work, and misinformation about influenza vaccinations. Facilitators included creating and enforcing equitable break policies and offering free, on-site influenza vaccinations. Spanish-speakers were particularly amenable to vaccination, despite their perceptions of low levels of management support for health promotion overall. Owners required a strong business case to consider investing in long-term prevention for their employees. Conclusion Tobacco cessation and influenza vaccinations are opportunities for health promotion among restaurant workers, whereas physical activity interventions face greater challenges. Promotion of equitable breaks, limited smoking-break policies, and free, on-site influenza vaccinations could improve health for restaurant workers, who often do not have health insurance. Workplace interventions may be particularly important for Hispanic workers who have additional access barriers.

Influenza Vaccination Status and Attitudes Among Restaurant Employees

CONTEXT Restaurant employees represent a substantial portion of the US workforce, interact closely with the public, and are at risk for contracting influenza, yet their influenza vaccination rates and attitudes are unknown. OBJECTIVE Assess influenza vaccination rates and attitudes among Seattle restaurant employees, to identify factors that could enhance the success of a restaurant-based vaccination program. DESIGN In 2012, we invited employees of Seattle restaurants to complete an anonymous paper survey assessing participant demographics, previous influenza vaccination status, and personal attitudes toward influenza vaccination (using a 5-point scale). SETTING Sit-down, full service restaurants in or near Seattle, Washington, were eligible if they had no previous history of offering worksite influenza vaccinations and had more than 20 employees who were older than 18 years and spoke either English or Spanish. PARTICIPANTS We invited staff in all restaurant positions (servers, bussers, kitchen staff, chefs, managers, etc) to complete the survey, which was available in English and Spanish. RESULTS Of 428 restaurant employees surveyed, 26% reported receiving the seasonal influenza vaccine in 2011-2012 (response rate = 74%). Across 8 attitude statements, participants were most likely to agree that the vaccine is not too expensive (89%), and least likely to agree that it is relevant for their age group (25%), or normative at their workplace (13%). Vaccinated participants reported significantly more positive attitudes than unvaccinated participants, and Hispanics reported significantly more positive attitudes than non-Hispanic whites. CONCLUSIONS Increasing influenza vaccination rates among restaurant employees could protect a substantial portion of the US workforce, and the public, from influenza. Seattle restaurant employees have low vaccination rates against seasonal influenza. Interventions aimed at increasing vaccination among restaurant employees should highlight the vaccines relevance and effectiveness for working-age adults.

Comparing Strategies for Recruiting Small, Low-Wage Worksites for Community-Based Health Promotion Research

Background. HealthLinks is a workplace health promotion program developed in partnership with the American Cancer Society. It delivers a package of evidence-based interventions and implementation support to small worksites in low-wage industries. As part of a randomized, controlled trial of HealthLinks, we studied approaches to recruiting these worksites. Aims. This study aims to guide future recruitment for community-based worksite health promotion interventions by comparing three approaches, including leveraging relationships with community partners. Method. We recruited 78 small, low-wage worksites in King County, Washington, to participate in the trial via three approaches: phone calls to companies on a purchased list (“cold”), phone calls to a list of eligible companies provided by a health insurer (“lukewarm”), and personal referrals from local health insurers and brokers (“warm”). Eligible and interested worksites received an in-person visit from researchers and completed additional steps to enroll. Results. Of the worksites screened and deemed eligible, 32% of the “cold” worksites enrolled in HealthLinks, as did 48% and 60%, respectively, of the “lukewarm” and “warm” worksites. Compared with “warm” worksites, “cold” worksites were twice as likely to be ineligible. Discussion. Two distinct factors help explain why “warmer” worksites were more likely to enroll in HealthLinks. First, eligibility was significantly higher among warmer referrals. Second, most of the warm-referred worksites eligible for the study agreed to meet in person with the project team to hear more about the project. Conclusions. “Warmer” recruitment approaches yielded higher recruitment. Leveraging relationships with community partners can help researchers identify and successfully recruit small, low-wage worksites.

Readiness to change over time: Change commitment and change efficacy in a workplace health-promotion trial

Introduction Organizational readiness to change may be a key determinant of implementation success and a mediator of the effectiveness of implementation interventions. If organizational readiness can be reliably and validly assessed at the outset of a change initiative, it could be used to assess the effectiveness of implementation-support activities by measuring changes in readiness factors over time. Methods We analyzed two waves of readiness-to-change survey data collected as part of a three-arm, randomized controlled trial to implement evidence-based health promotion practices in small worksites in low-wage industries. We measured five readiness factors: context (favorable broader conditions); change valence (valuing health promotion); information assessment (demands and resources to implement health promotion); change commitment (an intention to implement health promotion); and change efficacy (a belief in shared ability to implement health promotion). We expected commitment and efficacy to increase at intervention sites along with their self-reported effort to implement health promotion practices, termed wellness-program effort. We compared means between baseline and 15 months, and between intervention and control sites. We used linear regression to test whether intervention and control sites differed in their change-readiness scores over time. Results Only context and change commitment met reliability thresholds. Change commitment declined significantly for both control (−0.39) and interventions sites (−0.29) from baseline to 15 months, while context did not change for either. Only wellness program effort at 15 months, but not at baseline, differed significantly between control and intervention sites (1.20 controls, 2.02 intervention). Regression analyses resulted in two significant differences between intervention and control sites in changes from baseline to 15 months: (1) intervention sites exhibited significantly smaller change in context scores relative to control sites over time and (2) intervention sites exhibited significantly higher changes in wellness program effort relative to control sites. Discussion Contrary to our hypothesis, change commitment declined significantly at both Healthlinks and control sites, even as wellness-program effort increased significantly at HealthLinks sites. Regression to the mean may explain the decline in change commitment. Future research needs to assess whether baseline commitment is an independent predictor of wellness-program effort or an effect modifier of the HealthLinks intervention.