Kristyn Ertl

The Development and Validation of the Hypertension Evaluation of Lifestyle and Management Knowledge Scale

J Clin Hypertens (Greenwich). 2012; 14:461–466.. ©2012 Wiley Periodicals, Inc.

Veterans service organization engagement in ‘POWER,’ a peer-led hypertension intervention

Objectives: The purpose of this study was to determine the influence of program factors on participant engagement in POWER, a peer-led intervention designed to reduce hypertension, increase hypertension knowledge, and improve other relevant health behaviors, such as diet and exercise, among US veterans involved in veterans service organizations throughout Southeastern Wisconsin. Methods: Two hundred and nineteen hypertensive members from 58 VSOs participated in a year-long peer-led intervention designed to improve hypertension knowledge, disease self-management behaviors, and health outcomes. This study represents a qualitative evaluation of post and participant engagement in this intervention. We triangulated data collected via three qualitative approaches (observations, focus groups, and in-depth interviews) from intervention posts to derive a model of engagement. Results: Our findings indicate that discrete characteristics of the peer leaders, post members, posts, and the intervention itself contributed to intervention engagement. Discussion: We make suggestions for future research studies, particularly as related to understanding how peer leader identities and cultural norms within VSOs might contribute to peer-led health intervention success.

Engaging community-based veterans' organizations in health promotion programs.

Community organizations, such as churches, clubs, and senior centers, can be important locations for health programs. However, little is known about the organizational factors that influence participation and engagement in health programs. To learn more, we evaluated a community-based program designed to help US military veterans better manage their high blood pressure. The program involved training a pair of veterans to deliver health-related presentations at their local units. We found that factors such as larger meeting attendance size, rural location, age diversity, and member enthusiasm were positively associated with both a willingness to participate and a high level of engagement in program activities.

Patterns of arthritis medication use in a community sample

Background: Although arthritis is disabling, highly prevalent, and often treated without health professional input, little is known about the treatments selected by affected individuals. Such information is important because of the toxicity associated with some arthritis treatments. Objective: To describe the pattern of drug treatment use in a sample of persons with arthritis. Method: The authors distributed an 11-item survey to veterans attending veterans’ organization post meetings in southeastern Wisconsin during November and December 2009. Of 32 posts, 26 (81%) returned surveys from 446 persons; survey count and attendance figures suggest that the majority of attendees completed surveys at participating posts. Most respondents were older (75% aged 60 years or older) men (90%). Respondents with arthritis reported whether they had used each of seven drug therapies in the past year. Results: Almost all members of participating posts responded to the survey, increasing the likelihood that this was a representative sample. Most respondents (290 of 446, 65%) reported having arthritis, which impaired function in 78.6% of them. Most of those with arthritis (252 of 290, 86.9%) had used at least one drug treatment for arthritis in the last year. Acetaminophen use (41.0%) and use of an over-the-counter nonsteroidal anti-inflammatory drug (42.1%) were common. Nonsteroidal anti-inflammatory drug use did not decrease with older age or increase with greater functional impairment. Conclusions: Self-medication for arthritis is common and often does not follow clinical guidelines. Efforts to improve the quality of osteoarthritis care that focus solely on health care providers are unlikely to ensure optimal osteoarthritis care.

Empirically Derived Lessons Learned about What Makes Peer-Led Exercise Groups Flourish

Abstract:Background: Physical exercise confers many health benefits, but it is difficult to motivate people to exercise. Although community exercise groups may facilitate initiation and persistence in an exercise program, reports regarding factors that allow such groups to flourish are limited.Objectives: We performed a prospective qualitative evaluation of our experience starting a program of community-based, peer-led exercise groups for military veterans to identify important lessons learned.Methods: We synthesized data from structured observations, post-observation debriefings, and focus groups. Our participants were trained peer leaders and exercise group members. Our main outcomes consisted of empirically derived lessons learned during the implementation of a peer-led group exercise program for veterans at multiple community sites. We collected and analyzed data from 40 observation visits (covering 14 sites), 7 transcribed debriefings, and 5 focus groups.Results: We identified five lessons learned. (1) The camaraderie and social aspect of the exercise groups provided motivation for people to stay involved. (2) Shared responsibility and commitment to each other by the group members was instrumental to success. (3) Regular meeting times encouraged participation. (4) Variety, especially getting outdoors, was very popular for some groups. (5) Modest involvement of professionals encouraged ongoing engagement with the program.Conclusions: Both social and programmatic issues influence implementation of group exercise programs for older, predominantly male, veterans. These results should be confirmed in other settings.

Group Cohesion in a Formal Exercise Program Composed of Predominantly Older Men

Individuals reporting high group cohesion are less likely to discontinue participation in group exercise programs. A validated measure of group cohesion, the Physical Activity Group Environment Questionnaire (PAGEQ), is untested in older men. The PAGEQ was administered to, and questions about demographics and frequency and duration of participation were asked of, the Walk A Mile or More (WAMM) exercise group, which was composed of U.S. military Veterans. Forty participants (mean age = 62 years, 77.5% male) completed surveys. Cronbachs alpha for the overall PAGEQ was 0.976. Although no significant relationship was found between group cohesion scores and frequency of attending WAMM sessions, there was a trend for individuals who had participated for a longer time to report more group cohesiveness, particularly regarding the task (i.e., exercise) itself. The PAGEQ was easily administered and internally consistent in this group of older men, and provides a useful benchmark for future gerontological researchers. [Journal of Gerontological Nursing, 42(8), 18-23.].

Educational attainment does not modify the effect of educational interventions on blood pressure control: a secondary analysis of data from a randomised trial

Summary Objectives To assess whether the effects of community-based educational interventions to improve blood pressure, weight and health behaviours benefit participants with lower educational levels more than those with higher educational levels. Design Secondary data analysis. Setting Two 12-month community-based educational interventions, one led by trained peers and one delivered by health professionals. Participants A total of 403 hypertensive individuals, grouped by education (high school or less; 1–3 years college; 4 + years college). Main outcome measures Blood pressure, weight, physical activity and fruit and vegetable intake. Results We found that changes in blood pressure, weight and physical activity were similar across education levels; college graduates consumed more daily servings of fruits and vegetables at baseline (3.7 versus 3.6 for those with 12–15 years and 3.1 for those with < 12 years, p = 0.0112), and increased intake more after the intervention (+0.4 versus −0.1 and −0.1, p = 0.0142). The two methods of delivery – peer-led versus professional – had similar effects on all measures. Conclusions We conclude that educational interventions, whether delivered by peers or professionals, may improve chronic disease self-management among participants but do not confer greater benefits on participants with lower educational levels.