Laura Linnan

How We Design Feasibility Studies

Public health is moving toward the goal of implementing evidence-based interventions. To accomplish this, there is a need to select, adapt, and evaluate intervention studies. Such selection relies, in part, on making judgments about the feasibility of possible interventions and determining whether comprehensive and multilevel evaluations are justified. There exist few published standards and guides to aid these judgments. This article describes the diverse types of feasibility studies conducted in the field of cancer prevention, using a group of recently funded grants from the National Cancer Institute. The grants were submitted in response to a request for applications proposing research to identify feasible interventions for increasing the utilization of the Cancer Information Service among underserved populations.

Evaluation of motivationally tailored vs. Standard self-help physical activity interventions at the workplace

Purpose. This study compares the efficacy of a self-help intervention tailored to the individuals stage of motivational readiness for exercise adoption with a standard self-help exercise promotion intervention. Design. Interventions were delivered at baseline and 1 month; assessments were collected at baseline and 3 months. Setting. Eleven worksites participating in the Working Healthy Research Trial. Subjects. Participants (n = 1559) were a subsample of employees at participating worksites, individually randomized to one of two treatment conditions. Intervention. Printed self-help exercise promotion materials either (1) matched to the individuals stage of motivational readiness for exercise adoption (motivationally tailored), or (2) standard materials (standard). Measures. Measures of stage of motivational readiness for exercise and items from the 7-Day Physical Activity Recall. Results. Among intervention completers (n = 903), chi-square analyses showed that, compared to the standard intervention, those receiving the motivationally tailored intervention were significantly more likely to show increases (37% vs. 27%) and less likely to show either no change (52% vs. 58%) or regression (11% vs. 15%) in stage of motivational readiness. Multivariate analyses of variance showed that changes in stage of motivational readiness were significantly associated with changes in self-reported time spent in exercise. Conclusions. This is the first prospective, randomized, controlled trial demonstrating the efficacy of a brief motivationally tailored intervention compared to a standard self-help intervention for exercise adoption. These findings appear to support treatment approaches that tailor interventions to the individuals stage of motivational readiness for exercise adoption.

Results of the 2004 National Worksite Health Promotion Survey

OBJECTIVES We examined worksite health promotion programs, policies, and services to monitor the achievement of the Healthy People 2010 worksite-related goal of 75% of worksites offering a comprehensive worksite health promotion program. METHODS We conducted a nationally representative, cross-sectional telephone survey of worksite health promotion programs stratified by worksite size and industry type. Techniques appropriate for analyzing complex surveys were used to compute point estimates, confidence intervals, and multivariate statistics. RESULTS Worksites with more than 750 employees consistently offered more programs, policies, and services than did smaller worksites. Only 6.9% of responding worksites offered a comprehensive worksite health promotion program. Sites with a staff person dedicated to and responsible for health promotion were significantly more likely to offer a comprehensive program, and sites in the agriculture and mining or financial services sector were significantly less likely than those in other industry sectors to offer such a program. CONCLUSIONS Increasing the number, quality, and types of health promotion programs at worksites, especially smaller worksites, remains an important public health goal.

Stages of Change in Adopting Healthy Diets: Fat, Fiber, and Correlates of Nutrient Intake

The stages of change construct, which addresses the readiness to change, has only recently been applied to dietary behavior, such as fat consumption. This article describes the application of the stages of change construct to dietary fat and fiber consumption and examines the association of dietary stages to eating practices and related demographic and psychosocial factors in a large, geographically diverse population of workers. We present results from the baseline survey of 17,121 employees in the Working Well Trial. We assessed stage from an algorithm based on seven items and measured dietary intake with an 88-item food frequency questionnaire. Findings indicated that a greater proportion of the population has actively tried to reduce fat intake than to consume more fiber. Stage of change was associated with fat, fiber, and fruit and vegetable intake in a stepwise manner, as predicted. In multivariate analyses that controlled for demographic characteristics, stage of change predicted between 8 and 13% of the variance in dietary intake, and more than demographic variables. These findings have implications for the design of nutrition interventions and for the evaluation of intermediate outcomes.

Using organization theory to understand the determinants of effective implementation of worksite health promotion programs

The field of worksite health promotion has moved toward the development and testing of comprehensive programs that target health behaviors with interventions operating at multiple levels of influence. Yet, observational and process evaluation studies indicate that such programs are challenging for worksites to implement effectively. Research has identified several organizational factors that promote or inhibit effective implementation of comprehensive worksite health promotion programs. However, no integrated theory of implementation has emerged from this research. This article describes a theory of the organizational determinants of effective implementation of comprehensive worksite health promotion programs. The model is adapted from theory and research on the implementation of complex innovations in manufacturing, education and health care settings. The article uses the Working Well Trial to illustrate the models theoretical constructs. Although the article focuses on comprehensive worksite health promotion programs, the conceptual model may also apply to other types of complex health promotion programs. An organization-level theory of the determinants of effective implementation of worksite health promotion programs.

Knowledge, attitude, and concussion-reporting behaviors among high school athletes: A preliminary study

CONTEXT Many athletes continue to participate in practices and games while experiencing concussion-related symptoms, potentially predisposing them to subsequent and more complicated brain injuries. Limited evidence exists about factors that may influence concussion-reporting behaviors. OBJECTIVE To examine the influence of knowledge and attitude on concussion-reporting behaviors in a sample of high school athletes. DESIGN Cross-sectional study. SETTING Participants completed a validated survey instrument via mail. PATIENTS OR OTHER PARTICIPANTS A total of 167 high school athletes (97 males, 55 females, 5 sex not indicated; age = 15.7 ± 1.4 years) participating in football, soccer, lacrosse, or cheerleading. INTERVENTION(S) Athlete knowledge and attitude scores served as separate predictor variables. MAIN OUTCOME MEASURE(S) We examined the proportion of athletes who reported continuing to participate in games and practices while symptomatic from possible concussion and the self-reported proportion of recalled concussion and bell-ringer events disclosed after possible concussive injury. RESULTS Only 40% of concussion events and 13% of bell-ringer recalled events in the sample were disclosed after possible concussive injury. Increased athlete knowledge of concussion topics (increase of 1 standard deviation = 2.8 points) was associated with increased reporting prevalence of concussion and bell-ringer events occurring in practice (prevalence ratio [PR] = 2.27, 95% confidence interval [CI] = 1.60, 3.21) and the reporting prevalence of bell-ringer-only events overall (PR = 1.87, 95% CI = 1.38, 2.54). Athlete attitude scores (increase of 1 standard deviation = 11.5 points) were associated with decreases in the proportion of athletes stating they participated in games (PR = 0.74, 95% CI = 0.66, 0.82) and practices (PR = 0.67, 95% CI = 0.59, 0.77) while symptomatic from concussions. CONCLUSIONS Most recalled concussion events in our study were not reported to a supervising adult. Clinicians should be aware that knowledge and attitude influence concussion reporting. Clinicians and administrators should make concussion education a priority and encourage an optimal reporting environment to better manage and prevent concussive injuries in young athletes.

Using Theory to Understand the Multiple Determinants of Low Participation in Worksite Health Promotion Programs

Low participation at the employee or worksite level limits the potential public health impact of worksite-based interventions. Ecological models suggest that multiple levels of influence operate to determine participation patterns in worksite health promotion programs. Most investigations into the determinants of low participation study the intrapersonal, interpersonal, and institutional influences on employee participation. Community- and policy-level influences have not received attention, nor has consideration been given to worksite-level participation issues. The purpose of this article is to discuss one macrosocial theoretical perspective—political economy of health—that may guide practitioners and researchers interested in addressing the community- and policy-level determinants of participation in worksite health promotion programs. The authors argue that using theory to investigate the full spectrum of determinants offers a more complete range of intervention and research options for maximizing employee and worksite levels of participation.

Do processes of change predict smoking stage movements? A prospective analysis of the transtheoretical model

The transtheoretical model (TTM) posits that processes of change and the pros and cons of smoking predict progressive movement through the stages of change. This study provides both a cross-sectional replication and a prospective test of this hypothesis. As part of a larger study of worksite cancer prevention (the Working Well Trial), employees of 26 manufacturing worksites completed a baseline and 2 annual follow-up surveys. Of the 63% of employees completing baseline surveys, 27.7% were smokers (N = 1,535), and a cohort of these smokers completed the 2-year follow-up. Cross-sectional results replicated previous studies with virtually all the processes of change and the cons of smoking increasing in linear fashion from precontemplation to preparation (all ps < .00001), and the pros of smoking decreasing (p < .01). However, contrary to the hypothesis, the baseline processes of change and the pros and cons of smoking failed to predict progressive stage movements at either the 1- or the 2-year follow-ups. Possible explanations for these findings and concerns about the conceptual internal consistency of the TTM are discussed.

Stages of change versus addiction: a replication and extension

Data from the Working Well trial (n = 2379) were used to test the capacity of 19 variables to predict smoking cessation at 1- and 2-year follow-ups. Among the core constructs of transtheoretical model (TTM), stage of change was the best predictor. The processes of change and the pros and cons of smoking were relatively ineffective predictors. Among other variables, self-efficacy, cigarettes per day, duration of longest quit attempt during the previous year, and the contemplation ladder were the most effective stand-alone predictors. A composite of cigarettes per day and quit duration was particularly effective for predicting cessation. Consistent with Farkas et al. (Farkas AJ, Pierce JP, Zhu SH, Rosbrook B, Gilpin EA, Berry C, Kaplan RM, Addiction 91:1271-1280, 1996), multivariate analyses including the composite variable (cigarettes per day and quit duration) and the stages of change revealed the composite variable to be the better predictor of cessation.

A pilot study testing the effect of different levels of financial incentives on weight loss among overweight employees

Objective: To test the ability of two levels of modest financial incentives to encourage weight loss among overweight employees. Methods: This study used a randomized design with measurements at baseline, 3, and 6 months and two levels of financial incentives (