Megan A. Lewis

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.

Self-efficacy impacts self-care and HbA1c in young adults with Type I diabetes.

Objective The present study examined self-efficacy and self-esteem as basic aspects of the self that influence self-care and physiological outcomes among young adults with Type I diabetes. The two aims of this study were 1) to examine the cross-sectional and longitudinal role of the self-variables as they predict self-care and HbA1c and 2) to test whether self-care mediates the association between the self variables and HbA1c using cross-sectional and longitudinal data. Methods One hundred ten participants were recruited from a regional diabetes outpatient clinic. Inclusion criteria were age (18–35 years) and duration of diabetes (>1 year before recruitment). Participants were 61% female and 88% white. In addition, the sample had an average annual income between

Reliability and Validity of the Women's Health Initiative Insomnia Rating Scale

24,999 and

Chronic Stress and Illness in Children: The Role of Allostatic Load:

34,999, and 85% had completed some or all of college. The average duration of diabetes was 15 years. Results Using multiple regression analyses we found that, compared with self-esteem, self-efficacy was a better predictor of all aspects of self-care and HbA1c in cross-sectional analyses, in addition to diet and exercise self-care, and a better predictor of HbA1c in longitudinal analyses. The data also supported the cross-sectional and longitudinal mediational model in which better self-care helped account for the association between greater self-efficacy and better HbA1c. Conclusions Self-efficacy is an important factor for management of self-care practices and physiological outcomes among young adults with Type I diabetes, and self-care may be an important mechanism by which self-efficacy influences HbA1c levels.

Health-Related Social Influence: A Social Ecological Perspective on Tactic Use:

The reliability and construct validity of the 5-item Womens Health Initiative Insomnia Rating Scale (WHIIRS) were evaluated in 2 studies. In Study 1, using a sample of 66,269 postmenopausal women, validity of the WHIIRS was assessed by examining its relationship to other measures known to be related to sleep quality. Reliability of the WHIIRS was estimated using a resampling approach; the mean alpha coefficient was .78. Test-retest reliability coefficients were .96 for same-day administration and .66 after a year or more. Correlations of the WHIIRS with the other measures were in the predicted directions. Study 2 used a sample of 459 women and compared the WHIIRS with objective indicators of sleep quality. Results showed that differences in the objective indicators could be detected by the WHIIRS. Findings suggest that a between-group mean difference of approximately 0.50 of a standard deviation on the WHIIRS may be clinically meaningful.

The conceptualization and assessment of health-related social control:

Objective Recent studies of stress have highlighted the contributions of chronic psychological and environmental stressors to health and well-being. Children may be especially vulnerable to the negative effects of chronic stressors. Allostasis, the bodys ability to adapt and adjust to environmental demands, has been proposed as an explanatory mechanism for the stress-health link, yet empirical evidence is minimal. This study tested the proposition that allostasis may be an underlying physiological mechanism linking chronic stress to poor health outcomes in school-aged children. Specifically, we examined whether allostasis would mediate or moderate the link between chronic stress and health. Method To test the hypothesis that allostasis contributes to the relation between chronic stress and poor health, we examined household density as a chronic environmental stressor, cardiovascular reactivity (CVR) as a marker of allostatic load, and number of school absences due to illness as the health outcome in a sample of 81 boys. Results Structural Equation modelingindicated that the mediating model fit the data well, accounting for 17% of the variance in days ill. Conclusions Results provide the first evidence that CVR may mediate the relation between household density and medical illness in children. More generally, these findings support the role of allostasis as an underlying mechanism in the link between chronic stress and health.

Antecedents and Reactions to Health-Related Social Control

The present study investigated predictors of health-related social influence tactic use in close relationships. According to the social ecological perspective, predictors were classified as reflecting characteristics of the agent of social influence, characteristics of the target of social influence, characteristics of the agent and targets relationship, and characteristics of the social influence situation. One hundred and nine married couples reported on situations in which each partner was attempting to influence his or her spouse to change a health-related behavior. Using the actor-partner interdependence analysis approach, results revealed only actor effects for characteristics of the agent, primarily partner effects for characteristics of the target, and both actor and partner effects for characteristics of the situation when predicting health-related tactic use. Effects for relationship characteristics only emerged in interactions with respondent sex. These results indicate that social influence in marriage involves reciprocity and interdependence. The importance of examining the dyadic nature of health-related social influence in close relationships is also highlighted.

Best Practices in the Veterans Health Administration's MOVE! Weight Management Program

Three studies examined the conceptualization and assessment of health-related social control in marriage. Using a sample of 100 couples, Study 1 tested the idea that social control is best thought of as the exercise of power and control in close relationships. Results did not support this conceptualization or assessment of health-related social control in marriage. Based on these results, Study 2 collected qualitative data from husbands and wives via focus groups to explore the use of social control tactics that couples use to change health behavior. Results indicated that many tactics reported by spouses are not contained in the social influence literature, and that the exercise of social control in marriage may best be characterized of as an interdependent communally oriented process between spouses. Using another sample of 109 married couples, Study 3 tested the reliability and validity of a measure developed from the qualitative data. Results indicated the new measure of health-related social control tactics evidenced better reliability and validity than the measure used in Study 1.

In Search of Synergy: Strategies for Combining Interventions at Multiple Levels

A model of the antecedents and reactions to health-related social control is proposed. This model suggests health behavior characteristics, including type, frequency, and severity of consequences, are social control antecedents. Social control is then thought to elicit better health behavior and emotions. Attributions to explain social control are proposed to effect emotional reactions and behavior. Undergraduates read hypothetical scenarios to test the proposed model. Study 1 found that health-compromising behaviors and behaviors with more severe consequences elicited more social control. Study 2 found that, compared to negative tactics, positive social control tactics elicited more behavior change, and compared to social/appearance concerns, attributions to health elicited positive emotions. Attributions did not moderate the impact of social control on emotions or behavior.

HIV-specific social support predicts less sexual risk behavior in gay male couples:

BACKGROUND Obesity is a substantial problem in the Veterans Health Administration (VHA). VHA developed and disseminated the MOVE! Weight Management Program for Veterans to its medical facilities but implementation of the program has been variable. PURPOSE The objective was to explore variation in MOVE! program implementation to identify facility structure, policies, and processes associated with larger patient weight-loss outcomes. METHODS Qualitative comparative analysis (QCA) was used to identify facility conditions or combinations of conditions associated with larger 6-month patient weight-loss outcomes. QCA is a method that allows for systematic cross-case comparison to better understand causal complexity. Eleven sites with larger outcomes and 11 sites with smaller outcomes were identified and data were collected with site interviews, facility-completed program summary forms, and medical record abstraction in 2009 and 2010. Conditions were selected based on theory and experience implementing MOVE! and were calibrated using QCA methods. Configuration patterns were examined to identify necessary conditions (i.e., always present when outcome present, but alone do not guarantee outcome) and sufficient conditions (i.e., presence guarantees outcome) at sites with larger and smaller outcomes. A thematic analysis of site interview data supplemented QCA findings. RESULTS No two sites shared the same condition pattern. Necessary conditions included the use of a standard curriculum and group care-delivery format, and they were present at all sites with larger outcomes but at only six sites with smaller outcomes. At the 17 sites with both necessary conditions, four combinations of conditions were identified that accounted for all sites with larger outcomes. These included high program complexity combined with high staff involvement; group care-delivery format combined with low accountability to facility leadership; an active physician champion combined with low accountability to facility leadership; and the use of quality-improvement strategies combined with not using a waiting list. CONCLUSIONS The use of a standard curriculum delivered with a group care-delivery format is an essential feature of successful VHA facility MOVE! Weight Management Programs, but alone does not guarantee success. Program development and policy will be used to ensure dissemination of the best practices identified in this evaluation.