Sara S. Johnson

Acceptability of a School-Based Intervention for the Prevention of Adolescent Obesity:

This article describes the development and pilot testing of a computer-based, multiple-behavior obesity prevention program for adolescents. Using the Transtheoretical Model as a framework, this intervention offers individualized feedback based on readiness to engage in physical activity, to consume fruits and vegetables, and to limit television viewing. Focus groups and interviews with students, teachers, school administrators, and experts guided the development. Forty-five students participated in a baseline intervention session and completed a 16-item acceptability measure. Ratings were positive, with item means ranging from 3.60–4.75 on a 5-point scale. Student responses to open-ended questions aided in the enhancement of the intervention, for which an effectiveness trial begins in September 2006. This formative work demonstrated the acceptability of this school-based intervention approach, which can be promoted and prescribed by school nurses. Further, if found effective, it can be disseminated as an efficient, low-cost, population-based approach designed to address the epidemic of obesity.

Coaction in multiple behavior change interventions: consistency across multiple studies on weight management and obesity prevention.

OBJECTIVE Coaction refers to the extent to which taking action on one behavior increases the odds of taking action on a second behavior. This integrative study examines the generalization of coaction in three studies on weight-related behaviors. METHOD Data from three randomized trials of tailored interventions (n = 1,277, n = 1,800, and n = 6,000) were examined to determine if coaction of behavior change occurred differentially in treatment and control groups. In each analysis, the likelihood of progressing to the Action or Maintenance stages for the target behaviors was evaluated using logistic regression. RESULTS Despite differences in populations, targeted behaviors, levels of tailoring in interventions, and timing of follow-up assessments, 17 out of 24 (70.8%) logistic regressions revealed significant coaction in the treatment group as opposed to only three out of 24 (12.5%) in the control condition. In 23/24 analyses, coaction of behavior change was larger on an absolute basis in the treatment group. Individuals in the treatment group progressing to Action/Maintenance for one behavior were 1.4-5 times more likely to make progress on another behavior compared to those in the treatment group who did not make such progress on the first behavior. CONCLUSIONS This study demonstrates that despite considerable variability in study design, coaction reliably occurs more in the presence of Transtheoretical-Model based multiple behavior change interventions. Additional studies are needed to replicate these results in other behavioral areas and to examine the predictors of differential coaction. The ability to consistently create coaction within multiple behavior interventions can increase the efficacy and cost-effectiveness of multiple behavior change interventions.

Meeting Patients Where They Are At: Using a Stage Approach to Facilitate Engagement

In this chapter, authored by the leading authorities in the stage approach, readers learn how to engage entire populations in the change process, including those who are uninformed, discouraged, or resistant. A sophisticated understanding of how the characteristics of individuals across the stages of readiness impact engagement is delivered. Next, the application of the Transtheoretical Model of Behavior Change and specific tools for implementation is provided. Readers will gain or expand their understanding of applying the stage model to engaging patients in their health journey.

Proactive Health Consumerism: An Important New Tool for Worksite Health Promotion

Consumerism in health care has taken on the form of a major innovation among employers and health plans. Yet many of our efforts to enhance the skills and attitudes that enable consumerism have met with limited success. Proactive Health Consumerism is proposed as an approach that utilizes many of the hard-won lessons from health promotion research. Along with prerequisites that create the motivation and framework for increased health consumerism, this article provides a theory-driven example of a new tool for health promotion professionals to employ when enhancing the health consumer skills of working populations. Strategies for maximization of effectiveness and integration with supporting resources are also described.

The Art of Health Promotion: Linking research to practice

The Engagement Issue Sara S. Johnson, PhD Engagement This issue of The Art of Health Promotion features several different perspectives on engagement in health and well-being programs—a critical topic given that even the most effective initiatives will fail to produce outcomes in the absence of meaningful engagement. Adam Long and Roger Reed eloquently define health engagement and provide suggestions about how best to measure it using the corollary of goal achievement. M. J. Shaar helps us appreciate that engagement is one critical principle of positive psychology to which we should attend in our pursuit to promote and prioritize psychological well-being in our wellness offerings. Laura Putnam articulately advocates for boosting engagement in our worksite well-being initiatives by ‘‘starting with what’s right.’’ Finally, Michael Kim and Maria Elena Lara frame an approach to designing habits that they hypothesize will create more engagement in health promotion programs. Each of these promising strategies for increasing engagement in the well-being solutions we offer has the potential to be effective in its own right. Each is likely to be even more efficacious when used in combination with the others. In fact, we likely need these and a whole cadre of other strategies (eg, personalization, strategic communications, a focus on the employee experience) to move the needle on health engagement. One such often overlooked strategy is to consider different forms of engagement by exploring and leveraging the interactions between engagement in well-being initiatives and employee engagement. Failing to do so might well mean descending into a rabbit hole—as Willis Towers Watson contends that lack of employee engagement is the single biggest barrier to participation in and the success of health and well-being programs. Employee engagement is defined as a willingness to use discretionary effort and one’s best efforts to help the organization succeed and reflects a level of psychological investment and emotional commitment that far surpasses working for a paycheck. Gallup defines 3 levels of employee engagement. Employees who are engaged work with passion and feel a profound connection to their company, driving innovation, and advancing the organization. Those who are not engaged are essentially ‘‘checked out,’’ going through the motions and putting in time devoid of energy and passion. Those who are actively disengaged are acting on their unhappiness in ways that undermine the efforts of their engaged colleagues. There are clear correlations between employee engagement and wellbeing. Engaged employees are healthier, are less likely to have chronic disease, and have healthier habits than those who are not engaged or those who are actively disengaged. And those who are engaged are more likely to be involved in the wellness programs their employer offers. Furthermore, the risk of being disengaged is twice as high among employees who have financial distress and health risks as compared to employees who are healthier and more financially secure. Perhaps most importantly, promoting employee engagement and well-being simultaneously has the potential to create synergistic effects on employee engagement levels, as well as on a number of important organizational metrics, including health-care costs, retention, resilience, and performance. These links make it particularly disturbing that employee engagement is falling globally and in the United States. Fewer than one quarter of employees are highly engaged. In addition to being a barrier to participation in well-being programs, low employee engagement is costly: The estimated economic toll is

Transtheoretical Model-based Multiple Behavior Intervention for Weight Management: Effectiveness on a Population Basis

450 to

Applying the Transtheoretical Model to Regular Moderate Exercise in an Overweight Population: Validation of a Stages of Change Measure

550 billion annually. How can we increase employee engagement?