Sheleigh Lawler

Telephone counseling for physical activity and diet in primary care patients.

BACKGROUND The delivery of effective interventions to assist patients to improve their physical activity and dietary behaviors is a challenge in the busy primary care setting. DESIGN Cluster RCT with practices randomized to telephone counseling intervention or usual care. Data collection took place from February 2005 to November 2007, with analysis from December 2007 to April 2008. SETTING/PARTICIPANTS Four-hundred thirty-four adult patients with type 2 diabetes or hypertension (mean age=58.2 [SD=11.8]; 61% female; mean BMI=31.1 [SD=6.8]) from a disadvantaged community were recruited from ten primary care practices. INTERVENTION Twelve-month telephone counseling intervention. MAIN OUTCOME MEASURES Physical activity and dietary intake were assessed by self-report at baseline, 4, and 12 months. RESULTS At 12 months, patients in both groups increased moderate-to-vigorous physical activity by a mean of 78 minutes per week (SE=10). Significant intervention effects (telephone counseling minus usual care) were observed for: calories from total fat (decrease of 1.17%; p<0.007), energy from saturated fat (decrease of 0.97%; p<0.007), vegetable intake (increase of 0.71 servings; p<0.039), fruit intake (increase of 0.30 servings; p<0.001), and grams of fiber (increase of 2.23 g; p<0.001). CONCLUSIONS The study targeted a challenging primary care patient sample and, using a telephone-delivered intervention, demonstrated modest improvements in diet and in physical activity. Results suggest that telephone counseling is a feasible means of delivering lifestyle intervention to primary care patients with chronic conditions-patients whose need for ongoing support for lifestyle change is often beyond the capacity of primary healthcare practitioners.

Health Status of Long-term Cancer Survivors: Results from an Australian Population-Based Sample

Background: Despite considerable knowledge about the effect of cancer during the early stages of treatment and survivorship, understanding the longer-term effect of cancer has only recently become a priority. This study investigated the health implications of longer-term cancer survivorship in an Australian, population-based sample. Methods: Using the Australian National Health Survey, 968 longer-term cancer survivors were identified, along with 5,808 age- and sex-matched respondents without a history of cancer. Four measures of health effect were compared (quality of life, health status, days out of role, and mental well-being), using polytomous and logistic regression analyses controlling for other selected chronic conditions. These models were applied across both groups overall, across groups stratified by presence/absence of cancer, and other chronic conditions, as well as by tumor site. Results: Compared with matched respondents without cancer, longer-term cancer survivors reported significant decrements in health status, days out of role, and mental well-being (all P < 0.02), but not in quality of life. The likelihood of poor health outcomes (including quality of life) was much higher among survivors who also reported comorbid chronic conditions. Despite mixed results across tumor site, melanoma and prostate cancer survivors fared better across most outcomes. Conclusions: Clear evidence of excess morbidity among Australian longer-term cancer survivors seems to be further exacerbated by the presence of comorbid chronic conditions. Consistent with recent U.S. studies, these results further support the importance of ongoing surveillance of the growing number of cancer survivors worldwide along with increased attention to interventions to improve long-term health outcomes. (Cancer Epidemiol Biomarkers Prev 2006;15(10):1969–76)

Iterative development of Stand Up Australia: a multi-component intervention to reduce workplace sitting.

BackgroundSitting, particularly in prolonged, unbroken bouts, is widespread within the office workplace, yet few interventions have addressed this newly-identified health risk behaviour. This paper describes the iterative development process and resulting intervention procedures for the Stand Up Australia research program focusing on a multi-component workplace intervention to reduce sitting time.MethodsThe development of Stand Up Australia followed three phases. 1) Conceptualisation: Stand Up Australia was based on social cognitive theory and social ecological model components. These were operationalised via a taxonomy of intervention strategies and designed to target multiple levels of influence including: organisational structures (e.g. via management consultation), the physical work environment (via provision of height-adjustable workstations), and individual employees (e.g. via face-to-face coaching). 2) Formative research: Intervention components were separately tested for their feasibility and acceptability. 3) Pilot studies: Stand Up Comcare tested the integrated intervention elements in a controlled pilot study examining efficacy, feasibility and acceptability. Stand Up UQ examined the additional value of the organisational- and individual-level components over height-adjustable workstations only in a three-arm controlled trial. In both pilot studies, office workers’ sitting time was measured objectively using activPAL3 devices and the intervention was refined based on qualitative feedback from managers and employees.ResultsResults and feedback from participants and managers involved in the intervention development phases suggest high efficacy, acceptance, and feasibility of all intervention components. The final version of the Stand Up Australia intervention includes strategies at the organisational (senior management consultation, representatives consultation workshop, team champions, staff information and brainstorming session with information booklet, and supportive emails from managers to staff), environmental (height-adjustable workstations), and individual level (face-to-face coaching session and telephone support). Stand Up Australia is currently being evaluated in the context of a cluster-randomised controlled trial at the Department of Human Services (DHS) in Melbourne, Australia.ConclusionsStand Up Australia is an evidence-guided and systematically developed workplace intervention targeting reductions in office workers’ sitting time.

Follow-up care after breast cancer treatment: experiences and perceptions of service provision and provider interactions in rural Australian women

PurposeThis study aims to explore and examine experiences and perceptions of follow-up care (medical and psychosocial) after active treatment for breast cancer among women living outside major Australian cities.MethodTwenty-five semi-structured telephone interviews were conducted. Participants also completed a brief questionnaire to collect demographic, diagnosis, and treatment information. Interviews were audio-recorded, transcribed, independently coded, and then thematically analysed.ResultsThemes that emerged from the interviews centred on patient experiences and perceptions of follow-up service provision and provider interactions related to medical, psychosocial, and lifestyle (e.g., diet, physical activity) care. Many women perceived a marked decline in the quality and duration of follow-up consultations with clinicians in comparison to their initial treatment experiences. Several women experienced considerable overlap in follow-up care when multiple providers were involved resulting in ‘unnecessary’ time and travel costs. Generally, women experienced limited availability of medical providers in rural areas, resulting in a lack of continuity in care, exacerbated by limited communication and coordination between treating health professionals. Lastly, women perceived a lack of available psychosocial support and resources for rural breast cancer survivors in their areas.ConclusionsBreast cancer survivors living outside major Australian cities have limited access to medical follow-up care, and psychosocial and lifestyle support programmes. There is a need for greater co-ordination of care between health professionals to improve communication and reduce patient and medical system burden. Finding solutions (such as eHealth options) could help to alleviate these barriers and improve follow-up care for rural breast cancer survivors.

Maintenance of physical activity and dietary change following a telephone-delivered intervention.

OBJECTIVE To examine the maintenance of behavioral changes 6 months following a telephone-delivered physical activity and diet intervention. DESIGN Patients (n = 434) with Type 2 diabetes or hypertension were recruited from 10 primary care practices in a disadvantaged community; practices were randomized to a telephone-counseling intervention (TC; 5 practices, n = 228) or usual care (UC; 5 practices, n = 206). MAIN OUTCOME MEASURES Validated, self-report measures of physical activity and diet were taken at baseline, 12 months (end-of-intervention), and 18 months (6 months postintervention completion). RESULTS For physical activity, the significant (p < .001) within-groups improvements from baseline observed at 12 months remained at 18 months, in both the TC (62.2 ± 14.2 minutes/week; 2.2 ± 0.3 sessions/week) and UC (74.7 ± 14.9 minutes/week; 2.1 ± 0.4 sessions/week) groups. For all dietary outcomes, significant (p < .05) between-groups maintenance effects, similar to end-of-intervention outcomes, remained [TC-UC changes from baseline to 18 months (95% CI)]: total fat [-1.33 (-2.16, -0.50)% energy/day], saturated fat [-1.06 (-1.70, -0.43)% energy/day], fiber intake [1.90 (0.72, 3.15) grams/day], and fruit [0.22 (0.05, 0.40) servings/day]), except vegetables [0.59 (-0.01, 1.17) servings/day; p = .05]. Intervention effects across all health behavior outcomes were stronger for the subgroup (n = 145) adhering to the study protocol. CONCLUSION Telephone-delivered interventions can promote maintenance of health behavior change. Studies with longer-term follow-up are needed, particularly to determine how intervention duration and intensity might further enhance maintenance.

A Telephone-Delivered Physical Activity and Dietary Intervention for Type 2 Diabetes and Hypertension: Does Intervention Dose Influence Outcomes?

Purpose. To examine associations of intervention dose with behavior change outcomes in a telephone counseling intervention for physical activity and dietary change. Design. Secondary analysis of intervention participants from a cluster-randomized controlled trial. Setting. Primary care practices in a disadvantaged community in Queensland, Australia. Subjects. Adult patients with type 2 diabetes or hypertension. Intervention. Patients (n = 228) received telephone counseling over a 12-month period. The initiation phase (1–4 months) consisted of up to 10 weekly or fortnightly calls; the maintenance-enhancement phase (5–12 months) consisted of up to eight monthly calls. Measures. Intervention dose was defined as the number of calls completed in total and during each phase and was categorized into tertiles. Diet and physical activity were measured using validated self-report instruments. Analysis. Multivariate analyses of call completion and change in health behaviors. Results. Those completing a high number of calls were more likely to be female, white, older than 60 years, retired, and earning less than an average weekly Australian wage. Relative to low call completion, high completion during the maintenance-enhancement phase was associated with significantly greater (least squares mean [SE]) behavioral improvement for the following: total fat intake as percentage of calories (–3.58% [.74%]), saturated fat intake (–2.51% [.51%]), fiber intake (4.23 [1.20] g), and moderate-to-vigorous physical activity (187.82 [44.78] minutes). Conclusion. Interventions of longer duration may be required to influence complex behaviors such as physical activity and fat and fiber intake. (Am J Health Promot 2011;25[4]:257–263.)

Effectiveness of lifestyle-based weight loss interventions for adults with type 2 diabetes: a systematic review and meta-analysis.

To provide a systematic review and meta‐analysis of recent evidence on the effectiveness of lifestyle‐based weight loss interventions for adults with type 2 diabetes.

Sun exposure and sun protection behaviours among young adult sport competitors

Objective: To explore the relationship between sun protection and physical activity in young adults (18‐30 years) involved in four organised sports.

The Living Well after Breast Cancer™ Pilot Trial: a weight loss intervention for women following treatment for breast cancer

Obesity is associated with poor prognosis and risk of treatment side‐effects in breast cancer survivors. This pilot study assessed the feasibility, acceptability, safety and efficacy of a telephone‐delivered weight loss intervention, among women (BMI 25–40 kg/m2) following treatment for stage I–III breast cancer, on weight loss (primary outcome), quality of life and treatment‐related side‐effects (vs usual care).

Moderators of health behavior initiation and maintenance in a randomized telephone counseling trial

OBJECTIVE This study compares moderators of initiation and maintenance of health behavior changes. METHODS Data come from a cluster-randomized, 12-month telephone counseling intervention for physical activity and diet, targeting type 2 diabetes or hypertension patients (n=434, Australia,2005-2007). Demographic and health-related characteristics, theoretical constructs, and baseline behavioral outcomes were considered as moderators. Mixed models, adjusting for baseline values, assessed moderation of intervention effects for trial outcomes (physical activity, intakes of fat, saturated fat, fiber, fruit, vegetables) at end-of-intervention (12 months/initiation) and maintenance follow-up (18 months), and compared moderation between these periods. RESULTS Social support for physical activity and baseline physical activity were significant (p<0.05) moderators of physical activity at 12 months. Gender, marital status, social support for healthy eating, BMI, and number of chronic conditions were significant moderators of dietary changes at 12- and/or 18 months. Instances of moderation differing significantly between 12- and 18 months were: baseline physical activity for physical activity (initiation) and marital status for fat intake (maintenance). CONCLUSIONS This exploratory study showed that moderation of physical activity and diet effects sometimes differed between initiation and maintenance. To identify unique moderators for initiation and/or maintenance of behavior changes, future studies need to report on and statistically test for such differences.