Model: Ecological Model of Four Domains of Active Living (Sallis, 2006)
Objective: Pilot study tested the feasibility and acceptability of a novel multilevel walking intervention for older adults in a continuing care retirement community (CCRC). The intervention included site-specific walking route maps, pedometers, and individualized goal setting. Pedometers were worn for self-monitoring and for the primary outcome (steps per day).
Methods: Adults over the age of 65 years were recruited for a multilevel walking intervention, from a CCRC for military veterans located near San Diego, CA. A pre-test post-test design was used. All eligible volunteers were accepted.
Intervention Development: Development of the individual, social, and environmental interventions was based on literature reviews, focus groups with seniors, and pre-testing of written materials. The main novel component was improving perceptions of the environment for supporting walking by giving participants site-tailored walking route maps. The multilevel intervention included several components: changing perceptions of the environment via tailored walking route maps, social support, pedometers and self-monitoring, and brief individually tailored counseling for goal setting and problem solving.
- Baseline: Wear pedometers at usual level of activity. Complete survey.
- Beginning of Week 1: Record baseline step count. Receive intervention materials as a group. Meet with individual health counselor. Monitor steps for the week.
- Beginning of Week 2: Record step count from Week 1. Meet with individual health counselor. Monitor steps for the week.
- End of Week 2: Record final step count from Week 2. Complete final survey.
- Participants had very low activity levels at baseline with a mean daily step count of 3020 (SD=1858). Participants were also older and overweight on average.
- Average daily pedometer steps increased between baseline (M=3020; SD=1858) and Week 1 (M=4314; SD=2627; t(11)=âˆ'2.99, p=.012) and Week 2 (M=4246; SD=2331; t(11)=3.42, p=.006).
- Daily step counts between Weeks 1 and 2 were not significantly different (p=.79).
- All participants met their daily step goals (generally a 10% increase from baseline) in Week 1 while 50% met their step goals in Week 2.
- The results of this pilot study indicated that a brief multilevel place-based walking intervention is a promising method for promoting walking among seniors who live in CCRCs.
- Combining site-tailored maps and materials with brief weekly individualized goal setting led to a 41% increase in average dail y steps after 2 weeks.
Model: Social Ecological Model (Sorensen, 2003)
Study: Healthy Directions-Health Centers Study (a component of the Harvard Cancer Prevention Program Project)
Objective: Reduce cancer risk factors among working class, multiethnic populations seen in community health centers
Methods: Ten community health centers were randomized to intervention or control. Patients who resided in low-income, multiethnic neighborhoods were eligible. The intervention targeted fruit and vegetable consumption, red meat consumption, multivitamin intake, and physical activity. Outcomes were measured at 8 months among 2219 participants (1088 intervention, 1131 control).
Intervention Components: The intervention used a social contextual approach targeting multiple levels of influence on behaviors, with special attention to low literacy skills and the shared and unique features of culture across racial/ethnic groups. Project messages explicitly acknowledged that health behavior is influenced by context. The social context of health behavior change was addressed through:
- interventions that targeted social networks and participants' families and support systems
- the use of interventions designed with sensitivity toward limitations in material resources and toward cultural differences
- development of linkages to relevant activities in the participants' community
- the integration of the intervention into the health care delivery system, including efforts to draw upon positive aspects of the patients' relationship with their health care provider
- The intervention produced the largest effect on multivitamin use, with 70% of intervention participants reporting daily use at follow up.
- Fruit and vegetable consumption increased by ~1/3 serving among intervention participants, whereas control participants reported a decrease in consumption.
- Intervention yielded a significant reduction in red meat consumption compared with a slight increase in consumption among the control group.
- Physical activity did not change as a result of the intervention.
Findings suggest that interventions that incorporate aspects of the social context can lead to significant improvements in behavioral risk factors for cancer among low-income populations. Changes in social networks were not reported.