Health Behavior and Health Education
theory, research, and practice
theory, research, and practice
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.
Intervention Overview
Results
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:
Results:
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.