Evaluation of an Email-Mediated County Extension-Delivered Walking Intervention

2.50
Hdl Handle:
http://hdl.handle.net/10755/621694
Category:
Full-text
Format:
Text-based Document
Type:
Presentation
Level of Evidence:
N/A
Research Approach:
N/A
Title:
Evaluation of an Email-Mediated County Extension-Delivered Walking Intervention
Other Titles:
Improving Clinical Outcomes Through Physical Activity
Author(s):
Richards, Elizabeth A.; Woodcox, Stephanie
Lead Author STTI Affiliation:
Delta Omicron
Author Details:
Elizabeth A. Richards, PhD, RN, CHES, Professional Experience: 2013-present- Assistant Professor, Purdue University School of Nursing 2011-2013- Clinical Associate Professor, Purdue University School of Nursing 2007-present- Leadership team member of Physical Activity Section of the American Public Health Association 2012-present- Executive Board Member of Indiana Public Health Association Recipient of four School of Nursing teaching awards. Author or coauthor of 17 peer-reviewed publications primarily relating to public health nursing education and health promotion. Author or coauthor of 18 state, national, and international conference presentations. Author Summary: Dr. Richards’ research is focused on population-based physical activity promotion. She has developed walking interventions using several novel strategies including dog walking, email mediated, and dyad-level interventions. In addition, she serves in several leadership positions in the field of public health, including as a Board Member for the Indiana Public Health Association and as a member of the American Public Health Association Action Board.
Abstract:

Purpose:

Even though promotion of physical activity (PA) has been a public health priority for decades, key U.S. public health agencies, such as the Centers for Disease Control and Prevention (CDC), routinely collect data indicating that most Americans are not meeting PA guidelines (Centers for Disease Control and Prevention, 2012a). Physical inactivity is directly related to the prevalence of obesity and the development of many chronic diseases (Centers for Disease Control and Prevention, 2014). Walking is an excellent way for most people to increase their PA and has been declared by the Surgeon General as a powerful public health strategy (U.S. Department of Health and Human Services, 2015). Walking is an easy way to start and maintain a physically active lifestyle because walking is accessible to almost anyone, does not require specific skills or abilities to perform, can be performed alone or with others, and is adaptable (i.e., can be performed at any chosen intensity and is inexpensive) (U.S. Department of Health and Human Services, 2015). Intervention strategies are needed to increase walking across populations.

 Internet-mediated PA interventions have the potential to reach a large number of people with lower costs compared to in-person intervention delivery (van den Berg, Schoones, & Vliet Vlieland, 2007). By using e-mail, intervention participants can have flexibility with when and where they choose to interact and receive intervention information (Napolitano & Marcus, 2002). Previous reviews on the effectiveness of internet-mediated PA interventions have indicated e-mail as a promising intervention delivery mode (Marcus, Ciccolo, & Sciamanna, 2009; Marcus, Nigg, Riebe, & Forsyth, 2000; van den Berg et al., 2007).

 As one of the nation’s largest providers of scientific research-based information and education, the Cooperative Extension System is another established delivery method for health behavior change programs. Traditionally, Extension education programs are offered in group settings. In our region (state?), the current intervention was the first health promotion program to be delivered solely via e-mail. By delivering the intervention through county-based Purdue Extension Educators, it is important to evaluate the program not only in terms of outcomes, but also from the perspective of educators as well as community residents who participated. The purpose of this study is to evaluate the feasibility of delivering this intervention through county-based Extension Educators.

 Methods:

The Get WalkIN’ intervention was primarily based on a previously tested e-mail mediated social cognitive theory-based intervention which demonstrated effectiveness in a small, controlled sample (Richards et al., 2016). Based on this previous success, a team of Extension Educators and the lead researcher tailored the intervention to create Get WalkIN’ with the goal of making the intervention suitable for the various populations Extension serves.

In spring 2016, 300 participants were recruited from 12 counties across the state, each of which is served by county-based staff of Purdue Extension. Recruitment methods included newsletters, flyers, and social media. As this is a community-based program, there were no inclusion or exclusion criteria for participation. Intuitional review board approval was granted.

Get WalkIN’ consists of a total of 16 e-mails designed to increase walking. Program e-mails to participants by Extension Educators were sent bi-weekly for the first four weeks and then weekly for the next eight weeks. These e-mails targeted principles of self-efficacy, social support, goal-setting, and benefits/barriers to walking.

To assess the perceptions of acceptability of the intervention, participants were asked eight 5-point Likert scale questions (1=strongly disagree; 5=strongly agree). Questions included: the e-mails were easy to read; the frequency of the e-mails was adequate; and the advice appeared to be credible. Participants were also asked how often he/she read the e-mails and open-ended questions to determine what aspects of the intervention e-mails were helpful, seemed unnecessary, and if they would recommend this intervention to a friend.

The theoretical constructs of self-efficacy and social support were measured using existing measures with demonstrated reliability and validity and adapted to be specific to walking (Sallis, Grossman, Pinski, Patterson, & Nader, 1987; Sallis, Pinski, Grossman, Patterson, & Nader, 1988). Mean scores were computed across all items in each subscale. Self-reported PA was assessed using the Godin Leisure Time PA Questionnaire. Individuals reporting moderate-to-strenuous activity scores ≥24 were classified as active and individuals reporting moderate-to-strenuous activity scores ≤23 were classified as insufficiently active (Godin & Shephard, 1985).

 Descriptive statistics were used to summarize participant characteristics and analyze the feasibility and usability data. Means and standard errors were calculated for continuous variables and frequencies and percentages for categorical variables. Chi-square and two-sample t-tests were used to assess differences between baseline and post-intervention assessments. Data were analyzed using SAS 9.3 (SAS Institute Inc., 2009). Statistical significance was set at p < 0.05.

Results:

Most participants were non-Hispanic white females with an average age of 54.0±12.7. On average, participants were classified as obese (average BMI 30.9±8.2) and insufficiently active (52%). Additionally, participants agreed that the intervention e-mails were easy to read (mean=4.3), easy to understand (mean=4.3), frequency of e-mails was adequate (mean=4.3), and that the e-mails helped to increase walking (mean=4.0). Eighty-eight percent of participants reported reading the e-mails quite often or always, while 11% reported sometimes, and 2% reported rarely. While the theoretical constructions of self-efficacy and social support increased post-intervention, mean scores were not significantly different from baseline. Post-intervention, 82% of respondents were classified as sufficiently active compared to 48% pre-intervention (p<0.05).

Conclusion:

The novelty of this study is the partnership formed with Purdue Extension for the delivery of this intervention. Leveraging the strong infrastructure that Extension has statewide, it was possible to train county-based Extension Educators for intervention recruitment and delivery. Extension Educators live and work in the counties they serve, thus having strong community relationships, being a familiar face in their county, and trust established. In addition to discussing program evaluation, this presentation will discuss research implications for strengthening ties with and partnering with Cooperative Extension for community-based interventions and health promotion programing.

Keywords:
Intervention; Social Cognitive Theory; Walking
Repository Posting Date:
6-Jul-2017
Date of Publication:
6-Jul-2017
Other Identifiers:
INRC17E09
Conference Date:
2017
Conference Name:
28th International Nursing Research Congress
Conference Host:
Sigma Theta Tau International
Conference Location:
Dublin, Ireland
Description:
Event Theme: Influencing Global Health Through the Advancement of Nursing Scholarship

Full metadata record

DC FieldValue Language
dc.language.isoen_USen
dc.type.categoryFull-texten
dc.formatText-based Documenten
dc.typePresentationen
dc.evidence.levelN/Aen
dc.research.approachN/Aen
dc.titleEvaluation of an Email-Mediated County Extension-Delivered Walking Interventionen_US
dc.title.alternativeImproving Clinical Outcomes Through Physical Activityen
dc.contributor.authorRichards, Elizabeth A.en
dc.contributor.authorWoodcox, Stephanieen
dc.contributor.departmentDelta Omicronen
dc.author.detailsElizabeth A. Richards, PhD, RN, CHES, Professional Experience: 2013-present- Assistant Professor, Purdue University School of Nursing 2011-2013- Clinical Associate Professor, Purdue University School of Nursing 2007-present- Leadership team member of Physical Activity Section of the American Public Health Association 2012-present- Executive Board Member of Indiana Public Health Association Recipient of four School of Nursing teaching awards. Author or coauthor of 17 peer-reviewed publications primarily relating to public health nursing education and health promotion. Author or coauthor of 18 state, national, and international conference presentations. Author Summary: Dr. Richards’ research is focused on population-based physical activity promotion. She has developed walking interventions using several novel strategies including dog walking, email mediated, and dyad-level interventions. In addition, she serves in several leadership positions in the field of public health, including as a Board Member for the Indiana Public Health Association and as a member of the American Public Health Association Action Board.en
dc.identifier.urihttp://hdl.handle.net/10755/621694-
dc.description.abstract<p><strong>Purpose:</strong></p> <p>Even though promotion of physical activity (PA) has been a public health priority for decades, key U.S. public health agencies, such as the Centers for Disease Control and Prevention (CDC), routinely collect data indicating that most Americans are not meeting PA guidelines (Centers for Disease Control and Prevention, 2012a). Physical inactivity is directly related to the prevalence of obesity and the development of many chronic diseases (Centers for Disease Control and Prevention, 2014). Walking is an excellent way for most people to increase their PA and has been declared by the Surgeon General as a powerful public health strategy (U.S. Department of Health and Human Services, 2015). Walking is an easy way to start and maintain a physically active lifestyle because walking is accessible to almost anyone, does not require specific skills or abilities to perform, can be performed alone or with others, and is adaptable (i.e., can be performed at any chosen intensity and is inexpensive) (U.S. Department of Health and Human Services, 2015). Intervention strategies are needed to increase walking across populations.</p> <p> Internet-mediated PA interventions have the potential to reach a large number of people with lower costs compared to in-person intervention delivery (van den Berg, Schoones, & Vliet Vlieland, 2007). By using e-mail, intervention participants can have flexibility with when and where they choose to interact and receive intervention information (Napolitano & Marcus, 2002). Previous reviews on the effectiveness of internet-mediated PA interventions have indicated e-mail as a promising intervention delivery mode (Marcus, Ciccolo, & Sciamanna, 2009; Marcus, Nigg, Riebe, & Forsyth, 2000; van den Berg et al., 2007).</p> <p> As one of the nation’s largest providers of scientific research-based information and education, the Cooperative Extension System is another established delivery method for health behavior change programs. Traditionally, Extension education programs are offered in group settings. In our region (state?), the current intervention was the first health promotion program to be delivered solely via e-mail. By delivering the intervention through county-based Purdue Extension Educators, it is important to evaluate the program not only in terms of outcomes, but also from the perspective of educators as well as community residents who participated. The purpose of this study is to evaluate the feasibility of delivering this intervention through county-based Extension Educators.</p> <p> <strong>Methods:</strong></p> <p>The Get WalkIN’ intervention was primarily based on a previously tested e-mail mediated social cognitive theory-based intervention which demonstrated effectiveness in a small, controlled sample (Richards et al., 2016). Based on this previous success, a team of Extension Educators and the lead researcher tailored the intervention to create Get WalkIN’ with the goal of making the intervention suitable for the various populations Extension serves.</p> <p>In spring 2016, 300 participants were recruited from 12 counties across the state, each of which is served by county-based staff of Purdue Extension. Recruitment methods included newsletters, flyers, and social media. As this is a community-based program, there were no inclusion or exclusion criteria for participation. Intuitional review board approval was granted.</p> <p>Get WalkIN’ consists of a total of 16 e-mails designed to increase walking. Program e-mails to participants by Extension Educators were sent bi-weekly for the first four weeks and then weekly for the next eight weeks. These e-mails targeted principles of self-efficacy, social support, goal-setting, and benefits/barriers to walking.</p> <p>To assess the perceptions of acceptability of the intervention, participants were asked eight 5-point Likert scale questions (1=strongly disagree; 5=strongly agree). Questions included: the e-mails were easy to read; the frequency of the e-mails was adequate; and the advice appeared to be credible. Participants were also asked how often he/she read the e-mails and open-ended questions to determine what aspects of the intervention e-mails were helpful, seemed unnecessary, and if they would recommend this intervention to a friend.</p> <p>The theoretical constructs of self-efficacy and social support were measured using existing measures with demonstrated reliability and validity and adapted to be specific to walking (Sallis, Grossman, Pinski, Patterson, & Nader, 1987; Sallis, Pinski, Grossman, Patterson, & Nader, 1988). Mean scores were computed across all items in each subscale. Self-reported PA was assessed using the Godin Leisure Time PA Questionnaire. Individuals reporting moderate-to-strenuous activity scores ≥24 were classified as active and individuals reporting moderate-to-strenuous activity scores ≤23 were classified as insufficiently active (Godin & Shephard, 1985).</p> <p> Descriptive statistics were used to summarize participant characteristics and analyze the feasibility and usability data. Means and standard errors were calculated for continuous variables and frequencies and percentages for categorical variables. Chi-square and two-sample t-tests were used to assess differences between baseline and post-intervention assessments. Data were analyzed using SAS 9.3 (SAS Institute Inc., 2009). Statistical significance was set at <em>p</em> < 0.05.</p> <p><strong>Results:</strong></p> <p>Most participants were non-Hispanic white females with an average age of 54.0±12.7. On average, participants were classified as obese (average BMI 30.9±8.2) and insufficiently active (52%). Additionally, participants agreed that the intervention e-mails were easy to read (mean=4.3), easy to understand (mean=4.3), frequency of e-mails was adequate (mean=4.3), and that the e-mails helped to increase walking (mean=4.0). Eighty-eight percent of participants reported reading the e-mails quite often or always, while 11% reported sometimes, and 2% reported rarely. While the theoretical constructions of self-efficacy and social support increased post-intervention, mean scores were not significantly different from baseline. Post-intervention, 82% of respondents were classified as sufficiently active compared to 48% pre-intervention (<em>p</em><0.05).</p> <p><strong>Conclusion:</strong></p> <p>The novelty of this study is the partnership formed with Purdue Extension for the delivery of this intervention. Leveraging the strong infrastructure that Extension has statewide, it was possible to train county-based Extension Educators for intervention recruitment and delivery. Extension Educators live and work in the counties they serve, thus having strong community relationships, being a familiar face in their county, and trust established. In addition to discussing program evaluation, this presentation will discuss research implications for strengthening ties with and partnering with Cooperative Extension for community-based interventions and health promotion programing.</p>en
dc.subjectInterventionen
dc.subjectSocial Cognitive Theoryen
dc.subjectWalkingen
dc.date.available2017-07-06T19:20:49Z-
dc.date.issued2017-07-06-
dc.date.accessioned2017-07-06T19:20:49Z-
dc.conference.date2017en
dc.conference.name28th International Nursing Research Congressen
dc.conference.hostSigma Theta Tau Internationalen
dc.conference.locationDublin, Irelanden
dc.descriptionEvent Theme: Influencing Global Health Through the Advancement of Nursing Scholarshipen
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