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Biomedical subjects

Bess H Marcus

Publications and source records attributed to Bess H Marcus.

13 recordsLinked to original sources
PubMed2004

Visit satisfaction and tailored health behavior communications in primary care.

BACKGROUND: Although studies suggest that computer-tailored health communications can help patients improve health behaviors, their effect on patient satisfaction, when used in healthcare settings, has yet to be examined. METHODS: A stand-alone computer application was developed to provide tailored, printed feedback for patients and physicians about two of the most common adverse health behaviors seen in primary care: smoking and physical inactivity. Ten primary care providers and 150 of their patients were recruited to use the program in the office before their visit. After the visit, patients completed a self-report survey that addressed demographics, computer use history, satisfaction with the visit, and the extent to which the physician addressed the reports during the visit. All data presented were collected between October 2001 and February 2002. RESULTS: Most patients were female (67.6%), approximately half (46.0%) were seen for a routine exam, most (63.3%) had at least one chronic illness, and fewer than one third (31.3%) had ever used the Internet or e-mail. Most (81.1%) patients reported that the program was easy to use, but fewer than half of the doctors looked at the report in front of the patient (49.2%) or discussed the report with the patient (44.3%). Multivariate modeling showed that visit satisfaction was significantly greater among those whose doctor examined the report. This effect of the doctor examining the report on satisfaction was even greater for those who reported a chronic illness. CONCLUSIONS: Physicians who incorporate computer tailored messaging programs into the primary care setting, but who do not address the feedback reports that they create may contribute to patients being less satisfied with their care.

Adult↗
PubMed2004

Feasibility of incorporating computer-tailored health behaviour communications in primary care settings.

BACKGROUND: We set out to investigate the feasibility of incorporating a computer-tailored health behaviour program into routine care in a group of primary care practices in Rhode Island. METHODS: Two existing computer programs (physical activity, smoking) that tailored text and graphical feedback to survey responses were combined and adapted for use in primary care directly by patients. Ten primary care practices were recruited and worked closely with project staff to develop a practice-specific plan for incorporating the program into the workflow and office routine. Feasibility was measured by the percentage of patients who used the program during the day of their visit. RESULTS: Only one of the ten offices was able to successfully incorporate the program into their office workflow and delivery of routine care. The main categories of barriers to incorporating the computer program into routine care included: the program was viewed overall as inconsistent with practice workflow, the staff was inexperienced with the program, technical problems with the computer and/or printer, the program placed an additional time burden on staff who already felt overworked. Suggestions for improving the program or the way that it was incorporated into routine care included: shortening the program, modifying the program's orientation to a target population (such as patients with hypertension) and incorporating decision-support feedback to help physicians manage the target condition, modifying the program to include other programs pertinent to primary care (for example, depression screening), selecting patients to use the program, rather than asking all patients to use it. CONCLUSIONS: After working closely with ten highly motivated primary care offices, we were unable to fully implement a point-of-care health behaviour computer system for patients and providers. Suggestions for disseminating computer-tailored health behaviour communications in primary care settings are discussed.

Feasibility Studies↗
PubMed2003

Effect of exercise duration and intensity on weight loss in overweight, sedentary women: a randomized trial.

CONTEXT: A higher duration and intensity of exercise may improve long-term weight loss. OBJECTIVE: To compare the effects of different durations and intensities of exercise on 12-month weight loss and cardiorespiratory fitness. DESIGN, SETTING, AND PARTICIPANTS: Randomized trial conducted from January 2000 through December 2001 involving 201 sedentary women (mean [SD] age, 37.0 [5.7] years; mean [SD] body mass index, 32.6 [4.2]) in a university-based weight control program. INTERVENTION: Participants were randomly assigned to 1 of 4 exercise groups (vigorous intensity/high duration; moderate intensity/high duration; moderate intensity/moderate duration; or vigorous intensity/moderate duration) based on estimated energy expenditure (1000 kcal/wk vs 2000 kcal/wk) and exercise intensity (moderate vs vigorous). All women were instructed to reduce intake of energy to between 1200 and 1500 kcal/d and dietary fat to between 20% and 30% of total energy intake. MAIN OUTCOME MEASURES: Body weight, cardiorespiratory fitness, and exercise participation. RESULTS: After exclusions, 184 of 196 randomized participants completed 12 months of treatment (94%). In intention-to-treat analysis, mean (SD) weight loss following 12 months of treatment was statistically significant (P <.001) in all exercise groups (vigorous intensity/high duration = 8.9 [7.3] kg; moderate intensity/high duration = 8.2 [7.6] kg; moderate intensity/moderate duration = 6.3 [5.6] kg; vigorous intensity/moderate duration = 7.0 [6.4] kg), with no significant difference between groups. Mean (SD) cardiorespiratory fitness levels also increased significantly (P =.04) in all groups (vigorous intensity/high duration = 22.0% [19.9%]; moderate intensity/high duration = 14.9% [18.6%]; moderate intensity/moderate duration = 13.5% [16.9%]; vigorous intensity/moderate duration = 18.9% [16.9%]), with no difference between groups. Post hoc analysis revealed that percentage weight loss at 12 months was associated with the level of physical activity performed at 6 and 12 months. Women reporting less than 150 min/wk had a mean (SD) weight loss of 4.7% [6.0%]; inconsistent (other) pattern of physical activity, 7.0% [6.9%]; 150 min/wk or more, 9.5% [7.9%]; and 200 min/wk or more of exercise, 13.6% [7.8%]. CONCLUSIONS: Significant weight loss and improved cardiorespiratory fitness were achieved through the combination of exercise and diet during 12 months, although no differences were found based on different exercise durations and intensities in this group of sedentary, overweight women.

Adult↗
PubMed2003

Rationale, design, and baseline data for Commit to Quit II: an evaluation of the efficacy of moderate-intensity physical activity as an aid to smoking cessation in women.

BACKGROUND: Commit to Quit II is a 4-year randomized controlled trial comparing the efficacy of a cognitive-behavioral smoking cessation treatment plus moderate-intensity physical activity with the same cessation treatment plus contact control. METHODS: Sedentary women smokers (n = 217) were randomized to receive 8 weeks of treatment followed by 12 months of follow-up. This article outlines the study design, presents baseline data about the sample, and compares the sample to national samples and to our previous study examining vigorous-intensity exercise as an aid to smoking cessation. RESULTS: Married and white participants reported significantly higher levels of nicotine dependence than unmarried and minority participants. Higher levels of nicotine dependence were also significantly related to lower smoking cessation self-efficacy and higher levels of self-reported depression, anxiety, and perceived stress. Additionally, participants smoked significantly more cigarettes (mean 20.6) than a national sample of female smokers (mean 16.1). On average, participants were significantly older, weighed significantly more, and scored significantly higher on a measure of anxiety than participants in our previous trial. CONCLUSIONS: Our sample consisted of women who were heavier smokers than national samples seeking treatment. It remains to be determined how this will impact their ability to attain cessation in the present study.

Administration, Cutaneous↗
PubMed2003

Print versus website physical activity programs: a randomized trial.

BACKGROUND: Mediated physical activity interventions can reach large numbers of people at low cost. Programs delivered through the mail that target the stage of motivational readiness have been shown to increase activity. Communication technology (websites and e-mail) might provide a means for delivering similar programs. METHODS: Randomized trial conducted between August and October 2001. Participants included staff at an Australian university (n=655; mean age=43, standard deviation, 10 years). Participants were randomized to either an 8-week, stage-targeted print program (Print) or 8-week, stage-targeted website (Web) program. The main outcome was change in self-reported physical activity. RESULTS: There was no significant increase in total reported physical activity within or between groups when analyzed by intention to treat (F [1,653]=0.41, p=0.52). There was a significant increase in total physical activity reported by the Print participants who were inactive at baseline (t [1,173]=-2.21, p=0.04), and a significant decrease in the average time spent sitting on a weekday in the Web group (t [1,326]=2.2, p=0.03). CONCLUSIONS: There were no differences between the Print and Web program effects on reported physical activity. The Print group demonstrated slightly larger effects and a higher level of recognition of program materials.

Adult↗
PubMed2003

Population-based randomized controlled trial of a stage-targeted physical activity intervention.

BACKGROUND: Intervention trials with self-selected participants have shown that mailed stage-targeted print materials can increase participation in physical activity in the short term. We examined the effects of a mailed stage-targeted print intervention designed to promote physical activity, in a random sample of adults living in a regional city. METHOD: Participants (n = 462, 40-60 years of age) were randomly allocated to an intervention (n = 227) or control group (n = 235). Measures included validated 2-week physical activity recall and stage of motivational readiness for physical activity. The intervention consisted of a single mailing of a letter and full-color stage-targeted booklets (specific to precontemplation, contemplation, preparation, and action/maintenance) 1 week postbaseline. Follow-up interviews were conducted at 2 and 6 months postbaseline. RESULTS: After 2 months, participants in the intervention group were significantly more likely to meet the current American College of Sports Medicine/Centers for Disease Control and Prevention recommendation for sufficient physical activity than those in the control group (adjusted odds ratio [OR] = 2.40; 95% confidence interval [CI] = 1.44-3.99). After 6 months, intervention participants who reported receiving and reading the intervention materials were significantly more likely to be meeting the sufficient physical activity criterion compared with the control group (adjusted OR = 2.03; 95% CI = 1.16-3.56). CONCLUSIONS: The stage-targeted print intervention was effective in promoting short-term increases in physical activity and was most effective for participants who recognized and used the materials. This low-cost, generalizable intervention has demonstrated potential as a practical population-based physical activity promotion strategy. Further research is required before widespread dissemination would be justified, as additional strategies may be required to ensure sustained change.

Adult↗
PubMed2002

User attitudes toward a physical activity promotion website.

BACKGROUND: The goal of the present study was to examine participants' perceptions of a theory-driven, physical activity promotion website. METHODS: Participants in the present study were individuals in the website condition of a randomized trial designed to test the efficacy of the website. At 1 month, participants were surveyed regarding their self-report of barriers, frequency of use, and helpfulness of the website. RESULTS: Overall, 30 worksite participants were randomized to the website condition and 24 (80%) completed the survey at 1 month. The main barrier to using the website was a "lack of time" (63%). No participants endorsed trouble using the website, a lack of interest in using the internet, or a lack of interest in changing their activity level as barriers to using the website. Furthermore, most sections of the website were found to be "helpful." Patterns of use and perceived utility differed by readiness to become active. For example, more respondents in the "preparation" stage at baseline reported using the overall website, in addition to the "becoming active" and "physical activity and health" sections, than those in the "contemplation" stage at baseline. Perceived utility and frequency of use of specific sections were often divergent, where some sections were rated more helpful and used less frequently (the "Overcoming Barriers" section, for example), while the reverse was true for other sections (the "Walking Fitness Test" section, for example). CONCLUSION: In conclusion, the website was well accepted and few barriers were noted. Areas of the website that were used less frequently or found to be less helpful will become areas of focus for future iterations of the site.

Adolescent↗
PubMed2002

Effects of a computer-based, telephone-counseling system on physical activity.

BACKGROUND: There is increasing interest in developing interventions to promote physical activity (PA) that do not involve face-to-face contact with health professionals. We developed a fully automated PA counseling system (telephone-linked communication, TLC-PA) that was delivered via telephone. DESIGN: A randomized, controlled trial with 298 adult, sedentary members (mean age, 45.9 years; 72% women; 45% white; and 45% African American) of a multi-site medical practice. The comparison group (TLC-Eat) received an automated intervention promoting healthy eating, which was also delivered via telephone. INTERVENTION: The TLC-PA promoted moderate-intensity PA (MI-PA) based on the transtheoretical model of behavior change and social cognitive theory. The system was available to participants for 6 months. MAIN OUTCOMES: Energy expenditure in MI-PA, proportion of participants who met recommendations for MI-PA, and motivational readiness for PA. MEASURES: Self-reports of PA behavior and motivational readiness at baseline, 3 months, and 6 months. RESULTS: At 3 months, intention-to-treat analyses showed that the TLC-PA group was more likely to meet recommendations for MI- or vigorous-intensity PA (VI-PA) compared to the TLC-Eat group (TLC-PA=26% vs TLC-Eat=19.6%, p=0.04). Among study completers, TLC-PA subjects reported significantly higher daily kilocalorie energy expenditure in MI-PA (2.3 kcal/kg/d vs 2.0 kcal/kg/d, p=0.02); a larger proportion met recommendations for MI- or VI-PA (31.2% vs 21.3%, p=0.02) and were in more advanced stages of motivational readiness than TLC-Eat subjects (TLC-PA=52.5% vs TLC-Eat=42.2%, p=0.04). Results were not maintained at 6 months. The proportion of TLC-PA users decreased significantly over the intervention period. CONCLUSIONS: A fully automated counseling system had positive short-term effects on PA among sedentary adults. Lack of maintenance of effects may be due to a decrease in the number of participants who continued to use the system.

Chi-Square Distribution↗
PubMed2002

Psychosocial mediators of physical activity behavior among adults and children.

BACKGROUND: Researchers examining theory-based, physical activity (PA) interventions postulate that interventions are effective by changing theoretical constructs hypothesized to mediate the relationship between the intervention and PA behavior. Research indicates that PA interventions are effective for increasing PA behavior. However, whether effective interventions are due to predicted changes in theoretical constructs remains poorly understood. METHODS: Studies that examined theoretical constructs (i.e., mediators) in PA interventions of adults or children, which used experimental designs and met other criteria for evaluating mediation, were collected via literature searches, personal searches of files, and personal communications. Only studies examining the direct effect of the intervention on the hypothesized mediator were considered relevant for this study. RESULTS: Based on our criteria, the adult literature search yielded ten studies and the child literature search yielded two studies. The most common mediators examined included behavioral processes of change, cognitive processes of change, self-efficacy, decisional balance, social support, and enjoyment. Research indicates that behavioral processes are likely mediators. There was some support for the importance of self-efficacy as a mediator. CONCLUSIONS: Few studies have used statistically recommended methods to examine mediators in PA intervention studies. Therefore, definitive conclusions about the importance of the mediators reviewed are not possible at this time. Additional PA mediator-intervention studies using recommended statistical methods are necessary to truly test if theory-based PA interventions are effective due to predicted changes in theoretical constructs.

Adolescent↗
PubMed2002

Impact of weight-cycling history on bone density in obese women.

OBJECTIVE: The purpose of this study was to examine the effect of weight cycling (as defined by the frequency and magnitude of intentional weight loss) on bone mineral density and bone mineral content in obese sedentary women. RESEARCH METHODS AND PROCEDURES: Bone mineral content and density measured by DXA, submaximal physical fitness assessment, nutrient intake, oral contraceptive use, and weight-cycling history were assessed in 195 healthy, overweight sedentary women (age, 21 to 45 years; body mass index, 27 to 40 kg/m(2)) before beginning a behavioral weight-loss intervention. RESULTS: After controlling for body weight, multivitamin use, oral contraceptive/estrogen use, and calcium and magnesium intake, women who had a history of weight cycling did not have significantly lower total-body bone mineral content or density or total femur bone mineral density. In addition, 99% of subjects were above or within one SD of age and gender normative data for total femur bone mineral density. DISCUSSION: It does not seem that a history of weight cycling has an adverse affect on total femur and total-body bone mineral density in overweight sedentary premenopausal women.

Absorptiometry, Photon↗
PubMedDate not supplied

Reaching out to promote physical activity in Australia: a statewide randomized controlled trial of a stage-targeted intervention.

PURPOSE: This study examined the broader use of a print-media intervention, which was previously shown to be effective at promoting physical activity to participants recruited from a regional Australian community, as a strategy suitable for a more diverse statewide population sample. METHODS: Participants were randomly selected adults who responded to a telephone interview conducted by the New South Wales Health Department and consented to participate in a randomized controlled trial. Consenters were allocated to either intervention (n = 361) or control (n = 358) conditions. The intervention, a personalized letter plus stage-targeted booklets, was sent 1 week postbaseline. Data were collected via telephone interview at baseline and 2 and 8 months and were analyzed using repeated measures analysis of variance (ANOVA) and chi2 statistics. RESULTS: The groups were similar at baseline (mean age 43 +/- 3 years; 64% women). Process evaluation showed high intervention recall (76% at 2 months) and high follow-up response rates (> 85% at 8 months) were achieved. Nonsignificant increases in physical activity were observed (F1,719 = 2.18, p = .14). DISCUSSION: A single mailing of stage-targeted print materials was not effective in promoting increases in physical activity among participants selected from the statewide population. Future research could examine how the effectiveness of print media might be enhanced, possibly by using supplementary media, community-based prompts, or other incentives.

Adult↗