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Biomedical subjects

David A Dzewaltowski

Publications and source records attributed to David A Dzewaltowski.

At least 19 recordsLinked to original sources
PubMed2006

Evaluating the impact of health promotion programs: using the RE-AIM framework to form summary measures for decision making involving complex issues.

Current public health and medical evidence rely heavily on efficacy information to make decisions regarding intervention impact. This evidence base could be enhanced by research studies that evaluate and report multiple indicators of internal and external validity such as Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) as well as their combined impact. However, indices that summarize the combined impact of, and complex interactions among, intervention outcome dimensions are not currently available. We propose and discuss a series of composite metrics that combine two or more RE-AIM dimensions, and can be used to estimate overall intervention impact. Although speculative and, at this point, there have been limited empirical data on these metrics, they extend current methods and are offered to yield more integrated composite outcomes relevant to public health. Such approaches offer potential to help identify interventions most likely to meaningfully impact population health.

Decision Making↗
PubMed2006

Results of the first year of active for life: translation of 2 evidence-based physical activity programs for older adults into community settings.

OBJECTIVES: Translating efficacious interventions into practice within community settings is a major public health challenge. We evaluated the effects of 2 evidence-based physical activity interventions on self-reported physical activity and related outcomes in midlife and older adults. METHODS: Four community-based organizations implemented Active Choices, a 6-month, telephone-based program, and 5 implemented Active Living Every Day, a 20-week, group-based program. Both programs emphasize behavioral skills necessary to become more physically active. Participants completed pretest and posttest surveys. RESULTS: Participants (n=838) were aged an average of 68.4 +/-9.4 years, 80.6% were women, and 64.1% were non-Hispanic White. Seventy-two percent returned posttest surveys. Intent-to-treat analyses found statistically significant increases in moderate-to-vigorous physical activity and total physical activity, decreases in depressive symptoms and stress, increases in satisfaction with body appearance and function, and decreases in body mass index. CONCLUSIONS: The first year of Active for Life demonstrated that Active Choices and Active Living Every Day, 2 evidence-based physical activity programs, can be successfully translated into community settings with diverse populations. Further, the magnitudes of change in outcomes were similar to those reported in the efficacy trials.

Aged↗
PubMed2005

Prevention of the epidemic increase in child risk of overweight in low-income schools: the El Paso coordinated approach to child health.

OBJECTIVE: To assess the impact on children's health of translating an evidence-based national intervention trial (Child and Adolescent Trial for Cardiovascular Health [CATCH]) to low-income elementary schools with primarily Hispanic students. DESIGN: An untreated, matched control group design with repeated dependent pretest and posttest samples was used. SETTING: Four El Paso CATCH and 4 control elementary schools in El Paso, Tex, along the US-Mexico border region. All had Title I status (most were low-income students). PARTICIPANTS: Participants were 896 third-grade children (473 control schools [224 girls and 249 boys] and 423 CATCH schools [199 girls and 224 boys]); 93% were Hispanic. INTERVENTION: Community-based implementation of the national CATCH program. MAIN OUTCOME MEASURES: Risk of overweight or overweight, body mass index, waist-to-hip ratio, yards run in 9 minutes, passing rates for Fitnessgram national mile standards, moderate to vigorous physical activity and vigorous physical activity in physical education class, and percentage of fat and sodium in school lunches. RESULTS: Girls in control schools had significant increases in percentage of risk of overweight or overweight from third (26%) to fifth (39%) grades, as did girls in CATCH schools (30%-32%); however, the rate of increase for girls in the CATCH schools was significantly lower (2%) compared with the rate for control girls (13%). A similar pattern was seen for boys, with a rate of increase for boys in CATCH schools of 1% (40%-41%), which was significantly less than the 9% increase (40% to 49%) for control boys. CONCLUSIONS: The translation of the national CATCH program to low-income schools with Hispanic students successfully slowed the epidemic increase in risk of overweight or overweight seen in control school children. An emphasis should be placed on community organizing and evaluation feedback when implementing evidence-based school health programs in low-income Hispanic communities.

Anthropometry↗
PubMed2005

Beginning with the application in mind: designing and planning health behavior change interventions to enhance dissemination.

Failing to retain an adequate number of study participants in behavioral intervention trials poses a threat to interpretation of study results and its external validity. This qualitative investigation describes the retention strategies promoted by the recruitment and retention committee of the Behavior Change Consortium, a group of 15 university-based sites funded by the National Institutes of Health to implement studies targeted toward disease prevention through behavior change. During biannual meetings, focus groups were conducted with all sites to determine barriers encountered in retaining study participants and strategies employed to address these barriers. All of the retention strategies reported were combined into 8 thematic retention categories. Those categories perceived to be most effective for retaining study participants were summarized and consistencies noted among site populations across the life course (e.g., older adults, adults, children, and adolescents). Further, possible discrepancies between site populations of varying health statuses are discussed, and an ecological framework is proposed for use in future investigations on retention.

Behavior Therapy↗
PubMed2004

Comparison of the computerized ACTIVITYGRAM instrument and the previous day physical activity recall for assessing physical activity in children.

This study compared the validity of children's physical activity recall through a computerized assessment (ACTIVITYGRAM) and through a popular paper and pencil assessment (Previous Day Physical Activity Recall; PDPAR). A total of 147 sixth-grade children from two schools completed the two recall instruments. Data from both self-report instruments were obtained over the same 3 days, and these data were matched by time with data from a subsample of children who wore an accelerometry-based activity monitor (n = 28). To confirm previous validity research with the PDPAR, a larger sample (n = 128) with matched data on the PDPAR and the accelerometer were also used. Activity levels recorded from all three instruments were computed for three periods (afternoon: 3-6 pm, evening: 6-11 p.m. and afternoon/evening: 3-11 p.m.). Descriptive and correlational analyses were conducted across days and for the separate time periods to evaluate the two self-report instruments. There were no differences in mean activity bouts reported on the ACTIVITYGRAM and the PDPAR (p > .05). Correlations with the activity monitor were above .50 for both the PDPAR and the ACTIVITYGRAM, and the relationships were consistent across days and periods for both measures. The magnitude of the correlations varied widely in the two schools for the ACTIVITYGRAM comparisons (r = .80 vs. r = .20) but not for the PDPAR, suggesting differential administration or understanding of the ACTIVITYGRAM instrument. Direct correlations between the ACTIVITYGRAM and the PDPAR measures were high (r = .72), and classification agreement exceeded 80% for the school that provided adequate assistance and training on the ACTIVITYGRAM. Results were weaker in the school with less staff support. This study provides convergent and criterion evidence to support the validity of the computerized ACTIVITYGRAM assessment and suggests similar information as the paper and pencil PDPAR assessment in young children. The study also revealed no differences in PDPAR values or associations, when a simpler scoring procedure was used instead of the traditional more complex metabolic equivalent-based approach.

Adolescent↗
PubMed2004

Behavior change intervention research in community settings: how generalizable are the results?

This review examines the extent to which recent behavioral intervention studies conducted in community settings reported on elements of internal and external validity, with an emphasis on whether research has been conducted in representative settings with representative populations. A targeted review was conducted on community-based intervention studies that promoted good nutrition, physical activity or smoking cessation/prevention, and were published in 11 leading health behavior journals between 1996 and 2000. The RE-AIM framework (reach, efficacy, adoption, implementation and maintenance) was used to evaluate the extent to which each paper reported on elements of reach, efficacy/effectiveness, adoption, implementation and maintenance. A total of 27 publications were reviewed. Although most studies (88%) reported participation rates among eligible members of the target audience ('reach'), only 11% of studies reported the participation rate ('adoption') among eligible community-based organizations or settings. Few studies reported if participating individuals or settings were representative of those found in the broader population. Although a majority of studies (59%) reported whether the intervention was delivered ('implementation'), few reported whether individuals maintained behavior change (30%) or whether organizations maintained or institutionalized interventions (0%). To increase the potential to translate community research findings to practice, studies should place a greater emphasis on obtaining and reporting external validity information, such as representativeness. The lack of external validity information limits researchers' and practitioners' ability to judge the generalizability of effects and the comparative utility of interventions. Improved reporting will facilitate implementation of proven and broadly applicable intervention strategies in communities. To make significant progress, all parties, including researchers, reviewers, editors and funders, need to take responsibility for increased emphasis on external validity information and ask what role they can best play to facilitate this process.

Adolescent↗
PubMed2004

The future of physical activity behavior change research: what is needed to improve translation of research into health promotion practice?

There is a gap between physical activity intervention research and the delivery of evidence-based programs in practice. We describe individual and setting level factors important for translation that moderate the impact of interventions and often are not reported in the literature. The Reach, Efficacy/Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework provides a useful way of organizing and reporting these factors.

Behavior Therapy↗
PubMed2004

The future of health behavior change research: what is needed to improve translation of research into health promotion practice?

BACKGROUND: It is well documented that the results of most behavioral and health promotion studies have not been translated into practice. PURPOSE: In this article, reasons for this gap, focusing on study design characteristics as a central contributing barrier, are discussed. METHODS: Four reviews of recent controlled studies in work sites, health care, school, and community settings are briefly discussed and summarized. Their implications for future research and for closing the gap between research and practice are then discussed. RESULTS: These reviews come to consistent conclusions regarding key internal and external validity factors that have and have not been reported. It is very clear that moderating variables and generalization issues have not been included or reported in the majority of investigations, and that as a consequence little is known about the representatives or the robustness of results from current studies. CONCLUSIONS: To significantly improve the current state of affairs, substantial changes will be required on the part of researchers, funding agencies, and review and editorial boards. In conclusion, recommendations for each of these entities are provided.

Algorithms↗
PubMed2004

RE-AIM: evidence-based standards and a Web resource to improve translation of research into practice.

BACKGROUND: Health services data indicate that under present conditions evidence-based medical and preventive practices are not consistently implemented in clinical practice and affect the quality of care provided to patients. Operating with similar conditions and resources, it is unlikely that evidence-based behavioral medicine (EBBM) practices will be more successfully implemented. PURPOSE: In this article we propose ways to help improve the implementation of EBBM practice. METHODS: This article describes the RE-AIM (Reach, Efficacy/Effectiveness, Adoption, Implementation, and Maintenance) framework that is available on a free-use Web site (http://www.re-aim.org), which offers practical research translation tools, resources, and support for program planners, community leaders, and researchers. The material located at www.re-aim.org can be used to help anticipate and overcome likely barriers to dissemination and to estimate eventual public health impact. RESULTS: Data on Web site utilization and lessons learned thus far in its implementation are presented. CONCLUSIONS: Scientists and public health leaders should devote greater attention to reporting practice-oriented issues such as generalizability, breadth of application, and pragmatic and setting or contextual issues in addition to the current focus on internal validity issues. We hope that this and similar efforts will assist EBBM interventions to have broader applications, be consistently implemented, and be sustained.

Behavioral Medicine↗
PubMed2003

Reporting of validity from school health promotion studies published in 12 leading journals, 1996-2000.

A targeted review was conducted of school-based, controlled intervention studies that promoted good nutrition, physical activity, or smoking cessation/prevention, and were published in one of 12 leading health behavior journals between 1996 and 2000. The RE-AIM framework was used to evaluate the extent to which each paper reported on elements of reach, efficacy, adoption, implementation, and maintenance. Thirty-two publications were reviewed. Reporting rates across the RE-AIM dimensions varied substantially: Reach = 59.3%; Efficacy = 100%; Adoption = 14.8%; Implementation = 37%; Maintenance = 25.9% for individuals, 0% for schools. Few studies reported if characteristics of the study sample were representative of those found in the broader population of students or schools. Among studies reporting on the RE-AIM dimensions, participation rates generally were high (median 82%), adoption rates were moderate (median 72.5%), and reports of implementation were high (87%). To increase the potential to translate controlled research to "real-world" practice conditions, a stronger emphasis should be placed on reporting the representativeness of the sample of students and schools.

Child↗
PubMed2002

Behavior change intervention research in healthcare settings: a review of recent reports with emphasis on external validity.

BACKGROUND: Information to judge both the internal and external validity of health behavior research conducted in healthcare settings is vital to translate research findings to practice. This paper reviews the extent to which this research has reported on elements of internal and external validity, with emphasis on the extent to which research has been conducted in representative settings with representative populations. METHODS: A comprehensive review was conducted of controlled interventions for dietary change, physical activity, or smoking cessation conducted in healthcare settings and published in 12 leading health behavior journals between 1996 and 2000. Using the RE-AIM (reach, effectiveness, adoption, implementation, maintenance) framework, the characteristics and results of these studies were summarized to document the extent to which intervention reach, adoption, implementation, and maintenance were reported and what has been learned about each of these dimensions. RESULTS: A total of 36 studies qualified for review. Participation rates among eligible patients were reported in 69% of studies and were generally quite high; in contrast, only 30% of studies reported on participation rates among either healthcare settings or providers. Implementation data were reported in 77% of the studies and these rates were generally high, with the caveat that intervention was often delivered by paid research staff. Long-term maintenance results were reported very consistently at the individual level, but program continuation was almost never reported at the setting level. CONCLUSIONS: We conclude that a much stronger emphasis needs to be placed on the representativeness of providers and settings that are studied. Examples of how this can be done and recommendations for future research are provided.

Feeding Behavior↗
PubMed2002

Toward a better understanding of the influences on physical activity: the role of determinants, correlates, causal variables, mediators, moderators, and confounders.

BACKGROUND: For research on physical activity interventions to progress systematically, the mechanisms of action must be studied. In doing so, the research methods and their associated concepts and terminology become more complex. It is particularly important to clearly distinguish among determinants, correlates, mediators, moderators, and confounder variables used in physical activity research. This article examines the factors that are correlated with and that may have a causal relationship to physical activity. METHODS AND RESULTS: We propose that the term "correlate" be used, instead of "determinant," to describe statistical associations or correlations between measured variables and physical activity. Studies of the correlates of physical activity are reviewed. The findings of these studies can help to critique existing theories of health behavior change and can provide hypotheses to be tested in intervention studies from which it is possible to draw causal inferences. Mediator, moderator, and confounder variables can act to influence measured changes in physical activity. Intervening causal variables that are necessary to complete a cause-effect pathway between an intervention and physical activity are termed "mediators." The relationship between an intervention and physical activity behaviors may vary for different groups; the strata by which they vary are levels of "moderators" of the relationship. Other factors may distort or affect the observed relationships between program exposure and physical activity, and are known as "confounders." CONCLUSIONS: Consistent use of terms and additional research on mediators and moderators of intervention effects will improve our ability to understand and influence physical activity.

Behavioral Sciences↗
PubMed2002

Healthy youth places promoting nutrition and physical activity.

To reduce the risk for chronic disease, adolescents should eat at least five servings of fruit and vegetables and be physically active daily. The Healthy Youth Places Project will test if an intervention strategy that implements school environmental change--with adult leader and youth participation--will influence and maintain adolescent fruit and vegetable consumption and physical activity. Using an experimental design, middle schools will be randomized (eight intervention and eight control schools), and the health behavior of a cohort of adolescents will be assessed during Grades 6 (baseline), 7 and 8 (intervention), and 9 (follow-up). The project uses an ecologically informed social cognitive model to inform a place-based intervention that encourages participation in the process of planning and implemented environmental change in targeted adolescent physical and social environments (school lunch place and after school program place). Environmental change is defined as implemented practices, programs and policies that promote critical elements (connection, autonomy, skill-building and healthy norms) in places. These critical elements are hypothesized environmental antecedents of social cognitive mediators of behavior change. The Project develops a place-based dissemination model of multiple levels (project, school and place) that are hypothesized to build the skills and efficacy of leaders (school staff and youth) that implement environmental changes.

Adolescent↗
PubMed2002

Comparing the relationships between different types of self-efficacy and physical activity in youth.

A preliminary study was conducted to compare the relationships between different types of self-efficacy and youth physical activity. Two samples of sixth- and seventh-grade students (Sample 1: N= 57; Sample 2: N= 49) reported their confidence to be physically active (physical activity efficacy), to overcome barriers to physical activity (barriers efficacy), to ask others to be active with them (asking efficacy), and to find and create environments that support physical activity (environmental-change efficacy). Physical activity was measured by averaging three 24-hour recalls of physical activity. Regression analyses were used to test the relationships between the types of self-efficacy and youth physical activity. Compared with the other types of self-efficacy, environmental-change efficacy had the strongest relationship with youth physical activity. This suggests that strengthening young persons' belief in their ability to find and create environments that support physical activity might promote increases in their physical activity.

Adolescent↗