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Biomedical subjects

Paul A Estabrooks

Publications and source records attributed to Paul A Estabrooks.

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↗
PubMed2006

Translating effective clinic-based physical activity interventions into practice.

An increasing number of studies report on the efficacy of physical activity interventions conducted in, or in conjunction with, clinical settings. This article reviews the status of the literature with regard to translation to practice and describes methods that will heighten the likelihood of translation. In general, few physical activity programs have been designed for translation, and the diffusion models underlying most reported programs have relied on an assumption of linear diffusion into practice. However, recent developments are encouraging and examples are provided of programs that utilize relationship or systems approaches to translation.

Cooperative Behavior↗
PubMed2006

Outcomes of a multifaceted physical activity regimen as part of a diabetes self-management intervention.

BACKGROUND: Physical activity (PA) is important for management of diabetes, yet practical interventions that achieve sustained behavior change are rare. PURPOSE: The goals of this research were to evaluate the effectiveness of a multifaceted PA intervention for people with type 2 diabetes that emphasized participant choice in activity selection. Baseline activity patterns were examined to determine whether they predicted changes in PA at 2 months. METHODS: Three hundred thirty-five participants were recruited from 42 primary care physicians and then randomized to either a computer-assisted, tailored self-management intervention (N = 174) or health risk appraisal with feedback control (N = 161). Primary outcome measures included the Community Healthy Activities Model Program for Seniors Questionnaire, diet, and psychosocial assessments at baseline and 2 months. RESULTS: For 301 participants who completed the 2-month follow-up, the intervention significantly improved all PA (p < .01) and moderate PA (metabolic equivalents > 3.0, p < 01) relative to controls. Baseline cluster analyses grouped participant activity patterns into three categories. At 2 months, cluster assignment differentially predicted change in calories expended in moderate, rote, sport, and lifestyle PA. CONCLUSIONS: A computer-assisted, multifaceted approach to PA demonstrated improvement after 2 months. The results suggest that individuals are capable of adjusting their activity patterns to maximize their PA.

Choice Behavior↗
PubMed2005

Practical clinical trials for translating research to practice: design and measurement recommendations.

RATIONALE: There is a pressing need for practical clinical trials (PCTs) that are more relevant to clinicians and decision-makers, but many are unaware of these trials. Furthermore, such trials can be challenging to conduct and to report. OBJECTIVE: The objective of this study was to build on the seminal paper by Tunis et al (Practical clinical trials. Increasing the value of clinical research for decision making in clinical and health policy. JAMA. 2003;290:1624-1632.) and to provide recommendations and examples of how practical clinical trials can be conducted and the results reported to enhance external validity without sacrificing internal validity. KEY ISSUES: We discuss evaluating practical intervention options, alternative research designs, representativeness of samples participating at both the patient and the setting/clinician level, and the need for multiple outcomes to address clinical and policy implications. CONCLUSIONS: We provide a set of specific recommendations for issues to be reported in PCTs to increase their relevance to clinicians and policymakers, and to help reduce the gap between research and practice.

Clinical Trials as Topic↗
PubMed2005

Participatory research to promote physical activity at congregate-meal sites.

The purpose of this study was to determine the feasibility and effectiveness of an on-site physical activity (PA) program offered with congregate meals. Study 1 surveyed meal-site users on their likelihood to participate. Study 2 used meal-site-manager interviews and site visits to determine organizational feasibility. Study 3, a controlled pilot study, randomized meal sites to a 12-week group-based social-cognitive (GBSC) intervention or a standard-care control. Studies 1 and 2 indicated that most meal-site users would participate in an on-site PA program, and meal sites had well-suited physical resources and strong organizational support for this type of program. In Study 3, GBSC participants increased their weekly PA over those in the control condition (p < .05, ES = .79). Results indicated that changes in task cohesion might have mediated intervention effectiveness. These studies demonstrate that a PA program offered in this venue is feasible, is effective in promoting PA, and could have a strong public health impact.

Aged↗
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

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

Leadership in physical activity groups for older adults: a qualitative analysis.

The purpose of this study was to determine whether a theory-based framework could be used to deductively identify and understand the characteristics of motivational leaders of physical activity groups for older adults. Participants were 23 older adults (mean age = 78.5 +/- 8.0 years, 65% women). An interview-guide approach was employed to elicit older adults' thoughts on important characteristics of physical activity group leaders. The data suggested that effective leaders are those whom the participants feel are properly qualified, are able to develop a personal bond with participants, and can use their knowledge and the group to demonstrate collective accomplishments. It was concluded that the findings could be used to extend the leadership activities beyond the traditional technical performance and individual feedback to include activities of social integration. Furthermore, the conceptual framework identified can serve as a valuable tool in guiding future researchers in their examination of leadership in physical activity groups for older adults.

Aged↗
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

Exercise-related goals and self-efficacy as correlates of aquatic exercise in individuals with arthritis.

OBJECTIVE: To examine whether aquatic exercise-related goals, task self-efficacy, and scheduling self-efficacy are predictive of aquatic exercise attendance in individuals with arthritis. A secondary objective was to determine whether high attendees differed from low attendees on goals and self-efficacy. METHODS: The sample comprised 216 adults with arthritis (mean age 69.21 years). Measures included exercise-related goal difficulty and specificity, task and scheduling self-efficacy, and 8-week aquatic exercise attendance. RESULTS: Results of a multiple hierarchical regression analysis were significant (P < 0.01). Goal difficulty, specificity, and task self-efficacy were independent predictors of attendance (P < 0.05). A significant multivariate analysis of variance (P < 0.01) indicated that high attendees had higher task and scheduling self-efficacy and lower goal difficulty than did low attendees (P < 0.05). CONCLUSION: Support for the importance of exercise-related goal setting and self-efficacy was demonstrated. Implications pertain to the design of interventions to impact aquatic exercise.

Absenteeism↗
PubMed2003

Resources for physical activity participation: does availability and accessibility differ by neighborhood socioeconomic status?

The purpose of this study was to determine whether the availability and accessibility of physical activity resources differed by neighborhood socioeconomic status (SES) in a small U.S. city (population = 133,046). U.S. census tracts (N =32) were used to represent neighborhoods and categorized into high, medium, or low SES on the basis of the percentage of unemployed individuals, per capita income, and percentage of the population below the poverty threshold. We developed a geographic information system to generate a comprehensive list of physical activity resources available within each census tract in the city. We identified 112 parks, 33 sport facilities, 15 fitness clubs, 11 community centers, and 5 walking/biking trails. The total number of physical activity resources varied by neighborhood SES (p <.05); low-SES (M =4.5-/+2.3) and medium-SES (M =4.9-/+2.6) neighborhoods had significantly fewer resources than high-SES (M =8.4-/+3.5) neighborhoods. Low-, medium-, and high-SES neighborhoods did not differ on the number of pay-for-use facilities; however, low-SES (M =3.1-/+1.5) and medium-SES (M =3.8-/+1.6) neighborhoods had significantly fewer free-for-use resources than high- (M =6.1-/+2.4) SES neighborhoods (p <.01). Data suggest that individuals from lower SES neighborhoods may have limited ability to control their physical activity in the face of inaccessible environments. Community research and promotion efforts should include assessment and targeting of available and accessible physical activity resources.

Exercise↗
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↗