Background Brief scales to measure parental self-efficacy (PSE) in relation to children’s obesoge... more Background Brief scales to measure parental self-efficacy (PSE) in relation to children’s obesogenic behaviours have not been developed and validated using more rigorous methodology such as invariance testing, limiting their generalisability to sub-groups. This study aimed to assess the construct validity and measurement invariance of brief PSE scales for children’s intake of vegetables, soft drinks, and sweets, and physical activity. Methods Parents (n = 242) of five-to-seven-year-old children in disadvantaged and culturally diverse settings in Sweden responded to a questionnaire in Swedish with 12 items assessing PSE in relation to healthy and unhealthy behaviours. Construct validity was assessed with confirmatory factor analysis, invariance testing compared the scales by groups of parental sex, education, and child weight status. Criterion validity was evaluated using objective measures of children’s physical activity and semi-objective measures of diet. Results Two-factor models...
Background Brief scales to measure parental self-efficacy (PSE) in relation to children’s obesoge... more Background Brief scales to measure parental self-efficacy (PSE) in relation to children’s obesogenic behaviours have not been developed and validated using more rigorous methodology such as invariance testing, limiting their generalisability to sub-groups. This study aimed to assess the construct validity and measurement invariance of brief PSE scales for children’s intake of vegetables, soft drinks, and sweets, and physical activity. Methods Parents (n = 242) of five-to-seven-year-old children in disadvantaged and culturally diverse settings in Sweden responded to a questionnaire in Swedish with 12 items assessing PSE in relation to healthy and unhealthy behaviours. Construct validity was assessed with confirmatory factor analysis, invariance testing compared the scales by groups of parental sex, education, and child weight status. Criterion validity was evaluated using objective measures of children’s physical activity and semi-objective measures of diet. Results Two-factor models...
Latinos are the largest and most rapidly growing minority population group in the USA and are dis... more Latinos are the largest and most rapidly growing minority population group in the USA and are disproportionally affected by obesity and related chronic diseases. Child care providers likely influence the eating and physical activity behaviours of children in their care, and therefore are important targets for interventions designed to prevent childhood obesity. Nonetheless, there is a paucity of research examining the behaviours of family child care home (FCCH) providers and whether they model healthy eating and physical activity behaviours. Therefore, this study explored Latino FCCH providers' beliefs and practices related to healthy eating, physical activity and sedentary behaviours, and how they view their ability to serve as role models for these behaviours for young children in their care. This is a qualitative study consisting of six focus groups conducted in Spanish with a sample of 44 state-licensed Latino FCCH providers in the state of Massachusetts. Translated transcri...
Hypertension is more prevalent and clinically severe among African-Americans than whites. Several... more Hypertension is more prevalent and clinically severe among African-Americans than whites. Several health behaviors influence blood pressure (BP) control, but effective, accessible, culturally sensitive interventions that target multiple behaviors are lacking. We evaluated a culturally adapted, automated telephone system to help hypertensive, urban African-American adults improve their adherence to their antihypertensive medication regimen and to evidence-based guidelines for dietary behavior and physical activity. We randomized 337 hypertensive primary care patients to an 8-month automated, multi-behavior intervention or to an education-only control. Medication adherence, diet, physical activity, and BP were assessed at baseline and every 4 months for 1 year. Data were analyzed using longitudinal modeling. The intervention was associated with improvements in a measure of overall diet quality (+3.5 points, p < 0.03) and in energy expenditure (+80 kcal/day, p < 0.03). A decrease in systolic BP between groups was not statistically significant (-2.3 mmHg, p = 0.25). Given their convenience, scalability, and ability to deliver tailored messages, automated telecommunications systems can promote self-management of diet and energy balance in urban African-Americans.
Overweight management is challenging due to time constraints and minimal training in nutrition, p... more Overweight management is challenging due to time constraints and minimal training in nutrition, physical activity and brief counseling. The Telephone-linked Care for Healthy Eating and Activity Today system may help physicians counsel by providing home data and effective behavioral theory-based counseling. Incorporating Goal Directed Task Analysis, Display Task Description and usability testing helped align the interface with the user's needs and workflow. We recommend routine use of these approaches to improve interface quality and usability.
Efforts to use information technology (IT) to link pediatric primary care patients in the home wi... more Efforts to use information technology (IT) to link pediatric primary care patients in the home with their clinicians have been rudimentary to date. We have developed a model information system that uses a ubiquitous user-interface, the telephone, and the electronic health record (EHR) to support health behavior change and weight loss for overweight urban children and their parents. In this paper, we present the technical architecture and underlying psychological theories used to build the system.
Health behavior change interventions have focused on obtaining short-term intervention effects; f... more Health behavior change interventions have focused on obtaining short-term intervention effects; few studies have evaluated mid-term and long-term outcomes, and even fewer have evaluated interventions that are designed to maintain and enhance initial intervention effects. Moreover, behavior theory has not been developed for maintenance or applied to maintenance intervention design to the degree that it has for behavior change initiation. The objective of this paper is to describe a study that compared two theory-based interventions (social cognitive theory [SCT] vs goal systems theory [GST]) designed to maintain previously achieved improvements in fruit and vegetable (F&V) consumption. The interventions used tailored, interactive conversations delivered by a fully automated telephony system (Telephone-Linked Care [TLC]) over a 6-month period. TLC maintenance intervention based on SCT used a skills-based approach to build self-efficacy. It assessed confidence in and barriers to eating...
Overweight management is challenging due to time constraints and minimal training in nutrition, p... more Overweight management is challenging due to time constraints and minimal training in nutrition, physical activity and brief counseling. The Telephone-linked Care for Healthy Eating and Activity Today system may help physicians counsel by providing home data and effective behavioral theory-based counseling. Incorporating Goal Directed Task Analysis, Display Task Description and usability testing helped align the interface with the user's needs and workflow. We recommend routine use of these approaches to improve interface quality and usability.
Journal of nutrition education and behavior, Jan 8, 2015
To assess the validity of 5 parental stage-of-change (SOC) measures: (1) providing 5 servings/d o... more To assess the validity of 5 parental stage-of-change (SOC) measures: (1) providing 5 servings/d of fruits and vegetables (FV), (2) limiting television (TV) to 2 h/d, (3) helping children achieve 1 h/d physical activity (PA), (4) limiting sugary drinks (SD) to 1 serving/wk, and (5) limiting fruit juice (FJ) to 4-6 oz/d. Cross-sectional instrument development study. Construct validity was evaluated by examining whether parental self-efficacy, parental readiness ladder (ladder), and child's behavioral levels (eg, FV consumption) exhibited a theoretically consistent pattern across the SOC. Convenience sample (n = 283) of parents of children aged 4-10 years. Survey assessed SOC, ladder, and child's behavioral level score for each topic (FV, TV, PA, SD, and FJ), and parental self-efficacy for measure except TV. Analysis of variance with Tukey-Kramer post hoc tests examined whether variables differed by SOC. Percentages of parents in the pre-action SOC were 34% (PA), 39% (FV), 42% ...
The present research was designed to advance the theory and science of health behavior change by ... more The present research was designed to advance the theory and science of health behavior change by evaluating one of the most commonly used behavior change theories, the Transtheoretical Model (TTM). Two criteria were selected for evaluation, empirical adequacy (predictive ...
Objective: To examine the types of life and dietary goals individuals report and how these goal d... more Objective: To examine the types of life and dietary goals individuals report and how these goal domains interact as framed by goal systems theory. Methods: This work is a cross-sectional survey study. Measures included the incidence of common life and dietary goals and how these goals interact with and facilitate each other. Results: The results of a quantitative survey (n = 46 participants), which was informed by two focus groups (n = 17 participants), showed that participants are trying to achieve several different life (e.g. achieving financial success) and dietary goals (e.g. eating more fruits and vegetables, drinking more water, and losing weight) and that these two types of goals interact to both facilitate and conflict with each other. Having a life goal of exercising was significantly associated with healthy eating goals when compared with other life goals (p's < .05), suggesting these goals may be linked and help to facilitate one another. Being in the maintenance phase with the goal of healthy eating was associated with participants feeling like they were more successful in their other non-diet-related health goals (p < .05), suggesting maintenance of goals can facilitate success in achieving other goals. Conclusions: Life goals can have an impact on a person's ability to achieve and maintain dietary and other health goals. Health educators may help to facilitate long-term behavior change by examining a person's life goals as well as dietary goals.
2007 11th IEEE International Symposium on Wearable Computers, 2007
In this paper, we present a real-time algorithm for automatic recognition of not only physical ac... more In this paper, we present a real-time algorithm for automatic recognition of not only physical activities, but also, in some cases, their intensities, using five triaxial wireless accelerometers and a wireless heart rate monitor. The algorithm has been evaluated using datasets consisting of 30 physical gymnasium activities collected from a total of 21 people at two different labs. On these
Background Brief scales to measure parental self-efficacy (PSE) in relation to children’s obesoge... more Background Brief scales to measure parental self-efficacy (PSE) in relation to children’s obesogenic behaviours have not been developed and validated using more rigorous methodology such as invariance testing, limiting their generalisability to sub-groups. This study aimed to assess the construct validity and measurement invariance of brief PSE scales for children’s intake of vegetables, soft drinks, and sweets, and physical activity. Methods Parents (n = 242) of five-to-seven-year-old children in disadvantaged and culturally diverse settings in Sweden responded to a questionnaire in Swedish with 12 items assessing PSE in relation to healthy and unhealthy behaviours. Construct validity was assessed with confirmatory factor analysis, invariance testing compared the scales by groups of parental sex, education, and child weight status. Criterion validity was evaluated using objective measures of children’s physical activity and semi-objective measures of diet. Results Two-factor models...
Background Brief scales to measure parental self-efficacy (PSE) in relation to children’s obesoge... more Background Brief scales to measure parental self-efficacy (PSE) in relation to children’s obesogenic behaviours have not been developed and validated using more rigorous methodology such as invariance testing, limiting their generalisability to sub-groups. This study aimed to assess the construct validity and measurement invariance of brief PSE scales for children’s intake of vegetables, soft drinks, and sweets, and physical activity. Methods Parents (n = 242) of five-to-seven-year-old children in disadvantaged and culturally diverse settings in Sweden responded to a questionnaire in Swedish with 12 items assessing PSE in relation to healthy and unhealthy behaviours. Construct validity was assessed with confirmatory factor analysis, invariance testing compared the scales by groups of parental sex, education, and child weight status. Criterion validity was evaluated using objective measures of children’s physical activity and semi-objective measures of diet. Results Two-factor models...
Latinos are the largest and most rapidly growing minority population group in the USA and are dis... more Latinos are the largest and most rapidly growing minority population group in the USA and are disproportionally affected by obesity and related chronic diseases. Child care providers likely influence the eating and physical activity behaviours of children in their care, and therefore are important targets for interventions designed to prevent childhood obesity. Nonetheless, there is a paucity of research examining the behaviours of family child care home (FCCH) providers and whether they model healthy eating and physical activity behaviours. Therefore, this study explored Latino FCCH providers' beliefs and practices related to healthy eating, physical activity and sedentary behaviours, and how they view their ability to serve as role models for these behaviours for young children in their care. This is a qualitative study consisting of six focus groups conducted in Spanish with a sample of 44 state-licensed Latino FCCH providers in the state of Massachusetts. Translated transcri...
Hypertension is more prevalent and clinically severe among African-Americans than whites. Several... more Hypertension is more prevalent and clinically severe among African-Americans than whites. Several health behaviors influence blood pressure (BP) control, but effective, accessible, culturally sensitive interventions that target multiple behaviors are lacking. We evaluated a culturally adapted, automated telephone system to help hypertensive, urban African-American adults improve their adherence to their antihypertensive medication regimen and to evidence-based guidelines for dietary behavior and physical activity. We randomized 337 hypertensive primary care patients to an 8-month automated, multi-behavior intervention or to an education-only control. Medication adherence, diet, physical activity, and BP were assessed at baseline and every 4 months for 1 year. Data were analyzed using longitudinal modeling. The intervention was associated with improvements in a measure of overall diet quality (+3.5 points, p < 0.03) and in energy expenditure (+80 kcal/day, p < 0.03). A decrease in systolic BP between groups was not statistically significant (-2.3 mmHg, p = 0.25). Given their convenience, scalability, and ability to deliver tailored messages, automated telecommunications systems can promote self-management of diet and energy balance in urban African-Americans.
Overweight management is challenging due to time constraints and minimal training in nutrition, p... more Overweight management is challenging due to time constraints and minimal training in nutrition, physical activity and brief counseling. The Telephone-linked Care for Healthy Eating and Activity Today system may help physicians counsel by providing home data and effective behavioral theory-based counseling. Incorporating Goal Directed Task Analysis, Display Task Description and usability testing helped align the interface with the user's needs and workflow. We recommend routine use of these approaches to improve interface quality and usability.
Efforts to use information technology (IT) to link pediatric primary care patients in the home wi... more Efforts to use information technology (IT) to link pediatric primary care patients in the home with their clinicians have been rudimentary to date. We have developed a model information system that uses a ubiquitous user-interface, the telephone, and the electronic health record (EHR) to support health behavior change and weight loss for overweight urban children and their parents. In this paper, we present the technical architecture and underlying psychological theories used to build the system.
Health behavior change interventions have focused on obtaining short-term intervention effects; f... more Health behavior change interventions have focused on obtaining short-term intervention effects; few studies have evaluated mid-term and long-term outcomes, and even fewer have evaluated interventions that are designed to maintain and enhance initial intervention effects. Moreover, behavior theory has not been developed for maintenance or applied to maintenance intervention design to the degree that it has for behavior change initiation. The objective of this paper is to describe a study that compared two theory-based interventions (social cognitive theory [SCT] vs goal systems theory [GST]) designed to maintain previously achieved improvements in fruit and vegetable (F&V) consumption. The interventions used tailored, interactive conversations delivered by a fully automated telephony system (Telephone-Linked Care [TLC]) over a 6-month period. TLC maintenance intervention based on SCT used a skills-based approach to build self-efficacy. It assessed confidence in and barriers to eating...
Overweight management is challenging due to time constraints and minimal training in nutrition, p... more Overweight management is challenging due to time constraints and minimal training in nutrition, physical activity and brief counseling. The Telephone-linked Care for Healthy Eating and Activity Today system may help physicians counsel by providing home data and effective behavioral theory-based counseling. Incorporating Goal Directed Task Analysis, Display Task Description and usability testing helped align the interface with the user's needs and workflow. We recommend routine use of these approaches to improve interface quality and usability.
Journal of nutrition education and behavior, Jan 8, 2015
To assess the validity of 5 parental stage-of-change (SOC) measures: (1) providing 5 servings/d o... more To assess the validity of 5 parental stage-of-change (SOC) measures: (1) providing 5 servings/d of fruits and vegetables (FV), (2) limiting television (TV) to 2 h/d, (3) helping children achieve 1 h/d physical activity (PA), (4) limiting sugary drinks (SD) to 1 serving/wk, and (5) limiting fruit juice (FJ) to 4-6 oz/d. Cross-sectional instrument development study. Construct validity was evaluated by examining whether parental self-efficacy, parental readiness ladder (ladder), and child's behavioral levels (eg, FV consumption) exhibited a theoretically consistent pattern across the SOC. Convenience sample (n = 283) of parents of children aged 4-10 years. Survey assessed SOC, ladder, and child's behavioral level score for each topic (FV, TV, PA, SD, and FJ), and parental self-efficacy for measure except TV. Analysis of variance with Tukey-Kramer post hoc tests examined whether variables differed by SOC. Percentages of parents in the pre-action SOC were 34% (PA), 39% (FV), 42% ...
The present research was designed to advance the theory and science of health behavior change by ... more The present research was designed to advance the theory and science of health behavior change by evaluating one of the most commonly used behavior change theories, the Transtheoretical Model (TTM). Two criteria were selected for evaluation, empirical adequacy (predictive ...
Objective: To examine the types of life and dietary goals individuals report and how these goal d... more Objective: To examine the types of life and dietary goals individuals report and how these goal domains interact as framed by goal systems theory. Methods: This work is a cross-sectional survey study. Measures included the incidence of common life and dietary goals and how these goals interact with and facilitate each other. Results: The results of a quantitative survey (n = 46 participants), which was informed by two focus groups (n = 17 participants), showed that participants are trying to achieve several different life (e.g. achieving financial success) and dietary goals (e.g. eating more fruits and vegetables, drinking more water, and losing weight) and that these two types of goals interact to both facilitate and conflict with each other. Having a life goal of exercising was significantly associated with healthy eating goals when compared with other life goals (p's < .05), suggesting these goals may be linked and help to facilitate one another. Being in the maintenance phase with the goal of healthy eating was associated with participants feeling like they were more successful in their other non-diet-related health goals (p < .05), suggesting maintenance of goals can facilitate success in achieving other goals. Conclusions: Life goals can have an impact on a person's ability to achieve and maintain dietary and other health goals. Health educators may help to facilitate long-term behavior change by examining a person's life goals as well as dietary goals.
2007 11th IEEE International Symposium on Wearable Computers, 2007
In this paper, we present a real-time algorithm for automatic recognition of not only physical ac... more In this paper, we present a real-time algorithm for automatic recognition of not only physical activities, but also, in some cases, their intensities, using five triaxial wireless accelerometers and a wireless heart rate monitor. The algorithm has been evaluated using datasets consisting of 30 physical gymnasium activities collected from a total of 21 people at two different labs. On these
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