Individually-Adapted Behavior Change Programs
Part 1: Needs Assessment
- Describe in detail the population and setting with which you will work. Identify the public health problem. Use surveillance data to support the needs of the community. As appropriate, discuss the health disparities of your target community. (20 points)
- What stakeholders may be needed along the way? Describe the role of each stakeholder, and the questions they may want answered about the intervention. Also briefly describe how a successful intervention would impact that stakeholder, and how an unsuccessful program might impact that stakeholder. Stakeholders may be individuals, groups, or organizations. (20 points)
Recent evidence shows that more than 35 percent of adults across the United States are considered obese, with a BMI higher than or equal to 30, and this percentage continues to increase (Njororai & Njororai, 2015). Physical inactivity is one of the factors in the epidemic of obesity. Despite the many benefits for one’s health when having regular physical activity, less than one third of adults in the U.S. engage in the recommended amounts of physical activity (Ickes, et al., 2016). These recommended amounts include 30 minutes of moderate-intensity activity on 5 or more days per week, or 20 minutes of vigorous-intensity activity on 3 or more days per week (Kahn, et al., 2002). 29% report no leisure-time regular physical activity and only 27% of adolescents in high school engage in moderate-intensity physical activity (30 minutes, 5 or more days per week) (Kahn, et al., 2002).
Young adults in the college population are part of the overweight and obesity issues with approximately 34.6% of college students in the U. S. reportedly falling into these categories (Young, et al., 2015). Across college campuses in the United States, most college students do not meet the recommendations for physical activity, which is around 6 out of 10 students engaging in less than 3 days per week of vigorous-intensity (20 minutes or more) or moderate-intensity (30 minutes or more) physical activity (Ickes, et al., 2016). College opens the door to new opportunities and independence for students, which often can include more free time for leisure activities and sedentary behaviors rather than participating in physical activity.
Young and colleagues (2015) emphasize that the college years build the foundation for young adults’ lifelong healthy habits and physical activity, so it is important to address this issue sooner rather than later. The American College Health Association (ACHA) reported that one in every three students, about 34%, is either overweight or obese in the United States, and the physical inactivity of this population seems to emerge in adolescence and continue into adulthood (Quartiroli & Maeda, 2016). This is alarming, because the progression of obesity into adulthood can increase young adult’s risk of diabetes and other diseases at later stages in life. The unhealthy lifestyle habits can also affect the generations to come, therefore creating a vicious and continuing cycle of weight gain. Because of this, it is important to address this issue on college campuses before it leads into adulthood and the “real world.” By addressing this and finding ways to encourage physical activity on college campuses, there is hope that some progress can be made.
|Stakeholder||Role in Intervention||Questions from Stakeholder||Effect on Stakeholder of a Successful Program||Effect on Stakeholder of an Unsuccessful Program|
|UGA student||Active participant in the intervention program||How will the program benefit me? What positive changes is this program expected to influence? What is the length of this program?||Lifestyle changes for better health and decreased risk for disease and other health factors, reduced risk for obesity and increases in physical activity||Waste of time, no gains from program, risk for disease and continued unhealthy lifestyle habits, no new behavior skills for change; no change in physical activity|
|UGA faculty||Raises awareness of program and its health benefits||How will I benefit from this program? How will I be involved? Will this improve classroom learning?||Better lifestyle habits transfer into the classroom||Negative effects of unhealthy habits and obesity negatively affect students in the classroom|
|Program staff||Implements, monitors, and evaluates the program||What skills are needed to best conduct the program? How much of my time will spent on this program?||Skills acquired from leading this program that can be used in other situations or programs; positive influence on health and possible reduction in obesity||Loss of time and effort put toward the program|
|Parents||Promotes the program; models and encourages participation||How will this program make changes in my child’s overall health and well-being? What are the costs of this program? How will I be involved?||Better health for their kids; changes made that can be a part of their lifestyle||No changes in child’s health and lifestyle|
Funding agency – Assists in raising money and providing program tools and other needs /Questions: How much will the intervention cost? What changes are expected to result from this program? What are the benefits of this program?/Money put to good use toward an effective program; success in program shows other programs might be useful to fund as well/Waste of money and investment toward program
Part 2: Intervention Identification
- State and define the intervention strategy – what does it mean? What populations has this strategy been used with? What settings has it been used in? How are your community characteristics similar or different to those of the communities in which the strategy has been effective? (20 points)
- Is the strategy recommended by the Task Force? Why or why not? (10 points)
- Provide at least 3 examples from existing articles (peer-reviewed preferably, but could come from other places). These should be different than the research-tested intervention programs(RTIP) listed already. You can include or link to this information, but you should provide different examples. (45 points total)
- Describe the intervention – what did the authors do? What was the procedure? How long was the intervention? Please describe individual components as well as the broader intervention plan.
- What were the outcomes measured?
- What amount of change did they find?
For increasing physical activity, individually-adapted behavior programs focus on an individual’s interest for change and the development of skills that are specific to the individual’s needs and lifestyle. By focusing on what an individual enjoys doing based on his or her interests, strategies can be implemented into their everyday lives to increase their physical activity. This intervention focuses on setting goals and self-monitoring progress toward change, but the individual must first show a desire to change. Strategies are intended to increase the motivation to want change and continue to maintain it long-term. Individually-adapted behavior programs use skills such as identifying social support, self-monitoring, and setting goals to help the individual succeed in making positive changes in their physical activity (Community Guide, 2002).
This intervention has been used with many populations of adults and children, including specific groups such as sedentary individuals, smokers, and adults who are overweight or obese. These programs have been used in a variety of settings such as community-based, clinical, and home settings. This intervention has been shown to be effective in these settings, so transferring it to college settings would be beneficial. These programs have focused mainly on older adult populations, but these strategies could improve physical activity and be effective in young adults as well. Exercise sessions, one-on-one meetings with a professional, and online tools can be useful in the college setting in similar ways as the research-tested intervention programs mentioned from the Community Guide. The Task Force recommends this intervention because of its effectiveness in increasing physical activity among adults and children (Community Guide, 2002). Individually-adapted behavior programs focus on cognitive and behavioral skills to fully address the lifestyle behaviors of an individual.
Although limited, there are some programs that have used individually-adapted behavior interventions in the college setting to increase physical activity. An article by Ickes and colleagues (2016) examined the effectiveness of a 15-week program on obese college students’ physical activity behaviors, attitudes, and self-efficacy. This program aimed to change attitudes toward exercise to increase the motivation to engage in physical activity. The intervention was based on the Transtheoretical Stages of Change Model, which assesses an individual’s readiness to change by examining the stages of pre-contemplation, contemplation, preparation, and action maintenance. The procedure included pre- and post- intervention surveys and five components of intervention. The components included two 60-minute small group training sessions per week led by a personal trainer, two individual meetings with a dietitian, and access to a health coach as well as optional sessions of a group fitness class, cooking class, grocery store tour, and a hike at a local nature spot (Ickes et al., 2016). Each component focused on each individual’s needs and setting goals based on his or her individual capability levels. The outcome measures consisted of a variety of physical activity variables, such as behaviors (based on questionnaires), attitudes, the TTM stages of change, pros and cons to physical activity, self-efficacy, social support, and BMI. The authors found that the intervention increased physical activity and self-efficacy and decreased BMI levels when looking at pre- and post-test levels (P < .05) (Ickes et al., 2016). Specifically, moderate-intensity PA for at least 30 minutes, resistance/strength training, and flexibility exercises showed changes in the physical activity levels of the participants.
Another program by Quartiroli and Maeda (2016) examined the effects of a Lifetime Fitness Course (LPF) on college students’ health behaviors over a 15-week period. The goal was to increase physical activity among college students with a health fitness course based on Theory of Planned Behavior (TPB) and Self-Determination Theory. According to the TPB, an individual’s intention is the most important predictor of health-related behavior, mediating the effect of belief-based perceptions of behaviors: attitude, subjective norm, and perceived behavioral control (Quartiroli & Maeda, 2016). Self-determination theory focuses on the three psychological needs of autonomy, competence, and relatedness, enabling the individual to control one’s own actions and change. Fifty-eight participants from the four sections of the health fitness course participated by completing surveys before the course and then after the course ended. The outcome measures included physical activity levels, psychological need satisfaction, behavioral regulation, and motivation for physical activity. The authors did not find any statistically significant changes in the level of physical activity after participation in the course. This could be due to self-selection of participation and not setting a baseline with individuals that were not meeting the guidelines for physical activity. Therefore, the majority of participants could have already been participating in physical activity. However, there were increases in intrinsic motivation rather than exercising for extrinsic motives of exercise (Quartiroli & Maeda, 2016). With a few improvements to the methods, this intervention could promote positive changes with this population.
Joseph and colleagues (2011) developed a six month website intervention based on social cognitive theory to increase physical activity among African American female college students. Seventy-eight African American females participated in the study with the majority being obese. The intervention included two phases prior to the study. Phase one consisted of interviews and focus groups to figure out what participants’ thoughts and ideas were of using a website as a promotion tool. Phase two lasted for six weeks, and participants engaged in supervised moderate-intensity physical activity sessions and focus groups to give feedback of the website features and format. After the phases of implementation, the program included website applications such as an exercise tracker, blogs, and message boards, as well as social cognitive constructs of self-regulation, social support, and enjoyment. Participants were also given accelerometers to assist in tracking their progress. The program included supervised exercise sessions each week for six months that provided support and gave different options of exercise to fit each person’s interests. The authors wanted to examine the minutes of moderate-to-vigorous activity based on self-reports as well as the accelerometers to determine if participants increased their physical activity levels. Based on the website and sessions, the outcome measures were physical activity, outcome expectations, physical activity enjoyment, social support, and self-regulation. The results showed that there was a significant increase in physical activity from baseline to three months, but declined back to baseline levels when assessed at six months (Joseph et al., 2011). However, self-regulation did show increases across the intervention, so it seems that self-monitoring tools can be useful in assisting self-regulation. All programs and interventions have room for improvement, but these techniques and strategies can be effective in the college population if implemented in an appropriate way.
Part 3: Intervention Fit
- Provide a logic model and SMART Objectives for your intervention. You should have a SMART objective for each behavior you anticipate changing. (35 points; 10 points for SMART objectives, 25 points for the logic model)
*SMART Objective: This intervention will increase the physical activity levels of the majority of participants (80%) from baseline to the end of the 15-week program by 10%.
|Inputs/Resources||Activities||Outputs||Short-term Outcomes||Intermediate Outcomes||Long-term Outcomes|
Health coach from university health services
Graduate students in health promotion will help enroll participants based on eligibility
Pre- and post- intervention surveys
Exercise equipment (weights, mats, etc.)
The Aetna Foundation
Space at the Ramsey Center for training sessions
Space at the University Health Center for meetings with health coach
|Small group training sessions with personal trainer as instructor|
Meetings with health coach (including motivational interviewing)
Teaching goal-setting and self-monitoring progress of PA
Building social support
Motivating and encouraging through emails and text messages from health coach
|Small-group training sessions one-hour sessions per week for 15 weeks|
Two meetings with the health coach at beginning of intervention and midpoint
|Change of knowledge of exercising|
Exposure to different types of exercising
Awareness of exercise opportunities from training sessions
Set goals and self-monitor their behaviors
Motivation to increase PA
Interest in PA
|Increase physical activity from baseline|
Retention of intervention information
|Increase proportion of students regularly active|
Maintain physical activity
Decrease the proportion of students at risk for obesity
- Explain the logic of why this intervention may work. For example, why would teaching children about healthy eating change their actual eating behaviors? Or why would adding sidewalks increase physical activity for transportation or recreation? (15 points)
- Think about the “Field of Dreams” problem – if you offer the intervention, will it actually change behavior?
- Discuss limitations of the selected strategy, and things to look out for/be mindful of along the way. Examples may be limitations of resources, community capacity, or anticipated effect of the intervention. (15 points)
- What data would you collect to know if you are implementing the strategy the way it was intended (process evaluation/implementation monitoring)? Refer back to your logic model and the Logic Model module as needed. Be sure to cover dose, reach, fidelity, and implementation. (40 points)
This intervention helps to bring awareness to the importance of physical activity and how college students can incorporate exercising into their daily schedules. The different exercising options shown to students through this intervention can help them to find what best fits their interests as an individual. This program also teaches students about physical activity and provides social support for them by providing small group sessions. This intervention may help students form social groups through these sessions that they continue to have in the future as well. Motivational techniques, self-monitoring, and goal-setting are also taught through this intervention in hopes that students will continue to use these strategies throughout adulthood. In a study by Ickes and colleagues (2016), they found that self-efficacy was improved through the health coaching sessions. During these sessions participants developed and monitored goals throughout the intervention, which can increase self-efficacy. Goal setting and providing individualized and constructive feedback to participants based on their actions are both key in improving self-efficacy and increasing physical activity (Ickes et al., 2016). The intervention strategies in the article aimed to assist individuals’ progress and included the influence of a health coach or personal trainer to affect participants’ processes of change, decisional balance, and self-efficacy. These same techniques will be used in this intervention as well and should lead to behavior changes if delivered appropriately. Although this intervention hopes for a total success, this is not likely to happen. However, through the use of motivational techniques and monitoring strategies, students could be motivated to go to the exercise sessions which could change behavior. Beginning with these strategies effectively can hopefully increase the chances of students continuously going to the health coach and exercise sessions.
There are some limitations to this strategy that are important to be aware of throughout the intervention. One is the limited resources available due to funding. There was not enough funding to provide one-on-one personal training sessions as a option for students to participate in as well as more sessions to meet with a health coach. The intervention could also only enroll 30 students due to funding, and the majority of participants were females. It is also likely that only students interested in losing weight signed up to participate in this program, so it is not a good indication of the overall population.
To determine whether the intervention is being implemented as intended involves many factors that must be addressed. To ensure that the intended targets are receiving the program, attendance will be recorded at the beginning of the exercise sessions as well as the meetings with the health coach. Sign-in sheets will be given to participants at this time by the health coach or personal trainer. Observations will also take place through the project leader using a checklist to identify how many sessions are actually delivered. Observations will check to ensure that all services are accurate, high quality, and delivered as intended. The project leader will observe how well goals and objectives were communicated to participants as well as the participants’ engagement in the activities. Questionnaires and surveys will help determine the satisfaction of the program. Students, the health coach, and personal trainer will all be given surveys to examine aspects of the intervention including the quality and accuracy, duration, facilities, delivery style, materials, and overall satisfaction. Focus groups and interviews will also be conducted with the students, health coach, and personal trainer to explore more in depth the quality of implementation. This provides insight to the success or failure of the program through staff and participants’ attitudes on different components such as the small group training sessions and health meetings. The interviews and focus groups will be conducted by the project leader to hopefully gain useful information on improvements to apply to the intervention. Focus groups and interviews will give an idea of what participants thought about the program and their experience throughout the intervention.
Part 4: Reflection
- Oftentimes when working with communities, the initial plan is not what ultimately happens. What would your second choice strategy be for your identified behavior and community? Why would you choose this strategy? In other words, in what ways would this strategy also address the needs of the community based on your assessment for Part 1? (25 points)
- Reflect on how you may use the Community Guide, Nutrition Education Library, and other resources in the future. What did you like about these resources? What didn’t you like? Provide suggestions on how you would make the sites easier for practitioners to use. (20 points)
It is important to have a back-up plan or second option in mind since the initial plan is not always successful. If this intervention strategy fails, my second choice strategy would be Physical Activity: Creation of or enhanced access to places for physical activity combined with informational outreach programs. This multicomponent strategy could be useful in the college setting to address physical activity by promoting access to places for physical activity and also by providing information on how to use the resources available. Components in this strategy included training on the equipment, health behavior education and techniques, health and fitness programs, and buddy systems. These are some of the same aspects of my intervention that address increasing physical activity among college students. Since obesity rates among the college population are high and the physical activity levels are low, these components would be useful in addressing the needs of this community. College students are often unaware of what is available to them, especially when they first enter college, so it is important to use strategies that provide them with the knowledge of healthy behaviors and access to places for physical activity.
The resources used for this project provided me with new information that I can benefit from in the future. Although I do not know where my career path will take me, I know that I want to focus on health promotion in some way whether in the community or schools. The Community Guide provides a wide range of approaches to apply to various settings, so no matter what direction I go in, there is something from this resource that can be beneficial. I also like that empirical evidence is included for each intervention approach. This provides evidence of what is effective and research to go back to when implementing an intervention. The Community Guide’s review process is thorough and gives practitioners useful information to apply to one’s own intervention. However, I disliked how the included studies for each topic were difficult to locate. No links were provided for them, so I tried to find the resources through different databases and was unable to locate them. Although there are links for research-tested intervention programs available, links to the included studies would have been useful for easy access and to also have further information on studies that were related to the topic. This would be a beneficial change for practitioners as well. When using this guide in their practice, it is important to have as much information available as possible to understand how a strategy has been implemented. The site could also add a tutorial video for practitioners on how to use The Community Guide to have a better idea of everything it has to offer. This feature could assist them in finding specific information that can relate to their own intervention plan. The Navigating The Site tab has a brief overview of how to work the site, but it would be even more useful to have a tutorial available for a more detailed, step-by-step guide.
Ickes, M. J., McMullen, J., Pflug, C., & Westgate, P. M. (2016). Impact of a university-based program on obese college students’ physical activity behaviors, attitudes, and self-efficacy. American Journal of Health Education, 47(1), 47-55. doi: http://dx.doi.org.proxy-remote.galib.uga.edu/10.1080/19325037.2015.1111178
Joseph, R. P., Pekmezi, D. W., Lewis, T., Dutton, G., Turner, L. W., & Durant, N. H. (2013). Physical activity and social cognitive theory outcomes of an internet-enhanced physical activity intervention for African-American female college students. Journal of Health Disparities Research & Practice, 6(2), 1-18.
Kahn E., Ramsey L., Brownson R., Heath, G., Howze, E., Powell, K., Stone, E., Rajab, M., Corso, P. (2002). The effectiveness of interventions to increase physical activity: A systematic review. Am J Prev Med. 2002; 22: 73-107.
Njororai, W., & Njororai, F. (2015). College undergraduate students’ self-rating of their physical activity involvement over a 7-day period. Journal of Physical Education & Sport, 15(3), 502-508.
Quartiroli, A., & Maeda, H. (2016). The effects of a lifetime physical fitness (LPF) course on college students’ health behaviors. International Journal of Exercise Science, 9(2), 136-148.
Young, S. J., Lee, D., & Sturts, J. R. (2015). Motivational readiness of community college students engaging in physical activity. Recreational Sports Journal, 39(2), 92-104.