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Browsing by Author "Alexander, Ramine C."

Now showing 1 - 5 of 5
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    Assessing the Internal and External Validity of Mobile Health Physical Activity Promotion Interventions: A Systematic Literature Review Using the RE-AIM Framework
    Blackman, Kacie C. A.; Zoellner, Jamie M.; Berrey, Leanna M.; Alexander, Ramine C.; Fanning, Jason; Hill, Jennie L.; Estabrooks, Paul A. (JMIR Publications, 2013)
    Background: Mobile health (mHealth) interventions are effective in promoting physical activity (PA); however, the degree to which external validity indicators are reported is unclear. Objective: The purpose of this systematic review was to use the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework to determine the extent to which mHealth intervention research for promoting PA reports on factors that inform generalizability across settings and populations and to provide recommendations for investigators planning to conduct this type of research. Methods: Twenty articles reflecting 15 trials published between 2000 and 2012 were identified through a systematic review process (ie, queries of three online databases and reference lists of eligible articles) and met inclusion criteria (ie, implementation of mobile technologies, target physical activity, and provide original data). Two researchers coded each article using a validated RE-AIM data extraction tool (reach, efficacy/effectiveness, adoption, implementation, maintenance). Two members of the study team independently abstracted information from each article (inter-rater reliability >90%) and group meetings were used to gain consensus on discrepancies. Results: The majority of studies were randomized controlled trials (n=14). The average reporting across RE-AIM indicators varied by dimension (reach=53.3%, 2.67/5; effectiveness/efficacy=60.0%, 2.4/4; adoption=11.1%, 0.7/6; implementation=24.4%, 0.7/3; maintenance=0%, 0/3). While most studies described changes in the primary outcome (effectiveness), few addressed the representativeness of participants (reach) or settings (adoption) and few reported on issues related to maintenance and degree of implementation fidelity. Conclusions: This review suggests that more focus is needed on research designs that highlight and report on both internal and external validity indicators. Specific recommendations are provided to encourage future mHealth interventionists and investigators to report on representativeness, settings, delivery agents for planned interventions, the extent to which protocol is delivered as intended, and maintenance of effects at the individual or organizational level.
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    Effects of a behavioral and health literacy intervention to reduce sugar-sweetened beverages: a randomized-controlled trial
    Zoellner, Jamie M.; Hedrick, Valisa E.; You, Wen; Chen, Yi-Chun Yvonnes; Davy, Brenda M.; Porter, Kathleen J.; Bailey, Angela; Lane, Hannah; Alexander, Ramine C.; Estabrooks, Paul A. (Biomed Central, 2016-03-22)
    Background: Despite excessive consumption of sugar-sweetened beverages (SSB), little is known about behavioral interventions to reduce SSB intake among adults, particularly in medically-underserved rural communities. This type 1 effectiveness-implementation hybrid RCT, conducted in 2012–2014, applied the RE-AIM framework and was designed to assess the effectiveness of a behavioral intervention targeting SSB consumption (SIPsmartER) when compared to an intervention targeting physical activity (MoveMore) and to determine if health literacy influenced retention, engagement or outcomes. Methods: Guided by the Theory of Planned Behavior and health literacy strategies, the 6 month multi-component intervention for both conditions included three small-group classes, one live teach-back call, and 11 interactive voice response calls. Validated measures were used to assess SSB consumption (primary outcome) and all secondary outcomes including physical activity behaviors, theory-based constructs, quality of life, media literacy, anthropometric, and biological outcomes. Results: Targeting a medically-underserved rural region in southwest Virginia, 1056 adult participants were screened, 620 (59 %) eligible, 301 (49 %) enrolled and randomized, and 296 included in these 2015 analyses. Participants were 93 % Caucasian, 81 % female, 31 % ≤ high-school educated, 43 % < $14,999 household income, and 33 % low health literate. Retention rates (74 %) and program engagement was not statistically different between conditions. Compared to MoveMore, SIPsmartER participants significantly decreased SSB kcals and BMI at 6 months. SIPsmartER participants significantly decreased SSB intake by 227 (95 % CI = −326,−127, p < 0.001) kcals/day from baseline to 6 months when compared to the decrease of 53 (95 % CI = −88,−17, p < 0.01) kcals/day among MoveMore participants (p < 0.001). SIPsmartER participants decreased BMI by 0.21 (95 % CI = −0.35,−0.06; p < 0.01) kg/m2 from baseline to 6 months when compared to the non-significant 0.10 (95 % CI = −0.23, 0.43; NS) kg/m2 gain among MoveMore participants (p <0.05). Significant 0–6 month effects were observed for about half of the theory-based constructs, but for no biological outcomes. Health literacy status did not influence retention rates, engagement or outcomes. Conclusions: SIPsmartER is an effective intervention to decrease SSB consumption among adults and is promising for translation into practice settings. SIPsmartER also yielded small, yet significant, improvements in BMI. By using health literacy-focused strategies, the intervention was robust in achieving reductions for participants of varying health literacy status.
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    From Bright Bodies to iChoose: Using a CBPR Approach to Develop Childhood Obesity Intervention Materials for Rural Virginia
    Brito, Fabiana A.; Zoellner, Jamie M.; Hill, Jennie L.; You, Wen; Alexander, Ramine C.; Hou, Xiaolu; Estabrooks, Paul A. (2019-03-21)
    This community-based participatory research (CBPR) project used a collaborative process to develop a culturally relevant workbook for parents of overweight children. We followed a mixed methods iterative process to assess clear communication using a CBPR approach. Materials were evaluated using readability tests, the Clear Communication Index (CCI), and the Suitability Assessment of Materials (SAM). In addition, we used surveys and focus groups to investigate parents' perceptions and gather feedback from delivery staff using the workbook. While workbook materials maintained adequate grade reading levels, our iterative process and the use of CCI and SAM led to significant improvements in (a) clearly communicating the objectives of the program, (b) being culturally relevant, and (c) reaching a high satisfaction among users. These findings suggest that evaluative measures for written materials should move beyond readability and need to account for level of clarity and cultural appropriateness of messages. Furthermore, we found that that an iterative process to intervention's material development using clear communication strategies while involving community members, parents, and research partners can lead to workbook materials that are culturally relevant to the target audience, and better communicate program objectives. Finally, this is a potentially generalizable process for improving clear communication of written health information materials.
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    Participatory development and pilot testing of iChoose: an adaptation of an evidence-based paediatric weight management program for community implementation
    Hill, Jennie L.; Zoellner, Jamie M.; You, Wen; Brock, Donna J.; Price, Bryan; Alexander, Ramine C.; Frisard, Madlyn I.; Brito, Fabiana A.; Hou, Xiaolu; Estabrooks, Paul A. (2019-01-29)
    Background To describe the identification, adaptation, and testing of an evidence-based pediatric weight management program for a health disparate community. Methods A community advisory board (CAB) of decision-makers and staff from local health care, public health, and recreation organizations engaged with academic partners to select an evidence-based program (EBP) for local implementation. Three EBPs were identified (Traffic Light, Bright Bodies, Golan and colleagues Home Environmental Model) and each EBP was rated on program characteristics, implementation and adaptation, and adoptability. Following selection of the EBP that was rated highest, the POPS-CAB made adaptations based on the program principles described in peer-reviewed publications. The adapted intervention, iChoose, was then pilot tested in 3 iterative phases delivered initially by research partners, then co-delivered by research and community partners, then delivered by community partners. The RE-AIM framework was used to plan and evaluate the iChoose intervention across all waves with assessments at baseline, post program (3 months), and follow-up (6 months). Results Bright Bodies rated highest on program characteristics and adoptability (p’s < 0.05), while Home Environmental Model rated highest on implementation factors (p < 0.05). Qualitatively, the selection focused on important program characteristics and on matching those characteristics to the potential to fit within the community partner services. The adapted program—iChoose—had 18% reach and with participants that were representative of the target population on age, gender, ethnicity, and race. Effectiveness was demonstrated by modest, but significant reductions in BMI z-scores at post-program compared to baseline (MΔ = − 0.047; t = − 2.11, p = 0.046). This decrease returned to values similar to baseline 3 months (MΔ = 0.009) after the program was completed. Implementation fidelity was high and implementation fidelity did not differ between community or research delivery agents. Conclusions The process to help organizations identify and select evidence-based programs appropriate for their community led to consensus on a single EBP. While iChoose was successful in initiating changes in BMI z-scores, could be implemented in a low resource community with fidelity, it was insufficient to lead to sustained child BMI z-scores. In response to these data, maintenance of program effects and delivery are the current focus of the CBPR team.
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    Using a Community-Based Participatory Research Approach to Improve Health Disparities among Youth and Adults in the Dan River Region
    Alexander, Ramine C. (Virginia Tech, 2016-05-04)
    As defined by the US Department of Health and Human Services, health disparities are "a particular type of health differences that are closely linked with social or economic disadvantages." These disadvantages include, but are not limited to, unequal access to quality health care and health information. Health disparities adversely affect groups of people based on racial or ethnic group, religion, socioeconomic status, gender, age, mental health, cognitive, sensory, or physical disability, sexual orientation, geographic location, or other characteristics historically linked to discrimination or exclusion. To address the root cause of health disparities there has been a call for more comprehensive frameworks for detecting, understanding, and designing interventions that will reduce or eliminate health disparities. One such framework is a Community-Based Participatory Research (CBPR) approach. CBPR is an orientation to research that focuses on relationships between academic and community partners, with principles of co-learning, mutual benefits, and long term commitment. CBPR also focuses on aspects of importance to the community with the aim of combining knowledge and action for social change to improve community health and eliminate health disparities. The overall goal of this dissertation is to build capacity and address health disparities among youth and adults in the Dan River Region. This region is federally designated as a medically under-served area/population and is located in the health disparate region of south central Virginia and north central North Carolina. This research draws on two CBPR projects, including an 8-week community garden program lead by the Dan River Partnership for a Healthy Community (DRPHC) and a 3-month childhood obesity treatment program, iChoose, led by the Partnering for Obesity Planning and Sustainability (POPS) Community Advisory Board (CAB). Since one of the primary aims for CBPR is to increase community capacity, this approach is the ideal process for engaging communities that suffer from health disparities. Thus, engaging community members as collaborators, our studies reported on the relevance and application of CBPR while simultaneously addressing health and capacity outcomes in the health disparate Dan River Region.