Browsing by Author "Porter, Kathleen J."

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    A Content Analysis of Implementation Strategies Chosen by Virginia School Nutrition Directors
    Nelson, Rachel A.; Porter, Kathleen J.; Shomo, Kelly; Curwood, Sandra; Misyak, Sarah A. (Paris Scholar, 2021-11)
    Objective: School-based interventions are common approaches to address childhood obesity; however, there is little understanding of strategies that can foster their implementation into schools. In this study, we aimed to identify goals and the specific strategies selected by school nutrition directors (SNDs) in Virginia to execute school-based interventions. Methods: Between 2018 and 2019, SNDs in Virginia participated in Team Nutrition workshops through which they created action plans. We carried out a content analysis of 132 action plans collected from 100 school divisions. We developed codes deductively and inductively. The codes captured plan completion, goals, and strategies. Each plan was independently coded by 2 coders. Results: Action plans included 1.2 goals (SD = 0.54) and 3.9 strategies per goal (SD = 2.1). Goals were most commonly related to improving menus or increasing participation in the school meal programs. The strategies varied based on the goals. However, obtaining buy-in from school personnel and students was the most commonly included goal (64.4%) across plans. The level of action plan completion decreased with each subsequent section of the worksheet. Conclusions: Emerging patterns identified in this study suggest SNDs' strategy selection is based on goals and that trainings should be tailored to promote the development of skills required to execute optimal strategies.
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    Cultivating a Healthy School Environment: Evaluation of a Virginia School Nutrition Training Program
    Nelson, Rachel A. (Virginia Tech, 2020-05-18)
    The Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework was used to evaluate the impact of the Virginia Department of Education's (VDOE) implementation of the USDA's Team Nutrition training program on Virginia elementary schools from 2017-2020. The VDOE provided training for school nutrition directors (SNDs) at workshops in June 2018 and September 2019 and continued technical assistance to help SNDs improve the school food environment within their divisions. SNDs' perceived support, self-efficacy, and intention to implement changes to the school food environment was measured through pre- and post-training surveys and quarterly check-ins. Implementation was measured using lunchroom environment observations and strategic plans created at the workshops. SNDs representing 83.9% of Virginia elementary students (512,953 students) in 111 divisions attended at least one of the workshops. Within effectiveness, perceived support from cafeteria staff was highest among all stakeholders for both the 2018 and 2019 trainings, though it significantly decreased from before to after the training for both workshops. Average perceived support did not significantly change over time. Self-efficacy was significantly higher following the 2018 training workshop only. The intervention was adopted by 84% of divisions and both intention to implement and actual implementation were highest for strategies related to Farm to School, a VDOE priority. Effectiveness and implementation are expected to improve as it takes up to years for changes to occur in schools. Despite RE-AIM not being part of the initial evaluation plan, 62% of indicators were assessed. With some adaptations to improve effectiveness, the intervention should continue and be expanded.
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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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    Exploring the Relationship Between Food Security Status and Mental Health Among SNAP-Eligible Virginia Mothers
    Liebe, Rachel Antoinette (Virginia Tech, 2023-03-16)
    Food insecurity is associated with increased stress, symptoms of mental illness, and persistent health disparities. Women caregivers (referred to as mothers) may be at an increased risk because they often compensate for food shortages by reducing their own intake and make household food decisions. The current literature on the relationship between food security status and mental health in the U.S. lacks a clear framework for the relationship between these two phenomena. This dissertation describes three studies that aimed to explore the relationship between food security and mental health for mothers with low income in Virginia: (1) understanding differences in mental health outcomes by food security status (n=1,029), (2) a path analysis of a conceptual framework of the relationship (n=1,029), and (3) a thematic analysis of mothers' lived experiences with this relationship (n=29). An explanatory, sequential mixed methods design was employed with a cross-sectional survey informing semi-structured interviews. The survey (administered August-October 2021) was developed with previously validated measures of food security status, physical and mental health, symptoms of mental illness, behavioral food coping strategies, and social support. The interview guide was developed based on the findings of the survey and administered in May and June 2022. Collective findings of this series of studies suggested lower food security status was associated with negative mental health outcomes. However, there were no direct pathways from food security status to mental health outcomes. Social support and behavioral food coping strategies mediated the relationship between food security status and mental health outcomes. Mothers reported experiencing managing a variety of stressors associated with food insecurity. Mothers also indicated that stressors and coping strategies associated with managing food insecurity impacted their mental health. Future research should explore additional factors impacting household resiliency and strategies to reduce stigma associated with resource utilization. These findings can be built upon to develop screening tools and interventions to help improve food security and mental health status mothers with low income.
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    Predictors of engagement and outcome achievement in a behavioural intervention targeting sugar-sweetened beverage intake among rural adults
    Porter, Kathleen J.; Thomson, Jessica L.; Zoellner, Jamie M. (2020-02)
    Objective: To describe relationships among baseline characteristics, engagement indicators and outcomes for rural participants enrolled in SIPsmartER, a behavioural intervention targeting sugar-sweetened beverage (SSB) intake. Design: A secondary data analysis. Bivariate analyses determined relationships among baseline characteristics (e.g. age, gender, race, education, income), engagement indicators (completion of 6-month health screening, class attendance, call completion) and SSB outcomes (SSB ounce reduction (i.e. US fluid ounces; 1 US fl. oz = 29 center dot 57 ml), reduced >= 12 ounces, achieved <= 8 ounce intake). Generalized linear models tested for significant effects of baseline characteristics on engagement indicators and of baseline characteristics and engagement indicators on SSB outcomes. Setting: South-west Virginia, USA, a rural, medically underserved region. Participants: Participants' (n 155) mean age was 41 years; most were female (81 %), White (91 %) and earned <=$US 20 000 per annum (61 %). Results: All final models were significant. Engagement models predicted 12-17 % of variance, with age being a significant predictor in all three models. SSB outcome models explained 5-70 % of variance. Number of classes attended was a significant predictor of SSB ounce reduction (beta = -6 center dot 12, P < 0 center dot 01). Baseline SSB intake significantly predicted SSB ounce reduction (beta = -0 center dot 90, P < 0 center dot 001) and achieved <= 8 ounce intake (beta = 0 center dot 98, P < 0 center dot 05). Conclusions: The study identifies several participant baseline characteristics that may impact engagement in and outcomes from a community-based intervention targeting SSB intake. Findings suggest greater attendance of SIPsmartER classes is associated with greater reduction in overall SSB intake; yet engagement variables did not predict other outcomes. Findings will inform the future implementation of SIPsmartER and research studies of similar design and intent.
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    SIPsmartER delivered through rural, local health districts: adoption and implementation outcomes
    Porter, Kathleen J.; Brock, Donna J.; Estabrooks, Paul A.; Perzynski, Katelynn M.; Hecht, Erin R.; Ray, Pamela; Kružliaková, Natalie; Cantrell, Eleanor S.; Zoellner, Jamie M. (2019-09-18)
    Background SIPsmartER is a 6-month evidenced-based, multi-component behavioral intervention that targets sugar-sweetened beverages among adults. It consists of three in-person group classes, one teach-back call, and 11 automated phone calls. Given SIPsmartER’s previously demonstrated effectiveness, understanding its adoption, implementation, and potential for integration within a system that reaches health disparate communities is important to enhance its public health impact. During this pilot dissemination and implementation trial, SIPsmartER was delivered by trained staff from local health districts (delivery agents) in rural, Appalachian Virginia. SIPsmartER’s execution was supported by consultee-centered implementation strategies. Methods In this mixed-methods process evaluation, adoption and implementation indicators of the program and its implementation strategy (e.g., fidelity, feasibility, appropriateness, acceptability) were measured using tracking logs, delivery agent surveys and interviews, and fidelity checklists. Quantitative data were analyzed with descriptive statistics. Qualitative data were inductively coded. Results Delivery agents implemented SIPsmartER to the expected number of cohorts (n = 12), recruited 89% of cohorts, and taught 86% of expected small group classes with > 90% fidelity. The planned implementation strategies were also executed with high fidelity. Delivery agents completing the two-day training, pre-lesson meetings, fidelity checklists, and post-lesson meetings at rates of 86, 75, 100, and 100%, respectively. Additionally, delivery agents completed 5% (n = 3 of 66) and 10% (n = 6 of 59) of teach-back and missed class calls, respectively. On survey items using 6-point scales, delivery agents reported, on average, higher feasibility, appropriateness, and acceptability related to delivering the group classes (range 4.3 to 5.6) than executing missed class and teach-back calls (range 2.6 to 4.6). They also, on average, found the implementation strategy activities to be helpful (range 4.9 to 6.0). Delivery agents identified strengths and weakness related to recruitment, lesson delivery, call completion, and the implementation strategy. Conclusions In-person classes and the consultee-centered implementation strategies were viewed as acceptable, appropriate, and feasible and were executed with high fidelity. However, implementation outcomes for teach-back and missed class calls and recruitment were not as strong. Findings will inform the future full-scale dissemination and implementation of SIPsmartER, as well as other evidence-based interventions, into rural health districts as a means to improve population health.
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    Supporting maintenance of sugar-sweetened beverage reduction using automated versus live telephone support: findings from a randomized control trial
    Zoellner, Jamie M.; You, Wen; Estabrooks, Paul A.; Chen, Yi-Chun Yvonnes; Davy, Brenda M.; Porter, Kathleen J.; Hedrick, Valisa E.; Bailey, Angela; Kružliaková, Natalie (2018-10-04)
    Background Although reducing sugar-sweetened beverage (SSB) intake is an important behavioral strategy to improve health, no known SSB-focused behavioral trial has examined maintenance of SSB behaviors after an initial reduction. Guided by the RE-AIM framework, this study examines 6–18 month and 0–18 month individual-level maintenance outcomes from an SSB reduction trial conducted in a medically-underserved, rural Appalachia region of Virginia. Reach and implementation indicators are also reported. Methods Following completion of a 6-month, multi-component, behavioral RCT to reduce SSB intake (SIPsmartER condition vs. comparison condition), participants were further randomized to one of three 12-month maintenance conditions. Each condition included monthly telephone calls, but varied in mode and content: 1) interactive voice response (IVR) behavior support, 2) human-delivered behavior support, or 3) IVR control condition. Assessments included the Beverage Intake Questionnaire (BEVQ-15), weight, BMI, and quality of life. Call completion rates and costs were tracked. Analysis included descriptive statistics and multilevel mixed-effects linear regression models using intent-to-treat procedures. Results Of 301 subjects enrolled in the 6-month RCT, 242 (80%) were randomized into the maintenance phase and 235 (78%) included in the analyses. SIPsmartER participants maintained significant 0–18 month decreases in SSB. For SSB, weight, BMI and quality of life, there were no significant 6–18 month changes among SIPsmartER participants, indicating post-program maintenance. The IVR-behavior participants reported greater reductions in SSB kcals/day during the 6–18 month maintenance phase, compared to the IVR control participants (− 98 SSB kcals/day, 95% CI = − 196, − 0.55, p < 0.05); yet the human-delivered behavior condition was not significantly different from either the IVR-behavior condition (27 SSB kcals/day, 95% CI = − 69, 125) or IVR control condition (− 70 SSB kcals/day, 95% CI = − 209, 64). Call completion rates were similar across maintenance conditions (4.2–4.6 out of 11 calls); however, loss to follow-up was greatest in the IVR control condition. Approximated costs of IVR and human-delivered calls were remarkably similar (i.e., $3.15/participant/month or $38/participant total for the 12-month maintenance phase), yet implications for scalability and sustainability differ. Conclusion Overall, SIPsmartER participants maintained improvements in SSB behaviors. Using IVR to support SSB behaviors is effective and may offer advantages as a scalable maintenance strategy for real-world systems in rural regions to address excessive SSB consumption. Trial registry Clinicaltrials.gov; NCT02193009; Registered 11 July 2014. Retrospectively registered.
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    Understanding the Relationship between Food Security and Mental Health for Food-Insecure Mothers in Virginia
    Liebe, Rachel A.; Adams, Leah M.; Hedrick, Valisa E.; Serrano, Elena L.; Porter, Kathleen J.; Cook, Natalie E.; Misyak, Sarah A. (MDPI, 2022-04-02)
    Food insecurity, which disproportionately impacts mothers, can have chronic consequences on physical and mental health. There is a relationship between food insecurity and mental health, but the relationship’s mechanisms are unclear. This study aimed to understand how mental health outcomes differ by food insecurity severity and race among Virginia mothers. A cross-sectional survey employed previously validated food security status measures, physical and mental health, social support, and food coping strategies. Results were analyzed using descriptive statistics, Spearman’s rank-order correlations, linear regression, and chi-squared with effect sizes. Overall, respondents (n = 1029) reported worse mental health than the U.S. average (44.3 ± 10.1 and 50, respectively). There was a large effect of food security on mental health (d = 0.6), with worse mental health outcomes for mothers experiencing very low food security (VLFS) than low food security (LFS; p < 0.001). There was a small effect of race on mental health (φc = 0.02), with Black mothers having better mental health than White mothers (p < 0.001). Compared to mothers experiencing LFS, mothers experiencing VLFS had less social support (d = 0.5) and used more food coping strategies, especially financial strategies (d = −1.5; p < 0.001). This study suggests that food-insecure mothers experience stressors and lack adequate social support, which is even more distinct for mothers experiencing VLFS.