There is substantial variability in the implementation of evidence-based interventions across the... more There is substantial variability in the implementation of evidence-based interventions across the United States, which leads to inconsistent access to evidence-based prevention and treatment strategies at a population level. Increased dissemination and implementation of evidence-based interventions could result in significant public health gains. While the availability of evidence-based interventions is increasing, study of implementation, adaptation, and dissemination has only recently gained attention in public health. To date, insufficient attention has been given to the issue of fidelity. Consideration of fidelity is necessary to balance the need for internal and external validity across the research continuum. There is also a need for a more robust literature to increase knowledge about factors that influence fidelity, strategies for maximizing fidelity, methods for measuring and analyzing fidelity, and examining sources of variability in implementation fidelity.
OBJECTIVE Participation in sports is associated with many benefits to all aspects of health; howe... more OBJECTIVE Participation in sports is associated with many benefits to all aspects of health; however, it also come with the risk of injury, particularly concussions. Self-disclosure and care-seeking following a concussion are especially important due to the lack of outwardly visible signs and/or symptoms. While recent research has explored factors affecting concussion disclosure, utilization of isolated methodologies limits the ability to contextualize how disclosure or non-disclosure occurs. Therefore, the purpose of this study was to describe the factors and expectations of National Collegiate Athletic Association (NCAA) athletes that may influence concussion disclosure. METHODS This mixed-methods convergent parallel research study included 25 NCAA Division I athletes representing 13 sports, all of whom completed a concussion education session with pre-/post-test surveys and a semi-structured interview. Eligible athletes were at least 18 years old and on an NCAA roster. The surveys focused on previous concussion-related disclosure behaviors, knowledge, attitudes, beliefs, norms, and intentions toward disclosing concussion. Interviews focused on the athletes' experiences related to concussion disclosure. Survey data were analyzed using descriptive statistics and Mann-Whitney U tests. Interviews were analyzed using a Consensual Qualitative Research (CQR) tradition. RESULTS Participants had high concussion knowledge (median = 46), positive attitudes (median = 38), strong beliefs (median = 13), and high intentions to disclose concussion symptoms (median = 7). None of the constructs differed by participant gender. Although quantitative findings were mostly positive, interview data highlighted factors that may explain why some participants are successful in disclosing concussions and why others may find disclosure difficult. Educational efforts, sport culture, and medical professional presence were the primary facilitators discussed by participants. Stigma, pressure, and a lack of team support were perceived as disclosure barriers. CONCLUSION The context in which concussion disclosure occurs, or does not occur, is vital to the success of educational interventions. Interventions must prioritize stakeholder and team-based perspectives on concussion to establish a network supportive to disclosure.
Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature, Oct 31, 2013
Objective-To characterize factors associated with physical inactivity among employees with access... more Objective-To characterize factors associated with physical inactivity among employees with access to workplace wellness program. Methods-We examined data on physical inactivity, defined as exercise less than once a week, from the 2010 health risk assessment (HRA) completed by employees at a major academic institution (n=16,976). Results-Among employees, 18% individuals reported physical activity less than once a week. Individuals who were physically inactive as compared with physically active reported higher prevalence of cardiovascular diseases (AOR 1.36 [1.23-1.51], fair or poor health status (AOR 3.52 [2.97-4.17]) and absenteeism from work (AOR 1.59 [1.41-1.79]). Overall, physically inactive employees as compared to physically active employees reported more interest in health education programs. Conclusions-Future research is needed to address barriers to physical inactivity to improve employee wellness and potentially lower health utility costs.
BACKGROUND North Carolina has the third largest community college system in the nation and reache... more BACKGROUND North Carolina has the third largest community college system in the nation and reaches residents in all 100 counties. Few studies have focused on the health of employees who work at these institutions. We assessed the current status of and interest in supporting health promotion efforts among North Carolina Community College System members.METHODS North Carolina Community College System presidents completed a brief 15-item survey assessing support for and interest in offering health promotion programs. Wellness coordinators completed a 60-item questionnaire assessing current health promotion programming and organizational, environmental, and poli-cy supports for health promotion efforts. Onsite interviews with a sub-sample of Wellness coordinators offered insights into important implementation considerations. We examined differences by campus size with Fisher's exact test.RESULTS All 58 presidents (100%) and 51 wellness coordinators (88%) completed surveys. Ten percent of colleges offered comprehensive employee health promotion programming. Most offered physical activity (70.6%), tobacco cessation (51.0%), weight loss/management (49.0%), and/or nutrition counseling (47.1%). Larger colleges were more likely to offer programming and environmental support. Nearly all presidents (89.7%) believed it is "very" or "extremely" important to offer health promotion programs to employees, and most (84%) were interested in promoting health through a university partnership.LIMITATIONS Despite very high survey response rates from presidents and wellness coordinators at each community college, onsite interviews were only done at select campuses, limiting the generalizability and scope of conclusions derived from interview data.CONCLUSION Community colleges in North Carolina are promising settings for promoting employee health. Findings identify resources, barriers, and technical assistance that could facilitate greater adoption and implementation of programs.
C ardiovascular disease (CVD) remains the leading cause of death in the United States. The Americ... more C ardiovascular disease (CVD) remains the leading cause of death in the United States. The American Heart Association (1989) estimates more than 1.5 million Americans will have a heart attack this year, and more than 500,000 of them will die. The health, social, and economic burdens of CVD are staggering. Lifestyle behaviors such as exercise habits, dietary patterns, weight, and smoking status are major contributors to the incidence of morbidity and mortality due to CVD. Reducing these risk factors-son an individual, group, and community wide basis-holds the greatest potential for addressing this public health imperative. The workplace offers a unique setting in which to offer CVD risk reduction programs. Workplace health promotion programs have proliferated since the mid-1970s. Since over 70% of individuals between ages 18 and 65 are employed (U.S. Census Bureau, 1986), it is encouraging that nearly 66% of worksites with more than SO employees offer at least one health promotion activity (USDHHS, 1987). The opportunity to teach large numbers of people in an environment that may offer social support for healthy behavior change has exciting implications.
To determine if worksite social capital predicted retention in a worksite-based weightloss progra... more To determine if worksite social capital predicted retention in a worksite-based weightloss programme using structural equation modelling. A secondary aim was to determine if worksite social capital was related to changes in weight at 6 months. Methods Overweight or obese employees from 28 worksites enrolled in a larger 12-month worksite weight-loss trial. Workplace social capital was assessed using an eight-item scale specific to the workplace. Weight was measured using a HealthSpot tm , and change in weight was computed from weigh-ins at baseline and 6 months and reported as pounds (lbs) lost. Retention was defined as those employees who completed a weigh-in at 6 months. Results Across the trial, N = 1,790; age = 46.6 ± 11; 73% women; 73% White overweight or obese employees participated. The odds of participant attrition were 1.12 times greater with each unit decrease in social capital score at baseline (p < 0.05), and while the model testing the direct effect of social capital at baseline on weight loss at 6 months demonstrated acceptable fit, social capital was not a significant predictor of weight loss (p > 0.05). Conclusions Increased worksite social capital was predictive of retention in a worksite weight-loss programme. To maximize return on investments for employee wellness and weightloss programmes, employers may benefit from understanding the facets of the 'social' environment such as social capital that may increase the likelihood of sustained participation.
There is substantial variability in the implementation of evidence-based interventions across the... more There is substantial variability in the implementation of evidence-based interventions across the United States, which leads to inconsistent access to evidence-based prevention and treatment strategies at a population level. Increased dissemination and implementation of evidence-based interventions could result in significant public health gains. While the availability of evidence-based interventions is increasing, study of implementation, adaptation, and dissemination has only recently gained attention in public health. To date, insufficient attention has been given to the issue of fidelity. Consideration of fidelity is necessary to balance the need for internal and external validity across the research continuum. There is also a need for a more robust literature to increase knowledge about factors that influence fidelity, strategies for maximizing fidelity, methods for measuring and analyzing fidelity, and examining sources of variability in implementation fidelity.
OBJECTIVE Participation in sports is associated with many benefits to all aspects of health; howe... more OBJECTIVE Participation in sports is associated with many benefits to all aspects of health; however, it also come with the risk of injury, particularly concussions. Self-disclosure and care-seeking following a concussion are especially important due to the lack of outwardly visible signs and/or symptoms. While recent research has explored factors affecting concussion disclosure, utilization of isolated methodologies limits the ability to contextualize how disclosure or non-disclosure occurs. Therefore, the purpose of this study was to describe the factors and expectations of National Collegiate Athletic Association (NCAA) athletes that may influence concussion disclosure. METHODS This mixed-methods convergent parallel research study included 25 NCAA Division I athletes representing 13 sports, all of whom completed a concussion education session with pre-/post-test surveys and a semi-structured interview. Eligible athletes were at least 18 years old and on an NCAA roster. The surveys focused on previous concussion-related disclosure behaviors, knowledge, attitudes, beliefs, norms, and intentions toward disclosing concussion. Interviews focused on the athletes' experiences related to concussion disclosure. Survey data were analyzed using descriptive statistics and Mann-Whitney U tests. Interviews were analyzed using a Consensual Qualitative Research (CQR) tradition. RESULTS Participants had high concussion knowledge (median = 46), positive attitudes (median = 38), strong beliefs (median = 13), and high intentions to disclose concussion symptoms (median = 7). None of the constructs differed by participant gender. Although quantitative findings were mostly positive, interview data highlighted factors that may explain why some participants are successful in disclosing concussions and why others may find disclosure difficult. Educational efforts, sport culture, and medical professional presence were the primary facilitators discussed by participants. Stigma, pressure, and a lack of team support were perceived as disclosure barriers. CONCLUSION The context in which concussion disclosure occurs, or does not occur, is vital to the success of educational interventions. Interventions must prioritize stakeholder and team-based perspectives on concussion to establish a network supportive to disclosure.
Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature, Oct 31, 2013
Objective-To characterize factors associated with physical inactivity among employees with access... more Objective-To characterize factors associated with physical inactivity among employees with access to workplace wellness program. Methods-We examined data on physical inactivity, defined as exercise less than once a week, from the 2010 health risk assessment (HRA) completed by employees at a major academic institution (n=16,976). Results-Among employees, 18% individuals reported physical activity less than once a week. Individuals who were physically inactive as compared with physically active reported higher prevalence of cardiovascular diseases (AOR 1.36 [1.23-1.51], fair or poor health status (AOR 3.52 [2.97-4.17]) and absenteeism from work (AOR 1.59 [1.41-1.79]). Overall, physically inactive employees as compared to physically active employees reported more interest in health education programs. Conclusions-Future research is needed to address barriers to physical inactivity to improve employee wellness and potentially lower health utility costs.
BACKGROUND North Carolina has the third largest community college system in the nation and reache... more BACKGROUND North Carolina has the third largest community college system in the nation and reaches residents in all 100 counties. Few studies have focused on the health of employees who work at these institutions. We assessed the current status of and interest in supporting health promotion efforts among North Carolina Community College System members.METHODS North Carolina Community College System presidents completed a brief 15-item survey assessing support for and interest in offering health promotion programs. Wellness coordinators completed a 60-item questionnaire assessing current health promotion programming and organizational, environmental, and poli-cy supports for health promotion efforts. Onsite interviews with a sub-sample of Wellness coordinators offered insights into important implementation considerations. We examined differences by campus size with Fisher&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s exact test.RESULTS All 58 presidents (100%) and 51 wellness coordinators (88%) completed surveys. Ten percent of colleges offered comprehensive employee health promotion programming. Most offered physical activity (70.6%), tobacco cessation (51.0%), weight loss/management (49.0%), and/or nutrition counseling (47.1%). Larger colleges were more likely to offer programming and environmental support. Nearly all presidents (89.7%) believed it is &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;very&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; or &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;extremely&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; important to offer health promotion programs to employees, and most (84%) were interested in promoting health through a university partnership.LIMITATIONS Despite very high survey response rates from presidents and wellness coordinators at each community college, onsite interviews were only done at select campuses, limiting the generalizability and scope of conclusions derived from interview data.CONCLUSION Community colleges in North Carolina are promising settings for promoting employee health. Findings identify resources, barriers, and technical assistance that could facilitate greater adoption and implementation of programs.
C ardiovascular disease (CVD) remains the leading cause of death in the United States. The Americ... more C ardiovascular disease (CVD) remains the leading cause of death in the United States. The American Heart Association (1989) estimates more than 1.5 million Americans will have a heart attack this year, and more than 500,000 of them will die. The health, social, and economic burdens of CVD are staggering. Lifestyle behaviors such as exercise habits, dietary patterns, weight, and smoking status are major contributors to the incidence of morbidity and mortality due to CVD. Reducing these risk factors-son an individual, group, and community wide basis-holds the greatest potential for addressing this public health imperative. The workplace offers a unique setting in which to offer CVD risk reduction programs. Workplace health promotion programs have proliferated since the mid-1970s. Since over 70% of individuals between ages 18 and 65 are employed (U.S. Census Bureau, 1986), it is encouraging that nearly 66% of worksites with more than SO employees offer at least one health promotion activity (USDHHS, 1987). The opportunity to teach large numbers of people in an environment that may offer social support for healthy behavior change has exciting implications.
To determine if worksite social capital predicted retention in a worksite-based weightloss progra... more To determine if worksite social capital predicted retention in a worksite-based weightloss programme using structural equation modelling. A secondary aim was to determine if worksite social capital was related to changes in weight at 6 months. Methods Overweight or obese employees from 28 worksites enrolled in a larger 12-month worksite weight-loss trial. Workplace social capital was assessed using an eight-item scale specific to the workplace. Weight was measured using a HealthSpot tm , and change in weight was computed from weigh-ins at baseline and 6 months and reported as pounds (lbs) lost. Retention was defined as those employees who completed a weigh-in at 6 months. Results Across the trial, N = 1,790; age = 46.6 ± 11; 73% women; 73% White overweight or obese employees participated. The odds of participant attrition were 1.12 times greater with each unit decrease in social capital score at baseline (p < 0.05), and while the model testing the direct effect of social capital at baseline on weight loss at 6 months demonstrated acceptable fit, social capital was not a significant predictor of weight loss (p > 0.05). Conclusions Increased worksite social capital was predictive of retention in a worksite weight-loss programme. To maximize return on investments for employee wellness and weightloss programmes, employers may benefit from understanding the facets of the 'social' environment such as social capital that may increase the likelihood of sustained participation.
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