Browsing by Author "Steinberg, Dori"

Background: Church-based health promotion programs have been shown to be effective in improving health outcomes, but rarely do they approach wellness from a holistic standpoint. This is a missed opportunity for fuller integration within congregations. This study sought to assess and evaluate the feasibility of a holistic multi-site church-based health promotion program, through engagement, acceptability, and preliminary behavior change outcomes. Methods: This study utilized a concurrent mixed-methods approach in order to evaluate the “Congregational Wellness Challenge” (CWC), a pilot initiative that encouraged behavior change in three areas of holistic wellness: body, spirit, and soul, over six weeks. Participants were asked to complete one activity from each of the three categories every day for forty days, and congregations were encouraged to support those participating in the challenge. This study utilized a pre-post one-group design. Participants were surveyed at baseline and at six weeks about their health behaviors and opinions of the programs, as well as recording their behaviors on activity logs. Seventeen semi-structured in-depth interviews were conducted eight weeks post-challenge. Results: The 39 participants in the study completed 64.2% of the activities during the challenge. There was a significant increase in several of the body health variables. The number of people reporting 30 minutes of physical activity about once a week, two or three times a week or every day, compared to (no times a week?) nearly doubled, from 43.5% to 82.6% (p=0.012). Vegetable and fruit intake also significantly increased, from 52.2% of people reporting eating at least 5 servings of vegetables and fruits daily to 100% of respondents (p=0.001). Frequency of reading for pleasure significantly increased, as did Scripture meditation, bible study, and singing to the Lord. Qualitative results indicated an overall acceptability of the program. Participants had a variety of motivations for joining, and gave valuable feedback on the importance of recording their activities. Conclusion: The CWC pilot initiative was feasible in a wide variety of churches, and future research should focus on the effectiveness of holistic wellness programs and improving implementation practices.

Background: Hypertension is a primary risk factor for cardiovascular disease. Studies have shown that hypertension may have a more severe effect on cardiovascular disease outcomes among women. To mitigate this risk of hypertension in women, evidence supports that the DASH (Dietary Approaches to Stop Hypertension) diet as an effective treatment. Despite decades of evidence supporting the efficacy of the DASH diet to treat hypertension, compliance to DASH remains consistently low across all populations. However, given the importance of self-monitoring for producing behavior change, innovative efforts that utilize this strategy are needed to improve adoption of DASH on a population level. Methods: This thesis is a secondary analysis of 3-month digital health intervention (DASH Cloud) to improve adoption of DASH among high risk women conducted in Durham, NC at Duke University. Participants (N= 59) were allocated into the DASH Cloud arm (N= 30), or the attention control arm (N = 29). Both groups received publicly available booklets about the DASH diet and were asked to self-monitor their diet using a commercially available diet tracking app. Only the intervention arm received personalized feedback about their compliance to the DASH diet and skills training videos via text message. The goal of this study was to understand patterns and predictors of self-monitoring via the diet tracking app. Results: Overall, the median proportion of self-monitoring engagement was 76%. By treatment arm, the median proportion of engagement in the DASH Cloud arm and attention control arm was 68% and 85%, respectively. Significant predictors of self-monitoring include those who had 100% engagement during the first two weeks and first month of the study, had marital support, lower BMI, at least a college degree, insurance, a negative perception of their food environment, were somewhat comfortable with using apps and less likely to use an app to track medication adherence. Conclusion: This study provided evidence that self-monitoring of diet is high within the context of an intervention aimed at using digital health to promote compliance to the DASH diet among high risk women. The strongest predictor of self-monitoring engagement was early engagement. This suggests that interventions aiming to improve rates of self-monitoring an improve uptake of DASH using diet tracking apps should aim to improve early engagement to achieve success overall. However, given the small sample size of the study, future studies should include a larger population to describe patterns of self-monitoring and ascertain other predictors of engagement.

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