Combating Adult Obesity: An Examination of Program Implementation
Ryder, Holly Heather
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Background: The prevalence of adult overweight and obesity is increasing worldwide. Innovative weight reduction interventions are needed to decrease the physical, psychological, and financial costs associated with this condition. Individually-adapted physical activity interventions delivered by Health Educators in a primary care setting have shown promise in addressing adult overweight and obesity. Process evaluations are needed to clarify results obtained from randomized controlled trials and to provide insight regarding optimal programming strategies for obesity reduction interventions. Purpose: To investigate the process evaluation components dose, fidelity, and quality of implementation of the PROACTIVE intervention to increase physical activity among overweight and obese adults in a primary care setting. Methods: One hundred ninety-four overweight or obese adults (135 women, mean age = 51.3 years, SD = 10.8; 59 men, mean age = 54.3 years, SD = 10.6) were randomized to attend 22 individualized behavioural counselling sessions over 12 months. The Physical Activity Recall questionnaire, Session Summary Forms, and Health Care Climate Questionnaire were utilized to measure physical activity and intervention dose, fidelity, and quality. Hierarchical multiple regressions were conducted. Results: Overall physical activity and total active hours did not significantly change after 6 and 12 months of participation in PROACTIVE; however, physical activity intensity did significantly change. Light intensity physical activity decreased while moderate intensity physical activity increased from baseline to 6 months; this shift was maintained from 6 to 12 months. Dose and fidelity of implementation did not predict physical activity involvement at 6 and 12 months. Three-quarters of the intervention was implemented as planned and women received a significantly greater percentage of intervention content then men. Quality of the Health Educator-client relationship significantly predicted total number of hours spent being physically active at 12 months, but should be interpreted with caution due to the small sample size. Conclusion: Preliminary results suggest that dose and fidelity do not predict physical activity involvement and that additional research is warranted to investigate quality. It is recommended that future studies examine the critical intervention content that correlates to an increase in physical activity among overweight and obese adults.