A Lifestyle Intervention Via Email. Block Dietary Data Systems. An intervention to improve...

A Lifestyle Intervention Via Email

Block Dietary Data Systems. www.nutritionquest.com

• An intervention to improve– Nutrition– Physical Activity

• Developed by Block Dietary Data Systems*– In collaboration with Kaiser Permanente of

Northern California Division of Research

* Information about the developers of Alive may be found at the end of this presentation


Background

• Americans have a high prevalence of “unhealthy” diets – 77% have fewer than five servings of fruits and

vegetables each day – 77% have a fat intake greater than 30% of

calories• Americans have a low level of physical activity

– 51% fail to meet the recommended activity levels

– 24% are at the “sedentary” level

CLIFFORD BLOCK

CB say: We all know the poor nutritional habits and physical actiivity lacks of the US population.


Overview

• 12 weekly or bi-weekly messages

• Extensively tailored to individual characteristics

• Based on established learning and behavior-change theories and principles

• Available for groups reachable by email– Employees, group/organization members, HMO clients

• Requires minimal organizational effort or expertise

• Proven effective in a randomized controlled trial

CLIFFORD BLOCK

CB say: We all know the poor nutritional habits and physical actiivity lacks of the US population.


Behavioral Goals

• Increase physical activity• Decrease saturated and trans fats, decrease

added sugars, increase good fats and carbs• Increase fruit and vegetable intake

• Not a weight loss program

• Can be adapted to other intervention outcomes


Behavior Change Principles• Maximizing individual relevance--through

assessments, feedback and tailoring• Tailoring to stage-of-change, individual diet

habits, exercise preferences

• Goal setting • Small-steps toward new habits• Continued feedback and reinforcement • Increasing salience and motivation through

health information, tips and reminders• Encouraging social support

CLIFFORD BLOCK

Mention--can sign up family members, as example of social support


Proven Effective

• Randomized controlled trial• Funded by the Centers for Disease Control and

Prevention• 797 employees of Kaiser Permanente of

Northern California

• Statistically significant increases– Physical activity, fruits and vegetables

• Statistically significant decreases– Saturated fat, trans fats

CLIFFORD BLOCK



Proven Effective

• Randomized controlled trial results paper in preparation

• Results reported in June 2007 in Oslo at the International Society of Behavioral Nutrition and Physical Activity

• The Trial website contains much more information about Alive!, and about the randomized trial:– www.alive.kaiser.org

CLIFFORD BLOCK



Components• Weekly messages contain

– Suggested goals to try for the week, tailored to each individual

– Tips for achieving the selected goals– Tips for overcoming barriers– Health information, information on nutrition and

physical activity– Interactive tool to explore effects of specific changes– Links to other health/nutrition sites– Links to track diet and physical activity– More!


Some “Health Notes” Topics

• Carbs and the Glycemic Index• Fruits, Veggies and Cancer• Physical Activity and Breast Cancer• Diet and Cognitive Function• Mood, Stress and Physical Activity • Components of Fitness• Trends in Physical Activity Programs• “Good” Fats, “Bad” Fats• and many others


How it works

• Licensing agreement with Block Dietary Data Systems (BDDS)

• Organization/company promotes program to employees or membership– Inform them that it’s approved– BDDS can provide some promotional material

• BDDS sends invitation email to organization’s HR or other official

• Organization’s official forwards email to employee/membership list


How the process begins

• Email is sent by the organization or company– Batch email, to organization’s target group

• Email message appears in employee’s or member’s email reader


Invitation Email

• Appears in employee’s inbox


• Employee ‘clicks to get started’

• This is just an opportunity to take a Health Risk Assessment and receive feedback

• Then employee receives diet and physical activity assessment


Health Risk Assessments

• Dietary and physical activity screener tools provide tailoring information


Diet and Physical Activity Screeners

• Completed online in 15 minutes• Provide instant feedback on

– Saturated fat intake– Trans fat intake– Added sugar intake– Health-related physical activity– Cardiovascular-related physical activity– Sedentary behavior

• Available to all, free, whether they decide to participate or not


Instant Feedback

• Instant feedback shows each individual how their own behavior could be improved, in relation to their current health habits


Instant Feedback

• First example, person doing well in fats, less well in fruits and vegetables, so-so in physical activity


Instant Feedback

• Second example, person doing poorly in diet and physical activity


After Giving Diet and Physical Activity

Results:

• Opportunity to participate in the Alive program


• If persons choose to participate, they provide email to which Alive! emails will be sent.

• May provide an alternate email if they want to participate from home as well.


Tailoring Questionnaire

• Tailoring for diet is based partially on responses to diet questionnaire– E.g., if they report drinking whole milk, suggested

goals will propose switching to lower-fat milk

• All tailoring is based on responses to lifestyle/tailoring questionnaires– E.g., stage of change and preferences for structured

or unstructured physical activity – Or whether they cook, eating-out habits, kids at home


Participant Chooses Big Goal to Work On

• Will work on for next 12 weeks

• Can change goal in first two weeks

• By agreement, participant may rejoin at end of 12 weeks to work on same or different goal


Weekly email messages

• Come directly to participant’s email inbox



• Each week has a Health Notes (information about nutrition or physical activity and health), summarized in the weekly email by sidebar on the right

• Each week has suggested small-step goals; participant commits to one or two to try for following week


Barriers are addressed

• First weekly email lists common barriers to achieving diet (or physical activity goals)

• Participant indicates which ones are barriers for him

• Each week thereafter, tips for overcoming those particular barriers are suggested



• When participant choose a goal to work on for the following week….


After choosing weekly goal

• He is taken to his “Personal Home Page”• Containing tailored tips to achieve the

goal or goals he has chosen


Example of A Tailored Physical Activity Tip

• Physical Activity Path, “Kids at Home” sub-path

“Don’t just be a spectator at your kids’ sports activities. Walk around the field while you’re watching their soccer or baseball games. Consider helping out as a coach and do conditioning exercises with the kids. It will help all of you become more fit.”


Mid-week reminder

• Reminds you of your chosen goal for the week

• Offers opportunity to go to Discussion Board• Offers opportunity to track your diet or

physical activity at US Government’s MyPyramidTracker.gov


Each week a new email

• Report how you did on your goal last week• New goals to work on• New Health Note topic


Each week, choose a goal for the week

• Takes participant to his personal Home Page• For Tips• Other tools on their Home Page


Tools on the Personal Home Page


Health Notes

• A new one each week


Progress and Goal Tracker


What-If Tool

• Tools shows participant’s actual responses to foods or physical activities

• Participant can see effects of changes

• “What if I ate hamburgers once a week instead of 5 times a week?”

• Tool shows effect of that change on participant’s total saturated and trans fats


Other Resources on Home Page

• Links to other organizations’ sites

• Library of all Health Notes

• Links to diet and physical activity tracking tools


Health Note Library

• All Health Notes from all Big Goals (Carbs/fats, Fruit/vegs, Physical Activity)


Discussion Board

• Participants can share ideas and solutions

• Can be monitored by local dietitians


More Assessment Tools


Other Options

• Family member can sign up – increases social support


Demo Version

• This Powerpoint presentation has attempted to give you a sense of Alive’s process and content. A Demo Version of Alive! is also available, in which you can have a first-hand experience all of the features of Alive!, fast-forwarding through the weeks of the program.

• Contact Block Dietary Data System. (See contact information in last slide.)


Reports

• Reports can be provided to clients– What proportion participated in Alive!– Age and sex distribution of participants– Average diet and physical activity scores before and

after the Alive! intervention

• Arrangements can be made for participants to re-join after the end of the 12-week program– Discuss pricing arrangements with Block Dietary

Data Systems

www.nutritionquest.com

Costs• Pricing for the Alive! program is based on the

total number of employees to whom the program is offered:

1-99 employees = $1,200 annual fee100-499 employees = $1.50/member/month500- 999 employees = $1.25/member/month1,000-4,999 employees = $1.00/member/month5,000-9,999 employees = $0.85/member/month10,000-14,999 employees = $0.75/member/month15,000-19,999 employees = $0.55/member/month>20,000 = $0.50/member/month


Summary: Potential of an E-Mailed

Intervention at the Worksite• Uses an established channel of communication• Utilizes existing social support structures

– provides sources for group support– may produce changes in social norms

• Can reduce health care costs – Improvements in physical activity and diet

have been shown to improve productivity• Little or no burden on management

– Once launched, Alive! runs automatically


Alive’s Developers at Block Dietary Data Systems (BDDS)

• Gladys Block, PhD, is a professor of epidemiology and Public Health Nutrition in the School of Public Health, University of California at Berkeley and is the senior-scientist for BDDS. She is internationally known for her work in nutritional epidemiology and health promotion through dietary interventions.

• Clifford H. Block, PhD, is a research psychologist whose work has involved the use of information technologies for achieving behavior change in such fields as maternal and child health nutritional practices, oral rehydration, and AIDS and drug abuse prevention.

• Torin Block, BA, is the Manager of BDDS. He has 13 years of experience in the development and analysis of dietary questionnaires. He is responsible for the design and development of the electronic questionnaires, analysis algorithms and data management systems, and for the technical aspects of Alive!.


Alive’s Developers at Block Dietary Data Systems (BDDS)

• Jean Norris, DrPH, has a background in Public Health Nutrition and she is currently working as a scientist with BDDS. Prior to that, she worked for about 15 years as a nutritionist in community clinic settings with disadvantaged populations. She has designed food frequency questionnaires and researched hunger measurement and hardship, and has contributed her expertise to the study design of Project Alive! and the development of the dietary change interventions.

• Donald Hopkins created all the code to make Alive! work. He is a user interface designer and programmer, who developed a user interface component called "pie menus" at the University of Maryland Human Computer Interaction Lab, a game called "The Sims" for Maxis/Electronic Arts, and the OpenLaszlo video components for Laszlo Systems. He enjoys programming in Python and JavaScript, and working on the One Laptop Per Child project. He publishes a blog on his web site, "www.DonHopkins.com".

http://www.donhopkins.com/


Alive’s Developers at Kaiser

• Barbara Sternfeld, PhD, was the Principal Investigator of the randomized trial that tested Alive! She is Senior Research Scientist at Kaiser Permanente (Northern California) Division of Research. Her background is in epidemiology and exercise physiology. She has conducted numerous studies that document the health effects of physical activity.

• Heather A. Clancy, BA was a Research Associate at Kaiser Permanente’s Division of Research and the Project Coordinator for Project Alive!

CLIFFORD BLOCK



Block Dietary Data Systems

15 Shattuck Square, Suite 288

Berkeley, CA 94704

Phone: 510-704-8514

FAX: 510-704-8996

Email: [email protected]

A Lifestyle Intervention Via Email. Block Dietary Data Systems. An intervention to improve...

Documents

Transcript of A Lifestyle Intervention Via Email. Block Dietary Data Systems. An intervention to improve...