Summer 2006 Edition

August 25, 2006

In my brief experience as a scientist pursing the ultimate goal of getting everyone on the planet to do 30 minutes of moderate intensity physical 5 or more days every week, I’ve used the Kurt Lewin quote—there is nothing as practical as a good theory—in many talks. Tom Baranowski and his colleagues reviewed the literature on physical activity interventions and provided evidence to support this quote (1). The primary hypothesis is that interventions that are based on theoretical models include strategies that increase certain, personal, social, or environmental variables that in turn lead to physical activity. Of late, social ecological theories of physical activity behavior have become popular bases for intervention development (2-4). Our research team recently used a social ecological model of physical activity to develop an intervention called CardiACTION to promote physical activity for patients who had just completed a negative cardiac stress test (5). The table below shows some of the examples of potential mechanisms of physical activity change and the strategies we developed to address the each variable.

There are a few scientists who have recommended following a similar matching process of technological channels of intervention delivery to the strategies that are best suited for specific technologies (6). In CardiACTION we were committed to delivering an intervention that could be completely automated and delivered without extensive health care personnel time.

We began with strategies related to improving awareness of, and accessibility to, physical activity resources. Geographic information system (GIS) technology seemed ideal for these strategies. The interactive capabilities of GIS allow for the selection of a convenient fitness facility, reporting programming can develop glossy vouchers, and a printable directions from a participants home address to nearby parks, trails, and courts.

Following development of the GIS system we determined appropriate technologies for addressing participants’ risk appraisal. Interactive computer programming was developed to include video segments of the local Chief of Cardiology and a behavioral coach that allowed visual messages that allowed for the delivery of threat appraisals in a manner that expressed empathy and compassion for the participants. In addition, we followed-up with threat appraisal information in a tailored newsletter that was mailed to the participants one week following the interactive computer session.

Sustained support was necessary to address the strategies that would target the participants’ coping appraisal. To provide opportunities for tailoring and participant interaction we developed automated telephone counseling sessions to assess goal achievement, tailor new written messages, and set additional goals. In total, the final CardiACTION intervention included a 40 minute interactive computer session (with an embedded GIS interface), 4 tailored newsletters, and 3 automated telephone counseling sessions—all delivered over a 6 month period.

Our project provides an example of how theoretically driven strategies can be operationalized through multiple interactive technologies. It also points to the appropriateness of examining technologies that have previously been used as descriptive tools to examine effect modifiers (e.g., GIS) for their potential to deliver intervention. The matching of technologies can be used to ensure that sensitive messages are addressed in a manner that provides the participant with confidence and reassurance. In addition, using multiple technologies increases the chances that participants who best absorb information and strategies from audio, visual, or written sources will all benefit from the intervention. Finally, this model of integrated technological intervention highly scalable and can be delivered in a variety of contexts and populations.

Paul Estabrooks, PhD
Kaiser Permanente-Colorado

The views expressed in this article are those of the author and do not imply endorsement by The Robert Wood Johnson Foundation or the Health e-Technologies Initiative.

REFERENCE LIST

(1) BARANOWSKI T, ANDERSON C, CARMACK C. MEDIATING VARIABLE FRAMEWORK IN PHYSICAL ACTIVITY INTERVENTION: HOW ARE WE DOING? HOW MIGHT WE DO BETTER? AMERICAN JOURNAL OF PREVENTIVE MEDICINE 1998;15(4):266-97.
(2) WELK GJ. THE YOUTH PHYSICAL ACTIVITY PROMOTION MODEL: A CONCEPTUAL BRIDGE BETWEEN THEORY AND PRACTICE. QUEST 1999;31:5-22.
(3) DZEWALTOWSKI DA. THE ECOLOGY OF PHYSICAL ACTIVITY AND SPORT: MERGING SCIENCE AND PRACTICE. JOURNAL OF APPLIED SPORT PSYCHOLOGY 1997;9:254-76.
(4) SPENCE JC, LEE RE. TOWARD A COMPREHENSIVE MODEL OF PHYSICAL ACTIVITY. PSYCHOLOGY OF SPORT AND EXERCISE 2003;4:7-24.
(5) ESTABROOKS PA. MECHANISMS OF PHYSICAL ACTIVITY BEHAVIOR CHANGE: RO1 DK070553. NIDDK 2004.
(6) GLASGOW RE. EHEALTH EVALUATION AND DISSEMINATION RESEARCH. AMERICAN JOURNAL OF PREVENTIVE MEDICINE. IN PRESS 2006.