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Title: Participant adherence indicatiors predict changes in blood pressure, anthropometric measures, and self-reported physical activity in a lifestyle intervention: HUB City Steps

item Thomson, Jessica
item Landry, Alicia - University Of Southern Mississippi
item Zoellner, Jamie - Virginia Biotechnology Institute
item Connell, Carol - University Of Southern Mississippi
item Madson, Micheal - University Of Southern Mississippi
item Molaison, Elaine - University Of Southern Mississippi
item Yadrick, Kathleen - University Of Southern Mississippi

Submitted to: Health Education and Behavior
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 3/29/2014
Publication Date: 1/12/2015
Publication URL:
Citation: Thomson, J.L., Landry, A., Zoellner, J., Connell, C., Madson, M., Molaison, E., Yadrick, K. 2015. Participant adherence indicatiors predict changes in blood pressure, anthropometric measures, and self-reported physical activity in a lifestyle intervention: HUB City Steps. Health Education and Behavior. 42(1):84-91.

Interpretive Summary: Lack of adherence or “sticking” to a program is a major concern for healthy lifestyle research. Higher adherence is associated with more positive health results; hence, it is an important feature to track in health promotion studies. Researchers generally report the effects of only a single adherence measure on health changes, usually education class attendance. Thus, using two adherence measures, we created and compared the ability of several indicators to predict health changes. We used data from HUB City Steps, a study designed to test the effectiveness of a 6-month, educational walking program on improving blood pressure in a southern, African American adult population. Education session attendance and pedometer diary submission were the two measures used to create the adherence indicators. We tested both measures alone and in combination. HUB City Steps was effective at reducing blood pressure. Additionally, several adherence indicators did predict changes in health measures, including blood pressure, body composition (body mass index, % body fat, and fat mass), and LDL cholesterol. However, no single indicator emerged as the overall “best” predictor of health changes. Therefore, we cautiously suggest the use of a multi-component adherence measure for predicting favorable health changes in healthy lifestyle research studies.

Technical Abstract: Purpose. To evaluate several adherence indicators, created using 2 measures, separately and in combination, for predicting health outcome changes. Design. Non-experimental with pre-post measures. Setting. Mid-sized city in southern region of United States. Subjects. 269 primarily African-American adults participating in HUB City Steps. Intervention. 6-month multi-component intervention consisting of motivational enhancement, social support provided by peer coaches, pedometer diary self-monitoring, and monthly nutrition and physical activity education sessions. Measures. Education session attendance (ESA) and weekly steps/day pedometer diary submission (PDS). Analysis. Bivariate tests of association and multivariable linear regression to determine significant associations between 7 adherence indicators and health outcome changes, including anthropometric and clinical measures. Results. Significant decreases of approximately 6 and 4 mm Hg, respectively, in systolic and diastolic blood pressure (DBP) were apparent at 6 months. Significant improvements were not apparent in any other anthropometric or clinical measures. Adherence indicators and several health outcome changes were correlated (r=-.3 to -.2; P<.05). After controlling for baseline covariates, not all associations remained significant. For DBP, a 1 unit increase in the continuous-categorical ESA/PDS indicator resulted in .3 mm Hg decrease. Conclusion. Use of a multi-factorial adherence indicator for predicting health outcome changes in multi-component lifestyle interventions is cautiously advocated.