Predictors of engagement and outcome achievement in a behavioural intervention targeting sugar-sweetened beverage intake among rural adults

Authors: PORTER, KATHLEEN - University Of Virginia; Thomson, Jessica; ZOELLNER, JAMIE - University Of Virginia

Submitted to: Public Health Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 8/2/2019
Publication Date: 2/1/2020
Citation: Porter, K., Thomson, J.L., Zoellner, J. 2020. Predictors of engagement and outcome achievement in a behavioural intervention targeting sugar-sweetened beverage intake among rural adults. Public Health Nutrition. 23(3):554-563. https://10.1017/S1368980019003392.
DOI: https://doi.org/10.1017/S1368980019003392

Interpretive Summary: Evidence based, behavioral interventions that address nutrition related health issues are needed in medically underserved and health disparate communities, such as those in the rural Appalachian region of the United States. However, participant engagement is not well understood for many of these interventions. Therefore, the purpose of this research was to explore participant engagement in an effective behavioral intervention targeting sugar-sweetened beverage (SSB) intake. SIPsmartER was a 6-month, community based, multicomponent intervention designed to reduce SSB intake among rural Appalachian adults. Relationships among baseline characteristics, engagement indicators (completion of 6-month health screening, class attendance, telephone call completion), and SSB outcomes (total reduction, reduction = 12 ounces, achieved = 8 ounces of intake) were explored using statistical modeling. Older age was associated with greater engagement in all three indicators. White race was associated with completion of the 6-month health screening, while higher income and no children in the home were associated with greater call completion. Higher SSB intake at baseline and greater number of classes attended were associated with reduction in SSB intake. The results suggest greater attendance at educational classes was associated with more desirable changes for some SSB outcomes. These findings may be used to enhance future implementations of SIPsmartER and research studies of similar design and intent.

Technical Abstract: Objective: To describe relationships among baseline characteristics, engagement indicators, and outcomes for participants enrolled in SIPsmartER, an effective behavioral intervention that targeted sugar-sweetened beverage (SSB) intake. Design: This study is a secondary data analysis of SIPsmartER recruitment, baseline, intervention, and health screening data. Bivariate analyses were conducted to determine relationships among baseline characteristics, engagement indicators (completion of 6-month health screening, class attendance, call completion), and SSB outcomes (SSB ounce reduction, reduced = 12-ounce, achieved =8-ounce intake). Generalized linear models tested for significant effects of baseline characteristics on engagement indicators and for significant effects of baseline characteristics and engagement indicators on SSB outcomes. Setting: Southwest Virginia, USA, a rural, medically underserved region. Subjects: Participants’ (n=155) mean age was 41 years. The majority were female (81%), White (91%), and earned = $20,000 per year (61%). Results: All engagement and outcome models were significant. Engagement models predicted 15% to 17% of variance, with age, race, income, and presence of children in the home as significant predictors in at least one model. The SSB-outcome models explained 16% to 71% of variance; baseline SSB intake and number of classes attended were significant predictors for at least one model. Conclusion: This study identifies several participant baseline characteristics that may impact engagement in and outcomes from a rural community-based intervention targeting SSB intake. Findings suggest greater attendance of SIPsmartER classes is associated with more desirable changes for some SSB outcomes. Findings will inform the future implementation of SIPsmartER and research studies of similar design and intent.