March / April 2019

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AJHE: American Journal of Health Education



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  March/April 2019 (Volume 50, Issue 2)


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Table of Contents

 
Free Access Article
/Motivational Readiness to Change Exercise Behavior: An Analysis of the Differences in Exercise, Technology Tracking Technology and Exercise Frequency, Intensity and Time and BMI in University Students
 – Carrie McFadden & Qing Li

Background: Research indicates that increased exercise behaviors collectively called FIT (frequency, intensity, and time) values, equate with positive health outcomes. Young college adults often gain weight due to decreased exercise. 
Purpose: This study seeks to understand whether wearable exercise technology is associated with increased exercise among university students.
Method: A questionnaire identified motivational stages for exercise and wearable use.
Results: Of the 115 students meeting all three FIT recommendations, 70 regularly exercised within the last 6 months. Of these, nearly half (n = 31) also regularly wore a wearable technology. Overall, 90 students were identified as regularly using wearable technology, 31 met all three FIT recommendations, and 53 met two FIT recommendations (frequency and time). Of total regular exercisers meeting two of three recommendations (n = 112), nearly half (n = 53) were wearable technology users.
Discussion: Findings suggest that wearables may be associated with increased exercise and FIT values among university students.
Translation to Health Education Practice: Wearable exercise technology has potential to enhance theory-based physical activity promotion to help students increase exercise and decrease risks of obesity and chronic disease. Future studies could examine how active student exercisers and active users of wearable technology use that technology to motivate them to exercise more.


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Research Articles

Content Analysis of Health Warning Labels for Indoor Tanning in the United States
– Emma Sypes & Jennifer E. McWhirter
Background: State-level legislation regulates the posting of health warning labels (HWLs) in indoor tanning (IT) salons in the United States.
Purpose: The purpose of this study was to determine the content and appearance of state-level legislation-mandated IT HWLs.
Method:We conducted a directed content analysis of IT HWLs, evaluating location, health and aesthetic risk information, health communication theory constructs, and visual components.
Results: Thirty-three states require IT HWLs: 30 states require one and 3 states require two. Text for 36 labels was analyzed: 94.4% (n = 34) mentioned skin cancer and eye risks, 91.7% (n = 33) mentioned aesthetic risk, and none mentioned death. One label suggested an ultraviolet (UV)-tanning alternative and none addressed barriers to reducing IT. Seventeen electronic labels were available for visual analysis: 5.9% (n = 1) contained a symbol and 11.8% (n = 2) contained an image.
Discussion: IT HWLs are widely used and present basic risk information, yet their content and design may not be robustly informed by health communication best practices, theory, or research in the comparable field of tobacco HWLs. 
Translation to Health Education Practice: By understanding the current content and appearance of IT HWLs, we can substantiate the need for improvements to maximize their effectiveness as educational tools for deterring IT and reducing skin cancer risk.

Construct Validity of the Theory of Grief Recovery: A New Paradigm Toward Our Understanding of Grief and Loss
– Rachel Nolan & Jeffrey S. Hallam
Background: Many grief-based Health Education programs have not been theoretically examined to show how and why beneficial effects have been reported with their use and implementation.
Purpose:: We used a construct validity of the treatment approach to test the implicit theoretical structure of the theory of grief recovery (TOGR) and evaluate the extent of influence and estimated effect size that intervention exposure had on targeted variables of grief and grief recovery.
Methods:: Using a repeated measures design, the previously validated Grief Recovery Method® Instrument (GRM-I) was used to collect data from 3 observations where nonrandomized participants served as their own controls. 
Results: The repeated measures analysis of variance (ANOVA) showed significant increases in participants’ scores on targeted variables between observations. Wilks’ lambda showed an overall significant effect. Test–retest reliability of the GRM-I was acceptable. 
Discussion:A construct validity approach better equipped researchers to test theoretical assumptions of the TOGR-based intervention to produce desired changes in targeted variables.
Translation to Health Education Practice: The importance of Health Education interventions to influence variables supportive of behavioral change are well documented. The present study showed that the theoretical structure of the TOGR-based intervention held and had the intended influence on variables of grief and grief recovery.

Measurement Development and Validation for Construct Validity of the Grief Recovery Methods Instrument
– Rachel Nolan & Jeffrey S. Hallam
Background: Death education is focused on the lifestyle behavioral and emotional aspects of grief. Although several interventions exist that aim to influence grief, many have not been theoretically examined and have lacked valid and reliable instrumentation. 
Purpose: This study described a construct validity approach used to develop and validate the Grief Recovery Method® Instrument (GRM-I), a measure used to assess implicit theoretical variables of an intervention intended to influence grief and promote grief recovery. 
Methods:Content analysis of the program handbook, expert panel, and peer review were used to develop items. A pilot study and field and validity tests were used for validation purposes. Internal consistency was assessed using Cronbach’s alpha.
Results: Confirmatory analysis (n= 279) showed an overall adequate fit of the data to the hypothesized factorial structure (normed fit index = 0.97; relative fit index = 0.83; incremental fit index = 0.97; Tucker-Lewis index = 0.87; comparative fit index = 0.98; parsimony normed fit index = 0.19; parimony comparative fit index = 0.20; and root mean square error of approximation = 0.09). Cronbach’s alpha for the full measure was 0.87.
Discussion: This study established the GRM-I as a content valid and reliable measure.
Translation to Health Education Practice: With future evaluative use of the GRM-I to test the implicit theoretical structure of the death education intervention, research will be able to show how and to what extent intervention components influenced variables of grief and grief recovery.

Evaluation of a School-Community Linked Physical Activity Intervention Targeting 7-12 Year-Olds: A Social Ecological Perspective
– Lisa A. Griffiths & Mark A. Griffiths
Background: Public health professionals advocate school-based and community physical activity (PA) interventions as an effective method to increase PA levels and improve physical fitness. 
Purpose: This evaluation independently assessed a school–community linked PA intervention by exploring the provision, process, and impact of the program and its outcomes.
Methods:Students aged 7 to 12 years (n = 468, intervention group [IG]; n = 128, control group [CG]), teachers (n = 19), head teachers (n = 4), school program contacts (n = 4), and program administrator (n = 1) took part in the evaluation. Program content and processes were assessed using questionnaires and semistructured interviews. A mixed effect model was used to assess changes in physical fitness, PA levels, and attitudes toward PA at baseline and postintervention.
Results: CG increased body mass (P > .001), aerobic capacity (P > .001), and push-ups (P = .005), as well as improved attitudinal scores toward health and fitness and vertigo (P< .05) compared to the IG. Process evaluation revealed struggles with implementation and design, including pedagogical issues to facilitate program goals. The intervention did not improve attitudinal outcomes, PA levels, or physical fitness above that of the CG.
Translation to Health Education Practice: Sustainable PA interventions should consider adopting a sociocultural approach that is grounded in learning models and delivered by staff with relevant pedagogical content knowledge.

Computer-Mediated Experience of Patients with Chronic Obstructive Pulmonary Disease
–Samantha R. Paige, Michael Stellefson, Janice L. Krieger & Julia M. Alber
Background:The Internet is an important tool for empowering patients with chronic obstructive pulmonary disease (COPD) to learn about and self-manage their condition. 
Purpose: The purpose of this study was to understand which aspects of the online experience facilitates or hinders the perceived ability of patients with COPD to achieve their information and self-management goals.
Methods:Semistructured interviews were conducted with medically underserved patients with COPD (N = 25) who access the Internet for health. A conventional content analysis approach was applied and data were analyzed with the constant comparative method.
Results: The following themes were derived: (1) desire to associate with “in-group” members; (2) relationship building with other online users; (3) security of information and identity; (4) source and channel credibility appraisal; (5) user assistance and tutorials; and (6) strategies to adapt technological functions.
Discussion: Success in using the Internet was dependent on the functional use of technology and the ability and resilience to engage with similar online users to build meaningful and trustworthy connections. 
Translation to Health Education Practice: Prior to directing patients with COPD to a disease-specific online support platform, Certified Health Education Specialists must assess patients’ information goals and their skills to critically appraise and communicate with other online users.

The Case for Hair Health Education: Exploring Hair and Physical Activity Among Urban African-American Girls
–Patricia O’Brien-Richardson
Background:African American adolescent girls have the highest prevalence of overweight and obesity and the lowest levels of physical activity when compared to their peers, putting them at risk for a future of chronic diseases. Data from several studies have identified hair management as a perceived barrier to physical activity among African American women. However, the literature is deficient in identifying this barrier among girls. 
Purpose: The purpose of this qualitative study is to explore the relationship between cultural hair practices and physical activity in physical education (PE) class among urban African American girls. 
Methods:Fifty African American females, 14 to19 years old, were administered questions relating to (PE) physical activity and cultural hair practices.
Results: Including hair health in Health Education to teach participants how to maintain hairstyles during in-school physical activity could ameliorate challenges to being physically active in physical education class due to hair practices.
Discussion: This study provides important insights for culturally tailoring Health Education interventions in order to promote in-school physical activity. 
Translation to Health Education Practice: Health Education aimed at this population should include hair health as a facilitator to address challenges to physical activity in hopes of reducing obesity.