Lifestyle Training Research Articles

The effectiveness of lifestyle training program promoting adolescent health with polycystic ovarian syndrome: A study protocol for a randomized controlled study.

BACKGROUND:Lifestyle training is of a key important in adolescent age for better life in the future. Healthy lifestyle in adolescents can management of any disease such as diabetes and polycystic ovarian syndrome (PCOS). Schools can provide an important environment to identify and change the lifestyle of students. The aim of this protocol is designing and evaluating the effectiveness of school-based lifestyle training program improving the PCOS of adolescents.MATERIALS AND METHODS:A cluster-randomized controlled trial will be conducted to examine the effectiveness of school-based lifestyle training program in 16 to 18 years old adolescent girls. The healthy lifestyle program will be designed by modification of behavioral habit, dietary intake, and physical activity and educated in eight sessions for adolescents and one session for parents in the intervention groups with sixty participants.RESULTS:Changes in primary and secondary outcomes in PCOS and healthy adolescents before and after intervention in the intervention and control groups will be analyzed for evaluation effectiveness by one-way ANOVA or other nonparametric equivalents.CONCLUSION:The current study will provide information on the effectiveness of school-based lifestyle training programs for adolescents. With increasing numbers of PCOS at risk for long-term and/or late effects of treatment and other chronic diseases, efforts for promoting the healthy lifestyle of this important group are urgently needed. This lifestyle program may provide valuable information relating to the development of other healthy lifestyle interventions for PCOS and result in appropriate behavior change and self-management strategies.

Evaluating a Healthy Lifestyle Training Program for a Group of China Medical Students

Introduction Learning and developing a healthy lifestyle through training are crucial for individual wellbeing in the long run to prevent lifestyle-induced diseases. The study aimed to screen participants’ health risk indicators and evaluate the effectiveness of a healthy lifestyle training course for them. Method A cross-sectional design was used to evaluate an 8-hour structured healthy lifestyle course over one week. The course was conducted for 48 China medical students during their learning visit in Hong Kong in August 2017. A case scenario of potential lifestyle-induced health problems and workbook were provided for participants’ discussion, reflective learning, practice and application. Health risk indicators measurement was demonstrated for their self-measured analysis and awareness of risks with lifestyle intervention. Their health learning experience was evaluated by 12 questions posed after training. Results Participants’ indicators were measured and identified at moderate/high health risks which included overweight 15% (7/47), lifestyle-related hypertension 45% (21/47), excessive stress 13% (6/48), lack of adequate exercise 94% (44/46) and inadequate sleep 50% (23/46). A Pearson Correlation of BMI to Metabolic Age Gain is positive (coefficient=0.726, p<0.001). The participants strongly agreed that the learning method facilitated their health practice and enhanced their interest to change lifestyle habits in the learning process. Conclusion Education of healthy lifestyle for healthcare students is pivotal to prevent and control lifestyle-induced non-communicable diseases as a global concern. Training and coaching with reflective health practice are effective in skills learning for health gain and recommended to other healthcare professionals and community population of patients, family, staff and students.

Direct access lifestyle training improves liver biochemistry and causes weight loss but uptake is suboptimal in patients with non-alcoholic fatty liver disease

ObjectiveTo evaluate the uptake and effectiveness of an existing open access lifestyle intervention forged in collaboration between a third sector organisation, funded by local government and a secondary care non-alcoholic...

BERLATIH DIRI DENGAN POLA HIDUP SEHAT SEJAK DINI

This healthy lifestyle training activity is intended for students around the Perumahan Polda-Bhayangkara Buper Distrik Heram Kota Jayapura Propinsi Papua. Healthy lifestyle training activities are intended for students because they are easier to train a healthy lifestyle from an early age. By knowing healthy behavior from an early age, the trainees will be easier to do it from the beginning so that the formation of healthy behaviors is more easily achieved. The focus of this activity is focused on healthy lifestyle material through eating, drinking, hand washing and bathing. There were twenty school children around this housing complex who participated in this activity. This activity is carried out for three days. Material about health, especially the benefits of hand washing, healthy food, healthy drinks and the benefits of regular and clean baths. Also carried out in this activity is practice and guidance on how to wash your hands properly with cleansing soap. Healthy eating and drinking activities are also carried out along with a menu of bolu cakes, green beans, pudding and milk. At the end of the training there were tools for brushing teeth, toothpaste, notebooks and stationery for them. Through this healthy lifestyle training program the participants gained insight into doing a healthy lifestyle, practiced some healthy behaviors and got a tooth brushing tool. The hope is that by practicing some of these healthy behaviors during the training, these can be continued in daily life with the support of various parties, especially in their family.Keywords: Healthy lifestyle, training, students, Jayapura, Papua

FRI097 - Direct access lifestyle training improves liver biochemistry and causes weight loss but uptake is suboptimal in patients with NAFLD

FRI097 - Direct access lifestyle training improves liver biochemistry and causes weight loss but uptake is suboptimal in patients with NAFLD

Peningkatan Kesehatan dan Kesejahteraan Masyarakat Melalui Pendampingan Perencanaan Apresiatif Desa Di Desa Benelan Kidul Kecamatan Singojuruh Kabupaten Banyuwangi

This dedication was carried out to improve the health and welfare of the community through the assistance of Village Appreciative Planning in Benelan Kidul Village, Singojuruh Subdistrict, Banyuwangi Regency. The results of community service show that the community realizes that the problem of waste must be handled together with all elements of the community. Clean and healthy living is the desire of all citizens. Household Waste Sorting is based on the results of the Healthy Lifestyle Training that has been carried out in each hamlet with PKK cadre participants and study group mothers. The transportation system from households is temporarily collected in a sorting place located in each hamlet, where the selection points are determined by the hamlet head. Waste sorting is carried out in temporary sorting sites located in each hamlet by sorting out Organic and Inorganic waste. Where for organic waste is managed into fertilizer while inorganic waste, especially plastic waste will be managed into plastic ore. Garbage Bank is a business unit that is under the coordination of BUMDes so that marketing of organic and inorganic waste sorting results will be coordinated through BUMDes.

A Web-Based Multidomain Lifestyle Intervention for Older Adults: The eMIND Randomized Controlled Trial.

Importance/ObjectiveTo describe the feasibility and acceptability of a 6-month web-based multidomain lifestyle training intervention for community-dwelling older people and to test the effects of the intervention on both function- and lifestyle-related outcomes.Design6-month, parallel-group, randomized controlled trial (RCT).SETTINGToulouse area, South-West, France.ParticipantsCommunity-dwelling men and women, ≥ 65 years-old, presenting subjective memory complaint, without dementia.InterventionThe web-based multidomain intervention group (MIG) received a tablet to access the multidomain platform and a wrist-worn accelerometer measuring step counts; the control group (CG) received only the wrist-worn accelerometer. The multidomain platform was composed of nutritional advices, personalized exercise training, and cognitive training.Main Outcomes and MeasuresFeasibility, defined as the proportion of people connecting to ≥75% of the prescribed sessions, and acceptability, investigated through content analysis from recorded semi-structured interviews. Secondary outcomes included clinical (eg, cognitive function, mobility, health-related quality of life (HRQOL)) and lifestyle (eg, step count, food intake) measurements.ResultsAmong the 120 subjects (74.2 ± 5.6 years-old; 57.5% women), 109 completed the study (n=54, MIG; n=55, CG). 58 MIG subjects connected to the multidomain platform at least once; among them, adherers of ≥75% of sessions varied across multidomain components: 37 people (63.8% of 58 participants) for cognitive training, 35 (60.3%) for nutrition, and three (5.2%) for exercise; these three persons adhered to all multidomain components. Participants considered study procedures and multidomain content in a positive way; the most cited weaknesses were related to exercise: too easy, repetitive, and slow progression. Compared to controls, the intervention had a positive effect on HRQOL; no significant effects were observed across the other clinical and lifestyle outcomes.Conclusions and RelevanceProviding multidomain lifestyle training through a web-platform is feasible and well-accepted, but the training should be challenging enough and adequately progress according to participants’ capabilities to increase adherence. Recommendations for a larger on-line multidomain lifestyle training RCT are provided.

A healthy lifestyle education programme for health literacy and health-promoting behaviours: A pre-implementation and post-implementation study.

The aim of this study was to determine whether implementation of a healthy lifestyle education programme resulted in improved health literacy levels and healthy life style behaviours. A one-group pretest-posttest study design was used. This study was carried out with 30 women who were enrolled in a family health centre. A questionnaire comprising the Adult Health Literacy Scale, Healthy Lifestyle Behaviour Scale-II, Perception of Health Scale, and Short Test of Functional Health Literacy was used for data collection. Eight home visits including training and follow-up followed the first interview at the family health centre. The healthy lifestyle training was applied once per week during home visits. After the training sessions were completed, women were followed-up through four home visits biweekly in the second and the third months. The difference between the Adult Health Literacy Scale and Short Test of Functional Health Literacy pretest-posttest mean scores was statistically significant (P < .05). Although the Perception of Health Scale and the Healthy Lifestyle Behaviour Scale-II posttest scores were higher than the pretest scores, the difference between the groups was not statistically significant. The training and counselling intervention visits increased health literacy but did not significantly change the healthy life style behaviours and health perceptions of the women.

Implementation of a group-based diabetes prevention program within a healthcare delivery system

BackgroundGroup-based Diabetes Prevention Programs (DPP), aligned with recommendations from the Centers for Disease Control and Prevention, promote clinically significant weight loss and reduce cardio-metabolic risks. Studies have examined implementation of the DPP in community settings, but less is known about its integration in healthcare systems. In 2010, a group-based DPP known as the Group Lifestyle Balance (GLB) was implemented within a large healthcare delivery system in Northern California, across three geographically distinct regional administration divisions of the organization within 12 state counties, with varying underlying socio-demographics. The regional divisions implemented the program independently, allowing for natural variation in its real-world integration. We leveraged this natural experiment to qualitatively assess the implementation of a DPP in this healthcare system and, especially, its fidelity to the original GLB curriculum and potential heterogeneity in implementation across clinics and regional divisions.MethodsUsing purposive sampling, we conducted semi-structured interviews with DPP lifestyle coaches. Data were analyzed using mixed-method techniques, guided by an implementation outcomes framework consisting of eight constructs: acceptability, adoption, appropriateness, cost, feasibility, fidelity, penetration, and sustainability.ResultsWe conducted 33 interviews at 20 clinics across the three regional administrative divisions. Consistencies in implementation of the program were found across regions in terms of satisfaction with the evidence base (acceptability), referral methods (adoption), eligibility criteria (fidelity), and strategies to increase retention and effectiveness (sustainability). Heterogeneity in implementation across regions were found in all categories, including: the number and frequency of sessions (fidelity); program branding (adoption); lifestyle coach training (adoption), and patient-facing cost (cost). Lifestyle coaches expressed differing attitudes about curriculum content (acceptability) and suitability of educational level (appropriateness). While difficulties with recruitment were common across regions (feasibility), strategies used to address these challenges differed (sustainability).ConclusionsVariation exists in the implementation of the DPP within a large multi-site healthcare system, revealing a dynamic and important tension between retaining fidelity to the original program and tailoring the program to meet the local needs. Moreover, certain challenges across sites may represent opportunities for considering alternative implementation to anticipate these barriers. Further research is needed to explore how differences in implementation domains impact program effectiveness.

Lifestyles and Cardiovascular Prevention in Childhood and Adolescence.

Pathology studies demonstrated that coronary fatty streaks develop early in life and that even more advanced fibrous plaques are present in a proportion of adolescents. The presence and extent of atherosclerosis in children and adolescents can be correlated with the same risk factors present in adults; as well as, childhood levels of these risk factors predict adult cardiovascular diseases. Children are born with ideal cardiovascular health but, unfortunately, most of them develop over time modifiable behavioral risk factors. Achieving sustained lifestyle changes initiated too late in adults is difficult, and pharmacologic risk factor control cannot fully restore a low-risk state. Therefore, it seems eminently reasonable to initiate healthful lifestyle training as early in life, decreasing the prevalence of cardiovascular risk factors to retard atherogenic processes and reduce the future burden of cardiovascular diseases. Many guideline recommendations encourage universal adoption of healthier lifestyles, identification of children with cardiovascular risk factors, and their treatment using targeted lifestyle modification and, rarely, pharmacotherapy. Major gains will likely accrue from public health strategies targeting incorrect diet, physical activity, and cigarette smoking. Individualized strategies, however, will initially focus on the highest risk children such as those with familial hyperlipidaemia, diabetes, hypertension, and obesity. The primary purpose of this article is to provide a broad overview on the long-term cardiovascular effects of risk factors in children and youth and to outline various lines of evidence for the efficacy of primordial and primary prevention in young people, as well as recommendations for population- and individual-level strategies and evidence-based interventions.

Impact of lifestyle training on serum lipids of children and adolescents with dyslipidemia: a quasi-experimental study

Impact of lifestyle training on serum lipids of children and adolescents with dyslipidemia: a quasi-experimental study

Evaluation of a lifestyle intervention program in primary care on physical and mental health and quality of life of cancer survivors: A pilot study

IntroductionCancer survivors often suffer from fatigue and (mental) health impairments. Despite evidence for effectiveness, lifestyle interventions are seldom applied in their aftercare. The aim of this study was to assess feasibility of a lifestyle intervention program on physical and mental wellbeing and quality of life (QoL) of cancer survivors, and to get a first impression of effectiveness, by means of a pilot study. MethodsNine subjects were enrolled in a 12-month lifestyle intervention pilot study without a control group, conducted in a Dutch primary care centre. The intervention consisted of individual and group lifestyle training focusing on diet, exercise and mind-body interaction. The main outcomes were physical and mental health and QoL. ResultsAll 9 subjects completed the 12-month lifestyle intervention program. We found a large positive effect on fatigue (r = −0.9), stress (r = −0.8) and anxiety (r = −0.9). With respect to quality of life, large improvements in vitality (r = 0.7), role limitations due to physical health (r = −0.7), role limitations due to emotional problems (r = −0.8) and personal health experience (r = 0.8) were found. Subjects’ arm strength increased (r = 0.9), but there were no significant changes in other physical parameters, depressive symptoms, social optimism and autonomy. Contradictory results were found for pain. ConclusionImplementation of this lifestyle intervention program seems feasible in this small uncontrolled pilot study. The reduced QoL that is typical for cancer survivors was positively influenced by this program. Most prominent occurred for fatigue and mental functioning, whereas little effects were found for physical health.

A randomized controlled trial on the effect of lifestyle education for Iranian women and their husbands on post-partum anxiety and depression.

This randomized controlled trial was conducted on 189 pregnant women to determine the effect of lifestyle-based training for women and their husbands on post-partum anxiety (PPA) and depression (PPD). Follow-ups were continued up for 6 weeks after childbirth. Participants were allocated to three groups using block randomization. In the first intervention group, both the women and their husbands, and in the second intervention group only the women received the lifestyle-based education. In the control group, women received only routine care. Participants completed the Edinburgh Postnatal Depression Scale and Spielberger State-Trait Anxiety Inventory pre-intervention and 6 weeks after childbirth. When compared with the control group, significant reductions in PPD (adjusted difference: -5.5), state anxiety (-13.6) and trait anxiety (-12.6) scores were observed in the lifestyle education-dyad group, and also significant reductions in PPD (-3.2), state anxiety (-5.8) and trait anxiety (-4.9) scores were observed in the lifestyle education-women only group. Also, significant reductions were observed in PPD (-2.2), state anxiety (-7.8) and trait anxiety (-7.7) scores in the lifestyle education-dyad group compared with the lifestyle education-women only group. Results showed the positive effect of lifestyle training on PPD and PPA, especially if the training is given to the parental dyad.

Physical activity counseling in primary care and family medicine residency training: a systematic review

BackgroundPhysical inactivity is a global public health challenge. Physical activity (PA) promotion in healthcare delivery systems is effective to reduce physical inactivity. A primary care setting provides an appropriate environment for PA counseling since it is a primary contact with primary care or family physicians encounter the majority of the population. Lack of knowledge and inadequate training in PA counseling is one of the most important barriers to PA promotion. The purpose of this systematic review was to evaluate PA counseling training in primary care residency programs.MethodsThe authors systematically searched PubMed, Web of Science, Scopus and The Cochrane Library for articles published in English from 2000 to 2017. Articles regarding PA counseling in primary care residency training were extracted and outcomes assessed for this systematic review.ResultsBased on the initial review, 378 articles were excluded (362 articles excluded based on titles and abstracts and 16 articles excluded based on full texts). Four articles were included in this review, addressed PA counseling curricula in primary care residency training. All studies included PA counseling training as part of obesity and healthy lifestyle training. The training improved knowledge among primary care residents, but may not necessarily result in better attitudes or self-efficacy, which could be improved by elective rotations that focus on improved attitudes, self-efficacy, and professional norms for PA counseling. Brief training in counseling did not improve quality nor increase the rate of counseling.ConclusionsThis systematic review demonstrates a lack of evidence due to a small number of included studies. The heterogeneous outcomes from the minimal programs are needed to carefully interpret. However, this review sheds light on the importance of training in PA counseling in primary care residency programs. The development of training in PA counseling should focus on an approach that improves attitudes and the self-efficacy of primary care residents. Elective rotations, where residents voluntarily choose their subject, may provide the appropriate training period for PA counseling. Policymakers and academics should play an active role in the implementation of PA counseling as an essential competency for primary care physicians.

Effectiveness of an Educational Program on Health Promoting Lifestyle of Spouses of Veterans With Post-Traumatic Stress Disorder

Background: Taking care of veterans with Post-Traumatic Stress Disorder (PTSD) is associated with negative impacts on the quality of life and lifestyle of the caregivers, especially the spouses. Objectives: The current study aimed at evaluating the effect of a health promotion lifestyle training program on the spouses of veterans with PTSD in Gorgan city, Iran. Patients and Methods: A total of 63 spouses of Iranian veterans with PTSD covered by the Foundation of Martyrs and Veterans Affairs in Gorgan were enrolled in this quasi-experimental study by the target-based sampling method. Subjects were assigned to 2 groups of experimental (n = 30) and control (n = 33). Eight 45- to 60-minute sessions of educational training were held for the experimental group within 8 weeks. Demographic data checklist and the Health Promoting Lifestyle Profile (HPLP) questionnaire were employed to collect data. Results: The mean total scores of health promotion lifestyle and subscales of physical activity, stress management, health care responsibility, and spiritual development significantly increased in the experimental group after the intervention (P 0.05). Conclusion: According to the results of the current study, educational interventions significantly improved lifestyle and health promotion behaviors in the spouses of veterans with PTSD. Hence, it is recommended to emphasize on training interventions as part of health promotion programs and improvement of lifestyle in care givers.

Fibre supplementation for the prevention of type 2 diabetes and improvement of glucose metabolism: the randomised controlled Optimal Fibre Trial (OptiFiT)

Aims/hypothesisInsoluble cereal fibres have been shown in large prospective cohort studies to be highly effective in preventing type 2 diabetes, but there is a lack of interventional data. Our 2 year randomised double-blind prospective intervention study compared the effect of an insoluble oat fibre extract with that of placebo on glucose metabolism and incidence of diabetes.MethodsA total of 180 participants with impaired glucose tolerance underwent a modified version of the 1 year lifestyle training programme PREvention of DIAbetes Self-management (PREDIAS) and were randomised to receive a fibre supplement (n = 89; 7.5 g of insoluble fibre per serving) or placebo (n = 91; 0.8 g of insoluble fibre per serving) twice daily for 2 years. Eligible participants were men and women, were at least 18 years old and did not report corticosteroid or other intensive anti-inflammatory treatment, fibre intolerance or any of the following disorders: overt diabetes, chronic or malignant disease, or severe cardiopulmonary, endocrine, psychiatric, gastrointestinal, autoimmune or eating disorder. Participants were recruited at two clinical wards in Berlin and Nuthetal. The allocation was blinded to participants and study caregivers (physicians, dietitians, study nurses). Randomisation was conducted by non-clinical staff, providing neutrally numbered supplement tins. Both supplements were similar in their visual, olfactory and gustatory appearance. Intention-to-treat analysis was applied to all individuals.ResultsAfter 1 year, 2 h OGTT levels decreased significantly in both groups but without a significant difference between the groups (fibre −0.78 ± 1.88 mmol/l [p ≤ 0.001] vs placebo −0.46 ± 1.80 mmol/l [p = 0.020]; total difference 0.32 ± 0.29 mmol/l; not significant). The 2 year incidence of diabetes was 9/89 (fibre group) compared with 16/91 (placebo group; difference not significant). As secondary outcomes, the change in HbA1c level was significantly different between the two groups (−0.2 ± 4.6 mmol/mol [−0.0 ± 0.0%; not significant] vs +1.2 ± 5.2 mmol/mol [+0.1 ± 0.0%; not significant]; total difference 1.4 ± 0.7 mmol/mol [0.1 + 0.0%]); p = 0.018); insulin sensitivity and hepatic insulin clearance increased in both groups. After 2 years, improved insulin sensitivity was still present in both groups, although the effect size had diminished. Separate analysis of the sexes revealed a significantly greater reduction in 2 h glucose levels for women in the fibre group (−0.88 ± 1.59 mmol/l [p ≤ 0.001] vs −0.22 ± 1.52 mmol/l [p = 0.311]; total difference 0.67 ± 0.31 mmol/l; p = 0.015). Levels of fasting glucose, adipokines and inflammatory markers remained unchanged in the two groups. Significantly increased fibre intake was restricted to the fibre group, despite dietary counselling for both groups. No severe side effects occurred.Conclusions/interpretationWe cannot currently provide strong evidence for a beneficial effect of insoluble cereal fibre on glycaemic metabolism, although further studies may support minor effects of fibre supplementation in reducing glucose levels, insulin resistance and the incidence of type 2 diabetes.Trial registration:clinicaltrials.gov NCT01681173Funding: German Diabetes Foundation (grant no. 232/11/08)

For Health: A Family-oriented, Healthy Eating, Activity, and Lifestyle Training with Hands-on Experience – Preliminary phase-1 Results of a Community-based Pilot Treatment Program for Overweight and Obese Preschoolers

For Health: A Family-oriented, Healthy Eating, Activity, and Lifestyle Training with Hands-on Experience – Preliminary phase-1 Results of a Community-based Pilot Treatment Program for Overweight and Obese Preschoolers

Identifying training and informational components to develop a psoriasis self- management application.

Background: Psoriasis is a complex disease with lifelong emotional and social consequences for affected patients. It also reduces the patients’ quality of life and requires a long-term management. Therefore, in addition to appropriate treatment of the disease, selfmanagement strategies to improve patient health and quality of life are essential. On the other hand, smartphone-based applications alter the way people interact with health care and public health systems. This study aimed at identifying training and informational components to develop a psoriasis self- management application. Methods: This descriptive-analytic study was conducted on 100 patients with psoriasis and 26 dermatologists who were selected randomly, using Morgan table. The data were collected using a researcher- made questionnaire, which included demographic and clinical information, lifestyle training and management, and application capabilities in psoriasis self-management. A group of experts and a test-retest method were used to confirm the validity and reliability of the questionnaire, respectively. Results: The mean scores for demographic and clinical information, lifestyle training and management, and application capabilities in self-management were 80.55%, 85.7%, and 88.8% from the patients’ perspective, and 83.7%, 71%, and 75% from the specialists’ viewpoint, respectively. Conclusion: Determining self-management components by patients as persons who are suffering from the disease and physicians as specialists in the field will be helpful in efficient psoriasis self-management. It is more likely that self-reliant patients, who are aware of the benefits and risks of their disease management application, will follow their treatment plan and pursue the management of their disease more seriously

HEALTH (Healthy Eating, Activity, Lifestyle Training Headquarters) internet/mobile weight management program for the U.S. Army: Outcomes and future directions

HEALTH (Healthy Eating, Activity, Lifestyle Training Headquarters) internet/mobile weight management program for the U.S. Army: Outcomes and future directions

Selected weight management interventions for military populations in the United States: a narrative report.

Overweight and obesity continues to be a significant public health burden in the US and particularly among military personnel. Although the US Department of Defense mandates standardized physical activity requirements for military members, incidence and prevalence of overweight and obesity among military personnel continue to increase. Each military department controls their own interventional strategies for physical fitness and weight control. However, unique challenges such as geographic transients, lack of central standardization and empirical efficacy data across military departments, and chronic stress associated with military service adversely affect program outcomes. This brief narrative report explores overweight and obesity interventions among military populations from 2006 to 2016 and includes programmatic reviews of eight overweight and obesity interventions: The Prevention of Obesity in Military Community; Health Eating, Activity, and Lifestyle Training Headquarters (H.E.A.L.T.H); ArmyMOVE!; L.I.F.E.; Look AHEAD; Nutrition-focused Wellness Coaching; Go for Green; and LE3AN. A majority of these interventions did not report significant weight loss 6 months post intervention, and did not mention a theoretical foundation within the interventions. Further research to examine the importance of theory-based programming is warranted to improve process and outcome objectives.