Positive Lifestyle Changes Research Articles

Changes in lifestyle among prostate cancer survivors: A nationwide population-based study.

ObjectiveLong‐term information on lifestyle changes among prostate survivors is lacking. In this nationwide, population‐based study we investigated the prevalence of lifestyle changes, factors associated with lifestyle changes and associations between lifestyle changes and general quality of life.MethodsAll men registered in the National Prostate Cancer Register of Sweden diagnosed in 2008 with low‐risk prostate cancer at age 70 years or younger were sent a questionnaire. Logistic regression was used to calculate odds ratios (ORs) with 95% confidence intervals for factors potentially associated with lifestyle change.ResultsOut of 1288, 1720 men (75%) were responded. A total of 279 (22%) reported a positive lifestyle change regarding diet or exercise. Poor functional outcomes after treatment was associated with exercising less (OR 1.6, 95% CI 1.2‐2.1) and less interest in social activities and relationships (OR 1.8, 95% CI 1.5‐2.1). Men who exercised more (OR 7.9, 95% CI 4.4‐14) and men who had an increased interest in relationships and social activities (OR 5.2, 95% CI 2.1‐13) reported higher general quality of life.ConclusionsA considerable proportion of men reported making positive lifestyle changes after the prostate cancer diagnosis. The time after diagnosis may be a teachable moment that facilitates lifestyle interventions. Poor functional outcomes after treatment may reduce the willingness to engage in positive lifestyle change, which need be considered when supporting men after treatment. Men who made a positive lifestyle change, regardless of whether it was exercise or regarding relationships and social activities more often reported a high level of general quality of life.

Participant experiences of the DWELL programme: focus group findings on motivation, experiences, facilitators and barriers

Abstract Initiatives to increase effective, low-cost self-management are essential to the sustainability of care for type 2 diabetes (T2D), however research shows that there is currently no standard approach. The DWELL programme seeks to motivate and empower people with T2D to better self-manage their condition through focussed content underpinned by motivational interviewing. As part of the DWELL evaluation study, end-of-programme focus groups were conducted to elicit participant experiences. 33 focus groups with 153 participants (including a small number of partners) took place in the two UK DWELL delivery sites. The focus group data was subjected to thematic content analysis to elicit key themes. Findings indicate that DWELL participants are motivated through a desire for better knowledge and management of their diabetes. Facilitating factors of the programme include: facilitator and peer support; the holistic and autonomous approach which provides participants with the opportunity to better understand the condition and its impact on their whole lives; and a tailored individual approach. Barriers and suggested improvements include content and operational changes, which are fed back to DWELL facilitators as part of the process evaluation in order that they can continually update the programme. Participants report positive outcomes in terms of wellbeing, social and mental health, enhanced knowledge and positive lifestyle changes. These themes align with quantitative outcome measures for participants, including weight loss, reduced BMI and glycated haemoglobin (HbA1c), enhanced empowerment and improved eating behaviours and illness perceptions and control. Interim findings suggest that DWELL outcomes include improved health literacy, participant empowerment and self-management. These findings underscore the need to incorporate a holistic, tailored approach to structured patient education for T2D.

Technology-Assisted Self-Monitoring of Lifestyle Behaviors and Health Indicators in Diabetes: Qualitative Study.

BackgroundSelf-monitoring is key to successful behavior change in diabetes and obesity, and the use of traditional paper-based methods of self-monitoring may be time-consuming and burdensome.ObjectiveThis study aimed to explore participant experiences while using technology-assisted self-monitoring of lifestyle behaviors and health indicators among overweight or obese adults with type 2 diabetes.MethodsQualitative data collected from the intervention group of a 6-month, three-arm (control, paper diary, and technology-assisted self-monitoring groups) randomized clinical trial were analyzed. Study participants in the intervention group monitored their diet, exercise, and weight using the LoseIt! app, and their blood glucose levels using a glucometer and the Diabetes Connect app. Semistructured group discussions were conducted at 6 weeks (n=10) from the initiation of the behavioral lifestyle intervention and again at 6 months (n=9). All group interviews were audiotaped and transcribed verbatim. Using a combination of thematic and comparative analysis approaches, two trained professionals coded the transcriptions independently and then discussed and concluded common themes for the 6-week and 6-month discussions separately.ResultsThe sample (n=10), which primarily involved African American participants (n=7) and female participants (n=8), had a mean age of 59.4 years. The following eight themes emerged: (1) perceived benefits of technology-assisted self-monitoring; (2) perceived ease of use (eg, barriers: technical difficulties and lack of self-discipline; facilitators: help from family, friends, and the program); (3) use of technology-assisted self-monitoring; (4) facilitators of engaging in healthy lifestyle behaviors (eg, visualization and awareness of calorie input/expenditure); (5) positive lifestyle change; (6) barriers of engaging in healthy lifestyle behaviors (eg, event influence); (7) learning curve; and (8) monitored data sharing. The first six of these themes were shared between the 6-week and 6-month timepoints, but the codes within these themes were not all the same and differed slightly between the two timepoints. These differences provide insights into the evolution of participant thoughts and perceptions on using technology for self-monitoring and subsequent behavioral lifestyle changes while participating in lifestyle interventions. The findings from the 6-week and 6-month data helped to paint a picture of participant comfort and the integration of technology and knowledge overtime, and clarified participant attitudes, difficulties, behavioral processes, and modifications, as well as health indicators that were experienced throughout the study.ConclusionsAlthough there were some barriers, participants were able to identify various individual and external facilitators to adjust to and engage in technology-assisted self-monitoring, and it was concluded that the technology-assisted self-monitoring approach was beneficial, safe, and feasible to use for positive lifestyle change. These patient perspectives need to be considered in future research studies when investigating the effectiveness of using technology-assisted self-monitoring, as well as in clinical practice when recommending technology-assisted self-monitoring of lifestyle behaviors and health indicators to improve health outcomes.

An application of the theory of planned behavior to self-care in patients with hypertension

BackgroundSelf-care behaviors and positive changes in lifestyle are essential for successful hypertension control. We used a behavioral model based on the theory of planned behavior to assess which factors influence self-care behaviors for controlling hypertension.MethodsIn this cross-sectional study, five hundred patients with at leastaone-year history of diagnosed hypertension participated in this study. The data collection tool was designed based on the theory of planned behavior. Structural equation modeling was used to estimate the main parameters.ResultsFor self-care behaviors, ninety-six (19.2%) and forty-five (9.1%) participants had good knowledge and acceptable behavior(≥8 out of 10 points). Having perceived behavioral control regarding quitting smoking and alcohol intake was associated with the patient’s intention and behavior [b:1.283 ± .095 and b:1.59 ± .014 (p < .001)]. Having perceived behavioral control over the other self-care behaviors had a positive effect on the intention in female patients [b: .885 ± .442 (p = .045)]. Subjective norms had a positive effect on behavioral intention in younger patients [b:4.52 ± 2.24 (P = .04)].ConclusionsGroup-specific behavioral barriers are important when improving self-care behaviors in patients with hypertension. Perceived control over self-care behaviors is more important in vulnerable patients, such as the elderly and women.

Value-Based Care: An Executive Briefing

In today’s challenging health care environment, the paradigm shift from volume to value requires nurse leaders to develop enhanced skills to transform health care in 2020. Key drivers for success include: igniting innovation and change; embracing data and analytics; and launching new care delivery models that soar beyond organizational boundaries. Value-based care is here to stay, and nursing must be the catalyst for change. Equipped with new skills and the knowledge of CMS Pay for Performance programs, nurse leaders will design the future health care landscape.

Health education projects in Portuguese schools: A multicases study

Health education projects (HEP) incorporate all the educational projects of the Portuguese elementary and secondary schools in order to respond to four key areas: mental health and violence prevention; food education and physical activity; addictive behaviors and dependencies; and affection and sexuality education. This study aimed at identifying the effects of HEP as they are perceived by teachers and students. A multicase study was developed in five schools in the municipality of Castelo Branco, Portugal. The sample consisted of a HEP coordinating teacher and one student from each case. The content analysis of each HEP was performed and semi-structured interviews were conducted with the participants. The analysis of the information showed that HEPs induce positive changes in the educational community lifestyle, and especially in students. Despite this positive view, targeted areas were diagnosed for optimization processes in each of the four dimensions of the HEPs being studied. This allowed the different projects to qualitatively improve their performance among the target audience. The investigations acknowledged the lack of instruments and methodologies able to record the behavioral changes developed within the scope of health education (HE) while simultaneously stimulating reflection on these behavioral changes and their causes.

Validation of the Valuing Questionnaire (VQ) in adults with cardiovascular disease and risk

A common behavioral therapeutic target in the prevention and treatment of cardiovascular disease is activation of values-consistent living, which can facilitate positive lifestyle behavior change. However, the empirical study of values-consistent living has been limited by significant heterogeneity in measurement due to the absence of a ‘gold-standard’ assessment tool. The Valuing Questionnaire (VQ), a 10-item self-report measure that taps progress in and obstruction of values-consistent living, is well suited for use in research and clinical settings, yet its psychometric properties have been limitedly examined despite its frequent use. The current study utilized data from an anonymous online survey to evaluate the factor structure and psychometric properties of the VQ in adults (n = 252) with a self-reported history of cardiovascular disease or elevated disease risk. Results from a confirmatory factor analyses provided support for the two-factor structure, reflecting progress towards values and obstruction of valued living. Additionally, the VQ factor scores evidenced internal consistency, convergent, concurrent, and incremental predictive validity. VQ factors scores also evidenced known groups validity, distinguishing between those with/without psychological distress. The VQ appears to be an adequate measure of progress and obstruction towards valued-consistent living for use among adults at risk for or with cardiovascular disease. Findings support the use of the VQ in behavioral medicine research and practice.

“The Prophet Says…”: A Qualitative Analysis of the Mechanisms for Inducing Compliance among Congregants of Neo-Pentecostal Churches in Ghana

There has been a surge in the growth of neo-Pentecostal churches in the Ghanaian context. These churches broadcast their activities through television and are able to reach many people and have mass followers. Their main activities are miracles, healing, prophecies, and teaching. Although studies have been conducted on their activities, little is known of how leaders of these churches influence their followers to adhere to their teachings and doctrines. The present paper explored mechanisms used by church leaders to compel members to be obedient to them and the potential implications on congregants’ well-being, as well as their decision to either stay in or leave the church. Through a thematic analysis of interviews with 20 congregants, it emerged that the nature of the churches’ doctrine, the activities, and the charisma of the leaders are able to influence congregants to remain in or leave the church and to enhance their self-beliefs. Strategies that compelled congregants to remain in the church included techniques that encouraged giving, lifestyle restrictions, reverence of and obedience to church leaders, recruitment of congregants, and spiritual cleansing/fortification. Strategies that inadvertently compelled congregants to leave the church included excessive monetary demands, rigid lifestyle demands, and repeated false or unconfirmed prophecies. A few mechanisms appeared to enhance the well-being of congregants by building self-efficacy and instilling positive lifestyle changes. Implications of the findings are discussed along with the impact of these mechanisms on congregants’ well-being.

Heavy energy drink consumption is associated with risky substance use in young Swiss men.

Heavy consumption of energy drinks appears to pose a public health problem among young adults. This paper examines (i) the prevalence of chronic heavy energy drink use (consuming energy drinks more than once a day) and (ii) its associations with sociodemographic and health behaviour-related factors, especially substance use. We used multiple logistic regression analyses to examine the relationships between chronic heavy energy drink use and sociodemographic and health behaviour-related factors, based on cross-sectional data from 18&ndash;21-year-old men who took part in the &ldquo;Young Adult Survey Switzerland&rdquo; (YASS) in 2010/2011 (n = 10,345) and 2014/2015 (n = 9761). Prevalence of chronic heavy energy drink use was high in both data sets: 7.5% of young adult men in Switzerland in 2010/11, and 6.0% in 2014/15, consumed energy drinks more than once a day. Chronic heavy energy drink use followed a social gradient: people with a low level of education were more likely to consume energy drinks more than once a day. Multiple daily energy drink consumption was associated with other unhealthy behaviours, especially substance use (smoking, alcohol consumption, use of tranquilizers or sleeping pills, use of painkillers). Among the strongest associations were the use of painkillers (odds ratio [OR] 5.23, 95% confidence interval [95% CI] 3.51&ndash;7.79) and tranquilizers/sleeping pills (OR 4.07, 95% CI 2.66&ndash;6.25). Chronic heavy energy drink consumers are a significant population subgroup in Switzerland and are relevant for public health due to the co-occurrence of unhealthy substance use. This link and the close relationship between chronic heavy energy drink use and social class indicate the role of lifestyle in the emergence and distribution of energy drink consumption. Interventions that encourage chronic heavy energy drink consumers to make positive lifestyle changes may contribute to the prevention of unhealthy substance use.

NAMS 2019 Pre-Meeting Symposium, September 2019, Chicago Illinois: The Perimenopause.

The North American Menopause Society held the 2019 Pre-Meeting Symposium on September 25, 2019, in Chicago, Illinois, to review the current state of the science related to the physiology of the perimenopause and to address management of the most prevalent and pressing clinical issues. The perimenopause, as defined by the Stages of Reproductive Aging Workshop + 10, encompasses the menopause transition as well as the first year following menopause, the final menstrual period. This phase in the continuum of women's reproductive lives had been one of the least well understood. Fortunately, contributions from a number of prospective, longitudinal, decades-long studies have provided a better understanding of the perimenopause, whereas posing important new questions related to symptom interaction and linkages between symptoms and long-term health. There is now added clarity to distinguish the effects of reproductive hormonal changes from aging. The variation in symptoms, including vasomotor symptoms, among women over time including differences in experiences by ethnicity and race, provides paradigm shifts in clinical perspective. Refinements in understanding the character, timing, and potential predictive markers for menstrual cycles during the transition have emerged. From the perspective of myriad clinical management challenges, significant progress in recommendations for evaluation and therapeutic approaches has been achieved. Finally, recognizing the menopause transition as an opportunity to initiate positive lifestyle changes to enhance future health was emphasized.

Understanding and managing pelvic girdle pain from a person-centred biopsychosocial perspective

IntroductionClinicians need support to effectively implement a biopsychosocial approach to people with pelvic girdle pain disorders. PurposeA practical clinical framework aligned with a contemporary biopsychosocial approach is provided to help guide clinician's management of pelvic girdle pain. This approach is consistent with current pain science which helps to explain potential mechanistic links with co/multi-morbid conditions related to pelvic girdle pain. Further, this approach also aligns with the Common-Sense Model of Illness and provides insight into how an individual's illness perceptions can influence their emotional and behavioural response to their pain disorder. Communication is critical to supporting recovery and facilitating behaviour change within the biopsychosocial context and in this context, the patient interview is central to exploring the multidimensional nature of a persons' presentation. Focusing the biopsychosocial framework on targeted cognitive-functional therapy as a key component of care can help an individual with pelvic girdle pain make sense of their pain, build confidence and self-efficacy and facilitate positive behaviour and lifestyle change. There is growing evidence of the efficacy for this broader integrative approach, although large scale effectiveness trials are still needed. An in-depth case study provides guidance for clinicians, showing ‘how to’ implement these concepts into their own practice within a coherent practical framework. ImplicationsThis framework can give clinicians more confidence in understanding and managing pelvic girdle pain. The framework provides practical strategies to assist clinicians with implementation; assisting the transition from knowing to doing in an evidence-informed manner that resonates with real world practice.

The Effects of Preventive Counseling Followed by Remote Support Via Telephone on the Motivation to Change Lifestyle in Patients With High and Very High Cardiovascular Risk

Aim To evaluate effectiveness of preventive telephone counseling with a nutritional component and distance support for three months with respect of motivation for lifestyle modification in patients with high and very high cardiovascular risk (CVR).Material and methods This prospective, controlled, randomized clinical study in two parallel groups included patients with high and very high CVR (5-9 % and ≥10 % according to the SCORE scale) who had at least two criteria of metabolic syndrome. Patients were randomized to the main and control groups in a 1:1 ratio with age and gender stratification. The main group received comprehensive preventive counseling with a nutritional component and distant support via telephone once in two weeks for three months (total 6 consultations). Patients of the control group received standard counseling by a health center physician. Patients' motivation for lifestyle changes was evaluated with a questionnaire at baseline and at 6 and 12 months.Results The study included a total of 100 patients (mean age, 59.85±4.47 years, 80 % females). At baseline, 81 % of patients had high and 19% of patients had very high CVR. Patients of the study groups did not differ in major demographic and clinical characteristics. At 6 month of follow-up, the main group showed a significantly more pronounced positive changes in motivation and healthier lifestyle (50 % in the main group vs. 12% in the control group, р&lt;0.01). At 12 months of follow-up, the number of such patients somewhat decreased to 38%. In this process, a vast majority of patients in the control group (82 %) continued theoretically considering the expediency of lifestyle modification.Conclusions Preventive counseling with nutritional component and further distance support via telephone for three months for patients with high and very high CVR provided increased motivation for healthier lifestyle and positive behavioral changes.

Trends in Contraceptive Methods Among Substance Abusers Reveals Unmet Need [36I

INTRODUCTION: Female substance abusers are a vulnerable population facing numerous barriers to care, especially gynecological health. Access to contraception is a crucial part of women’s health; however, research on contraceptive use in substance abusers is limited. Our aim was to investigate contraceptive methods in a women’s substance abuse rehabilitation facility. METHODS: Data was taken from 697 intake surveys of reproductive-aged women between 2013 and 2019. Analysis examined contraceptive use by sociodemographic variables. Trends were compared with data from 2015-2017 National Surveys of Family Growth and 2017 state-level data from the CDC. RESULTS: The majority of women did not use contraceptives (40.3%), were sterilized (22.7%) or used condoms (21.1%). Compared to national and Louisiana-specific rates, this data reveals significantly higher proportions of no contraception and sterilization; conversely, there were lower rates of hormonal and long-acting reversible contraceptive methods (6.9; 4.9%). Substance-abusing women reported sterilization at a younger age (37) compared to national averages. 64.8% reported Medicaid enrollment; education and insurance were independent of contraceptive choice (X2=5.76, P=.22; X2=3.15, P=.53; P&lt;.05). CONCLUSION: Women in rehabilitation reported both a high rate of sterilization, and limited use of reversible contraceptives. Lack of variability in method could include amenorrhea from chronic substance use, mistrust of the healthcare system, and inadequate education on gynecological health. Residential rehabilitation facilities provide a unique opportunity for providers to deliver contraceptive education in a positive, encouraging environment, while women are focused on making positive lifestyle changes. Addressing this need would give these women greater autonomy over their health and fertility.

Your Next Move: Improving the health of middle-aged men who are overweight or obese

Background: Your NeXt Move: X Fans in Training Program is a healthy lifestyle program tailored for men who are overweight or obese and was based on another intervention implemented in an urban setting. The goal of ‘Your NeXt Move’ was to improve men’s health through exercise and health literacy-based lessons using humor and competition to facilitate positive lifestyle changes. This paper shares the efficacy of the 12-week program regarding weight, body mass index, waist circumference, blood pressure and physical activity in 35 to 65-year-old men who were overweight and obese living in a rural area. Methods: 25 men (49.4±8.3 yrs) provided data for this study. Results: Upon program completion, these men experienced, on average, a significant decrease in body weight (2.1 kg, p = 0.006), BMI (0.7 kg/m2, p=0.006), waist circumference, (3.6 cm, p=0.007), and systolic (7.7 mmHg, p=0.007) and diastolic (4.3 mmHg, p=0.036) blood pressure. They also, on average, increased their daily steps by about 2000, indicating improved levels of physical activity. Conclusion: These findings suggest ‘Your neXt Move’ was successful in improving the physiological health of the men who participated. Keywords: Physical activity; Exercise; waist circumference; Blood pressure; Comradery

Commentary on Conigrave et al. (2020): Meta-analysis of drinking patterns in Aboriginal and Torres Strait Islander populations highlights policy and research opportunities.

Tailored community-driven alcohol interventions require information regarding local alcohol consumption patterns and the factors driving alcohol consumption behaviours. Future research could focus on the moderators of risky drinking patterns so that local interventions can be successfully developed. Routinely, policy in this area is informed using national statistics regarding alcohol consumption, resulting in what Conigrave and colleagues refer to as ‘broad-stroke’ interventions that are not tailored to the communities in which they are implemented. This problem is further exacerbated by the heterogeneous nature of drinking behaviours between different Indigenous Australian subgroups, as described by this meta-analysis [1]. In response, the authors call for community-controlled responses to risky drinking at a local level, which is a promising approach given evidence for improved health outcomes among Indigenous people who receive health care from Aboriginal community-controlled health services (ACCHS) rather than mainstream general practice [2]. However, it is unclear exactly how these ACCHS, or other organizations, could deliver interventions reducing risky drinking behaviours. This lack of clarity regarding how to achieve this is not unique to this article [3, 4]. It does, however, highlight a clear need for further research on the ‘solution’ in the future, rather than further quantification of the ‘problem’ of high levels of risky alcohol use. For example, a randomized controlled trial currently under way, which involves several of the authors of this meta-analysis [5], is addressing this gap by investigating the effectiveness of a model of tailored and collaborative support for ACCHS in increasing use of alcohol use screening and treatment provision. Conigrave and colleagues [1] also highlight the often damaging sporadic drinking patterns in ‘dry’ communities propagated by current policy aimed at encouraging abstinence. Future research could examine these patterns more fully. For instance, studies could explore how community-driven social marketing approaches may impact upon such episodic patterns. These approaches employ the use of marketing concepts with the purpose of eliciting positive behaviour changes among their target audiences [6]. Social marketing, which has been used effectively to promote positive life-style changes in Canadian First Nation's communities, is underutilized in Australian Indigenous communities [7], despite evidence for its effectiveness in promoting healthy behaviour changes [7, 8], including reductions in risky drinking behaviours [6]. While this approach does not take into account the social determinants that potentially drive risky alcohol use among Australian Indigenous people, it may have the potential to be a pragmatic solution allowing adaption to suit the needs of individual communities. Conigrave and colleagues also highlighted the influence of moderators such as gender and age on drinking patterns among Australian Indigenous people, reflecting the findings of a number of other studies conducted among non-Indigenous populations [9, 10]. We agree with the authors that future research examining these moderating factors, especially from a socio-cultural perspective, is critical. It should be coupled with research into other moderating factors, such as socio-economic status, which was poorly reported in the studies reviewed [1], and past experience of trauma or violence, which has a known impact but was not examined [11]. Furthermore, as many studies in this area have traditionally been guided by western paradigms [11], there is clearly an urgent need for the involvement of Indigenous researchers and Elders in the design and implementation of future studies, and for the culturally appropriate adaptation of instruments measuring alcohol consumption for an Indigenous context [1]. In conclusion, the meta-analysis by Conigrave et al. [1] highlights a number of critical directions for policy and research policy, including strengthening the evidence base for effective interventions targeting risky drinking patterns (especially by ACCHS) and the crucial need for future research to consider the benefits of a social marketing approach, and the roles of socio-economic status and a broader range of other moderating factors on risky drinking patterns among Australian Indigenous populations. None. Cheneal Puljević: Conceptualization; data curation; formal analysis; funding acquisition; investigation; methodology; project administration; resources; software; supervision; validation; visualization. Helen Haydon: Conceptualization; data curation; formal analysis; funding acquisition; investigation; methodology; project administration; resources; software; supervision; validation; visualization. Centaine Snoswell: Conceptualization; data curation; formal analysis; funding acquisition; investigation; methodology; project administration; resources; software; supervision; validation; visualization.

The impact of lifestyle behaviours, physical activity and smoking on morbidity and mortality in patients with rheumatoid arthritis

Rheumatoid arthritis (RA) is associated with pain, disability and increased risk of developing comorbidities and premature mortality. While these poor outcomes have improved in line with advances in the treatment of RA, they still persist to some degree today. Physical activity and smoking are two areas of patients' lives where changes may have a substantial impact on the poor outcomes associated with RA. Physical activity in RA has been well studied, with many randomised trials indicating the benefits of physical activity on pain and disability. A number of observational studies have assessed the impact of smoking on RA, also indicating the benefits of quitting smoking on RA-related outcomes, but with less consistent findings, potentially due to epidemiological challenges (e.g. collider bias, recall bias). There are also a number of barriers preventing patients making these positive lifestyle changes, such as lack of time and motivation, lack of knowledge and advice, as well as disease-specific barriers, such as pain and fatigue.

Pregnancy and weight monitoring: A feasibility study of weight charts and midwife support.

Around half of pregnant women in the United Kingdom are overweight or obese. The antenatal period provides an opportunity for encouraging women to adopt positive lifestyle changes, and in recent years, this has included development of strategies to support women in avoiding excessive gestational weight gain. The objective of this interventional cohort study was to incorporate individualised gestational weight monitoring charts supported by motivational interviewing (MI)‐based conversations into midwifery‐led antenatal care and assess potential of the intervention for further development and evaluation. The study setting was a community midwifery team within a large maternity unit. The study explored the facilitators and barriers to engagement with the intervention as experienced by women and midwives; 52 women were recruited, of whom 48 were included in the analysis. A single training session was found adequate to prepare midwives to use antenatal weight charts but was insufficient to result in the incorporation of motivational interview techniques into clinical practice. We did not find sufficient evidence to recommend effectiveness testing of this intervention, and there is currently insufficient evidence to support reintroducing regular weighing of pregnant women into UK antenatal care. Given the public health importance of reducing rates of obesity, future interventions aimed at controlling gestational weight gain should continue to be developed but need to include innovative strategies particularly for women who are already obese or gain weight above that recommended.

Abstract P2-13-03: Lifestyle changes after breast cancer: A prospective study among 8580 women

Abstract Background: Persistence of unhealthy behaviors may adversely affect breast cancer (BC) outcomes and quality of life. Cancer diagnosis can represent a teachable moment and a powerful catalyst to correct such behaviors. It has been suggested that some cancer patients (pts) may be motivated towards a healthier lifestyle, particularly in case of a worse cancer-related prognosis. In this study we aimed at understanding the evolution and barriers in adoption of health behaviors after BC. Methods: We analyzed 8580 pts enrolled from 2012-2015 in a nationwide, multicenter study of stage I-III BC (CANTO, NCT01993498). Pts were longitudinally assessed at diagnosis (baseline), year(y)1 and y2 post-diagnosis. Recreational physical activity (PA) was reported using the GPAQ-16. An unhealthy smoking behavior was defined as active smoker status and an unhealthy alcohol behavior as consumption of ≥1 drink/day at y1 and y2. First, we described the longitudinal evolution of health behaviors. Then, we examined factors associated with health behaviors, to define pts that fail to adopt healthy lifestyle changes. Random effect mixed models evaluated changes in PA over time. Logistic regression models estimated odds of unhealthy smoke and alcohol behavior at y1 and y2. All models were adjusted for tumor, including BC stage, clinico-behavioral and treatment characteristics. Results: Mean age at diagnosis was 55 y (SD 11), 9% pts had stage III BC, 49% were overweight/obese (body mass index [BMI] ≥25 Kg/m2), 41% did not meet PA recommendations (&amp;lt;10 MET-h/week), 18% were active smokers, 14% reported ≥1 drink/day. Some small increases in PA were reported in the overall cohort (mean change from baseline [95%CI], MET-h/week: to y1 +0.8 [-0.2 to +1.9]; to y2 +1.2 [+0.1 to +2.3]). Particularly, there were significant increases in PA among pts that did not use to meet PA recommendations at baseline, regardless of BC stage (mean change from baseline [95%CI], MET-h/week: to y1 +8.7, to y2 +9.7 among stage I/II pts; to y1 +12.9, to y2 +10.4 among stage III pts [all p&amp;lt;0.0001]). However, pts who had stage I/II BC and who were overweight/obese failed to improve their PA uptake over time (p&amp;gt;0.05 at both time points). Among pts who were active smokers at baseline, 37% at y1 and 30% at y2 reported reduced tobacco, and among those who used to have ≥1 drink/day at baseline, 11% at y1 and 8% at y2 reported reduced alcohol consumption. 11% pts at y1 and 12% pts at y2 had unhealthy smoke behavior whereas 13% pts at y1 and 14% pts at y2 had unhealthy alcohol behavior (Cochran-Armitage trend test: p=0.034 for smoke and p=0.193 for alcohol). Older age (adjusted odds ratio [aOR] for a 5-year increase in age, 0.69 [95%CI 0.66-0.73]) and being in a relationship (aOR vs not, 0.66 [95% CI 0.54-0.82]) were associated with reduced odds of unhealthy smoke behavior, although older pts (aOR for a 5-year increase in age, 1.34 [95%CI 1.22-1.40]) and those in a relationship (aOR vs not, 1.35 [95% CI 1.10-1.68]) were also more prone to unhealthy alcohol behavior. Lower BMI was consistently associated with higher odds of unhealthy smoke and alcohol behavior (aOR for each decreasing BMI unit: for smoke behavior, 1.05 [95%CI 1.03-1.07]; for alcohol behavior, 1.02 [95% CI 1.01-1.04]). BC stage was not associated with smoke and alcohol behavior. Conclusions: This large clinical study suggests that a substantial proportion of pts pursue a healthy lifestyle after BC. However, there are still survivors that fail to adopt positive and durable lifestyle changes. Uptake of increased levels of PA was not homogenous in this cohort, and we found an upward trend in unhealthy smoke behavior and steady rates of unhealthy alcohol behavior over time. We defined diverse behavioral profiles of pts, according, among others, to age, social status, BMI and BC characteristics. These data will help better inform targeted lifestyle interventions to improve health behaviors after BC. Citation Format: Antonio Di Meglio, Arnauld S Gbenou, Elise Martin, Laurence Vanlemmens, Charles Guenancia, Olivier Rigal, Marion Fournier, Patrick Soulie, Marie-Ange Mouret-Reynier, Carole Tarpin, Florence Boiffard, Sophie Guillermet, Sibille Everhard, Anne-Laure Martin, Sylvie Giacchetti, Thierry Petit, Florence Dalenc, Philippe Rouanet, Antoine Arnaud, Fabrice Andre, Ines Vaz-Luis. Lifestyle changes after breast cancer: A prospective study among 8580 women [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P2-13-03.

Abstract WP450: Stroke Support Group Partnership With Community Wellness Program Provides Education and Interventions Improving Self-Care Outcomes

Background and Purpose: The purpose of this program is to offer education and support with attention to post acute transitions. The multidisciplinary team: social worker, dietician, and registered nurse encourage the development of attainable behaviors and activities. Methods: The participants, (311), enrolled in the free three month program of 12 sessions. Upon enrollment blood chemistry, weight, Body Mass Index, and blood pressure are measured and recorded. Subsequent visits include weight and blood pressure measurements. The program is designed to promote a one to one relationship to foster lifestyle behaviors. These consults assist with goal identification and promote self-management. Nutritional education includes healthy eating guidelines. The social worker leads sessions on navigation of social services, financial wellness, accepting change, awareness of emotions, and stress triggers. Stroke prevention, personal risk factors, living with disabilities, importance of care coordination and transition of care are discussed with emphasis on following up with primary care providers and specialists. Results: Participants share results such as increase in physical activity, and feelings of well-being. In 2017 and 2018, outcomes include: 266 of the participants (86% of 311 totals) began the program with a BMI &gt; 25. 145 participants lost a total of 792 pounds with small changes in diet and exercise. 134 participants began the program with a BP &gt; 140/90 mmHg or a diagnosis of hypertension. Of these, 118 or 88% achieved a BP reading of ≤ 140/90 mmHg by their post program evaluation. In the first year of the program, 73 participants (46% of 158) began exercising regularly for the first time. In addition, class evaluations and narratives reveal positive lifestyle and behavioral changes for participants and their families Conclusions: In conclusion, partnering a stroke support group with a wellness program provides an effective collaboration pooling resources and knowledge supporting the patient and caregiver.

Liver transplant recipients’ experiences and perspectives of a telehealth-delivered lifestyle programme: A qualitative study

Introduction Dietary modification and exercise are encouraged to address cardiometabolic risk factors after solid organ transplantation. However, the lived experience of attempting positive lifestyle changes for liver transplant recipients is not known. The aim of this study was to explore the experiences of liver transplant recipients and their perspectives of a 12-week telehealth lifestyle programme and assess the feasibility of this innovative health service. Methods Focus groups and one-on-one interviews were conducted with participants who had completed a 12-week, group-based, telehealth-delivered diet and exercise programme and thematic qualitative analysis was used to code and theme the data. Results In total, 19 liver transplant recipients participated in the study (25–68 years, median time since transplant 4.4 years, 63% male). Overarching themes included: (a) ‘broad telehealth advantages' which highlighted that telehealth reduced the perceived burdens of face-to-face care; (b) ‘impact of employment' which identified employment as a competing priority and appeared to effect involvement with the programme; (c) ‘adapting Mediterranean eating pattern to meet individual needs' which identified the adaptability of the Mediterranean diet supported by sessions with the dietitian; (d) ‘increasing exercise confidence' which recognised that a tailored approach facilitated confidence and acceptability of the exercise component of the programme. Discussion A telehealth lifestyle programme delivered by dietitians and exercise physiologists is an acceptable alternative to face-to-face care that can meet the needs of liver transplant recipients. There is a need to further innovate and broaden the scope of routine service delivery beyond face-to-face consultations.