LINDA – a solution-focused low-intensity intervention aimed at improving health behaviors of young females: a cluster-randomized controlled trial

BMC Public Health

Susanna Anglé⁴  Arja Rimpelä³  Marja-Terttu Saha¹  Pirjo Lindfors⁴  Matti Lehtinen⁴  Tiina Eriksson⁴  Susanna Lehtinen-Jacks⁵  Päivi Valve² 

[1] School of Medicine, Department of Paediatrics, University of Tampere, 33521 Tampere, Finland;Pirkanmaa Hospital District, Science Centre, 33521 Tampere, Finland;Department of Adolescent Psychiatry, Tampere University Hospital, 33380 Pitkäniemi, Finland;School of Health Sciences, University of Tampere, 33014 Tampere, Finland;Nutrition Unit, National Institute of Health and Welfare, P.O. Box 30, 00271 Helsinki, Finland

关键词: BMI;    Overweight;    Sleep;    Meal pattern;    Physical activity;    Solution-focused;    RCT;   

Others  :  1161582
DOI  :  10.1186/1471-2458-13-1044

 received in 2013-04-08, accepted in 2013-10-23,  发布年份 2013

【 摘 要 】

Background

We aimed to develop and evaluate the effectiveness of an individualized, long-term support lifestyle counseling approach in promoting healthy physical activity, improving dietary and sleeping behaviors, and preventing weight gain in young females. The counseling approach’s intensity was designed to be low enough to be implementable in primary health care.

Methods

Young women (n = 3,059, age at baseline 17–21 years) attending a population-based human papilloma virus vaccination trial (clinicaltrials.gov identifier: NCT00122681) in 15 vaccination centers in different communities across Finland, were cluster-randomized into intervention and control arms of the LINDA intervention. Both intervention and control arms received counseling on sexual health and contraception from the study nurses as part of the vaccination trial. Additionally, the LINDA intervention arm (n = 1,537) received a 20-minute individualized lifestyle counseling session followed by further support at the six-monthly follow-up visits of the vaccination trial, in total for 1.5–2.5 years.

The LINDA solution-focused brief therapy intervention focused on healthy physical activity, and dietary and sleeping behaviors, based on the needs and interests of the participants. Anthropometrics were measured, and data on health-related behaviors were collected using self-report questionnaires at baseline and after the intervention at 1.5–2.5 years.

Results

In the intervention arm, 37% vs. 31% in the control arm made an overall improvement in their health behaviors concerning physical activity, meal regularity and/or earlier bedtime (NNT = 18, 95% CI = 11–50). The per-protocol analysis further revealed that 30% of those who actually received lifestyle change support on healthy physical activity behaviors improved their physical activity level vs. 23% in the control group (NNT = 15, 95% CI = 9–38). Respectively, 36% of those who received support on healthy sleeping behaviors went to sleep earlier before school-/work-days after the intervention vs. 28% in the control group (NNT = 13, 95% CI = 7–61). Dinner irregularity increased in both groups, but less in the intervention group among those who received support on healthy dietary behaviors (NNT = 15, 95%CI = 9–46). There was no effect on weight gain between baseline and study end-point.

Conclusions

The solution-focused brief therapy intervention, with individually tailored content, helped to make small, long-term overall improvements in health behaviors concerning physical activity, meal regularity and/or earlier bedtime.

【 授权许可】

   
2013 Valve et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Finucane MM, Stevens GA, Cowan MJ, Danaei G, Lin JK, Paciorek CJ, Singh GM, Gutierrez HR, Lu Y, Bahalim AN, Farzadfar F, Riley LM, Ezzati M, Global Burden of Metabolic Risk Factors of Chronic Diseases Collaborating Group (Body Mass Index): National, regional, and global trends in body-mass index since 1980: systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9.1 million participants. Lancet 2011, 377:557-567.
• [2]Wang Y, Lobstein T: Worldwide trends in childhood overweight and obesity. Int J Pediatr Obes 2006, 1:11-25.
• [3]Kautiainen S, Koivisto AM, Koivusilta L, Lintonen T, Virtanen SM, Rimpela A: Sociodemographic factors and a secular trend of adolescent overweight in Finland. Int J Pediatr Obes 2009, 4:360-370.
• [4]Kautiainen S, Rimpela A, Vikat A, Virtanen SM: Secular trends in overweight and obesity among Finnish adolescents in 1977–1999. Int J Obes Relat Metab Disord 2002, 26:544-552.
• [5]Helakorpi S, Pajunen T, Jallinoja P, Virtanen S, Uutela A: Health behaviour and health among the Finnish adult population, spring 2010. Helsinki: National Institute for Health and Welfare (THL); 2011.
• [6]Sherry B, Jefferds ME, Grummer-Strawn LM: Accuracy of adolescent self-report of height and weight in assessing overweight status: a literature review. Arch Pediatr Adolesc Med 2007, 161:1154-1161.
• [7]Laakso L, Nupponen H, Rimpelä A, Pere L, Telama R: Trends in leisure time physical activity among young people in Finland, 1977–2007. Eur Phys Eduction Rev 2008, 14:139-155.
• [8]Husu P, Paronen O, Suni J, Vasankari T: Suomalaisten fyysinen aktiivisuus ja kunto 2010: terveyttä edistävän liikunnan nykytila ja muutokset. Helsinki: Opetus- ja kulttuuriministeriö; 2011. [Opetus- ja kulttuuriministeriön julkaisuja 2011:15] http://www.minedu.fi/export/sites/default/OPM/Julkaisut/2011/liitteet/OKM15.pdf?lang=fi webcite
• [9]Kruk J: Physical activity and health. Asian Pac J Cancer Prev 2009, 10:721-728.
• [10]Knutson KL: Does inadequate sleep play a role in vulnerability to obesity? Am J Human Biol 2012, 24:361-371.
• [11]Guidolin M, Gradisar M: Is shortened sleep duration a risk factor for overweight and obesity during adolescence? A review of the empirical literature. Sleep Med 2012, 13:779-786.
• [12]Finnish Ministry of Social Affairs and Health: Government resolution on development guidelines for health-enhancing physical activity and nutrition brochure 2008:10 eng. Helsinki: Finnish Ministry of Social Affairs and Health; 2008. http://www.stm.fi/julkaisut/nayta/_julkaisu/1069549 webcite
• [13]Finnish Diabetes Association: Programme for the prevention of type 2 diabetes in Finland, 2003–2010. Edited by Etu-Seppälä L, Ilanne-Parikka P, Haapa E, Marttila J, Korkee S, Sampo T. Jyväskylä, Finland: Finnish Diabetes Association; 2003. http://www.diabetes.fi/files/1108/Programme_for_the_Prevention_of_Type_2_Diabetes_in_Finland_2003-2010.pdf webcite
• [14]Patrick K, Calfas KJ, Norman GJ, Zabinski MF, Sallis JF, Rupp J, Covin J, Cella J: Randomized controlled trial of a primary care and home-based intervention for physical activity and nutrition behaviors: PACE + for adolescents. Arch Pediatr Adolesc Med 2006, 160:128-136.
• [15]Neumark-Sztainer D, Story M, Hannan PJ, Rex J: New moves: a school-based obesity prevention program for adolescent girls. Prev Med 2003, 37:41-51.
• [16]Neumark-Sztainer DR, Friend SE, Flattum CF, Hannan PJ, Story MT, Bauer KW, Feldman SB, Petrich CA: New moves-preventing weight-related problems in adolescent girls a group-randomized study. Am J Prev Med 2010, 39:421-432.
• [17]Eiben G, Lissner L: Health hunters–an intervention to prevent overweight and obesity in young high-risk women. Int J Obes (Lond) 2006, 30:691-696.
• [18]Lehtinen M, Apter D, Dubin G, Kosunen E, Isaksson R, Korpivaara EL, Kyha-Osterlund L, Lunnas T, Luostarinen T, Niemi L, Palmroth J, Petaja T, Rekonen S, Salmivesi S, Siitari-Mattila M, Svartsjo S, Tuomivaara L, Vilkki M, Pukkala E, Paavonen J: Enrolment of 22,000 adolescent women to cancer registry follow-up for long-term human papillomavirus vaccine efficacy: guarding against guessing. Int J STD AIDS 2006, 17:517-521.
• [19]Angle S, Engblom J, Eriksson T, Kautiainen S, Saha MT, Lindfors P, Lehtinen M, Rimpela A: Three factor eating questionnaire-R18 as a measure of cognitive restraint, uncontrolled eating and emotional eating in a sample of young Finnish females. Int j behav nutr phys act 2009, 6:41. BioMed Central Full Text
• [20]Greaves CJ, Sheppard KE, Abraham C, Hardeman W, Roden M, Evans PH, Schwarz P, IMAGE Study G: Systematic review of reviews of intervention components associated with increased effectiveness in dietary and physical activity interventions. BMC Public Health 2011, 11:119. BioMed Central Full Text
• [21]Bannink FP: Solution-focused brief therapy. J Contemp Psychother 2007, 37:87-94.
• [22]Greenberg G, Ganshorn K, Danilkewich A: Solution-focused therapy: counseling model for busy family physicians. Can Fam Physician 2001, 47:2289-2295.
• [23]McAllister M: Doing practice differently: solution-focused nursing. J Adv Nurs 2003, 41:528-535.
• [24]Saari A, Sankilampi U, Hannila ML, Kiviniemi V, Kesseli K, Dunkel L: New Finnish growth references for children and adolescents aged 0 to 20 years: length/height-for-age, weight-for-length/height, and body mass index-for-age. Ann Med 2011, 43:235-248.
• [25]Murray DM, Varnell SP, Blitstein JL: Design and analysis of group-randomized trials: a review of recent methodological developments. Am J Public Health 2004, 94:423-432.
• [26]Poobalan AS, Aucott LS, Precious E, Crombie IK, Smith WC: Weight loss interventions in young people (18 to 25 year olds): a systematic review. Obes Rev 2010, 11:580-592.
• [27]Hebden L, Chey T, Allman-Farinelli M: Lifestyle intervention for preventing weight gain in young adults: a systematic review and meta-analysis of RCTs. Obes Rev 2012, 13:692-710.
• [28]Rautio N, Jokelainen J, Oksa H, Saaristo T, Peltonen M, Niskanen L, Puolijoki H, Vanhala M, Uusitupa M, Keinanen-Kiukaanniemi S, FIN-D2D Study G: Socioeconomic position and effectiveness of lifestyle intervention in prevention of type 2 diabetes: one-year follow-up of the FIN-D2D project. Scand J Public Health 2011, 39:561-570.
• [29]Hebert JR, Clemow L, Pbert L, Ockene IS, Ockene JK: Social desirability bias in dietary self-report may compromise the validity of dietary intake measures. Int J Epidemiol 1995, 24:389-398.
• [30]Brener ND, Collins JL, Kann L, Warren CW, Williams BI: Reliability of the youth risk behavior survey questionnaire. Am J Epidemiol 1995, 141:575-580.
• [31]Lintonen T, Rimpelä M: The validity of the concept of “self-perceived drunkenness” in adolescent health surveys. J Subst Use 2001, 6:145-150.
• [32]Koivusilta L: Health-related selection into educational tracks: a mechanism producing socio-economic health differences. University of Turku, Medical Faculty: Public Health: PhD thesis; 2000.
• [33]Fagt S, Andersen LF, Anderssen SA, Becker W, Borodulin K, Fogelholm M, Groth MV, Gunnardottir I, Helakorpi S, Kolle E, Matthiessen J, Rosenlund-Sorensen M, Simonen R, Sveinsson T, Tammelin T, Thorgeirsdottir H, Valsta L, Trolle E: Nordic monitoring of diet, physical activity and overweight: validation of indicators. Denmark: Kailow Express ApS; 2011.
• [34]Wolfson AR, Carskadon MA, Acebo C, Seifer R, Fallone G, Labyak SE, Martin JL: Evidence for the validity of a sleep habits survey for adolescents. Sleep 2003, 26:213-216.
• [35]Street RL Jr, Makoul G, Arora NK, Epstein RM: How does communication heal? Pathways linking clinician-patient communication to health outcomes. Patient Educ Couns 2009, 74:295-301.
• [36]Deci E, Ryan R: Self-determination theory: a macrotheory of human motivation, development, and health. Can Psychol 2008, 49:182-185.
• [37]Ryan R, Patrick H, Deci E, Williams G: Facilitating health behaviour change and its maintenance: interventions based on self-determination theory. Eur Health Psychol 2008, 10:2-5.
• [38]Jakicic JM, Davis KK: Obesity and physical activity. Psychiatr Clin North Am 2011, 34:829-840.