Consuming a balanced diet and regular activity have health benefits. However, many adults have a difficult time adhering to diet and activity recommendations, especially in lifestyle interventions. Adherence to recommendations could be improved if common facilitators and barriers are accounted for in intervention design. The aim of this systematic review was to understand perceived barriers and facilitators to lifestyle (diet and/or activity) intervention guidelines.This review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Studies included relied on qualitative methods to explore the barriers and facilitators healthy adults ([Formula: see text] 18 years) experienced in lifestyle interventions. Google Scholar, Cochrane Reviews, Medline, PubMed, and Web of Science were searched from January 2005 to October 2021. Main themes from each paper were thematically analyzed and reported as a barrier or facilitator to adherence at the individual, environment or intervention level using inductively derived themes. Study quality was assessed using the Critical Appraisal Skills Programme.Thirty-five papers were included. Of these, 46% were conducted in North America and the majority had more female participants (86% in mixed-sex studies, 26% females only). Similar themes emerged across all three levels as facilitators and barriers. At the individual level, attitudes, concern for health and physical changes. At the environmental level, social support, social accountability, changeable and unchangeable aspects of the community. Finally, delivery and design and content at the intervention level. An additional facilitator at the intervention level included fostering self-regulation through Behavior Change Taxonomies (BCT).Lifestyle interventions that foster self-regulatory skills, opportunities for social engagement and personalization of goals may improve behaviour adherence. This can be achieved through inclusion of BCT, tapering off of intervention supports, identification of meaningful goals and anticipated barriers with participants. 

/pdf/barriers-and-facilitators-to-diet-physical-activity-and-1utlv06p.pdf

Barriers and facilitators to diet, physical activity and lifestyle behavior intervention adherence: a qualitative systematic review of the literature

As mindfulness-based programs (MBPs) become widespread, MBP research samples should be representative of the general public to avoid exclusion of minoritized groups. This systematic review retrospectively investigates demographic diversity in MBP research, based on reported variables and patterns of omission during that time. We reviewed randomized controlled trials (RCTs) of standard MBSR and MBCT that targeted self-regulation outcomes through 2016 with healthy and clinical adult populations. Completeness of documentation and analyses for race, ethnicity, gender, sexual orientation, language, education, age, and intersectionality were extracted, compared with census data when possible, and tracked over time based on the date of publication. The included 94 RCTs comprised populations that were predominantly White (79%), middle-aged (46 years), highly educated (15 years), and female (70%). The composition of studies from the USA differed significantly from the US census data. Only 41% of studies reported race or ethnicity, 95% reported gender without non-binary categories, 64% reported education, 89% reported age variance, 2% reported sexual orientation, 9% stratified analyses by demographic variables, and none reported identity multiplicity or intersectionality. MBP efficacy could not be determined for subgroups due to lack of subgroup analyses. Temporal trends show limited improvements in diversity composition and reporting of race over time. MBPs’ potential benefit for diverse populations will depend on adequate reporting of currently underreported demographic variables. To develop culturally responsive interventions, MBPs research must include underrepresented populations to counter observed systemic bias and address inclusion disparities in the field. We offer recommendations to further this aim. The PROSPERO review registration (number: CRD42016051765 (Loucks et al., American Journal of Health Behavior 40:258–267, 2016)) with a review protocol was submitted on December 9, 2016, and confirmed on December 16, 2016.

A Retrospective Systematic Review of Diversity Variables in Mindfulness Research, 2000–2016

Losing a Loved One to Homicide: What We Know about Homicide Co-Victims [Bibliography]

Background Evidence-Based Quality Improvement (EBQI) involves researchers and local partners working collaboratively to support the uptake of an evidence-based intervention (EBI). To date, EBQI has not been consistently included in community-engaged dissemination and implementation literature. The purpose of this paper is to illustrate the steps, activities, and outputs of EBQI in the pre-implementation phase. Methods The research team applied comparative case study methods to describe key steps, activities, and outputs of EBQI across seven projects. Our approach included: (1) specification of research questions, (2) selection of cases, (3) construction of a case codebook, (4) coding of cases using the codebook, and (5) comparison of cases. Results The cases selected included five distinct settings (e.g., correction facilities, community pharmacies), seven EBIs (e.g., nutrition promotion curriculum, cognitive processing therapy) and five unique lead authors. Case examples include both community-embedded and clinically-oriented projects. Key steps in the EBQI process included: (1) forming a local team of partners and experts, (2) prioritizing implementation determinants based on existing literature/data, (3) selecting strategies and/or adaptations in the context of key determinants, (4) specifying selected strategies/adaptations, and (5) refining strategies/adaptations. Examples of activities are included to illustrate how each step was achieved. Outputs included prioritized determinants, EBI adaptations, and implementation strategies. Conclusions A primary contribution of our comparative case study is the delineation of various steps and activities of EBQI, which may contribute to the replicability of the EBQI process across other implementation research projects.

/pdf/evidence-based-quality-improvement-ebqi-in-the-pre-18e6g0ze.pdf

Evidence-Based Quality Improvement (EBQI) in the pre-implementation phase: key steps and activities

Introduction Community-based participatory research (CBPR) is an effective health promotion approach for reaching socially disadvantaged groups. However, there is limited evidence on how such interventions and their effects can be reproduced across time and place. The present study examines the effects of BIG (i.e., movement as an investment in health), a long-standing German CBPR project. Since 2005, BIG has aimed to empower women in difficult life situations to increase control over their health determinants and reduce social inequalities by promoting physical activity. One of BIG's key features is its implementation in several German municipalities since 2005. This study explores (a) whether participation could change women's empowerment, and (b) how increased empowerment affects other areas of women's lives. Methods With a total of 63 interviewees (i.e., 40 participating women, 7 trainers, 3 project coordinators, and 13 stakeholders), we conducted 53 semi-structured qualitative interviews in five BIG communities between 2007 and 2011. Some interviews were conducted with two people simultaneously. The interview guide contained questions on various dimensions of empowerment (e.g., project engagement, increased self-efficacy, and developed competencies). Framework analysis was used for the analytical process. Results BIG contributed to women's empowerment in various ways, including increased self-efficacy, social network promotion, competency development, and increased motivation to change physical activity behavior. Women who took on added tasks and became more involved in project planning also strengthened their organizational empowerment. Furthermore, increased empowerment had a positive influence on the women's quality of life, family, and professional lives. Conclusion The novel findings helped in understanding the effects of a complex empowerment-based approach that promoted physical activity among women in difficult life situations. Future research should focus on the long-term effects of these programs and their transferability to other sites. Further effort is necessary in the area of public health policy.

/pdf/for-me-it-s-just-a-piece-of-freedom-increased-empowerment-1mutf9rn.pdf

“For me, it's just a piece of freedom”—Increased empowerment through physical activity promotion among socially disadvantaged women

Purpose This study uses participatory research methods with survivors of homicide and their service providers to explore the feasibility and acceptability of a culturally adapted mindfulness intervention for stress reduction and resilience in homicide survivors. Procedures Our mixed methods approach included: (a) previewing a Mindfulness-Based Stress Reduction program with providers and survivors; (b) using their iterative feedback during focus groups to revise the curriculum; and (c) studying the acceptability of the adapted curriculum for survivors through focus group and standardized data collection. Findings We learned that providers use mindfulness for self-care and both providers and survivors view the approach for survivors as promising. Based on attendance, participation, and focus group data, the adapted curriculum was both feasible and acceptable. Survivors' reports suggested most experienced improved emotion regulation, feelings of empowerment, and better coping. Conclusions Culturally adapted mindfulness programs may support healing for homicide survivors and possibly other low-income people of color with significant trauma backgrounds. Further investigation is needed to rigorously assess outcomes and specific effects, both positive and negative, of mindfulness in this and other more diversified populations.

/pdf/feasibility-and-acceptability-of-mindfulness-for-survivors-2xc1t541wl.pdf

Feasibility and Acceptability of Mindfulness for Survivors of Homicide and Their Providers

One strategy to promote physical activity (PA) is for health care providers to give exercise prescriptions (ExRx) that refer to community-based facilities. However, facilitators and barriers specific to urban programs in the US for under-resourced women are unknown. Thus the purpose of this formative research was to explore ExRx barriers and facilitators specific to US under-resourced women to inform future intervention targets and strategies. This mixed-methods community-engaged research was conducted in partnership with an urban women's only wellness center that exchanged ExRx for free access (1-3 months). Qualitative semi-structured interviews and validated quantitative questionnaires (SF-12, International Physical Activity Questionnaire, Physical Activity Self-Efficacy, Physical Activity Stage of Change, and Barriers to Physical Activity, Social Support for Exercise, and Confusion, Hubbub, and Order Scale) were administered by phone and guided by the socio-ecological model. ExRx utilization was defined as number visits/week divided by membership duration. Means and percentages were compared between ≥1 visit/week vs. <1 visit/week with t-tests and chi-square, respectively. Women (n = 30) were 74% Black, 21-78 years of age, 50% had ≤ high school diploma, and 69% had household incomes ≤45,000/year. Women with ≥1 visit/week (n = 10; 33%) reported more education and higher daily activity, motivation, number of family CVD risk factors and family history of dyslipidemia compared with <1 visit/week. Facilitators among women with ≥1 visit/week were "readiness" and "right timing" for ExRx utilization. Barriers among women with <1 visit/week (n = 20; 67%) were "mismatched expectations" and "competing priorities". Common themes among all women were "sense of community" and "ease of location". ExRx utilization at an US urban wellness center may be dependent on a combination of multi-level factors including motivation, confidence, peer support, location and ease of access in under-sourced women. Additional resources may be needed to address mental and/or physical health status in additional to physical activity specific programming.

Socioecological Factors Associated with an Urban Exercise Prescription Program for Under-Resourced Women: A Mixed Methods Community-Engaged Research Project.

Mindfulness is recognized as an evidence-based practice that can improve a person’s physical and emotional health and well-being. Practicing mindfulness can help individuals decrease stress, anxiety and emotional attachment to negative events (Kabat-Zinn, 2003). This research project examined the cultural relevance and potential acceptability of mindfulness practices by frontline providers working with a low-income community of color affected by gun homicide.

Using Mindfulness for Increasing Provider Capacity to Support Inner City Survivors of Violence

https://escholarship.umassmed.edu/cgi/viewcontent.cgi?article=1094&context=pib

Using Mindfulness for Increasing Provider Capacity to Support Inner City Survivors of Violence [English and Spanish versions]

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Feasibility and Acceptability of Mindfulness for Survivors of Homicide and Their Providers

Socioecological Factors Associated with an Urban Exercise Prescription Program for Under-Resourced Women: A Mixed Methods Community-Engaged Research Project.

Using Mindfulness for Increasing Provider Capacity to Support Inner City Survivors of Violence

Using Mindfulness for Increasing Provider Capacity to Support Inner City Survivors of Violence [English and Spanish versions]