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The intervention used in this study gave participants health information and a self-reporting instrument that accentuated positive reinforcement by providing the user with personal feedback about what they had done correctly and potential areas for improvement. This unique, complementary intervention was designed to help participants build competence and autonomy with regard to lifestyle health promoting choices. The evaluation of this intervention queried, was this intervention effective in helping participants develop self-managed behaviors? Also, was this intervention user-friendly, with regard to time and ease of use, as it promoted healthy lifestyle cognition and behaviors?

Two unique pilot groups tested this self-management health promotion intervention. The initial group of tests was done with university students and the second set of pilot tests were completed with corporate employees. Two diverse groups were used to test this intervention in an effort to determine if this technique was appropriate for different populations. A post-test survey was used to determine its usability and effectiveness.

INTERVENTION

The intervention, "Learning to Live Well: A Road Map to a Better Life" was presented to participants in both groups. The program design evolved as an adaptation of total quality management techniques that focus on managing the business process to produce high quality products. The "Learning to Live Well" program adapted these management techniques by treating a person's lifestyle as the process and health as the desired product. The intervention presentation by the author at the start of the program included information about how to use this technique and introduced the participants to the concepts and benefits of health. The research developed presentation also reviewed how self-management techniques in this intervention were designed to help participants achieve positive health benefits. The intervention was designed to help people develop better health through healthier lifestyle behaviors. The major intent of these programs was to help people learn and use effective self-management techniques that would allow them to incorporate healthy behaviors into their busy lifestyles.

After the presentation, participants used the self-management instrument contained in a packet that was given to them and discussed at the presentation. The packet contained a lifestyle self-management instrument, explanatory instructions, supporting health information, and completed examples of the lifestyle instrument.

Instrument. The self-management instrument focused on three lifestyle areas: coping behaviors, food selection, and physical activity (each area had similar worksheets). Coping Behaviors focused on patience, drugs, support system, realistic goals, listening, responsibility, dilemmas, and positive actions (. Today I was able to show patience in situations that normally cause me to become agitated). Food Selection focused on lean protein choices, snacks, food variety, fats and oils, carbohydrate rich foods, non-nutritious choices, overeating, and alcohol (. Today my food selection choices included a variety of foods to assure proper nutrition). Physical Activity focused on walking, biking, sports, stair climbing, programmed exercise, other physical activity, leisure physical activity, and additional moderate to vigorous activity (. Today I took a walk of good duration and distance).

Research, testing, and expert advice determined that each area would list eight health supporting lifestyle cognition/behaviors and each area would have a criterion goal of engaging in at least four of the eight associated items. Daily, participants marked which of the eight health promoting lifestyle activities they had completed. Participants recorded and charted their daily lifestyle activities in each area to provide evaluative feedback (Figure 1). Participants also calculated and charted a weekly summary of their lifestyle activities in each area for additional feedback. Weekly summary scores for each behavior area were calculated by adding daily scores and dividing total by seven (days of the week) and rounding it to nearest whole number. These summary scores and a summary score for all areas were calculated, recorded, and charted on a lifestyle summary sheet (see Figure 2). For all scores obtained, participants were prompted to attain a criterion of four or greater.

[FIGURE 1-2 OMITTED]

PILOT TEST 1 SAMPLE

Three hundred fifteen undergraduate students enrolled in one of three separately taught sections of a required Physical Education Fitness Wellness Lecture (PEFWL) class at a large public university in the Midwest. The course students attended introduced the concepts of health promotion, lifestyle behaviors, self-management, and other general health and wellness information. The intervention self-management instrument was used to provide practical experience to students with regard to the concept of lifestyle self-management.

PILOT TEST 2 SAMPLE

One hundred thirty-seven self-selected employees of Dial Corp., Micro-Rel, employees working a several sites for the State of Arizona, employees of the City of Scottsdale, and employees of Associated Geriatric Clinics of Arizona participated in the second group of pilot tests. Participants signed up for and attended health promotion workshops advertised in their company newsletters. The intervention self-management instrument was used to provide a practical guide to participants with regard to incorporating health promotion concepts introduced in the workshop.

EVALUATION SURVEY

The same evaluation survey was used for both pilot tests. The evaluation survey inquired about the usability and effectiveness of the self-management intervention. The first three questions focused on usability whereas the four remaining ones queried its effectiveness (see Table 1). The usability questions examined whether the participants believed the self-management intervention was user-friendly, if it could be completed in a reasonable amount of time, and whether it should be changed or modified. Two of the four effectiveness questions examined the effects of the self-management intervention had on lifestyle cognition and behaviors. The remaining two questions examined whether the participant believed the intervention was helpful to them and if they believed it would be helpful to others wishing to change their lifestyle behavior. Participants indicated if they agreed (Yes) or disagreed (No) with six of the seven questions. On the remaining question (Question 3), participants circled the approximate time in minutes required to use intervention each day. The survey was administered after participants had used of the self-management intervention instrument for four weeks.

RESULTS

Table 1 shows that ninety-eight and ninety-two percent (98% and 92%) of the respondents (students, employees) indicated the intervention was user-friendly and easy to use. Eighty-four and ninety-six percent (84% and 96%) of respondents reported that they liked the intervention as it was designed. Additionally, a majority (87% and 81%) indicated that it took them ten minutes or less to each day. In regards to its effectiveness, ninety-four and eighty-six percent (94% and 86%) of the participants reported that the intervention caused them to reevaluate and think about their lifestyle. A majority of participants (86% and 94%) also indicated that the intervention prompted changes in their lifestyle behaviors. Ninety-seven percent (98% and 97%) or more of participants in both groups would recommend the intervention to others. (see Table 1)

DISCUSSION

The potential to reach optimal health may remain elusive unless individuals develop appropriate self-management skills (Nicholas, Gobble, Crose, & Frank, 1992). Self-monitoring, self-evaluation and feedback are cited as important in behavior modification programs designed to encourage healthy lifestyle behaviors (Mehra et al., 2001). Understanding this need should encourage researchers and other practitioners to develop interventions that focus on helping individuals learn how to independently gather information and competency as they learn to become self-directed.

The use of the self-management instrument in this intervention appeared to support self-management research and overall there was strong reported effectiveness. A clear majority reported positive changes in cognition and most reported changes in behaviors. With regard to generalizability, not only did participants believe the intervention was helpful to themself, but most believed this intervention would be helpful to anyone wishing to make lifestyle changes. Participants found this to be a user-friendly intervention that took less than ten minutes a day to use, both important intervention characteristics as employers demand employees to do more with less.

Although the results are generally positive, it is important to consider limitations regarding the population. The first group was a convenience sample from a large university and the second group included self-selected participants from organizations. Another limitation regards whether respondents reports are reflective of actual cognition and behaviors (. data obtained via self-report). While it is believed it was the combination of self-evaluation, feedback, and education about health and wellness obtained in this intervention, it is not dear which of these components produced positive effects on lifestyle cognition and behaviors. In addition, pre-testing individuals would further discern baseline levels from post-intervention levels.

In summary, good health, higher productivity, improved quality of life and a higher level of wellness may be achieved by facilitating the development of self-management skills that engender autonomy and competency in individual health behavior choices (Ryan & Deci, 2000).

Table 1. Percent of Participants Responding Positively to Evaluation.

 University Business
 Participants Participants
Questions (N=343) (N=137)

1. Did you find the self-management
 intervention to be "user- friendly"?
 (. was it clear and easy to use?) 98% 92%

2. Would you make any changes to improve
 this intervention? 16% 4%

3. How much time did it take you to use
 the intervention?--Indicating 10
 minutes or less per day 87% 81%

4. Did use of this self-management
 intervention cause you to re-evaluate
 or think about your lifestyle? 94% 97%

5. Did use of the intervention cause you
 to sincerely try to make some changes? 86% 91%

6. Was this intervention helpful to you
 in anyway? 94% 93%

7. Do you think this intervention would
 be helpful to anyone trying to make
 lifestyle changes? 98% 97%

REFERENCES

Aldana, . (2001). Financial impact of health promotion programs: Comprehensive review of literature. American Journal of Health Promotion, 15(5), 296-320.

Becker, ., McMahan, S., Emier, J., & Nelson, . (2002). The Potency of Health Promotion Versus Disease Prevention Messages in a College Population. American Journal of Health Studies, 18(1), 26-30.

Botelho RJ & Skinner, H. (1995). Motivating Change in Health Behavior: Implications for Health Promotion and Disease Prevention. Primary Care, 22(4), 565-589.

Briley, R. Fowler, P. & Teel J. (1999). How are we doing? (performance measurement). Journal of Environmental Health, 62(5) 35-46.

Fries, ., Carey, C., & McShane, D. J. (1997). Patient education in arthritis: Randomized controlled trial for a mail delivered program. Journal of Rheumatology, 24, 1378-1383.

Harris, J S. & Fries, J. (2002). The health effects of health promotion. In O'Donnell, M. P. (Ed.). (2002). Health Promotion in the Workplace (3rd ed.) (pp. 1-22). Albany, NY: Delmar.

Institute of Medicine. (2001 ). Health and behavior: The interplay of biological, behavioral, and societal influences. Washington: National Academy Press.

Mehra, A., Kilduff, M., Brass, & Daniel J. (2001). The social networks of high and low self-monitors: Implications for workplace performance. Administrative Science Quarterly, 46(1), 121-146.

Nicholas, D. R., Gobble, D. C., Crose, R. G., & Frank, B. (1992). A systems view of health, wellness, and gender: Implications for mental health counseling. Journal of Mental Health & Counseling, 128(6), 731-743.

O'Donnell, M. P. (2000). Health Productivity management: The concept, impact and opportunity. American Journal of Health Promotion, 14(4), 211-214.

Ryan, R. M. & Deci, E. L. (2000). Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. American Psychologist, 55(1), 68-78.

Schultz, A. B., Broder, J. S., Braunstein, A., & Edington, . (2000, Spring/Summer). Trends in worksite health literature: 1969-1999. AWHP Worksite Health, 27-32.

HEALTH EDUCATION RESPONSIBILITY AND COMPETENCY ADDRESSED

Responsibility IV: Evaluating Effectiveness of Health Education Programs Competency C: Interpret results of program evaluation Sub-competency 3: Report effectiveness of educational programs in achieving proposed objectives

Craig M. Becker, . is an Assistant Professor at East Carolina University. Shari McMahan, . is an Associate Professor at California State University at Fullerton. Donna Allen, ., CHES, FAWHP is a Professor at Nebraska Methodist College. J. Ron Nelson, . is an Associate Professor at the University Nebraska at Lincoln. Address all correspondence to Craig M. Becker, ., Assistant Professor, East Carolina University, 110 Christenbury, Greenville, NC 27858. PHONE: .5312, E-MAIL: .edu.