title: Implementation of a cancer prevention program for working class, multiethnic populations.
abstract: BACKGROUND
  This paper describes the implementation of the Healthy Directions-Health Centers intervention and examines the characteristics of participants associated with completion of intervention activities. Healthy Directions-Health Centers was designed to address social contextual factors relevant to cancer prevention interventions for working class, multi-ethnic populations.
  
  
  METHODS
  Ten community health centers were paired and randomly assigned to intervention or control. Patients who resided in low income, multi-ethnic neighborhoods were approached for participation. This study targeted fruit and vegetable consumption, red meat consumption, multi-vitamin intake, and physical activity. The intervention components consisted of: (1) a brief study endorsement from a clinician; (2) an in-person counseling session with a health advisor; (3) four follow-up telephone counseling sessions; and (4) multiple distributions of tailored materials.
  
  
  RESULTS
  Among the 1,088 intervention group participants, 978 participants (90%) completed at least five out of six intervention activities. Participants who missed clinical appointments were less likely to complete all components of the intervention. Participant characteristics that predicted receipt of clinician endorsement differed from characteristics that predicted completion of health advisor activities. Low acculturation did not present a barrier to delivery of the intervention once the participant was enrolled.
  
  
  CONCLUSIONS
  Collection and reporting on process evaluation results can help explain variations in program implementation.
authors.affiliation: Department of Ambulatory Care and Prevention, Harvard Pilgrim Health Care, Boston, MA 02215, USA. Rebeca_hannigan@hphc.org
authors.forename: Rebecca
authors.initials: R
authors.lastname: Lobb
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Gonzalez Suarez
authors.forename: Martha E
authors.initials: ME
authors.lastname: Fay
authors.forename: Caitlin M
authors.initials: CM
authors.lastname: Gutheil
authors.forename: Mary K
authors.initials: MK
authors.lastname: Hunt
authors.forename: Robert H
authors.initials: RH
authors.lastname: Fletcher
authors.forename: Karen M
authors.initials: KM
authors.lastname: Emmons
mesh_terms: D003151:Community Health Centers / Q000458:organization & administration*; D003376:Counseling; D004032:Diet; D005006:Ethnicity; D005260:Female; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000517:prevention & control*; D012923:Social Class