title: Process evaluation of the Albany Physical Activity and Nutrition (APAN) program, a home-based intervention for metabolic syndrome and associated chronic disease risk in rural Australian adults.
abstract: Issue addressed The Albany Physical Activity and Nutrition (APAN) study investigated the effects of the APAN program, a home-based intervention on dietary and physical activity behaviours and chronic disease risk for rural Australian adults. This paper reports on the process evaluation to gain insight into the link between intervention elements and outcomes. Methods The APAN program comprised resources to improve participants' diet and physical activity. Printed and online resources were provided to participants, complemented by motivational interviews via telephone. Process evaluation used mixed-methods, with a sample of 201 intervention participants residing in a disadvantaged rural area. Participants were aged 50 to 69 years with, or at risk of, metabolic syndrome. Quantitative data were collected using an online survey (n=73); qualitative data were collected via telephone exit interviews with intervention completers (n=8) and non-completers (n=8), and recruitment notes recorded by research assistants. Results The attrition rate of the program was 18%; major reasons for withdrawal were health and personal issues and a loss of interest. The majority of participants found the printed resources useful, attractive, and suitable to their age group. The website was the least preferred resource. Reasons for completing the program included the desired health benefits, wanting to honour the commitment, and wanting to assist with research. Conclusions Carefully planned recruitment will reduce the burden on resources and improve uptake. Understanding reasons for attrition such as family or personal barriers and health issues will assist practitioners to support participants overcome these barriers. Given participants' preference for printed resources, and the known effectiveness of these in combination with other strategies, investigating methods to encourage use of telephone and online support should be a priority. So what? This process evaluation provided an overview of recruitment challenges and preferred intervention components. It is desirable that future work determines the most effective intervention components for rural adults at risk of chronic disease.
authors.affiliation: Collaboration for Evidence, Research and Impact in Public Health (CERIPH), Curtin University, GPO Box U1987, Perth, WA 6845, Australia.
authors.forename: Krysten
authors.initials: K
authors.lastname: Blackford
authors.affiliation: School of Public Health, Curtin University, GPO Box U1987, Perth, WA 6845, Australia.
authors.forename: Andy
authors.initials: A
authors.lastname: Lee
authors.affiliation: School of Public Health, Curtin University, GPO Box U1987, Perth, WA 6845, Australia.
authors.forename: Anthony P
authors.initials: AP
authors.lastname: James
authors.affiliation: Collaboration for Evidence, Research and Impact in Public Health (CERIPH), Curtin University, GPO Box U1987, Perth, WA 6845, Australia.
authors.forename: Tracy
authors.initials: T
authors.lastname: Waddell
authors.affiliation: School of Health Sciences, University of Tasmania, Locked Bag 1322, Newnham Drive, Launceston, Tas. 7250, Australia.
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Hills
authors.affiliation: Centre for Public Health Nutrition Research, Division of Cancer Research, Level 7, Mailbox 7, Ninewells Medical School, Dundee DD1 9SY, Scotland.
authors.forename: Annie S
authors.initials: AS
authors.lastname: Anderson
authors.affiliation: Collaboration for Evidence, Research and Impact in Public Health (CERIPH), Curtin University, GPO Box U1987, Perth, WA 6845, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: Howat
authors.affiliation: Collaboration for Evidence, Research and Impact in Public Health (CERIPH), Curtin University, GPO Box U1987, Perth, WA 6845, Australia.
authors.forename: Jonine
authors.initials: J
authors.lastname: Jancey
mesh_terms: D000368:Aged; D001315:Australia; D002908:Chronic Disease / Q000628:therapy; D004032:Diet / Q000379:methods; D015444:Exercise; D005260:Female; D006293:Health Promotion / Q000379:methods; D006801:Humans; D020407:Internet; D008297:Male; D024821:Metabolic Syndrome / Q000628:therapy*; D008875:Middle Aged; D062405:Motivational Interviewing / Q000379:methods; D009752:Nutritional Status; D010353:Patient Education as Topic / Q000379:methods*; D015397:Program Evaluation / Q000379:methods*; D012424:Rural Population; D012648:Self Care / Q000379:methods*; D016896:Treatment Outcome