title: The Influence of Health Literacy on Reach, Retention, and Success in a Worksite Weight Loss Program.
abstract: To examine if employee health literacy (HL) status moderated reach, retention, and weight outcomes in a worksite weight loss program.
  
  
  
  The study was a two-group cluster randomized controlled weight loss trial.
  
  
  
  The study was conducted in 28 worksites.
  
  
  
  Subjects comprised 1460 employees with a body mass index >25 kg/m(2).
  
  
  
  Two 12-month weight loss interventions targeted diet and physical activity behaviors: incentaHEALTH (INCENT; incentivized individually targeted Internet-based intervention) and Livin' My Weigh (LMW; less-intense quarterly newsletters).
  
  
  
  A validated three-item HL screening measure was self-completed at baseline. Weight was objectively assessed with the Health Spot scale at baseline and 12-month follow-up.
  
  
  
  The impact of HL on program effectiveness was assessed through fixed-effect parametric models that controlled for individual (i.e., age, gender, race, ethnicity, income, education) and worksite random effects.
  
  
  
  Enrolled employees had significantly higher HL status [13.54 (1.68)] as compared to unenrolled [13.04 (2.17)] (p < .001). This finding was consistent in both interventions. Also, HL moderated weight loss effects (beta = .66; SE = 027; p = .014) and losing >5% weight (beta = -1.53; SE = .77; p < .047). For those with lower baseline HL, the INCENT intervention produced greater weight loss outcomes compared to LMW. The HL level of employees retained was not significantly different from those lost to follow-up.
  
  
  
  HL influences reach and moderates weight effects. These findings underscore the need to integrate recruitment strategies and further evaluate programmatic approaches that attend to the needs of low-HL audiences.
authors.affiliation: Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA, USA zoellner@vt.edu.
authors.forename: Jamie
authors.initials: J
authors.lastname: Zoellner
authors.affiliation: Department of Agricultural and Applied Economics, Virginia Tech, Blacksburg, VA, USA.
authors.forename: Wen
authors.initials: W
authors.lastname: You
authors.affiliation: Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA, USA.
authors.forename: Fabio
authors.initials: F
authors.lastname: Almeida
authors.affiliation: Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
authors.forename: Kacie C A
authors.initials: KC
authors.lastname: Blackman
authors.affiliation: Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA, USA.
authors.forename: Samantha
authors.initials: S
authors.lastname: Harden
authors.affiliation: Colorado Health Outcomes Program, University of Colorado School of Medicine, Aurora, CO, USA.
authors.forename: Russell E
authors.initials: RE
authors.lastname: Glasgow
authors.affiliation: Gillings School of Global Public Health, University of North Carolina-Chapel Hill, NC, USA.
authors.forename: Laura
authors.initials: L
authors.lastname: Linnan
authors.affiliation: Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA, USA.
authors.forename: Jennie L
authors.initials: JL
authors.lastname: Hill
authors.affiliation: Department of Human Nutrition, Foods and Exercise, Virginia Tech Riverside, Roanoke, VA, USA.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Estabrooks
mesh_terms: D057186:Comparative Effectiveness Research; D005260:Female; D057220:Health Literacy; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000523:psychology / Q000706:statistics & numerical data; D016896:Treatment Outcome; D061217:Weight Reduction Programs; D017132:Workplace
keywords: behavioral sciences; employee health; health literacy; obesity; prevention research; randomized controlled trial