Men and women have similar rates of obesity but the combined prevalence of overweight and obesity is higher among men. Men who are overweight are a high-risk group for many obesity-related chronic diseases, as they are more likely to carry excess weight in the abdomen, which is generally more harmful than weight stored in the lower body. Men are also less likely than women to perceive themselves as overweight, and thus are less likely to initiate weight loss through organized weight loss programs. On average, less than 27% of weight loss trial participants have been men. Internet-based research is a low-cost, efficient way to produce novel hypotheses related to weight loss that may have previously escaped weight loss professionals. Additionally, incentives are an effective tool to motivate behavior change, and there is ample evidence to support the use of incentives to encourage many health-promoting behaviors, such as weight loss. The purpose our initial study was to facilitate intervention development by using crowdsourcing to detect unexpected beliefs and unpredicted barriers to male weight loss. The aim of our main study was to evaluate the impact of financial incentives to facilitate weight loss in men, delivered as part of a weight loss intervention. Two separate studies were conducted. In the first project, participants were recruited to a crowdsourcing survey website which was used to generate hypotheses for behaviors related to overweight and obesity in men. Participants provided 21,846 responses to 193 questions. While several common themes seen in prior research were revealed such as previous health diagnoses and physical activity participation, other potential weight determinants such as dietary habits, sexual behaviors and self-perception were reported. Crowdsourcing in this context provides a mechanism to further investigate perceptions of weight and weight loss interventions in the male population that have not previously been documented. These insights will help guide future intervention design. For the main project, a randomized trial compared the Gutbusters weight loss program (based on the REFIT program) alone with Gutbusters with escalating incentives for successful weight loss. The six-month intervention was conducted online with weekly in-person weight collections for the first 12 weeks. Gutbusters encouraged participants to make six 100-calorie changes to their daily diet, utilizing a variety of online lessons targeting specific eating behaviors. Measures included demographic information, height, weight, waist circumference, and body fat percentage. Participants (N=102, 47. 0± 12. 3 yrs old, 32. 5 kg/m2, 80. 4% with at least two years of college) were randomized in a 1:1 ratio to Gutbusters or Gutbusters+Incentive. Significantly more Gutbusters+Incentive participants lost at least 5% of their baseline weight compared to the Gutbusters group at both 12 and 24 weeks. Similar to the aforementioned REFIT program, Gutbusters participants were able to achieve clinically significant weight loss. The Gutbusters+Incentive achieved greater rates of weight loss than the Gutbusters alone group, further supporting the value of incentives in promoting health behaviors.

Thesis (Ph. D.)--Rutgers University, 2008. / "Graduate Program in Psychology." Includes bibliographical references (p. 65-70).

published_or_final_version / Nursing Studies / Master / Master of Nursing

This portfolio presents a unique and significant body of research which together provides a substantial, original description and analysis of women’s engagement with weight management behaviours and services during pregnancy. This body of research examines this topic from multiple perspectives, concluding with a detailed interpretative study which sheds light on the deep-rooted determinants of women’s weight-related behaviours during pregnancy. All outputs are articles published in peer-reviewed scientific journals: Article one describes an evaluation of the acceptability of an individual, home-based perinatal weight management service, based on a qualitative examination of the experiences of obese women who used the service during pregnancy. The findings showed that women valued the support they received from the service, and highlighted home visits, personalised advice and regular weight monitoring as beneficial, while suggesting that more frequent appointments and practical support with target behaviours would enhance the service. Article two describes a qualitative study of the views and experiences of obese women who had declined or disengaged from the service evaluated in article one. The study identified the referral experience as key to women’s decisions to decline participation, highlighting the need for midwives and other health professionals to have detailed knowledge of the service and training on how to sensitively offer this additional support. Findings also demonstrated that some obese women lacked the confidence or capability to successfully change weight-related behaviours, even with support, leading them to disengage from the service. Article three compares and combines qualitative data obtained from two sets of midwives, each referring women to either a one to one, home-based weight management service, or a group, community-based weight management service, to explore how midwives approach the referral with obese and overweight women, and their views of women’s responses to being offered a referral. Findings highlighted the important role midwives play as gatekeepers to weight management services and raised questions regarding how midwives approach the referral process within the wider context of the maternal obesity issue. The findings also suggest that services might improve uptake through addressing pragmatic and motivational barriers, and through better communication with their referral agents. Article four describes analysis of qualitative data collected from women who declined a referral to a group, community-based weight management service during their pregnancy, specifically exploring their views on being referred to the service by their midwife. In contrast to the findings described in article two, women in this study reported finding the referral acceptable, and that they expected to receive information about such services from their midwife. The more positive response of these women could be attributed to a number of potential factors, including; an increase in women’s awareness of the risks of maternal obesity, an increase in midwives’ confidence and skill to raise the issue of weight in the time elapsed between the two studies, or a different approach to making the referral between the two services. Article five reports the findings of a qualitative study using Interpretive Phenomenological Analysis (IPA) which sought to explore in detail the lived experience of a first pregnancy and the process of making decisions about diet and physical activity during this time. The article aimed to further illuminate the multiple and significant barriers to adopting positive dietary and physical activity behaviours during pregnancy, and to challenge the commonly cited belief that ‘pregnancy is a good time for behaviour change’ by examining women’s experiences with specific reference to the model of ‘Teachable Moments’ (McBride, Emmons, & Lipkus 2003). While partially supporting the model, the results also indicated that women with healthy, uncomplicated conception and pregnancy experiences base their diet and physical activity choices primarily on automatic judgements, physical sensations and perceptions of what pregnant women are supposed to do, which in turn suggests limited opportunity for antenatal health professionals to intervene and subsequently influence behaviour. These accumulated findings suggest that there is much that can be done to increase obese women’s engagement with maternal weight management behaviours and services. Service providers and commissioners could draw on these findings to design services which better meet the needs of many obese women, such as receiving personalised support, at a time and location convenient for them, and providing regular weight monitoring. There are also implications for health professionals’ education and clinical practice, with findings indicating that midwives would benefit from further training and better information about the weight management services they are asked to refer to, in order to make referrals more evidence-based and increase their confidence to advocate for the service to women who might benefit. Finally, the work presented in this portfolio further informs our understanding of the psychosocial determinants of women’s weight-related behaviour during pregnancy. It suggests that researchers and practitioners should consider how to tackle the largely socially learned, sub-optimal behaviour patterns that are often established in early pregnancy and how to activate more reflective decision-making in relation to diet, physical activity and weight management. The portfolio also includes critical reflection on each of the outputs and the contribution of each unique study to the development of the author into an independent and expert researcher, and concludes with suggestions for future research.

The purpose of this study was to determine if a didactic approach to assertion training (AT) that focused on cognitive skills was as effective as a behavioral approach to assertion training in a study population of overweight women who resided in an American military community in Germany. The study sought to determine if the two approaches differed statistically significantly in effecting decrease in degree of discomfort and increase in response probability of making an assertive response when in a stressful interpersonal situation.A review of assertive literature reflected a preponderance of studies that utilized college students, psychiatric in-patients or hospitalized patients as subject populations. Thus, a non-college and non-psychiatric in-patient population of overweight women, depicted in the literature as non-assertive and unhappy, was selected as the study's population.The 23 subjects were volunteers from self-help weight loss groups who professed difficulty in their dieting efforts. The subjects were randomly assigned to either the didactic approach group or the behavioral approach group.The didactic approach to AT focused on the cognitive aspects of AT with little interaction or overt involvement on the part of the subject. The behavioral approach to AT utilized the behavior therapy techniques of rehearsal, role play, practice, modeling, and combinations thereof with active participation on the part of the subject.The design of the study was a two factor mixed design with repeated measures on one factor (pre- and post-test scores). The dependent variables in the study were the scores on the measures of degree of discomfort and response probability on the Gambrill and Richey Assertion Inventory (GRAI), a self-report measure of assertive behavior.Difference of means t tests disclosed no statistically significant differences for pre-test scores on the GRAI or demographic data measures between the two groups. A repeated measures analysis of variance was computed for both degree of discomfort and response probability measures; there were no statistically significant differences between the groups at the .05 level of acceptance. However, statistical significance was found at the .01 level for trials on both measures.The conclusion reached was that since the two approaches did not differ statistically significantly in outcome measures there was no real difference between the two approaches to AT. The findings of statistical significance on trials reflects that both approaches increased assertiveness at a greater than chance level of confidence. The success of the didactic approach offered support for concluding that one can learn or change psychologically while only sitting, looking, and listening.Implications of the study include: (1) the behavioral approach to AT need not be the only presentation method to effect assertive change in the subject and (2) a didactic approach to AT or other aspects of human behavior may be of importance in that the method allows for larger groups of subjects and therefore, a more efficient use of therapeutic time and resources. In addition, (3) do we often place too much emphasis on the need for the individual to be involved or "active" in our processes to reflect or demonstrate internal change?Recommendations for possible replication of this study included:Include a third treatment group that utilizes a cognitive-behavioral approach to further investigate the cognitive aspects of the treatment. 2. If a similar population is used, obtain three and six month post treatment data relative to assertiveness and weight loss to test treatment effectiveness over extended periods of time. 3. Include an IN VIVO assertive experience to investigate if the didactic approach effectively transfers to real life situations.

Thesis (M. Nurs.)--University of Hong Kong, 2009. / Includes bibliographical references (p. 95-103).

Thesis (M. Nurs.)--University of Hong Kong, 2007.

Thesis (M.A.)--Bowling Green State University, 2007. / Document formatted into pages; contains vi, 59 p. Includes bibliographical references.

Thesis (M.A.)--Kutztown University of Pennsylvania, 1991. / Source: Masters Abstracts International, Volume: 45-06, page: 3295. Typescript. Includes bibliographical references (leaves 79-85).

Thesis (Ph. D.)--Washington State University, May 2008. / Includes bibliographical references.