Objective To describe a systematic assessment of patient educational materials for the Growing Right Onto Wellness (GROW) trial, a childhood obesity prevention study targeting a low health literate population. Methods Process included: (1) expert review of educational content, (2) assessment of the quality of materials including use of the Suitability Assessment of Materials (SAM) tool, and (3) material review and revision with target population. Results 12 core modules were developed and assessed in an iterative process. Average readability was at the 6th grade reading level (SMOG Index 5.63 ± 0.76, and Fry graph 6.0 ± 0.85). SAM evaluation resulted in adjustments to literacy demand, layout & typography, and learning stimulation & motivation. Cognitive interviews with target population revealed additional changes incorporated to enhance participant's perception of acceptability and feasibility for behavior change. Conclusion The GROW modules are a collection of evidence-based materials appropriate for parents with low health literacy and their preschool aged children, that target the prevention of childhood overweight/obesity. Practice implications Most trials addressing the treatment or prevention of childhood obesity use written materials. Due to the ubiquitous prevalence of limited health literacy, our described methods may assist researchers in ensuring their content is both understood and actionable.

Objective Many behavior change programs are delivered in group settings to manage implementation costs and to foster support and interactions among group members to facilitate behavior change. Understanding the group dynamics that evolve in group settings (e.g., weight management, Alcoholics Anonymous) is important, yet rarely measured. This paper examined the relationship between social network ties and group cohesion in a group-based intervention to prevent obesity in children. Method The data reported are process measures from an ongoing community-based randomized controlled trial. 305 parents with a child (3-6 years) at risk of developing obesity were assigned to an intervention that taught parents healthy lifestyles. Parents met weekly for 12 weeks in small consistent groups. Two measures were collected at weeks 3 and 6: a social network survey (people in the group with whom one discusses healthy lifestyles); and the validated Perceived Cohesion Scale (Bollen & Hoyle, 1990). We used lagged random and fixed effects regression models to analyze the data. Results Cohesion increased from 6.51 to 6.71 (t=4.4, p<0.01). Network nominations tended to increase over the 3-week period in each network. In the combined discussion and advice network, the number of nominations increased from 1.76 to 1.95 (z=2.59, p<0.01). Cohesion at week 3 was the strongest predictor of cohesion at week 6 (b=0.55, p<0.01). Number of new network nominations at week 6 was positively related to cohesion at week 6 (b=0.06, p<.01). In sum, being able to name new network contacts was associated with feelings of cohesion. Conclusion This is the first study to demonstrate how network changes affect perceived group cohesion within a behavioral intervention. Given that many behavioral interventions occur in group settings, intentionally building new social networks could be promising to augment desired outcomes.

BackgroundPerception of undesirable features may inhibit built environment use for physical activity among underserved families with children at risk for obesity.MethodsTo examine the association of perceived availability, condition, and safety of the built environment with its self-reported use for physical activity, we conducted a cross-sectional analysis on baseline data from a randomized controlled trial. Adjusted Poisson regression was used to test the association between the primary independent variables (perceived availability, physical condition, and safety) with the primary outcome of self-reported use of built environment structures.ResultsAmong 610 parents (90% Latino) of preschool-age children, 158 (26%) reported that there were no available built environment structures for physical activity in the neighborhood. The use of built environment structures was associated with the perceived number of available structures (B = 0.34, 95% CI 0.31, 0.37, p < 0.001) and their perceived condition (B = 0.19, 95% CI 0.12, 0.27, p = 0.001), but not with perceived safety (B = 0.00, 95% CI −0.01, 0.01, p = 0.7).ConclusionsIn this sample of underserved families, perceived availability and condition of built environment structures were associated with use rather than perceived safety. To encourage physical activity among underserved families, communities need to invest in the condition and availability of built environment structures.Trial registrationRegistered at ClinicalTrials.gov (NCT01316653) on March 11, 2011.

Poverty is one of the most significant determinants of health inequity in the United States, yet students of the health professions are more likely to come from higher rather than from lower income families, separating them economically from many of the individuals they will serve. Poverty simulations can expose health professional students to experiences of those living in poverty and provide a more holistic, structural perspective of poverty that informs their later practice. We sought to understand the current state of poverty simulations being utilized throughout the United States. Through a review of abstracts via Ovid and Google Scholar, we identified nine articles that focus directly on describing poverty simulations in university-based programs with health or social work university students and that incorporate some form of pre- and postevaluation methods. After a careful review of these articles, we describe the distinct differences in components and contexts between the simulations, including Bridging the Gaps–Pittsburgh’s Experiential Poverty Exercise, and how effects on students is determined across the various simulations. Additionally, we review how unique aspects of the Bridging the Gaps–Pittsburgh’s Experiential Poverty Exercise can serve as a model for providing multidisciplinary graduate students the opportunity to increase their knowledge and shift attitudes about people experiencing poverty before working with them as health professionals. In presenting the current status of these simulations, we seek to develop recommendations regarding the components and context of poverty simulations as well as approaches to assessing effects.

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