Research Brief| Volume 50, ISSUE 10, P1015-1025, November 2018

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Changing Diet and Physical Activity in Nurses: A Pilot Study and Process Evaluation Highlighting Challenges in Workplace Health Promotion

Published:April 09, 2018DOI:



      To use the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework to evaluate and understand key implementation and context factors of a diet and physical activity (PA) workplace intervention for nurses.


      A 3-month pilot intervention was developed to promote diet and PA behavior through self-monitoring, goal setting, and social support using pedometers, a smartphone app, and a dedicated Facebook group. Measures included diet quality, daily PA, adoption, and implementation (including qualitative data). Maintenance was assessed at 6-month follow-up.


      Forty-seven nurses participated in the study. At 3 months, fruit and vegetable intake significantly increased (P = .04) whereas PA significantly decreased (P = .01). The intervention was partially adopted as planned, with low reach and efficacy. Participants reported that changing 2 behaviors at the same time was difficult, with the majority feeling it was easier to change diet than to become more physically active.

      Conclusions and Implications

      The ability to change diet and PA behaviors at the same time was challenging in nurses. Future studies examining whether similar occupational groups with high stress, fatigue, and lack of time face the same challenges would contribute to understanding these results.

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        • Ford E.S.
        • Bergmann M.M.
        • Kroger J.
        • Schienkiewitz A.
        • Weikert C.
        • Boeing H.
        Healthy living is the best revenge: findings from the European Prospective Investigation into Cancer and Nutrition–Potsdam study.
        Arch Intern Med. 2009; 169: 1355-1362
        • Lim S.S.
        • Vos T.
        • Flaxman A.D.
        • et al.
        A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010.
        Lancet. 2012; 380: 2224-2260
        • Tudor-Locke C.
        • Brashear M.M.
        • Johnson W.D.
        • Katzmarzyk P.T.
        Accelerometer profiles of physical activity and inactivity in normal weight, overweight, and obese U.S. men and women.
        Int J Behav Nutr Phys Act. 2010; 7: 60
        • Heikkila K.
        • Fransson E.I.
        • Nyberg S.T.
        • et al.
        Job strain and health-related lifestyle: findings from an individual-participant meta-analysis of 118,000 working adults.
        Am J Public Health. 2013; 103: 2090-2097
        • Lim J.
        • Bogossian F.
        • Ahern K.
        Stress and coping in Australian nurses: a systematic review.
        Int Nurs Rev. 2010; 57: 22-31
        • Sumaira M.
        • Holly B.
        • Mark B.
        How healthy are our nurses? New and registered nurses compared.
        Br J Nurs. 2011; 8: 489-496
        • Phiri L.P.
        • Draper C.E.
        • Lambert E.V.
        • Kolbe-Alexander T.L.
        Nurses' lifestyle behaviours, health priorities and barriers to living a healthy lifestyle: a qualitative descriptive study.
        BMC Nurs. 2014; 13: 38
        • Torquati L.
        • Kolbe-Alexander T.
        • Pavey T.
        • Persson C.
        • Leveritt M.
        Diet and physical activity behaviour in nurses: a qualitative study.
        Int J Health Promot. 2016; 54: 268-282
        • Tuckett A.
        • Henwood T.
        The impact of five lifestyle factors on nurses' and midwives' health: the Australian and New Zealand nurses' and midwives' e-cohort study.
        Int J Health Promot. 2015; 53: 156-168
        • Torquati L.
        • Pavey T.
        • Kolbe-Alexander T.
        • Leveritt M.
        Promoting diet and physical activity in nurses: a systematic review.
        Am J Health Promot. 2017; 31: 19-27
        • Chan C.W.
        • Perry L.
        Lifestyle health promotion interventions for the nursing workforce: a systematic review.
        J Clin Nurs. 2012; 21: 2247-2261
        • American Nurses Association
        Year of the Healthy Nurse.
        • Moore G.F.
        • Audrey S.
        • Barker M.
        • et al.
        Process evaluation of complex interventions: Medical Research Council guidance.
        BMJ. 2015; 350: h1258
        • Gaglio B.
        • Shoup J.A.
        • Glasgow R.E.
        The RE-AIM framework: a systematic review of use over time.
        Am J Public Health. 2013; 103: e38-e46
        • Kahwati L.C.
        • Lance T.X.
        • Jones K.R.
        • Kinsinger L.S.
        RE-AIM evaluation of the Veterans Health Administration's MOVE! Weight Management Program.
        Transl Behav Med. 2011; 1: 551-560
        • Glasgow R.E.
        • Vogt T.M.
        • Boles S.M.
        Evaluating the public health impact of health promotion interventions: the RE-AIM framework.
        Am J Public Health. 1999; 89: 1322-1327
        • Abraham C.
        • Michie S.
        A taxonomy of behavior change techniques used in interventions.
        Health Psychol. 2008; 27: 379-387
        • Bandura A.
        Social Foundations of Thought and Action: A Social Cognitive Theory.
        Prentice-Hall, Englewood Cliffs, NJ1986
        • Latham G.P.
        • Locke E.A.
        New developments in and directions for goal-setting research.
        Eur Psychol. 2007; 12: 290-300
        • Carver C.S.
        • Scheier M.F.
        Control theory: a useful conceptual framework for personality—social, clinical, and health psychology.
        Psychol Bull. 1982; 92: 111
        • Bartholomew L.K.
        • Parcel G.S.
        • Kok G.
        • Gottlieb N.H.
        • Fernandez M.E.
        Planning Health Promotion Programs: An Intervention Mapping Approach.
        Jossey-Bass, San Francisco, CA2011
        • Brug J.
        • Oenema A.
        • Ferreira I.
        Theory, evidence and Intervention Mapping to improve behavior nutrition and physical activity interventions.
        Int J Behav Nutr Phys Act. 2005; 2: 2
        • Lift Worldwide app.
        Date accessed: November 11, 2016
        • Kohl H.W.
        • Murray T.D.
        Measuring physical activity.
        in: Kohl H.W. Murray T.D. Foundations of Physical Activity and Public Health. Human Kinetics, Champaign, IL2012: 55-70
        • Bravata D.M.
        • Smith-Spangler C.
        • Sundaram V.
        • et al.
        Using pedometers to increase physical activity and improve health: a systematic review.
        JAMA. 2007; 298: 2296-2304
        • Santos-Lozano A.
        • Santin-Medeiros F.
        • Cardon G.
        • et al.
        Actigraph GT3X: validation and determination of physical activity intensity cut points.
        Int J Sports Med. 2013; 34: 975-982
        • Ward D.S.
        • Evenson K.R.
        • Vaughn A.
        • Rodgers A.B.
        • Troiano R.P.
        Accelerometer use in physical activity: best practices and research recommendations.
        Med Sci Sports Exerc. 2005; 37: S582-S588
        • Motl R.W.
        • McAuley E.
        • Dlugonski D.
        Reactivity in baseline accelerometer data from a physical activity behavioral intervention.
        Health Psychol. 2012; 31: 172-175
        • Department of Health, Australian Goverment
        Australia's Physical Activity and Sedentary Behaviour Guidelines.
        • Collins C.E.
        • Young A.F.
        • Hodge A.
        Diet quality is associated with higher nutrient intake and self-rated health in mid-aged women.
        J Am Coll Nutr. 2008; 27: 146-157
        • Burrows T.L.
        • Hutchesson M.J.
        • Rollo M.E.
        • Boggess M.M.
        • Guest M.
        • Collins C.E.
        Fruit and vegetable intake assessed by food frequency questionnaire and plasma carotenoids: a validation study in adults.
        Nutrients. 2015; 7: 3240-3251
        • National Health and Medical Research Council, Australian Government
        Australian Dietary Guidelines Summary.
        • National Health and Medical Research Council
        Dietary guidelines for all Australians.
        • World Health Organization
        Obesity and overweight.
        • World Health Organization
        Waist circumference and waist-hip ratio: report of a WHO expert consultation.
        • Sallis J.F.
        • Grossman R.M.
        • Pinski R.B.
        • Patterson T.L.
        • Nader P.R.
        The development of scales to measure social support for diet and exercise behaviors.
        Prev Med. 1987; 16: 825-836
        • Norman G.J.
        • Carlson J.A.
        • Sallis J.F.
        • Wagner N.
        • Calfas K.J.
        • Patrick K.
        Reliability and validity of brief psychosocial measures related to dietary behaviors.
        Int J Behav Nutr Phys Act. 2010; 7: 56
        • Sallis J.F.
        • Pinski R.B.
        • Grossman R.M.
        • Patterson T.L.
        • Nader P.R.
        The development of self-efficacy scales for health related diet and exercise behaviors.
        Health Educ Res. 1988; 3: 283-292
        • Pedersen M.M.
        • Zebis M.K.
        • Langberg H.
        • et al.
        Influence of self-efficacy on compliance to workplace exercise.
        Int J Behav Med. 2013; 20: 365-370
        • Bowling A.
        Just one question: if one question works, why ask several?.
        J Epidemiol Community Health. 2005; 59: 342
        • White I.R.
        • Carpenter J.
        • Horton N.J.
        Including all individuals is not enough: lessons for intention-to-treat analysis.
        Clin Trials. 2012; 9: 396-407
        • Braun V.
        • Clarke V.
        Using thematic analysis in psychology.
        Qual Res Psychol. 2006; 3: 77-101
        • Flannery K.
        • Resnick B.
        • Galik E.
        • Lipscomb J.
        • McPhaul K.
        • Shaughnessy M.
        The Worksite Heart Health Improvement Project (WHHIP): feasibility and efficacy.
        Public Health Nurs. 2012; 29: 455-466
        • Viester L.
        • Verhagen E.A.
        • Bongers P.M.
        • van der Beek A.J.
        Process evaluation of a multifaceted health program aiming to improve physical activity levels and dietary patterns among construction workers.
        J Occup Environ Med. 2014; 56: 1210-1217
        • Strijk J.E.
        • Proper K.I.
        • van der Beek A.J.
        • van Mechelen W.
        A process evaluation of a worksite vitality intervention among ageing hospital workers.
        Int J Behav Nutr Phys Act. 2011; 8: 58
        • Craig P.
        • Dieppe P.
        • Macintyre S.
        • et al.
        Developing and evaluating complex interventions: the new Medical Research Council guidance.
        BMJ. 2008; 337: a1655
        • Prochaska J.O.
        • Velicer W.F.
        The transtheoretical model of health behavior change.
        Am J Health Promot. 1997; 12: 38-48
        • Richert J.
        • Lippke S.
        • Ziegelmann J.P.
        Intervention-engagement and its role in the effectiveness of stage-matched interventions promoting physical exercise.
        Res Sports Med. 2011; 19: 145-161
        • Griffiths J.
        • Maggs H.
        • George E.
        Stakeholder involvement. World Health Organization/World Economic Forum Joint Event on Preventing Noncommunicable Diseases in the Workplace.
        (September; Dalian, China)