Abstract
Background.
FUEL Your Life (FYL) is a worksite translation of the Diabetes Prevention Program (DPP). In a randomized controlled trial, participants in a phone coaching condition demonstrated greater weight loss compared to participants in a group coaching or self-study condition. The purpose of this article is to describe the differences in participant reach, intervention uptake, and participant satisfaction for each delivery mode.
Method.
Employees who were overweight, obese, or at high risk for diabetes were recruited from city–county governments. Process evaluation data were collected from health coach records, participant surveys, and research team records. Differences between groups were tested using Pearson chi-square test and one-way analysis of variance.
Results.
Employee reach of targeted enrollment was highest for the self-study condition. Overall, intervention uptake was highest in the phone coaching condition. Participants who received phone coaching had increased uptake of the participant manual and self-monitoring of food compared to participants who received group coaching or self-study.
Discussion.
FYL demonstrated that DPP could be effectively delivered in the worksite by three different modalities. When implemented in a self-study mode, reach is greater but intervention uptake is lower. Phone health coaching was associated with greater intervention exposure.
Keywords: worksite health promotion, obesity, health coach, diabetes prevention program, translation, process evaluation
INTRODUCTION AND BACKGROUND
More than two thirds of working adults are overweight or obese (Ogden, Carroll, Kit, & Flegal, 2014). Obese individuals have a lower quality of life and are at increased risk for chronic diseases including type 2 diabetes and cardiovascular disease (National Heart, Lung, and Blood Institute, 2013). Furthermore, workers who are obese have more work limitations, lower productivity, and higher health care costs (Finkelstein, DiBonaventura, Burgess, & Hale, 2010; Hertz, Unger, McDonald, Lustik, & Biddulph-Krentar, 2004).
The Diabetes Prevention Program lifestyle management program (DPP) is considered the gold standard for behavioral weight loss. DPP was a large, multicenter clinical trial that demonstrated a lifestyle program, based on nutrition and physical activity behavior change, resulted in significant weight loss and a 58% reduction in the onset of type 2 diabetes (Knowler et al., 2002). In the original DPP, trained lifestyle coaches met with participants face-to-face weekly for 30 to 60 minutes (The Diabetes Prevention Program Research Group, 2002). The limited trained staff and resources in many work settings makes DPP, as originally designed, challenging to implement in the workplace. As a result, DPP has been translated to worksites and other settings with modifications that reduce the time and cost of program delivery (Whittemore, 2011; Wilson, DeJoy, Vandenberg, Corso, et al., 2016; Wilson, DeJoy, Vandenberg, Padilla, & Davis, 2016).
FUEL Your Life (FYL) is a translation of DPP designed specifically for worksites (Wilson, DeJoy, Vandenberg, Corso, et al., 2016; Wilson, DeJoy, Vandenberg, Padilla, & Davis, 2016). FYL was originally tested as a self-study program and proved effective for weight maintenance in the worksite setting (Wilson, DeJoy, Vandenberg, Padilla, & Davis, 2016). In a randomized controlled trial (RCT), small group coaching and phone coaching were compared with the self-study condition (Wilson, DeJoy, Vandenberg, Corso, et al., 2016). Participants in all conditions lost weight; however, participants who received phone coaching lost significantly more weight (2.2 kg) at the end of the intervention than participants who received group coaching (1.5 kg) or no coaching (self-study, 1.2 kg; Wilson, DeJoy, Vandenberg, Corso, et al., 2016).
Health promotion practitioners must often make decisions about the mode of the program delivery based on availability of resources. In the RCT testing different delivery modes of FYL, phone coaching was more effective than group coaching or self-study but also more expensive—costing $354.60 per participant, considerably more than the group coaching ($154.60/participant) and self-study ($75.50/participant; Ingels et al., 2016). Lower intensity interventions with less effectiveness but higher reach may have greater public health impact (Glasgow, Vogt, & Boles, 1999). Understanding differences in reach, exposure, and satisfaction across program delivery modes is important for informing decisions about what modality to use when delivering worksite programs. Using process evaluation data from the RCT testing the three modes of delivering FYL—self-study, phone coaching, small group coaching—we examined reach of the target population, exposure to the intervention, and satisfaction for each of the delivery modes.
METHOD
Participants and Setting
FYL was implemented in three city and county governments in Georgia from 2012 to 2015. City and county governments employ a diverse workforce in multiple departments, including administration, public service (utilities, planning, etc.), public safety (police, fire, etc.), public works (engineering, streets and drainage, etc.), and the court system. Each city-county government was randomly assigned to one of three conditions: (1) self-study (no coaching), (2) small-group facilitated by a health coach (group coaching), and (3) individual health coaching by phone (phone coaching). Research staff attended employee meetings to explain the program and recruit participants who were overweight, obese, or at high risk for diabetes. Worksites placed posters in breakrooms/common areas and sent e-mails to all employees with information about the program. While recruitment was directed at employees who were overweight, obese, or at high risk for diabetes based on the Diabetes Risk Screener (Bang et al., 2009), participation was open to all employees consistent with other workplace programs. The research team set a goal of enrolling 300 participants for each condition based on the power needed to test study hypotheses, project resources, and expected attrition. Power analysis conducted using the GPower software program indicated that a total sample size of 700 would permit detection of a .07 effect size at a .99 power level with alpha set to .05. The study protocol was approved by the Institutional Review Board at the University of Georgia.
Intervention
The original DPP consisted of 16 sessions over 6 months followed by a maintenance period (The Diabetes Prevention Program Research Group, 2002). The six core components of DPP are weight loss and physical activity goal-based behavioral intervention, lifestyle coach delivery, ongoing contact, individual tailoring of the intervention, materials for ethnically diverse populations, and network support for the coaches (The Diabetes Prevention Program Research Group, 2002). The FYL translations retained the core components of DPP but modified the frequency and format of the coach interaction. The three delivery modes were designed to be applicable to a variety of worksite settings, cost efficient, and nondisruptive of work activities. The study design has been described elsewhere (Wilson, DeJoy, Vandenberg, Corso, et al., 2016).
The research team hired and trained three health coaches to deliver the intervention. Health coaches attended weekly meetings with the research team who provided oversight for all intervention activities. This tight control of the dose delivered ensured that all participants had equal opportunity to receive the full dose of the intervention.
FYL was delivered over 12 months with a 6-month core intervention period followed by a 6-month maintenance period. On enrollment, participants in all conditions had an orientation session with a health coach where participants set goals for a 7% loss of body weight, fat gram intake needed to achieve weight loss, and 150 minutes of physical activity. Participants were instructed to weigh themselves weekly, record food intake at all meals, and increase physical activity to 150 minutes per week. During the orientation, participants received a FYL participant manual, based on the original DPP participant manual. The FYL participant manual outlined the intervention goals; provided 16 lessons on healthy eating, physical activity, and problem solving; and included self-monitoring worksheets for participants to record weight, physical activity, and food. Participants in all conditions were instructed to complete the first eight lessons weekly and the last eight lessons biweekly. The participant manual included a calendar with lesson assignments. Additionally, participants received an email reminder for each lesson.
After orientation, participants in all conditions worked through each lesson in the FYL participant manual on their own. In the group coaching and phone coaching conditions, health coaches provided eight coaching sessions over 6 months (Wilson, DeJoy, Vandenberg, Corso, et al., 2016). Group coaching sessions were 50 minutes and held at the worksites with 5 to 10 participants. Phone sessions were 20 minutes and held one-on-one with the participant at predetermined times (health coaches made up to five attempts to reach a participant). The first four coaching sessions occurred every 2 weeks, and the final four coaching sessions occurred once per month. In comparison to the original DPP, the self-study condition was a low level of contact, and the phone and group coaching conditions were a moderate level of contact.
At the end of the core intervention period, all participants met with a health coach for a 30-minute transition session. Participants received a FYL Resource Manual containing worksheets and handouts that encouraged weight maintenance (i.e., handling holidays and vacations, family support, etc.). During the 6-month maintenance, health coaches delivered three coaching sessions for participants in both the phone and group coaching conditions that focused on maintaining behavior changes but did not introduce new content.
Data Sources
Saunders, Evans, and Joshi (2005) developed a comprehensive and systematic guide for creating a process evaluation plan that builds on the framework described by Steckler and Linnan (2002), and includes fidelity, dose delivered (completeness), dose received (exposure), reach, recruitment, and context. In the planning phase of this study, the research team created a process evaluation plan following the steps described by Saunders et al. (2005). The plan guided data collection in all three study conditions. Data were collected from multiple sources including health coach records, participant surveys, and research team records and observations. The process evaluation data presented here focuses on measures of fidelity, reach, dose delivered, and dose received. Each data instrument is described in more detail below and outlined in Table 1.
TABLE 1.
Description of Data Sources and Parameters Assessed for Each Process Evaluation Element
| Process Evaluation Element | Data Sources | Parameters Assessed |
|---|---|---|
| Fidelity | Research team records and observations | % of sessions observed that health coach followed study protocol % of sessions observed that health coach followed session script |
| Reach | Enrollment records Baseline body weight and BMI Baseline diabetes risk screener |
No. of employees enrolled (% of targeted enrollment) % of enrolled participants with BMI > 25 or at high risk for type 2 diabetes |
| Dose delivered | Health coach records | % of participants who received a participant manual % of orientation sessions held % of groups that held all eight scheduled health coaching sessions % of phone sessions that followed protocol for attempts to reach participant |
| Dose-received uptake | Participation and satisfaction survey | Mean number of lessons read in manual Frequency of engaging with program elements (manual, self-monitoring of weight, food, and physical activity) as prescribed |
| Dose-received satisfaction | Participation and satisfaction survey | Overall program rating on scale of 1-5, where 1 = poor and 5 = excellent % of participants reporting FYL program provided information needed to lose weight % reporting weight loss goal was helpful % reporting physical activity goal was helpful % reporting that health coaches were helpful |
NOTE: BMI = body mass index; FYL = FUEL Your Life.
Health Coach Records.
Health coaches completed forms in a Microsoft Access database for each interaction with a participant. They recorded attempts to contact the participant, the date a session occurred, the time that the session began and ended, and information discussed during a session that would inform future sessions with the participant (i.e., challenges and facilitators of participant behavior).
Participation and Satisfaction Survey.
Participants completed an electronic survey at 6 months using Qualtrics Survey Software. The primary purpose of the survey was to measure the secondary project outcomes of physical activity, nutrition, and organizational measures. Process evaluation questions were added to the survey to assess dose delivered for both exposure and satisfaction (Saunders et al., 2005). Specifically, the questions assessed the use of the FYL participant manual and the frequency of self-monitoring weight, food, and physical activity. Sample questions were “Of the 16 lessons in the manual, how many did you read?” with an open response; “How often did you review the FUEL Your Life manual?” with response options on a 5-point Likert-type scale where 1 = never, 5 = daily; “How often did you keep track of your [weight, food, activity]?” with response options on a 5-point scale consistent with program recommendations: weight (1 = not at all, 5 = every week), food (1 = not at all, 5 = every meal), and physical activity (1 = not at all, 5 = every day Questions about the helpfulness of the weight loss and physical activity goals and health coaches assessed participants’ satisfaction with the program. Each question had a dichotomous response of yes or no. Additionally, participants were asked, “Overall, did the FUEL Your Life program provide the information you needed to lose weight?” and “Did the FUEL Your Life manual provide the information that you needed?” (yes or no response). Participants rated the program overall on a 5-point scale of 1 = poor to 5 = excellent.
Research Team Records and Observations.
The research director maintained a database on employee enrollment in the study to document reach. Additionally, a member of the research team conducted quality checks of the coaching sessions by observing a random sample of phone and group sessions. During the quality checks, the observer completed a checklist of items indicating whether the health coach followed the study protocol and session script.
Measures
Fidelity.
Trained members of the research team observed sessions to assess the fidelity to the key components of DPP—goal based behavioral intervention, lifestyle coach delivery, frequent contact, individual tailoring of the intervention, materials for ethnically diverse participants, and support for lifestyle coaches (The Diabetes Prevention Program Research Group, 2002). The observer completed a checklist that was coded separately for following study protocol and session script. Fidelity to implementation is reported as the percentage of sessions coded as following study protocol and following session script, separately.
Reach.
Reach is expressed as the number of participants recruited at the organization and as the percentage of the targeted 300 participants for each worksite (condition). We also report the percentage of employees who enrolled who were the intended participants (body mass index [BMI] > 25 or at high risk for type 2 diabetes). We did not have rates of overweight or risk for type 2 diabetes for each organization.
Dose Delivered.
The research team measured dose delivered for the core elements of FYL, including provision of the participant manual, orientation session with health coach, and phone and small group coaching sessions. Dose delivered is reported as the percentage of participants who received a manual, orientation sessions held, and coaching sessions held.
Dose Received.
Dose received was defined in terms of both exposure and satisfaction as suggested by Saunders et al. (2005). Responses to the process evaluation questions on the participation and satisfaction survey provided data on dose received. Exposure was the extent to which participants engaged with key intervention components including reading the participant manual and self-monitoring their weight, activity, and food. Exposure is reported as the mean number of lessons read in the participant manual and the frequency of self-monitoring weight, food, and physical activity as prescribed by the program. Participant satisfaction was assessed by the perceived helpfulness of the program. This includes an overall rating of the program and the percentage of participants who reported that the program provided the information needed to lose weight, weight loss goal was helpful, physical activity goal was helpful, and health coach was helpful.
Analysis
Descriptive statistics were calculated for all variables. To compare differences between conditions, we used Pearson chi-square tests for categorical variables and one-way analysis of variance for continuous variables. All statistical analyses were performed in SPSS Version 24.
RESULTS
Fidelity
The research team completed 102 quality checks to monitor program implementation. The health coaches followed study protocols in 94% of the sessions observed with similar compliance between the two conditions (95% phone and 93% group). Health coaches met expectations for following the script in 92% of the sessions observed with compliance being slightly higher in the phone sessions (95%) compared with the group sessions (88%).
Reach
The self-study condition had the most employees enroll (n = 242) and came closest to meeting the goal of recruiting 300 participants. In comparison, 236 employees enrolled in the group coaching condition, and 182 employees enrolled in the phone condition. Participants in the self-study condition were 61% female, 3% Hispanic or Latino, 50% White, 46% Black, and 4% other races. Participants in the group condition were 59% female, 5% Hispanic, 67% White, 31% Black, and 2% other races. Participants in the phone condition were 64% female, 3% Hispanic or Latino, 40% White, 56% Black, and 4% other races. The group condition had significantly fewer Black participants and significantly more White participants than the phone condition (p < .001). There were no other differences between conditions.
In both the group and phone coaching conditions, 77% of participants were high risk for diabetes as measured by BMI > 25 or scoring high-risk on the diabetes risk screener. In the self-study condition, 71% of participants were at high risk for diabetes. Overall, the self-study condition had significantly higher reach (χ2 = 37.227, p < .001) when comparing the percentage of targeted enrollment. There were no differences in reach of high-risk participants across the three study conditions.
Dose Delivered
An orientation session was held with all participants (100%) in all conditions. During the orientation session, all participants received a copy of the FYL participant manual (100%).
For the group coaching condition, 37 groups were created with 5 to 10 participants per group (M = 6.7 participants). Ninety-four percent of all groups held all eight coaching sessions. Health coaches made five attempts to reach each participant, according to protocol 100% of the time.
Dose Received
Three hundred and eighty-two participants completed the participation and satisfaction survey. The participants had an average age of 47 years, 3% were Hispanic, 53% were White, 43% were Black or African American, and 61% were female. Participants who completed the participation and satisfaction survey did not differ from those who did not complete the survey (n = 278) on any demographic variable nor on baseline body weight or BMI. Table 2 provides data on dose received—exposure. There was considerable variability in the number of lessons completed for each condition. Out of 16 possible lessons, participants in the self-study condition read 9 lessons (SD = 5.1), on average, which was significantly less than participants in the group (M = 12.4, SD = 4.0) and phone conditions (M = 13.1, SD = 3.8), F(2, 361) = 26.90, p < .00001. Participants in the self-study condition monitored their weight, physical activity, and food less frequently than either the group or phone coaching conditions. Participants in the phone coaching condition self-monitored their food more frequently than participants in the group coaching condition.
TABLE 2.
Dose Received—Exposure for Key Program Elements at End of Core Intervention Period Measured as the Frequency of Engaging in the Element (n = 382)
| Program Element | Self-Study | Group Coaching | Phone Coaching | Coefficient | p |
|---|---|---|---|---|---|
| Reviewing the manual1 | 2.93a (1.11) | 3.35b (0.85) | 3.48b (0.88) | F(2, 378) = 11.08 | <.001 |
| Tracking weight2 | 3.31a (1.56) | 3.97b (1.21) | 3.84b (1.28) | F(2, 378) = 9.03 | <.001 |
| Tracking food3 | 2.79a (1.34) | 2.88a (1.23) | 3.29b (1.31) | F(2, 377) = 4.52 | .011 |
| Tracking activity4 | 2.81a (1.44) | 3.20b (1.3) | 3.38b (1.30) | F(2, 378) = 5.15 | .006 |
NOTE: Values are presented at M (SD). Values with a different superscript differ significantly from one another.
Based on a rating scale ranging from 1 (never) to 5 (daily).
Based on a rating scale ranging from 1 (not at all) to 5 (every week).
Based on a rating scale ranging from 1 (not at all) to 5 (every meal).
Based on a rating scale ranging from 1 (not at all to 5 (every day).
With regard to dose received—satisfaction, the intervention was well-received in all conditions (Table 3). Participants in the phone condition (M = 4.45, SD = 0.73) rated FYL significantly more positively than either the group (M = 4.10, SD = 0.85) or the self-study (M = 3.96, SD = 0.93) conditions, F(2, 377) = 9.30. More than 90% of participants in all three conditions reported that the program and the participant manual provided the information needed to lose or maintain weight. A significantly greater proportion of participants in the phone condition (94.6%) rated the weight loss goal as helpful compared to the group (82.8%) and self-study (81.4%) conditions. A lower proportion of participants in the self-study condition (78.5%) rated the physical activity goal as helpful compared to both the group (91.0%) and phone (94.6%) conditions. A significantly lower proportion of participants in the self-study condition (95.4%) indicated the health coaches were helpful compared with the phone (98.9%) and group (99.4%) conditions.
TABLE 3.
Dose Received—Satisfaction With Key Program Elements at the End of the Core Intervention (n = 382)
| Program Element | Self-Study (%) | Group Coaching (%) | Phone Coaching (%) | χ2 (2) | p |
|---|---|---|---|---|---|
| Program provided info needed to lose or maintain weight | 90.6 | 94.9 | 96.8 | 4.00 | .14 |
| Manual provided info needed | 95.8 | 96.7 | 97.8 | 0.69 | .71 |
| Weight loss goal helpful | 81.4a | 82.8a | 94.6b | 8.76 | .01 |
| Physical activity goal helpful | 78.5a | 91.0b | 94.6b | 15.90 | <.001 |
| Health coaches helpful | 95.4a | 99.4b | 98.9b | 6.00 | .05 |
NOTE: Values are presented as the percentage of respondents indicating Yes. Values with a different superscript differ significantly from one another.
DISCUSSION
This study was conducted in city-county governments that employ a diverse workforce in multiple departments to ascertain the effects of the intervention within a diverse group of workers that may be more generalizable to a broader group of worksites. The research team employed the health coaches and closely monitored and tightly controlled implementation resulting in high fidelity of implementation. High fidelity of implementation ensured all participants had the opportunity for full exposure to the intervention. This allowed us to make comparisons in participant reach and dose received as a function of the delivery modality. All study conditions retained fidelity of the core components of DPP with varying levels of frequent contact in an effort to reduce costs and resources associated with the high intensity and frequent contact design of DPP. Reach of the target enrollment was higher in the self-study condition compared to both group and phone coaching conditions. Overall, dose received of all intervention elements was lower in the self-study condition compared with either the phone or group coaching conditions. There were few differences between the group and phone coaching conditions though the differences observed are important and may explain why participants who received phone coaching lost more weight than participants who received group coaching or self-study (Wilson, DeJoy, Vandenberg, Corso, et al., 2016). Participants who received phone coaching read more lessons in the participant manual. Also, more participants in the phone condition reported tracking their food intake. Previous studies have shown that self-monitoring of diet is a powerful intervention in and of itself (Burke, 2011).
Overall, satisfaction was high in all study conditions; however, a higher proportion of participants in the phone and group coaching conditions reported that the health coaches and physical activity goal were helpful when compared with the self-study condition. This is likely due to the higher levels of coach interaction for participants in the phone and group coaching conditions. A higher percentage of participants in the phone coaching condition found the weight loss goal to be helpful. These findings, along with the increased uptake of the intervention in the coaching conditions, suggest that the health coaching increased adherence (uptake) and the perceived usefulness of the intervention elements. Pagoto and Appelhans (2013) have argued that improving adherence to weight loss programs is critical for successful weight loss. This study suggests phone health coaching is one potential mechanism for improving adherence to a weight loss intervention offered in a worksite setting. The trade-off is higher costs and lower reach.
Conducting a process evaluation is critical to improving implementation of future worksite programs; however, making direct comparisons to other process evaluation studies is difficult due to different operationalization of process components (Wierenga et al., 2013) and the lack of process data from health coaching interventions (Hill, Richardson, & Skouteris, 2015). This article fills a gap associated with the latter by reporting process data on both group and phone coaching modalities and making comparisons between the two. Our findings are consistent with reports that health coaching increased participant’s confidence to set and reach health goals (Bezner, Franklin, Lloyd, & Crixell, 2018).
Limitations
Several limitations should be noted. First, employees voluntarily participated in the intervention and, as such, there is the possibility of selection bias. All participants in a city-county government received the intervention modality assigned to that city-county government. Participants were not given a choice of which modality they received, and it may be that some participants were in an intervention modality that would not have been their preference (e.g., they were in the group coaching condition and uncomfortable with sharing their health with coworkers). Also, employees who were less receptive to the modality offered at the city-county government where they were employed may have opted to not participate. Future research should examine the effects of participant choice of modality and the effectiveness of that modality. Second, data related to the dose received and satisfaction are self-reported and, therefore, the responses are possibly subject to social desirability. Finally, although the research team made multiple visits to worksites on multiple days to try to reach all participants for data collection, not all participants completed the 6-month data collection. Although there were no differences in demographics between those who participated in the survey and those who did not, it is possible that there are differences in variables not measured.
Conclusions and Implications for Practice
FYL was an effective translation of DPP in the worksite setting. It can be effectively delivered by self-study, small group health coaching, and phone health coaching. The self-study modality had lower effectiveness but higher reach. The use of a health coach increased adherence to the key intervention elements and the perceived helpfulness of the intervention. Phone health coaching, specifically, may increase compliance with self-monitoring of food intake, a key behavior in weight loss. If resources are abundant, health promotion practitioners would benefit from offering phone health coaching to increase adherence with the intervention. In worksites with limited resources, self-study programs could yield positive but smaller effects but may reach more participants. Health promotion practitioners must weigh these trade-offs while considering resource availability when deciding what mode of delivery is appropriate for the target population.
Acknowledgments
The project described was supported by Grant Number R18DK090672 from the National Institute of Diabetes and Digestive and Kidney Diseases. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Diabetes and Digestive and Kidney Diseases or the National Institutes of Health.
REFERENCES
- Bang H, Edwards AM, Bomback AS, Ballantyne CM, Brillon D, Callahan MA, … Kern LM (2009). Development and validation of a patient self-assessment score for diabetes risk. Annals of Internal Medicine, 151, 775–783. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Bezner JR, Franklin KA, Lloyd LK, & Crixell SH (2018). Effect of group health behaviour change coaching on psychosocial constructs associated with physical activity among university employees. International Journal of Sport and Exercise Psychology. Advance online publication. doi: 10.1080/1612197X.2018.1462232 [DOI] [Google Scholar]
- Burke L (2011). Self-monitoring in weight loss: A systematic review of the literature. Journal of the American Dietetic Association, 111, 92–102. doi: 10.1016/j.jada.2010.10.008. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Self-Monitoring The Diabetes Prevention Program Research Group. (2002). The Diabetes Prevention Program (DPP): Description of lifestyle intervention. Diabetes Care, 25, 2165–2171. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Finkelstein E, DiBonaventura M, Burgess S, & Hale B (2010). The costs of obesity in the workplace. Journal of Occupational and Environmental Medicine, 52, 971–976. [DOI] [PubMed] [Google Scholar]
- Glasgow RE, Vogt TM, & Boles SM (1999). Evaluating the public health impact of health promotion interventions: The RE-AIM framework. American Journal of Public Health, 89, 1322–1327. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Hertz RP, Unger AN, McDonald M, Lustik MB, & Biddulph-Krentar J (2004). The impact of obesity on work limitations and cardiovascular risk factors in the U.S. workforce. Journal of Occupational and Environmental Medicine, 46, 1196–1203. [PubMed] [Google Scholar]
- Hill B, Richardson B, & Skouteris H (2015). Do we know enough to design effective health coaching interventions: A systematic review of the state of the literature. American Journal of Health Promotion, 29, e158–e168. [DOI] [PubMed] [Google Scholar]
- Ingels JB, Walcott RL, Wilson MG, Corso PS, Padilla HM, Zuercher H, … Vandenberg RJ (2016).A prospective programmatic cost analysis of Fuel Your Life: A worksite translation of DPP. Jounral of Occupational and Environmental Medicine, 58, 1106–1112. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, & Nathan DM (2002). Reduction in the incidence of type 2 diabetes with lifestyle intervention or Metformin. New England Journal of Medicine, 346, 393–403. [DOI] [PMC free article] [PubMed] [Google Scholar]
- The National Heart, Lung, and Blood Institute. (2013). Managing overweight and obesity in adults. Systematic evidence review from the Obesity Expert Panel. Retrieved from http://www.nhlbi.nih.gov//guidelines [Google Scholar]
- Ogden CL, Carroll MD, Kit BK, & Flegal KM (2014). Prevalence of childhood and adult obesity in the United States, 2011-2012. Journal of the American Medical Association, 311, 806–814. doi: 10.1001/jama.2014.732 [DOI] [PMC free article] [PubMed] [Google Scholar]
- Pagoto S, & Appelhans B (2013). A call for an end to the diet debates. Journal of the American Medical Association, 310, 687–688. doi: 10.1186/1475-2891-10-9.6 [DOI] [PubMed] [Google Scholar]
- Saunders RP, Evans MH, & Joshi P (2005). Developing a process-evaluation plan for assessing health promotion program implementation: A how-to guide. Health Promotion Practice, 6, 134–147. doi: 10.1177/1524839904273387 [DOI] [PubMed] [Google Scholar]
- Steckler A, & Linnan L (2002). Process evaluation for public health interventions and research. San Francisco, CA: Jossey Bass. [Google Scholar]
- Whittemore R (2011). A systematic review of the translational research on the Diabetes Prevention Program. Translational Behavioral Medicine, 1, 480–491. doi: 10.1007/s13142-011-0062-y [DOI] [PMC free article] [PubMed] [Google Scholar]
- Wierenga D, Engbers LH, Van Empelen P, Duijts S, Hildebrandt VH, & Van Mechelen W (2013). What is actually measured in process evaluations for worksite health promotion programs: A systematic review. BMC Public Health, 13. doi: 10.1186/1471-2458-13-1190 [DOI] [PMC free article] [PubMed] [Google Scholar]
- Wilson MG, DeJoy DM, Vandenberg RJ, Corso P, Padilla H, & Zuercher H (2016). Effect of intensity and program delivery on the translation of Diabetes Prevention Program to worksites. Journal of Occupational and Environmental Medicine, 58, 113–1120. doi: 10.1097/JOM.0000000000000873 [DOI] [PMC free article] [PubMed] [Google Scholar]
- Wilson MG, DeJoy DM, Vandenberg R, Padilla H, & Davis M (2016). FUEL Your Life: A translation of the Diabetes Prevention Program to worksites. American Journal of Health Promotion, 30, 188–197. doi: 10.4278/ajhp.130411-QUAN-169 [DOI] [PubMed] [Google Scholar]