Americans In Motion - Healthy Interventions

Study Description and Methods

This research project brought together the American Academy of Family Physicians National Research Network (AAFP NRN) and the AAFP’s public health initiative, Americans In Motion (AIM). This project evaluated a practice improvement program to improve family physicians’ delivery of effective patient-centered behavior-change interventions for “fitness” (i.e., physical activity, healthy eating, and emotional well-being).

The practice improvement program aimed to position fitness in a central role as “the treatment of choice” when dealing with issues of prevention and treatment of chronic conditions. The project sought to shift the paradigm of family physicians’ use of common advice-giving methods to more effective patient-centered lifestyle counseling. The evaluation took place in 24 practices within the AAFP-NRN, Southeast Regional Clinicians' Network (hsc.unm.edu)(SERCN), and LA Net(www.lanetpbrn.net).

The study consisted of a two-level randomized controlled trial. The first level of randomization was at the practice level, where one group was asked to create a healthy office environment and work on clinician, staff, and patient personal lifestyle changes, while the other was asked only to implement the program with patients. The second level of randomization occurred at the patient level to evaluate the effectiveness of feedback of two novel physiologic measures, homeostatic assay-insulin resistance (HOMA-IR) and nuclear molecular resonance lipoprotein profiles (NMRLP), on self-reported diet, physical activity, and emotional well-being, and on established physiologic measures of behavioral change.

The effectiveness of the intervention on patient-level behavioral change and additional physiologic measures of increased exercise and improved diet are evaluated for all research study patients at baseline, 4 months, and 10 months.

Specific Aims and Objectives

  1. Develop, from existing materials, sets of culturally appropriate patient education materials to support office-based counseling on behavior change for physical activity, diet, and emotional well-being (depression and anxiety).
  2. Develop, from existing materials, an evidence-based educational/implementation program to improve delivery of effective patient-centered lifestyle counseling during routine office visits.
  3. Evaluate the impact of an evidence-based educational/implementation program using a randomized controlled trial.
    1. Evaluate the effects of encouraging clinicians and office staff to personally use educational tools and how this affects the intervention as delivered to patients.
    2. Evaluate the effectiveness of the intervention on (both primary and secondary) patient-level behavioral change and additional physiologic measures of increased exercise and improved diet.

The AIM-HI Approach

Family physicians play a vital role in encouraging patients to lead healthy lives through physical activity, healthy eating, and emotional well-being. The AIM-HI approach focuses on facilitating a conversation between the physician and their patients.

Timeline

This study was conducted from December 2006 through November 2010.

Status

This project is complete. Please see below for findings and publications from the study.

Contact Information

Principal Investigator for this study is Dr. Wilson D. Pace, MD, Network Director, AAFP NRN.

For additional information on the study, please contact:

Brian K. Manning, MPH
Associate Research Director
AAFP National Research Network
11400 Tomahawk Creek Parkway
Leawood, KS 66211
913-609-6000 x3179 (AAFP)
913-906-6099 (fax)
bmanning@aafp.org

Key Findings and Publications

While many beneficial techniques were employed in the AIM-HI intervention study, preliminary findings indicate that, like the patients they care for, clinicians and staff are resistant to health behavior change. The effect of the AIM-HI intervention on patient care is still unknown; analysis is ongoing.

Access the complete manuscripts:

Outcomes of Biomarker Feedback on Physical Activity, Eating Habits, and Emotional Health: From the Americans in Motion-Healthy Intervention (AIM-HI) Study.(9 page PDF) Nia S. Mitchell, Brian K. Manning, Elizabeth W. Staton, Caroline D. Emsermann, L. Miriam Dickinson, and Wilson D. Pace. J Am Board Fam Med January-February 2014 27:61-69 (http://www.jabfm.org/content/27/1/61.full.pdf+html)

Effectiveness of 2 methods of promoting physical activity, healthy eating, and emotional well-being with the Americans in motion--healthy interventions approach. Pace WD, Lanigan AM, Staton EW, Graham DG, Manning BK, Dickinson M, Stewart EE.AnnFamMed. 2013; 11(4): 371-80.

Use of the Americans in Motion-Healthy Interventions (AIM-HI) Intervention to Create a Culture of Fitness in the Family Practice.(7 page PDF) Erskine J, Lanigan AM, Emsermann CB,et al. J Am Board Fam Med. 2012;25(5):694-700.

Encouraging Patients to Change Unhealthy Behaviors With Motivational Interviewing.(5 page PDF) Stewart EE, Fox C. Fam Pract Manag. 2011;18(3):21-25.

4 Strategies for Promoting Healthy Lifestyles in Your Practice.(5 page PDF) McAndrews JA, McMullen S, Wilson SL. Fam Pract Manag. 2011;18(2):16-20. 


This project was funded by a grant from the Pepsico Foundation.