The purpose of this investigation is to develop and evaluate a computer assisted instruction (CAI) weight management program in an adult population with low literacy at Sheehan Memorial Hospital's Family Care Center (FCC), an outpatient clinic serving the inner city of Buffalo, New York. The CAI will feature voice recognition, giant cursor movement, and a graphics-based environment using pictures to facilitate an exceptionally easy to use and understand software program and booklet. The voice recognition technology will be linked with compact disk read only memory (CD ROM) to visually display food choices and physical activities for ease of recording data by the individual. The software will be formatted so that health professionals may select preference levels which correspond to the motivational level of the individual. The four-session CAI intervention will have two planned maintenance sessions. The output will be personalized and in color. It will be designed to identify problematic foods in the diet, improve food selections, and increase physical activity. Stars will be printed for adherence to individual goals. One hundred and fifty (150) men and 150 women, between age 20 and age 44, with a reading level of 8th grade or less, who are between 20 percent and 40 percent over their ideal body weight, will be randomly assigned to three groups. The design compares a control group without the intervention, a group experiencing the CAI intervention and hands-on computer use, and a group experiencing the intervention but not the CAI component or computer use. All groups will be pretested, posttested, and follow-up tested at six months and twelve months following baseline. The primary outcome measures will be weight loss, nutrient intake, and physical activity. Data will be analyzed using a two-way analysis of covariance and appropriate t-tests. This will be a first study in patient care informatics in which nutrient analysis methodology will be used on a day-to-day basis to motivate low literate individuals to improve their food choice behavior and physical activity. The deliverables of this investigation include revised and enhanced software, professional documentation, and a participant workbook. These materials will be designed so that they can be integrated into any risk factor reduction program for low literacy populations.
