The purpose of this study is to evaluate the effectiveness of an intervention framed within the Health Promotion Model (Pender, 1996) in changing the health-related behaviors of insufficient physical activity and poor diet among an underserved and vulnerable population of rural women aged 50 to 69. Women's health risks increase at menopause, but chronic diseases and their associated disability and economic costs are not an inevitable consequence of aging. It has been demonstrated that lifestyle choices play a greater role than genetics in determining how well one ages. The Healthy People 2010 objectives reflect consensus that midlife and older women should reduce consumption of dietary fat, increase consumption of fruits, vegetables, and grain products, and engage regularly in moderate intensity physical activity and in activities that enhance muscular strength, muscular endurance and flexibility to reduce risk for many chronic diseases. A randomized by group controlled trial will evaluate prospectively whether 110 women who receive a theory-based intervention tailored to constructs in the HPM will be more successful than 110 who receive a standard intervention in initiating and maintaining long-term change in physical activity and healthy eating behaviors. The theory-based intervention will include individualized plans of action and newsletters with content tailored to HPM constructs; the standard intervention will include customary instructional materials arranged in non-tailored newsletter format. The project's aims are to: 1) compare the effectiveness of an HPM-tailored and a standard (non-tailored) intervention in facilitating initiation (3, 6 mo.) and maintenance (9, 12, 18, 24 mo.) of change in physical activity and healthy eating (as measures by behavioral and biomarkers); 2) compare the effectiveness of an HPM-tailored and a standard intervention in facilitating change in behavior-specific influences from the HPM (perceived benefits, perceived barriers, perceived self-efficacy and interpersonal influences) at 6 &12 months during the intervention and at 18 &24 months following the intervention.; and 3) determine the extent to which HPM variables: individual characteristics and experiences (prior related behavior, age, health/functional status and readiness for behavior change) and behavior-specific influences (perceived benefits, barriers, self-efficacy and interpersonal influences) explain and predict the initiation and maintenance of physical activity and healthy eating. Innovative features of the study are: a) targeting of under-served rural women, b) creative approaches to reach these women c) simultaneous focus on two behaviors, d) multiple points of intervention over 1 year to allow time for incorporation of behavior change into lifestyle, e) evaluation of maintenance of behavior change over 2 years, and f) technologically advanced use of the Intranet to obtain assessment data and computer algorithms to generate tailored newsletters.
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