COLUMBUS, Ohio - When researchers asked prospective study participants who they would like to see in videos promoting healthy lifestyle behaviors, the answer was unequivocal: They wanted to see themselves - that is, other mothers living in low-income households who were overweight or obese.
The researchers obliged. And the intervention they designed produced the desired results when it came to improving participants' diet. As a group, the women in the study who watched the videos and talked to their peers over 16 weeks were more likely to have reduced their fat consumption than women in a comparison group who were given print materials about lifestyle change.
The participants were women who face stubborn health challenges - highly stressed overweight low-income mothers of young children who, for example, tend to retain 10 or more pounds of pregnancy weight after childbirth and are likely to eat high-fat foods. They are at risk for life-long obesity and potential problems for themselves and new babies if they become pregnant again.
"I asked them during focus groups who should be in the videos, and they said, 'We want to see us. And our children. Do not lie to us and hire professionals, because we'll be able to tell,'" said Mei-Wei Chang, lead author of the study and associate professor of nursing at The Ohio State University.
"They said, 'We want to see them before the change and the struggles they had, and what happened after that.'"
Chang and colleagues identified two factors that led to the intervention's success: The study was designed to appeal to the participants' personal values and instill in these mothers enough confidence to take on the challenge of living a healthier life.
"My experience with this population is that they really want to make a change. Some might perceive that they don't want to. But they do - they just don't know how to," Chang said.
The research is published online in the journal Appetite and will appear in the August print issue.
The two psychosocial factors Chang and colleagues examined in this study are known as autonomous motivation (what's important in a person's life) and self-efficacy (a person's confidence in her ability to carry out a behavior or task). Previous research has shown that poverty can lead to low self-efficacy.
Autonomous motivation differs by population. In this study, the participants told researchers in focus groups before the intervention began that they wanted to be role models for their children. They hoped to be less stressed and happier, and to maintain good family relationships.
Chang recruited participants from the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), which serves low-income pregnant, postpartum and breastfeeding women and children up to age 5. Those eligible for the program must have an annual household income no higher than 185 percent of the federal poverty line.
The mothers were between the ages of 18 and 39 and their body mass index ranged from 25.0 to 39.9 - from the lowest indicator of being overweight to just below the extreme obesity range. The intervention was aimed at preventing weight gain by promoting stress management, healthy eating and physical activity. This study analyzed only the diet-related results.
During the trial, the 212 participants randomized into the intervention group watched a total of 10 videos in which women like them gave testimonials about healthy eating and food preparation, managing their stress and being physically active.
In the videos, the women wore casual clothes and told their stories, unscripted. They demonstrated meal prep with familiar foods and showed that simple, practical steps - like reading food labels - could gradually lead to a healthier lifestyle.
"They talked about a lot of things I didn't know," said Chang, who has worked with women enrolled in WIC for about 20 years. "They spoke their mind about what was important - like how they mentally dealt with changing behavior but not losing weight. And about being afraid to fail."
The participants also dialed in to 10 peer support group teleconferences over the course of the study.
In phone interviews, the researchers asked the mothers about what they were eating, their confidence in sticking to a low-fat diet and why they wanted to eat more healthfully.
Based on those surveys, the researchers determined that, compared to the group reading print materials, the mothers who watched videos and spoke with their peers reported larger increases in autonomous motivation and self-efficacy and a more significant decrease in fat intake after the 16-week intervention.
"Essentially, they said, 'If she could do it, I could do it.' That's why we used peers to develop the intervention," Chang said.
The researchers are still analyzing data related to physical activity results, and have found that the intervention's emphasis on coping self-efficacy helped reduce participants' stress. The videos are now part of WIC's continuing education series for mothers.
This work was supported by the National Institutes of Health.
Co-authors included Alai Tan and Duane Wegener from Ohio State and Jiying Ling and Lorraine Robbins from Michigan State University.
Contact: Mei-Wei Chang, Chang.firstname.lastname@example.org; 614-247-7211
Written by Emily Caldwell, Caldwell.email@example.com; 614-292-8152