Building Strong and Ready Army Families: A Multirisk Reduction Health Promotion Pilot Study

Military Medicine, Mar 2005 by Niederhauser, Victoria P, Maddock, Jay, LeDoux, Francine, Arnold, Martin

A quasi-experimental prospective study was conducted to assess the stage of change progression and elimination of unhealthy behaviors among active duty Army soldiers and their spouses (N = 245) before and after attending a community-based wellness program. Significant differences in stage progression between the intervention group and a comparison group was seen in the fitness (p = 0.05) and communication risk categories (p = 0.03) immediately after the intervention; significant differences in stage progression in fitness (p = 0.05) and spirituality (p = 0.005) risk categories 6 months after baseline. There was a significant increase in seat belt use (p = 0.008), a decrease in reported tobacco use (p

Introduction

Risk behaviors adversely affect health and wellness. Unhealthy behaviors have been shown to decrease longevity and to adversely affect physical and mental health. It is estimated that almost two-thirds of premature deaths are linked to one or more modifiable health risk behaviors (HRB).1 In fact, many people are at risk for more than one health behavior.

The health of our active duty Army soldiers is critical to the security of the United States. Combat readiness is dependent on soldiers who are physically and psychologically ready to face the challenges inherent in operational missions and frequent deployments. Beginning in the 1980s, the Department of Defense (DoD) implemented programs to reduce HRB first in active duty personnel and later in beneficiaries of active duty personnel.2,3 Implied in these initiatives is the assertion that the combat readiness of our troops is enhanced when the spouse left behind is healthy and confident in his/her ability to care for self and family. Furthermore, marital relationships involving active duty Army soldiers are affected by stresses related to operational commitments and increasing tension with world events.4 A soldier needs to be "ready" to deploy to dangerous assignments on a few week's notice. The spouses' physical and mental health contributes to this readiness.5,6

Most traditional models of care focus on the resulting condition caused by risk behaviors rather than the proactive focus on prevention through behavior change, thus reducing or eliminating unhealthy behaviors. Behavior change for unhealthy behaviors and healthy lifestyles acquisition is a dynamic, iterative process.7 The lifestyles and unhealthy behaviors of soldiers and their spouses can put them "at risk" for acute and chronic illnesses. Many engage in more than one unhealthy behavior.8-10 Therefore, interventions aimed at healthy lifestyle promotion and change for multiple risk behaviors can positively impact health and wellness.

Multiple Intervention Studies

Individuals are often at risk for more than one behavior; however, the majority of intervention research is focused on individual behaviors.11 For individuals with multiple risks, health risks also increase dramatically.12 Interventions for multiple behaviors may have synergistic effects on outcomes if similar theoretical models are used.

The purpose of this article was to describe a community-based health promotion intervention aimed at reduction of multiple unhealthy behaviors in Army soldiers and their spouses and to report the results of a pilot study examining readiness to change and health behavior risk reduction outcomes for participants.

The Transtheoretical Model (TTM)

The conceptual framework for this pilot study was the TTM of change. The strength of the TTM is its focus on the dynamic nature of health behavior change. The stages of change (SOC) are used as a framework to describe the temporal aspect of the adoption and maintenance of healthy behaviors. Individuals modifying a given behavior move through a series of five motivational stages, from precontemplation to maintenance.7

"Precontemplation" is when an individual has no intention to change his/her behavior in the near future, usually measured as the next 6 months. Individuals in the "contemplation" stage openly state their intent to change within the next 6 months. In the "preparation" stage, individuals plan on changing, usually within the next 30 days. Preparers may have already made minor adjustments in their thought patterns and behaviors, but have not reached the predetermined "action" criteria. In the action stage, an individual has made overt, perceptible lifestyle modifications for fewer than 6 months, and those in the "maintenance" stage are working to prevent relapse and consolidate gains secured during action.7,13,14

Methods

A quasi-experimental prospective study was conducted between October 2000 and December 2001 to examine differences between intervention and comparison groups for several health behaviors and improvement in SOC. The sample consisted of active duty infantry soldiers and their spouses. Soldiers were eligible if they were married, assigned to the 25th Infantry Division (Light) Artillery, Schofield Barracks, Hawaii, and were willing to participate in the full program. The initial plan was to randomize eligible couples into intervention and comparison groups; however, the brigade commanders requested that all soldiers that were in a certain training schedule attend the program. As a result, participants were chosen by the 25th Infantry Division (Light) Artillery leadership. The comparison group came from the same brigade and leadership and only differed by training schedule. This program was highly appealing to soldiers because they earned promotion points for attendance in the full program, received time off from work (4 days) to attend the program, and the last session was an overnight stay for the participants at a hotel in Waikiki. This led to all eligible soldiers enrolling in the program. Participants in the comparison group were given a $20 long-distance calling card after each data collection session and were able to attend the program at the end of the study.