The POWERPLAY workplace physical activity and nutrition

5 downloads 0 Views 287KB Size Report
Jul 14, 2015 - promotion intervention focusing on physical activity and healthy eating in male-dominated rural and ..... Godin Leisure-Time Exercise Questionnaire—GLTEQ [38]. ..... questionnaire: 12-country reliability and validity, Med. Sci.
Contemporary Clinical Trials 44 (2015) 42–47

Contents lists available at ScienceDirect

Contemporary Clinical Trials journal homepage: www.elsevier.com/locate/conclintrial

The POWERPLAY workplace physical activity and nutrition intervention for men: Study protocol and baseline characteristics Cristina M. Caperchione a,b,⁎, Paul Sharp b, Joan L. Bottorff b, Sean Stolp b, John L. Oliffe c, Steven T. Johnson d, Margaret Jones-Bricker e, Sally Errey f, Holly Christian g, Theresa Healy h, Kerensa Medhurst e, Sonia Lamont i a

School of Health and Exercise Sciences, University of British Columbia, Kelowna, Canada Institute for Healthy Living and Chronic Disease Prevention, University of British Columbia, Kelowna, Canada School of Nursing, University of British Columbia, Vancouver, Canada d Centre for Nursing and Health Studies, Athabasca University, Edmonton, Canada e Canadian Cancer Society, British Columbia & Yukon Division, Prince George, Canada f Prevention Programs, British Columbia Cancer Agency, Williams Lake, Canada g Population Health Department, Northern Health, Fort St. John, Canada h Population Health Department, Northern Health, Prince George, Canada i Prevention Programs, British Columbia Cancer Agency, Vancouver, Canada b c

a r t i c l e

i n f o

Article history: Received 29 April 2015 Received in revised form 7 July 2015 Accepted 12 July 2015 Available online 14 July 2015 Keywords: Physical activity Healthy eating Men Rural and remote Gender-sensitive workplace intervention Feasibility

a b s t r a c t Many health promotion programs hold little “manly” appeal and as a consequence fail to influence men's self-health practices. That said, the workplace can provide an important delivery point for targeted health promotion programs by supporting positive aspects of masculinity. The purpose of this article is to, a) describe the intervention design and study protocol examining the feasibility of a gender-sensitive workplace health promotion intervention focusing on physical activity and healthy eating in male-dominated rural and remote worksites, and b) report baseline findings. This study is a non-randomized quasi-experimental intervention trial examining feasibility and acceptability, and estimated intervention effectiveness. The POWERPLAY program was developed through consultations with men and key workplace personnel, and by drawing on a growing body of men's health promotion research. The program includes masculine print-based messaging, face-to-face education sessions, friendly competition, and self-monitoring concerning physical activity and healthy eating. Male participants (N = 139) were recruited from four worksites in northern British Columbia, Canada. Baseline data were collected via computer assisted telephone interview (CATI) survey which assessed physical activity, dietary behavior and workplace environment. This protocol will also be used to collect follow-up data at 6 months. A process evaluation, using semi-structured interviews, will be undertaken to assess feasibility and acceptability among participants and worksites. Study outcomes will guide intervention refinement and further testing in a sufficiently powered randomized control trial. © 2015 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

1. Introduction It has well been established that regular physical activity (PA) and healthy eating are associated with decreased prevalence of chronic disease (e.g., cardiovascular disease, some cancers, type 2 diabetes, obesity and poor mental health) and premature mortality [1–4]. Engaging men in the aforementioned health promoting behaviors, however, remains a public health challenge [5–8]. In general, men are less aware of the links between diet, PA and ill-health, less willing to attend lifestyle-related education sessions, and are less interested in information concerning disease prevention compared to women [9]. Furthermore, a large ⁎ Corresponding author at: School of Health and Exercise Sciences, University of British Columbia, 33333 University Way, RHS 117, Kelowna, BC V1V 1V7, Canada. E-mail address: [email protected] (C.M. Caperchione).

proportion of men do not meet the recommended PA guidelines [10, 11] (150 min or more of moderate intensity PA per week) and have poor eating behaviors, consisting of low consumption of vegetables and fruit and high intake of fat [7,12]. This trend is more prevalent in rural communities with greater isolation and less accessibility to PA opportunities and healthy food options [13,14]. Northern British Columbia (BC), Canada, is a regional area of the province comprising many isolated rural and remote communities. Men in these communities report some of the lowest levels of PA and fruit and vegetable consumption, and the highest levels of fat intake, alcohol consumption and tobacco use, compared to rural-dwelling women and the whole of BC [15,16]. Moreover, the prevalence of all cancers, cardiovascular disease, hypertension, asthma and chronic obstructive pulmonary disorder (COPD) is highest among men from Northern BC in comparison to other regions in the province [15,16].

http://dx.doi.org/10.1016/j.cct.2015.07.013 1551-7144/© 2015 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

C.M. Caperchione et al. / Contemporary Clinical Trials 44 (2015) 42–47

Thus, men from Northern BC are recognized as an unhealthy and ‘hard to reach’ population who would benefit from targeted effectual programs to engage them in healthy lifestyle behaviors, such as PA and healthy eating. Within this context, gender-specific programs that integrate locale specific masculine values and virtues are a lynchpin to engaging men with their health [17–20]. In Northern BC, masculine norms including competitiveness and resilience are often deeply linked to men's paid work [21]. For example, mining, forestry and transport sectors predominately employ men, many of whom take on physically demanding and isolated work. Hence, beyond being men-centered, health promotion programs also need to be locale specific to engage potential end-users [22]. The goal of the POWERPLAY program is to improve PA and healthy eating behaviors by designing and evaluating innovative strategies that specifically address the unique needs of men living and working in rural and remote communities in Northern BC, Canada. This workplace program was built in response to the large, male-dominated workplaces located in the North, and previous research demonstrating that workplaces are an effective setting for improving PA and healthy eating behaviors in adults [23–25], and particularly in men [8,20]. The over-arching aim of the study was to examine the feasibility and acceptability of the POWERPLAY program, however, the specific objective of this paper is to describe the intervention design and study protocol, and report baseline characteristics. 2. Methods 2.1. Study design This study is based on a quasi-experimental pre-post design to evaluate the feasibility and acceptability of a gender-sensitive workplace health promotion program focused specifically on PA and healthy eating in male-dominated worksites in rural and remote communities. The study period extends September 2014 to July 2015. Recruitment and baseline measures were assessed in the fall of 2014, and post-program measures will be completed in June 2015. Process evaluation measures will be completed in July 2015. Baseline and follow-up measures will be conducted via a computer assisted telephone interview (CATI) survey and process evaluation data will be collected via semi-structured interviews. Participants provided informed consent prior to participation. 2.2. Study population, recruitment and eligibility Participants were recruited from male-dominated workplaces located in Northern BC, Canada. Worksites were selected based on their size (i.e., N200 employees), proportion of male employees (i.e., N50%), and their existing relationships with community partners and research team members. Four workplaces agreed to participate including two transport companies, a shipping terminal, and a regional municipality. Eligible participants were males 18 years of age or older who lived in the northern region and were employed by one of the four selected workplaces. As this study is based on a quasi-experimental pre-post design, and all participants will receive the intervention, there was no randomization and the study was not blinded. Recruitment at each workplace included a number of strategies. For example, posters were designed to raise workplace awareness about the launch of the POWERPLAY program. Gender-sensitive messaging and imagery were used to entice men to consider their own health behaviors and participate in the program. Themes for posters included staying healthy to keep up with their kids and being a provider for their family — as these had been identified as relatable messages to the target audience. Prior to the start of the program, information sessions were held at each worksite to introduce the program. To further attract participation, confidential workplace health screenings (i.e., blood pressure and heart rate) were provided by nurses.

43

Information collected from the health screening were not used as an outcome measure for the program, rather as an opportunity to raise men's awareness levels about their health behaviors and to use any information to support them to make small changes toward improving their health. Additional information about the program was provided and men were invited to sign up to be contacted by phone to participate in the program. Program sign-up sheets were left after each session for any additional men to consent to being contacted. Rolling recruitment occurred between September 2014 and October 2014. 2.3. Intervention The POWERPLAY program was designed on the basis of our systematic review of PA interventions in males [5], focus group consultations with men and community partners, and existing literature concerning PA and healthy eating behaviors in men [6,8,26,27]. In addition, in designing the program we drew on established gender-related factors influencing men's health and health promotion [28–30], and genderspecific promotional and delivery strategies found to be successful in promoting men's health including the use of activity-led interventions, self-monitoring, stimuli to increase PA such as friendly-competition and social interaction, and positive messaging [6,22,31]. The POWERPLAY program is comprised of a suite of resources including promotional materials, educational materials, booklets for selfmonitoring, and implementation resources (e.g., weekly Toolbox Tips, tracking posters, team logbooks). Participants were also encouraged to progressively increase their PA levels and engage in healthy eating (e.g., increase vegetable and fruit intake) by participating in two challenges that focused on different strategies and approaches to increasing these behaviors. Both challenges included friendly competition between employees as well as tools (e.g., resources for tracking progress, pedometers) to assist with self-monitoring of PA and healthy eating behaviors. All resources and materials were designed to be gender-sensitive, incorporating a masculine look and feel and providing clear messaging around PA and healthy eating. Program components are detailed in Table 1. The POWERPLAY challenges were designed as 6-week modules in which participants engaged in a variety of PA and healthy eating strategies. Each challenge was themed and encouraged friendly competition between workplace-determined teams. The first challenge focused solely on PA. During the first challenge, known as the Northern Circle Route Challenge, participants were required to accumulate enough steps to ‘virtually’ walk around Northern BC, a distance of approximately 3.66 million steps or 2775 km. To assist with this challenge, participants were given a personal pedometer and a My PLAYBOOK booklet (outlined below) and asked to record their daily step counts. Participants were encouraged to accumulate 10,000 steps per day, a goal which has been associated with indicators of good health [32–34]. Educational materials were also included and focused on providing participants with tips for; being active at work, healthy eating on the go, stress management, making healthy drink choices, and PA maintenance. Although POWERPLAY was primarily focused on PA and healthy eating, additional topics such as stress management and alcohol consumption were included for three reasons; 1) during the focus group consultations, the men indicated that they would like these topics to be included, 2) a report on men's health in the study region pointed to the salience of these issues [15], and 3) research has suggested including such topics in health promotion interventions as these are additional risk factors to many chronic diseases [35,36]. All information materials were graphically designed to appeal to men, specifically tailored to include man-friendly language, imagery, and examples. The second challenge, known as the POWER PLAY-OFF Challenge, focused on the accumulation of minutes of PA (rather than steps), as well as meeting a number of pre-determined healthy eating goals. The challenge was designed as a ‘virtual’ hockey game, where minutes

44

C.M. Caperchione et al. / Contemporary Clinical Trials 44 (2015) 42–47

Table 1 Components of the POWERPLAY intervention. Major component

Sub-component

Promotional materials

Teaser promotional posters Facebook page

Educational materials

Tips for being active at work Man meals on the go Stress busting Choose your drink wisely Staying on track Fuel for power Keep your head in the game

Shopping like a pro

Self-monitoring

Implementation support

Keep your stick on the ice My playbook Pedometers Tracking posters Weekly toolbox tips Environmental recommendations Policy changes

Challenges

Great Northern Circle Route challenge Power playoff challenge

of PA were equivalent to time spent on the ice and achieving healthy eating goals were analogous to scoring goals in the game. Healthy eating goals where based on Canada's Food Guide recommendations [37] and other healthy nutrition-related behaviors. There were ten goals in total, including eating; 5 vegetables or fruit in one day, 4 whole grain products in one day, 2 low fat milk products in one day, 3 servings of lean meat or alternatives in one day, as well as, having a soft drink free day, an alcohol free day, a red meat free day, an unhealthy snack free day, and a fast food free day. Information handouts were also included in the POWER PLAY-OFF Challenge, focusing on both PA and healthy eating including fueling your body, limiting alcohol consumption, healthy grocery shopping, and “keeping your stick on the ice” (referring to staying on track). Participants were encouraged to track all PA and eating behaviors in a pocket sized booklet called My PLAYBOOK. The booklet included space to record personal health measures (e.g., blood pressure, blood glucose, cholesterol, etc.), develop challenge goals, create a personal contract, and record weekly challenge data. At the end of each week, participants were required to tear the respective week's tracking log from their PLAYBOOK and return it to a workplace champion. Workplace champions were identified at each worksite to lead the implementation of the program with the support and guidance of a POWERPLAY representative. Program champions emerged at each worksite based on their position within the organization (e.g., wellness committee member, and/or leadership). Workplace champions were encouraged to organize teams and promote friendly competition among participants. Workplace champions were also responsible for collecting participants tracking logs and recording the accumulated total of each team on a graphically designed tracking poster that visually represented progress. The posters were displayed within each workplace so that workplace teams could monitor progress. In the case of a between workplace team challenge, POWERPLAY representatives received accumulated totals from each workplace and posted results on a POWERPLAY specific Facebook page. Champions were encouraged to set up displays and offer informational sessions based on the theme of each week's educational material. Discussion points, learning outcomes, goals, and helpful resources were provided (Toolbox Tips) to assist with preparation and facilitation.

Description - Themed posters to raise awareness for the program and personal health behaviors - Program information, including educational materials and URLs of other health promotion website and resources for further information - Five tips for ways to become more active at work - Strategies for eating healthy on the road or with little time to prepare meals - Common causes of stress and strategies to stay stress free - Sugar content of common beverages and suggestions for healthy alternatives - Tips for staying motivated and maintaining PA - Suggestions for healthy meals that will provide ample sustenance and achieve satiety - Recommendations for consumption of alcoholic beverages - Strategies for limiting alcohol intake - Short and long term effects of alcohol consumption - Strategies for making healthy choices at the grocery store - Suggestions for healthy options - Strategies for maintaining a healthy lifestyle - Pocket size booklet to self-monitor personal progress during the two challenges - Personal step counter provided to participants at the beginning of the program to track walking behavior during the first challenge - Tracking posters to graphically represent teams progress during the two challenges - Weekly discussion points and suggestions for activities provided to workplace champions for presentation during the challenges - Provide consultation with employers on strategies for situationally modifying the built environment to better support PA - Provide consultation with employers on strategies for adapting policies to better support PA and healthy eating - 6-week pedometer based walking challenge - 6-week combined PA and healthy eating challenge

2.4. Baseline measures Baseline measures were collected via computer assisted telephone interview (CATI) survey. All participants who signed up to participate in the survey were contacted by a research assistant trained in CATI. Upon making contact, interviewers identified themselves, verified the telephone number, and obtained informed consent to conduct the telephone interview. Participants were then asked a series of questions concerning demographics, height and weight, PA and healthy eating behaviors (including questions regarding stages of change and selfefficacy for PA and healthy eating), and workplace environment. All interviews were conducted in English and averaged 36 min in duration. If initial contact was unsuccessful, a maximum of 10 call-back attempts were made before declaring a telephone number as “no contact.” Messages were left on the answering machine for the first attempt and eighth attempt if there was no contact or a gap in contact across several attempts. As an incentive and a token of appreciation for participating in the baseline telephone survey, respondents received a $20 gift card in the mail and were entered in a prize draw for a trip to a popular fishing resort (Value of $1000 CDN). Participants were also informed that they would receive another $20 gift card and be entered for an equally valued prize draw if they participated in the second telephone survey following the completion of the POWERPLAY program. Participation in the survey at both time points was open to all men employed at the workplaces and did not require a commitment to participate in the program. 2.4.1. Demographic and anthropometrics Demographic data were collected including: age, place of birth, ethnicity, marital status, education and employment. Self-reported height (in centimeters) and weight (in kilograms) was collected to calculate BMI (kg/m2). Participants were offered information to assist with converting imperial measurements to metric; however, no assistance was provided with how to measure their height or weight. 2.4.2. Physical activity PA participation was assessed through a modified version of the Godin Leisure-Time Exercise Questionnaire—GLTEQ [38]. The GLTEQ is

C.M. Caperchione et al. / Contemporary Clinical Trials 44 (2015) 42–47

a reliable and valid tool [39,40] which asks participants to indicate the frequency and type of intensity (light, moderate, vigorous) of their PA sessions, this was modified to include the duration (minutes) of these sessions [38]. PA levels were calculated using the Met-min method [41]. A cut-off point off ≥600 Met-min was then used to dichotomize participants as either “adequately active for health benefit” or “inadequately active” [41,42]. 2.4.3. Weekly walking minutes Minutes spent walking in a week was assessed through three selected questions from the International Physical Activity Questionnaire [43] (“During the last seven days, on how many of those days did you walk for at least ten minutes at a time: (1) as part of work (2) to go from place to place (3) in your leisure time”). These were preceded by “How much time did you usually spend on one of those days walking (1) as part of work (2) to go from place to place (3) in your leisure time” respectively. 2.4.4. Eating behaviors In open-ended questions, participants were asked to report on how many servings of fruits and vegetables they usually consumed in day, following a similar protocol previous used by Ma et al. [44]. 2.4.5. Stages of change Stages of Change [45] for PA was assessed through a series of four questions with different branching options depending on response. The instrument has previously been evaluated and reported on [46]. The stages of change instrument placed participants either in the preadoption stages (pre-contemplation, contemplation or preparation) or the adoption stages (action or maintenance) [46,47]. Stages of Change for healthy eating was assessed and scored similarly to the stages of change for PA where “regular physical activity” was replaced with “regularly eating 7 or more servings a day of vegetables and fruit”. 2.4.6. Self-efficacy Using a validated measure of the transtheoretical model in an exercise sample [48,49], regular PA self-efficacy was assessed by asking participants “over the next 6 months, how confident are you that you can participate in regular PA on no less than 5 days of the week?” Rated on a Likert scale from “not at all confident” to “extremely confident” (1–5). Healthy eating self-efficacy was assessed through two questions adapted from the Plotinkoff et al. [48] measure. One which asked participants how confident they were in eating two servings of fruit a day and the other asked participants how confident they were in eating five servings of vegetables a day. Both were rated on a five point Likert scale, 1 = not at all confident to 5 = extremely confident. 2.4.7. Workplace environment The Perceived Workplace Environment Scale—PWES [50], a six item five-point Likert scale, was used to determine how supportive the workplace environment is for PA [51,52]. An average score was calculated using all six questions to determine an overall perceived workplace environment score. Reliability and factor analyses supporting a one-dimensional factor structure have previously been reported [51]. 2.5. Follow-up measures Using the same CATI survey protocol to collect baseline data, a follow-up assessment will occur at six months post baseline data collection. All outcome measures assessed at baseline, including; weight, PA and healthy eating behaviors, stages of changes, self-efficacy and workplace environment, will also be assessed at the six month followup time period. Participants will also be invited to participate in a process evaluation (semi-structured interview outlined in Process

45

Measures) to gain further insight concerning the feasibility and acceptability of the POWERPLAY intervention program. 2.6. Statistical analysis Data from pre and post questionnaires will be analyzed using general linear models. Interaction effects of time point and worksite on dependent variables will be assessed. All analyses will be conducted using SPSS for Windows (V.22). The level of significance (α) will be set at 0.05. As the primary outcome is feasibility, a power calculation was not performed. 2.7. Process measures and analysis Following completion of the program, semi-structured interviews will be conducted with the men who participated in the program and the stakeholders who implemented the program. These interviews will be used to explore program feasibility, satisfaction, and challenges of program implementation, and the findings will support any necessary refinements to the program for further testing (RCT) and dissemination. The process evaluation interviews will be audio recorded to ensure accurate transcription of the information. The audio recording will be transcribed verbatim in a non-identifiable form and the recording deleted. Data from the process evaluation interviews with the men and stakeholders will be analyzed using thematic content analysis. To ensure rigor, two members of the research team will independently identify and code participant responses into relevant sub-themes. Once all coding has been completed, the sub-themes will be openly discussed among the two research team members to ensure that bias was minimized. Any disagreements or concerns that may arise during the analysis will be presented at this time and further discussion will be carried out until consensus is reached. This process will occur separately for each unit of analysis — the participants and the stakeholder. 2.8. Baseline characteristics of the sample Across the four worksites, 212 men signed up to participate in the CATI survey. Of these, 139 men were successfully contacted and consented to completing the survey (response rate 68.5%). The proportional distribution was relatively equal across the four worksites (n = 29, 31, 39 and 40). The mean age was 43.7 (SD 12.5), with a range of 18–66 years and a mean BMI of 28.6 kg/m2 (SD 4.1). Engagement in recommended levels of PA (150 min/week of moderate to vigorous PA) was reported by 66.7% of the sample and the daily average number of servings of fruit and vegetables was 3.26 (SD 1.9). With regards to stages of changes for PA, 61.9% of participants were in the action or maintenance stages of participating in regular PA, no significant differences were found between worksites. The majority of participants (92.1%) were in the pre-adoption stages of change for eating healthy. When assessing workplace environment, the average PWES rating across all participants was 2.76 (std. = .894). Table 2 provides a detailed description of the baseline characteristics of the sample. 3. Discussion This article describes the intervention design, study protocol, and baseline characteristics of the POWERPLAY program, a workplace PA and healthy eating intervention specifically designed for men living and working in rural and remote communities. Engaging men in preventive health measures, such as PA and healthy eating can be challenging. Recruitment, for example, of notoriously ‘hard to reach’ men is widely chronicled [53,54], highlighting the need to employ innovative strategies and approaches to peak men's interest and entice them to participate. Specifically tailored and targeted, men-friendly recruitment strategies and approaches are strongly recommended

46

C.M. Caperchione et al. / Contemporary Clinical Trials 44 (2015) 42–47

Table 2 Baseline characteristics of the sample.

Age (years) % Canadian born % Caucasian % married or in a common-law relationship % received a secondary certificate or diploma % annual household income over $60,000 Body Mass Index (kg/m2) % meeting physical activity guidelines Weekly walking (minutes) Weekly Met-minutes Servings of fruit and vegetables consumed per day Self-efficacy for regular physical activity (1–5) Self-efficacy for eating five vegetables a day (1–5) Self-efficacy for eating two servings of fruit a day (1–5) Stages of change—regular PA % pre-contemplation % contemplation % preparation % action % maintenance Stages of change—eating healthy % pre-contemplation % contemplation % preparation % action % maintenance Perceived Workplace Environment Scale

N

M (SD)

139 133 116 99 71 131 139 92 139 138 139 139 139 139

43.7 (12.5) 95.7% 83.5% 71.2% 51% 91.6% 28.6 (4.1) 66.7% 166.67 (182.2) 1764.9 (2039.7) 3.32 (2) 4.14 (.9) 3.31 (1.2) 4.24 (.8)

7 10 36 6 80 65 10 53 1 10 139

5.0% 7.2% 25.9% 4.3% 57.6% 46.8% 7.2% 38.1% 0.7% 7.2% 2.76 (.894)

when trying to re-norm men's masculine ideals toward being proactively involved with their health [6,19,55]. These recommendations, along with previous masculinities and men's health research [28,29,56], affirm our strategies for identifying a particular setting (male-dominated workplaces) and designing gender-sensitive messaging to appeal to the values and virtues of men living and working in rural and remote communities. By messaging and engaging men within environments familiar to them (i.e., the workplace) we were able to engage the men in ways that bypassed men's resistance to health help-seeking and traditional hierarchical interactions synonymous with patient– provider consultations. In addition to recruiting a ‘hard to reach’ population, we were especially interested in targeting men who were recognized as not active (defined as not meeting the PA recommended guidelines of 150 min or moderate-vigorous PA per week) [57]. Although we relayed this priority during the launch sessions (which acted as a primary recruitment method) and via the workplace champions, our baseline characteristics indicate that this was not accomplished given that nearly 67% of our sample met the recommended PA guidelines. In part, this could be a result of men's overestimation, which is common with selfreported physical activity [58,59]; however, we believe that it most likely reflects our broad eligibility criteria and lack of participant screening prior to enrollment. Influenced by much cited challenges about recruiting men in general, and concerns that we might inadvertently shame some particularly vulnerable men, we decided against specifically targeting those who were inactive. In moving forward, the use of a comprehensive screening process prior to participant enrollment, such as a brief screening interview (specific to PA) previously recommended [60,61], could be trialed. It is important to note, however, that although a large proportion of the current study sample were active, the mean BMI of nearly 29 kg/m2 indicated that our sample was predominately overweight/obese, which in turn, are associated with physical inactivity and are well known risk factors for chronic disease development [62,63]. The seemingly discordant relationship between reported PA levels and BMI among the current sample may also indicate, that overall, the men's PA levels did impact their weight status, suggesting that engaging in more physical activity, combined with healthy eating, may be required. This confirms that among

the current relatively active study sample, significant benefit can be garnered from engaging in the POWERPLAY intervention. The current study protocol also provides knowledge concerning effective recruitment strategies and approaches, as well as an estimate of sample size. Feasibility studies, such as the current study protocol, are essential prior to undertaking a sufficiently powered randomized control trial (RCT) as they provide vital information concerning; 1) diverse methods of identifying/recruiting participants; 2) the practicality of delivering men's programs in the workplace; 3) the potential transferability of the program to other settings; 4) the acceptability of the program to the users and 5) an estimate of sample size [64–66]. The outcomes of this feasibility trial have provided us this crucial information, guiding intervention refinement and future program delivery. Of course, the current study protocol is not without its limitations. The intervention described above was designed for men living in communities in northern regions of Canada, thus the program specificities both in terms of content and delivery may not be applicable to working men in other jurisdictions, nor transferable to other groups of men in general. It is important to note, however, that our intervention was designed in conjunction with end-users, thus the design was informed by men, and for men within specific work contexts. Men's health needs and interests can vary, thus it is recommended that when replicating this type of intervention model, participatory action research approaches inclusive of a formative evaluation are carried out with the target population prior to the intervention development and delivery. We acknowledge great diversity among men in Canada, and thus we anticipate that prior to a larger, multi-site dissemination of the POWERPLAY intervention, further formative evaluation is warranted to gain knowledge concerning local, regional and global masculine values and norms to assist with intervention tailoring and refinement. In conclusion, the knowledge gained from the current study protocol provides critical insights regarding the importance of considering specific masculine values when developing recruitment strategies and designing workplace interventions for men. The lessons learned from this study protocol will help with future study refinement and to generate protocol approaches toward ultimately extending the delivery of male-centered health promotion programs to ‘hard to reach’ men's groups.

Abbreviations CATI computer assisted telephone interview PA physical activity BC British Columbia RCT randomized control trial MET metabolic equivalent of task GLTEQ Godin Leisure Time Exercise Questionnaire PWES Perceived Workplace Environment Scale

Acknowledgments This work was supported by the Canadian Cancer Society Research Institute (Grant # 701259-00). The authors would also like to recognize other members of the Men's Healthy Eating and Active Living team for their collective contributions to this project: Cherisse Seaton (University of British Columbia), Megan Klitch (BC & Yukon Cancer Society), Kelsey Yarmish (Northern Health), Haleema Jaffer-Hirji (University of British Columbia) and Andriyana Chychkevych (University of British Columbia). Appendix A. Supplementary data Supplementary data to this article can be found online at http://dx. doi.org/10.1016/j.cct.2015.07.013.

C.M. Caperchione et al. / Contemporary Clinical Trials 44 (2015) 42–47

References [1] I.M. Lee, E.J. Shiroma, F. Lobelo, et al., Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy, Lancet 380 (9838) (2012) 219–229. [2] WHO, Global strategy of diet, physical activity, and health, Diet and Physical Activity: A Public Health Priority. , World Health Organization, Geneva, 2004. [3] L.J. Ignarro, M.L. Balestrieri, C. Napoli, Nutrition, physical activity, and cardiovascular disease: an update, Cardiovasc. Res. 73 (2) (2007) 326–340. [4] L.H. Kushi, C. Doyle, M. McCullough, et al., American Cancer Society Guidelines on nutrition and physical activity for cancer prevention: reducing the risk of cancer with healthy food choices and physical activity, CA Cancer J. Clin. 62 (1) (2012) 30–67. [5] J.L. Bottorff, C.L. Seaton, S.T. Johnson, et al., An updated review of interventions that include promotion of physical activity for adult men, Sports Med. 45 (6) (2014) 775–800. [6] C.M. Caperchione, C. Vandelanotte, G.S. Kolt, et al., What a man wants: understanding the challenges and motivations to physical activity participation and healthy eating in middle-aged Australian men, Am. J. Mens Health 6 (6) (2012) 453–461. [7] P.J. Taylor, G.S. Kolt, C. Vandelanotte, et al., A review of the nature and effectiveness of nutrition interventions in adult males—a guide for intervention strategies, Int. J. Behav. Nutr. Phys. Act. 10 (2013) 13. [8] P.J. Morgan, C.E. Collins, R.C. Plotnikoff, et al., Efficacy of a workplace-based weight loss program for overweight male shift workers: the Workplace POWER (Preventing Obesity Without Eating like a Rabbit) randomized controlled trial, Prev. Med. 52 (5) (2011) 317–325. [9] C. Lee, G.R. Owen, The Psychology of Men's Health. Payne S, Horn S, editors, Open University Press, Philadelphia, 2002. [10] H.W. Kohl III, C.L. Craig, E.V. Lambert, et al., The pandemic of physical inactivity: global action for public health, Lancet 380 (9838) (2012) 294–305. [11] WHO, Global Recommendations on Physical Activity for Health, World Health Organization, Geneva, 2010. [12] J. Wardle, A.M. Haase, A. Steptoe, et al., Gender differences in food choice: the contribution of health beliefs and dieting, Ann. Behav. Med. 27 (2) (2004) 107–116. [13] M.C. Kegler, D.W. Swan, I. Alcantara, et al., The influence of rural home and neighborhood environments on healthy eating, physical activity, and weight, Prev. Sci. 15 (1) (2014) 1–11. [14] S.S. Frost, R.T. Goins, R.H. Hunter, et al., Effects of the built environment on physical activity of adults living in rural settings, Am. J. Health Promot. 24 (4) (2010) 267–283. [15] Northern Health, Where are all the men? in: Department PH (Ed.), Chief Medical Officer's Report on the Health & Wellbeing of Men and Boys in Northern BC, Northern Health Authority, Prince George, 2011. [16] Provinical Health Services Authority, Summary Report on the Health for British Columbia from Regional, Longitudinal and Gender Perspectives, Provincial Health Services Authority, Vancouver, 2010. [17] Northern Health, Northern BC Man Challenge[cited 2015 February 25]; Available from: http://men.northernhealth.ca/2014. [18] A. Wilson-Stronks, K.K. Lee, C.L. Cordero, et al., One Size Does Not Fit All: Meeting the Health Care Needs of Diverse Populations, The Joint Commission, Oakbrook Terrace, IL, 2008. [19] K. Hunt, S. Wyke, C.M. Gray, et al., A gender-sensitised weight loss and healthy living programme for overweight and obese men delivered by Scottish Premier League football clubs (FFIT): a pragmatic randomised controlled trial, Lancet 383 (9924) (2014) 1211–1221. [20] M. Duncan, C. Vandelanotte, G.S. Kolt, et al., Effectiveness of a web- and mobile phone-based intervention to promote physical activity and healthy eating in middle-aged males: randomized controlled trial of the ManUp study, J. Med. Internet Res. 16 (6) (2014) e136. [21] S.E. Coen, J.L. Oliffe, J.L. Johnson, et al., Looking for Mr. PG: masculinities and men's depression in a northern resource-based Canadian community, Health Place 21 (2013) 94–101. [22] J.L. Oliffe, J.L. Bottorff, G. Sarbit, Supporting fathers' efforts to be smoke-free: program principles, Can. J. Nurs. Res. 44 (3) (2012) 64–82. [23] L. Quintiliani, J. Sattelmair, G. Sorensen, The Workplace as a Setting for Interventions to Improve Diet and Promote Physical Activity, World Health Organization, Geneva, 2007. [24] V.S. Conn, A.R. Hafdahl, P.S. Cooper, et al., Meta-analysis of workplace physical activity interventions, Am. J. Prev. Med. 37 (4) (2009) 330–339. [25] A.D. Hutchinson, C. Wilson, Improving nutrition and physical activity in the workplace: a meta-analysis of intervention studies, Health Promot. Int. 27 (2) (2012) 238–249. [26] E.S. George, G.S. Kolt, M.J. Duncan, et al., A review of the effectiveness of physical activity interventions for adult males, Sports Med. 42 (4) (2012) 281–300. [27] P.J. Morgan, J.M. Warren, D.R. Lubans, et al., Engaging men in weight loss: experiences of men who participated in the male only SHED-IT pilot study, Obes. Res. Clin. Pract. 5 (3) (2011) e169–e266. [28] W.H. Courtenay, Constructions of masculinity and their influence on men's well-being: a theory of gender and health, Soc. Sci. Med. 50 (10) (May 2000) 1385–1401. [29] S. Robertson, Understanding Men and Health: Masculinities, Identity and Well-being, Open University Press, Buckingham, 2007. [30] W. Courtenay, Dying to be Men: Psychological, Environmental, and Behavioral Directions in Promoting the Health of Men and Boys, Routledge Taylor & Francis Group, New York: NY, 2011. [31] A. Pringle, S. Zwolinsky, J. McKenna, et al., Delivering men's health interventions in English Premier League football clubs: key design characteristics, Public Health 127 (8) (Aug 2013) 716–726.

47

[32] C. Tudor-Locke, B.E. Ainsworth, M.C. Whitt, et al., The relationship between pedometer-determined ambulatory activity and body composition variables, Int. J. Obes. Relat. Metab. Disord. 25 (11) (Nov 2001) 1571–1578. [33] C. Tudor-Locke, D.R. Bassett Jr., How many steps/day are enough? Preliminary pedometer indices for public health, Sports Med. 34 (1) (2004) 1–8. [34] E.M. Murtagh, M.H. Murphy, J. Boone-Heinonen, Walking: the first steps in cardiovascular disease prevention, Curr. Opin. Cardiol. 25 (5) (Sep 2010) 490–496. [35] E.B. Kahn, L.T. Ramsey, R.C. Brownson, et al., The effectiveness of interventions to increase physical activity. A systematic review, Am. J. Prev. Med. 22 (4 Suppl) (May 2002) 73–107. [36] J.J. Prochaska, J.O. Prochaska, A review of multiple health behavior change interventions for primary prevention, Am. J. Lifestyle Med. 5 (3) (May 2011). [37] Health Canada, Eating Well with Canada's Food Guide, in: Canada H (Ed.), 2011 (Ottawa, ON). [38] G. Godin, R.J. Shephard, A simple method to assess exercise behavior in the community, Can. J. Appl. Sport Sci. 10 (3) (1985) 141–146. [39] G. Godin, R.J. Shephard, Godin leisure-time exercise questionnaire, Med. Sci. Sports Exerc. 29 (6 s) (1997) S36. [40] G. Godin, J. Jobin, J. Bouillon, Assessment of leisure time exercise behavior by self-report: a concurrent validity study, Can. J. Public Health 77 (5) (1986) 359–362. [41] W.J. Brown, A.E. Bauman, Comparison of estimates of population levels of physical activity using two measures, Aust. N. Z. J. Public Health 24 (5) (2000) 520–525. [42] R.C. Plotnikoff, S.T. Johnson, C.A. Loucaides, et al., Population-based estimates of physical activity for adults with type 2 diabetes: a cautionary tale of potential confounding by weight status, J. Obes. 2011 (2011). [43] C.L. Craig, A.L. Marshall, M. Sjostrom, et al., International physical activity questionnaire: 12-country reliability and validity, Med. Sci. Sports Exerc. 35 (8) (2003) 1381–1395. [44] J. Ma, N.M. Betts, T. Horacek, et al., Assessing stages of change for fruit and vegetable intake in young adults: a combination of traditional staging algorithms and food-frequency questionnaires, Health Educ. Res. 18 (2) (2003) 224–236. [45] J.O. Prochaska, C.C. DiClemente, Stages and processes of self-change of smoking: toward an integrative model of change, J. Consult. Clin. Psychol. 51 (3) (1983) 390–395. [46] S.C. Dumith, D.P. Gigante, M.R. Domingues, Stages of change for physical activity in adults from Southern Brazil: a population-based survey, Int. J. Behav. Nutr. Phys. Act. 4 (2007) 25. [47] C.R. Nigg, There is more to stages of exercise than just exercise, Exerc. Sport Sci. Rev. 33 (1) (2005) 32–35. [48] R.C. Plotnikoff, S.B. Hotz, N.J. Birkett, et al., Exercise and the transtheoretical model: a longitudinal test of a population sample, Prev. Med. 33 (5) (Nov 2001) 441–452. [49] R.C. Plotnikoff, C. Blanchard, S.B. Hotz, et al., Validation of the decisional balance constructs of the transtheoretical model in the exercise domain: a longitudinal test in a population sample, Meas. Phys. Educ. Exerc. Sci. 5 (4) (2001) 191–206. [50] R.C. Plotnikoff, T.R. Prodaniuk, A.J. Fein, et al., Development of an ecological assessment tool for a workplace physical activity program standard, Health Promot. Pract. 6 (4) (2005) 453–463. [51] T.R. Prodaniuk, R.C. Plotnikoff, J.C. Spence, et al., The influence of self-efficacy and outcome expectations on the relationship between perceived environment and physical activity in the workplace, Int. J. Behav. Nutr. Phys. Act. 1 (1) (2004) 7. [52] Y.P. Lin, T.S. Kao, M.C. McCullagh, et al., Translation and psychometric properties of the Chinese version of the perceived workplace environment scale in Taiwanese information technology professionals, J. Occup. Health 54 (3) (2012) 223–231. [53] A. Deeks, C. Lombard, J. Michelmore, et al., The effects of gender and age on health related behaviors, BMC Public Health 9 (2009) 213. [54] P. Carroll, L. Kirwan, B. Lambe, Engaging ‘hard to reach’ men in community based health promotions, Int. J. Health Promot. Educ. 52 (3) (2014) 120–130. [55] C.E. Foster, G. Brennan, A. Matthews, et al., Recruiting participants to walking intervention studies: a systematic review, Int. J. Behav. Nutr. Phys. Act. 8 (2011) 137. [56] W. Courtenay, Making health manly: social marketing and men's health, J. Men Health Gender 1 (2–3) (2004). [57] M.S. Tremblay, D.E. Warburton, I. Janssen, et al., New Canadian physical activity guidelines, Appl. Physiol. Nutr. Metab. 36 (1) (Feb 2011) 36–46 (7–58). [58] S.A. Prince, K.B. Adamo, M.E. Hamel, et al., A comparison of direct versus self-report measures for assessing physical activity in adults: a systematic review, Int. J. Behav. Nutr. Phys. Act. 5 (2008) 56. [59] J.F. Sallis, B.E. Saelens, Assessment of physical activity by self-report: status, limitations, and future directions, Res. Q. Exerc. Sport 71 (2 Suppl) (Jun 2000) S1–S14. [60] M.J. Duncan, C. Vandelanotte, R.R. Rosenkranz, et al., Effectiveness of a website and mobile phone based physical activity and nutrition intervention for middle-aged males: trial protocol and baseline findings of the ManUp Study, BMC Public Health 12 (2012) 656. [61] W.J. Chodzko-Zajko, B. Resnick, M.G. Ory, Beyond screening: tailoring physical activity options with the EASY tool, Transl. Behav. Med. 2 (2) (Jun 2012) 244–248. [62] P.T. Katzmarzyk, S.A. Lear, Physical activity for obese individuals: a systematic review of effects on chronic disease risk factors, Obes. Rev. 13 (2) (Feb 2012) 95–105. [63] A.H. Mokdad, E.S. Ford, B.A. Bowman, et al., Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001, JAMA 289 (1) (Jan 1 2003) 76–79. [64] M. Arain, M.J. Campbell, C.L. Cooper, et al., What is a pilot or feasibility study? A review of current practice and editorial policy, BMC Med. Res. Methodol. 10 (2010) 67. [65] G. Hubbard, A. Campbell, Z. Davies, et al., Experiences of recruiting to a pilot trial of Cardiac Rehabilitation in patients with bowel cancer (CRIB) with an embedded process evaluation: lessons learned to improve recruitment, Pilot Feasib. Studies 1 (15) (2015). [66] S.S. Tai, S. Iliffe, Considerations for the design and analysis of experimental studies in physical activity and exercise promotion: advantages of the randomised controlled trial, Br. J. Sports Med. 34 (3) (Jun 2000) 220–224.