The EPRC core research, funded by the CDC, included the Healthy Rural Communities study, which qualitatively and quantitatively explored the relationships between diet, physical activity, and tobacco use across three settings (home, church, and worksite). These studies informed the development and testing of a coach based intervention to prevent weight gain among adults in South Georgia. The intervention, called Healthy Homes/Healthy Families, is an environmental change intervention. Coaches work with families to make changes in their home so that both their social and physical home environments are more supportive of healthy eating and physical activity.
Our first Healthy Homes/Healthy Families trial began in early 2011 and was completed in the summer of 2013. Participants randomized to the intervention group were coached by community health workers trained by the EPRC and the Cancer Coalition of South Georgia (now named Horizons Community Solutions). The 5-month intervention was delivered through 3 home visits, 4 coaching calls, and 4 mailings of support materials. Coaches use two primary tools to guide families into creating healthier home environments: a Home Environment Profile, which is tailored to each home using baseline data, and a menu of Healthy Actions, which consists of strategies to make the home more supportive of healthy eating and physical activity. Participants randomized to the control group received 3 mailings of health education materials related to diet and physical activity. Data were collected via telephone interviews at baseline and at 6 and 12 months post baseline using a home environment survey, two 24 hour dietary recalls, and a physical activity recall. Additionally, we collected objective physical activity data using accelerometers.
We saw significant changes in the home environment and food related behaviors of participants in the study. More recently, we completed a pilot and feasibility trial to adapt this intervention for telephone-based delivery with 2-1-1 clients. Results from this trial showed a significant increase in the Healthy Eating Index, a decrease in kcals per day and self-reported weight, changes in household food inventories, family meals from non-home sources (e.g. less eating out), and more.
The EPRC’s Healthy Homes/Healthy Families is a research tested environmental change intervention designed to prevent weight gain by modifying the home environment. The original Healthy Homes/Healthy Families intervention was tested among adults in South Georgia and focused on decreasing energy intake and increasing physical activity. Coaches worked with families to make changes in their home so that it was more supportive of healthy eating and physical activity. The intervention was 16 weeks and included home visits.
More recently, the EPRC partnered with United Way of Greater Atlanta 2-1-1 to adapt Healthy Homes/Healthy Families for an urban 2-1-1 population. The adaptation focused on the home food environment, excluding the physical activity component. The adapted intervention included 6 coaching calls and 6 text messages, delivered weekly, reducing the intervention from 16 weeks to 12 weeks.
We finished testing the feasibility of our Healthy Homes/Healthy Families 2-1-1 intervention in 2017. One hundred participants were recruited and pre-screened by 2-1-1 community connection specialists. Emory staff then attempted to contact potential participants to confirm eligibility, obtain verbal consent, and complete one of two baseline interviews. Each participant received the 12-week intervention, delivered by trained health coaches. Similar to the original Healthy Homes/Healthy Families intervention, coaches promoted healthy eating by using two primary tools to guide families into creating healthier home environments: a Home Food Environment Profile and a menu of Healthy Actions. The Home Food Environment Profile is tailored to each home using baseline data, and the menu of Healthy Actions consist of strategies to make the home more supportive of healthy eating. Data were collected via two telephone 24-hr dietary recalls at baseline and again at four months, a home environment follow-up survey, and post-intervention qualitative interviews.
Next, we will conduct a hybrid effectiveness-implementation trial with four 2-1-1 agencies, in Albany, Macon, Columbus, and Atlanta. This will help us better assess whether this adaptation is effective and how to best integrate a prevention program like Healthy Homes/Healthy Families into 2-1-1 systems.