A Multilevel Influence Approach

Pause Well works to reduce the prevalence of chronic disease and improve or stabilize disease risk markers in its participants by utilizing the socioecological framework that includes individual, interpersonal, and community levels of influence.

Individual: In-person lessons offer a personalized approach, encouraging participants to set unique goals as they improve their nutrition knowledge, attitudes, and skills through multimedia lectures, interactive activities, take-home supplemental materials, and a private Facebook group page. The FB page includes a weekly live Q&A with the program leader, recipes, cooking demo videos, adherence tips, shopping lists, and other action materials to help participants achieve their SMART goals.

Interpersonal: The in-person lessons include partnering and group activities to cultivate a supportive network among the participants. Also, participants are assigned a "PW Buddy" for support between lessons. PW Buddies share their SMART goals during lessons, then hold each other accountable by checking in with each other at least once weekly throughout the following month as they gradually implement dietary changes. In addition to providing supplemental action materials, the FB page initiates social support by encouraging participants to share and "like" successes, challenges, and tips.

Community: The program's promotional aspect raises healthcare providers', yoga studio managers', and yoga students' awareness of the essential need for targeted nutrition education that addresses women's changing needs during and after menopause and encourages them to promote our program and others like it. The program initiates awareness and promotion of the program by partnering with local yoga studios and healthcare providers and providing information, flyers, and media materials promoting the program.

Contento, I. R. (2021). Nutrition education: Linking research, theory, and Practice (3rd ed.). Jones & Bartlett Learning.

Theory-Based Strategy

The program’s target audience is moderately active women ages 40-60 from middle-income households who are struggling with body composition changes, inflammation, and increased disease risk due to menopausal changes. Our surveys showed that yoga studio members within this demographic are already experiencing disease risk markers like fat gain and muscle loss, hypertension, and depression/anxiety. Our surveys also show that most experiment with fad diets that remove entire food groups; consequently, they are not eating the recommended amounts of whole grains, vegetables, and fruit. 80% of those surveyed said they would adhere to a long-term behavior change if they believed it healthy. Therefore, the underlying theory for the program is the Health Belief Model (Jones et al., 2014). The theory focuses on understanding the cognition of vulnerability to disease along five dimensions:

Perceived risk of a disease. This variable includes perceived susceptibility to contracting a health condition and its perceived severity once contracted. Lesson 1 familiarizes participants with the significant increase in disease risks and mortality rates associated with menopause.
Perceived benefits of diet adherence. A second variable is the believed effectiveness of dietary strategies designed to help reduce the threat of disease. Lesson 1 also informs participants about the research showing significant reductions in disease risk and improved quality of life after adopting an anti-inflammatory diet.
Perceived barriers to diet adherence. This variable includes potential negative consequences that may result from taking particular health actions, including physical (weight gain or loss), psychological (lack of spontaneity in food selection), and financial demands (cost of new foods). Lessons 3 and 4 target common misconceptions in today’s fad diet culture and introduce strategies to overcome barriers such as social pressures, cravings, time, and cost.
Cues to action. Events that motivate people to take action in changing their dietary habits are crucial determinants of change. Participants will identify personal cues to action and implement behavior change strategies through activities in lessons 1-4. Examples include setting SMART goals, habit stacking, and addressing environmental triggers.
Self-efficacy (SE). A very important variable is the belief in oneself to successfully execute the dietary behavior required to produce the desired outcomes. Regular yoga and meditation are shown to improve SE (Martin et al., 2015). Moreover, most participants will already have successfully implemented a regular yoga practice, which will likely enhance their SE (Jones et al., 2014). The program will use yoga and meditation principles to set clear intentions, visualize success, and foster self-control and confidence.

References

Jones, C. L., Jensen, J. D., Scherr, C. L., Brown, N. R., Christy, K., & Weaver, J. (2014). The health belief model as an explanatory framework in communication research: Exploring Parallel, serial, and moderated mediation. Health Communication, 30(6), 566–576. https://doi.org/10.1080/10410236.2013.873363

Martin, E. C., Dick, A. M., Scioli-Salter, E. R., & Mitchell, K. S. (2015). Impact of a Yoga Intervention on Physical Activity, Self-Efficacy, and Motivation in Women with PTSD Symptoms. Journal of alternative and complementary medicine (New York, N.Y.), 21(6), 327–332. https://doi.org/10.1089/acm.2014.0389

Strategies to Reach Objectives

Promotion

The promotional component focuses on raising awareness, establishing partnerships, and promoting the program to the public. The program leader familiarizes the studio manager and local healthcare providers with the need for targeted nutrition education for midlife women and the validity of Pause Well. The leader provides flyers and multimedia materials so providers and managers can effectively promote the program to yoga students and patients.

Nutrition Education

The curriculum component addresses knowledge gaps by providing 4 in-person nutrition education modules to be delivered monthly for 4 months. The theory-based lessons work to improve knowledge and encourage adherence to healthy behaviors through activities that encourage small attainable changes over the 4 month period. See below for more details.

Social Media

The social media component includes a private Facebook group page, providing a community network of healthy-minded midlife women, reinforcing the lesson concepts, and giving practical skills. The leader engages daily to answer questions and offer support throughout the 4-month curriculum. Participants can post their successes and challenges for peer support. The leader posts at least 2 action materials weekly to increase skills and self-efficacy (live cooking demos, recipes, shopping lists, etc.).

Process Evaluation Plan

Program Curriculum

The Pause Well body-positive lessons will include short lectures with accompanying take-home handouts, interactive science-based proven motivational and adherence activities, individualized guidance and goal setting, and guided meditations to create strong intention and help participants embrace their transforming bodies and nutritional needs. The 90-minute lessons are designed to be given once per month for four months, giving participants plenty of time to begin implementing new health habits and receive follow-up support. The program's curriculum works to lower participants' disease risk by transitioning them to a predominantly anti-inflammatory whole-food diet that includes the recommended amounts for protective nutrients, such as omega-3, vitamins A, D, E, and B, calcium, fiber, and plant-based protein. The curriculum acknowledges the yoga community's "health savvy" culture by addressing higher literacy concepts like inflammation and the microbiome. However, the multi-sensory lectures, hand-outs, and demos break down the complex concepts for all nutrition literacy levels. Click here for a sample take-home hand-out: The Anti-Inflammatory Lifestyle

Lesson 1: Pause and Thrive -- The Health Risks Associated with Menopause & Introduction to an Anti-Inflammatory Diet. Activities: Set SMART Goals w/ Partner, Check Your Knowledge, Guided Meditation for Clarity of Intention, Evaluation Forms.

Lesson 2: Pause Smart -- Nutrition to Improve the Microbiome and Support Brain & Heart Health. Activities: Rate Your Inflammation, SMART Goal Check-in, Meditation for Stress Reduction

Lesson 3: Pause Empowered -- Weight Control Strategies & Body Positivity. Activities: Rate Your Inflammation, SMART Goals, Meditation for Self-Acceptance

Lesson 4: Pause Together — Review Key Concepts. Activities: Rate Your Inflammation, Group Sharing, San Kalpa Meditation (Vow to Self), Create Vision Boards, Evaluation Forms.