1. Lorraine O. Walker, Sunghun Kim, Bobbie Sue Sterling, Lara Latimer
University of Texas at Austin, School of Nursing
Public Health Nurs. 2010; 27 (2):188-195.
Presented by Sherisse M. Butler for the Requirements of HBSS 5110
Teachers College, Columbia University NewYork, NY 10027
COLUMBIA UNIVERSITY
IN THE CITY OF NEW YORK
Background: Six weeks after childbirth, women reportedly retain approximately
15lbs of weight gained during pregnancy. The inability to lose the weight
contributes to long-term weight-gain, obesity, and chronic illness. While there
exists numerous community health interventions for weight loss in White
postpartum women, these interventions have not been effective nor specifically
designed to meet the needs of multiethnic populations and their special health
concerns. Objective: Thus, this intervention sought to target low-income,
ethnically diverse postpartum women. Utilizing the Multi-Source Method (MSM),
this intervention draws upon theory-based evidence and information obtained
from local populations in order that psychosocial, economic, and cultural dynamics
are made known. Theoretical Framework: The MSM brings together the
knowledge of the population with the generalized knowledge from scientific
inquiry and theory. The Social Cognitive Theory and the building of Self-Efficacy
was adapted. Methods: After the MSM was carried out, a preliminary 13-week
intervention with a targeted weight loss of 5kg (11 lbs) was developed to address
nutrition, physical activity, behavioral skills, and psychosocial concerns. Results:
Upon pilot-testing, the effectiveness of the intervention is determined by increases
in self-efficacy related to nutrition and activity patterns, weight loss, and
improvement in dietary intake, physical activity, and the overall psychosocial well-
being of those who successfully lose weight. Conclusion: The MSM aided in the
development of an intervention for underprivileged women. Each step provided
distinct information that increased the efficiency of the program. It offers a well-
rounded view of the population, the program, and potential strategies for change.
Implications: The MSM may be useful for designing programs for other
specialized populations.
The Multi-Source Method was a useful and effective in developing a community health
intervention for low-income, multiethnic postpartum women. While the results of the
actual intervention remains to be seen, the MSM method has several strengths and has
many implications for the planning and development of specialized interventions.
• The MSM is a viable approach to the development and planning of community
health interventions. The components of which are practical tools that generate
essential, distinct information that help to mold the planning and formation of the
intervention.
• The MSM combines an array of sources that offer a well-rounded view of
the population, its problem, and the strategies for change.
• The application and synthesis of information obtained from focus groups and
community advisory committees with theory-based evidence yield a unique and
theoretically-grounded approach to the formation, design, and
implementation of future community health interventions.
• The MSM is useful in designing and tailoring interventions to the needs of
specialized groups (especially groups for whom applicable and effective
interventions are unavailable). Thus, the program’s ingenuity, significance,
productivity and efficiency are increased.
Once the proposed intervention is piloted, the assessment of its effectiveness will
be determined by increases in self-efficacy related to nutrition and activity
patterns, weight loss, and improvement in dietary intake, increased physical activity,
and the overall psychosocial well-being. The women will also be regularly assessed
to determine the changes in weight, weight-related self-efficacy, and the
psychosocial characteristics of those women who successfully lose weight via this
intervention.
• Multi-Source Method (MSM) brings together the knowledge of the specialized
target population with the generalized knowledge from scientific inquiry and the
subsequent theories. The six components of MSM include positive deviance local
findings and processes, focus groups, community advisors, behavioral change
theory, and evidence-based conclusions and recommendations.
• Social Cognitive Theory: The dynamic process through which personal factors,
environmental factors, and other human behavior have an effect on an individuals
behavior. A person’s perceived self efficacy, goals, and outcome expectations
affects their health behavior. Thus, this intervention focuses on the building of
self-efficacy beliefs through strategic modeling. (This was congruent with the
positive deviance elicitation.) The outcomes focused on nutrition and activity
patterns, weight loss, and improvement in psychosocial well-being and improved
dietary intake.
Because the majority of weight loss interventions for new mothers
were tested upon non-minority women with educational and
economic privilege, this intervention sought to target low-income,
ethnically diverse postpartum women. Utilizing the Multi-Source
Method (MSM) this intervention draws upon evidence-based
theory and information obtained directly from the specific target
population in order that psychosocial, economic, and cultural
barriers and support systems are effectively implemented in
designing and assessing ethnic-specific weight loss interventions.
The Six Components of the Multi-Source Method (MSM)
Method Function
Positive Deviance
Local Findings
Identifies local knowledge of preventive strategies by studying outliers who avoid risk (Requires field
interviews and observations)
Evidence-Based
Strategies
The reviews and recommendations found in scholarly journals based on studies of risk factors,
descriptive studies, or studies of interventions. (Evidence based conclusions from related
populations—May be the starting point for developing interventions)
Focus Groups Qualitative data obtained from group interviews that reveal the needs and experiences of the targeted
population; Provides picture of daily living. (Detailed information about experiences and stresses
might be a focal point for interventions and providing contextual factors.)
Community Advisory
Committees
Provide a key means of validating intervention approaches for the suitability to a local population
Positive Deviance
Process
The utilization of elicitation processes to capitalize on the experiences of intervention participants,
their observation of others, to identify behaviors in daily living that may be useful for behavior change
Behavior Change
Theory
Of the numerous theories, program planners must self the best suited behavior change theory
according to target population and their circumstances.
With a targeted weight loss of 5kg (11lbs), a 13-week intervention was developed
to address four strands: nutrition, physical activity, behavioral skills, and contextual
concerns. The community advisory board and focus groups helped to ensure
relevance of three ethnic-specific interventions (African American, Latina, and
Anglo).
Low Income Postpartum Multiethnic Women’s Weight Loss Intervention
Summary of Intervention
Duration 13 week program; the approximate time it takes to lose ~5kg (11 lbs)
Assessments Weekly Weigh Ins; Behavioral and psychosocial assessments three times throughout intervention:
Beginning Middle, and End
Format Group Intervention with content and discussion focused on increasing and building self-efficacy,
the capacity for behavior change
Setting Health Clinics in community settings
Dietary Focus Consulting a registered dietician, the Food Guide Pyramid was adapted to develop eating plans and
nutritional recommendations for lactating and non-lactating women in order to improve diet quality
Physical Focus Each woman set individual physical activity goals; Pedometers were provided as an option for
feedback.
Psychosocial Focus Skills that improve upon stress management, body image, and goal-setting were developed in order
to enhance behavior changes.
Tailoring of
Interventions
Intervention content was adapted for ethnic groups; for certain ethnic groups specific topics, such
as family celebrations, were highlighted
Figure 1. Multi-Source Method for
Developing Health Promotion Programs
Figure 2. Illustration of Preliminary Program Theory for Weight Loss
Interventions
The Multi-Source Method data collection was carried out and a preliminary
intervention was developed. Theoretically, the individual's perceived control was the
center of the process and it was enhanced by efficacy- building behaviors, e.g. eating
patterns, stress reduction, and physical activity. The program focused on skill-building
and goal-setting. In addition to the informed, strategic and specialized delivery of
nutrition and physical activity content. (Figure 2.)
 Each team member targeted a specific
area related to the intervention in order to
ensure coverage of relevant sources of
knowledge related to the target
population and health concern.
 Team members worked
collaboratively in the development of
program theory and program content
using a workshop format.
 Each strand of knowledge obtained by
the six methods was utilized in the
development of the intervention.
 The sources of knowledge worked
dynamically and led to an iterative
intervention process.
 Community advisory committees
composed of former research
participants were knowledgeable about
health concerns and the research
experience for the targeted population.
Helpful Tips for Intervention Planning using the Multiple-Source Method