The Community-based Nutrition And Physical Activity Intervention Among Urban Women In Beijing And Shanghai

BackgroundIndividual health behaviors of women has great effect on their health and quality of life, unhealthy diet habits and meditation lifestyle may increase risk of developing certain diseases such as breast cancer, cervical cancer, and menopause-related diseases. Balanced diet and regular physical activity are important components of a healthy lifestyle.National Nutrition Survey showed that the prevalence of overweight and obesity in our population is growing gradually with age increased. Overseas study found that dietary pattern that high in fruits, vegetables; low-fat milk and whole grains intake can reduce the risk of overweight and obesity. Domestic and international studies have found that physical activity is beneficial for women in all age groups. For young women, it can reduce the risk of cardiovascular disease; for aged women, low-frequency standard physical activity can help women to improve heart and lung comfort and form positive daily activity pattern. For peri-menopausal and post-menopause women, balanced diet and regular physical activity is of great significance for improving peri-menopausal symptoms and prevention of postmenopausal cardiovascular disease and osteoporosis.Social cognitive theory suggests that the design of health promotion intervention projects should take consideration of the environment besides individual, isolated behavior. Transtheoretical Model emphasizes on different health promotion strategies for individuals in different stages of psychological change. Community, as women's main living environment, has its important role in guiding on women's lives and behavior. Therefore, the formation of appropriate and effective nutrition and physical activity intervention for community-women, is not only an important part of primary health care, but also can play its role to improve women's health wide promotion.ObjectiveApplying social cognitive theory and Transtheoretical Model, launch intervention for community women, explore the best model promote women's nutrition and physical activity behavior change, providing information and basis for decision-making and community nutrition intervention.MethodsAfter the baseline survey, two modes of nutrition and physical activity intervention, integrated intervention and simple intervention will be implemented, evaluate effects of different interventions, and finally draw the conclusion of appropriate nutrition and physical activity intervention for women in the community. Structured questionnaires will be used in baseline and intervention surveys with on-site survey method.Results1. Health Status:The rates of overweight and obesity women in Beijing and Shanghai were up 48.0% and 47.3%, and the rate is growing with age increasing. The ratio of overweight and obese women with waist circumference greater than 80cm, was 87.0% in Shanghai and 41.9% in Beijing.2. Physical activity status:46.1% and 42.1% were categorized as high and moderate physical activity level; the percent in Shanghai were 84.8% and 13.4%. Shanghai women's obesity had a positive correlation with average sit time (P=0.045).3. Dietary pattern:Four major dietary patterns were identified in both Beijing and Shanghai, and the results in both cities indicate that oil, sugar and condiments pattern associated with lower educated and household income. Rice, vegetables, dairy pattern indentified in Shanghai were inversely correlated with BMI (P=0.019).4. Intervention needs assessment:over 90% percent women though it is necessary to carry out nutrition education in community. Posters and brochures is the best way women in Beijing and Shanghai wanted as the access to nutritional knowledge, respectively,29.9% and 27.5% response rate.45.9% of Beijing women and 46.6% of Shanghai women though time interval of intervention is appropriate once a quarter.5. Intervention:specific intervention objectives were made according to the results of baseline analysis, posters & brochures and lecture were the main intervention tools. Only brochures will be issued in simple intervention group. Besides brochures, the intervention in intergrated intervention group will be supported by community-posters, and also lectures in community to strengthen the nutrition topics. The content object of "maintaining the health, adhere to 1～6" is proposed to as the intervention slogan for subjects to maintain health behavior.6. Intervention:obvious effect of intervention on Nutrition KAP in both Beijing and Shanghai were observed. After intervention, women sorted as high physical activity were a decreased compared with the baseline, but DBI-LBS also decreased in both Beijing and Shanghai. The cumulative effect of growth for integrated intervention model and simple intervention model was 215.4% and 173.7%, increased effect per thousand cost was 40.9% and 54.8% respectively. The best overall intervention effect was observed at aged 45 to 50 women with college and above education.Conclusion and SuggestionBoth intervention models were effective:From the aspect of intervention effect, intervention target women below 60-year-old age, the effect of integrated intervention group were better than that of simple intervention group, which is also true for women of middle school education or below. However, from the aspects of cost effectiveness point of view, simple intervention model can gain better effect than integrated intervention group in all ages and all levels of education.The cost-effectiveness advantage of simple intervention model is obvious towards young and high education level subjects, the results have s, and it is also less time-consuming, low community environment required, strong feasibility and accessibility. For over 50-year-old and less educated subjects, since the increased effect per thousand cost of integrated intervention model were close that of simple intervention model, integrated intervention model can be used to ensure the intervention effect if conditions permitting.