The principal aim of this thesis was to develop and explore how a multidisciplinary programme can empower women over their health in a Western sociocultural context. Thus, the research objectives were:
1. Develop an intervention to empower women over their health that encompasses physical, mental and social dimensions and is informed by existing research.
2. Implement the programme to a group of healthy New Zealand women and evaluate the impact of the intervention in terms of its outcomes and outcome sustainability for women’s health-promoting behaviours, holistic health and participants’ perceived outcomes.
3. Evaluate the impact of programme implementation in terms of its reach, fidelity and participant satisfaction.
4. Identify key factors of the programme that empowered women over their holistic health.
72 Chapter 4 – Methods for Evaluation The development of NLH was achieved as described in Chapter Three (objective 1). Thus, data were collected to evaluate the programme based on women’s outcomes after participating in NLH (research objective 2) and programme implementation (research objective 3), which would collectively inform key factors that contributed to women’s empowerment over their holistic health (research objective 4).
Following the mixed-methods convergent design, quantitative and qualitative data were collected separately, yet simultaneously. Figure 11 outlines the outcome assessments that occurred during the initial meeting at 0 months (baseline) and again at 6 months (post-intervention). Women also completed outcome assessments at 12 months, six months following post- intervention (follow up). Data for process evaluation were collected throughout the implementation of NLH. The women also completed evaluation forms at post-intervention and follow up to provide additional data regarding both process and outcome evaluation.
The assessments and monthly meetings were conducted on-site at Massey University in Wellington, NZ. The following paragraphs briefly summarise each type of assessment. A detailed description of women’s outcomes and process evaluation are then described in the next section.
Entry interviews. At the start of the baseline meeting, women participated in a brief, open-
ended interview. Interviews were conducted face-to-face between myself and each participant in a private room. Women were asked why they had decided to participate in NLH. Interviews were recorded using a smartphone application (Supernote, Fitness22 Ltd).
Physical assessments. As part of the outcomes, women participated in physical
assessments including anthropometric measures and a step test at baseline, post-intervention and follow up. The step test, height and weight were measured in a shared laboratory space. Women were explicitly informed that weight and height were assessed for descriptive purposes as part of the research study and were unrelated to outcomes for the programme. Further precautions were taken to uphold an ethical practice, which can be found detailed in the ethical considerations section at the end of the chapter. Women were instructed to avoid strenuous activity within 24 hours and not consume caffeine within five hours prior to testing to ensure the results (i.e., heart rate) were not influenced by external factors.
Surveys. The majority of data were collected via surveys at baseline, post-intervention
and follow up. The surveys included a series of validated questionnaires: Recent Physical Activity Questionnaire (RPAQ; Appendix I; Besson, Brage, Jakes, Ekelund, & Wareham, 2010); Pittsburgh Sleep Quality Index (PSQI; Appendix J; Buysse, Reynolds III, Monk, Berman, & Kupfer, 1989); Brief Resilience Scale (Appendix K; Smith et al., 2008); Flourishing Scale (Appendix L; Diener et al., 2009); Subjective Happiness Scale (Appendix M; Lyubomirsky & Lepper, 1999); 21-Item version of the Depression, Anxiety and Stress Scale (DASS-21; Appendix N; Lovibond & Lovibond, 1995) and Figure Rating Scale (Appendix O; Pulvers et al., 2004). Each survey is described at greater depth as the associated outcome is presented.
74 Chapter 4 – Methods for Evaluation Additionally, the Next Level Health Questionnaire (NLHQ; Appendix P) was designed to capture items specifically relevant to NLH. The NLHQ comprised items that assessed women’s HPBs and aspects of women’s health outcomes under psychological empowerment, self- perception and social health. The NLHQ contained questions specific to the HPBs that were primarily designed according to the NLH framework. Items were also adapted from previously validated surveys and integrated into the NLHQ as opposed to the full questionnaires in an effort to attenuate participant burden. Questions from the New Zealand Adult Nutrition Survey (Ministry of Health, 2008) informed the majority of items regarding the nutrition HPBs. As part of the assessment for psychological empowerment, two questions were derived from the Internal Health Locus of Control scale (Wallston, Strudler Wallston, & DeVellis, 1978). To evaluate the positive aspects of self-perception, two items were derived from the Body Appreciation Scale-2 (Tylka & Wood-Barcalow, 2015a) and integrated into the NLHQ to assess body comfort and confidence in support of a strengths-based approach. The social health questions were items adapted from the UCLA Loneliness Scale (Russell, Peplau, & Cutrona, 1980).
The surveys were implemented via an online questionnaire platform (Qualtrics.com). Women completed the questionnaires on-site in a private room using a portable laptop computer. While women completed the surveys, I was available to answer questions, but was not present in the room. In the case of distance responses (n = 5) at follow up, women were sent links to access the online surveys via email. Collectively, the surveys took about 45 to 60 minutes to complete.
NLH evaluation forms. Women completed two evaluation forms for NLH: one at post-
intervention (Appendix Q) and one follow up (Appendix R). The evaluation forms were completed at the very start of the session prior to any other assessments or conversing with me so as not to influence women’s responses. The evaluation forms were specifically designed to collect data for both outcome and process evaluation data and were filled out by hand.