***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Introduction Diabetes self-management education interventions in community gathering places have been moderately effective , but very few studies of intervention effectiveness have been conducted among African Americans with type 2 diabetes . This paper describes a church-based diabetes self-management education intervention for African Americans , a r and omized controlled trial to evaluate the intervention , and baseline characteristics of study participants . Methods A New DAWN : Diabetes Awareness & Wellness Network was conducted among 24 churches of varying size in North Carolina . Each church recruited congregants with type 2 diabetes and design ated a diabetes advisor , or peer counselor , to be part of the intervention team . Participants were enrolled at each church and r and omized as a unit to either the special intervention or the minimal intervention . The special intervention included one individual counseling visit , twelve group sessions , three postcard messages from the participant 's diabetes care provider , and twelve monthly telephone calls from a diabetes advisor . Baseline data included measures of weight , hemoglobin A1c , blood pressure , physical activity , dietary and diabetes self-care practice s , and psychosocial factors . The study to evaluate the intervention ( from enrollment visit to last follow-up ) began in February 2001 and ended in August 2003 . Results Twenty-four churches ( with 201 total participants ) were r and omized . Sixty-four percent of the participants were women . On average , the participants were aged 59 years and sedentary . They had an average of 12 years of education , had been diagnosed with diabetes for 9 years , had a body mass index of 35 , had a  hemoglobin  A1c level of 7.8 % , and had a reported dietary intake of 39 % of calories from fat . Conclusion A New DAWN is a culturally sensitive , church-based diabetes self-management education program for African Americans with type 2 diabetes that is being evaluated for effectiveness in a r and omized controlled trial . The outcomes of A New DAWN will contribute to the literature on community-based interventions for minority population s and help to inform the selection of approaches to improve diabetes care in this population BACKGROUND This article provides a descriptive overview of the implementation process of the Heart , Body , and Soul program . The program objective was to test strategies to reduce the prevalence of cigarette smoking among urban African Americans in East Baltimore . METHOD This study constitutes a prospect i ve r and omized trial among inner-city African Americans design ed to improve quit rates among church attenders . A r and om-digit-dialing survey was conducted to establish baseline levels of self-reported cigarette smoking , examine attendant attitudes , and determine the presence of known cardiovascular risk factors among community residents of the catchment area . A similar survey was conducted among churchgoers to establish a baseline . Twenty-two churches were recruited and r and omly assigned to either intensive or minimal ( self-help ) intervention strategies . Baseline health screenings were held in all participating churches . Innovative culturally specific smoking cessation strategies mediated through lay volunteers from participating churches were implemented in the intensive intervention churches . RESULTS Pastors of all churches were directly involved in all aspects of the planning and implementation process . A total of 29 volunteer lay smoking-cessation specialists were trained and successfully implemented the intensive interventions in churches . An additional 272 church members were trained to conduct their church 's health screenings . CONCLUSION The essential component of this successful implementation process were building trust and acceptance and providing the technical support to encourage smoking-cessation strategies . This description of the project is presented to assist others involved in church-based trials in urban African American communities The goals of this education outreach demonstration study were to prepare a cadre of registered nurses ( RN ) as Church Health Educators ( CHE ) , and to test the efficacy of a hypertension ( HBP ) education and support program in African American ( AA ) churches for persons with HBP in managing blood pressure ( BP ) .  In this two-phase study , RNs were prepared as CHEs in phase 1 and a convenience sample of 97 subjects with HBP was taught by the CHEs in phase 2 . The intervention 's content included the bases of HBP and HBP management strategies , and was taught in eight 1-hour sessions . Using a pre-test-post-test design , data on knowledge , social support and BP were collected at baseline ( pre ) , post-intervention ( post1 ) and 3 months post-intervention ( post2 ) . Major findings include : ( 1 ) there was a significant increase in knowledge scores from pre to post1 and post2 ( P < or = 0.0001 ; F = 95.08 ; df = 1.79 ) ; ( 2 ) education , age and number of years with HBP explained 49 % of the variance associated with HBP knowledge ; ( 3 ) systolic BP ( SBP ) and mean arterial BP ( MAP ) significantly decreased from pre to post1 and post2 ( SBP-p < or = 0.0001 , F = 18.35 , df = 1.91 ; MAP-p < or = 0.0001 , F = 17.80 , df = 1.86 ) ; ( 4 ) DBP significantly decreased from pre to post1 only ( p < or = 0.008 , F = 17.48 , df = 1.91 ) ; and ( 5 ) relationships were found between social support and DBP , and social support and MAP . Issues that emerged from this study with implication s for outreach programming include recruitment and retention , r and omization , selective sampling , intervention design and use of volunteers Objective : The impact of worksite intervention studies is maximized when reach and enrollment are high and attrition is low . Differences in reach , enrollment , and retention were investigated by comparing 2 different  employee recruitment methods for a home-based cancer-prevention intervention study . Methods : Twenty-two worksites ( N = 10,014 employees ) chose either active or passive methods to recruit employees into a home-based intervention study .  Reach ( e.g. , number of employees who gave permission to be called at home ) , Enrollment ( e.g. , number of employees who joined the home intervention study ) , and Attrition ( e.g. , number who did not complete the 12- and 24-month follow-ups ) were determined . Analysis at the cluster level assessed differences between worksites that selected active ( n = 12 ) versus passive ( n = 10 ) recruitment methods on key outcomes of interest . Employees recruited by passive methods had significantly higher reach ( 74.5 % vs. 24.4 % for active ) but significantly lower enrollment ( 41 % vs. 78 % ) and retention ( 54 % vs. 70 % ) rates ( all ps = .0001 ) . Passive methods also successfully enrolled a more diverse , high-risk employee sample .  Passive ( vs. active ) recruitment methods hold advantages for increased reach and the ability to retain a more representative employee sample . Implication s of these results for the design of future worksite studies that involve multilevel recruitment methods are discussed Background The purpose of this study was to demonstrate how formative program process evaluation was used to improve dose and fidelity of implementation , as well as reach of the intervention into the target population , in the " Active by Choice Today " ( ACT ) r and omized school-based trial from years 1 to 3 of implementation . Methods The intervention integrated constructs from Self-Determination Theory and Social Cognitive Theory to enhance intrinsic motivation and behavioral skills for increasing long-term physical activity ( PA ) behavior in underserved adolescents ( low income , minorities ) .  ACT formative process data were examined at the end of each year to provide timely , corrective feedback to keep the intervention " on track " . Results Between years 1 and 2 and years 2 and 3 , three significant changes were made to attempt to increase dose and fidelity rates in the program delivery and participant attendance ( reach ) . These changes included exp and ing the staff training , reformatting the intervention manual , and developing a tracking system for contacting parents of students who were not attending the after-school programs regularly . Process outcomes suggest that these efforts result ed in notable improvements in attendance , dose , and fidelity of intervention implementation from years 1 to 2 and 2 to 3 of the ACT trial . Conclusion Process evaluation methods , particularly implementation monitoring , are useful tools to ensure fidelity in intervention trials and for identifying key best practice s for intervention delivery Objective . The authors tested the impact on cardiovascular risk profiles of African American women ages 40 years and older after one year of participation in one of three church-based nutrition and physical activity strategies : a st and ard behavioral group intervention , the st and ard intervention supplemented with spiritual strategies , or self-help strategies . Methods . Women were screened at baseline and after one year of participation . The authors analyzed intention-to-treat within group and between groups using a generalized estimating equations adjustment for intra-church clustering . Because spiritual strategies were added to the st and ard intervention by participants themselves , the results from both active groups were similar and , thus , combined for comparisons with the self-help group . Results . A total of 529 women from 16 churches enrolled . Intervention participants exhibited significant improvements in body weight ( −1.1 lbs ) , waist circumference ( −0.66 inches ) , systolic blood pressure ( −1.6 mmHg ) , dietary energy ( −117 kcal ) , dietary total fat ( −8 g ) , and sodium intake ( −145 mg ) . The self-help group did not . In the active intervention group , women in the top decile for weight loss at one year had even larger , clinical ly meaningful changes in risk outcomes ( −19.8 lbs ) . Conclusions . Intervention participants achieved clinical ly important improvements in cardiovascular disease risk profiles one year after program initiation , which did not occur in the self-help group . Church-based interventions can significantly benefit the cardiovascular health of African American women OBJECTIVE Go Girls was a church-based nutrition and physical activity program design ed for overweight African-American ( AA ) adolescent females . RESEARCH METHODS AND PROCEDURES Ten predominantly middle-socioeconomic churches were r and omized to either a high-intensity ( 20 to 26 sessions ) or moderate-intensity ( six sessions ) culturally tailored behavioral group intervention delivered over 6 months . Each session included an experiential behavioral activity , approximately 30 minutes of physical activity , and preparation and tasting of healthy foods . In the high-intensity group , girls also received four to six telephone counseling calls .  From the 10 churches , 123 girls completed baseline and 6-month post-test assessment s. The primary outcome was BMI ; secondary outcomes included waist and hip circumferences , percentage body fat estimated by bioimpedance , serum insulin , glucose , and lipids , and cardiovascular fitness at 6-month follow-up . Selected measures were also collected at 1-year follow-up . RESULTS At 6-month follow-up , the net difference between the high- and moderate-intensity groups was 0.5 BMI units . This difference was not statistically significant ( p = 0.20 ) . There were no significant group differences in secondary outcomes . Girls in the high-intensity condition , however , who attended more than three-quarters of the sessions had significantly lower BMI and percentage body fat relative to girls in the high-intensity group who attended fewer sessions . Findings at 1-year follow-up mirrored those at 6 months . DISCUSSION We concluded that the intervention was not effective in reducing adiposity , although there were some positive findings among high attenders . Despite the null result , the intervention was generally well received by participants . Future interventions may require greater dose and a more structured dietary change program BACKGROUND Given the relatively low spontaneous quit rates and poor treatment outcomes among African American smokers , this study was design ed to evaluate the effects of a multimodal culturally relevant intervention for  smoking behavior change  compared with a self-help strategy among urban African Americans in Baltimore churches . METHOD This r and omized controlled trial in urban African American churches used the stages of change model to compare the effectiveness of two interventions in moving smokers along a continuum toward smoking cessation . Twenty-two churches were r and omly assigned to either an intensive culturally specific intervention or a minimal self-help intervention .  Smokers were interviewed at baseline church health fairs and at a 1-year follow-up . Self-reported quitters at follow-up were evaluated using saliva cotinine and exhaled carbon monoxide levels ( CO ) . Stages of change were measured by applying a st and ardized stages of change instrument to individual interview response sequences . Analysis compared the two intervention groups at 1-year follow-up with baseline stages . Outcomes included quit rates and positive progress along the stages of change . RESULTS Multiple logistic regression results , controlling for intrachurch correlation and demographic and baseline smoking characteristics , showed that the multimodal cultural intervention group was more likely to make positive progress along the stages of change continuum , compared with self-help intervention group ( OR = 1.68 ; P = 0.04 ) . Church denomination and intervention status interacted in the multivariate model ; Baptists in the intensive intervention were three times ( OR = 3.23 ; P = 0.010 ) more likely to make progress than all the other denomination groups . CONCLUSION The multimodal culturally relevant intervention was more likely than a self-help intervention to positively influence smoking behavior . This is the first community-based intervention study to report progress along the stages of change as a process-oriented measure of success . It is notable that a spiritually based model focusing on environmental sanctions was more likely than a st and ard church disseminated self-help intervention to positively influence smoking behavior in an urban African American population 
    Output:
    
Consistency in the conceptualization and measurement of  process evaluation may facilitate the implementation of a comprehensive process evaluation effort in church-based and other health promotion interventions