Ruth Q Wolever | Vanderbilt University Medical Center (original) (raw)

Papers by Ruth Q Wolever

BMC health services research, Mar 28, 2024

Background As the popularity and demonstrated effectiveness of Health and Wellness Coaching (HWC)... more Background As the popularity and demonstrated effectiveness of Health and Wellness Coaching (HWC) continue to grow to address chronic disease prevalence worldwide, delivery of this approach in a group format is gaining traction, particularly in healthcare. Nonetheless, very little empirical work exists on group coaching and no published competencies currently exist for Group Health and Wellness Coaching (GHWC). Methods We used a well-established two-phase (Development and Judgment) process to create and validate GHWC competencies with strong content validity. Results Seven highly qualified Subject Matter Experts systematically developed and proposed the GHWC competencies, which were then validated by 78 National Board Certified Health and Wellness Coaches (NBC-HWCs) currently practicing GHWC who rated the importance and use frequency of each one. The validation study led to 72 competencies which are organized into the structure and process of GHWC. Conclusions GHWC requires not only...

Chronic Fatigue Syndrome (CFS) patients have reported that alterations in attention, concentratio... more Chronic Fatigue Syndrome (CFS) patients have reported that alterations in attention, concentration and memory contribute significantly to social and occupational dysfunction. However, little empirical work has substantiated these claims. This dissertation documents the neuropsychological deficits of CFS patients and then explores the relationship of those deficits to affective and immunological functioning. Thirty-three patients (25 female, eight male) who met Centers for Disease Control criteria for CFS were matched on gender, age, and education with two appropriate reference groups: (1) 33 normal, healthy control subjects, and (2) 33 renal pre-transplant patients (medical controls). Subjects were administered a neuropsychological battery which was heavily loaded with measures of attention and concentration (Continuous Performance Test, WAIS-R Digit Span, WAIS-R Digit Symbol, Enhanced Cued Recall, Rey-Osterrieth Complex Figure, Stroop Color Word Test, and Trail Making Test). A MANOVA revealed that the performance of both the CFS subjects and medical controls was below that of the healthy controls on a gross measure of attention, concentration and psychomotor speed. However, only the performance of the CFS patients was below that of the healthy controls on specific measures of sustained attention, concentration and speed of cognitive processing. Repeated measures ANOVAs then revealed that the CFS group demonstrated no deficits in memory storage or retrieval; any memory difficulties noted in the literature were likely due to an attentional deficit which resulted in difficulties encoding information. The data of a larger group of CFS subjects (N = 71) was then explored using hierarchical multiple regression analyses. First, the role of affect proved to be negligible in explaining variance in the neuropsychological measures. However, affect did help to explain subjects\u27 self-report of cognitive difficulties. Second, cognitive processing was partially explained by immune markers indicative of lymphocyte activation (HLA-DR, CD26), and ability to encode information was partially explained by impaired immune function (natural killer cell cytotoxicity and lymphoproliferative response to PHA). Self-report of cognitive difficulties was independently explained by affect and two indicators of lymphocyte dysregulation (CD4/CD8 and response to PHA). Possible explanations for these immune and neuropsychological relationships are considered, and the clinical implications of our findings are discussed

Frontiers in sports and active living, Jul 10, 2023

Purpose: To determine if race and sex differences exist in determinants and timing of dropout amo... more Purpose: To determine if race and sex differences exist in determinants and timing of dropout among individuals enrolled in an exercise and/or caloric restriction intervention. Methods: A total of 947 adults with dyslipidemia (STRRIDE I, STRRIDE AT/RT) or prediabetes (STRRIDE-PD) were randomized to either inactive control or to 1 of 10 exercise interventions, ranging from doses of 8-23 kcal/kg/week, intensities of 50%-75%VO 2 peak, and durations of 6-8 months. Two groups included resistance training, and one included a dietary intervention (7% weight loss goal). Dropout was defined as an individual withdrawn from the study, with the reasons for dropout aggregated into determinant categories. Timing of dropout was defined as the last session attended and aggregated into phases (i.e., "ramp" period to allow gradual adaptation to exercise prescription). Utilizing descriptive statistics, percentages were generated according to categories of determinants and timing of dropout to describe the proportion of individuals who fell within each category. Results: Black men and women were more likely to be lost to follow-up (Black men: 31.3% and Black women: 19.6%), or dropout due to work responsibilities (15.6% and 12.5%), "change of mind" (12.5% and 8.9%), transportation issues (6.3% and 3.6%), or reported lack of motivation (6.3% and 3.6%). Women in general noted lack of time more often than men as a reason for dropout (White women: 22.4% and Black women: 22.1%). Regardless of race and sex, most participants dropped out during the ramp period of the exercise intervention; with Black women (50%) and White men (37.1%) having the highest dropout rate during this period. Conclusion: These findings emphasize the importance of targeted retention strategies when aiming to address race and sex differences that exist in determinants and timing of dropout among individuals enrolled in an exercise and/or caloric restriction intervention.

Journal of Cardiovascular Nursing, May 29, 2023

Circulation, Feb 28, 2023

Introduction: Most adults recognize the positive health benefits of being physically active and m... more Introduction: Most adults recognize the positive health benefits of being physically active and maintaining a healthy weight, yet inactivity and obesity rates continue to rise. This disconnect is even more pronounced among racial and ethnic minorities across the United States, with Black/African American women being the highest risk group for inactivity an obesity. To begin to close this growing racial disparity gap, racial differences in exercise intervention dropout must be assessed. Hypothesis: We hypothesized that compared to their White counterpart, Black participants would dropout earlier and more often due to environmental factors. Methods: A total of 947 adults with dyslipidemia (STRRIDE I, STRRIDE AT/RT) or prediabetes (STRRIDE-PD) were randomized to either inactive control or to 1 of 10 exercise interventions, ranging from doses of 8 to 23 kcal/kg/wk, intensities of 50% to 75%VO 2 peak, and durations of 6 to 8 months. Two groups included resistance training, and one included dietary intervention (7% weight loss goal). Dropout was defined as an individual who withdrew from the study. Timing of intervention dropout was defined as the last session attended and categorized into phases. Chi-square or t -tests assessed differences in baseline characteristics by race. Results: Black versus White participants were on average younger (50.7 ± 7.7 vs. 56.0 ± 8.9 years; p<0.01), however they had similar fitness levels (24.5 ± 6.0 vs. 24.7 ± 5.5 ml/kg/min; p=0.83) and body mass indexes (31.6 ± 3.1 vs. 30.8 ± 3.1 kg/m 2 ; p=0.07). Black participants were particularly more likely to dropout during the ramp period (43.1% vs. 35.4%) of the exercise intervention compared to their White counterparts. Black participants were more likely to dropout because they lacked time (43.2% vs. 38.7%), work responsibilities (26.3 % vs. 14.3%), were lost to follow-up (23.9% vs. 14.6%), had transportation issues (4.6% vs 0.0%), changed their mind (10.2% vs. 8.5%), or lack of motivation (10.5% vs. 1.3%). Conclusions: Understanding racial differences among determinants and timing of exercise intervention dropout provides key insights for future interventions aiming to optimize exercise adoption and adherence. These insights will in turn improve cardiometabolic risk among this understudied minority group.

Archives of internal medicine, Dec 12, 2011

1. Norris SL, Engelgau MM, Narayan KM. Effectiveness of self-management training in type 2 diabet... more 1. Norris SL, Engelgau MM, Narayan KM. Effectiveness of self-management training in type 2 diabetes: a systematic review of randomized controlled trials. Diabetes Care. 2001;24(3):561-587. 2. Eakin E, Reeves M, Lawler S, et al. Telephone counseling for physical activity and diet in primary care patients. Am J Prev Med. 2009;36(2):142-149. 3. Eakin EG, Glasgow RE, Riley KM. Review of primary care-based physical activity intervention studies: effectiveness and implications for practice and future research. J Fam Pract. 2000;49(2):158-168. 4. Goldstein MG, Whitlock EP, DePue J; Planning Committee of the Addressing Multiple Behavioral Risk Factors in Primary Care Project. Multiple behavioral risk factor interventions in primary care: summary of research evidence. Am J Prev Med. 2004;27(2)(Suppl):61-79. 5. Boyle JP, Honeycutt AA, Narayan KM, et al. Projection of diabetes burden through 2050: impact of changing demography and disease prevalence in the U.S. Diabetes Care. 2001;24(11):1936-1940. 6. Shaw JE, Sicree RA, Zimmet PZ. Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes Res Clin Pract. 2010;87(1):4-14. 7. Ariza MA, Vimalananda VG, Rosenzweig JL. The economic consequences of diabetes and cardiovascular disease in the United States. Rev Endocr Metab Disord. 2010;11(1):1-10. 8. Bott DM, Kapp MC, Johnson LB, Magno LM. Disease management for chronically ill beneficiaries in traditional Medicare. Health Aff (Millwood). 2009;28 (1):86-98. 9. Piette JD, Weinberger M, Kraemer FB, McPhee SJ. Impact of automated calls with nurse follow-up on diabetes treatment outcomes in a Department of Veterans Affairs Health Care System: a randomized controlled trial. Diabetes Care. 2001;24(2):202-208. 10. Sacco WP, Malone JI, Morrison AD, Friedman A, Wells K. Effect of a brief, regular telephone intervention by paraprofessionals for type 2 diabetes. J Behav Med. 2009;32(4):349-359. 11. Wolever RQ, Dreusicke M, Fikkan J, et al. Integrative health coaching for patients with type 2 diabetes: a randomized clinical trial. Diabetes Educ. 2010; 36(4):629-639. 12. Young RJ, Taylor J, Friede T, et al. Pro-active call center treatment support (PACCTS) to improve glucose control in type 2 diabetes: a randomized controlled trial. Diabetes Care. 2005;28(2):278-282. 13. Egede LE, Strom JL, Durkalski VL, Mauldin PD, Moran WP. Rationale and design: telephone-delivered behavioral skills interventions for blacks with type 2 diabetes. Trials. March 29 2010;11:35. 14. Rosal MC, White MJ, Borg A, et al. Translational research at community health centers: challenges and successes in recruiting and retaining low-income Latino patients with type 2 diabetes into a randomized clinical trial. Diabetes Educ. 2010;36(5):733-749. 15. Elwyn G, Frosch D, Rollnick S. Dual equipoise shared decision making: definitions for decision and behaviour support interventions. Implement Sci. November 18 2009;4:75. 16. Fitzgerald JT, Funnell MM, Hess GE, et al. The reliability and validity of a brief diabetes knowledge test. Diabetes Care. 1998;21(5):706-710. 17. Toobert DJ, Hampson SE, Glasgow RE. The summary of diabetes self-care activities measure: results from 7 studies and a revised scale. Diabetes Care. 2000; 23(7):943-950. 18. Pocock SJ, Assmann SE, Enos LE, Kasten LE. Subgroup analysis, covariate adjustment and baseline comparisons in clinical trial reporting: current practice and problems. Stat Med. 2002;21(19):2917-2930. 19. Larson NI, Story MT, Nelson MC. Neighborhood environments: disparities in access to healthy foods in the US. Am J Prev Med. 2009;36(1):74-81.

Contemporary Clinical Trials, Nov 1, 2022

Background: Despite numerous gaps in the literature, mindfulness training in the workplace is rap... more Background: Despite numerous gaps in the literature, mindfulness training in the workplace is rapidly proliferating. Many "online" or "digital mindfulness" programs do not distinguish between live teaching and recorded or asynchronous sessions, yet differences in delivery mode (eg, face-to-face, online live, online self-guided, other) may explain outcomes. Objective: The aim of this study was to use existing data from an online mindfulness solutions company to assess the relative contribution of live and recorded mindfulness training to lower perceived stress in employees. Methods: Perceived stress and the amount of live and recorded online mindfulness training accessed by employees were assessed during eMindful's One-Percent Challenge (OPC). The OPC is a 30-day program wherein participants are encouraged to spend 1% of their day (14 minutes) practicing mindfulness meditation on the platform. We used linear mixed-effects models to assess the relationship between stress reduction and usage of components of the eMindful platform (live teaching and recorded options) while controlling for potential reporting bias (completion) and sampling bias. Results: A total of 8341 participants from 44 companies registered for the OPC, with 7757 (93.00%) completing stress assessments prior to the OPC and 2360 (28.29%) completing the postassessment. Approximately one-quarter of the participants (28.86%, 2407/8341) completed both assessments. Most of the completers (2161/2407, 89.78%) engaged in the platform at least once. Among all participants (N=8341), 8.78% (n=707) accessed only recorded sessions and 33.78% (n=2818) participated only in the live programs. Most participants engaged in both live and recorded options, with those who used any recordings (2686/8341, 32.20%) tending to use them 3-4 times. Controlling for completer status, any participation with the eMindful OPC reduced stress (B=-0.32, 95% CI-0.35 to-0.30, SE=0.01, t 2393.25 =-24.99, P<.001, Cohen d=-1.02). Participation in live programs drove the decrease in stress (B=-0.03, SE=0.01, t 3258.61 =-3.03, P=.002, d=-0.11), whereas participation in recorded classes alone did not. Regular practice across the month led to a greater reduction in stress. Conclusions: Our findings are in stark contrast to the rapid evolution of online mindfulness training for the workplace. While the market is reproducing apps and recorded teaching at an unprecedented pace, our results demonstrate that live mindfulness programs with recorded or on-demand programs used to supplement live practices confer the strongest likelihood of achieving a significant decrease in stress levels.

Mindfulness, Dec 19, 2019

Objective Describe the two-phase validation process for a taxonomy of skills learned through mind... more Objective Describe the two-phase validation process for a taxonomy of skills learned through mindfulness practice. Methods Phase I (development) utilized 11 subject matter experts (SMEs) over 5 months. Phase II (judgment) enrolled 60 international SMEs from 116 invited through snowball sampling. They were mostly white (80%) or Asian (15%) women (70%) with longstanding personal mindfulness practices (M = 20 years; SD = 9.6) and extensive mindfulness teaching experience (M = 11 years; SD = 6.7); 59% > 50 years; 88% had graduate degrees. SMEs rated relevance and clarity to calculate Individual Content Validity Indices (I-CVIs) for each category per tier and average CVIs (ave-CVIs) for entire tiers. Participation rate was 52% and 42 SMEs rated secondary tiers. Results I-CVIs ranged from 0.57 to 0.97, suggesting the removal of one category from the primary tier, leaving an ave-CVI for relevance of 0.92 (range 0.73-0.97). Clarity ratings for the primary tier (ave-CVI = 0.75; range of I-CVI = 0.52-0.88) necessitated exploration of the subcategories of Awareness (second tier; N = 42) to refine description (ave-CVI = 0.80 for clarity; range 0.64-0.93) while showing excellent content validity for both relevance and fit (ave-CVI = 0.95; range 0.88-1.0 for both). Conclusions The eMindful Mindfulness Classification Construct™ (eMCC™) is a validated, atheoretical taxonomy of skills learned through mindfulness practice, created to support development of more precise mindfulness-based interventions (MBIs) that target skill deficits associated with clinical conditions. Further research will validate subcategories, associate specific practices per category, and assess MBIs designed to target specific skills from the eMCC™.

Advances in integrative medicine, Mar 1, 2020

Objectives: Following the British Medical Research Council recommendations for pilot trials, this... more Objectives: Following the British Medical Research Council recommendations for pilot trials, this study aims to increase experience with a complex integrative medicine (IM) intervention in a randomized controlled design to assess the feasibility for studying this intervention in a larger trial. Specific objectives are to: 1) assess the feasibility of implementing this IM approach to improve dysfunction from tinnitus in a large clinical trial; 2) evaluate patient satisfaction with this complex intervention; and 3) obtain preliminary clinical efficacy data using the planned procedures and measures. Design & Methods: This XXXX-funded pilot study targets retention of 40 participants with significant tinnitus-related dysfunction, recruited from a conventional otolaryngology clinic. To maximize experience with the intervention, enrolled participants are randomized in a 3:1 ratio to IM + a commonly applied sound-based and educational therapy (SBE) or to SBE alone. The 6-month IM treatment includes the same SBE, modeled after the Veteran's Affairs Progressive Tinnitus Management approach, as well as 3 cognitive behavioral psychotherapy sessions, an 8-week Mindfulness Based Stress Reduction course, 5 acupuncture sessions, and 9 telephonic health coaching sessions. Enrollment, retention, patient satisfaction and lessons learned by the trial team will determine the feasibility of using this complex IM intervention in a large trial. Baseline, post-treatment, and 3-months follow-up measures and trial procedures planned for the

Complementary Therapies in Clinical Practice, Feb 1, 2019

Background and purpose: Trauma is highly prevalent, with estimates that up to 90% of the U.S. pop... more Background and purpose: Trauma is highly prevalent, with estimates that up to 90% of the U.S. population have been exposed to a traumatic event. The adverse health consequences of trauma exposure are diverse and often long-lasting. While expressive writing has been shown to improve emotional and physical health in numerous populations, the feasibility and potential effectiveness of a novel expressive writing program provided in a clinical setting to improve resilience is unknown. Our objective was to determine the feasibility and potential effectiveness of a 6-week expressive writing course provided in a clinical setting to improve resilience in individuals with a history of trauma. Materials and methods: This prospective, observational trial of a 6-week expressive writing intervention (Transform Your Life: Write to Heal) was conducted in an academic outpatient integrative clinic. Eligible participants were a self-referred sample of 39 English-speaking adults who identified as having had a trauma, or significant emotional/physical upheaval, within the past year. Main outcome measures included: Feasibility: Enrollment, Retention in Program and Trial, Adherence. Acceptability: Adverse Events; Participant Ratings. Primary Psychological Outcome: Connor-Davidson Resilience Scale (CD-RISC). Secondary Psychological Outcomes: Perceived Stress Scale-10 item (PSS-10); Center for Epidemiologic Studies Depression Scale (CES-D); Rumination Response Scale (RRS). Results: All measures of feasibility including those related to enrollment, retention, and adherence support feasibility. All measures of acceptability including adverse events and participant ratings support the intervention as being safe, well-received and personally valuable. Resilience scores increased from baseline (64.3 ± 14.40) to post-intervention (74.2 ± 13.15), t(37) = 4.61, p < 0.0005; Cohen's d = 0.75. In addition, across the same period, Perceived Stress scores decreased close to a standard deviation (20.5 ± 7.43 to 14.3 ± 6.64), t(37) = −4.71, p < 0.0005, Cohen's d = 0.76; depression symptoms decreased (from 19.0 ± 13.48 to 12.7 ± 11.68), t(37) = −3.21, p = 0.003, Cohen's d = 0.52; and rumination scores decreased from 48.5 ± 12.56 to 39.8 ± 10.07), t(37) = −5.03, p < 0.0005, Cohen's d = 0.82. Effect sizes ranged from medium to large. Conclusion: The Transform Your Life: Write to Heal program is feasible to offer in a clinical setting, was wellreceived by participants, and demonstrated preliminary findings of effectiveness. Our study suggests that this novel 6-week writing intervention including expressive, transactional, poetic, affirmative, legacy, and mindful writing prompts increases resilience, and decreases depressive symptoms, perceived stress, and rumination in an outpatient sample of those reporting trauma in the past year. The program appears suitable to be evaluated in a larger randomized controlled trial.

Global advances in health and medicine, May 1, 2013

Annals of Pharmacotherapy, Sep 23, 2009

P harmacotherapy can have a range of benefits, including symptom reduction, preservation of physi... more P harmacotherapy can have a range of benefits, including symptom reduction, preservation of physical function, reduced risk of death, and improved quality of life. However, the effectiveness of any medication depends on the patient's adherence to the treatment regimen. Poor adherence can limit the benefits of treatment, leading to decreased efficacy, greater adverse effect potential, disease relapse, increased medical expenditures, and decreased quality of life. 1-13 In contrast, better adherence is associated with improved health outcomes and reduced healthcare utilization. Yet, nonadherence remains a common problem across the full spectrum of medical and psychiatric conditions, including life-threatening and less serious conditions. 2,4,6,8,13-18 Poor adherence behavior may include discontinuing treatment early, taking a medication irregularly, or taking less or more than the prescribed dose. Because adherence to prescribed medication regimens is essential for maximizing treatment effectiveness and improving patient outcomes, it is important to have useful, valid, and practical tools for assessing adherence and related factors in research and clinical settings. 19 Consequently, the ASK-20 survey (ie, Adherence Starts with Knowledge) has recently been developed to assess behavior and barriers related to treatment adherence. 20 This 20-item questionnaire is distinct from previous patient-report measures of adherence. Whereas previous measures, such as the Morisky Medication Adherence Scale, tend to be brief and focus primarily on the degree of medication adherence, 21 the ASK-20 was designed to provide a practical, yet detailed, assessment of adherence behavior as well as potential barriers to adherence. The ASK-20 is also distinct from condition-specific adherence mea

Journal of contextual behavioral science, Oct 1, 2017

Objective: Mindfulness-informed cognitive behavioral interventions for obesity are promising. How... more Objective: Mindfulness-informed cognitive behavioral interventions for obesity are promising. However, results on the efficacy of such treatments are inconsistent which in part may be due to their substantially different methods of practice. This study is the first direct comparison of two theoretically distinct mindfulness-based weight loss approaches: increasing awareness of homeostatic/innate physiological cues versus hedonic/externally-driven cues for eating. Methods: Overweight adults were randomized to one of three group-based workshops: Mindful Eating (ME; n = 21), Mindful Decision-Making (MD; n = 17), or active standard behavioral control (SC; n = 19). Outcome measures included percent weight change and reduction in caloric intake from baseline to 6 weeks. Results: Differences in weight loss and calorie reduction did not differ significantly among groups. However, the difference in weight loss between the MD and ME groups trended towards significance, with medium-large effect sizes. Conclusions: Results provide modest preliminary evidence for the utility of mindful decision-making strategies over mindful eating for short-term weight loss and calorie reduction.