Intervention Summary

InShape Prevention Plus Wellness

InShape Prevention Plus Wellness is a brief intervention designed to reduce drug abuse and increase positive mental and physical health outcomes among college students ages 18-25. The intervention incorporates naturally motivating social images (image prototypes of a typical peer who engages in a specific health behavior) and future self-images (images of a possible future desired self) to help young adults think about and plan positive changes in their lives. InShape is based on the Behavior-Image Model, which asserts that positive social images and future self-images can be used to link multiple divergent health risk habits among adolescents and young adults and motivate them to effect change in multiple behaviors. Following self-regulation theory of health, this model supports the use of feedback on behaviors and self-images to facilitate goal setting for change across multiple health habits. InShape specifically targets avoidance of alcohol, tobacco, and illicit drugs and increases in physical activity and exercise, healthy eating, sleep, and stress management.

The key components of InShape include (1) a self-administered fitness behavior-image screen measuring targeted health habits and self-images, (2) a fully scripted and standardized one-on-one consultation using PowerPoint slides to provide brief, tailored feedback to participants and highlight key positive image content, and (3) a goal plan that provides fitness recommendations and facilitates commitment to setting goals and achieving positive change across several health habits, leading to a desired future self-image.

InShape is offered to individual participants in a single session of approximately 30 minutes. It can be used as a standalone intervention, as was the case in the study reviewed for this summary; a supplement to other programs; or a continual booster session. Fitness specialists implementing InShape are not required to have special qualifications, but they must receive orientation training to know how to effectively administer and evaluate the program and tailor it to specific populations and settings.

Descriptive Information

Areas of Interest	Mental health promotion Substance use disorder prevention
Outcomes	1: Alcohol use and driving after drinking 2: Marijuana use 3: Health-related quality of life 4: Quantity of sleep
Outcome Categories	Alcohol Drugs Quality of life
Ages	18-25 (Young adult)
Genders	Male Female
Races/Ethnicities	Black or African American Hispanic or Latino White Race/ethnicity unspecified
Settings	School
Geographic Locations	Urban Suburban Rural and/or frontier
Implementation History	InShape, formerly called In Shape, has since been used in two university settings with more than 700 students. Three evaluations of the program have been conducted.
NIH Funding/CER Studies	Partially/fully funded by National Institutes of Health: Yes Evaluated in comparative effectiveness research studies: Yes
Adaptations	No population- or culture-specific adaptations of the intervention were identified by the developer.
Adverse Effects	No adverse effects, concerns, or unintended consequences were identified by the developer.
IOM Prevention Categories	Universal

Quality of Research

Documents Reviewed

The documents below were reviewed for Quality of Research. The research point of contact can provide information regarding the studies reviewed and the availability of additional materials, including those from more recent studies that may have been conducted.

Study 1

Werch, C. E., Moore, M. J., Bian, H., DiClemente, C. C., Ames, S. C., Weiler, R. M., et al. Efficacy of a brief image-based multiple-behavior intervention for college students. Annals of Behavioral Medicine, 36(2), 149-157.

Supplementary Materials

In Shape Fitness & Health Survey

Mielenz, T., Jackson, E., Currey, S., DeVellis, R., & Callahan, L. F. Psychometric properties of the Centers for Disease Control and Prevention Health-Related Quality of Life (CDC HRQOL) items in adults with arthritis. Health and Quality of Life Outcomes, 4(66).

Scoring Guidelines for the In Shape Fitness & Health Survey

Zullig, K. J., Valois, R. F., & Drane, J. W. Adolescent distinctions between quality of life and self-rated health in quality of life research. Health and Quality of Life Outcomes, 3(64).

Outcomes

Outcome 1: Alcohol use and driving after drinking
Description of Measures	The Fitness & Health Survey was used to collect self-report data on alcohol use and driving after drinking. Items asked about initiation of use and frequency of any use, frequency of heavy use, and quantity of use in the past 30 days. Heavy use of alcohol was defined as five or more drinks "in a row" for males and four or more drinks "in a row" for females. The survey also included a single measure of the frequency of driving after drinking during the past 30 days.
Key Findings	College students exposed to the intervention, in relation to those in the comparison condition who received a commercial health education brochure, had a significant decrease from baseline to 3-month follow-up in the frequency of any alcohol use (p < .0001), heavy alcohol use (p < .0001), and driving after drinking (p = .02). Students in the comparison group had an increase in the frequency of each of these behaviors. These findings are associated with small effect sizes (Cohen's d = 0.27, 0.29, and 0.23, respectively).
Studies Measuring Outcome	Study 1
Study Designs	Experimental
Quality of Research Rating	2.7 (0.0-4.0 scale)

Outcome 2: Marijuana use
Description of Measures	The Fitness & Health Survey was used to collect self-report data on marijuana use. Items asked about initiation of use and frequency of any use, frequency of heavy use, and quantity of use in the past 30 days. Heavy use was defined as "getting really 'high' or 'stoned' from using marijuana."
Key Findings	College students exposed to the intervention, in relation to those in the comparison condition who received a commercial health education brochure, had a significant decrease in the frequency of heavy marijuana use (p = .02) and the quantity of marijuana use (p = .03) from baseline to 3-month follow-up. Students in the comparison group showed increases on these measures of marijuana use over time. These findings were associated with a very small effect size (Cohen's d = 0.19) and a small effect size (Cohen's d = 0.23), respectively. In addition, a smaller percentage of intervention than comparison group students initiated marijuana use from baseline to 3-month follow-up (p = .02), a finding associated with a very small effect size (Cohen's d = 0.19).
Studies Measuring Outcome	Study 1
Study Designs	Experimental
Quality of Research Rating	2.7 (0.0-4.0 scale)

Outcome 3: Health-related quality of life
Description of Measures	The Fitness & Health Survey was used to collect self-report data on health-related quality of life. Four items assessed the number of days during the past 30 days in which physical health (physical illness and injury), mental health (stress, depression, and problems with emotions), spiritual health (lack of purpose in life, no sense of a greater power/God, and no belief in life after death), and social health (lack of contact or communication with other people and meaningful relationships) were "not good." A fifth item assessed the number of days during the past 30 days in which poor health of any kind kept the individual from doing his or her usual activities.
Key Findings	College students exposed to the intervention, in relation to those in the comparison condition who received a commercial health education brochure, had a significant decrease from baseline to 3-month follow-up in the number of days in which their spiritual health (p = .01) and social health (p < .0001) were not good. Students in the comparison group experienced increases in the days in which their spiritual and social health were not good. These findings are associated with small effect sizes (Cohen's d = 0.32 and 0.38, respectively).
Studies Measuring Outcome	Study 1
Study Designs	Experimental
Quality of Research Rating	2.5 (0.0-4.0 scale)

Outcome 4: Quantity of sleep
Description of Measures	Quantity of sleep was measured with one self-report item in the Fitness & Health Survey, which asked about the number of hours usually slept each night during the past 30 days. The five response options ranged from "9 or more hours" to "5 or less hours."
Key Findings	College students exposed to the intervention, in relation to those in the comparison condition who received a commercial health education brochure, had a significant increase in sleep from baseline to 3-month follow-up (p < .0001). This finding is associated with a small effect size (Cohen's d = 0.32).
Studies Measuring Outcome	Study 1
Study Designs	Experimental
Quality of Research Rating	2.4 (0.0-4.0 scale)

Study Populations

The following populations were identified in the studies reviewed for Quality of Research.

Study	Age	Gender	Race/Ethnicity
Study 1	18-25 (Young adult)	59.5% Female 40.5% Male	71.6% White 12.7% Black or African American 8.7% Hispanic or Latino 7% Race/ethnicity unspecified

Quality of Research Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the Quality of Research for an intervention's reported results using six criteria:

Reliability of measures
Validity of measures
Intervention fidelity
Missing data and attrition
Potential confounding variables
Appropriateness of analysis

For more information about these criteria and the meaning of the ratings, see Quality of Research.

Outcome	Reliability of Measures	Validity of Measures	Fidelity	Missing Data/Attrition	Confounding Variables	Data Analysis	Overall Rating
1: Alcohol use and driving after drinking	3.0	2.5	2.3	3.2	2.6	2.6	2.7
2: Marijuana use	3.0	2.5	2.3	3.2	2.6	2.6	2.7
3: Health-related quality of life	2.3	1.9	2.3	3.2	2.6	2.6	2.5
4: Quantity of sleep	2.2	1.7	2.3	3.2	2.5	2.6	2.4

Study Strengths

All the outcome measures in the instrument used in this study have been used in various other studies and have been found to be reliable. The outcome measures have face validity, and some attempt was made to test the validity of responses (e.g., by including a bogus drug name in items about substance use). Implementation of both intervention and comparison conditions was very straightforward. Fitness specialists received extensive training, standardized protocols, and an implementation checklist. Some intervention sessions were randomly selected for audiotaping to measure implementation fidelity. The attrition rate was very low, and efforts were made to compare individuals who dropped out of the study with study completers. Participants were randomly assigned to study condition, and no significant differences were found between the two groups at baseline. The data analysis plan was generally very good, and the sample size was large.

Study Weaknesses

The reliability data reported for the health-related quality of life measure was based on a population of adults with arthritis, not an adolescent population. The results of the audiotaped sessions were not provided. No statistical techniques were used to compensate for the multiple comparisons made, thus increasing the likelihood of the analysis falsely identifying significant findings.

Readiness for Dissemination

Materials Reviewed

The materials below were reviewed for Readiness for Dissemination. The implementation point of contact can provide information regarding implementation of the intervention and the availability of additional, updated, or new materials.

Directions for Implementing: In Shape

In Shape consultation posters [PowerPoint slides]

In Shape Consultation Protocol

In Shape Feedback Form

In Shape Fitness & Health Survey

In Shape Fitness Behavior-Image Screen

In Shape Program Flyer

In Shape Recommendations

Interventionist/Fitness Specialist Consultation Self-Evaluation

Scoring Guidelines for the In Shape Fitness & Health Survey

Werch, C. C. In Shape: A brief multiple behavior program for young adults [PowerPoint slides].

Readiness for Dissemination Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the intervention's Readiness for Dissemination using three criteria:

Availability of implementation materials
Availability of training and support resources
Availability of quality assurance procedures

For more information about these criteria and the meaning of the ratings, see Readiness for Dissemination.

Implementation Materials	Training and Support Resources	Quality Assurance Procedures	Overall Rating
2.9	1.8	2.4	2.3

Dissemination Strengths

Clear and detailed information on how this program can be implemented is provided. The materials have been developed so that individuals of varying skill levels can deliver the program. Because implementation directions are clear, training requirements are minimal. Training is available in person, by phone, and online. The survey used to collect data on student perceptions and behaviors is specific and well designed. The self-evaluation form is concise and easy to understand.

Dissemination Weaknesses

Little information is provided on how to integrate this program into existing operations and how to manage it once it is implemented. The materials do not address implementation challenges or adaptations to diverse settings. Although training is required for all implementers, the training materials provided did not include a curriculum to ensure that all sites receive standardized implementation guidance. Little information is provided on how to use data collected from students. Tools to support quality assurance and program fidelity are limited and are primarily self-administered.

Costs

The cost information below was provided by the developer. Although this cost information may have been updated by the developer since the time of review, it may not reflect the current costs or availability of items (including newly developed or discontinued items). The implementation point of contact can provide current information and discuss implementation requirements.

Item Description	Cost	Required by Developer
Teacher's Manual (includes program implementation and evaluation materials, reproducible program materials on a CD-ROM, recorded introductory webinar, and technical assistance)	$399 each	Yes
DVD Training Webinar	$149 each	No
Introductory webinar and technical assistance supported by phone or email	Included in cost of teacher's manual	No
Live four-hour online certified implementer or trainer workshop	$599 for 1-2 participants	No
On-site 1-day certified implementer or trainer workshop	$2,000 plus travel expenses for trainer	No
Site and area licenses to reproduce all program and training materials	Depends upon number of sites or area size	No
Quality assurance process and outcome evaluation instruments	Included in teacher's manual	No

Additional Information

Discounts are available if InShape is implemented over multiple years or used with greater numbers of young adults.