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.
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. 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. 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).
The following populations were identified in the studies reviewed for Quality of
Research.
External reviewers independently evaluate the Quality of Research for an intervention's
reported results using six criteria:
For more information about these criteria and the meaning of the ratings, see Quality of Research.
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. 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.
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].
External reviewers independently evaluate the intervention's Readiness for Dissemination
using three criteria: For more information about these criteria and the meaning of the ratings, see Readiness for Dissemination.
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. 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.
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. Discounts are available if InShape is implemented over multiple years or used with greater numbers of young adults. 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
Documents Reviewed
Study 1
Supplementary Materials
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
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)
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
Study Weaknesses
Materials Reviewed
Readiness for Dissemination Ratings by Criteria (0.0-4.0 scale)
Implementation
Materials
Training and Support
Resources
Quality Assurance
Procedures
Overall
Rating
2.9
1.8
2.4
2.3
Dissemination Strengths
Dissemination Weaknesses
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