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Health Education Research Advance Access published online on September 22, 2007
Health Education Research, doi:10.1093/her/cym047
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© The Author 2007. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oxfordjournals.org

Moderators and mediators of behaviour change in a lifestyle program for treated hypertensives: a randomized controlled trial (ADAPT)

Valerie Burke*, Lawrie J. Beilin, Hayley E. Cutt, Jacqueline Mansour and Trevor A. Mori

School of Medicine and Pharmacology, University of Western Australia, Royal Perth Hospital Unit, the Cardiovascular Research Centre and West Australian Institute for Medical Research, GPO Box X2213, Perth, WA 6847, Australia

Correspondence to: * Correspondence to: V. Burke. E-mail: vburke{at}cyllene.uwa.edu.au

We aimed to examine moderators and mediators of behaviour change in a cognitive lifestyle program for drug-treated overweight hypertensives in Perth, Australia. We collected data at baseline, 4 months (post-intervention) and 1-year follow-up in a randomized controlled trial of a program that focused on weight loss, diet, and exercise. Mediation analysis used regression models that estimate indirect effects with bootstrapped confidence limits. Outcomes examined were saturated fat intake (% energy) and physical activity (hours per week). In total, 90/118 individuals randomized to usual care and 102/123 to the program-completed follow-up. Sex was a moderator of response post-intervention for diet and physical activity, with a greater response among women with usual care and among men with the program. Change in self-efficacy was a mediator of dietary change post-intervention [effect size (ES) –0.055, 95% confidence interval (CI) –0.125, –0.005] and at follow-up (ES 0.054, 95% CI –0.127, –0.005), and in physical activity post-intervention (ES 0.059, 95% CI 0.003, 0.147). These findings highlight different responses of men and women to the program, and the importance of self-efficacy as a mediator. Mediators for physical activity in the longer term should be investigated in other models, with appropriate cognitive measurements, in future trials.

Received on March 16, 2006; accepted on July 26, 2007


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