摘要：Six sites of the California Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participated in a staff wellness pilot intervention designed to improve staff self-efficacy in counseling WIC clients about childhood overweight. A pre-post test design with intervention and control groups was used; outcome measures included staff perceptions of the intervention’s effects on the workplace environment, their personal habits and health beliefs, and their counseling self-efficacy. Intervention site staff were more likely to report that the workplace environment supported their efforts to make healthy food choices (P < .001), be physically active (P < .01), make positive changes in counseling parents about their children’s weight (P < .01), and feel more comfortable in encouraging WIC clients to do physical activities with their children (P < .05). The prevalence of childhood overweight in the United States is increasing among both boys and girls of all ages, races, and ethnic groups. 1 Recently reported increases in the prevalence of overweight among low-income preschool children are particularly alarming. 2 Some evidence suggests that by 5 to 10 years of age, 60% of overweight children have at least 1 associated biochemical or clinical cardiovascular risk factor and 25% have 2 or more. 3 Perhaps even more troubling is evidence that overweight developed in early childhood persists through adolescence and adulthood. 4, 5 The prevalence of early childhood overweight among low-income children is highest among Latino children at 12.0%, compared with 9.6% in Asian/Pacific Islanders, 7.8% in African Americans, and 7.1% in Whites. 6 Accordingly, rates of early childhood overweight are increasing among participants of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). 7 It is not clear why young Latino children are at the greatest risk for being overweight. 8 In the WIC setting, this phenomenon may be exacerbated by nutrition education techniques that are not well suited to Latino culture. 9 Additionally, data from WIC have documented staff’s reluctance to talk to WIC mothers about their children’s weight. 10 We postulate that 1 way to reduce staff reluctance to talk about weight issues is to engage staff in a health promotion program. Traditionally, staff health promotion programs have not been instituted for the purpose of empowering health workers to better educate their clients. 11 Rather, they have been designed to address the end point of employee health, specifically, to increase health awareness, to reduce health risk, and to produce positive health effects on the individual such as disease prevention. 11 Further, staff wellness programs have been instituted to improve employee morale and reduce medical claims and absenteeism. 12 Few worksite wellness programs have been conducted in community-based nonprofit settings. Both the content and the experience of participating in a staff wellness program provide workers with an opportunity for professional and personal development and may help empower them to make lifestyle changes. Additionally, these lifestyle changes may in turn enable staff who work with clients to be more effective counselors and role models. The personal health habits of health workers have been found to be associated with their belief in the importance of the particular behavior for others. For example, Martin et al. found that 85% of dietetic professionals who exercised regularly rated exercise as a very important area of counseling versus only 48% of dietetic professionals who were nonexercisers. 13 Physicians who exercised regularly were more likely to counsel their patients to exercise. 14 Lewis and colleagues 15 found significant associations between personal health habits and self-reported counseling practices in the areas of smoking, alcohol use, exercise, and weight control among physicians. Those with poorer health habits generally were not as likely to counsel patients about those habits, while those attempting to improve their own health habits counseled patients significantly more often than those who were not making such efforts. Even the act of disclosing one’s own health habits enhanced physicians’ ability to motivate patients to make healthy lifestyle changes. 16 Self-efficacy or belief in one’s ability to perform determines whether behavior will be initiated, how much effort will be expended, and whether the effort will be sustained. 17 In California, where most WIC staff are lay health workers rather than professionals, self-efficacy associated with the practice of healthy behaviors theoretically may exert influence on counseling practices. Use of lay health workers is believed to foster empathy and increased communication with clients. 18 A high proportion of California WIC staff members are, like their clients, overweight. Modeling of behaviors from staff to client or peer to peer can be an effective way to facilitate the adoption of healthy behaviors. Further, the WIC environment offers a setting with only moderate sociodemographic distance between most staff and their clients and is thus an ideal setting for peer modeling influence. 19 Sociodemographic similarities such as ethnicity and gender may enhance the opportunities for role modeling. 20 Worksite health promotion programs are well suited to provide skill acquisition and demonstration as well as the social support that has been described by Marcus and colleagues as a primary predictor of sustained involvement. 21 This article describes a pilot program instituted as part of the California Fit WIC project, which promoted healthy behaviors and a stronger sense of counseling self-efficacy among staff to improve their perceptions of their interactions with WIC clients. This 1-year staff health promotion program was designed to enable staff to counsel WIC clients more willingly and effectively with regard to prevention of childhood overweight. Outcome measures included staff perceptions of the intervention’s effects on the workplace environment, their personal habits and health beliefs, and their counseling self-efficacy.
