A Randomized Control Trial of Conversations Advancing Resilience and Empowerment (CARE) Intervention

Health-related Quality of Life

The health-related quality of life (HRQOL) is measured by a decrease in the number of total unhealthy days compared to the control group at baseline, end of intervention at 4-weeks, and the 3- and 6-month follow-ups. The assessment used to measure this outcome is the World Health Organization Quality-of-Life-Scale Brief version (WHOQOL-BREF). The items from this assessment are scored using a likert scale of 1-5, 1 being the worst and 5 being the best. The raw score is calculated for each facet and each domain. Both facets and domains are scored through a simple summation of each item in that scale. Each question contributes equally to the facet score and each facet contributes equally to the domain score. Since each facet has four items with response values of 1 through 5, the raw score for any facet must have a minimum value of 4 and a maximum value of 20. Community narratives can be powerful tools that increase health narratives and promote behavior change.

Flawed information on nutrition, physical activity, blood pressure, and mental health

Flawed information measures the increase in self-efficacy in evaluating health information (flawed information) and to prevent and/or manage chronic conditions, health promotion knowledge, intention to change behavior. Trust in health information sources is measured using 11 investigator-developed items assessing trust in healthcare providers, media, government agencies, community health workers, and community organizations. Responses are rated from 1 (Not at all) to 4 (A great deal), with a Does Not Apply option treated as missing. Item scores are averaged across rated items; higher scores indicate greater trust. Flawed nutrition, physical activity, blood pressure, and mental health information are measured using two likert-scale items rated from 1 (Strongly agree) to 5 (Strongly disagree). Items are reverse coded as needed so higher scores indicate lower endorsement of nutrition flawed information.

Health knowledge on nutrition, physical activity, blood pressure, and mental health

Nutrition knowledge is measured using investigator-developed multiple-choice items based on the USDA Dietary Guidelines for Americans. Correct responses receive one point; incorrect and "Don't know" responses receive zero points. Scores are summed, with higher scores indicating greater nutrition knowledge. Physical activity knowledge is measured using investigator-developed true/false and multiple-choice items informed by the Physical Activity Guidelines for Americans. Blood pressure knowledge is assessed using investigator-developed true/false and multiple-choice items based on American Heart Association recommendations. Correct responses receive one point; higher summed scores indicate greater knowledge. Knowledge of the relationship between sleep and mental health is measured using five investigator-developed true/false items informed by the CDC and Journal of Clinical Sleep Medicine. Higher summed scores indicate greater sleep-related knowledge.

Attitudes and beliefs on nutrition, physical activity, blood pressure, and sleep

Nutrition, physical activity, blood pressure, and sleep attitudes and beliefs are measured using six different Theory of Planned Behavior-based (TPB) items rated 1-5 for each measure. Composite scale scores are created after reverse-coding any negatively worded items. Higher scores indicate more favorable attitudes and beliefs for each measure.

Health Behavior

This survey variable is an adoption of preventative health behaviors. Smoking behavior is measured by current smoking status and average cigarettes smoked per day. Lower smoking frequency indicates healthier behavior. Nutrition behavior is measured by self-reported frequency of fruit, vegetable, sugar-sweetened beverage intake and stage of change. Higher healthy food intake and advanced stage indicate healthier behavior. Physical activity behavior is measured by activity frequency, minutes/week and stage of change. Higher activity and maintenance stage indicate healthier behavior. Blood pressure behavior is measured by stage of change and confidence checking blood pressure at home. Higher scores indicate greater engagement. Sleep behavior is measured by using a stage-of-change item for obtaining 7-9 hours of sleep. Higher stage indicates healthier sleep behavior.