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Physical Activity and Nutrition Assessment Forms: one-page questionnaires which determine the patient's level of physical activity or dietary habits, and their readiness to make improvements in these areas. The score on these assessments determines which of the three counseling protocols the patient receives.

Interactive Counseling Protocols tailor health messages to meet different patient needs:

	Pre-contemplator Protocols motivate those currently uninterested in physical activity or healthy eating habits to seriously consider changing their behaviors.
	Contemplator Protocols design a physical activity or dietary change program for those interested in making changes.
	Active Protocols instruct patients on how to maintain currently active life-styles or healthy eating habits.

Patient Tip Sheets also support the patient's behavior change:

	Physical Activity Sheet: health/safety information for patients performing moderate or vigorous exercise.
	"The Balancing Act": instructs how to balance caloric intake and expenditure
	"Trimming the Fat": provides tips on decreasing dietary fat intake
	"Focus on Fiber, Fruit, & Vegetables": Helps patients increase intake of these nutrients

Chart Stickers provide a record of the patient's assessment scores and provider recommendations, for insertion into the patient’s medical record.

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SAMPLE RESEARCH STUDY USING PACE+ WRITTEN MATERIALS: The Adult Weight Management and Healthy Lifestyles Initiative at MetroHealth Medical Center, Cleveland, Ohio.

In Spring 2006, the PACE+™ program was incorporated at a community clinic serving primarily African American patients that is part of MetroHealth Medical Center, a teaching affiliate of Case Western Reserve University School of Medicine. The Adult Weight Management and Healthy Lifestyles Initiative implements recommendations for the care for obese patients, rarely feasible in a primary care setting. It is funded by a ten-year commitment from the St. Luke’s Foundation. Interventions that are part of this program for adults include:

Annual obesity screening
Screening obese patients for targeted comorbid medical conditions
Annual PACE+™ counseling of obese patients (x eight years)
Development and implementation of a lower literacy PACE+™ version, for administration in the last 6 years of the intervention

The MetroHealth PACE+™ counselors were trained by PACE+™ faculty. As of March 2006, the screening process and documentation of the PACE+™ counseling (Assessment forms and Counseling Protocol forms) has been mediated through an electronic medical record intervention. It is estimated that 8,000-10,000 patients a year will be screened and offered the PACE+™ counseling. Health outcomes will be compared in patients with PACE+™ only, to a subset of patients receiving more intensive group interventions.

For additional information contact:
Maureen Lemieux, Project Coordinator
Eileen Seeholzer, M.D., M.S., Director Weight Management Center
Case Western Reserve University
MetroHealth Medical Center
2500 MetroHealth Drive, R228A
Cleveland, OH 44109-1998

mlemieux@metrohealth.org
Phone: (216) 7-STRIDE (778-7433)
Fax: (216) 778-3945

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For Adolescents:

PACE+ print materials for this group includes a teen participant manual (Teen Guide) and Tip Sheets, and designed for apparently healthy adolescents ages 12-16, and a Parent Support Guide for their parents/guardians. The materials support behavior change in the following four areas: Decreased dietary fat, increased fruit/vegetable intake, increased minutes per week of physical activity (moderate and vigorous intensity), and decreased time in sedentary habits (excluding school and homework time). Three types of materials are available:

The PACE+ Teen Guide is the manual for adolescent participants, revised in June 2006. It is 199 pages and organized into 11 chapters covering educational topics in diet and physical activity and behavior change skills. Each chapter reviews a different behavioral skill and includes worksheets about how to apply that behavior change skill to the four behavior change goals.
PACE+ Tip Sheets (revised June 2006) are PDF files of 101 1-2 page, color Tip Sheets on various topics related to dietary fat, fruits/vegetables, sedentary behavior, physical activity, behavior change, general nutrition topics and seasonal tips. These are designed for adolescent participants.
The PACE+ Parent Support Guide (revised June 2006) is a 23 page spiral-bound manual with educational information and specific advice to help parents and guardians create a more health-promoting home environment and effectively support their adolescent children in improving diet and activity.

These materials were initially developed as part of a primary care-based intervention to improve diet and physical activity. Individual chapters of the Teen Guide were reviewed with adolescents during a brief phone counseling call monthly for one year. Tip sheets were mailed as needed, and all parents received the Parent Manual without additional counseling.

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