The Science Behind the SHIFT Program

SHIFT was developed by Dr. Ryan Olson’s research team at Oregon Health and Science University (OHSU).  Initial program development was funded by the Center for Research on Occupational & Environmental Toxicology at OHSU, and the Northwest Center for Occupational Health & Safety at the University of Washington. The components of the SHIFT program are based on research evidence and tailored for the isolated nature of truck driving work. These program components include team competition, computer-based training, habit-tracking, and health coaching.

Team Competition

The majority of studies of team weight loss competitions resulted in average group weight loss ranging between 10 to 18 lbs (e.g., Brownell et al., 1984; Brownell & Felix, 1987; Stunkard et al., 1989).  The competition format appears to be enjoyable for most participants, as evidenced by very low drop out rates.  For example, study drop out averaged only 2.6% (range = 0% to 13%) across 10 different weight loss competitions reported by Stunkard et al. (1989, study 2).  Team competitions are also particularly effective with male workers (e.g., Brownell & Felix), and 95% of truck drivers are men (95%, Global Insight, 2005).

Computer-Based Training

Research shows that behavioral computer-based training is twice as effective as passive training in booklets (Eckerman et al., 2002; Rohlman et al., 2005).  A meta-analysis of the efficacy of training methods also shows that more engaging training is more effective than passive formats for both increasing knowledge and changing behavior (Burke et al., 2006).  SHIFT computer-based training is presented in cTRAIN, which is a specialized training software system developed by Kent Anger and colleagues.  The features of cTRAIN are based on behavioral education principles (e.g., frequent quizzes, interactive feedback, high accuracy criterion) and were developed with feedback from blue-collar workers (Anger et al., 2001).  cTRAIN employs user-friendly features for individuals with limited literacy or computer skills (clear instructions, icon-based navigation with no commands to remember, spoken text options on every screen), and allows pictures and movies on each screen.  cTRAIN encourages mastery by having learners repeat information screens after failing a quiz question.

Habit-Tracking

Behavioral self-monitoring techniques (habit-tracking), where individuals repeatedly observe, evaluate, and record aspects of their own behavior, produce large effects when included in multi-component workplace interventions (Olson & Winchester, in press).  Olson (PI) and Winchester (in press) reviewed 24 studies of workplace interventions that included self-monitoring and found that the standardized effect size for 66 intervention phases was large by Cohen’s (1969) standards (mean weighted d=3.0; 95% CI 2.3, 3.3), as was the mean effect size for interventions targeting driving and other safety behaviors (d=2.6). 

Motivational Interviewing (Health Coaching)

Motivational interviewing has emerged as an alternative and more effective approach to health coaching than traditional office based counseling, which lacks proven effectiveness for promoting exercise and healthy eating (Pignone et al. 2003, Whitlock et al. 2002).  Motivational interviewing is described as “a client-centered, directive method for enhancing intrinsic motivation to change by exploring and resolving client ambivalence” (Miller & Rollnick, 2007).  Motivational interviewing technique has been operationally defined (Miller et al., 2003), and examples of techniques include reflective listening, asking open-ended questions, and encouraging change talk.  The guiding principles are to express empathy, develop discrepancy, avoid argumentation, roll with resistance, and support self-efficacy (Miller & Rollnick, 1991; 2002).  Burke, Arkowitz, and Menchola (2003) conducted a meta-analysis of 31 controlled clinical trials of motivational interviewing treatments.  Standardized differences between treatment and control group means ranged from d=0.25 to d=0.56, with effects on exercise and diet averaging d=.53 (95% CI: 0.32, 0.74)

References

Anger, K. W., D. S. Rohlman, J. Kirkpatrick, R. R. Reed, C. A. Lundeen and D. A. Eckerman. 2001. cTRAIN: a computer-aided training system developed in SuperCard for teaching skills using behavioral education principles. Behavior Research Methods, Instruments and Computers. 33:277-281.

Brownell, K. D., Cohen, R. Y., Stunkard, A. J., Felix, M. R. J., & Cooley, N. B. 1984.  Weight loss competitions at the work site: Impact on weight, morale and cost-effectiveness.  American Journal of Public Health, 74 (11): 1283-1285.

Brownell, K. D., & Felix, R. J. 1987.  Competitions to facilitate health promotion: Review and conceptual analysis.  American Journal of Health Promotion, Summer: 28-36.

Burke, M., S. Sarpy, K. Smith-Crowe, S. Chan-Serafin, R. Salvador and G. Islam. 2006. Relative effectiveness of worker safety and health training methods. American Journal of Public Health. 96:315-324.

Burke B. L., H. Arkowitz and M. Menchola. 2003. The efficacy of motivational interviewing: a meta-analysis of controlled clinical trials. J Consult Clin Psychol. 71:843-61.

Eckerman, D. A., C. A. Lundeen, A. Steele, H. L. Fercho, T. A. Ammerman and W. K. Anger. 2002. Interactive training versus reading to teach respiratory protection. Journal of Occupational Health Psychology. 7:313-323.

Global Insight, Inc., May, 2005.  The U.S. truck driver shortage: Analysis and forecasts.  Retrieved June 2006 from www.truckline.com/priorityissues/drivershortage/index.

Miller, W. R. and S. Rollnick, 2007.  Motivational interviewing home page.  Retrieved December 2007 from http://motivationalinterview.org/

Miller, W. R., Moyers, T. B., Ernst, D.  & Amrhein. P. 2003.  Manual for the motivational interviewing skill code (MISC).  Available at casaa.unm.edu/download/misc.pdf

Olson, R. & Winchester, J. in press.  Behavioral self-monitoring of safety and productivity in the workplace: A methodological primer and quantitative literature review.  Journal of Organizational Behavior Management.

Pignone M. P., A. Ammerman, L. Fernandez, et al. 2003. Counseling to promote a healthy diet in adults. A summary of the evidence for the U.S. Preventive Services Task Force. Am J Prev Med. 24:75-92.

Rohlman, D. S., D. A. Eckerman, T. A. Ammerman, H. L. Fercho, C. A.  Lundeen, C. Blomquist, et al. 2005. Computer Based Instruction Vs. Traditional Training In Working Adults: Information and Quiz Presentation and Interactivity. Journal of Organizational Behavior and Management 24:1-26.

Stunkard A, Cohen R, Felix M. 1989.  Weight loss competitions at the worksite: how they work and how well. Preventative Medicine, 18: 460-474.

Whitlock E. P., C. T. Orleans, N. Pender and J. Allan. 2002. Evaluating primary care behavioral counseling interventions: an evidence-based approach.  Am J Prev Med. 22:267-84.