Análisis Ambiental: impactos producidos por el uso de combustibles

Figure 16 describes women’s achievement for individual HPBs. Out of the possible 31 HPBs, women were the most successful at aerobic activity, limiting less healthy fats and limiting

sodium at baseline. In contrast, women began NLH with least achievement for stretching, muscle

strengthening and reading nutrition labels.At post-intervention, women showed the greatest ratio

of percentage change normalized to baseline completion for stretching and flexibility (220.0%),

reading nutrition labels (183.3%) and personal goals/values (125.0%) and the least improvement

for limiting sodium (-4.65%), aerobic activity (1.96%), meal preparation (2.63%). At follow up,

women demonstrated the greatest ratio of percentage change normalized to baseline completion

for reading labels (108.3%), muscle strengthening (88.9%), personal goals/values (87.5%) and

avoiding sleep stealers (87.5%) and the least improvement for iron sources (-6.25%), meal

preparation (-2.63%) and aerobic activity (0.00%).

Physical activity

At baseline, women achieved 1 [1, 2] physical activity HPB (Table 9), which significantly improved to 2 [1, 2] at post-intervention (z = -3.28, p < 0.01, r = .50), but was no longer significantly improved at follow up. Most women were successful at achieving aerobic activity at baseline (Figure 16), but there was little difference between time points due to a ceiling effect (baseline: 92.7%, post-intervention: 94.5%, and follow up: 92.7%). More women achieved the

stretching and flexibility HPB at post-intervention (58.2%) improved from baseline (18.2%), but

the success was minimal at follow up (30.9%). While women consistently improved achievement

of muscle strengthening HPBs, the percentage of completion was still comparatively low.

Sleep

For the sleep HPB category, women achieved 3 [2, 4] out of 6 possible HPBs at baseline (Table 9). Women significantly increased their HPB achievement to 5 [4, 5] HPBs at post- intervention (z = -5.33, p < .001, r = .50). At follow up, the magnitude of improvement was not maintained, but still remained higher compared to baseline, z = -3.59, p < .001, r = .34).

Figure 16. Individual HPB achievement by the proportion of women (%) who achieved them.

Individual HPBs are colour-coded by HPB category and descend from most to least achieved at baseline. HPB = health-promoting behaviour, PA = physical activity, SL = sleep, NU = nutrition, EB = eating behaviour, SC = self-care, SM = stress management. Baseline = 0-months, post-intervention = 6-month, follow up = 12-months.

Similarly, substantial improvements were seen across all individual sleep HPBs between baseline and post-intervention (Figure 16). All sleep HPBs dropped at follow up, however, they remained

114 Chapter 5 – NLH Outcomes higher at follow up compared to baseline. Women were most successful at sleeping at least seven hours per night and limiting eating and working in bed at all three time points. The greatest increase in achievement for sleep HPBs was seen for limiting screen time before bed and

performing a wind down routine between baseline and post-intervention. The least improvement

was seen for sleeping the recommended amount; however, little room for improvement was possible due to the high achievement rate of this HPB seen at baseline.

Nutrition

Women’s achievement for HPBs in the nutrition category increased significantly from a 6 [4, 7] HPBs at baseline to 8 [6, 9] HPBs at post-intervention (z = -4.92, p < .001, r = .47) out of 10 possible HPBs (Table 9). HPB increases in the nutrition category were also detected at follow up (Mdn = 7 [6, 8], z = -3.71, p < 0.001, r = .35), but to a lesser degree compared to post- intervention. For individual nutrition HPB achievement (Figure 16), women were most successful

at limiting less healthy fat sources (82.1%), limiting added sodium (78.6%) and limiting added

sugar sources (75.0%) at baseline. Women’s achievement for limiting less healthy fat sources and

limiting added sugar sources further improved at post-intervention (respectively, 98.2% and

92.9%) and improvements remained relatively maintained at follow up (respectively, 94.6% and 91.1%). Achievement for limiting sodium slightly decreased at post-intervention (75.0%) but improved at follow up (85.7%) compared to baseline. The greatest improvement from baseline was seen for reading nutrition labels (62.5%) at post-intervention, which was well-maintained to follow up (46.4%). Women also showed good improvement for achieving intakes of vegetables

(80.4%) and fibre sources (71.4%) at post-intervention that declined yet were still improved at follow up (respectively 73.2% and 57.1%) compared to baseline. Despite improved achievement seen at post-intervention for intake of healthy fat sources (75.0%), little to no improvement were seen at follow up (64.3%). Only one woman improved achievement for intake of calcium at post- intervention and follow up (64.3%) compared to baseline (62.5%).

Eating Behaviour

Women achieved 3 [1, 4] out of 5 possible HPBs for the eating behaviour category at all three time points (Table 9). Women’s HPB improvement for eating behaviour was small, but significant at post-intervention compared to baseline, z = -4.18, p < .001, r = .40. However, improvement detected at post-intervention was no longer significant at follow up. Women showed the lowest improvement for HPBs in the eating behaviour category compared to other HPB categories. For individual HPB achievement for eating behaviour (Figure 16), women made the greatest improvement for meal planning at post-intervention (87.5%) compared to baseline (48.2%) that remained relatively high at follow up (73.2%). Improvement was also seen for eating

breakfast at post-intervention (67.9%) compared to baseline (55.4%) that remained relatively

well-maintained at follow up (66.1%). Eating three meals or equivalent and preparing the majority of their meals showed little change across the three time points. Despite improved achievement seen at post-intervention for water intake (42.9%) little improvement was seen at follow up (30.4%) compared to baseline (27.3%).

Self-Care

Out of four possible HPBs for the self-care category, women achieved 1 [0, 2] HPB at baseline (Table 9). At post-intervention, women significantly improved their self-care achievement to 2 [2, 3] HPBs (z = -4.12, p < .001, r = .39), which were well maintained through to follow up (Mdn = 2 [1, 3], z = -2.86, p < .01, r = .27). Women greatly improved all self-care HPBs demonstrated by more than half of the women achieving each self-care HPB at post- intervention compared to about a third of women completing each self-care HPB at baseline (Figure 16). At follow up, over half of the women still achieved each self-care HPB with exception to practicing self-appreciation (35.7%). The greatest improvement was seen for personal goals/values at post-intervention (66.1%) compared to baseline (30.4%), which was relatively maintained at follow up (55.4%).

116 Chapter 5 – NLH Outcomes

Stress Management

Similar to women’s achievement for self-care HPBs, women significantly increased their achievement for HPBs under the stress management HPBs from 1 [1, 2] HPB at baseline to 2 [2, 3] HPBs at post-intervention, z = -5.07, p < .001, r = .48 (Table 9). Women maintained this improvement through to follow up, z = -4.10, p < .001, r = .39. Women showed the greatest improvement for time management at post-intervention (71.4%) compared to baseline (33.9%), which decreased but remained improved at follow up (55.4%; Figure 16). Reaching out to others

and self-reflection were improved at post-intervention (respectively, 83.9% 58.9%) and were

either completely maintained (reaching out to others: 83.9%) or continued to improve (self-

reflection: 60.7%) at follow up compared to post-intervention.