The data from the standardized instruments used in this study indicate support for all four of the sub-hypotheses for Hypothesis 1 when comparing baseline to post-intervention results from program participants. The data indicate the workshop did have a positive impact on the health-related self-efficacy (SAHP) and on the nutritional awareness and behaviors (HPLP Nutrition sub-scale) for participants in the Workshop group. The HPLP Stress Management score indicates the workshop had a positive impact on use of stress management techniques for the Workshop group, while the PSS score indicates the stress management techniques being used are resulting in less perceived stress for this group. The HPLP Physical Activity sub-scale indicated a significant increase for the workshop participants, but the PADS Total Activity scale showed no increase. The PADS Total Activity scale score is derived from three sub-scale scores for exercise activity, leisure activity, and household activity. Although none of the measured changes reached statistical significance, the Control group showed decreases in mean scores on all three sub-scales, while the Workshop group showed a decrease in the Household Activity sub-scale and increases in the Exercise Activity and Leisure Activity sub-scales. The PADS Exercise Activity and Leisure Activity sub-scales showed some positive trends for the Workshop group, which supports the HPLP results, but in the calculation of the Total Activity score these gains were outweighed by the decrease in the reported Household Activity sub-scale (an aspect of activity not measured by the HPLP Physical Activity sub-scale). The small sample size and the large standard deviations for the PADS measures appears to have precluded attaining any statistical significance on any of the sub-scales. Overall, while the Workshop group was showing significant gains in these several standardized scales, the Control group showed no change in any of the scales over the period of the study, which strengthens the conclusion that the workshop series had a positive impact on the participants.

With regard to the biometric data collected for this study, while there were some positive trends in several of the measures for sub-hypothesis 1d (Improved Physical Fitness), most notably in the arm ergometer results, the small sample size and the short time frame for this project probably precluded attaining statistically significant changes. Increasing the sample size and increasing the time the subjects are followed will likely improve the possibility of obtaining significant changes, particularly in the physiological variables.

Hypothesis 2 was more difficult to analyze because of the lack of variables that could be directly tied to this hypothesis as it was originally written. However, two measures utilizing collected data could be synthesized testing for a link between improvement in health practices (i.e., improvement in health risk behaviors) and a decrease in the number and severity of secondary conditions. The more specific of these two measures (utilizing health behavior data from the U-M Health Risk Appraisal and the Secondary Conditions Scale) did provide support for the hypothesis.

Four of the seven predicted Outcomes for this study were supported by these results. Measures of both the number and severity of secondary conditions (Outcome a) showed significant decreases by the end of the study for the workshop participants, and no change for the Control group. This is a key finding, since the focus of the workshop instruction is on preventing or reducing the severity of secondary conditions and, indeed, it is a major focus of this study. The Workshop group showed expected decreases in the means for the three measures of physiological health (Outcome b) but overall the changes were not significant, while the Control group reported significantly more unscheduled doctor or clinic visits. Given that hospitalizations, unscheduled doctor/clinic visits and sick days were relatively rare events for this group in the time frame of this project, it might be expected that this result of essentially no changes would be seen. Following the study sample for a longer period of time will be necessary to find any significant changes. Outcome c (Improved Psychological Health) was not supported by the results from any of the three scales utilized for this outcome. The HPLP Interpersonal Relations sub-scale showed a strong trend toward improvement, but the change was not statistically significant. There also was a trend toward improvement for the Workshop group in the HPLP Spiritual Growth sub-scale scores, but the changes were not statistically significant for either group. The other standardized measure related to this outcome was the GSES, which showed an improvement for the Workshop group, but this change was not significant. Given that the focus of this project was not general self-efficacy, but rather health-related self-efficacy (as measured by SAHP for sub-hypothesis 1a), it is not surprising that, while there was a significant improvement shown in health-related self-efficacy, there was not a significant change in general self-efficacy for the Workshop group.

Another important outcome for this study is Outcome d (Perceive Improved Quality of Life), which was supported by the results from the SWLS and the physical component score for the SF-12v2. The gain in wellness knowledge predicted by Outcome e was quite evident in the scores on the knowledge items from the Home Survey. The analysis of the items for Outcome f (Change Health Beliefs) produced negative results. Most likely this is an indication that these were rather poor measures for this particular purpose and were not specific enough for this outcome. Another problem was that for 5 of the 14 items in this set of questions the number of subjects answering at the positive end of the scale at baseline was very high for the Workshop group (and the Control group). This left little or no room for any positive change on these items during the course of the study. The final outcome (Outcome g - Change in Health Behaviors) received strong support from the two primary measures (HPLP Total Score and HPLP Health Responsibility sub-scale). These results indicate the workshop sessions did have a positive impact on the health behaviors of the participants, which is another critical aspect of this study.