Children's Perceived Barriers to a Healthy Diet: The Influence of Child and Community-Related Factors

A healthy diet influences the promotion and maintenance of health throughout an individual’s life. Many individuals struggle to have a healthy diet, despite it being mainly under their control. The current study aims to explore children’s perceived barriers to a healthy diet. A qualitative study with the open-ended question, “Please identify the top 5 barriers to a healthy diet”, was undertaken between January–June 2019 in which 274 students from the 5–6th grades wrote down their answers to the open-ended question. Content analysis was used to analyze responses with a codebook based on the Six C’s Model. Five categories were identified: Child, Clan, Community, Country, and Culture-related barriers. Findings showed that the barriers most highlighted were in the Child sphere (e.g., dietary intake) and the Community sphere (e.g., peer food choices). Children seldom referred to barriers from the Clan sphere, i.e., related to family (e.g., food available at home). Additionally, it seems that girls emphasize more barriers from the Child sphere, while boys emphasize more barriers from the Community sphere. Due to the qualitative nature of this study, interpretation of the data should take into account the specific characteristics and context of the sample. Nevertheless, the current data are helpful in identifying implications for practice, for example, the need to empower children with tools (e.g., self-regulation-based interventions) likely to help them overcome perceived barriers. Finally, advocacy groups may help set environmental and structural changes in the community likely to facilitate children’s healthy choices.

Social Cognitive and Ecological Factors Influence Physical Activity Among Thai Adolescents

BACKGROUND

The aim of this study was to examine the intrapersonal, social, and physical environmental factors associated with physical activity (PA) practice in Thai adolescents.

METHODS

A total of 5536 adolescents aged 14-17 years participated in the survey. Confirmatory factor analyses and structural equation modeling were conducted to determine associations between intrapersonal, social, and physical environmental factors with PA.

RESULTS

The mean age of participants was 15.50 (1.12) years. Community environment had an overall effect on PA (β = 0.08). Perceived family support had direct (β = -0.14) and indirect (β = 0.17) effects on PA through perceived barriers (β = 0.14). Perceived barriers were directly related to PA (β = -0.23) and indirectly (β = -0.16) related to PA through self-efficacy (β = -0.14) and through perceived benefits and self-efficacy (β = -0.02). Perceived usefulness was indirectly related to PA through self-efficacy (β = 0.07). Self-efficacy was directly related to PA (β = 0.43). Girls were more likely to report more perceived barriers (βtotal = 0.13). The model explained 45% of the variance in PA.

CONCLUSION

Self-efficacy and perceived barriers are important intrapersonal factors, whereas perceived family support is an important interpersonal factor for PA among Thai adolescents.

Medication Administration Safety Practices and Perceived Barriers Among Nurses: A Cross-Sectional Study in Northern Nigeria

Introduction

Safe medication administration is a vital process that ensures patients' safety and quality of life. However, reports of medication errors and their solutions are lacking. The aim of this study was to examine the correlation between medication administration safety practices and perceived barriers among nurses in northern Nigeria.

Methods

A descriptive approach to research and cross-sectional design was applied to this study. The study population included nurse employees of the Zamfara State Government in northern Nigeria. Simple random sampling and systematic sampling were used in selecting the respondents of the study. Descriptive analysis and the Spearman rank-order correlation were used in data analysis.

Results

Fewer than 50% of the respondents were found to agree or strongly agree that they identify allergic patients before administering medication. Most of the respondents had agreed or strongly agreed with the following as barriers to medication administration safety practices: lack of appropriate coordination between physicians and nurses, and lack of favorable policies and facilities. There was a very weak positive correlation between medication safety practices and barriers to medication safety practices, and the correlation was statistically significant (r_s = 0.180, P = 0.009).

Conclusion

There was a high level of desirable medication administration safety practices that the respondents followed. Nonidentification of a patient's allergic status and inadequate information on the effects of medications were among the identified medication administration practice gaps. There should be policies guiding medication administration in all hospitals in Zamfara, Nigeria.

Predictors of Physical Activity in Patients With Fibromyalgia: A Path Analysis

BACKGROUND/OBJECTIVE

The aim of this study was to identify psychological factors that influence moderate-vigorous physical activity (MVPA) participation in patients with fibromyalgia.

METHODS

In this secondary data analysis, 170 patients received personalized exercise plans and completed baseline and follow-up assessments of self-reported physical activity at weeks 12, 24, and 36. Structural equation modeling was used to examine the predictive strengths of psychological factors (exercise self-efficacy, perceived barriers, and intention) on MVPA participation.

RESULTS

Using a threshold increase in MVPA of 10 or greater metabolic equivalent hours per week (MET h/wk), 3 groups were defined based on subjects who achieved a minimum increase of 10 MET h/wk that was sustained for at least 12 weeks (SUS-PA), achieved an increase of 10 MET h/wk that was not sustained for at least 12 weeks (UNSUS-PA), and did not achieve an increase of 10 MET h/wk (LO-PA). Increases in exercise self-efficacy and intention and reductions in perceived barriers were associated with increased volume of PA, showing the greatest change in the SUS-PA, followed by UNSUS-PA. For the LO-PA group, there was no change in exercise self-efficacy, a decrease in intention, and an increase in barriers. Using path analysis, exercise self-efficacy and perceived barriers were associated with higher volumes of physical activity via greater intention to engage in MVPA.

CONCLUSIONS

For patients with fibromyalgia, exercise self-efficacy, perceived barriers, and intention to exercise are important constructs for increasing physical activity. Our findings provide guidance for practitioners who seek to promote physical activity in fibromyalgia and suggestions for researchers aiming to improve prediction models.

Perceived barriers to mental health and substance use treatment among US childbearing-aged women: NSDUH 2008-2014

This study compared and contrasted perceived barriers to mental health and substance use treatment among pregnant and non-pregnant women from 2008-2010 to 2011-2014. A trend study was conducted using secondary data from the National Survey on Drug Use and Health 2008-2014 from a propensity score-matched sample of pregnant (n = 5,520) and nonpregnant women (n = 11,040) aged 18 to 44 years. The most frequently perceived barriers to mental health treatment among all women ranked similarly in 2008-2010 compared to 2011-2014: cost (45.2% vs. 50.6%), opposition to treatment (41.9% vs. 41.4%), and stigma (28.2% vs. 24.7%). The rank order of barriers to substance use treatment in 2008-2010 among all women was cost (38.7%), stigma (18.2%), and time/transportation limitations (17%), whereas in 2011-2014, stigma ranked first (35.5%), followed by cost (25.9%) and time/transportation limitations (22.2%). In 2011-2014, the women were significantly more likely than women in 2008-2010 to report not knowing where to go (8.2% vs. .9%, p = .003) and a lack of substance use treatment programs (17.7% vs. 3.0%, p = .014). Perceived barriers to mental health treatment did not change overtime; however, there was a decrease in reported availability of substance use treatment programs between 2008-2010 and 2011-2014.

Exploring Readiness for Birth Control in Improving Women Health Status: Factors Influencing the Adoption of Modern Contraceptives Methods for Family Planning Practices

Background: Pakistan is the world’s sixth most populated country, with a population of approximately 208 million people. Despite this, just 25% of legitimate couples say they have used modern contraceptive methods. A large body of literature has indicated that sexual satisfaction is a complex and multifaceted concept, since it involves physical and cultural components. The purpose of this study is to investigate the impact of influencing factors in terms of contraceptive self-efficacy (CSE), contraceptive knowledge, and spousal communication on the adoption of modern contraceptive methods for family planning (FP) under the moderating role of perceived barriers. Methods: Data were collected using an adopted questionnaire issued to married women of reproductive age belonging to the Rawalpindi and Neelum Valley regions in Pakistan. The sample consisted of 250 married women of reproductive age. SPSS was used to analyze the respondents’ feedback. Results: The findings draw public attention towards CSE, contraceptive knowledge, and spousal communication, because these factors can increase the usage of modern methods for FP among couples, leading to a reduction in unwanted pregnancies and associated risks. Regarding the significant moderation effect of perceived barriers, if individuals (women) are highly motivated (CSE) to overcome perceived barriers by convincing their husbands to use contraceptives, the probability to adopt modern contraceptive methods for FP practices is increased. Conclusions: Policymakers should formulate strategies for the involvement of males by designing male-oriented FP program interventions and incorporating male FP workers to reduce communication barriers between couples. Future research should address several other important variables, such as the desire for additional child, myths/misconceptions, fear of side effects, and partner/friend discouragement, which also affect the adoption of modern contraceptive methods for FP practices.

Associations between Perceptions and Measures of Weather and Walking, United States-2015

INTRODUCTION

Weather can be a barrier to walking. Understanding how perceptions of weather as a barrier and measured temperature are associated with walking can inform monitoring and promotion strategies. The objective of this study is to examine the association between perceptions of weather as a barrier to walking and measured weather with the volume of leisure and transportation walking.

METHODS

The 2015 National Health Interview Survey (NHIS) assessed participation in and volume of walking (transportation, leisure) in the past week and frequency of reporting weather as a barrier to walking. Data were collected over the entire year. In 2019, we merged month-specific temperature data from the PRISM climate group with individual NHIS records. We examined associations using logistic (participation) and linear regression models (volume).

RESULTS

Participation in walking increased as frequency of reporting weather as a barrier to walking decreased, from 'almost always' (transportation: 23%, leisure: 42%) to 'a little of the time' (transportation: 40%, leisure: 67%). Among adults reporting walking, walking volume increased as frequency of reporting weather as a barrier decreased from 'almost always' (transportation: 51 min/week, leisure: 64 min/week) to 'never' (transportation: 69 min/week, leisure: 98 min/week). Month-specific temperature was significantly associated with leisure walking with lower participation at the lowest and highest temperature quintiles, although the strength of the association differed by frequency of reporting weather as a barrier.

CONCLUSIONS

In general, prevalence and volume of leisure and transportation walking decreased as the perception of weather as a barrier increased. Low and high temperature conditions were also associated with leisure walking participation, particularly among adults with increased perceptions of weather as a barrier. Our findings highlight the importance of including strategies to help adults overcome perceived and actual weather-related barriers in walking promotion efforts.

Postnatal exercises: perceived barriers and self-efficacy among women at maternal and children hospital at Najran, kingdom of Saudi Arabia

Sedentary lifestyle is very high in the Saudi population in general and significantly high among females. Furthermore, some postpartum tradition imposes limited activities during postpartum periods. For women to be active during the postpartum period, they should have enough self-efficacy (SE) to overcome perceived barriers (BP). This study aimed to evaluate postnatal exercises' PB and SE among postpartum women. A descriptive cross-sectional research design was followed in this study. This study was conducted at the outpatient department/ Maternal and Child hospital in Najran city, KSA. The study comprised a convenience sample of 368 postnatal women. Data collection was done using a questionnaire composed of three parts; socio-demographic data and obstetric history, exercise benefits/barriers scale and exercise self-efficacy scale. Data were analyzed using SPSS 23.0. The relationships between variables were assessed using the Chi-square or Fisher's exact test. The correlations were assessed using Pearson correlation. The study results illustrated that 52.4% of the postpartum women had moderate SE to exercise, and 71.5% had moderate PB. Also, there were statistically significant relationships between the study participants' SE and PB and their educational level and nationality (p <0.05). In addition, significant negative correlations existed between the participants' SE and their Body Mass Index (BMI), age, gravidity, parity, number of children, and PB (p <0.05). On the other hand, significant positive correlations were observed between the participants' PB and their BMI, age, gravidity, parity, and number of children. This study concluded that about two-thirds of the postpartum women in Najran had low or moderate SE to practice postnatal exercises, and the majority of them had moderate or high BP. Efforts to enhance postnatal exercises should be directed to increase SE to overcome BP concerning postnatal exercises.

Perceived Barriers to Mental Health Services among the Elderly in the Rural of Vietnam: A Cross Sectional Survey in 2019

While the burden of neurological and mental disorders has been drastically increased in Vietnam, the current mental healthcare services do not meet the public demand. In order to determine perceived barriers to the use of mental health services, we conducted a cross-sectional study on 376 elderly people from a rural district in Hanoi, Vietnam. We found that depression may be an important indicator of the need for formal and informal community and home care mental health services. Barriers to mental healthcare access were categorized into 7 groups namely stigma, emotional concerns, participation restrictions, service satisfaction, time constraints, geographic and financial conditions, and availability of services. The most significant barriers are the limited availability of and accessibility to health professionals and services in rural areas. Our study highlights the urgent efforts that need to be made in order to enhance availability of mental healthcare services in rural areas of Vietnam.

Determinants of Breast Cancer Screening in Three Arab American Women Subgroups

INTRODUCTION

Arab American women (AAW) have significantly low mammography screening (MS) rates; religious and sociocultural factors may serve as facilitators or barriers to screening. Understanding associations with screening practices and attitudes is imperative. The purpose of this study was to examine associations of sociodemographic characteristics with perceived benefits and barriers to MS and explore relationships of MS with sociodemographics, and perceived benefits and barriers in Muslim and Christian AAW from three Arab countries, Jordan, Lebanon, and Egypt.

METHOD

In this exploratory, cross sectional study, a convenience sample of 316 AAW completed a survey that combined sociodemographics and the Arab Specific-Culture Barriers instrument.

RESULTS

Religion was significantly associated with perceived benefits and country of birth had a significant association with perceived barriers. Significant relationships were found between some variables and MS.

DISCUSSION

This study provided insights into facilitators and barriers influencing behaviors and attitudes regarding MS in AAW. Additional efforts are to be made to overcome barriers within a religious and cultural context to empower these women.

Factors that increase risk for poor adherence to phenylketonuria treatment in Brazilian patients

Neurotoxic effects caused by high phenylalanine (Phe) in patients with phenylketonuria (PKU) can be avoided through dietary treatment. However, achieving the recommended Phe levels has been a challenge. This study aimed to investigate factors associated with adherence to PKU treatment among patients followed at a medical genetics public service in southern Brazil. Twenty-nine patients (early diagnosed, n = 20; late-diagnosed, n = 9) with classical (n = 16) or mild PKU (n = 13) aged 6-34 years (16.4 ± 7.5) and 16 caregivers were included. Blood Phe levels were recorded, and assessment tools measuring barriers to treatment, IQ, knowledge about disease, treatment, and perceived adherence were collected. Classical PKU patients showed higher current blood Phe levels than mild PKU patients (U = 37.000, p = 0.003). Lifetime and childhood Phe levels were associated with recent metabolic control (τ = 0.76, p = 0.000; τ = 0.70, p = 0.000, respectively). The perception of barriers to treatment was associated with a higher blood Phe level (τ = 0.39, p = 0.003). Tolerance to Phe, metabolic control throughout childhood, and perceived difficulty in living with demands of treatment are important factors of greater vulnerability to poor adherence in PKU patients.

What Predicts Korean Citizens' Mask-Wearing Behaviors? Health Beliefs and Protective Behaviors against Particulate Matter

Air pollution has become a critically important contemporary issue, exposing people to various health risks worldwide. Air pollution problems cannot be resolved in the short-term; therefore, citizens in regions with low air quality are encouraged to take protective actions such as wearing masks to filter particulate matter. However, compliance with such recommendations is limited. To enhance the effectiveness of health promotion in this regard, this study applied the health belief model to examine the factors that affect mask-wearing behaviors. It also investigates the factors that influence particulate matter-related health beliefs and protective behaviors. A cross-sectional survey with 200 Korean citizens was conducted. The results revealed associations between masking behaviors and both perceived benefits of and perceived physical barriers to wearing masks. In addition, sex, education, income, and having heard of different particulate matter-related health consequences were found to predict mask-wearing. This study demonstrates the utility of the health belief model in the context of air pollution and has practical implications for health promotion practitioners.

What Can We Learn from Parents of Caries-Free and Caries-Active Hispanic Children?

OBJECTIVE

This study evaluated strength-based motivators within Hispanic families that support the creation of health in their children. A mixed-methods approach was used to understand differences in Hispanic parental factors between caries-free (CF) and caries-active (CA) children.

METHODS

A cross-sectional survey was conducted with 200 parent-child triads (primary child: between 0 and 6 y; reference child: between 0 and 10 y) recruited from health centers in the Denver Metro area. All the participating children received an oral examination, and the triads were grouped as CF or CA based on the caries status of the primary child. Qualitative data were collected through in-depth individual interviews with the parents. The analysis only involved the primary child. Bivariable analysis were conducted between parent factors (independent variables) and presence or absence of caries (outcome variable). The variables with P < 0.20 in the bivariable analysis were subjected to 2 multivariable logistic regression models. The children in the CF group had mean (SD) age of 2.8 (1.28) y compared to the CA group at 4.0 (1.55) y (P < 0.001). Bivariable analysis demonstrated that parents in the CF group reported higher oral hygiene behavior scores (P = 0.047), perceived fewer barriers (P = 0.009) to accessing preventive dental care, and considered their children more susceptible to cavities (P = 0.001) compared to parents in the CA group. Multivariable model (adjusting for socioeconomic characteristics) demonstrated that parents of CF children perceived high susceptibility to caries for their children (P = 0.040). Multivariable model (adjusting for acculturation) demonstrated an association of parental oral hygiene behavior (P = 0.040) and parent-perceived susceptibility to caries (P = 0.010) with CF child status. Qualitative interviews revealed that parents in the CF group were concerned about their children's higher susceptibility to caries and tried to establish good oral hygiene routines for their children.

CONCLUSION

The results of this study demonstrated that parental behaviors and health beliefs could be significant determinants of caries status in Hispanic children.

KNOWLEDGE TRANSFER STATEMENT

Results of this study indicate that parental oral health beliefs and behaviors are significant determinants of caries status in children of Hispanic population. Parental beliefs could motivate them to take action or establish behavior that prevents dental caries in their children. Health care providers and caries prevention efforts can incorporate this information to tailor oral health promotional messaging and approaches to improve the oral health of Hispanic children.

Assessing opinions and barriers to providing evidence-based tobacco treatment among health care providers within an in-patient psychiatric facility

Background: Tobacco-related morbidity and mortality is high among people with mental illnesses (PMI); yet tobacco treatment (TT) is often not provided by mental health care providers (MHPs). Studies that examine barriers to TT for people with MI are critical in addressing this disparity.Aims: To determine factors associated with MHPs' opinions of, self-efficacy in, barriers to and training needs for providing TT by job role.Methods: 205 MHPs in a psychiatric facility were surveyed using a standardized questionnaire on demographics and opinions, self-efficacy, barriers and needs to providing TT. Descriptive and multivariate regression analyses examined factors associated with the main outcomes.Results: MHP's gave high ratings to both the appropriateness of delivering evidence-based TT and their confidence in providing TT medications. In regards to perceived barriers to providing TT, MHP's further endorsed that patients should be provided nicotine replacement therapy and be motivated to engage in TT. Key needs were for training in cessation counseling, cessation materials and community support for TT.Conclusions: Based on our findings, future studies are needed to address providers' biases and concerns, eliminate system-barriers and determine effective provider training. Moreover, these findings may guide research, practice and policies toward enhancing TT in PMI.

Efficacy of a Brief Self-management Intervention in Type 2 Diabetes Mellitus: A Randomized Controlled Trial from India

BACKGROUND

Diabetes mellitus places a considerable burden on the individual and the family with respect to lifestyle changes. There is a paucity of systematic studies in India examining the efficacy of self-management programs for diabetes. The study examined the impact of a brief self-management intervention (SMI) on primary outcome of HbA1c and secondary outcomes of quality of life (QOL), self-care, perceived barriers to self-care (BSC), perceptions regarding illness and mood in patients with type 2 diabetes mellitus.

METHODS AND MATERIALS

Eighty patients with type 2 diabetes mellitus were randomly allocated to either a 4-session SMI or treatment as usual (TAU) and were assessed on HbA1c levels, QOL, self-care, BSC, illness perceptions, anxiety, and depression at baseline, postintervention , and at three-month postintervention follow-up.

RESULTS

Repeated measures analysis of variance indicated significant improvement in the SMI group from baseline to follow-up on HbA1c (P = 0.001), impact of diabetes on QOL (P = 0.006), self-care with respect to diet and exercise (Ps = 0.001), perceived barriers in adherence to diet, exercise, (P = 0.001), medication (P < 0.01), glucose testing (P = 0.04), general BSC (P = 0.001), total barriers (P = 0.001), illness perceptions-timeline or chronicity of illness (P = 0.002), personal control over illness, (P = 0.001), belief in effectiveness of treatment (P = 0.002), understanding of one's illness (P = 0.001), and emotional representations regarding illness (P =0.001), depression, (P = 0.001), and anxiety (P = 0.001). In the SMI group, large effect sizes were obtained at the postintervention assessment and the three-month follow-up on most outcome measures.

CONCLUSIONS

Brief psychological intervention is efficacious in patients with type 2 diabetes.

Using the health belief model to predict concussion-reporting intentions and behaviour

PURPOSE

To determine whether Health Belief Model (HBM) factors predict concussion-reporting intentions and behaviour. Methods: Participants completed a cross-sectional survey to measure the HBM constructs of concussion knowledge, perceived susceptibility, perceived severity, perceived benefits, perceived barriers, and cues to action. We also asked participants to indicate their concussion-reporting intentions and behaviourfor symptom and concussion reporting. Four separate multivariable regressions were conducted to predict concussion-reporting intentions and behaviour based on HBM constructs. Results: Cues to action (β = 0.25, p= .016) predicted symptom reporting intentions (F_7,318 = 4.44, p< .001, R² = 0.089), while perceived benefits (β = 0.12, p= .018), perceived barriers (β = -0.11, p= .034) and cues to action (β = 0.29, p< .001) predicted concussion-reporting intentions (F_7,318 = 11.34, p < .001, R² = 0.200). The HBM did not predict symptom or concussion-reporting behavior (symptom: Χ² = 5.51, p= .138, Nagelkerke R² = 0.096; concussion: Χ² = 5.20, p= .157, Nagelkerke R² = 0.159). Conclusions: Strategies to reduce perceived barriers and increase benefits of reporting concussion symptoms may improve reporting intentions. This may include cues to action in sharing a positive view toward long-term health and dispelling that reporting a concussion would let down teammates. .

Professional development perspectives across gender and age groups of under-qualified rural NEETs

Our study explored how self-efficacy perceptions are associated with Perceived Barriers (PB), meaning beliefs about constraints on current/future vocational development, and Professional Expectations (PE) among rural, under-qualified youths Not in Employment, nor in Education or Training (NEET). We also analyzed how the connections between these factors varied across gender and age groups. One hundred and eighty-eight NEETs participated in this study (58.20% female; (M = 23.05; standard deviation = 1.96). Through linear regression analysis using PROCESS macros, we found that higher self-efficacy was associated with stronger PB, after accounting for the effects of training offers and income. Moreover, men showing stronger self-efficacy also displayed stronger PB, while men depicting weaker self-efficacy presented weaker PB, compared with women in similar conditions. Being offered more training opportunities resulted in stronger perceptions of professional barriers for these NEETs. Thus, rural, under-qualified NEETs require person-centered approaches from employment services, to support their transition to employment/training.

Perceived Barriers Toward Provider-Initiated HIV Testing and Counseling (PITC) in Pediatric Clinics: A Qualitative Study Involving Two Regional Hospitals in Dar-Es-Salaam, Tanzania

BACKGROUND

According to Provider-Initiated HIV Testing and Counseling (PITC), healthcare providers recommend HIV testing and counseling to persons attending health care facilities as a standard component of medical care. In order to reduce the morbidity and mortality of late Human Immunodeficiency Virus (HIV) diagnosis, timely diagnosis and initiation of ARVs is necessary. This aims to accelerate universal access to HIV prevention, treatment, care, and support services for people living with HIV/AIDS. The present study aimed to explore perceived barriers toward PITC provision in pediatric clinics.

METHODS

The study had a cross-sectional exploratory study design. In-depth interviews were used to collect data from the informants in Mwananyamala and Temeke hospitals in Dar-es-Salaam. Nineteen informants were recruited purposely for in-depth interviews. All the interviews were audio recorded, transcribed verbatim, and translated from Swahili to English. Lastly, data were analyzed using a thematic analysis approach.

RESULTS

The study findings showed six barriers including inadequate training on PITC among healthcare providers, little practice of PITC provision, inability to properly counsel patients due to little knowledge, poor attitude of healthcare providers in providing PITC, shortage of healthcare providers, and little motivation and incentives among healthcare providers. Patient barriers included little understanding of PITC among parents/guardians of children and its importance in terms of their children's health, absence of parents, overcrowding at clinics, HIV/AIDS stigma, lack of privacy at clinics, and harsh language of some of the healthcare providers. Health facility barriers included inadequate space to provide PITC and shortage of medical equipment and medical supplies for HIV testing. Policy-related barriers included the absence of PITC guidelines in each consultation room.

CONCLUSION

Perceived barriers toward PITC must be understood for effective implementation of PITC to reach 90-90-90 goal. The study identified several barriers which need to be addressed in order to improve PITC provision.

Temporal Sequencing of Physical Activity Change Constructs within the Transtheoretical Model

OBJECTIVE

Studies support the Transtheoretical Model's (TTM) ability to describe behavior change processes and guide interventions; however, the temporal sequencing of constructs is less understood. This cohort study tested five sequences to identify TTM construct changes related to physical activity.

METHODS

A random sample provided baseline data (n=689; 63% female; M _age (SD)=47(17); 37% white), with 401 participants providing 24-month data, at six-month intervals.

RESULTS

Structural equation models revealed processes to cognitions to stage (AIC=29313.093, BIC=29514.883, CFI=0.999, RMSEA=0.006, SRMR=0.026); processes to stage to cognitions (AIC=27788.651, BIC=27973.268, CFI=0.978, RMSEA=0.024, SRMR=0.038), self-efficacy/temptations to processes to decisional balance to stage (AIC=13914.771, BIC=14031.169, CFI=0.981, RMSEA=0.018, SRMR=0.034), and stage to processes to cognitions (AIC=22048.324, BIC=22212.986, CFI=0.976, RMSEA=0.026, SRMR=0.029) all fit well. However, cognitions to processes to stage did not fit the data well (AIC=10353.555, BIC=10444.179, CFI=0.937, RMSEA=0.038, SRMR=0.035).

CONCLUSIONS

Integrating results revealed a cyclical model so that intervention efforts should focus on processes to change cognitions related to barrier self-efficacy and decisional balance, which then lead to change in stage and then renew focus on the processes.

Perceived Barriers to Follow AHA Dietary Recommendations in Hypercholesterolemic Patients

Hypercholesterolemia is an important risk factor for cardiovascular disease. Lifestyle modification including dietary changes is the first step for the treatment. Low adherence to dietary recommendations has reported earlier. This study purposed to identify barriers to the American Heart Association dietary recommendations in hypercholesterolemic patients. A 30-item structured questionnaire was designed and the reliability and validity of the questionnaire were evaluated. The exploratory factor analysis was performed on 160 hypercholesterolemic patients and extracted seven interpretable underlying factors of diet non-adherence (52.35% of total variance). These factors included "situational barriers and gathering," "takeaways and eating out," "psychological factors," "false beliefs and food habits," "lack of motivation," "enjoy eating and difficulty resisting the temptation" and "satisfaction with previous food habits". From the practical point of view, considering these perceived barriers, patient's culture, traditions, and dietary preferences can be beneficial in improving dietary adherence among hypercholesterolemic patients.

Nothing to sneeze at - uptake of protective measures against an influenza pandemic by people with schizophrenia: willingness and perceived barriers

OBJECTIVES

To examine willingness to adopt protective behaviours, and perceived barriers, during a pandemic influenza, in people with schizophrenia.

METHODS

A cross-sectional study using a questionnaire was conducted exploring the responses of 71 adults with schizophrenia and 238 adults without schizophrenia attending a general practice setting, regarding willingness and perceived barriers to adopting protective measures against the 2009 swine influenza pandemic in Australia.

RESULTS

The majority of participants with schizophrenia reported that they would be at least moderately willing to be vaccinated (74.2%), isolate themselves (73.2%), wear a face mask (54.9%) and increase hand washing (88.6%). However, 71.8% were concerned about "catching" flu from vaccination. Predictors of willingness to adopt protective actions included self-efficacy (vaccination, face mask, isolation), perceived likelihood of contracting swine flu (vaccination), educational status (face mask) and perceived overall risk from swine flu (face mask). Key modifiable perceived barriers to adopting protective measures were identified, including cost and need for transport assistance for vaccination.

CONCLUSIONS

People with schizophrenia report being generally willing to adopt protective measures, especially increased hand washing, during a pandemic influenza. Understanding perceived barriers may enable development of effective interventions to increase uptake of protective measures.

Demographics, self-efficacy, benefits/barriers, stages of adopting pap testing among Korean American women

Korean American women (KAW) experience the third highest incidence rate of cervical cancer among nine major Asian Americans. This study examined cervical cancer screening among KAW using constructs from the transtheoretical model (TTM). Using a cross-sectional survey design, 102 KAW aged 21-65 years of age were recruited through convenience sampling. Twenty-seven per cent of participants reported of never receiving a Pap smear. Women who were older and married were more likely to report being in the action/maintenance stages; women who perceived themselves to be in poor health were less likely to be in the action/maintenance stages. Higher self-efficacy and lower perception of barriers were significantly associated with more advanced TTM stages. The perceived benefits were not statistically different across TTM stages of change. A special attention should be given to young and unmarried KAW to increase screening participation. Impact statement What is already known on this subject? The utilisation of Pap test among Korean American women (KAW) was low. Using the transtheoretical model (TTM) approach has the potential to increase a screening adherence. What do the results of this study add? This is the first study to examine the association between TTM constructs related to Pap testing among KAW. Younger and unmarried women reported the lowest levels of screening attitudes or behaviours; and tailored efforts may be beneficial in increasing the screening among these women. What are the implications of these findings for clinical practice and/or further research? Increasing the self-efficacy and decreasing the barriers to obtaining Pap screening are critical to move Korean women to the advanced TTM stages. Further investigation is needed with KAW to fully understand the relationships between TTM constructs.

Physical activity for healthy pregnancy among Iranian women: Perception of facilities versus perceived barriers

BACKGROUND

Regular physical activity during preconception period has beneficial effects on the health of women during conception and the identification of factors associated with it is an effective factor for improving the behavior. Therefore, the aim of this study is to evaluate the relationship between the physical activity and health belief model (HBM) constructs (perceived susceptibility/severity, barriers, and self-efficacy) as intrapersonal factors among women undergoing preconception care.

METHODS

In this cross-sectional study, 110 women who were undergoing preconception care were carried out. Moreover, health belief constructs and attitude toward physical activity were assessed through the use of researcher-made questionnaire. In addition, the duration of physical activity with moderate/vigorous intensity was evaluated utilizing a long form of the International Physical Activity Questionnaire.

RESULTS

The results showed that although there was a relationship between the all health belief constructs and attitude toward physical activity and the duration of leisure physical activities carried out during (P < 0.05), but using the linear regression test showed that only perceived barriers, independent from other variables, had a significant inverse correlation with this type of activities (β = -0.27, P = 0.02).

CONCLUSION

The findings of this study showed that among the constructs of theHBM, perceived barriers are the most important predictor of physical activity in women during the preconception period and emphasize the need to design possible means to promote physical activity to remove barriers to effective physical activity.

Physicians' attitudes towards psycho-oncology, perceived barriers, and psychosocial competencies: Indicators of successful implementation of adjunctive psycho-oncological care?

Objective

Clinical experience reveals a gap between recommended psychosocial care and actual support for psycho‐oncology. Physicians are essential for managing psychosocial distress and for the successful implementation of psycho‐oncology. The aim was to explore physician's attitudes towards psycho‐oncology, their self‐perceived barriers towards referral to psycho‐oncology, and their personal psychosocial competencies in a maximum‐care hospital.

Method

Semistructured interviews informed the development of a questionnaire administered to a monocentric sample of 120 physicians at the University Hospital Frankfurt. The data were exploratively analysed.

Results

One hundred two physicians completed the questionnaire. Physicians provided high ratings concerning the value of psycho‐oncology, beliefs about its efficacy, and their personal commitment to psycho‐oncology. Physicians noticed especially barriers that originated from patients themselves. They estimated their own psychosocial education and knowledge as moderate but rated their psychosocial skills and abilities as higher. Frequency of integration of psychosocial care was most strongly influenced by physicians' psychosocial competencies and their personal commitment to psycho‐oncology. Integration of psycho‐oncological issues occurs in 43% of patients.

Conclusion

Physicians are an important indicator of successful implementation. The discrepancy between the positive evaluation and actual support for psycho‐oncology may be explained by several factors, eg, the lack of support from clinic leaders. Patient‐related barriers, most often identified by physicians, seem to be an indication of actual lack of psychosocial competencies. Physicians' psychosocial competencies positively affect the implementation of psycho‐oncology. Sound knowledge of psychosocial topics may result in increased integration of psychosocial aspects into treatment. Therefore, medical training should focus more on psychosocial issues.