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Teichmüller K, Schönbach B, Boujong D, Böger A, Sabatowski R, Scharnagel R. [Booster treatments in interdisciplinary multimodal pain therapy : Preparing structural and process parameters for the implementation of cross-sectoral booster treatments]. Schmerz 2024:10.1007/s00482-024-00807-z. [PMID: 38592523 DOI: 10.1007/s00482-024-00807-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/29/2024] [Indexed: 04/10/2024]
Abstract
Interdisciplinary multimodal pain therapy (IMPT) is an established procedure in the treatment of chronic pain. In daily practice, many institutions regard so-called booster units as an integral part of IMPT. However, no consensual recommendations and evidence for booster concepts are available to date. This article uses the results of a discussion between clinical experts in the field of IMPT at the German Pain Congress in 2022 in order to show the status quo in care. It has been shown that currently applied booster offers vary greatly in terms of time intervals, intensities, therapy content and patient selection and that there is a need for structural and process parameters for the implementation of cross-sectoral booster treatments. In conclusion, the authors outline how the development of these parameters will be planned as an expert consensus with the participation of interested institutions and the inclusion of the patient perspective and offer opportunities for participation in this process.
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Affiliation(s)
- Karolin Teichmüller
- Klinik und Poliklinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Zentrum für interdisziplinäre Schmerzmedizin, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - Benjamin Schönbach
- UniversitätsSchmerzCentrum, Universitätsklinikum und Medizinische Fakultät "Carl Gustav Carus", Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland
| | - Dirk Boujong
- Schmerztagesklinik, Stiftungskrankenhaus Nördlingen, Nördlingen, Deutschland
| | - Andreas Böger
- Klinik für Schmerzmedizin, Manuelle Therapie und Naturheilverfahren, Vitos Orthopädische Klinik Kassel, Kassel, Deutschland
| | - Rainer Sabatowski
- UniversitätsSchmerzCentrum, Universitätsklinikum und Medizinische Fakultät "Carl Gustav Carus", Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland
- Klinik für Anästhesiologie und Intensivtherapie, Universitätsklinikum und Medizinische Fakultät "Carl Gustav Carus", Technische Universität Dresden, Dresden, Deutschland
| | - Rüdiger Scharnagel
- UniversitätsSchmerzCentrum, Universitätsklinikum und Medizinische Fakultät "Carl Gustav Carus", Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland.
- Klinik für Anästhesiologie und Intensivtherapie, Universitätsklinikum und Medizinische Fakultät "Carl Gustav Carus", Technische Universität Dresden, Dresden, Deutschland.
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Sedhed J, Johansson H, Andersson N, Åkesson E, Kalbe E, Franzén E, Leavy B. Feasibility of a novel eHealth intervention for Parkinson's disease targeting motor-cognitive function in the home. BMC Neurol 2024; 24:114. [PMID: 38580913 PMCID: PMC10996106 DOI: 10.1186/s12883-024-03614-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 03/29/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND Parkinson's disease (PD) drastically affects motor and cognitive function, but evidence shows that motor-cognitive training improves disease symptoms. Motor-cognitive training in the home is scarcely investigated and eHealth methods can provide continual support for PD self-management. Feasibility testing is however required. OBJECTIVE To assess the feasibility (i) Recruitment capability (ii) Acceptability and Suitability (iii) Demand and Safety of a home-based motor-cognitive eHealth exercise intervention in PD. METHODS The 10-week intervention was delivered using the ExorLive® application and exercises were individually adapted and systematically progressed and targeted functional strength, cardiovascular fitness, flexibility, and motor-cognitive function. People with mild-to moderate PD were assessed before and after the intervention regarding; gait performance in single and dual-task conditions; functional mobility; dual-task performance; balance performance; physical activity level; health related quality of life and perceived balance confidence and walking ability; global cognition and executive function. Feasibility outcomes were continuously measured using a home-exercise diary and contact with a physiotherapist. Changes from pre- and post-intervention are reported descriptively. RESULTS Fifteen participants (mean age 68.5 years) commenced and 14 completed the 10-week intervention. In relation to intervention Acceptability, 64% of the motor sessions and 52% of motor-cognitive sessions were rated as "enjoyable". Concerning Suitability, the average level of exertion (Borg RPE scale) was light (11-12). Adherence was high, with 86% of all (420) sessions reported as completed. No falls or other adverse events occurred in conjunction with the intervention. CONCLUSIONS This motor-cognitive eHealth home exercise intervention for PD was safe and feasible in terms of Recruitment capability, Acceptability, Safety and Demand. The intensity of physical challenge needs to be increased before testing in an efficacy trial. TRIAL REGISTRATION This trial is registered at Clinicaltrials.gov (NCT05027620).
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Affiliation(s)
- Jenny Sedhed
- Stockholm Sjukhem Foundation, R&D unit, Stockholm, Sweden.
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Alfred Nobels Allé 23, Huddinge, 141 83, Sweden.
| | - Hanna Johansson
- Stockholm Sjukhem Foundation, R&D unit, Stockholm, Sweden
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Alfred Nobels Allé 23, Huddinge, 141 83, Sweden
- Theme Women's Health and Allied Health Professionals, Medical unit Occupational Therapy & Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
| | - Nina Andersson
- Stockholm Sjukhem Foundation, R&D unit, Stockholm, Sweden
| | - Elisabet Åkesson
- Stockholm Sjukhem Foundation, R&D unit, Stockholm, Sweden
- Department of Neurobiology, Care sciences and Society, Division of Neurogeriatrics, Karolinska Institutet, Stockholm, Sweden
| | - Elke Kalbe
- Medical Psychology | Neuropsychology and Gender Studies and Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Erika Franzén
- Stockholm Sjukhem Foundation, R&D unit, Stockholm, Sweden
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Alfred Nobels Allé 23, Huddinge, 141 83, Sweden
- Theme Women's Health and Allied Health Professionals, Medical unit Occupational Therapy & Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
| | - Breiffni Leavy
- Stockholm Sjukhem Foundation, R&D unit, Stockholm, Sweden
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Alfred Nobels Allé 23, Huddinge, 141 83, Sweden
- Theme Women's Health and Allied Health Professionals, Medical unit Occupational Therapy & Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
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Winters S, Martinez S, Johannsen J. Do improvements in infant and young child feeding (IYCF) practices endure the test of time? JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2024; 43:49. [PMID: 38580998 PMCID: PMC10998429 DOI: 10.1186/s41043-024-00507-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 01/13/2024] [Indexed: 04/07/2024]
Abstract
BACKGROUND Reducing malnutrition is a key priority for governments in low- and middle-income countries given its lasting effects on child development, health, income, and economic growth. Strategies to improve recommended infant and young child feeding (IYCF) practices, especially during the first two years of life, are considered among the most effective. METHODS In this paper, we evaluate the long-run impacts of an innovative education strategy based on interactive play and performing arts implemented in El Alto, Bolivia on caregivers' IYCF knowledge and practices. Two thousand and fifteen households were randomly assigned to intervention and control groups. Two rounds of data were collected approximately 30 and 42 months after baseline. We estimate short-term (30 month) and longer-term (42 month) intent-to-treat effects using multivariate linear regression analysis, with and without controlling for covariates. RESULTS The program significantly increased caregiver IYCF knowledge by 0.13 SDs in the short run, and this effect grew over time. The program also improved adherence to recommended IYCF practices by 0.23 standard deviations (SDs) in the short term, but the effect on practices dissipated over time, and no longer-term impacts were detected. Caregivers with above median baseline knowledge, number of children, and age appear to have benefited most from the program. CONCLUSIONS Our findings suggest that entertainment-education interventions are a promising model for improving and maintaining IYCF knowledge. However, their ability to sustain more permanent changes in IYCF practices is less certain. Further evidence is needed to identify other avenues for producing long-term, sustainable behavior change, especially among indigenous populations in Latin America, where literature on education and behavior-change interventions related to IYCF practices is limited.
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Affiliation(s)
- Solis Winters
- School of Public Health, University of California Berkeley, Berkeley, CA, USA
| | - Sebastian Martinez
- International Initiative for Impact Evaluation (3ie), Washington, DC, USA.
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Kwasnicka D, Potthoff S, Hagger MS, Vandelanotte C, Rebar A, Short CE, Crook D, Gardner B. Challenging assumptions underlying physical activity promotion for health care professionals in Australia: A data-prompted interview study. Health Promot J Austr 2024; 35:542-550. [PMID: 37537885 DOI: 10.1002/hpja.784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 07/20/2023] [Accepted: 07/21/2023] [Indexed: 08/05/2023] Open
Abstract
ISSUE ADDRESSED Interventions targeting health care professionals' behaviours are assumed to support them in learning how to give behavioural advice to patients, but such assumptions are rarely examined. This study investigated whether key assumptions were held regarding the design and delivery of physical activity interventions among health care professionals in applied health care settings. This study was part of the 'Physical Activity Tailored intervention in Hospital Staff' randomised controlled trial of three variants of a web-based intervention. METHODS We used data-prompted interviews to explore whether the interventions were delivered and operated as intended in health care professionals working in four hospitals in Western Australia (N = 25). Data were analysed using codebook thematic analysis. RESULTS Five themes were constructed: (1) health care professionals' perceived role in changing patients' health behaviours; (2) work-related barriers to physical activity intervention adherence; (3) health care professionals' use of behaviour change techniques; (4) contamination between groups; and (5) perceptions of intervention tailoring. CONCLUSIONS The intervention was not experienced by participants, nor did they implement the intervention guidance, in the way we expected. For example, not all health care professionals felt responsible for providing behaviour change advice, time and shift constraints were key barriers to intervention participation, and contamination effects were difficult to avoid. SO WHAT?: Our study challenges assumptions about how health care professionals respond to behaviour change advice and possible knock-on benefits for patients. Applying our learnings may improve the implementation of health promotion interventions in health care settings.
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Affiliation(s)
- Dominika Kwasnicka
- NHMRC CRE in Digital Technology to Transform Chronic Disease Outcomes, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
- SWPS University of Social Sciences and Humanities, Faculty of Psychology, Wroclaw, Poland
| | - Sebastian Potthoff
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle upon Tyne, UK
| | - Martin S Hagger
- Department of Psychology, University of California, Merced, USA
- Department of Sport Sciences, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Corneel Vandelanotte
- Physical Activity Research Group, Appleton Institute, School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Australia
| | - Amanda Rebar
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Australia
| | - Camille E Short
- Melbourne Centre for Behaviour Change, Melbourne School of Psychological Sciences, Parkville, Victoria, Australia
- Melbourne School of Health Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Dawn Crook
- Serco, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
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Al-Adhami M, Durbeej N, Daryani A, Wångdahl J, Larsson EC, Salari R. Can extended health communication improve newly settled refugees' health literacy? A quasi-experimental study from Sweden. Health Promot Int 2024; 39:daae015. [PMID: 38430509 PMCID: PMC10908352 DOI: 10.1093/heapro/daae015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2024] Open
Abstract
Structural and contextual factors such as limited work and housing opportunities negatively affect the health and well-being of newly settled refugee migrants in receiving high-income countries. Health promotion initiatives aiming at strengthening health and integration have been tried out within the Swedish Introduction program for refugee migrants. However, longitudinal evaluations of these interventions are rare. The aim of the current study was to compare the effectiveness of a regular and an extended civic orientation course with added health communication and examine whether the latter would improve self-rated health and psychological well-being, health literacy and social capital among newly settled refugee migrants in Sweden. Pre- and post-assessment questionnaires were collected from the intervention group receiving the extended course (n = 143) and a control group receiving the regular course (n = 173). Linear mixed models and chi-square analyses showed a significant increase with a small effect size (0.21) in health literacy in the intervention group. However, there were no significant changes in emotional and practical support, general self-rated health or psychological well-being. The findings indicate that added health communication provided embedded in the civic orientation course can increase health literacy. However, further longitudinal studies are needed to confirm the sustainability of the observed effect and examine whether these short-term improvements in health literacy translate to long-term advances in health and integration.
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Affiliation(s)
- Maissa Al-Adhami
- Child Health and Parenting (CHAP), Department of Public Health and Caring Sciences, Uppsala University, Husargatan 3, 752 37 Uppsala, Sweden
- Research and Learning for Sustainable Development and Global Health (SWEDESD), Department of Women’s and Children’s Health, Uppsala University, Hammarskjölds väg 14B, 752 37 Uppsala, Sweden
| | - Natalie Durbeej
- Child Health and Parenting (CHAP), Department of Public Health and Caring Sciences, Uppsala University, Husargatan 3, 752 37 Uppsala, Sweden
| | - Achraf Daryani
- Department of Public Health and Caring Sciences, Uppsala University, Husargatan 3, 752 37 Uppsala, Sweden
| | - Josefin Wångdahl
- Aging Research Center, Karolinska Institutet and Stockholm University, Tomtebodavägen 18 A, 171 65 Stockholm, Sweden
| | - Elin C Larsson
- Research and Learning for Sustainable Development and Global Health (SWEDESD), Department of Women’s and Children’s Health, Uppsala University, Hammarskjölds väg 14B, 752 37 Uppsala, Sweden
- Department of Women’s and Children’s Health, Karolinska Institutet, Tomtebodavägen 18A, 171 77 Stockholm, Sweden
- Department of Global Public Health, Karolinska Institutet, Tomtebodavägen 18 A, 171 65 Stockholm, Sweden
| | - Raziye Salari
- Child Health and Parenting (CHAP), Department of Public Health and Caring Sciences, Uppsala University, Husargatan 3, 752 37 Uppsala, Sweden
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Bertram W, Penfold C, Glynn J, Johnson E, Burston A, Rayment D, Howells N, White S, Wylde V, Gooberman-Hill R, Blom A, Whale K. REST: a preoperative tailored sleep intervention for patients undergoing total knee replacement - feasibility study for a randomised controlled trial. BMJ Open 2024; 14:e078785. [PMID: 38508646 PMCID: PMC10961562 DOI: 10.1136/bmjopen-2023-078785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 02/19/2024] [Indexed: 03/22/2024] Open
Abstract
OBJECTIVES To test the feasibility of a randomised controlled trial (RCT) of a novel preoperative tailored sleep intervention for patients undergoing total knee replacement. DESIGN Feasibility two-arm two-centre RCT using 1:1 randomisation with an embedded qualitative study. SETTING Two National Health Service (NHS) secondary care hospitals in England and Wales. PARTICIPANTS Preoperative adult patients identified from total knee replacement waiting lists with disturbed sleep, defined as a score of 0-28 on the Sleep Condition Indicator questionnaire. INTERVENTION The REST intervention is a preoperative tailored sleep assessment and behavioural intervention package delivered by an Extended Scope Practitioner (ESP), with a follow-up phone call 4 weeks postintervention. All participants received usual care as provided by the participating NHS hospitals. OUTCOME MEASURES The primary aim was to assess the feasibility of conducting a full trial. Patient-reported outcomes were assessed at baseline, 1-week presurgery, and 3 months postsurgery. Data collected to determine feasibility included the number of eligible patients, recruitment rates and intervention adherence. Qualitative work explored the acceptability of the study processes and intervention delivery through interviews with ESPs and patients. RESULTS Screening packs were posted to 378 patients and 57 patients were randomised. Of those randomised, 20 had surgery within the study timelines. An appointment was attended by 25/28 (89%) of participants randomised to the intervention. Follow-up outcomes measures were completed by 40/57 (70%) of participants presurgery and 15/57 (26%) postsurgery. Where outcome measures were completed, data completion rates were 80% or higher for outcomes at all time points, apart from the painDETECT: 86% complete at baseline, 72% at presurgery and 67% postsurgery. Interviews indicated that most participants found the study processes and intervention acceptable. CONCLUSIONS This feasibility study has demonstrated that with some amendments to processes and design, an RCT to evaluate the clinical and cost-effectiveness of the REST intervention is feasible. TRIAL REGISTRATION NUMBER ISRCTN14233189.
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Affiliation(s)
- Wendy Bertram
- Musculoskeletal Research Unit, University of Bristol Medical School, Bristol, UK
- NIHR Bristol Biomedical Research Centre, Bristol, UK
| | - Chris Penfold
- Musculoskeletal Research Unit, University of Bristol Medical School, Bristol, UK
| | - Joel Glynn
- University of Bristol Medical School, Bristol, UK
| | - Emma Johnson
- University of Bristol Medical School, Bristol, UK
| | - Amanda Burston
- Musculoskeletal Research Unit, University of Bristol Medical School, Bristol, UK
| | | | | | - Simon White
- Cardiff and Vale University Health Board, Cardiff, UK
| | - Vikki Wylde
- Musculoskeletal Research Unit, University of Bristol Medical School, Bristol, UK
- NIHR Bristol Biomedical Research Centre, Bristol, UK
| | - Rachael Gooberman-Hill
- NIHR Bristol Biomedical Research Centre, Bristol, UK
- University of Bristol Medical School, Bristol, UK
| | | | - Katie Whale
- Musculoskeletal Research Unit, University of Bristol Medical School, Bristol, UK
- NIHR Bristol Biomedical Research Centre, Bristol, UK
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Joyal-Desmarais K, Rothman AJ, Evans EH, Araújo-Soares V, Sniehotta FF. Furthering Scientific Inquiry for Weight Loss Maintenance: Assessing the Psychological Processes Impacted by a Low intensity Technology-Assisted Intervention (NULevel Trial). Ann Behav Med 2024; 58:296-303. [PMID: 38394391 DOI: 10.1093/abm/kaae002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND NULevel was a randomized control trial to evaluate a technology-assisted weight loss maintenance (WLM) program in the UK. The program included: (a) a face-to-face goal-setting session; (b) an internet platform, a pedometer, and wirelessly connected scales to monitor and report diet, physical activity, and weight, and; (c) regular automated feedback delivered by mobile phone, tailored to participants' progress. Components were designed to target psychological processes linked to weight-related behavior. Though intervention participants showed increased physical activity, there was no difference in WLM between the intervention and control groups after 12 months (Sniehotta FF, Evans EH, Sainsbury K, et al. Behavioural intervention for weight loss maintenance versus standard weight advice in adults with obesity: A randomized controlled trial in the UK (NULevel Trial). PLoS Med. 2019; 16(5):e1002793. doi:10.1371/journal.pmed.1002793). It is unclear whether the program failed to alter targeted psychological processes, or whether changes in these processes failed to influence WLM. PURPOSE We evaluate whether the program influenced 16 prespecified psychological processes (e.g., self-efficacy and automaticity toward diet and physical activity), and whether these processes (at 6 months) were associated with successful WLM (at 12 months). METHODS 288 adults who had previously lost weight were randomized to the intervention or control groups. The control group received wireless scales and standard advice via newsletters. Assessments occurred in person at 0, 6, and 12 months. RESULTS The intervention significantly altered 10 of the 16 psychological processes, compared with the control group. However, few processes were associated with WLM, leading to no significant indirect effects of the intervention via the processes on WLM. CONCLUSIONS Changes in targeted processes were insufficient to support WLM. Future efforts may more closely examine the sequence of effects between processes, behavior, and WLM.
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Affiliation(s)
| | | | | | - Vera Araújo-Soares
- Department for Prevention of Cardiovascular and Metabolic Disease, Medical Faculty Mannheim, CPD, University of Heidelberg, Mannheim, Germany
| | - Falko F Sniehotta
- Department for Public Health, Social and Preventive Medicine, Medical Faculty Mannheim, CPD, University of Heidelberg, Mannheim, Germany
- NIHR Policy Research Unit Behavioural Science, Faculty of Medical Sciences, Newcastle University, Newcastle, UK
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JaKa MM, Ziegenfuss JY, Dinh JM, Jacobson LJ, Kottke TE, Knudson SM, Heim CC, Gallagher JM, Campbell KD, Rivard RL, Pronk NP. Evidence to support health system prioritization of health behaviors in the COVID-19 era. Prog Cardiovasc Dis 2024; 83:77-83. [PMID: 38423235 DOI: 10.1016/j.pcad.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 02/24/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Since the COVID-19 pandemic health systems have shifted necessarily from chronic to infectious disease treatment, but chronic disease remains critical. One large health system uniquely tracks member health behaviors. This analysis compares data from select months of an ongoing monthly cross-sectional survey before and during the pandemic. METHODS Responses in April 2019 (pre-pandemic), April 2020 (early pandemic) or April 2021 (later pandemic) were included in the primary analysis (N = 252). Differences in meeting health behavior guidelines were analyzed via logistic regression. RESULTS A significant decline was seen for physical activity (19% not meeting guidelines pre-pandemic vs. 41% later pandemic) but not fruit/vegetable, alcohol, or sleep from early to later pandemic. Prevalence of women not meeting tobacco guidelines increased from early (5%) to later pandemic (10%) while prevalence in men decreased (10% vs 4% respectively). The percent of people not thinking about the good things that happen to them fluctuated closely with reports of new COVID-19 cases. CONCLUSIONS Findings show the nuance of changing health behaviors throughout the pandemic. Results should be used by health systems to tailor support based on insights from the pandemic experience.
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Affiliation(s)
- Meghan M JaKa
- Center for Evaluation & Survey Research, HealthPartners Institute, 8170 33(rd) Ave S, Bloomington, MN 55425, United States of America.
| | - Jeanette Y Ziegenfuss
- Center for Evaluation & Survey Research, HealthPartners Institute, 8170 33(rd) Ave S, Bloomington, MN 55425, United States of America
| | - Jennifer M Dinh
- Center for Evaluation & Survey Research, HealthPartners Institute, 8170 33(rd) Ave S, Bloomington, MN 55425, United States of America
| | - Laura J Jacobson
- Center for Evaluation & Survey Research, HealthPartners Institute, 8170 33(rd) Ave S, Bloomington, MN 55425, United States of America
| | - Thomas E Kottke
- HealthPartners Institute, 8170 33(rd) Ave S, Bloomington, MN 55425, United States of America; HealthPartners, 8170 33rd Ave S, Bloomington, MN 55425, United States of America
| | - Susan M Knudson
- HealthPartners, 8170 33rd Ave S, Bloomington, MN 55425, United States of America
| | - Chad C Heim
- HealthPartners, 8170 33rd Ave S, Bloomington, MN 55425, United States of America
| | - Jason M Gallagher
- HealthPartners, 8170 33rd Ave S, Bloomington, MN 55425, United States of America
| | - Kevin D Campbell
- HealthPartners, 8170 33rd Ave S, Bloomington, MN 55425, United States of America
| | - Rachael L Rivard
- Center for Evaluation & Survey Research, HealthPartners Institute, 8170 33(rd) Ave S, Bloomington, MN 55425, United States of America
| | - Nicolaas P Pronk
- HealthPartners Institute, 8170 33(rd) Ave S, Bloomington, MN 55425, United States of America; HealthPartners, 8170 33rd Ave S, Bloomington, MN 55425, United States of America
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Knapova L, Cho YW, Chow SM, Kuhnova J, Elavsky S. From intention to behavior: Within- and between-person moderators of the relationship between intention and physical activity. PSYCHOLOGY OF SPORT AND EXERCISE 2024; 71:102566. [PMID: 37981291 DOI: 10.1016/j.psychsport.2023.102566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 11/10/2023] [Accepted: 11/14/2023] [Indexed: 11/21/2023]
Abstract
Intention is a proximal predictor of behavior in many theories of behavior change, but intentions to be physically active do not always translate to actual physical activity. Little research has examined intensive longitudinal changes in physical activity and corresponding within-person moderators needed to elucidate the mechanisms, hurdles, and facilitators of individuals' everyday physical activity behaviors. The present study set out to evaluate the possible moderators of the intention-physical activity relationship across within-person and between-person levels, including cross-level interactions. Data comprise the first intensive measurement burst (14 days) of the longitudinal prospective Healthy Aging in Industrial Environment (HAIE) study, with N = 1135 participants (N = 10,030 person-days), aged 18-65. Physical activity was operationalized as step counts measured objectively using Fitbit Charge 3/4 fitness monitor. Intention, barriers to physical activity, and social support for physical activity were measured daily via smartphone surveys. Stable characteristics, i.e., physical activity habit and exercise identity, were measured using an online questionnaire. A multilevel moderation regression model with Bayesian estimator was fitted. At the within-person level, the relation between intention and steps was weaker on days when barriers were more severe than usual for a given person (Estimate = -0.267; CI95 = [-0.340, -0.196]) and social support was below average for a given person (Est = 0.143; CI95 = [0.023, 0.262]). Additionally, the daily intention-behavior relationship was stronger for people with lower average severity of barriers (Est = -0.153; CI95 = [-0.268, -0.052]), higher exercise identity (Est = 0.300; CI95 = [0.047, 0.546]), men (Est = -1.294, CI95 = [-1.854, -0.707]), and older individuals (Est = 0.042, CI95 = [0.017, 0.064]). At the between-person level, only physical activity habit strengthened the intention-behavior link (Est = 0.794; CI95 = [0.090, 1.486]). Our results underscore the need to separate the between-person differences from the within-person fluctuations to better understand the individual dynamics in physical activity behaviors. Personalized interventions aimed at helping individuals translate intentions to actual physical activity could be tailored and become more intensive when there is a higher risk of intention-behavior gap on a given day for a specific individual (i.e., a day with more severe barriers and less social support), by increasing the dosage or deploying more precisely targeted intervention strategies and components. In addition, interventionists should take gender and age into account when tailoring everyday strategies to help individuals act on their intentions.
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Hardcastle SJ, Maxwell-Smith C, Cavalheri V, Boyle T, Román ML, Platell C, Levitt M, Saunders C, Sardelic F, Nightingale S, McCormick J, Lynch C, Cohen PA, Bulsara M, Hince D. The promoting physical activity in regional and remote cancer survivors (PPARCS) trial: Physical activity maintenance. Scand J Med Sci Sports 2024; 34:e14572. [PMID: 38424471 DOI: 10.1111/sms.14572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 01/12/2024] [Accepted: 01/17/2024] [Indexed: 03/02/2024]
Abstract
INTRODUCTION The study examined whether increased physical activity (PA) in nonmetropolitan cancer survivors was maintained 12 weeks following the PPARCS intervention. METHODS PA outcomes were assessed using an accelerometer at baseline, end of the intervention, and at 24 weeks. Linear mixed models were used to examine between-group changes in PA outcomes. RESULTS The increased moderate-to-vigorous PA (MVPA) following intervention was maintained with significantly higher MVPA in the intervention group at 24 weeks (vs. controls) compared to baseline nett change of 52.5 min/week (95% CI 11.0-94.0.4). CONCLUSIONS Distance-based interventions using wearables and health coaching may produce MVPA maintenance amongst nonmetropolitan cancer survivors.
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Affiliation(s)
- Sarah J Hardcastle
- Sport and Physical Activity Research Centre, Sheffield Hallam University, Sheffield, UK
- Institute for Health Research, The University of Notre Dame, Fremantle, Western Australia, Australia
| | - Chloe Maxwell-Smith
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Vinicius Cavalheri
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
- Allied Health, South Metropolitan Health Service, Murdoch, Western Australia, Australia
| | - Terry Boyle
- Australian Centre for Precision Health, University of South Australia, Adelaide, South Australia, Australia
| | - Marta Leyton Román
- Department of Didactics of Musical, Plastic and Body Expression, University of Extremadura, Caceres, Spain
| | - Cameron Platell
- St. John of God Subiaco Hospital, Perth, Western Australia, Australia
| | - Michael Levitt
- St. John of God Subiaco Hospital, Perth, Western Australia, Australia
| | - Christobel Saunders
- St. John of God Subiaco Hospital, Perth, Western Australia, Australia
- Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
| | - Frank Sardelic
- Tamara Private Hospital, Tamworth, New South Wales, Australia
| | | | - Jacob McCormick
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Craig Lynch
- College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - Paul A Cohen
- Institute for Health Research, The University of Notre Dame, Fremantle, Western Australia, Australia
- St. John of God Subiaco Hospital, Perth, Western Australia, Australia
- Division of Obstetrics and Gynaecology, Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - Max Bulsara
- Institute for Health Research, The University of Notre Dame, Fremantle, Western Australia, Australia
| | - Dana Hince
- Institute for Health Research, The University of Notre Dame, Fremantle, Western Australia, Australia
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Harakeh Z, Preuhs K, Eekhout I, Lanting C, Klein Velderman M, van Empelen P. Behavior Change Techniques That Prevent or Decrease Obesity in Youth With a Low Socioeconomic Status: A Systematic Review and Meta-Analysis. Child Obes 2024; 20:128-140. [PMID: 37204322 DOI: 10.1089/chi.2022.0172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Background: Interventions, targeting youth, are necessary to prevent obesity later in life. Especially youth with low socioeconomic status (SES) are vulnerable to develop obesity. This meta-analysis examines the effectiveness of behavioral change techniques (BCTs) to prevent or reduce obesity among 0 to 18-year-olds with a low SES in developed countries. Method: Intervention studies were identified from systematic reviews or meta-analyses published between 2010 and 2020 and retrieved from PsycInfo, Cochrane systematic review, and PubMed. The main outcome was body mass index (BMI), and we coded the BCTs. Results: Data from 30 studies were included in the meta-analysis. The pooled postintervention effects of these studies indicated a nonsignificant decrease in BMI for the intervention group. Longer follow-up (≥12 months) showed favorable differences for intervention studies, although that BMI change was small. Subgroup analyses showed larger effects for studies with six or more BCTs. Furthermore, subgroup analyses showed a significant pooled effect in favor of the intervention for the presence of a specific BCT (problem-solving, social support, instruction on how to perform the behavior, identification of self as role model, and demonstration of the behavior), or absence of a specific BCT (information about health consequences). The intervention program duration and age group of the study population did not significantly influence the studies' effect sizes. Conclusions: Generally, the effects of interventions on BMI change among youth with low SES are small to neglectable. Studies with more than six BCTs and/or specific BCTs had a higher likelihood of decreasing BMI of youth with low SES.
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Affiliation(s)
- Zeena Harakeh
- Department of Child Health, TNO, Netherlands Organization for Applied Scientific Research, Leiden, Netherlands
| | - Katharina Preuhs
- Department of Child Health, TNO, Netherlands Organization for Applied Scientific Research, Leiden, Netherlands
| | - Iris Eekhout
- Department of Child Health, TNO, Netherlands Organization for Applied Scientific Research, Leiden, Netherlands
| | - Caren Lanting
- Department of Child Health, TNO, Netherlands Organization for Applied Scientific Research, Leiden, Netherlands
| | - Mariska Klein Velderman
- Department of Child Health, TNO, Netherlands Organization for Applied Scientific Research, Leiden, Netherlands
| | - Pepijn van Empelen
- Department of Child Health, TNO, Netherlands Organization for Applied Scientific Research, Leiden, Netherlands
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Chan OSK, Lam W, Zhao S, Tun H, Liu P, Wu P. Why prescribe antibiotics? A systematic review of knowledge, tension, and motivation among clinicians in low-, middle- and high-income countries. Soc Sci Med 2024; 345:116600. [PMID: 38394944 DOI: 10.1016/j.socscimed.2024.116600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 01/05/2024] [Accepted: 01/11/2024] [Indexed: 02/25/2024]
Abstract
Medical professionals such as physicians and veterinarians are responsible for appropriate antimicrobial prescription (AMP) and use. Although seemingly straightforward, the factors influencing antibiotic prescription, a category of antimicrobials, are complex. Many studies have been conducted in the past two decades on this subject. As a result, there is a plethora of empirical evidence regarding the factors influencing clinicians' AMP practices. AIM A systematic review of AMR studies on AMP was conducted, condensing findings according to a combination of the Knowledge, Attitude, and Practice (KAP) and Capacity, Opportunity, Motivation-Behavior (COM-B) models. Review findings were then synthesized and analyzed for policy implementation according to the Consolidated Framework for Implementation Research (CFIR). DESIGN AND METHODOLOGY A systematic literature review was conducted according to PRISMA guidelines to identify peer-reviewed papers indexed in pre-determined medical science, social sciences, and humanities databases that apply the KAP model in their investigations. Antimicrobial prescription factors were compared and contrasted among low- and middle-income countries (LMICs) and high-income countries (HICs). FINDINGS The KAP model is a heuristic and structured framework for identifying and classifying respondents' knowledge. However, other than medical knowledge, factors that influence prescription decision-making can be expanded to include attitudes, perception, personal affinities, professional circumstances, relational pressure, and social norms.
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Affiliation(s)
- Olivia S K Chan
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China.
| | - Wendy Lam
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China.
| | - Shilin Zhao
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong Special Administrative Region, China.
| | - Hein Tun
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong Special Administrative Region, China.
| | - Ping Liu
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China.
| | - Peng Wu
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China.
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Blicher-Hansen J, Chilcot J, Gardner B. Experiences of successful physical activity maintenance among adults with type 2 diabetes: a theory-based qualitative study. Psychol Health 2024; 39:399-416. [PMID: 35475454 DOI: 10.1080/08870446.2022.2063863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 04/04/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Approximately 70% of adults with type 2 diabetes (T2D) fail to achieve the 150 minutes of weekly physical activity (PA) recommended for self-management. Interventions to promote PA adoption in T2D rarely achieve stable maintenance. Analysis of lived experiences of adults with T2D who have successfully transitioned to long-term PA maintenance can build understanding of factors influencing long-term maintenance. DESIGN Semi-structured interviews were conducted among 18 adults with T2D who had transitioned to a lifestyle incorporating maintenance of recommended PA. Interview topics were informed by the three phases of the 'Multi-Process Action Control' (M-PAC) Framework, and explored attitudes, beliefs and experiences relating to PA decision, adoption and the transition to stable maintenance. Transcripts were thematically analysed. FINDINGS Seven themes emerged. Results variously showed that negative affect engendered by T2D diagnosis and inspiration from peers influenced intention formation, and that setting easy, fun goals, and experiencing biopsychosocial gains were important to behaviour adoption. PA maintenance was regulated by habit, expectations of positive affect, and a new sense of identity. CONCLUSION Phase-based frameworks can help understand how regulation of behaviour evolves over time. PA promotion strategies for inactive adults with T2D should be phase-tailored, to help people transition from intentions to maintenance.
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Affiliation(s)
- Jennie Blicher-Hansen
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Joseph Chilcot
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Benjamin Gardner
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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64
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Blacket CT, Fuller JT, Bennett H, Crozier AJ, Dziano JK, Arnold JB. Just Run: Development of a theory-based motivational online intervention for promoting ongoing running participation. PSYCHOLOGY OF SPORT AND EXERCISE 2024; 71:102581. [PMID: 38061406 DOI: 10.1016/j.psychsport.2023.102581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 11/23/2023] [Accepted: 12/01/2023] [Indexed: 12/18/2023]
Abstract
Running is a popular form of physical activity yet discontinuation is common. Interventions targeting physical activity adoption have shown modest effects, often with little translation into long-term participation, which may limit the health benefits available to the wider community. This paper details the development of a new online running intervention (Just Run) aimed at improving continuation of running activity in new runners through a motivational and psychological lens, including aspects of design, content, refinement, and usability testing. A six-step intervention mapping process was used to develop a theory-based online intervention using a mix of research designs. Key stakeholders including runners, coaches and relevant experts in physical activity and behavior change provided valuable insight, feedback and refinement of the education to be delivered. The final Just Run intervention included ten modules delivered online over twelve weeks to promote ongoing running participation through videos, testimonials, and activities. Key themes identified through the literature and stakeholder engagement process related to goal setting, self-efficacy, intrinsic motivation, social support and overcoming barriers to running participation. Usability testing confirmed the quality and suitability of the education to the target population. Just Run has been developed with a range of stakeholders to address an area of unmet need in the adoption and promotion of running. Just Run is a robust online intervention that has been designed and pre-tested with positive feedback and unique insights from key stakeholders. Further investigation is required to support its implementation to the wider community.
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Affiliation(s)
- Chloe T Blacket
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Allied Health & Human Performance, University of South Australia, Australia.
| | - Joel T Fuller
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Hunter Bennett
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Allied Health & Human Performance, University of South Australia, Australia
| | - Alyson J Crozier
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Allied Health & Human Performance, University of South Australia, Australia
| | - Jenelle K Dziano
- Centre for Heart Rhythm Disorders, University of Adelaide, South Australia, Australia
| | - John B Arnold
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Allied Health & Human Performance, University of South Australia, Australia
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Robinson L, Arden MA, Dawson S, Walters SJ, Wildman MJ, Stevenson M. A machine-learning assisted review of the use of habit formation in medication adherence interventions for long-term conditions. Health Psychol Rev 2024; 18:1-23. [PMID: 35086431 DOI: 10.1080/17437199.2022.2034516] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 01/21/2022] [Indexed: 12/20/2022]
Abstract
Adherence to medication in long-term conditions is around 50%. The key components of successful interventions to improve medication adherence remain unclear, particularly when examined over prolonged follow-up periods. Behaviour change theories are increasingly interested in the utility of habit formation for the maintenance of health behaviour change, but there is no documentation on how habit has been conceptualised in the medication adherence intervention literature, or what effect the key technique identified in habit formation theory (context dependent repetition) has in these studies. To examine this, a machine-learning assisted review was conducted. Searches of MEDLINE, EMBASE and PSYCInfo and the reference list of a comprehensive systematic review of medication adherence interventions yielded 5973 articles. Machine learning-assisted title and abstract screening identified 15 independent RCTs published between 1976 and 2021, including 18 intervention comparisons of interest. Key findings indicate that conceptualisations of habit in the medication adherence literature are varied and behaviour change technique coding identified only six studies which explicitly described using habit formation. Future work should aim to develop this evidence base, drawing on contemporary habit theory and with explicit demonstration of what techniques have been used to promote habit formation.
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Affiliation(s)
- L Robinson
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - M A Arden
- Centre for Behavioural Science and Applied Psychology, Sheffield Hallam University, Sheffield, UK
| | - S Dawson
- Wolfson Adult Cystic Fibrosis Centre, Nottingham University Hospitals NHS Trust, City Hospital, Nottingham, UK
| | - S J Walters
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - M J Wildman
- Sheffield Adult Cystic Fibrosis Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Sheffield, UK
| | - M Stevenson
- Department of Computer Science, The University of Sheffield, Sheffield, UK
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66
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Caldwell AE, More KR, Chui TK, Sayer RD. Psychometric validation of four-item exercise identity and healthy-eater identity scales and applications in weight loss maintenance. Int J Behav Nutr Phys Act 2024; 21:21. [PMID: 38395833 PMCID: PMC10885534 DOI: 10.1186/s12966-024-01573-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 02/12/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Identifying as someone who engages in health promoting behaviors like healthy eating and exercising may be associated with sustained engagement in those behaviors, but reliable and valid instruments are needed to improve the rigor of this research. Two studies were conducted to (1) examine the psychometric properties of a four-item exerciser identity measure (4-EI) and an adapted healthy-eater identity measure (4-HEI) and (2) examine differences in identity strengths across categories of weight loss success. METHODS Data from 1,709 community dwelling adults in the International Weight Control Registry (IWCR) were used. A random half of the sample was used to assess the proposed unidimensional factor structure of the 4-EI and 4-HEI and examine convergent and discriminant validity using Spearman rank-order correlations. One-way ANOVA was used in the other random half of the sample to compare 4-EI and 4-HEI scores (-3 to + 3) across three self-defined weight loss categories ('Successful', 'Regain', and 'Unsuccessful') and those maintaining ≥ 5% weight loss for > 1 year vs. not. RESULTS Results support the unidimensional factor structure with all four items (eigenvalue scores > 2.89) as well as convergent and discriminant validity for both measures. Exercise identity was strongly correlated with self-reported physical activity (r (735) = 0.52, p <.001) and measures of autonomous motivation. Healthy eating identity was moderately correlated with cognitive restraint in eating (r (744) = 0.42, p <.001) and other measures predictive of eating behavior. 4-EI and 4-HEI are stronger in Successful (4-EI: M = 0.90, SD = 1.77; 4-HEI: M = 1.56 SD = 1.37) vs. Regain (4-EI: M=-0.18, SD = 1.68; 4-HEI: M =.57, SD = 1.48) and Unsuccessful (4-EI:M=-0.28, SD = 1.62; 4-HEI: M = 0.51, SD = 1.33) and those maintaining ≥ 5% weight loss (4-EI:M = 0.47, SD = 1.78; 4-HEI: M = 1.13, SD = 1.49) vs. not (4-EI:M=-0.27, SD = 1.66; 4-HEI: M = 0.53, SD = 1.47), p's < 0.001. CONCLUSIONS The 4-EI and 4-HEI have acceptable psychometric properties and can advance understanding of the role of identity in exercise and dietary behaviors and weight loss maintenance. TRIAL REGISTRATION The parent observational study, International Weight Control Registry (IWCR), for these sub-studies is registered in ClinicalTrials.gov (NCT04907396).
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Affiliation(s)
- Ann E Caldwell
- Division of Endocrinology, Metabolism, & Diabetes, Anschutz Health and Wellness Center, University of Colorado Anschutz School of Medicine, 12348 E. Montview Blvd, 80045, Aurora, CO, USA.
| | | | - Tsz Kiu Chui
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
| | - R Drew Sayer
- Department of Family and Community Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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Waki K, Tsurutani Y, Waki H, Enomoto S, Kashiwabara K, Fujiwara A, Orime K, Kinguchi S, Yamauchi T, Hirawa N, Tamura K, Terauchi Y, Nangaku M, Ohe K. Efficacy of StepAdd, a Personalized mHealth Intervention Based on Social Cognitive Theory to Increase Physical Activity Among Patients With Type 2 Diabetes Mellitus: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2024; 13:e53514. [PMID: 38393770 PMCID: PMC10924262 DOI: 10.2196/53514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 01/03/2024] [Accepted: 01/04/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Increasing physical activity improves glycemic control in patients with type 2 diabetes (T2D). Mobile health (mHealth) interventions have been proven to increase exercise, but engagement often fades with time. As the use of health behavior theory in mHealth design can increase effectiveness, we developed StepAdd, an mHealth intervention based on the constructs of social cognitive theory (SCT). StepAdd improves exercise behavior self-efficacy and self-regulation through the use of goal-setting, barrier-identifying, and barrier-coping strategies, as well as automatic feedback functions. A single-arm pilot study of StepAdd among 33 patients with T2D showed a large increase in step count (mean change of 4714, SD 3638 daily steps or +86.7%), along with strong improvements in BMI (mean change of -0.3 kg/m2) and hemoglobin A1c level (mean change of -0.79 percentage points). OBJECTIVE In this study, we aim to investigate the efficacy and safety of StepAdd, an mHealth exercise support system for patients with T2D, via a large, long, and controlled follow-up to the pilot study. METHODS This is a randomized, open-label, multicenter study targeting 160 patients with T2D from 5 institutions in Japan with a 24-week intervention. The intervention group will record daily step counts, body weight, and blood pressure using the SCT-based mobile app, StepAdd, and receive feedback about these measurements. In addition, they will set weekly step count goals, identify personal barriers to walking, and define strategies to overcome these barriers. The control group will record daily step counts, body weight, and blood pressure using a non-SCT-based placebo app. Both groups will receive monthly consultations with a physician who will advise patients regarding lifestyle modifications and use of the app. The 24-week intervention period will be followed by a 12-week observational period to investigate the sustainability of the intervention's effects. The primary outcome is between-group difference in the change in hemoglobin A1c values at 24 weeks. The secondary outcomes include other health measures, measurements of steps, measurements of other behavior changes, and assessments of app use. The trial began in January 2023 and is intended to be completed in December 2025. RESULTS As of September 5, 2023, we had recruited 44 patients. We expect the trial to be completed by October 8, 2025, with the follow-up observation period being completed by December 31, 2025. CONCLUSIONS This trial will provide important evidence about the efficacy of an SCT-based mHealth intervention in improving physical activities and glycemic control in patients with T2D. If this study proves the intervention to be effective and safe, it could be a key step toward the integration of mHealth as part of the standard treatment received by patients with T2D in Japan. TRIAL REGISTRATION Japan Registry of Clinical Trials (JRCT) jRCT2032220603; https://rctportal.niph.go.jp/en/detail?trial_id=jRCT2032220603. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/53514.
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Affiliation(s)
- Kayo Waki
- Department of Biomedical Informatics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Planning, Information and Management, The University of Tokyo Hospital, Tokyo, Japan
| | - Yuya Tsurutani
- Endocrinology and Diabetes Center, Yokohama Rosai Hospital, Yokohama, Japan
| | - Hironori Waki
- Department of Metabolism and Endocrinology, Akita University Graduate School of Medicine, Akita, Japan
| | - Syunpei Enomoto
- Department of Planning, Information and Management, The University of Tokyo Hospital, Tokyo, Japan
| | - Kosuke Kashiwabara
- Data Science Office, Clinical Research Promotion Center, The University of Tokyo Hospital, Tokyo, Japan
| | - Akira Fujiwara
- Department of Nephrology and Hypertension, Yokohama City University Medical Center, Yokohama, Japan
| | - Kazuki Orime
- Department of Endocrinology and Diabetes, Yokohama City University Medical Center, Yokohama, Japan
| | - Sho Kinguchi
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Toshimasa Yamauchi
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Nobuhito Hirawa
- Department of Nephrology and Hypertension, Yokohama City University Medical Center, Yokohama, Japan
| | - Kouichi Tamura
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Yasuo Terauchi
- Department of Endocrinology and Metabolism, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Masaomi Nangaku
- Division of Nephrology and Endocrinology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kazuhiko Ohe
- Department of Biomedical Informatics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Planning, Information and Management, The University of Tokyo Hospital, Tokyo, Japan
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Brandt T, Heinz E, Klaaßen Y, Limbara S, Mörsdorf M, Schinköthe T, Schmidt A. The MedXFit-study - CrossFit as a workplace health intervention: a one-year, prospective, controlled, longitudinal, intervention study. Front Public Health 2024; 12:1304721. [PMID: 38450146 PMCID: PMC10915069 DOI: 10.3389/fpubh.2024.1304721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 02/01/2024] [Indexed: 03/08/2024] Open
Abstract
Introduction Workplace health interventions aim to motivate employees toward healthy behaviors to improve fitness and health in the long-term. We investigated whether CrossFit® is an effective training concept to achieve these goals in inactive employees with sedentary occupations. Methods The study followed a prospective, controlled intervention design. Employees were invited to participate in intervention group (IG) or control group (CG) on their own preferences. Inclusion criteria were a predominantly sedentary occupation and execution of less than two muscle and/or mobility enhancing training sessions per week at the time of enrolling. The IG did at least two times a week a CrossFit training of 1 h. Mobility, strength, well-being, and back-issues were measured at the beginning, after 6, and 12 months. Participants in the CG were free to choose any other activities offered at the same time (e.g., circuit training, meditation, full body stability training). Adherence, respectively, behavioral change and maintenance qualities were evaluated based on the COM-B system and presence of behavior maintenance motives. Results 89 employees were enrolled into the trial, from where 21 dropped out due to external factors (24%). From the remaining participants, 10 out of 39 (26%) in the IG and 1 out of 29 (4%) in the CG stopped for intrinsic reasons, leading to a non-adherence to the intervention of 22 percentage points. Motivation for behavioral change and maintenance in the IG was primarily driven by enhanced physical and psychological capability. Development of physical capability was evident by significant improvements (p < 0.001) in the IG compared to the CG for mobility (d = 3.3), maximal isometric strength (min. d = 1.7, max. d = 2.5), as well as reduction in pain intensity (p = 0.003, r = 0.4) and frequency (p = 0.009, r = 0.35) after 12 months. Significant improvements between the 6-month and the 12-month measurement in mobility and 6 out of 8 strength measures within the IG indicated the effectiveness of CrossFit beyond the beginner phase. Conclusion CrossFit is a motivating training concept that led to long-term health and fitness improvements in inactive employees doing sedentary work and should be given greater consideration in workplace health promotion.
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Affiliation(s)
- Tom Brandt
- Institute of Sports Science, University of the Bundeswehr Munich, Neubiberg, Germany
| | - Elisabeth Heinz
- Institute of Sports Science, University of the Bundeswehr Munich, Neubiberg, Germany
| | - Yannik Klaaßen
- Institute of Sports Science, University of the Bundeswehr Munich, Neubiberg, Germany
| | - Selina Limbara
- Institute of Sports Science, University of the Bundeswehr Munich, Neubiberg, Germany
| | - Marian Mörsdorf
- Institute of Sports Science, University of the Bundeswehr Munich, Neubiberg, Germany
| | | | - Annette Schmidt
- Institute of Sports Science, University of the Bundeswehr Munich, Neubiberg, Germany
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Blomqvist A, Bäck M, Klompstra L, Strömberg A, Jaarsma T. Usability and feasibility analysis of an mHealth-tool for supporting physical activity in people with heart failure. BMC Med Inform Decis Mak 2024; 24:44. [PMID: 38347499 PMCID: PMC10860324 DOI: 10.1186/s12911-024-02452-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 02/02/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Physical inactivity and a sedentary lifestyle are common among people with heart failure (HF), which may lead to worse prognosis. On an already existing mHealth platform, we developed a novel tool called the Activity coach, aimed at increasing physical activity. The aim of this study was to evaluate the usability of the Activity coach and assess feasibility of outcome measures for a future efficacy trial. METHODS A mixed-methods design was used to collect data. People with a HF diagnosis were recruited to use the Activity coach for four weeks. The Activity coach educates the user about physical activity, provides means of registering daily physical activity and helps the user to set goals for the next week. The usability was assessed by analysing system user logs for adherence, reported technical issues and by interviews about user experiences. Outcome measures assessed for feasibility were objective physical activity as measured by an accelerometer, and subjective goal attainment. Progression criteria for the usability assessment and for the proposed outcomes, were described prospectively. RESULTS Ten people with HF were recruited, aged 56 to 78 with median age 72. Data from nine of the ten study participants were included in the analyses. Usability: The Activity coach was used 61% of the time and during the first week two study participants called to seek technical support. The Activity coach was found to be intuitive and easy to use by all study participants. An increased motivation to be more physically active was reported by six of the nine study participants. However, in spite of feeling motivated, four reported that their habits or behaviours had not been affected by the Activity coach. FEASIBILITY Data was successfully stored in the deployed hardware as intended and the accelerometers were used enough, for the data to be analysable. One finding was that the subjective outcome goal attainment, was challenging to collect. A proposed mitigator for this is to use pre-defined goals in future studies, as opposed to having the study participants be completely free to formulate the goals themselves. CONCLUSIONS It was confirmed that the Activity coach was easy to use. Furthermore, it might stimulate increased physical activity in a population of people with HF, who are physically inactive. The outcomes investigated seem feasible to include in a future efficacy trial. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT05235763. Date of first registration: 11/02/2022.
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Affiliation(s)
- Andreas Blomqvist
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
| | - Maria Bäck
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Leonie Klompstra
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Anna Strömberg
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Tiny Jaarsma
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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70
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Berdal G, Sand-Svartrud AL, Linge AD, Aasvold AM, Tennebø K, Eppeland SG, Hagland AS, Ohldieck-Fredheim G, Lindtvedt Valaas H, Bø I, Klokkeide Å, Sexton J, Azimi M, Dager TN, Kjeken I. Does follow-up really matter? A convergent mixed methods study exploring follow-up across levels of care in rehabilitation of patients with rheumatic and musculoskeletal diseases. Disabil Rehabil 2024:1-14. [PMID: 38334113 DOI: 10.1080/09638288.2024.2310170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 01/19/2024] [Indexed: 02/10/2024]
Abstract
PURPOSE To explore what patients with rheumatic and musculoskeletal diseases (RMDs) need and receive of follow-up care after specialized rehabilitation, and whether received follow-up is associated with health outcomes after 1 year. Further, to compare these findings with patients' experiences to improve the understanding of how follow-up takes place. METHODS In a mixed methods study, patients received a rehabilitation programme designed to improve the continuity in rehabilitation across care levels. A total of 168 patients completed questionnaires, of which 21 were also interviewed. RESULTS At discharge, most patients reported needs for follow-up. These needs were largely met within 1 year, mainly resulting from patients' initiatives to re-connect with previous contacts. The degree of received follow-up was not associated with goal attainment, quality of life, or physical function. Factors related to providers (competence, communication skills), context (delays, limited access to care), and patients (motivation, life situation, preferences) seemed to be decisive for the progress of the rehabilitation process over time. CONCLUSIONS The results provide evidence that access to follow-up care is crucial to patients with RMDs. However, it also highlights several factors that may influence its impact. These results can be used to optimise design and implementation of future follow-up interventions.
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Affiliation(s)
- Gunnhild Berdal
- Norwegian National Advisory Unit on Rehabilitation in Rheumatology, Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Anne-Lene Sand-Svartrud
- Norwegian National Advisory Unit on Rehabilitation in Rheumatology, Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | | | | | | | - Siv G Eppeland
- Department of Physiotherapy, Sørlandet Hospital, Arendal, Norway
| | | | | | | | - Ingvild Bø
- Department of Rehabilitation, Hospital for Rheumatic Diseases, Lillehammer, Norway
| | - Åse Klokkeide
- Rehabilitering Vest Rehabilitation Centre, Haugesund, Norway
| | - Joseph Sexton
- Norwegian National Advisory Unit on Rehabilitation in Rheumatology, Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Maryam Azimi
- REMEDY Patient Advisory Board, Diakonhjemmet Hospital, Oslo, Norway
| | - Turid N Dager
- Norwegian National Advisory Unit on Rehabilitation in Rheumatology, Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Ingvild Kjeken
- Norwegian National Advisory Unit on Rehabilitation in Rheumatology, Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
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Brandt T, Schwandner CTL, Schmidt A. Resistance exercise snacks improve muscle mass in female university employees: a prospective, controlled, intervention pilot-study. Front Public Health 2024; 12:1347825. [PMID: 38379679 PMCID: PMC10877054 DOI: 10.3389/fpubh.2024.1347825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 01/23/2024] [Indexed: 02/22/2024] Open
Abstract
Background Although resistance training (RT) is essential to preserve musculoskeletal fitness and maintain a healthy, independent life into old age, few women perform RT. We investigated whether resistance exercise snacking (RES) could be an efficient training approach for the workplace health promotion (WHP) to minimize barriers for participation and facilitate RT in women in order to improve musculoskeletal fitness. Methods This pilot-study followed a prospective, controlled intervention design. Female employees with sedentary occupations doing RT on less than 2 days/week before study participation were included. Participants self-selected for either intervention (IG) or control group (CG). While the IG [N = 15, mean age 42.1 (SD = 11.1) years] did 10 min of RES on working days for 12 weeks, the CG [N = 15, mean age 49.9 (SD = 9.7) years] was instructed to maintain their habitual physical activity. Primary endpoint was change in muscle mass. Secondary endpoint was change in maximum isometric strength. Balance, cardiovascular fitness, perceived health, and general life satisfaction was assessed for exploratory purpose. Measurements were taken before and after the intervention. Results 12 participants of IG and 14 of CG completed the study. Muscle mass improved significantly more in the IG [+0.42 (SD = 0.54) kg] compared to the CG [-0.16 (SD = 0.51) kg] (p = 0.01, ƞ2p = 0.24). Strength did not change significantly between groups. Nevertheless, there was a trend for greater improvements in the IG compared to the CG for trunk extension, trunk flexion, and upper body push but not upper body pull. Regarding exploratory endpoints, no significant between-group changes were found. Despite their poor fitness, both groups perceived their health as good and had high life satisfaction before and after the intervention. Conclusion RES could be an effective approach for the WHP to promote RT in inactive women with sedentary occupations and improve their muscle mass.
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Papies EK, Nielsen KS, Soares VA. Health psychology and climate change: time to address humanity's most existential crisis. Health Psychol Rev 2024:1-31. [PMID: 38320578 DOI: 10.1080/17437199.2024.2309242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 01/18/2024] [Indexed: 02/08/2024]
Abstract
Climate change is an ongoing and escalating health emergency. It threatens the health and wellbeing of billions of people, through extreme weather events, displacement, food insecurity, pathogenic diseases, societal destabilisation, and armed conflict. Climate change dwarfs all other challenges studied by health psychologists. The greenhouse gas emissions driving climate change disproportionately originate from the actions of wealthy populations in the Global North and are tied to excessive energy use and overconsumption driven by the pursuit of economic growth. Addressing this crisis requires significant societal transformations and individual behaviour change. Most of these changes will benefit not only the stability of the climate but will yield significant public health co-benefits. Because of their unique expertise and skills, health psychologists are urgently needed in crafting climate change mitigation responses. We propose specific ways in which health psychologists at all career stages can contribute, within the spheres of research, teaching, and policy making, and within organisations and as private citizens. As health psychologists, we cannot sit back and leave climate change to climate scientists. Climate change is a health emergency that results from human behaviour; hence it is in our power and responsibility to address it.
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Affiliation(s)
- Esther K Papies
- MRC/CSO Social and Public Health Sciences Unit, School of Health and Wellbeing, University of Glasgow, United Kingdom
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73
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Burke CA, Seidler KJ, Rethorn ZD, Hoenig H, Allen K, Tabriz AA, Norman K, Murphy-McMillan LK, Sharpe J, Joseph LM, Dietch JR, Kosinski AS, Cantrell S, Gierisch JM, Ear B, Gordon A, Goldstein KM. Interventions to Improve Long-Term Adherence to Physical Rehabilitation: A Systematic Review. J Geriatr Phys Ther 2024; 47:00139143-990000000-00044. [PMID: 38215396 PMCID: PMC11239800 DOI: 10.1519/jpt.0000000000000402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2024]
Abstract
OBJECTIVE To evaluate the impact of physical rehabilitation interventions, supplemented with one or more adherence-enhancing components, on outcomes among adults with hip or knee osteoarthritis or chronic lower back pain. DESIGN Primary literature search from inception of each database to July 27, 2021, guided by relevant search terms and keywords to search titles and abstracts. All articles meeting eligibility criteria were included for data abstraction. DATA SOURCES MEDLINE, CINAHL Complete, and Embase. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Randomized and nonrandomized trials evaluating adherence-focused intervention components conducted in addition to an index usual care or usual care-like physical rehabilitation program among adults with hip or knee osteoarthritis or chronic low back pain. Eligible studies included a comparator group of the same index physical rehabilitation intervention without the adjunctive adherence components. Included studies measured outcomes at least 3 months after the rehabilitation course. RESULTS Of the 10 studies meeting inclusion criteria, 6 interventions were delivered concurrent to an index rehabilitation program and 4 were delivered sequentially. Of the 3 studies that reported a positive effect on long-term adherence, only 1 was a low risk of bias study. There is very limited evidence of a beneficial treatment effect of adjunct adherence interventions on long-term physical function, self-efficacy, or adverse events. CONCLUSION We found inadequate evidence evaluating adherence-enhancing interventions for the specific promotion of long-term adherence to home rehabilitation programs. Future studies should consider testing interventions specifically built to target behavioral maintenance of home rehabilitation programs.
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Affiliation(s)
- Colleen A. Burke
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina
- Department of Population Health Sciences, Duke University, Durham, North Carolina
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina
| | - Katie J. Seidler
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina
| | - Zachary D. Rethorn
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina
| | - Helen Hoenig
- Durham VA Health Care System, Durham, North Carolina
- Department of Medicine, Duke University, Durham, North Carolina
| | - Kelli Allen
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina
- University of North Carolina at Chapel Hill, Chapel Hill
| | - Amir Alishahi Tabriz
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
- Department of Oncological Sciences, University of South Florida, Tampa, Florida
| | - Katherine Norman
- Department of Population Health Sciences, Duke University, Durham, North Carolina
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina
| | | | - Jason Sharpe
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina
| | - Letha M. Joseph
- Durham VA Health Care System, Durham, North Carolina
- Duke University School of Nursing, Durham, North Carolina
| | | | - Andrzej S. Kosinski
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina
| | - Sarah Cantrell
- Duke University School of Medicine, Durham, North Carolina
| | - Jennifer M. Gierisch
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina
- Department of Population Health Sciences, Duke University, Durham, North Carolina
- Durham VA Medical Center Evidence Synthesis Program, Durham, North Carolina
| | - Belinda Ear
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina
- Durham VA Medical Center Evidence Synthesis Program, Durham, North Carolina
| | - Adelaide Gordon
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina
- Durham VA Medical Center Evidence Synthesis Program, Durham, North Carolina
| | - Karen M. Goldstein
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina
- Durham VA Medical Center Evidence Synthesis Program, Durham, North Carolina
- Durham VA Medical Center, Durham, North Carolina
- Department of Medicine, Division of General Internal Medicine, Duke University, Durham, North Carolina
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Claflin SB, Campbell J, van der Mei I, Mainsbridge C, Taylor BV. Self-reported behaviour change among multiple sclerosis community members and interested laypeople 6 months following participation in a free online course about multiple sclerosis. Health Promot J Austr 2024; 35:100-109. [PMID: 36894322 DOI: 10.1002/hpja.716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 02/27/2023] [Accepted: 03/06/2023] [Indexed: 03/11/2023] Open
Abstract
ISSUE ADDRESSED Evaluated the impact of the Understanding Multiple Sclerosis (MS) massive open online course, which was intended to increase understanding and awareness about MS, on self-reported health behaviour change 6 months after course completion. METHODS Observational cohort study evaluating precourse(baseline) and postcourse (immediately postcourse and six-month follow-up) survey data. The main study outcomes were self-reported health behaviour change; change type; and measurable improvement. We also collected participant characteristic data (eg, age, physical activity). We compared participants who reported health behaviour change at follow-up to those who did not and compared those who improved to those who did not using χ2 and t tests. Participant characteristics, change types and change improvement were described descriptively. Consistency between changes reported immediately postcourse and at the 6-month follow-up was assessed using χ2 tests and textual analysis. RESULTS N = 303 course completers were included in this study. The study cohort included MS community members (eg, people with MS, healthcare providers) and nonmembers. N = 127 (41.9%) reported behaviour change in ≥1 area at follow-up. Of these, 90 (70.9%) reported a measured change, and of these, 57 (63.3%) showed improvement. The most reported change types were knowledge, exercise/physical activity and diet. N = 81 (63.8% of those reporting a change) reported a change in both immediately and 6 months after course completion, with 72.0% of those that described both changes giving similar responses each time. CONCLUSION Understanding MS encourages health behaviour change among course completers up to 6 months after course completion. SO WHAT?: An online education intervention can effectively encourage health behaviour change over a 6-month follow-up period, suggesting a transition from acute change to maintenance. The primary mechanisms underpinning this effect are information provision, including both scientific evidence and lived experience, and goal-setting activities and discussions.
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Affiliation(s)
- Suzi B Claflin
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Julie Campbell
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Ingrid van der Mei
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Casey Mainsbridge
- School of Education, College of Arts, Law, and Education, University of Tasmania, Hobart, Tasmania, Australia
| | - Bruce V Taylor
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
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Bruinsma J, Loukas VS, Kassiotis T, Heger I, Rosenberg A, Visser LNC, Mangialasche F, Fotiadis DI, Hanke S, Crutzen R. Socio-Cognitive Determinants of Lifestyle Behavior in the Context of Dementia Risk Reduction: A Population-Based Study in the Netherlands. J Alzheimers Dis 2024; 99:941-952. [PMID: 38759007 PMCID: PMC11191482 DOI: 10.3233/jad-231369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2024] [Indexed: 05/19/2024]
Abstract
Background Unhealthy behavior increases the risk of dementia. Various socio-cognitive determinants influence whether individuals persist in or alter these unhealthy behaviors. Objective This study identifies relevant determinants of behavior associated to dementia risk. Methods 4,104 Dutch individuals (40-79 years) completed a screening questionnaire exploring lifestyle behaviors associated with dementia risk. Subsequently, 3,065 respondents who engaged in one or more unhealthy behaviors completed a follow-up questionnaire investigating socio-cognitive determinants of these behaviors. Cross-tables were used to assess the accuracy of participants' perceptions regarding their behavior compared to recommendations. Confidence Interval-Based Estimation of Relevance (CIBER) was used to identify the most relevant determinants of behavior based on visual inspection and interpretation. Results Among the respondents, 91.3% reported at least one, while 65% reported two or more unhealthy lifestyle behaviors associated to dementia risk. Many of them were not aware they did not adhere to lifestyle recommendations. The most relevant determinants identified include attitudes (i.e., lacking a passion for cooking and finding pleasure in drinking alcohol or smoking), misperceptions on social comparisons (i.e., overestimating healthy diet intake and underestimating alcohol intake), and low perceived behavioral control (i.e., regarding changing physical inactivity, altering diet patterns, and smoking cessation). Conclusions Individual-level interventions that encourage lifestyle change should focus on enhancing accurate perceptions of behaviors compared to recommendations, while strengthening perceived control towards behavior change. Given the high prevalence of dementia risk factors, combining interventions at both individual and environmental levels are likely to be the most effective strategy to reduce dementia on a population scale.
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Affiliation(s)
- Jeroen Bruinsma
- Department of Health Promotion of the Care and Public Health Research Institute at Maastricht University, Maastricht, The Netherlands
| | - Vasileios S. Loukas
- Department of Materials Science and Engineering, Unit of Medical Technology and Intelligent Information Systems, University of Ioannina, Ioannina, Greece
- Biomedical Research Institute, Foundation for Research and Technology–Hellas, FORTH-BRI, Ioannina, Greece
| | - Thomas Kassiotis
- Computational BioMedicine Laboratory, Institute of Computer Science, Foundation for Research and Technology – Hellas, FORTH-ICS-CBML, Heraklion, Greece
| | - Irene Heger
- Department of Psychiatry and Neuropsychology of the School for Mental Health and Neuroscience at Maastricht University, Maastricht, The Netherlands
| | - Anna Rosenberg
- Finnish Institute for Health and Welfare, Helsinki, Finland
- Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Center for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden
| | - Leonie N. C. Visser
- Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Center for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden
- Department of Medical Psychology, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Quality of Care/Personalized Medicine, Amsterdam, The Netherlands
| | - Francesca Mangialasche
- Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Center for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden
- FINGERS Brain Health Institute, Stockholm, Sweden
- Theme Inflammation and Aging, Medical Unit Aging, Karolinska University Hospital, Solna, Sweden
| | - Dimitrios I. Fotiadis
- Department of Materials Science and Engineering, Unit of Medical Technology and Intelligent Information Systems, University of Ioannina, Ioannina, Greece
- Biomedical Research Institute, Foundation for Research and Technology–Hellas, FORTH-BRI, Ioannina, Greece
| | - Sten Hanke
- Institute of eHealth at University of Applied Science at FH Joanneum, Graz, Austria
| | - Rik Crutzen
- Department of Health Promotion of the Care and Public Health Research Institute at Maastricht University, Maastricht, The Netherlands
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Valen EN, Øverby NC, Hardy‐Johnson P, Vik FN, Salvesen L, Omholt ML, Barker ME, Hillesund ER. Lessons learned from talking with adults about nutrition: A qualitative study in the PREPARED project. MATERNAL & CHILD NUTRITION 2024; 20 Suppl 2:e13540. [PMID: 37277971 PMCID: PMC10765357 DOI: 10.1111/mcn.13540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 05/15/2023] [Accepted: 05/19/2023] [Indexed: 06/07/2023]
Abstract
Improving diet and dietary behaviour of men and women before pregnancy has the potential to benefit both their current and long-term health and the health of their children. Little is known, however, about adults' perception of diet's role in prepregnancy health. This study aimed to explore the state of knowledge and awareness of preconception nutritional health in adults within the fertile age range and what they perceived could motivate healthy eating using the self-determination theory as a theoretical framework. We analysed 33 short exploratory interviews with men (n = 18) and women (n = 15) aged 18-45 years. Participants were grab sampled from three different public locations in the southern part of Norway. Interviews were audio-recorded, transcribed verbatim in 2020 and analysed using a thematic analysis with a semantic approach in 2022. The findings suggest that adults within the fertile age range are not intrinsically motivated to eat healthily, but when they do, it is because eating healthily often aligns with other goals consistent with their values, that is, getting fit or looking good. They possess some basic knowledge of healthy behaviours during pregnancy but are generally unaware of the importance of preconception health and nutrition. There is a need to increase awareness of the impact of preconception health on the health of this and future generations. Improved nutritional education on the significance of diet before conception might facilitate optimal conditions for conceiving and for pregnancy in the adult population within fertile age range.
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Affiliation(s)
- Erlend N. Valen
- Department of Nutrition and Public HealthUniversity of AgderKristiansandVest‐AgderNorway
| | - Nina Cecilie Øverby
- Department of Nutrition and Public HealthUniversity of AgderKristiansandVest‐AgderNorway
| | - Polly Hardy‐Johnson
- Medical Research Council Lifecourse Epidemiology UnitUniversity of SouthamptonSouthamptonUK
| | - Frøydis N. Vik
- Department of Nutrition and Public HealthUniversity of AgderKristiansandVest‐AgderNorway
| | - Lorentz Salvesen
- Department of Nutrition and Public HealthUniversity of AgderKristiansandVest‐AgderNorway
| | - Mona L. Omholt
- Department of Nutrition and Public HealthUniversity of AgderKristiansandVest‐AgderNorway
| | - Mary Elizabeth Barker
- Department of Nutrition and Public HealthUniversity of AgderKristiansandVest‐AgderNorway
- Medical Research Council Lifecourse Epidemiology UnitUniversity of SouthamptonSouthamptonUK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation TrustSouthamptonUK
| | - Elisabet R. Hillesund
- Department of Nutrition and Public HealthUniversity of AgderKristiansandVest‐AgderNorway
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Bass GA, Chang CWJ, Sorce LR, Subramanian S, Laytin AD, Somodi R, Gray JR, Lane-Fall M, Kaplan LJ. Gamification in Critical Care Education and Practice. Crit Care Explor 2024; 6:e1034. [PMID: 38259864 PMCID: PMC10803028 DOI: 10.1097/cce.0000000000001034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024] Open
Abstract
OBJECTIVES To explore gamification as an alternative approach to healthcare education and its potential applications to critical care. DATA SOURCES English language manuscripts addressing: 1) gamification theory and application in healthcare and critical care and 2) implementation science focused on the knowledge-to-practice gap were identified in Medline and PubMed databases (inception to 2023). STUDY SELECTION Studies delineating gamification underpinnings, application in education or procedural mentoring, utilization for healthcare or critical care education and practice, and analyses of benefits or pitfalls in comparison to other educational or behavioral modification approaches. DATA EXTRACTION Data indicated the key gamification tenets and the venues within which they were used to enhance knowledge, support continuing medical education, teach procedural skills, enhance decision-making, or modify behavior. DATA SYNTHESIS Gamification engages learners in a visual and cognitive fashion using competitive approaches to enhance acquiring new knowledge or skills. While gamification may be used in a variety of settings, specific design elements may relate to the learning environment or learner styles. Additionally, solo and group gamification approaches demonstrate success and leverage adult learning theory elements in a low-stress and low-risk setting. The potential for gamification-driven behavioral modification to close the knowledge-to-practice gap and enable guideline and protocol compliance remains underutilized. CONCLUSIONS Gamification offers the potential to substantially enhance how critical care professionals acquire and then implement new knowledge in a fashion that is more engaging and rewarding than traditional approaches. Accordingly, educational undertakings from courses to offerings at medical professional meetings may benefit from being gamified.
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Affiliation(s)
- Gary Alan Bass
- Division of Trauma, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | | | - Lauren R Sorce
- Department of Pediatrics (Critical Care), Northwestern University, Chicago, IL
| | - Sanjay Subramanian
- Department of Anesthesiology, Critical Care Medicine, Washington University in St. Louis, St. Louis, MO
- Omnicure Inc., St. Louis, MO
| | - Adam D Laytin
- Departments of Anesthesia and Critical Care Medicine and Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Reka Somodi
- Section of Surgical Critical Care, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA
| | - Jaime R Gray
- Department of Pharmacy, Temple University Health System, Philadelphia, PA
| | - Meghan Lane-Fall
- Departments of Anesthesiology and Critical Care Medicine and Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Lewis J Kaplan
- Division of Trauma, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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McCormick A, Pedmanson P, Jane B, Watson P. How do new runners maintain their running, and what leads to others stopping? A qualitative, longitudinal study. PSYCHOLOGY OF SPORT AND EXERCISE 2024; 70:102515. [PMID: 37717492 DOI: 10.1016/j.psychsport.2023.102515] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 08/20/2023] [Accepted: 08/21/2023] [Indexed: 09/19/2023]
Abstract
Many people who start running do not maintain their behaviour change. We used qualitative, longitudinal methods to explore and interpret the experiences of new runners and answer the question, "What experiences explain how new runners maintain their running or explain why they stop?" We interviewed 20 new runners (all White British, 14 women, 6 men) about their experiences; we interviewed 10 until they stopped running and 10 until they maintained running for 6-12 months (65 interviews in total). We also conducted nine participant observations at a running club, invited external reflections at a running club, and analysed six sets of participant diaries. Four themes were constructed using a reflexive thematic analysis: (1) Identifying a meaningful "why"; (2) "Life gets in the way" of running; (3) Learning that I can run; and (4) Opportunities are unequal and experiences contrast. The runners' reasons for running helped us to interpret changes in their experiences through time. Meaningful reasons helped runners to learn that they can run, prioritise running, and prevent life getting in the way. These reasons tended to be reasons to run, as opposed to reasons to be physically active, and they related to their identity, values, special memories, relationships, enjoyment of running, or a personal goal. Nevertheless, social inequalities like gendered experiences, wealth, and health differences meant that opportunities and experiences of running differed, creating more barriers for some runners. When runners faced substantial barriers, having a meaningful reason was helpful but it was sometimes insufficient for maintenance. The analysis illustrates how people's reasons for exercise influence their experiences through time, the dynamic nature of people's exercise barriers and facilitators, and the unequal nature of opportunities and experiences.
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Affiliation(s)
- Alister McCormick
- School of Health & Wellbeing, Plymouth Marjon University, Plymouth, UK.
| | - Pille Pedmanson
- School of Health & Wellbeing, Plymouth Marjon University, Plymouth, UK
| | - Ben Jane
- School of Health & Wellbeing, Plymouth Marjon University, Plymouth, UK
| | - Paula Watson
- School of Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK; Made Up to Move Ltd, Liverpool, UK
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79
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Yamaguchi S, Foo JC, Sasaki T. A survey of suicide literacy in Japanese school teachers. Sci Rep 2023; 13:23047. [PMID: 38155213 PMCID: PMC10754903 DOI: 10.1038/s41598-023-50339-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 12/19/2023] [Indexed: 12/30/2023] Open
Abstract
School teachers are in a unique position to recognize suicide-related problems in their students and to appropriately support them; teachers may need high levels of suicide literacy. However, few studies have examined current levels of suicide literacy in teachers. This study aimed to investigate suicide literacy in school teachers. Teachers (n = 857) from 48 Japanese schools (primary and junior-/senior-high) answered a self-administered questionnaire assessing (a) knowledge about suicide, (b) intention to ask about students' suicidal thoughts/plans, and (c) attitudes towards talking to students with mental health problems. The average proportion of correct answers to the knowledge questions (10 items) was 55.2%. Over half of the teachers knew that suicide is a leading cause of death in adolescents (55.0%), and that asking about suicidality is needed (56.2%). Half of the teachers intended to ask students about their suicidal thoughts (50.2%) and fewer intended to ask about experiences of planning suicide (38.8%). Most of the teachers (90.4%) agreed with the idea that talking to students with mental health problems was a teacher's responsibility. Intention to ask about students' suicidal thoughts/plans were higher in teachers in their 20s (vs. 40s-60s) and working at junior-/senior-high schools (vs. primary schools). Suicide literacy in Japanese school teachers was observed to be limited. However, teachers felt responsibility for helping students with mental health problems. The development and implementation of education programs may help improve teachers' suicide literacy, which, in turn, could encourage effective helping behaviors of teachers for students struggling with suicidality.
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Affiliation(s)
- Satoshi Yamaguchi
- Department of Physical and Health Education, Graduate School of Education, The University of Tokyo, Tokyo, Japan
- Unit for Mental Health Promotion, Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Jerome Clifford Foo
- Institute for Psychopharmacology, Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany
- Department of Genetic Epidemiology in Psychiatry, Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany
- Department of Psychiatry, College of Health Sciences, University of Alberta, Edmonton, Canada
| | - Tsukasa Sasaki
- Department of Physical and Health Education, Graduate School of Education, The University of Tokyo, Tokyo, Japan.
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Eekholm S, Samuelson K, Ahlström G, Lindhardt T. Development of an Implementation Strategy Tailored to Deliver Evidence-Based and Person-Centred Nursing Care for Patients with Community-Acquired Pneumonia: An Intervention Mapping Approach. Healthcare (Basel) 2023; 12:32. [PMID: 38200938 PMCID: PMC10779328 DOI: 10.3390/healthcare12010032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 12/18/2023] [Accepted: 12/19/2023] [Indexed: 01/12/2024] Open
Abstract
Community-acquired pneumonia is a serious public health problem, and more so in older patients, leading to high morbidity and mortality. However, this problem can be reduced by optimising in-hospital nursing care. Accordingly, this study describes a systematic process of designing and developing a tailored theory- and research-based implementation strategy that supports registered nurses (RNs) in delivering evidence-based and person-centred care for this patient population in a hospital setting. The implementation strategy was developed by completing the six steps of the Intervention Mapping framework: (1) developing a logic model of the problem and (2) a logic model of change by defining performance and change objectives, (3) designing implementation strategy interventions by selecting theory-based change methods, (4) planning the interventions and producing materials through a co-design approach, (5) developing a structured plan for adoption, maintenance and implementation and (6) developing an evaluation plan. This method can serve as a guide to (1) target behavioural and environmental barriers hindering the delivery of nursing care in local clinical practice, (2) support evidence uptake, (3) support RNs in the delivery of nursing care according to individual patient needs and thereby (4) optimise health-related patient outcomes.
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Affiliation(s)
- Signe Eekholm
- Department of Health Sciences, Faculty of Medicine, Lund University, Sölvegatan 19, P.O. Box 117, SE-221 00 Lund, Sweden; (K.S.); (G.A.)
- Department of Internal Medicine, Copenhagen University Hospital Herlev and Gentofte, Gentofte Hospitalsvej 4, 2nd. Floor, DK-2900 Hellerup, Denmark;
| | - Karin Samuelson
- Department of Health Sciences, Faculty of Medicine, Lund University, Sölvegatan 19, P.O. Box 117, SE-221 00 Lund, Sweden; (K.S.); (G.A.)
| | - Gerd Ahlström
- Department of Health Sciences, Faculty of Medicine, Lund University, Sölvegatan 19, P.O. Box 117, SE-221 00 Lund, Sweden; (K.S.); (G.A.)
| | - Tove Lindhardt
- Department of Internal Medicine, Copenhagen University Hospital Herlev and Gentofte, Gentofte Hospitalsvej 4, 2nd. Floor, DK-2900 Hellerup, Denmark;
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Signal N, Olsen S, Rashid U, McLaren R, Vandal A, King M, Taylor D. Haptic Nudging Using a Wearable Device to Promote Upper Limb Activity during Stroke Rehabilitation: Exploring Diurnal Variation, Repetition, and Duration of Effect. Behav Sci (Basel) 2023; 13:995. [PMID: 38131851 PMCID: PMC10740938 DOI: 10.3390/bs13120995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 11/15/2023] [Accepted: 11/27/2023] [Indexed: 12/23/2023] Open
Abstract
Haptic nudging via wearable devices promotes physical activity and may increase upper limb movement in stroke rehabilitation. This study investigated the optimal approach to haptic nudging by examining diurnal variation, duration of effect, and repeated nudging. The study analysed data from a multiple-period randomised crossover study. A 12 h inpatient rehabilitation day was divided into 72 intervals in which participants with stroke (n = 20) randomly received either a 'nudge' or 'no nudge'. Upper limb movement was observed, classified, and analysed using longitudinal mixed models. The odds of affected upper limb movement following a nudge compared with no nudge were significantly higher during active periods such as breakfast, lunch, and morning and afternoon activities (odds ratios (ORs) 2.01-4.63, 95% CIs [1.27-2.67, 3.17-8.01]), but not dinner (OR 1.36, 95% CI [0.86, 2.16]). The effect of nudging was no longer statistically significant at 50-60 s post-nudge. Consecutive delays in nudging significantly decreased the odds of moving when a nudge was eventually delivered. Contrary to expectations, people with stroke appear more responsive to haptic nudging during active periods rather than periods of inactivity. By understanding the optimal timing and frequency of haptic nudging, the design of wearable devices can be optimised to maximise their therapeutic benefits.
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Affiliation(s)
- Nada Signal
- Health and Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand; (N.S.)
| | - Sharon Olsen
- Health and Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand; (N.S.)
| | - Usman Rashid
- Health and Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand; (N.S.)
- Centre for Chiropractic Research, New Zealand College of Chiropractic, Auckland 1060, New Zealand
| | - Ruth McLaren
- Health and Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand; (N.S.)
| | - Alain Vandal
- Department of Statistics, University of Auckland, 38 Princes Street, Auckland 1010, New Zealand;
| | - Marcus King
- Callaghan Innovation, 5 Sheffield Crescent, Burnside, Christchurch 8053, New Zealand
| | - Denise Taylor
- Health and Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand; (N.S.)
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Grill M, Ulfdotter Samuelsson A, Matton E, Norderfeldt E, Rapp-Ricciardi M, Räisänen C, Larsman P. Individualized behavior-based safety-leadership training: A randomized controlled trial. JOURNAL OF SAFETY RESEARCH 2023; 87:332-344. [PMID: 38081706 DOI: 10.1016/j.jsr.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 05/04/2023] [Accepted: 08/07/2023] [Indexed: 12/18/2023]
Abstract
INTRODUCTION Construction site managers play a critical role in occupational safety in the construction industry. This study aimed to develop and test a method for training construction site managers in positive feedback and active listening by incorporating the behavioral training components of behavior analysis, goal setting, practice with behavior feedback, homework, and maintenance planning into individualized behavior-based safety-leadership training (IBST), and to assess the effect of IBST on construction site managers' safety-leadership behaviors and performance. METHOD In a naturalistic randomized controlled trial, construction site managers were randomly assigned to an experimental group (n = 16) or a control group (n = 19). The experimental-group managers received IBST, while the control-group managers received no training. Paired sample t-tests on pre- to post-training (i.e., six weeks after the final training session) were performed separately for the experimental- and control-group managers. RESULTS The safety-leadership behaviors of the experimental-group managers improved in terms of favorable feedback (d = 0.99, p <.01), safety-specific feedback (d = 0.89, p =.02), behavior-specific feedback (d = 0.66, p =.02), antecedent listening (d = 0.68, p =.02), and consequential listening (d = 0.78, p =.01). In addition, safety-leadership performance improved in terms of transformational leadership (d = 0.78, p =.01) and contingent-reward leadership (d = 0.64, p =.02). No significant change was found for the control-group managers. CONCLUSIONS The results indicate that behavior analysis, goal setting, practice with behavior feedback, homework, and maintenance planning are effective behavioral training components of safety-leadership training. Positive feedback and active listening were also found to be important behavioral requisites for transformational and contingent-reward leadership. PRACTICAL APPLICATIONS IBST can be used to develop occupational safety in the construction industry by improving construction site managers' safety-leadership behaviors and performance.
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Affiliation(s)
- Martin Grill
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden.
| | | | - Erik Matton
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
| | - Edit Norderfeldt
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
| | | | | | - Pernilla Larsman
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
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Avallone Mantelli R, Forster J, Edelblute A, Sinn H, Torres K, Adams T, Morgan C, Henry M, Reed K, Moss M. Creative Arts Therapy for Healthcare Professionals Is Associated With Long-Term Improvements in Psychological Distress. J Occup Environ Med 2023; 65:1032-1035. [PMID: 37705403 DOI: 10.1097/jom.0000000000002963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
OBJECTIVE Burnout in healthcare professionals (HCPs) is a pressing issue in healthcare. We report the long-term impact of our previous creative arts therapy (CAT) intervention for reducing psychological distress in HCPs. METHODS Healthcare professionals were randomized to CAT intervention or control group. The CAT group completed surveys evaluating symptoms of psychological distress at 4 months, 8 months, and 1 year postintervention, whereas the control group completed surveys at the 1-year mark. RESULTS The CAT group demonstrated sustained improvement in distress scores for anxiety, depression, and affect at 4 and 8 months postintervention. At the 12-month mark, the CAT group exhibited improvements in anxiety, depression, and affect compared with the control group. CONCLUSION Creative arts therapy has lasting benefits for HCPs. Long-term follow-ups are crucial for assessing sustainability, and further investigation should focus on disseminating and implementing CAT programs for HCPs.
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Affiliation(s)
- Rafaela Avallone Mantelli
- From the Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado School of Medicine, Aurora, Colorado (R.A.M., K.T., M.M.); Ponzio Creative Arts Therapy Program, Children's Hospital Colorado, Aurora, Colorado (A.E., H.S., K.R.); Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, Colorado (J.F.); and Lighthouse Writers Workshop, Denver, Colorado (C.M., M.H.)
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84
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Madden SK, Ahuja KDK, Blewitt C, Hill B, Hills AP, Skouteris H. Understanding the pathway between work and health outcomes for women during the preconception, pregnancy, and postpartum periods through the framing of maternal obesity. Obes Rev 2023; 24:e13637. [PMID: 37655832 PMCID: PMC10909566 DOI: 10.1111/obr.13637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 07/25/2023] [Accepted: 08/09/2023] [Indexed: 09/02/2023]
Abstract
The link between work and health outcomes for preconception, pregnant, and postpartum (PPP) working women is complex. Further, innovation and enhanced understanding are required to address the work-related determinants of maternal obesity. However, workplace health promotion is not typically systems-based nor attuned to the specific needs and context of individual PPP women. We propose that to improve health outcomes for PPP women, we must understand the pathways between paid work and health for the individual woman by taking a systems-thinking approach. In this paper, we (a) outline the rationale for why the oversimplification or "dilution" of individual context may occur; (b) present a systems-informed pathway model (the "Context-Exposure-Response" Model) and overview of potential work-related impacts on health and wellbeing outcomes for PPP women using maternal obesity to provide context examples; (c) further investigate the role of motivational factors from a systems perspective; and (d) briefly examine the implications for policy, practice, and intervention design. It is anticipated that this research may act as a starting point to assist program developers, researchers, and policymakers to adopt a systems-focused perspective while contributing to the health improvement and obesity prevention of PPP women.
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Affiliation(s)
- Seonad K. Madden
- School of Health Sciences, College of Health and MedicineUniversity of TasmaniaLauncestonTasmaniaAustralia
- Health and Social Care Unit, School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Kiran D. K. Ahuja
- School of Health Sciences, College of Health and MedicineUniversity of TasmaniaLauncestonTasmaniaAustralia
| | - Claire Blewitt
- Health and Social Care Unit, School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Briony Hill
- Health and Social Care Unit, School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Andrew P. Hills
- School of Health Sciences, College of Health and MedicineUniversity of TasmaniaLauncestonTasmaniaAustralia
| | - Helen Skouteris
- Health and Social Care Unit, School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
- Warwick Business SchoolUniversity of WarwickCoventryUK
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85
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Squires H, Kelly MP, Gilbert N, Sniehotta F, Purshouse RC. The long-term effectiveness and cost-effectiveness of public health interventions; how can we model behavior? A review. HEALTH ECONOMICS 2023; 32:2836-2854. [PMID: 37681282 PMCID: PMC10843043 DOI: 10.1002/hec.4754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 05/15/2023] [Accepted: 08/14/2023] [Indexed: 09/09/2023]
Abstract
The effectiveness and cost of a public health intervention is dependent on complex human behaviors, yet health economic models typically make simplified assumptions about behavior, based on little theory or evidence. This paper reviews existing methods across disciplines for incorporating behavior within simulation models, to explore what methods could be used within health economic models and to highlight areas for further research. This may lead to better-informed model predictions. The most promising methods identified which could be used to improve modeling of the causal pathways of behavior-change interventions include econometric analyses, structural equation models, data mining and agent-based modeling; the latter of which has the advantage of being able to incorporate the non-linear, dynamic influences on behavior, including social and spatial networks. Twenty-two studies were identified which quantify behavioral theories within simulation models. These studies highlight the importance of combining individual decision making and interactions with the environment and demonstrate the importance of social norms in determining behavior. However, there are many theoretical and practical limitations of quantifying behavioral theory. Further research is needed about the use of agent-based models for health economic modeling, and the potential use of behavior maintenance theories and data mining.
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Affiliation(s)
- Hazel Squires
- Sheffield Centre for Health and Related Research, University of Sheffield, Sheffield, UK
| | - Michael P Kelly
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Nigel Gilbert
- Centre for Research in Social Simulation, University of Surrey, Guildford, UK
| | - Falko Sniehotta
- Faculty of Medicine Mannheim and Clinic Mannheim, Universität Heidelberg, Heidelberg, Germany
| | - Robin C Purshouse
- Department of Automatic Control and Systems Engineering, University of Sheffield, Sheffield, UK
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Yamaguchi S, Ando S, Miyashita M, Usami S, Yamasaki S, Endo K, DeVylder J, Stanyon D, Baba K, Nakajima N, Niimura J, Nakanishi M, Hiraiwa-Hasegawa M, Kasai K, Nishida A. Longitudinal Relationships Between Help-Seeking Intentions and Depressive Symptoms in Adolescents. J Adolesc Health 2023; 73:1061-1067. [PMID: 37665304 DOI: 10.1016/j.jadohealth.2023.06.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 06/27/2023] [Accepted: 06/28/2023] [Indexed: 09/05/2023]
Abstract
PURPOSE Cross-sectional studies have shown an association between lower help-seeking intentions and greater depressive symptoms among adolescents. However, no longitudinal study has examined the direction of this association. The current study investigated whether help-seeking intentions and depressive symptoms are reciprocally associated at the within-person (individual) level during early to mid-adolescence. METHODS Longitudinal data on help-seeking intentions and depressive symptoms in adolescents were obtained from a population-based birth cohort study (Tokyo Teen Cohort; N = 3,171) at four time points (10y, 12y, 14y, and 16y). A random intercept cross-lagged panel model was used to evaluate the within-person prospective associations between help-seeking intentions and depressive symptoms. RESULTS At the within-person level, significant associations were consistently observed between antecedent greater depressive symptoms and subsequent lower help-seeking intentions across all time points (10y-12y: standardized regression coefficient (β) = -0.12, p < .001; 12y-14y: β = -0.07, p < .05; and 14y-16y: β = -0.09, p < .01). Meanwhile, significant within-person associations were partly observed between antecedent lower help-seeking intentions and subsequent greater depressive symptoms from 10y to 12y (β = -0.07, p < .05) and from 14y to 16y (β = -0.12, p < .001). These prospective associations were almost the same when adjusted for the number of potential confidants as a time-varying confounder. DISCUSSION Adolescents with worsening depressive symptoms may become increasingly reluctant to seek help over time. Proactive early recognition and intervention with support from parents, teachers, and other individuals may facilitate the management of depression in adolescents.
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Affiliation(s)
- Satoshi Yamaguchi
- Unit for Mental Health Promotion, Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Setagaya-ku, Tokyo, Japan; Center for Research and Development on Transition from Secondary to Higher Education, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Shuntaro Ando
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Mitsuhiro Miyashita
- Unit for Mental Health Promotion, Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Setagaya-ku, Tokyo, Japan.
| | - Satoshi Usami
- Center for Research and Development on Transition from Secondary to Higher Education, The University of Tokyo, Bunkyo-ku, Tokyo, Japan; Division of Educational Psychology, Graduate School of Education, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Syudo Yamasaki
- Unit for Mental Health Promotion, Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Setagaya-ku, Tokyo, Japan
| | - Kaori Endo
- Unit for Mental Health Promotion, Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Setagaya-ku, Tokyo, Japan
| | - Jordan DeVylder
- Graduate School of Social Service, Fordham University, New York, New York
| | - Daniel Stanyon
- Unit for Mental Health Promotion, Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Setagaya-ku, Tokyo, Japan
| | - Kaori Baba
- Unit for Mental Health Promotion, Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Setagaya-ku, Tokyo, Japan
| | - Naomi Nakajima
- Unit for Mental Health Promotion, Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Setagaya-ku, Tokyo, Japan
| | - Junko Niimura
- Unit for Mental Health Promotion, Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Setagaya-ku, Tokyo, Japan
| | - Miharu Nakanishi
- Department of Psychiatric Nursing, Tohoku University Graduate School of Medicine, Sendai-shi, Miyagi, Japan
| | - Mariko Hiraiwa-Hasegawa
- School of Advanced Science, SOKENDAI (Graduate University for Advanced Studies), Hayama, Kanagawa, Japan
| | - Kiyoto Kasai
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan; The International Research Center for Neurointelligence (WPI-IRCN), The University of Tokyo Institutes for Advanced Study (UTIAS), Bunkyo-ku, Tokyo, Japan; UTokyo Institute for Diversity and Adaptation of Human Mind (UTIDAHM), The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Atsushi Nishida
- Unit for Mental Health Promotion, Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Setagaya-ku, Tokyo, Japan
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Carvalho MCRD, Lopes MS, Freitas PPD, Lopes ACS. Evolution of fruit and vegetable intake among health promotion service participants in a Brazilian metropolis: 48-month follow-up of a randomized controlled community trial. Prev Med 2023; 177:107748. [PMID: 37913915 DOI: 10.1016/j.ypmed.2023.107748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 10/26/2023] [Accepted: 10/28/2023] [Indexed: 11/03/2023]
Abstract
OBJECTIVE To assess longitudinal effects of a nutrition intervention on fruit and vegetable (F&V) intake among Primary Health Care (PHC) service participants in Belo Horizonte, Brazil. METHODS Demographics and health data on 3414 PHC service participants were collected at baseline in 2013-2014. F&V intake was assessed at baseline, 12, 36, and 48 months until 2017-2018. Services were randomized to control (CG, usual care) or intervention (IG, usual care and a Transtheoretical Model-based intervention to increase F&V intake). We performed difference-in-differences (DiD) analysis to identify intervention effects on F&V intake, and sensitivity analyses of participants observed at all timepoints. RESULTS Participants were mostly middle-aged, low-income women. Mean baseline intakes were 168.7 g of fruit, 202.0 g of vegetables, and 370.7 g of F&V, with lower fruit in the IG (164.1 g) than the CG (172.3 g). At 12 months, the intervention increased fruit intake in the IG and fruit and F&V intake among individuals with low baseline F&V intake. Fruit intake remained higher at 36 months in the IG. No effect on vegetable intake was identified. According to sensitivity analyses, effects on fruit intake among the complete sample did not remain significant at 36 months, and an effect on fruit intake at 36 months was identified among those with adequate baseline F&V intake. Reductions in F&V intake did not remain significant. CONCLUSIONS At 12 months, a TTM-based intervention increased fruit intake in the overall sample, and fruit and F&V intake among individuals with low baseline intakes. Repeated interventions may be needed over time. TRIAL REGISTRATION NUMBER RBR-9h7ckx.
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Affiliation(s)
- Maria Cecília Ramos de Carvalho
- Universidade Federal de Minas Gerais, Grupo de Pesquisa de Intervenções em Nutrição, 190 Alfredo Balena Avenue, Nursing School, Room 102, Santa Efigênia, 30130-100 Belo Horizonte, MG, Brazil.
| | - Mariana Souza Lopes
- Universidade Federal da Paraíba, Centro de Ciências da Saúde, Departamento de Nutrição, Campus I, Cidade Universitária, 58051-900 João Pessoa, PB, Brazil. Universidade Federal de Minas Gerais, Grupo de Pesquisa de Intervenções em Nutrição.
| | - Patrícia Pinheiro de Freitas
- Universidade Federal de Minas Gerais, Grupo de Pesquisa de Intervenções em Nutrição, 190 Alfredo Balena Avenue, Nursing School, Room 102, Santa Efigênia, 30130-100 Belo Horizonte, MG, Brazil.
| | - Aline Cristine Souza Lopes
- Universidade Federal de Minas Gerais, Escola de Enfermagem, Departamento de Nutrição, Grupo de Pesquisa de Intervenções em Nutrição, 190 Alfredo Balena Avenue, Nursing School, Room 316, Santa Efigênia, 30130-100 Belo Horizonte, MG, Brazil.
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Spreckley M, de Lange J, Seidell J, Halberstadt J. Primary care-led weight-management intervention: qualitative insights into patient experiences at two-year follow-up. Int J Qual Stud Health Well-being 2023; 18:2276576. [PMID: 38016037 PMCID: PMC11007633 DOI: 10.1080/17482631.2023.2276576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 10/25/2023] [Indexed: 11/30/2023] Open
Abstract
PURPOSE The prevalence of overweight and obesity is continuously increasing globally and long-term weight loss intervention outcomes remain disappointing. To determine which behavioural intervention approaches improve the probability of achieving long-term weight loss, this two-year follow-up study aimed to identify distinct factors and strategies for successful long-term weight loss maintenance. METHODS A cohort of 20 participants with overweight and obesity from a primary-care led weight management programme with diverse backgrounds was interviewed at baseline, after 1 and 2 years, and asked to do quantitative self-description. This study focused on the 2-year follow-up interviews from this study series. RESULTS We found that agile, continuous self-monitoring with personalized, sustainable lifestyle habits correlated with positive outcomes. Participants reported health benefits, maintained weight loss, and found motivation in supportive peer networks. Challenges like anxiety, disappointment, and disruptions derailed progress. Long-term success relied on a strong support system of healthcare professionals, friends, and family. CONCLUSIONS The findings of this study series highlight the intricate nature of long-term weight loss maintenance. This study corroborates the persistence of overarching themes while highlighting the individual variability in their relative importance. Findings emphasize the importance of long-term support to effectively address the diverse needs of patients trying to achieve long-term weight loss maintenance.
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Affiliation(s)
- Marie Spreckley
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, London, UK
| | | | - Jaap Seidell
- Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Brust M, Gebhardt WA, van Bruggen S, Janssen V, Numans ME, Kiefte-de Jong JC. Making sense of a myocardial infarction in relation to changing lifestyle in the five months following the event: An interpretative phenomenological analysis. Soc Sci Med 2023; 338:116348. [PMID: 37922741 DOI: 10.1016/j.socscimed.2023.116348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 10/04/2023] [Accepted: 10/19/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVE Previous research has shown that experiencing an acute cardiac event, such as a myocardial infarction (MI), can lead to lifestyle changes. This study aimed to explore the potential of a MI as a 'teachable moment' (TM) for positive lifestyle changes and to identify psychosocial sensemaking processes that facilitate or hinder the presence of a TM. METHOD We conducted semi-structured interviews with 14 patients who suffered their first MI and were hospitalized in a larger Dutch city. Participants were interviewed twice, respectively one and five months after their hospitalization. They were encouraged to explain how they experienced their MI and how this had affected their lifestyle. We used an Interpretative Phenomenological Analysis approach to the data collection and analysis. FINDINGS The participants varied in their willingness to adopt a healthy lifestyle due to their MI. Most participants experienced their event as a TM for changing specific health behaviors, for example facilitated by reflecting on self-concept or social roles and by constructing and comprehending a personal narrative of their MI. Some participants struggled to follow through on their intentions to change their behavior, for example because of a negative attitude towards a healthy behavior or because they perceived it as incongruent to their identity. Only three participants maintained most former health behaviors, for example because they failed to acknowledge their MI as severe or because of earlier life events that elicited more blunted cognitive responses. CONCLUSION Cardiac patients may experience a TM, which is the consequence of interrelated processes of psychosocial sensemaking. As this does not occur at a singular time point, we suggest using the term 'teachable window' rather than 'moment'. Given these findings, there is a window of opportunity to provide continuous psychosocial and lifestyle support during and after hospitalization for acute cardiac events.
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Affiliation(s)
- Michelle Brust
- Health Campus the Hague, Department of Public Health and Primary Care, Leiden University Medical Center, The Hague, the Netherlands.
| | - Winifred A Gebhardt
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, the Netherlands.
| | - Sytske van Bruggen
- Health Campus the Hague, Department of Public Health and Primary Care, Leiden University Medical Center, The Hague, the Netherlands; Haaglandse Dokters, The Hague, the Netherlands.
| | - Veronica Janssen
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, the Netherlands; Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
| | - Mattijs E Numans
- Health Campus the Hague, Department of Public Health and Primary Care, Leiden University Medical Center, The Hague, the Netherlands.
| | - Jessica C Kiefte-de Jong
- Health Campus the Hague, Department of Public Health and Primary Care, Leiden University Medical Center, The Hague, the Netherlands.
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90
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Heino MTJ, Proverbio D, Marchand G, Resnicow K, Hankonen N. Attractor landscapes: a unifying conceptual model for understanding behaviour change across scales of observation. Health Psychol Rev 2023; 17:655-672. [PMID: 36420691 PMCID: PMC10261543 DOI: 10.1080/17437199.2022.2146598] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 11/07/2022] [Indexed: 11/25/2022]
Abstract
Models and theories in behaviour change science are not in short supply, but they almost exclusively pertain to a particular facet of behaviour, such as automaticity or reasoned action, or to a single scale of observation such as individuals or communities. We present a highly generalisable conceptual model which is widely used in complex systems research from biology to physics, in an accessible form to behavioural scientists. The proposed model of attractor landscapes can be used to understand human behaviour change on different levels, from individuals to dyads, groups and societies. We use the model as a tool to present neglected ideas in contemporary behaviour change science, such as hysteresis and nonlinearity. The model of attractor landscapes can deepen understanding of well-known features of behaviour change (research), including short-livedness of intervention effects, problematicity of focusing on behavioural initiation while neglecting behavioural maintenance, continuum and stage models of behaviour change understood within a single accommodating framework, and the concept of resilience. We also demonstrate potential methods of analysis and outline avenues for future research.
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Affiliation(s)
| | | | | | - Kenneth Resnicow
- School of Public Health, University of Michigan. Rogel Cancer Center University of Michigan
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91
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Varman SD, Jones RA, Kelly B, Hammersley ML, Parrish AM, Stanley R, Cliff DP. The effect of experiential learning interventions on physical activity outcomes in children: A systematic review. PLoS One 2023; 18:e0294987. [PMID: 38033028 PMCID: PMC10688861 DOI: 10.1371/journal.pone.0294987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 11/13/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND This systematic review examined the effectiveness of experiential learning interventions for improving children's physical activity knowledge, attitudes, and behaviours. It also aimed to identify intervention characteristics that resulted in the greatest impact. METHODS Four databases: Education Research Complete, Scopus, Web of Science and PsychINFO were searched from database inception to January 2023. Eligible studies: (1) included children 0-12 years; (2) assessed the effect of physical activity outcomes on children's physical activity knowledge, attitudes or behaviour and (3) were randomised controlled trials conducted in any setting. Study risk of bias was assessed by two independent reviewers using the Cochrane risk of bias tool. Intervention approaches were categorised, and effect sizes were compared across studies for each outcome. RESULTS Twelve studies were included in the review: ten in school age and two in below five years. For behavioural outcomes, six of eight studies showed medium to large effects (effects size (ES) range: 0.3-0.9), two of the three studies that assessed attitudinal outcomes displayed medium effects (ES range: 0.4-0.5) and both studies that assessed knowledge outcomes displayed medium to large effects (ES range: 0.4-1.3). The two experiential learning interventions among children < 5 years demonstrated small to medium effects on behaviour change (ES range: 0.2-0.5). Effective interventions combined enjoyable practical activities (fitness activities, games and challenges), with behaviour change techniques (goal setting, and self-monitoring), were underpinned by a behaviour change theory, and were often of short duration (< 4 months) but intense (several sessions/week). Moderate to high statistical heterogeneity was observed for behaviour outcomes and risk of bias across studies was generally high. CONCLUSIONS This review provides some evidence supporting the effectiveness of experiential learning interventions in improving physical activity outcomes in school-aged children. Additional evidence is needed in children <5 years old. Future experiential learning interventions need to strengthen the evidence with rigorous methodological quality and clear reporting of the experiential learning components.
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Affiliation(s)
- Sumantla D. Varman
- Faculty of the Arts, Social Sciences and Humanities, Early Start, School of Health and Society, University of Wollongong, Wollongong, NSW, Australia
| | - Rachel A. Jones
- Faculty of the Arts, Social Sciences and Humanities, Early Start, School of Education, University of Wollongong, Wollongong, NSW, Australia
- Illawarra Health and Medical Research Institute, Wollongong, NSW, Australia
| | - Bridget Kelly
- Faculty of the Arts, Social Sciences and Humanities, Early Start, School of Health and Society, University of Wollongong, Wollongong, NSW, Australia
| | - Megan L. Hammersley
- Faculty of the Arts, Social Sciences and Humanities, Early Start, School of Health and Society, University of Wollongong, Wollongong, NSW, Australia
- Illawarra Health and Medical Research Institute, Wollongong, NSW, Australia
| | - Anne-Maree Parrish
- Faculty of the Arts, Social Sciences and Humanities, Early Start, School of Education, University of Wollongong, Wollongong, NSW, Australia
| | - Rebecca Stanley
- Faculty of the Arts, Social Sciences and Humanities, Early Start, School of Education, University of Wollongong, Wollongong, NSW, Australia
| | - Dylan P. Cliff
- Faculty of the Arts, Social Sciences and Humanities, Early Start, School of Education, University of Wollongong, Wollongong, NSW, Australia
- Illawarra Health and Medical Research Institute, Wollongong, NSW, Australia
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Smith PJ, Whitson HE, Merwin RM, O’Hayer CV, Strauman TJ. Engineering Virtuous health habits using Emotion and Neurocognition: Flexibility for Lifestyle Optimization and Weight management (EVEN FLOW). Front Aging Neurosci 2023; 15:1256430. [PMID: 38076541 PMCID: PMC10702760 DOI: 10.3389/fnagi.2023.1256430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 10/20/2023] [Indexed: 02/12/2024] Open
Abstract
Interventions to preserve functional independence in older adults are critically needed to optimize 'successful aging' among the large and increasing population of older adults in the United States. For most aging adults, the management of chronic diseases is the most common and impactful risk factor for loss of functional independence. Chronic disease management inherently involves the learning and adaptation of new behaviors, such as adopting or modifying physical activity habits and managing weight. Despite the importance of chronic disease management in older adults, vanishingly few individuals optimally manage their health behavior in the service of chronic disease stabilization to preserve functional independence. Contemporary conceptual models of chronic disease management and health habit theory suggest that this lack of optimal management may result from an underappreciated distinction within the health behavior literature: the behavioral domains critical for initiation of new behaviors (Initiation Phase) are largely distinct from those that facilitate their maintenance (Maintenance Phase). Psychological factors, particularly experiential acceptance and trait levels of openness are critical to engagement with new health behaviors, willingness to make difficult lifestyle changes, and the ability to tolerate aversive affective responses in the process. Cognitive factors, particularly executive function, are critical to learning new skills, using them effectively across different areas of life and contextual demands, and updating of skills to facilitate behavioral maintenance. Emerging data therefore suggests that individuals with greater executive function are better able to sustain behavior changes, which in turn protects against cognitive decline. In addition, social and structural supports of behavior change serve a critical buffering role across phases of behavior change. The present review attempts to address these gaps by proposing a novel biobehavioral intervention framework that incorporates both individual-level and social support system-level variables for the purpose of treatment tailoring. Our intervention framework triangulates on the central importance of self-regulatory functioning, proposing that both cognitive and psychological mechanisms ultimately influence an individuals' ability to engage in different aspects of self-management (individual level) in the service of maintaining independence. Importantly, the proposed linkages of cognitive and affective functioning align with emerging individual difference frameworks, suggesting that lower levels of cognitive and/or psychological flexibility represent an intermediate phenotype of risk. Individuals exhibiting self-regulatory lapses either due to the inability to regulate their emotional responses or due to the presence of executive functioning impairments are therefore the most likely to require assistance to preserve functional independence. In addition, these vulnerabilities will be more easily observable for individuals requiring greater complexity of self-management behavioral demands (e.g. complexity of medication regimen) and/or with lesser social support. Our proposed framework also intuits several distinct intervention pathways based on the profile of self-regulatory behaviors: we propose that individuals with intact affect regulation and impaired executive function will preferentially respond to 'top-down' training approaches (e.g., strategy and process work). Individuals with intact executive function and impaired affect regulation will respond to 'bottom-up' approaches (e.g., graded exposure). And individuals with impairments in both may require treatments targeting caregiving or structural supports, particularly in the context of elevated behavioral demands.
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Affiliation(s)
- Patrick J. Smith
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Heather E. Whitson
- Department of Medicine, Duke University Medical Center, Durham, NC, United States
- Department of Medicine, Durham Veterans Affairs Medical Center, Durham, NC, United States
| | - Rhonda M. Merwin
- Department of Psychiatry, Duke University Medical Center, Durham, NC, United States
| | - C. Virginia O’Hayer
- Department of Psychiatry and Human Behavior, Thomas Jefferson University, Philadelphia, PA, United States
| | - Timothy J. Strauman
- Department of Psychiatry, Duke University Medical Center, Durham, NC, United States
- Department of Psychology and Neuroscience, Duke University, Durham, NC, United States
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Peralta M, Viscioni G, Melo X, Gouveia ÉR, Griesser T, Blocher A, Bertollo M, Di Blasio A, Marques A. Does the Installation or the Improvement of Existing Outdoor Parks Increase Physical Activity Levels? A Systematic Review. Sports (Basel) 2023; 11:221. [PMID: 37999438 PMCID: PMC10675755 DOI: 10.3390/sports11110221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/31/2023] [Accepted: 11/06/2023] [Indexed: 11/25/2023] Open
Abstract
Investment in outdoor parks is proposed as a promising large-scale strategy to promote physical activity (PA). This study aimed to systematically review the impact of park renovations or installing new ones in increasing PA. Searches were conducted using predefined terms in three databases (PubMed, Scopus, and Web of Science) in March 2022. Studies examining the effectiveness of park renovations or developing new ones in increasing PA and having control or comparison were eligible for inclusion. Study quality was assessed using the Quality Assessment Tool for Quantitative Studies. Data were extracted from the included records using a predefined extraction table. The database search yielded 959 records, and 26 were included. For park renovations (n = 17), 11 (65%) studies presented findings supporting a positive effect on PA. The other six (35%) studies found no PA benefits when compared to control or pre-renovations/improvement levels. Regarding new installations (n = 9), five (56%) studies presented improvements in PA, and four (44%) did not. A promising positive impact of park renovations and new installations on park use and PA was observed. The review findings reflect the need to understand the context, daily routines, and interests of the surrounding population before renovating or installing new outdoor parks.
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Affiliation(s)
- Miguel Peralta
- Centro Interdisciplinar de Estudo da Performance Humana (CIPER), Faculdade de Motricidade Humana, Universidade de Lisboa, 1495-751 Cruz Quebrada, Portugal;
- Instituto de Saúde Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, 1649-026 Lisbon, Portugal
| | - Gianluca Viscioni
- Department of Medicine and Aging Sciences, “G. d’Annunzio” University of Chieti-Pescara, 66100 Chieti, Italy; (G.V.); (M.B.); (A.D.B.)
| | - Xavier Melo
- Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Escola Superior de Saúde Egas Moniz, 2829-511 Caparica, Portugal;
| | - Élvio R. Gouveia
- Department of Physical Education and Sport, University of Madeira, 9020-105 Funchal, Portugal;
- Laboratory of Robotics and Engineering Systems, Interactive Technologies Institute, 9020-105 Funchal, Portugal
| | - Thorsten Griesser
- Planet O GmH, Post SV Nuremberg e.V., 90482 Nuremberg, Germany; (T.G.); (A.B.)
| | - Alexander Blocher
- Planet O GmH, Post SV Nuremberg e.V., 90482 Nuremberg, Germany; (T.G.); (A.B.)
| | - Maurizio Bertollo
- Department of Medicine and Aging Sciences, “G. d’Annunzio” University of Chieti-Pescara, 66100 Chieti, Italy; (G.V.); (M.B.); (A.D.B.)
| | - Andrea Di Blasio
- Department of Medicine and Aging Sciences, “G. d’Annunzio” University of Chieti-Pescara, 66100 Chieti, Italy; (G.V.); (M.B.); (A.D.B.)
| | - Adilson Marques
- Centro Interdisciplinar de Estudo da Performance Humana (CIPER), Faculdade de Motricidade Humana, Universidade de Lisboa, 1495-751 Cruz Quebrada, Portugal;
- Instituto de Saúde Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, 1649-026 Lisbon, Portugal
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Golsteijn RHJ, Bolman C, Peels DA, Volders E, de Vries H, Lechner L. Long-term efficacy of a computer-tailored physical activity intervention for prostate and colorectal cancer patients and survivors: A randomized controlled trial. JOURNAL OF SPORT AND HEALTH SCIENCE 2023; 12:690-704. [PMID: 37591482 PMCID: PMC10658345 DOI: 10.1016/j.jshs.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 03/18/2023] [Accepted: 07/24/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND Physical activity (PA) can improve the physical and psychological health of prostate and colorectal cancer survivors, but PA behavior change maintenance is necessary for long-term health benefits. OncoActive is a print- and web-based intervention in which prostate and colorectal cancer patients and survivors receive automatically generated, personalized feedback aimed at integrating PA into daily life to increase and maintain PA. We evaluated the long-term outcomes of OncoActive by examining the 12-month follow-up differences between OncoActive and a control group, and we explored whether PA was maintained during a 6-month non-intervention follow-up period. METHODS Prostate or colorectal cancer patients were randomly assigned to an OncoActive (n = 249) or a usual care waitlist control group (n = 229). OncoActive participants received PA advice and a pedometer. PA outcomes (i.e., ActiGraph and self-report moderate-to-vigorous intensity PA (MVPA) min/week and days with ≥30 min PA) and health-related outcomes (i.e., fatigue, depression, physical functioning) were assessed at baseline, 6 months, and 12 months. Differences between groups and changes over time were assessed with multilevel linear regressions for the primary outcome (ActiGraph MVPA min/week) and all additional outcomes. RESULTS At 12 months, OncoActive participants did not perform better than control group participants at ActiGraph MVPA min/week, self-report MVPA min/week, or ActiGraph days with PA. Only self-report days with PA were significantly higher in OncoActive compared to the control group. For health-related outcomes only long-term fatigue was significantly lower in OncoActive. When exploratively examining PA within OncoActive, the previously found PA effects at the end of the intervention (6 months follow-up) were maintained at 12 months. Furthermore, all PA outcomes improved significantly from baseline to 12 months. The control group showed small but non-significant improvements from 6 months to 12 months (and from baseline to 12 months), resulting in a decline of differences between groups. CONCLUSION The majority of previously reported significant between-group differences at 6 months follow-up were no longer present at long-term follow-up, possibly because of natural improvement in the control group. At long-term follow-up, fatigue was significantly lower in OncoActive compared to control group participants. Computer-tailored PA advice may give participants an early start toward recovery and potentially contributes to improving long-term health.
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Affiliation(s)
| | - Catherine Bolman
- Department of Psychology, Open University of the Netherlands, Heerlen, 6401 DL, the Netherlands
| | - Denise Astrid Peels
- Department of Psychology, Open University of the Netherlands, Heerlen, 6401 DL, the Netherlands
| | - Esmee Volders
- Department of Psychology, Open University of the Netherlands, Heerlen, 6401 DL, the Netherlands
| | - Hein de Vries
- Department of Health Promotion, Maastricht University, Maastricht, 6200 MD, the Netherlands
| | - Lilian Lechner
- Department of Psychology, Open University of the Netherlands, Heerlen, 6401 DL, the Netherlands
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95
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Dhumal T, Scott VG, Powers R, Kelly KM. Assessing the impact of the skin cancer awareness now (SCAN!) intervention several months following the intervention. J Am Pharm Assoc (2003) 2023; 63:1803-1807. [PMID: 37717920 DOI: 10.1016/j.japh.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 08/23/2023] [Accepted: 09/12/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND West Virginia (WV) is the third most rural state in the US and has a high incidence of skin cancer. Intervention efforts in WV are impeded by structural barriers, low health literacy, and lack of health care access. Community pharmacies and pharmacists are highly accessible and may be helpful in promoting skin cancer prevention. OBJECTIVE(S) The purpose of the study was to evaluate the impact of the Skin Cancer Awareness Now (SCAN!) pharmacy-based sun-safety intervention at follow-up. METHODS Surveys assessed SCAN's effect on skin cancer prevention at preintervention and follow-up. The follow-up survey was administered between 8 and 12 months after our initial feasibility study. Questions included demographics, cancer history, cancer worry, knowledge, cancer communication, and skin cancer screening intentions. Multivariate repeated measures ANOVA assessed the change in worry, importance, knowledge, and intentions to be sun safe. RESULTS Participants (n=56, response rate= 62.2%) had a mean age of 44.7 (standard deviation: 19.3) years. Most were females (87.5%), Whites (92.9%), and 48.2% lived in rural areas. Knowledge and intentions significantly improved over time. At follow-up, participants (41.1%) mentioned that they plan on discussing skin cancer prevention with their pharmacist in the future. CONCLUSION The SCAN! intervention can be a useful resource for skin cancer prevention in community pharmacy settings. Community pharmacies have the potential to be change agents in skin cancer prevention by providing education on sun protection or detection and by promoting sun-safety behaviors.
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96
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Li Y, Yang W, Qu Y, Zhang X, Lin M, Fu L, Wang C, Qiu P, Zang X. Effects of an autonomy-supportive intervention programme (ASIP) on self-care, quality of life, and mental health in heart failure patients: a randomized controlled trial. Qual Life Res 2023; 32:3039-3052. [PMID: 37418228 DOI: 10.1007/s11136-023-03467-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2023] [Indexed: 07/08/2023]
Abstract
PURPOSE Patients with heart failure (HF) possess low self-care activation and motivation, leading to a deprived quality of life and adverse mental health conditions. To this end, self-determination theory emphasizes that autonomy-supportive interventions (ASI) can stimulate intrinsic motivation and improve behaviors and quality of life. Nevertheless, studies that focused on ASI for HF are inadequate. This study aims to evaluate the effects of an HF-ASIP on self-care, quality of life and mental health in HF patients. METHODS In a two-arm randomized controlled trial, the participants are randomly allocated to the intervention (n = 41) or control (n = 41) groups. The intervention group received routine care and participated in an 8-week HF-ASIP, including individual education and consultation sessions. In contrast, the control group received only routine care. The primary outcome includes self-care management, while the secondary outcomes include self-care maintenance, quality of life, mental health, and motivation. After measuring the outcomes at baseline (T0), 4-week (T1), 8-week (T2), and 12-week (T3) follow-up, the intervention effects are assessed using the generalized equation models. RESULTS The outcomes indicated that self-care management (T2: P = 0.001; T3: P = 0.016), self-care maintenance (T2: P = 0.003; T3: P = 0.001), depression (T2: P = 0.007; T3: P = 0.012), anxiety (T2: P = 0.001; T3: P = 0.012), MLHFQ total score (T1: P = 0.004; T2: P < 0.001; T3: P = 0.001), autonomous motivation (T2: P = .0.006; T3: P = 0.002) showed statistically difference between the groups. CONCLUSION In summary, the 8-week HF-ASIP significantly improved the attributes of self-care, quality of life, mental health, and motivation in HF patients, suggesting the potential for practical intervention effect. TRIAL REGISTRATION ChiCTR2100053970.
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Affiliation(s)
- Yanting Li
- School of Nursing, Tianjin Medical University, N.22 Qixiangtai Rd, Heping District, Tianjin, 300070, China
| | - Weiling Yang
- School of Nursing, Tianjin Medical University, N.22 Qixiangtai Rd, Heping District, Tianjin, 300070, China
| | - Yuanyuan Qu
- School of Nursing, Tianjin Medical University, N.22 Qixiangtai Rd, Heping District, Tianjin, 300070, China
| | - Xiaonan Zhang
- School of Nursing, Tianjin Medical University, N.22 Qixiangtai Rd, Heping District, Tianjin, 300070, China
| | - Mei Lin
- Tianjin Medical University General Hospital, Tianjin, China
| | - Li Fu
- The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Cuicui Wang
- The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Pingping Qiu
- School of Nursing, Fujian Medical University, Fujian, China.
| | - Xiaoying Zang
- School of Nursing, Tianjin Medical University, N.22 Qixiangtai Rd, Heping District, Tianjin, 300070, China.
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Walburn J, Foster L, Araújo-Soares V, Sarkany R, Weinman J, Sainsbury K, Morgan M. Acceptability and influence of a complex personalized intervention on changes in photoprotection behaviours among people with xeroderma pigmentosum. Br J Health Psychol 2023; 28:1113-1131. [PMID: 37414737 DOI: 10.1111/bjhp.12675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 05/05/2023] [Accepted: 05/23/2023] [Indexed: 07/08/2023]
Abstract
OBJECTIVES Rigorous photoprotection is the only means to prevent skin cancer in people with the rare condition of xeroderma pigmentosum (XP). We conducted a qualitative process evaluation of patient experiences and responses to a highly personalized, multi-component intervention, 'XPAND', designed to influence the psychosocial determinants of inadequate photoprotection among adults with XP. DESIGN Qualitative study of 15 patients following participation in a RCT. METHODS Semi-structured interviews explored acceptability, changes in photoprotection and attributions for behavioural changes. Analysis followed a framework approach. RESULTS Participants were overwhelmingly positive in their views of the quality and range of components of XPAND and the relevance to their personal photoprotection barriers. All participants reported improved adherence to at least one photoprotection activity and nearly two-thirds of participants noted improvements across multiple activities. Participants believed improvements in their photoprotection behaviours were influenced by different change mechanisms. Sunscreen application, was mainly facilitated by habit formation, prompted by text messages, whereas the wearing of a photoprotective face buff was influenced by strategies, learnt during one-to-one sessions, to overcome worry about looking different. Enhancement of general self-confidence and perceived support from XPAND described by participants facilitated change more broadly. CONCLUSIONS Exploration of responses to XPAND is required in the international XP population, followed by adaptation and evaluation to see if it could benefit other patient groups at higher risk of skin cancer. Implications for approaches to behaviour change include the acceptability of complex multidimensional interventions, the importance of dynamic personalization and the interactive nature of behaviour change mechanisms.
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Affiliation(s)
- Jessica Walburn
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Lesley Foster
- National Xeroderma Pigmentosum Service, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Vera Araújo-Soares
- Division of Prevention, Center for Preventive Medicine and Digital Health (CPD), Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Robert Sarkany
- National Xeroderma Pigmentosum Service, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - John Weinman
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Kirby Sainsbury
- Faculty of Medical Sciences, Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Myfanwy Morgan
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
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Greaves CJ, Poltawski L, van Beurden SB, Price L, Taylor RS, Merrifield R, O'Loughlin L. Addressing the psychology of weight loss and maintenance: A feasibility study of the Skills for weight loss and Maintenance weight management programme. Br J Health Psychol 2023; 28:1261-1282. [PMID: 37487646 DOI: 10.1111/bjhp.12683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 06/08/2023] [Indexed: 07/26/2023]
Abstract
OBJECTIVES Building on prior theory, we aimed to evaluate the feasibility and acceptability of integrating novel, weight loss maintenance strategies into existing weight management programmes. We also piloted recruitment and data collection procedures for future research. DESIGN Two phases of action research nested within a single-arm feasibility study. The intervention was refined between phases using feedback from intervention fidelity analysis and qualitative exploration of patient and provider experiences. Changes in outcomes were assessed up to 18 months post-baseline. METHODS One hundred adults with a mean body mass index of 37 kg/m2 were offered the Skills for weight loss and Maintenance (SkiM) intervention. This included existing weight management programme content and additional weight loss maintenance techniques delivered fortnightly for 6 months in local community centres to groups of 11-15 people. RESULTS Of the 100 participants, 65%, 58% and 56% provided data at 7, 12 and 18 months. Across both phases, the mean initial weight loss was 4.2 kg (95% CI: 2.4-5.9) and 3.1 kg at 18 months (95% CI: .8-5.5). In Phase 2, we observed better weight loss maintenance (.5 kg [13.2%] regain from 7 to 18 months, vs. 1.7 kg [36.2%] in Phase 1). Variation in outcomes, high early dropout rates and qualitative feedback indicated that, although delivery of the intervention and trial procedures was feasible and acceptable, there was scope to refine the intervention to engage a wider range of participants. Intervention fidelity was acceptable, particularly in Phase 2. CONCLUSIONS The SkiM intervention seems promising, but more research is needed to improve recruitment and retention prior to further evaluation.
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Affiliation(s)
- Colin J Greaves
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Leon Poltawski
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | | | - Lisa Price
- School of Sport and Health Sciences, University of Exeter, Exeter, UK
| | - Rodney S Taylor
- University of Exeter Medical School, University of Exeter, Exeter, UK
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
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99
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Karloh M, Matias TS, de Oliveira JM, de Lima FF, Araújo Pinheiro DH, Barbosa GB, Furlanetto KC, Carvalho CRF. Breaking barriers to rehabilitation: the role of behavior change theories in overcoming the challenge of exercise-related behavior change. Braz J Phys Ther 2023; 27:100574. [PMID: 38056192 PMCID: PMC10749239 DOI: 10.1016/j.bjpt.2023.100574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 10/30/2023] [Accepted: 11/13/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Promoting exercise-related behavior change in rehabilitation is a challenge. The lack of integration between rehabilitation program prescriptions, behavior change interventions, and behavioral change theories is profound. Using behavior change theories properly is crucial for better adherence and promoting positive outcomes. Therefore, it is essential to bring theories that support the understanding of exercise-related behavioral change to the attention of rehabilitation practitioners. OBJECTIVE This masterclass article aims to provide the theoretical background of theories and strategies for exercise behavior change within the physical therapy context based on acknowledged behavioral change theoretical models. METHODS This is a narrative review that examines six behavior theories; five of them well-established, and a new (and promising) theory that has exhibited the most favorable outcomes in rehabilitation settings. The development process for this masterclass included conversations between authors, reviewing behavior theories, summarizing and discussing the theories' concepts and strategies for physical therapy. RESULTS The included theories were self-determination theory, social-cognitive theory, the transtheoretical model, the theory of planned behavior, the health belief model, and the unifying theory of physical activity. Each theory offers a unique perspective on exercise behavior change within rehabilitation, exploring constructs such as motivation, self-efficacy, stages of change, behavioral intention, perceived threat, and the core elements of physical activity expression. CONCLUSION These theoretical models provide a foundation for understanding and developing strategies for promoting exercise behavior change in rehabilitation. Knowing and using these theories is important for respecting the patient's individuality.
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Affiliation(s)
- Manuela Karloh
- Center for Assistance, Teaching and Research in Pulmonary Rehabilitation (NuReab). Center for Health Sciences and Sport (CEFID), Universidade do Estado de Santa Catarina (UDESC), Florianópolis, SC, Brazil; Graduate Program in Physical Therapy, Center for Health Sciences and Sport (CEFID), Universidade do Estado de Santa Catarina (UDESC), Florianópolis, SC, Brazil.
| | - Thiago Sousa Matias
- Department of Physical Education, School of Sports, Graduate Program in Physical Education, Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil; Graduate Program in Public Health, Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil
| | - Joice Mara de Oliveira
- Laboratory of Research in Respiratory Physical Therapy (LFIP), Department of Physical Therapy, Universidade Estadual de Londrina (UEL), Londrina, PR, Brazil; Graduate Program in Rehabilitation Sciences, Universidade Pitágoras-Unopar (UNOPAR), Londrina, PR, Brazil
| | - Fabiano Francisco de Lima
- Physical Therapy Department, School of Medicine, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | | | - Graziele Besen Barbosa
- Center for Assistance, Teaching and Research in Pulmonary Rehabilitation (NuReab). Center for Health Sciences and Sport (CEFID), Universidade do Estado de Santa Catarina (UDESC), Florianópolis, SC, Brazil; Graduate Program in Physical Therapy, Center for Health Sciences and Sport (CEFID), Universidade do Estado de Santa Catarina (UDESC), Florianópolis, SC, Brazil
| | - Karina Couto Furlanetto
- Laboratory of Research in Respiratory Physical Therapy (LFIP), Department of Physical Therapy, Universidade Estadual de Londrina (UEL), Londrina, PR, Brazil; Graduate Program in Rehabilitation Sciences, Universidade Pitágoras-Unopar (UNOPAR), Londrina, PR, Brazil
| | - Celso R F Carvalho
- Physical Therapy Department, School of Medicine, Universidade de São Paulo (USP), São Paulo, SP, Brazil
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100
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van de Ven D, Schuring M, Kouwenhoven-Pasmooij TA, Blom P, Burdorf A, Robroek SJW. Reach and effectiveness of a worksite health promotion program combining a preventive medical examination with motivational interviewing; a quasi-experimental study among workers in low socioeconomic position. BMC Public Health 2023; 23:2130. [PMID: 37904106 PMCID: PMC10617210 DOI: 10.1186/s12889-023-16908-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 10/05/2023] [Indexed: 11/01/2023] Open
Abstract
BACKGROUND This study aimed to evaluate individual characteristics associated with participation and effectiveness of a worksite health promotion program with motivational interviewing targeting health and health behaviour among Dutch workers in low socioeconomic position. METHODS In a production company and a hospital, 838 workers were invited for a Preventive Medical Examination and subsequent coaching with motivational interviewing up to 7 sessions within 6 months. Follow-up information was collected after 6 months. Characteristics associated with participation in coaching were assessed with logistic regression models. The effectiveness of coaching on body mass index (BMI), bodyweight, self-rated health, vigorous physical activity, smoking, alcohol intake, fruit- and vegetable consumption, work ability, and sickness absence was evaluated with linear regression models and on participation in health promotion activities with logistic regression analysis. The analyses on effectiveness were performed without and with propensity score adjustment. RESULTS Of the 838 invited workers, 313 workers participated in the Preventive Medical Examination and follow-up data were available for 176 workers, of whom 100 workers with increased cardiovascular risk attended coaching. The majority of workers with obesity (73%), overweight (60%), and unhealthy behaviours (58%-69%) at baseline participated in motivational interviewing. Males, workers with overweight or obesity, workers at the production company, workers with insufficient vigorous physical activity, and workers with a low educational level were most likely to participate in coaching. Coaching with motivational interviewing after the Preventive Medical Examination was associated with a 4.74 times higher likelihood [95% confidence interval (CI): 1.99;11.32] to participate in health promotion activities and 10.9% (95%CI: 0.6;21.3) more persons who quit smoking compared to workers without coaching. No statistically significant effects were observed on BMI, bodyweight, health, health behaviour, work ability and sickness absence. CONCLUSIONS The program combining a Preventive Medical Examination with follow-up coaching reached - as intended - workers with obesity or overweight, those with a low education and with unhealthy behaviours. Adding coaching with motivational interviewing to a Preventive Medical Examination contributed to higher participation in health promotion activities and an increase in smoking cessation after 6 months among workers with a lower socioeconomic position, but was not effective on other outcomes. TRIAL REGISTRATION The study was registered retrospectively in the Netherlands Trial Register as NL8178 on 22/11/2019.
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Affiliation(s)
- David van de Ven
- Department of Public Health, Erasmus University Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - Merel Schuring
- Department of Public Health, Erasmus University Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands.
| | | | - Philip Blom
- Health Centre Zwolle, Zwolle, the Netherlands
| | - Alex Burdorf
- Department of Public Health, Erasmus University Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - Suzan J W Robroek
- Department of Public Health, Erasmus University Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands
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