Adding effect sizes to a systematic review on interventions for promoting physical activity among European teenagers

Effectiveness of an intervention program to develop e-cigarette control leaders at the University in Lampang Province, Thailand

INTRODUCTION

The use of e-cigarettes is increasing worldwide, especially among young adults. Due to the health risks, this study aimed to assess undergraduate students' e-cigarette use and attitudes toward them, and evaluate the effectiveness of an intervention program to develop e-cigarette control leaders at the University in Lampang province, Thailand.

METHODS

Participatory action research (PAR) was conducted among 46 undergraduate students. To assess the situations of undergraduate students' e-cigarette use and attitudes toward them, in-depth interviews were conducted with 18 of those students - nine users and nine non-users. The remaining 28 were student leaders who were given questionnaires and took part in focus groups to evaluate the effectiveness of the intervention program in developing e-cigarette control leaders. Descriptive statistics and the Wilcoxon signed rank test were used to analyze quantitative data. The qualitative data were analyzed using a thematic analysis of the content. This study took place at the University in Lampang province, Thailand, in 2023.

RESULTS

Regarding the use of e-cigarettes on the part of undergraduate students and their attitudes about their use, the majority of users stated that e-cigarettes were accessible, appealing, and more socially acceptable than conventional cigarettes. However, most non-users cited vapor smell and health impacts as their main reason for not using e-cigarettes. The intervention program to develop leaders in e-cigarette control could significantly enhance the leaders' knowledge (p<0.001) and attitude regarding e-cigarettes (p=0.001). After their anti-e-cigarette campaign, the soft skills and managerial abilities of the leaders in e-cigarette control improved, and the knowledge and attitude regarding e-cigarettes of undergraduate students who attended the campaign also increased.

CONCLUSIONS

The intervention program to develop leaders in e-cigarette control resulted in positive outcomes. This program could enhance the leaders' knowledge and attitude regarding e-cigarettes. Their soft skills and managerial abilities in e-cigarette control also improved.

The impact of perceived school climate on exercise behavior engagement among obese adolescents: a dual mediation effect test of exercise benefits and perseverance qualities

Introduction

This study explores the relationship between perceived school climate and exercise behavior among obese adolescents, as well as the multiple mediating effects of perseverance qualities and exercise benefits.

Methods

A survey was conducted on 586 obese adolescents in Beijing, with an age range of 13-18 years old and an average age of 15.40 ± 1.824, among who 337 were male, 249 were female, 303 were high school students and 238 were middle school students. A standard scale was used to evaluate perceived school climate, exercise benefits, perseverance qualities, and exercise behaviors. The data was analyzed by independent samples t-test, bivariate correlation analysis, descriptive statistical analysis, and structural equation model (SEM).

Results

(1) Perceived school climate among obese adolescents positively predicted exercise behavior (Z = 2.870, p < 0.01), perseverance qualities (Z = 3.107, p < 0.01) and exercise benefits (Z = 4.290, p < 0.001); perseverance qualities positively predicted exercise behavior in obese adolescents (Z = 4.431, p < 0.001); exercise benefits positively predicted the obese adolescents' exercise behavior (Z = 4.267, p < 0.001). (2) Perseverance qualities (Z = 2.282, 95% CI [0.032, 0.191], [0.028, 0.179]) and exercise benefits (Z = 2.518, 95% CI [0.060, 0.287], [0.053, 0.271]) play a mediating role in the obese adolescents' perceived school climate and exercise behavior, respectively. These two factors have parallel multiple mediating effects between obese adolescents' perceived school climate and exercise behavior, with mediating effects accounting for 16 and 25%, respectively. The mediating effect of exercise benefits is greater than that of perseverance qualities. (3) There is no difference in the specific indirect effects of perseverance qualities and exercise benefits (Z = -0.800, 95% CI [- 0.198, 0.064], [-0.190, 0.068]).

Conclusion

Obese adolescents' perception of school climate can effectively enhance their motivation to participate in exercise behavior and indirectly influence exercise behavior through exercise benefits and perseverance qualities, cultivate good physical exercise behavior among obese adolescents, and effectively prevent and intervene in the occurrence of obesity.

Evaluation of career planning group counseling and its effectiveness for intern male nursing students

OBJECTIVE

To investigate the influence of group counselling on the career planning and career maturity of male nursing students.

METHOD

Sixty male nursing students were randomly selected from a specific-level first-class hospital in Hunan Province from July to August 2020 by using the convenience sampling method and were subsequently divided into the control group and the experimental group using the random number table method. The control group received routine pre-job training, including aspects concerning the hospital profile, nurse etiquette, nursing core systems, professional ethics, nursing emergency treatment and career prospects and planning. In the experimental group, career planning group counselling was added after the regular pre-service training (once a week) with each session lasting 2 h for a total of six training sessions. At six weeks and three months after the intervention, the career status evaluation scale and the college students' career maturity scale were used to compare the career planning and career maturity status of the two groups of male nursing students.

RESULTS

After six weeks and three months of intervention, all the dimensions and total scores of both the career status evaluation scale and the career maturity scale in the experimental group were superior to those in the control group with statistically significant differences (all P < 0.05). The repeated measures of variance analysis indicated that the differences in the total score for career planning and the four dimensions in terms of intergroup effect, time effect and interaction effect between the two groups were statistically significant (P < 0.05). The intergroup effect, time effect and interaction effect of the total score for vocational maturity, career goal, career confidence, career value, career freedom and career reference of the two groups were statistically significant (P < 0.05), while the time effect of the relative dependency dimension was also statistically significant (P < 0.05).

CONCLUSION

Group counselling can significantly improve the career planning and career maturity status of male nursing students and has a certain long-term effect.

Home- and Community-Based Interventions for Physical Activity and Early Child Development: A Systematic Review of Effective Strategies

This systematic review examined the effects of home/family and community-based interventions on physical activity (PA) and developmental outcomes in early childhood. A search strategy was employed using four electronic databases (Academic Search Complete, CINAHL Complete, MEDLINE, and SPORTDiscus). Interventions investigating weight status (i.e., BMI), physical activity, sedentary behavior, and/or motor proficiency that took place in home, family, or community settings were assessed. Studies were eligible if they were peer-reviewed, available in English, published between 2011 and 2021, and if samples consisted of healthy young children (2-5 years old). There were 24 studies retained (8351 participants) spanning from the United States (n = 12), Australia (n = 3), Canada (n = 2), Switzerland (n = 2), Finland (n = 2), Netherlands (n = 1), and other Eastern European countries (n = 2). There were 19 studies that incorporated home/family-based approaches and 14 studies that incorporated community-based approaches. Studies ranged in intervention duration from 6 weeks to 24 months. It suggests that improving PA participation in young children was especially challenging to solicit improvement (only 25% of all studies found significant improvement in PA after intervention). Distributing educational material to parents/families, consistent, direct contact with parents, and encouraging community engagement were identified as effective strategies to promote physical activity, healthy weight status, and motor skills in young children.

Depression, Is It Treatable in Adults Utilising Dietary Interventions? A Systematic Review of Randomised Controlled Trials

This systematic literature review examined whole food or whole diet interventions to treat depression. The inclusion criteria encompassed adults, depression, a recognized depression scale and a whole food or diet intervention. APA PsychINFO, CINAHL, the Cochrance Central Register of Controlled Trails, MEDLINE and Scopus were searched for original research addressing diet as a treatment for depression in adult populations. The quality of the study was assessed using the Academy of Nutrition and Dietetics Quality Criteria Checklist. Seven studies; with 49,156 participants; met the eligibility criteria. All these studies found positive outcomes with depression levels decreasing after dietary intervention. The calculated effect size varied from small (Cohen’s d = 0.32) to very large (Cohen’s d = 1.82). The inconsistent nature of the studies limited the synthesis of the data. Recommendations are provided to enhance future study design and measurement outcomes. Overall, the findings show a positive result for diets that promote an increased intake of fresh produce, wholegrains, low-fat dairy and lean protein sources, while also decreasing the intake of processed and high-fat foods. No funding was provided for this review. The protocol for this review is registered with PROSPERO (CRD42020210426).

The effects of long-term physical activity interventions in communities: Scoping review in the Nordic countries

Aims: Physical activity (PA) is an important part of maintaining good overall health. Currently, the number of insufficiently physically active adults and children is alarmingly high worldwide. To tackle the challenge, several interventions have been conducted, however, current knowledge on intervention effectiveness is still inconclusive. This scoping review aimed to summarize the effects of long-term PA interventions across all age groups in the Nordic countries. Methods: A scoping review was conducted by including all age groups and interventions lasting more than 12 months. The aims of the interventions had to focus on increasing PA and/or fitness. The Behaviour Change Wheel framework was used to describe components of the intervention functions. Results: Initially, 1937 studies were identified. Twelve intervention studies fulfilled the inclusion criteria and were included in the analysis. From the included studies, seven focused on children and/or their parents and five on working-age adult populations. Most of the studies built on theoretical backgrounds and included several behaviour change functions. A hindering factor for synthesis was variation in measurement methods: both subjective and objective outcome measures were reported. Among all age groups, intervention effects on PA were modest. Conclusions: There was no clear evidence of increased PA or fitness from long-term interventions in communities. However, even small improvements in PA are important for increasing PA at a population level and enhancing public health. More research is required for evidence-based community and public health planning.

The effectiveness of physical activity interventions in Asian children and adolescents: a systematic review

OBJECTIVE

The objective of this review is to investigate the effectiveness of interventions to promote physical activity (PA) among children and adolescents in Asian countries.

STUDY DESIGN

Systematic review.

METHODS

A systematic search of eight electronic databases was performed to retrieve articles published between January 1990 and August 2019, in English language, including any interventions to promote PA outcomes among children (aged 3-12 years) and adolescents (aged 13-18 years) in Asian countries.

RESULTS

Thirty studies met the eligibility criteria and were included. Most studies were school-based (70%, n = 21), and half were cluster randomized controlled trials (53%, n = 16). Twelve of 30 included studies were among children, 15 among adolescents, and three among both children and adolescents. Only four studies (13%) used device-based measures of PA. The duration of intervention ranged from one day to 60 months (median 4.5 months). Twenty-one studies were of moderate-to-high quality, of which 15 demonstrated significant increases in PA behavior or physical fitness. Evidence was found that school-based, short-term (up to six months) interventions with a single or multicomponent approach including PA sessions, physical education, health education, and/or educational materials may increase overall PA in Asian children and adolescents.

CONCLUSIONS

The present review provides some evidence supporting the effectiveness of interventions in promoting PA-related outcomes. However, the findings are inconsistent due to the low number of studies, low-methodological quality, and/or small sample size. Well-designed interventions are needed to inform strategies to enhance PA engagements among children and adolescents in Asia.

Blended Self-Management Interventions to Reduce Disease Burden in Patients With Chronic Obstructive Pulmonary Disease and Asthma: Systematic Review and Meta-analysis

Background

Chronic obstructive pulmonary disease (COPD) and asthma have a high prevalence and disease burden. Blended self-management interventions, which combine eHealth with face-to-face interventions, can help reduce the disease burden.

Objective

This systematic review and meta-analysis aims to examine the effectiveness of blended self-management interventions on health-related effectiveness and process outcomes for people with COPD or asthma.

Methods

PubMed, Web of Science, COCHRANE Library, Emcare, and Embase were searched in December 2018 and updated in November 2020. Study quality was assessed using the Cochrane risk of bias (ROB) 2 tool and the Grading of Recommendations, Assessment, Development, and Evaluation.

Results

A total of 15 COPD and 7 asthma randomized controlled trials were included in this study. The meta-analysis of COPD studies found that the blended intervention showed a small improvement in exercise capacity (standardized mean difference [SMD] 0.48; 95% CI 0.10-0.85) and a significant improvement in the quality of life (QoL; SMD 0.81; 95% CI 0.11-1.51). Blended intervention also reduced the admission rate (relative ratio [RR] 0.61; 95% CI 0.38-0.97). In the COPD systematic review, regarding the exacerbation frequency, both studies found that the intervention reduced exacerbation frequency (RR 0.38; 95% CI 0.26-0.56). A large effect was found on BMI (d=0.81; 95% CI 0.25-1.34); however, the effect was inconclusive because only 1 study was included. Regarding medication adherence, 2 of 3 studies found a moderate effect (d=0.73; 95% CI 0.50-0.96), and 1 study reported a mixed effect. Regarding self-management ability, 1 study reported a large effect (d=1.15; 95% CI 0.66-1.62), and no effect was reported in that study. No effect was found on other process outcomes. The meta-analysis of asthma studies found that blended intervention had a small improvement in lung function (SMD 0.40; 95% CI 0.18-0.62) and QoL (SMD 0.36; 95% CI 0.21-0.50) and a moderate improvement in asthma control (SMD 0.67; 95% CI 0.40-0.93). A large effect was found on BMI (d=1.42; 95% CI 0.28-2.42) and exercise capacity (d=1.50; 95% CI 0.35-2.50); however, 1 study was included per outcome. There was no effect on other outcomes. Furthermore, the majority of the 22 studies showed some concerns about the ROB, and the quality of evidence varied.

Conclusions

In patients with COPD, the blended self-management interventions had mixed effects on health-related outcomes, with the strongest evidence found for exercise capacity, QoL, and admission rate. Furthermore, the review suggested that the interventions resulted in small effects on lung function and QoL and a moderate effect on asthma control in patients with asthma. There is some evidence for the effectiveness of blended self-management interventions for patients with COPD and asthma; however, more research is needed.

Trial Registration

PROSPERO International Prospective Register of Systematic Reviews CRD42019119894; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=119894

Adventurous Play as a Mechanism for Reducing Risk for Childhood Anxiety: A Conceptual Model

In this conceptual article, we draw upon the literature regarding cognitive and behavioural factors that underpin childhood anxiety to outline how a range of these risk markers might be targeted through adventurous play. When children play in an adventurous way, climbing trees, riding their bikes fast downhill and jumping from rocks, they experience feelings of fear and excitement, thrill and adrenaline. We propose that the positive, thrilling and playful emotions associated with this type of child-led play facilitate exposure to fear-provoking situations and, in doing so, provide opportunities for children to learn about physiological arousal, uncertainty and coping. We hypothesise that these learning opportunities will, over time, reduce children's risk for elevated anxiety by increasing children's expectations and ability to cope with anxiety, decreasing intolerance of uncertainty and preventing catastrophic misinterpretations of physiological arousal. If our conceptual model is correct, then ensuring that children have the physical and psychological space required to play in an adventurous way may help to decrease their risk for elevated or clinical anxiety.

Clinical outcome measures to evaluate the effects of orthotic management post-stroke: a systematic review

PURPOSE

To identify, and classify, according to International Classification of Functioning, Disability and Health (ICF), clinically applicable outcome measures that have been used to evaluate lower limb orthotic management post-stroke and to investigate which outcome measures recorded the largest effect sizes.

MATERIALS AND METHODS

Electronic searches were performed in Pubmed, Cochrane, Web of Science, Cinahl, Scopus and Embase databases from inception to May 2020. Articles were included if they investigated clinical outcomes in people post-stroke who had received a lower-limb orthotic intervention.

RESULTS

88 articles underwent full-text review and 54 were included in the review, which was performed in accordance with the Preferred Reporting Items for Systematic Review (PRISMA) principles. 48 different outcome measures were identified; effect sizes were able to be calculated from 39 studies. The most frequently applied outcome measures were the 10-metre Walk Test and the timed-up-and-go test. Outcome measures that recorded large effect sizes in two or more studies were the 10-metre Walk Test, Functional Reach Test, and Physiological Cost Index. When coded according to the ICF, the most frequently represented codes were d450 (Walking) and d455 (moving around).

CONCLUSIONS

Results suggest that outcome measures related to mobility (ICF chapter d4) are most often applied to evaluate orthotic management post-stroke. Effect sizes appear to be greatest in outcome measures related to velocity, balance, and energy expenditure.IMPLICATIONS FOR REHABILITATIONThe 10-meter Walk Test appears to have the greatest effect size when evaluating orthotic management post-stroke.While outcome measures related to mobility are commonly applied when evaluating orthotic management post-stroke, rehabilitation professionals should consider complementing these with measures representing the participation domain of the ICF.

Changing activity behaviours in vocational school students: the stepwise development and optimised content of the 'let's move it' intervention

Background: School-based interventions that increase physical activity (PA) in a sustainable way are lacking. Systematic and participatory, theory and evidence-based intervention development may enhance the effectiveness of complex behavioural interventions in the long term. However, detailed descriptions of the intervention development process are rarely openly published, hindering transparency and progress in the field. Aims: To illustrate a stepwise process to develop intervention targeting PA and sedentary behaviour (SB) among older adolescents, and to describe the final, optimised version of the intervention, detailing content of sessions by theoretical determinants and techniques. Methods: Two established intervention development frameworks (Intervention Mapping and Behaviour Change Wheel) were integrated, leading to a comprehensive evidence and theory-based process. It was informed by empirical studies, literature reviews, expert and stakeholder consultation, including scenario evaluation and component pre-testing. In all steps, contextual fit and potential for sustainability were ensured by stakeholder engagement. Results: As a large majority of youth opposed decreasing screen time, increasing PA and decreasing SB were defined as target behaviours, with peers and the school context including classroom practices as key social environments in influencing youth PA (problem specification, step 1). Behavioural diagnosis (step 2) identified a variety of determinants in the domains of capability (e.g. self-regulation skills), motivation (e.g. outcome expectations) and environmental opportunities. These were organised into an intervention theory integrating several formal theories, including Self-Determination Theory. Theory-aligned principles guided material design (Step 3). Feasibility RCT allowed optimisation into a final intervention protocol (step 4). Conclusions: Intervention elements target students directly, and indirectly by changing teacher behaviour and the school and wider environment. A systematic development and optimisation led to a high potential for sustainability. The detailed intervention content, with specification of the hypothesised mechanisms, allows for other researchers to replicate, adapt or refine parts or the whole intervention, considering specific target groups and (sub-)cultures.

How Can Physical Activity Be Promoted Among Children and Adolescents? A Systematic Review of Reviews Across Settings

Introduction: A vast majority of children and adolescents are physically inactive. As a result, high obesity rates and related diseases have made physical activity promotion a politically relevant topic. In order to form the basis for political decision making, evidence is required regarding the efficacy and effectiveness of interventions for physical activity promotion. In contrast to previous research, this systematic review of reviews targets three key settings (family and home, childcare, school), and is among the largest to have been conducted. Methods: A systematic review of reviews was conducted as part of a large-scale project to develop national recommendations for physical activity promotion in Germany. Six electronic databases were searched and inclusion criteria were defined. Two independent reviewers screened the titles and abstracts of potentially relevant literature. 213 reviews were identified and categorised by target group. A total of 74 reviews were identified dealing with children and adolescents. Each review underwent a quality assessment. Results: 39 reviews with the highest quality and relevance were analysed. Three reviews focused on the family and home setting, 4 on the childcare setting, 28 on the school setting and 4 on other settings. Evidence revealed the key role played by parents in promoting physical activity in children within each setting. Furthermore, evidence pointed toward the efficacy of multi-component interventions in the childcare and school setting. Several evidence-based intervention strategies were identified for childcare facilities and schools. Discussion: The review of reviews identified a number of promising strategies for PA promotion among children and adolescents. Among reviews, multi-component interventions in childcare facilities and schools stand out prominently. At the same time, the review of reviews indicated that there is still a lack of studies on the efficacy of interventions that go beyond the individual level. We recommend that future research should also target community and policy level interventions and interventions other than the school setting. In order to make more specific recommendations regarding the scale-up of promising intervention strategies, further knowledge about the effectiveness, health equity and cost effectiveness of interventions is needed.

Building on a YMCA's health and physical activity promotion capacities: A case study of a researcher-organization partnership to optimize adolescent programming_

School-based physical activity programs are only effective for increasing adolescents' school-based physical activity. To increase out-of-school-time physical activity, complementary community programs are warranted. Partnerships between universities and community organizations may help build the capacity of these organizations to provide sustainable programs. To understand capacity building processes and outcomes, we partnered with a YMCA to build on their adolescent physical activity promotion capacity. Together, we designed and implemented means to evaluate the YMCA teen program to inform program planning. For this qualitative case study, emails and interviews and meetings transcripts were collected over 2.5 years and analyzed using inductive and deductive thematic analysis. Findings illustrate that the YMCA's workforce and organizational development capacities (e.g., evaluation and health promotion capacity and competence) were increased through our partnership, resource allocation, and leadership. We responded to YMCA partners' perceived needs, yet guided them beyond those needs, successfully combining our complementary objectives, knowledge, and skills to generate an integrated program vision, rationale, and evaluation results. This provided YMCA partners with validation, reminders, and awareness. In turn, this contributed to programming and evaluation practice changes. In light of extant capacity building literature, we discuss how our partnership increased the YMCA's capacity to promote healthy adolescent programs.

'Let's Move It' - a school-based multilevel intervention to increase physical activity and reduce sedentary behaviour among older adolescents in vocational secondary schools: a study protocol for a cluster-randomised trial

Background

Physical activity (PA) has been shown to decline during adolescence, and those with lower education have lower levels of activity already at this age, calling for targeted efforts for them. No previous study has demonstrated lasting effects of school-based PA interventions among older adolescents. Furthermore, these interventions have rarely targeted sedentary behaviour (SB) despite its relevance to health. The Let’s Move It trial aims to evaluate the effectiveness and the cost-effectiveness of a school-based, multi-level intervention, on PA and SB, among vocational school students. We hypothesise that the intervention is effective in increasing moderate-to-vigorous-intensity physical activity (MVPA), particularly among those with low or moderate baseline levels, and decreasing SB among all students.

Methods

The design is a cluster-randomised parallel group trial with an internal pilot study. The trial is conducted in six vocational schools in the Helsinki Metropolitan area, Finland. The intervention is carried out in 30 intervention classes, and 27 control classes retain the standard curriculum. The randomisation occurs at school-level to avoid contamination and to aid delivery.

Three of the six schools, randomly allocated, receive the ‘Let’s Move It’ intervention which consists of 1) group sessions and poster campaign targeting students’ autonomous PA motivation and self-regulation skills, 2) sitting reduction in classrooms via alterations in choice architecture and teacher behaviour, and 3) enhancement of PA opportunities in school, home and community environments. At baseline, student participants are blind to group allocation. The trial is carried out in six batches in 2015–2017, with main measurements at pre-intervention baseline, and 2-month and 14-month follow-ups. Primary outcomes are for PA, MVPA measured by accelerometry and self-report, and for SB, sedentary time and breaks in sedentary time (accelerometry).

Key secondary outcomes include measured body composition, self-reported well-being, and psychological variables. Process variables include measures of psychosocial determinants of PA (e.g. autonomous motivation) and use of behaviour change techniques. Process evaluation also includes qualitative interviews. Intervention fidelity is monitored.

Discussion

The study will establish whether the Let’s Move It intervention is effective in increasing PA and reducing SB in vocational school students, and identify key processes explaining the results.

Trial registration

ISRCTN10979479. Registered: 31.12.2015

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-016-3094-x) contains supplementary material, which is available to authorized users.

What do we know about how to promote physical activity to adolescents? A mapping review

To date, adolescent physical activity (PA) intervention research has focused on the school setting and suggests a need to extend interventions beyond this setting to influence teenagers' overall level of PA. But, the relative effectiveness of PA promotion strategies that can be part of such multi-setting interventions remains unknown. We completed a mapping review of PA intervention research that focused on increasing adolescents' level of PA to describe the sum of what has been learned in this area and to expose research and knowledge gaps. We searched data bases from 1993 to September 2014, included PA promotion intervention studies targeting 12- to 17-year-old youth and assessing changes in their level of PA, and used ecological and capacity building frameworks to review this research. The 46 included studies suggest that little is known about strategies targeting the interpersonal, organizational, community or policy levels of teenagers' PA behavior influences; our current knowledge remains concentrated in the intrapersonal domain and the school setting. We suggest avenues for researchers as well as practitioners who design and implement adolescent PA programs such that we further develop our research and practice knowledge base and develop programs to positively impact adolescents' PA behavior.

Empowering adolescents to be physically active: three-year results of the Sigue la Huella intervention

OBJECTIVE

To examine the effects of a school-based intervention called Sigue la Huella (Follow the Footstep) on adolescents' daily moderate-to-vigorous physical activity (MVPA).

METHOD

This quasi-experimental, cohort study took place in four secondary schools in Huesca (Spain) during the 2009-2010, 2010-2011, and 2011-2012 academic years (students aged 12-15 years). Two schools were assigned to the experimental condition (n=368) and two schools to the control condition (n=314). Sigue la Huella was based on the social ecological model and self-determination theory. MVPA was measured for 7 days on 4 occasions using accelerometers. Data were analyzed with individual growth curve models.

RESULTS

There was a significant difference in linear growth rate of daily MVPA between the experimental and the control group, independent of study wave, type of school (public vs. private), grade level and gender (p<0.001). Specifically, MVPA increased in the experimental group (β=7.02, 95% confidence interval (CI)=1.27 to 12.78, p=0.017) and tended to decrease in the control group (β=-5.26, 95% CI=-11.17 to 0.65, p<0.081). The observed increase was larger in boys than in girls (p=0.003).

CONCLUSIONS

Sigue la Huella had a positive effect on adolescents' daily MVPA over three school years. Both genders benefited from the intervention, although boys to a greater extent.

Can interest and enjoyment help to increase use of Internet-delivered interventions?

OBJECTIVE

Internet-delivered interventions have proven efficacious in changing people's behaviours and related determinants, but the actual use of these interventions by the target group is often very low. This article investigates whether arousing interest and enjoyment results in increased intervention use in an online context.

DESIGN

Invitations to visit a website about Hepatitis A, B and C virus infections (Studies 1 and 3) and the website itself (Studies 2 and 3) were manipulated to arouse interest and enjoyment.

MAIN OUTCOME MEASURES

Intention to visit the website (Study 1), clicking on the link to visit the website (Studies 2 and 3) and the number of pages visited on the website (Study 3).

RESULTS

Arousing interest through an invitation resulted in a higher intention to visit the website (Study 1) and a higher likelihood of clicking on the link to visit the website in comparison with arousing enjoyment (Study 2). The number of pages visited increased when interest was aroused on the website itself (Study 3).

CONCLUSION

Arousing interest is a promising strategy to increase use of Internet-delivered interventions and potentially increase the public health impact of these interventions.

Effectiveness of YouRAction, an intervention to promote adolescent physical activity using personal and environmental feedback: a cluster RCT

BACKGROUND

In this study the one and six months effects of the computer-tailored YouRAction (targeting individual level determinants) and YouRAction+e (targeting in addition perceived environmental determinants) on compliance with the moderate-to-vigorous physical activity (MVPA) guideline and weight status are examined. In addition the use and appreciation of both interventions are studied.

METHODS

A three-armed cluster randomized trial was conducted in 2009-2010 with measurements at baseline, one and six months post intervention. School classes were assigned to one of the study arms (YouRaction, YouRAction+e and Generic Information (GI) control group). MVPA was derived from self-reports at baseline, one and six months post intervention. Body Mass Index and waist circumference were measured at baseline and six months post intervention in a random sub-sample of the population. Use of the interventions was measured by webserver logs and appreciation by self-reports. Multilevel regression analyses were conducted to study the effects of the intervention against the GI control group. ANOVA's and chi-square tests were used to describe differences in use and appreciation between study arms.

RESULTS

There were no statistically significant intervention effects on compliance with the MVPA guideline, overweight or WC. Access to the full intervention was significantly lower for YouRAction (24.0%) and YouRAction+e (21.7%) compared to the GI (54.4%).

CONCLUSION

This study could not demonstrate that the YouRAction and YouRAction+e interventions were effective in promoting MVPA or improve anthropometric outcomes among adolescents, compared to generic information. Insufficient use and exposure to the intervention content may be an explanation for the lack of effects.

TRIAL REGISTRATION

TrialRegister.nl NTR1923.

Bringing loyalty to e-Health: theory validation using three internet-delivered interventions

Background

Internet-delivered interventions can effectively change health risk behaviors, but the actual use of these interventions by the target group once they access the website is often very low (high attrition, low adherence). Therefore, it is relevant and necessary to focus on factors related to use of an intervention once people arrive at the intervention website. We focused on user perceptions resulting in e-loyalty (ie, intention to visit an intervention again and to recommend it to others). A background theory for e-loyalty, however, is still lacking for Internet-delivered interventions.

Objective

The objective of our study was to propose and validate a conceptual model regarding user perceptions and e-loyalty within the field of eHealth.

Methods

We presented at random 3 primary prevention interventions aimed at the general public and, subsequently, participants completed validated measures regarding user perceptions and e-loyalty. Time on each intervention website was assessed by means of server registrations.

Results

Of the 592 people who were invited to participate, 397 initiated the study (response rate: 67%) and 351 (48% female, mean age 43 years, varying in educational level) finished the study (retention rate: 88%). Internal consistency of all measures was high (Cronbach alpha > .87). The findings demonstrate that the user perceptions regarding effectiveness (beta_range .21–.41) and enjoyment (beta_range .14–.24) both had a positive effect on e-loyalty, which was mediated by active trust (beta_range .27–.60). User perceptions and e-loyalty had low correlations with time on the website (r_range .04–.18).

Conclusions

The consistent pattern of findings speaks in favor of their robustness and contributes to theory validation regarding e-loyalty. The importance of a theory-driven solution to a practice-based problem (ie, low actual use) needs to be stressed in view of the importance of the Internet in terms of intervention development. Longitudinal studies are needed to investigate whether people will actually revisit intervention websites and whether this leads to changes in health risk behaviors.

Effect of school-based interventions on physical activity and fitness in children and adolescents: a review of reviews and systematic update

BACKGROUND

School-based interventions are thought to be the most universally applicable and effective way to counteract low physical activity (PA) and fitness although there is controversy about the optimal strategy to intervene.

OBJECTIVES

The objective of this review was to summarise recent reviews that aimed to increase PA or fitness in youth and carry out a systematic review of new intervention studies.

METHODS

Relevant systematic reviews and original controlled and randomised controlled school-based trials with a PA or fitness outcome measure, a duration of ≥12 weeks, a sufficient quality and involvement of a healthy population aged 6-18 years that were published from 2007 to 2010 were included. Results In these reviews, 47-65% of trials were found to be effective. The effect was mostly seen in school-related PA while effects outside school were often not observed or assessed.

CONCLUSIONS

The school-based application of multicomponent intervention strategies was the most consistent, promising strategy, while controversy existed regarding the effectiveness of family involvement, focus on healthy populations at increased risk or duration and intensity of the intervention. All 20 trials in the review update showed a positive effect on in-school, out-of-school or overall PA, and 6 of 11 studies showed an increase in fitness. Taking into consideration both assessment quality and public health relevance, multicomponent approaches in children including family components showed the highest level of evidence for increasing overall PA. This review confirms the public health potential of high quality, school-based PA interventions for increasing PA and possibly fitness in healthy youth.

Characteristics of effective Internet-mediated interventions to change lifestyle in people aged 50 and older: a systematic review

Worldwide, the number of people aged 60 years and older steadily grows to a predicted 2 billion in 2050. Online interventions increasingly target lifestyle risk factors to promote healthy aging. The objective of this systematic review is to evaluate whether Internet mediated lifestyle interventions can successfully change lifestyle in people aged 50 and older. A PubMed search was conducted resulting in twelve articles, based on ten studies. The studies focused on physical activity, weight loss, nutrition, and diabetes. Nine studies used feasible interventions, with an average small to moderate effect size. The most important result is that there are multiple studies reporting positive lifestyle changes in an older population. On average, complex interventions, whether they present tailored or generic information, and online or offline comparison, are more effective than interventions with only one component. Internet mediated interventions hold great potential in implementing effective lifestyle programs, capable of reaching large populations of older persons at very low costs.

Does social desirability compromise self-reports of physical activity in web-based research?

Background

This study investigated the relation between social desirability and self-reported physical activity in web-based research.

Findings

A longitudinal study (N = 5,495, 54% women) was conducted on a representative sample of the Dutch population using the Marlowe-Crowne Scale as social desirability measure and the short form of the International Physical Activity Questionnaire. Social desirability was not associated with self-reported physical activity (in MET-minutes/week), nor with its sub-behaviors (i.e., walking, moderate-intensity activity, vigorous-intensity activity, and sedentary behavior). Socio-demographics (i.e., age, sex, income, and education) did not moderate the effect of social desirability on self-reported physical activity and its sub-behaviors.

Conclusions

This study does not throw doubt on the usefulness of the Internet as a medium to collect self-reports on physical activity.