Measurement properties of the German version of the Physical Activity Enjoyment Scale for adults

Implementation and dissemination of physical activity-related health competence in vocational nursing training: study protocol for a cluster-randomized controlled intervention trial

BACKGROUND

Although the nursing sector gains growing importance in an aging society, students representing the future workforce often show insufficient health. Acknowledging the health-enhancing effects of adequate physical activity, the educational system in Bavaria, Germany, has recently integrated the promotion of physical activity-related health competence (PAHCO) into the nursing curriculum. However, it cannot be assumed that PAHCO has sufficiently permeated the educational practices and routines of the nursing schools. Therefore, the goal of the present study is to examine and compare the effectiveness as well as implementation of different intervention approaches to address PAHCO in the Bavarian nursing school system.

METHODS

We randomly assign 16 nursing schools (cluster-based) to four study arms (bottom-up, top-down led by teachers, top down led by external physical activity experts, control group). Schools in intervention group 1 (IG-1) develop multicomponent inventions to target PAHCO via cooperative planning (preparation, planning, and implementation phase). Intervention groups 2 and 3 (IG-2, IG-3) receive both an expert-based intervention (developed through intervention mapping) via trained mediators to address PAHCO. External physical activity experts deliver the structured PAHCO intervention in IG-2, while teachers from the nursing schools themselves conduct the PAHCO intervention in IG-3. In line with a hybrid effectiveness implementation trial, we apply questionnaire-based pre-post measurements across all conditions (sample size calculation: nfinal = 636) to examine the effectiveness of the intervention approaches and, simultaneously, draw on questionnaires, interview, and protocol data to examine their implementation. We analyze quantitative effectiveness data via linear models (times-group interaction), and implementation data using descriptive distributions and content analyses.

CONCLUSION

The study enables evidence-based decisions about the suitability of three intervention approaches to promote competencies for healthy, physically active lifestyles among nursing students. The findings inform dissemination activities to effectively reach all 185 schools of the Bavarian nursing system.

TRIAL REGISTRATION

Clinical trials NCT05817396. Registered on April 18, 2023.

KIJANI App to Promote Physical Activity in Children and Adolescents: Protocol for a Mixed Method Evaluation

BACKGROUND

The prevalence of physical inactivity among children and adolescents is alarmingly high despite the well-documented and comprehensive benefits of regular physical activity (PA). Therefore, PA promotion should start early in childhood and adolescence. Although reducing recreational screen time in children and adolescents is an urgent concern, digital approaches have the potential to make activity promotion attractive and age appropriate for the target group. KIJANI is a mobile app approach to promote PA in children and adolescents via gamification and augmented reality.

OBJECTIVE

This study protocol aims to describe the KIJANI intervention in detail, as well as the evaluation approach.

METHODS

KIJANI is based on the concept that virtual coins can be earned through PA, for example, in the form of a collected step count. With these coins, in turn, blocks can be bought, which can be used to create virtual buildings and integrate them into the player's real-world environment via augmented reality. PA of users is detected via accelerometers integrated into the smartphones. KIJANI can be played at predefined play locations that were comprehensively identified as safe, child-friendly, and attractive for PA by the target group in a partner project. The evaluation process will be divided into 2 different stages. The phase-I evaluation will be a mixed methods approach with one-on-one semistructured interviews and questionnaires to evaluate the user experience and receive feedback from the target group. After the implementation of results and feedback from the target group, the phase-II evaluation will proceed in the form of a 2-arm randomized controlled trial, in which the effectiveness of KIJANI will be assessed via objectively measured PA as well as questionnaires.

RESULTS

The study received ethical approval from the ethical board of the Technical University of Munich. Participants for the phase-I evaluation are currently being recruited.

CONCLUSIONS

The study will help to determine the efficacy, applicability, and user experience of a gamified activity promotion application in children and adolescents. Overall, digital health approaches provide easy and wide reachability at low cost and are age appropriate and attractive for the target group of adolescents. Strategies have to be developed to apply digital health approaches in the best possible way for activity promotion.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/55156.

Evaluation of the gamified application KIJANI to promote physical activity in children and adolescents: A multimethod study

Objective

Digital approaches have the potential to make activity promotion attractive and age-appropriate for children and adolescents. KIJANI is a mobile application aiming to increase physical activity (PA) in youth via gamification and augmented reality. This study investigates the user experience with KIJANI through a multimethod approach.

Approaches

KIJANI is based on the concept that virtual coins can be earned through PA, for example, in the form of collected step counts. With these coins, blocks can be bought, which can be used to create virtual buildings and landscapes and integrate these into the player's real-world environment via augmented reality. To evaluate the user experience, participants played KIJANI in groups of three for 25 min. Afterwards KIJANI was evaluated qualitatively with one-on-one semi-structured interviews as well as quantitatively with standardized questionnaires.

Results

Overall, 22 participants (12.6 ± 1.7 years, 6 girls) were included in the study. The overall game concept and realization were well received by the target group. Study participants did have various and creative ideas for the further development of KIJANI. The majority (n = 16) thought that using KIJANI would increase their PA level. User experience based on the UEQ scale was (mean ± SD): attractiveness (1.78 ± 1.82), perspicuity (2.15 ± 0.680), efficiency (0.67 ± 1.25), dependability, (1.21 ± 0.93), stimulation (1.24 ± 1.78), and novelty (1.27 ± 1.34).

Conclusion

With these insights, a further step has been taken in the participatory development of KIJANI. Apps like KIJANI appear to be suitable for PA promotion in children and adolescents.

Sport in prison: social and subjective health outcomes of different sport programs

PURPOSE

The purpose of this study is to examine the effects of four different sport programs on various social and subjective health outcomes among prisoners.

DESIGN/METHODOLOGY/APPROACH

Four different sport programs (endurance, strength, dance-like martial arts, soccer) were provided in 2020 and 2021 in a German prison. Participants completed paper-pencil surveys before and after the sport programs (n = 134 observations), including questions about potential social health (enjoyment of physical activity, interpersonal exchange, interpersonal trust, self-efficacy) and subjective health outcomes (health status, health satisfaction, well-being). Further information such as prisoner characteristics were added to the data.

FINDINGS

Results of regression analyses show that the endurance program had a significant positive effect on interpersonal trust, while the soccer program had a negative effect. Subjective well-being increased significantly after the strength and the soccer program. The weekly sport hours before imprisonment had a positive association with enjoyment of physical activity and interpersonal exchange while being negatively related to health status and health satisfaction. Furthermore, the number of months of imprisonment before the survey, being a young offender, the prisoners' body mass index, educational level and migration background were significantly associated with several social and subjective health outcomes.

ORIGINALITY/VALUE

This study analyzed the effects of different sport programs for prisoners on various social and subjective health outcomes, revealing differences across programs and outcomes. The findings suggest that sport can be a way to enhance prisoners' social and subjective health, ultimately facilitating their rehabilitation process.

Development and initial validation of the German version of the Exergame Enjoyment Questionnaire (EEQ-G)

BACKGROUND

Analyzing and adjusting training programs to increase exercise enjoyment is crucial to achieve long-term adherence and thus also maximize health benefits. The Exergame Enjoyment Questionnaire (EEQ) is the first questionnaire specifically developed to monitor exergame enjoyment. To be used in German speaking countries, the EEQ must be translated, cross-culturally adapted, and tested on its psychometric properties.

OBJECTIVES

The aim of this study was to develop (i.e., translate and cross-culturally adapt) the German Version of the EEQ (EEQ-G) and investigate its psychometric properties.

METHODS

Psychometric properties of the EEQ-G were tested using a cross-sectional study design. Each participant performed two consecutive exergame sessions (i.e., 'preferred' and 'unpreferred' condition) in randomized order and rated the EEQ-G as well as reference questionnaires. Internal consistency of the EEQ-G was assessed by calculating Cronbach's α. Construct validity was assessed by calculating Spearman's rank correlation coefficients (rs) between the scores of the EEQ-G and reference questionnaires. Responsiveness was analyzed by performing a Wilcoxon signed-rank test between the median EEQ-G scores of the two conditions.

RESULTS

Fourty-three healthy older adults (HOA; mean age = 69.4 ± 4.9 years; 53.5% females) were included. Cronbach's α of the EEQ-G was 0.80. The rs values between the EEQ-G and reference questionnaire scores for intrinsic motivation, game enjoyment, physical activity enjoyment, and external motivation were 0.198 (p = 0.101), 0.684 (p < 0.001), 0.277 (p = 0.036), and 0.186 (p = 0.233), respectively. The EEQ-G was rated higher in the 'preferred' than the 'unpreferred' condition (p < 0.001, r = 0.756).

CONCLUSION

The EEQ-G has high internal consistency and is responsive to changes in exergame enjoyment. The highly skewed data with ceiling effects in some of the reference questionnaires deem the construct validity of the EEQ-G to be inconclusive and thus in need of further evaluation.

A Study on the Psychometric Properties of the Short Version of the Physical Activity Enjoyment Scale in an Adult Population

A new measure of the short form of the Physical Activity Enjoyment Scale (PACES-S), including four items, has been developed that focuses on the subjective experience of enjoyment. As validation has so far only been conducted in a youth population, the purpose of the present article was to test the psychometric properties of the measure in an adult population in three studies. In the first study (n = 1017) the results supported the unidimensional structure of the instrument (χ² = 10.0; df = 2; p < 0.01; CFI = 0.992; RMSEA = 0.063), revealed a satisfactory level of internal consistency (ω = 0.79), and showed that the measure is invariant across gender. The results on factorial validity and internal consistency were generally supported by the second study (n = 482), which additionally showed satisfactory test-retest reliability (r = 0.73). Finally, the third study (n = 1336) also supported the factorial validity and internal consistency of the measure and additionally showed a positive correlation with physical activity (r = 0.40), thus supporting the criterion-related validity of the measure. This more economical version of PACES seems to be particularly useful for large-scale studies.

A Short Version of the Physical Activity Enjoyment Scale: Development and Psychometric Properties

Objective: The purposes of this paper were to (a) develop a new short, theory-driven, version of the physical activity enjoyment scale (PACES-S) using content analysis; and (b) subsequently to measure the psychometric properties (construct validity, internal consistency, test–retest reliability, and concurrent validity) of the PACES-S for adolescents. Methods: Six experts used a four-point Likert scale to assess the content validity of each of the 16 items of the physical activity enjoyment scale according to a provided definition of physical activity enjoyment. Based on the results, exploratory factor analysis was used to analyze survey data from a longitudinal study of 182 individuals (Measure 1 of Study 1: 15.75 ± 3.39 yrs; 56.6% boys, 43.4% girls), and confirmatory factor analysis (Measure 2 of Study 1: 15.69 ± 3.44 yrs; 56.3% boys, 43.7% girls) was used to analyze the survey data from a cross-sectional study of 3219 individuals (Study 2; 15.99 ± 3.10 yrs; 47.8% boys, 52.2% girls) to assess the construct validity of the new measure. To assess the reliability, test–retest reliability was assessed in Study 1 and internal consistency in Study 1 and 2. For the concurrent validity, correlations with self-reported and device-based physical activity behavior were assessed in both studies. Results: Four out of sixteen items were selected for PACES-S. Exploratory factor analysis and confirmatory factor analyses identified and supported its factorial validity (χ² = 53.62, df = 2, p < 0.001; RMSEA = 0.073; CFI = 0.99; RFI = 0.96; NFI = 0.99; TLI = 0.96; IFI = 0.99). Results showed good test–retest reliability (r = 0.76) and internal consistency (a = 0.82 to 0.88). Regarding concurrent validity, the results showed positive correlations with a physical activity questionnaire (Study 1: r = 0.36), with a physical activity diary (Study 1: r = 0.44), and with accelerometer-recorded data (Study 1: r = 0.32; Study 2: r = 0.21). Conclusions: The results indicate that PACES-S is a reliable and valid instrument that may be particularly useful to measure physical activity enjoyment in large-scale studies. It shows comparable measurement properties as the long version of PACES.

Effectivity of a mHealth intervention for individuals with obesity: a study protocol for a controlled intervention study

BACKGROUND

Obesity is considered an epidemic problem with an increasing number of individuals affected. The physical and psychological complaints associated with obesity point to the importance of implementing effective interventions. Innovative mHealth applications appear to be promising in helping provide a continuous and flexible support during the intervention. Since research on mHealth interventions is still relatively sparse, the main goal of the current study is to assess the effectiveness of an mHealth obesity intervention in terms of weight reduction, health behaviours as well as health-related quality of life. In addition, the study aims to investigate various psychological explicit and implicit processes associated with physical activity behaviour.

METHODS

The study includes quantitative and qualitative methods. Regarding the quantitative methods, the goal is to recruit up to 450 individuals at baseline in different obesity centres across Germany with some of these centres offering an mHealth intervention. All individuals who agree to take part in the mHealth intervention will be assigned to the intervention group, while all other individuals will be assigned to the control group. The mHealth obesity intervention consists of three stays at an obesity centre, with approximately six months between stays during which patients are supported by the digital platform CASPAR. The study includes three measurements with a baseline measurement and two follow-up measurements, one after six months and one after twelve months. To assess the effectiveness of the intervention, body weight, physical activity behaviour, eating behaviour as well as health related quality of life will be assessed. In addition, motivation, intentions, self-efficacy, enjoyment, and habit will be used to assess the psychological processes related with physical activity behaviour. A multivariate analysis of variance with repeated measurement and latent growth curve models will be used to compare the development of the variables within the two groups. In relation to the qualitative methods, interviews with individuals of the intervention group will be conducted to shed light on the applicability, acceptance, and usability of the mHealth intervention.

DISCUSSION

This study may provide a valuable insight into the potential of mHealth obesity interventions and the psychological processes related to physical activity behaviour. Trial registration The trial has been registered with the German Register of Clinical Studies (DRKS) on June 30, 2021 under the registration number: DRKS00024836.