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Hua J, Li T, Liu S, Zhang D, Chen X, Cai W, Chen L. Self-efficacy with Pelvic floor muscle training mediates the effect of an App-based intervention on improving postpartum urinary incontinence severity among pregnant women: A causal mediation analysis from a randomised controlled trial. Midwifery 2024; 135:104052. [PMID: 38875972 DOI: 10.1016/j.midw.2024.104052] [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: 11/18/2023] [Revised: 05/23/2024] [Accepted: 06/05/2024] [Indexed: 06/16/2024]
Abstract
BACKGROUND A pragmatic randomised controlled trial has confirmed the effectiveness of Urinary Incontinence for Women (UIW) app-based intervention in improving postpartum urinary incontinence (UI) severity among pregnant women. However, the causal mechanisms underlying this intervention effect remain unclear. OBJECTIVE To examine the mediating role of self-efficacy with pelvic floor muscle training (PFMT) on the effect of the UIW app-based intervention in improving postpartum UI severity. METHODS This was a secondary causal mediation analysis of a single-center, 2-arm, unblinded pragmatic randomised controlled trial. Singleton pregnant women without UI before pregnancy aged ≥18 years and between 24 and 28 weeks of gestation were recruited from a tertiary public hospital in China and randomised to receive the UIW app intervention plus oral PFMT instructions (n = 63) or oral PFMT instructions alone (n = 63). The primary outcome was postpartum changes in UI severity at 6 weeks. Changes in self-efficacy with PFMT 2 months after randomisation were a hypothesised mediator. Causal mediation analysis was used to estimate the average causal mediation effect (ACME), average direct effect (ADE), average total effect (ATE), and proportion mediated. A sensitivity analysis was conducted to examine the robustness of the ACME in relation to potential unmeasured confounding. RESULTS Data from 103 participants were analyzed. The ATE of UIW app-based intervention on postpartum UI severity was 2.91 points (95 % confidence intervals [CI] 1.69 to 4.12), with ADE of 1.97 points (95 % CI 0.63 to 3.41) and the ACME 0.94 points (95 % CI 0.27 to 1.72). The proportion of ATE mediated by self-efficacy with PFMT was 0.32 (95 % CI 0.08 to 0.67). Sensitivity analysis revealed the robust ACME with respect to the potential effects of unmeasured confounding. CONCLUSION An increase in self-efficacy with PFMT partially mediated the effect of the UIW app intervention on improvements in postpartum UI severity. TRIAL REGISTRATION The original trial was prospectively registered in the Chinese Clinical Trial Registry under the reference number ChiCTR1800016171 on 16/05/2018. Further details can be accessed at: http://www.chictr.org.cn/showproj.aspx?proj=27455.
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Affiliation(s)
- Jie Hua
- Department of Nursing, Shenzhen Hospital, Southern Medical University, Shenzhen, PR China; School of Nursing, Southern Medical University, Guangzhou, PR China
| | - Tiantian Li
- Department of Nursing, Shenzhen Hospital, Southern Medical University, Shenzhen, PR China
| | - Sha Liu
- Department of Nursing, Shenzhen Hospital, Southern Medical University, Shenzhen, PR China
| | - Danli Zhang
- Department of Nursing, Shenzhen Hospital, Southern Medical University, Shenzhen, PR China
| | - Xiaomin Chen
- Department of Nursing, Obstetrics & Gynecology Hospital of Fudan University, Shanghai, PR China
| | - Wenzhi Cai
- Department of Nursing, Shenzhen Hospital, Southern Medical University, Shenzhen, PR China; School of Nursing, Southern Medical University, Guangzhou, PR China.
| | - Ling Chen
- Department of Nursing, Shenzhen Hospital, Southern Medical University, Shenzhen, PR China; School of Nursing, Southern Medical University, Guangzhou, PR China.
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He Y, Zhou L, Liang W, Liu Q, Liu W, Wang S. Individual, family, and environmental correlates of fundamental motor skills among school-aged children: a cross-sectional study in China. BMC Public Health 2024; 24:208. [PMID: 38233777 PMCID: PMC10795326 DOI: 10.1186/s12889-024-17728-2] [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: 08/03/2023] [Accepted: 01/10/2024] [Indexed: 01/19/2024] Open
Abstract
OBJECTIVE This cross-sectional study examined the socio-ecological factors influencing fundamental motor skills (FMS) in Chinese school-aged children. METHODS A total of 1012 parent-child pairs were randomly sampled between March-1st and April-15th, 2022. Based on the socio-ecological model of Children's FMS, three levels of factors: individual-level (e.g., demographic, physical, psychological, and behavioral characteristics of children), family-level (e.g., caregiver demographics, parental support, and socioeconomic status), and environmental factors (e.g., availability of physical activity equipment) were assessed using self-reported scales (e.g., the Self-perception Profile for Children, the Physical Activity Enjoyment Scale, and the 12-item Psychological Well-Being Scale for Children) and objective measures (e.g., ActiGraph GT3X, the Chinese National Student Physical Fitness Standard, and the Test of Gross Motor Development-Third Edition). Multi-level regression models were employed using SPSS. RESULTS The results demonstrated that children's age, sex, physical fitness, parental support, and the quality of home and community physical activity environments consistently influenced all three types of FMS, including locomotor, ball, and composite skills. Additionally, seven individual-level factors (children's age, sex, body mass index, light physical activity, sleep duration, perceived motor competence, and physical fitness) were associated with different types of FMS. CONCLUSIONS The findings underscore the multidimensional and complex nature of FMS development, with individual-level factors playing a particularly significant role. Future research should adopt rigorous longitudinal designs, comprehensive assessment tools covering various FMS skills, and objective measurement of parents' movement behaviors to better understand the strength and direction of the relationship between socio-ecological factors and children's FMS.
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Affiliation(s)
- Yuxiu He
- School of Physical Education, Hebei Normal University, Shijiazhuang, China.
- Key Laboratory of Measurement and Evaluation in Exercise Bioinformation of Hebei Province, Shijiazhuang, China.
| | - Lin Zhou
- School of Physical Education, Hebei Normal University, Shijiazhuang, China.
- Key Laboratory of Measurement and Evaluation in Exercise Bioinformation of Hebei Province, Shijiazhuang, China.
| | - Wei Liang
- College of Physical Education, Shenzhen University, Shenzhen, China
| | - Qi Liu
- School of Physical Education, Hebei Normal University, Shijiazhuang, China
| | - Wanxin Liu
- School of Physical Education, Hebei Normal University, Shijiazhuang, China
| | - Shijian Wang
- Key Laboratory of Measurement and Evaluation in Exercise Bioinformation of Hebei Province, Shijiazhuang, China
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Xie QW, Fan XL, Luo X, Chen J. Associations of Lifestyle Patterns With Overweight and Depressive Symptoms Among United States Emerging Adults With Different Employment Statuses. Int J Public Health 2023; 68:1606451. [PMID: 38058458 PMCID: PMC10696088 DOI: 10.3389/ijph.2023.1606451] [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: 07/31/2023] [Accepted: 10/29/2023] [Indexed: 12/08/2023] Open
Abstract
Objective: To identify lifestyle patterns in emerging adults and examine the association of lifestyle patterns with overweight and depression. Methods: Data was from the National Health and Nutrition Examination Survey between 2011 and 2018. A latent class analysis (LCA) was conducted with 2,268 US emerging adults based on sedentary behavior, moderate-to-vigorous physical activity, diet, sleep, alcohol drinking, and cigarette smoking. The associations of lifestyle groups with overweight and depression were examined by logistic regression and were further stratified by employment status. Results: The LCA results favored a four-class solution: "unhealthy but non-substance use" (59%), "healthy but sleepless and drinking" (12%), "unhealthy lifestyle" (15%), and "healthy but sedentary" group (14%). Compared to the "unhealthy lifestyle" group, participants in the "unhealthy but non-substance use" (coef. = -1.44, SE = 0.27; OR = 0.40, 95% CI [0.26, 0.61]), "healthy but sleepless and drinking" (coef. = -1.49, SE = 0.35; OR = 0.38, 95% CI [0.20, 0.72]), and "healthy but sedentary" (coef. = -1.97, SE = 0.34; OR = 0.29, 95% CI [0.14, 0.57]) groups had lower depression severity and reported fewer depressive symptoms. Moreover, lifestyle groups and health outcomes showed different relationships among employed and unemployed participants. Conclusion: This study found that the combinations of lifestyle behaviors had synergistic effects on mental health, and such effects differed by employment status.
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Affiliation(s)
- Qian-Wen Xie
- Department of Social Welfare and Risk Management, School of Public Affairs, Zhejiang University, Hangzhou, China
- Research Center for Common Prosperity, Future Regional Development Laboratory, Innovation Center of Yangtze River Delta, Zhejiang University, Jiaxing, China
- Center of Social Welfare and Governance, Zhejiang University, Hangzhou, China
| | - Xu Li Fan
- Department of Social Welfare and Risk Management, School of Public Affairs, Zhejiang University, Hangzhou, China
| | - Xiangyan Luo
- Department of Social Welfare and Risk Management, School of Public Affairs, Zhejiang University, Hangzhou, China
| | - Jieling Chen
- School of Nursing, Sun Yat-sen University, Guangzhou, China
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Wang S, Liang W, Song H, Su N, Zhou L, Duan Y, Rhodes RE, Liu H, Yang YD, Lau WCP, Baker JS. Prospective association between 24-hour movement behaviors and mental health among overweight/obese college students: a compositional data analysis approach. Front Public Health 2023; 11:1203840. [PMID: 37854249 PMCID: PMC10579788 DOI: 10.3389/fpubh.2023.1203840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 09/14/2023] [Indexed: 10/20/2023] Open
Abstract
Background 24-h movement behaviors, including light physical activity (LPA), moderate-to-vigorous physical activity (MVPA), screen-based sedentary behavior (SSB), non-screen-based sedentary behavior (NSB) and sleep are crucial components affecting mental health. This study aimed to examine the associations of movement behaviors with mental health outcomes among overweight/obese college students using a compositional data analysis approach. Methods Using a prospective design, 437 Chinese college students (20.1 ± 1.7 years, 51.7% female) completed a two-wave online data collection, where demographics and movement behaviors (LPA, MVPA, SSB, NSB, sleep) were collected at baseline, while depression, anxiety and stress were measured at the 2-month follow-up (Apr-Jul 2022). Compositional data analyses were implemented using R. Results Depression, anxiety, and stress were negatively associated with time spent in MVPA and sleep (p < 0.001) and positively associated with time spent in SSB and NSB (p < 0.001). Reallocating 15 min to MVPA from LPA, SSB and NSB predicted improvements in depression (LPA: -0.234 unit; SSB: -0.375 unit; NSB: -0.249 unit), anxiety (LPA: -0.092 unit; SSB: -0.284 unit; NSB: -0.165 unit), and stress (LPA: -0.083 unit; SSB: -0.312 unit; NSB: -0.191 unit). For dose-response relationships of 5-55 min isotemporal substitution, when time was reallocated to MVPA from LPA, NSB, and SSB, the estimated detriments to mental health were larger in magnitude than the estimated benefits of time reallocation from MVPA to LPA, NSB, and SSB. Conclusion The findings emphasize the importance of participating in MVPA to improve mental health in overweight/obese college students during the post-COVID-19 era. The compositional analysis produced clear targets for the time allocation of these behaviors for future interventions and policymaking.
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Affiliation(s)
- Shuai Wang
- School of Economics and Business Administration, Chongqing University of Education, Chongqing, China
- Department of Military Medical Geography, Army Medical Service Training Base, Army Medical University, Chongqing, China
| | - Wei Liang
- School of Physical Education, Shenzhen University, Shenzhen, Guangdong, China
| | - Huiqi Song
- Department of Sport, Physical Education and Health, Hong Kong Baptist University, Kowloon, Hong Kong SAR, China
| | - Ning Su
- School of Physical Education, Shenzhen University, Shenzhen, Guangdong, China
| | - Lin Zhou
- School of Physical Education, Hebei Normal University, Shijiazhuang, Hebei, China
| | - Yanping Duan
- Department of Sport, Physical Education and Health, Hong Kong Baptist University, Kowloon, Hong Kong SAR, China
| | - Ryan E. Rhodes
- School of Exercise Science, Physical and Health Education, University of Victoria, Victoria, BC, Canada
| | - Huaxuan Liu
- School of Physical Education and Sport Science, Fujian Normal University, Fuzhou, Fujian, China
| | - Yi-de Yang
- School of Medicine, Hunan Normal University, Changsha, China
| | - Wing Chung Patrick Lau
- Department of Sport, Physical Education and Health, Hong Kong Baptist University, Kowloon, Hong Kong SAR, China
| | - Julien Steven Baker
- Department of Sport, Physical Education and Health, Hong Kong Baptist University, Kowloon, Hong Kong SAR, China
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Thein KS, Takahashi Y, Soe AT. The Impact of Action Planning after Causation-and-Effectuation-Based Entrepreneurship Education. Behav Sci (Basel) 2023; 13:569. [PMID: 37504016 PMCID: PMC10376794 DOI: 10.3390/bs13070569] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 06/29/2023] [Accepted: 07/07/2023] [Indexed: 07/29/2023] Open
Abstract
The entrepreneurship literature shows inconsistent results in outcome effectiveness, such as entrepreneurial self-efficacy (ESE), entrepreneurial intention (EI), and entrepreneurial behavior. This could be due to the sole focus on the motivational aspects of behavioral change. Action planning, a volitional intervention used to modify health behavior, could resolve the inconsistent results mentioned above. Therefore, this study aims to evaluate the direct impacts of action planning intervention (API) following entrepreneurship education (EE) on ESE, EI, and opportunity recognition and to examine the behavioral change process from motivational and volitional perspectives. In this randomized controlled trial (RCT), we considered action planning to enhance entrepreneurial behavior after EE. The sample included 83 participants from a university in Myanmar. We randomly assigned the students to the API and control groups. We collected data on ESE and EI before and after training. We used objective measures for opportunity recognition through an opportunity evaluation framework. Serial mediation analysis revealed that the volitional impact on opportunity recognition was positively significant. From a motivational standpoint, ESE improved significantly, but we found no significant impact on EI; ESE and EI were serial mediators, with no specific mediation solely by ESE or EI. The findings contribute to the EE literature by presenting a brief and cost-effective API for EE.
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Affiliation(s)
- Khin Sandar Thein
- Graduate School of Humanities and Social Sciences, Hiroshima University, Hiroshima 739-8529, Japan
| | - Yoshi Takahashi
- Graduate School of Humanities and Social Sciences, Hiroshima University, Hiroshima 739-8529, Japan
| | - Aye Thanda Soe
- Department of Commerce, Yangon University of Economics, Yangon 11041, Myanmar
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Zhou L, Liang W, He Y, Duan Y, Rhodes RE, Lippke S, Baker JS, Liang Y, Han L, Liu WX, Liu Q. A school-family blended multi-component physical activity program for Fundamental Motor Skills Promotion Program for Obese Children (FMSPPOC): protocol for a cluster randomized controlled trial. BMC Public Health 2023; 23:369. [PMID: 36803486 PMCID: PMC9942318 DOI: 10.1186/s12889-023-15210-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 02/03/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND Fundamental motor skills (FMSs) are crucial for children's health and comprehensive development. Obese children often encounter a considerable challenge in the development of FMSs. School-family blended PA programs are considered a potentially effective approach to improve FMSs and health-related outcomes among obese children, however, empirical evidence is still limited. Therefore, this paper aims to describe the development, implementation, and evaluation of a 24-week school-family blended multi-component PA intervention program for promoting FMSs and health among Chinese obese children, namely the Fundamental Motor Skills Promotion Program for Obese Children (FMSPPOC) employing behavioral change techniques (BCTs) and building on the Multi-Process Action Control (M-PAC) framework as well as using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework for improving and evaluating the program. METHODS Using a cluster randomized controlled trial (CRCT), 168 Chinese obese children (8-12 years) from 24 classes of six primary schools will be recruited and randomly assigned to one of two groups by a cluster randomization, including a 24-week FMSPPOC intervention group and a non-treatment waiting-list control group. The FMSPPOC program includes a 12-week initiation phase and a 12-week maintenance phase. School-based PA training sessions (2 sessions/week, 90 min each session) and family-based PA assignments (at least three times per week, 30 min each time) will be implemented in the initiation phase (semester time), while three 60-min offline workshops and three 60-min online webinars will be conducted in the maintenance phase (summer holiday). The implementation evaluation will be undertaken according to the RE-AIM framework. For intervention effectiveness evaluation, primary outcome (FMSs: gross motor skills, manual dexterity and balance) and secondary outcomes (health behaviors, physical fitness, perceived motor competence, perceived well-being, M-PAC components, anthropometric and body composition measures) will be collected at four time-points: at baseline, 12-week mid-intervention, 24-week post-intervention, and 6-month follow-up occasions. DISCUSSION The FMSPPOC program will provide new insights into the design, implementation, and evaluation of FMSs promotion among obese children. The research findings will also supplement empirical evidence, understanding of potential mechanisms, and practical experience for future research, health services, and policymaking. TRIAL REGISTRATION Chinese Clinical Trial Registry; ChiCTR2200066143; 25 Nov 2022.
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Affiliation(s)
- Lin Zhou
- grid.256884.50000 0004 0605 1239School of Physical Education, Hebei Normal University, Shijiazhuang, China ,Key Laboratory of Measurement and Evaluation in Exercise Bioinformation of Hebei Province, Hebei, Wuhan, China
| | - Wei Liang
- grid.263488.30000 0001 0472 9649College of Physical Education, Shenzhen University, Shenzhen, China ,grid.221309.b0000 0004 1764 5980Department of Sport, Physical Education and Health; Hong Kong Baptist University, Kowloon, Hong Kong
| | - Yuxiu He
- School of Physical Education, Hebei Normal University, Shijiazhuang, China. .,Key Laboratory of Measurement and Evaluation in Exercise Bioinformation of Hebei Province, Hebei, Wuhan, China.
| | - Yanping Duan
- grid.221309.b0000 0004 1764 5980Department of Sport, Physical Education and Health; Hong Kong Baptist University, Kowloon, Hong Kong
| | - Ryan E. Rhodes
- grid.143640.40000 0004 1936 9465School of Exercise Science, Physical and Health Education, University of Victoria, Victoria, Canada
| | - Sonia Lippke
- grid.7704.40000 0001 2297 4381Constructor University Bremen (formerly known as Jacobs University Bremen), Bremen, Germany
| | - Julien S. Baker
- grid.221309.b0000 0004 1764 5980Department of Sport, Physical Education and Health; Hong Kong Baptist University, Kowloon, Hong Kong
| | - Yu Liang
- grid.256884.50000 0004 0605 1239School of Physical Education, Hebei Normal University, Shijiazhuang, China ,Key Laboratory of Measurement and Evaluation in Exercise Bioinformation of Hebei Province, Hebei, Wuhan, China
| | - Lin Han
- Shenzhen Sports School, Shenzhen, China ,grid.419993.f0000 0004 1799 6254The Education University of Hong Kong, Ting Kok, Hong Kong
| | - Wan Xin Liu
- grid.256884.50000 0004 0605 1239School of Physical Education, Hebei Normal University, Shijiazhuang, China ,Key Laboratory of Measurement and Evaluation in Exercise Bioinformation of Hebei Province, Hebei, Wuhan, China
| | - Qi Liu
- grid.256884.50000 0004 0605 1239School of Physical Education, Hebei Normal University, Shijiazhuang, China ,Key Laboratory of Measurement and Evaluation in Exercise Bioinformation of Hebei Province, Hebei, Wuhan, China
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