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Baretta D, Inauen J. Implications of the COVID-19 trajectory for the evaluation of hand hygiene interventions: Secondary analysis of the Soapp trial. Transl Behav Med 2024; 14:66-71. [PMID: 38001051 PMCID: PMC10782897 DOI: 10.1093/tbm/ibad075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2023] Open
Abstract
Hand hygiene behavior is crucial to counter the spread of infectious diseases. However, its adoption during the early stages of the Coronavirus disease (COVID-19) pandemic showed temporal fluctuations associated with the trajectory of the pandemic (e.g. new COVID-19 infections). Such associations can confound conclusions about the effectiveness of interventions aimed at promoting hand hygiene during a pandemic. In this study, we performed a secondary analysis of a dataset from the optimization phase of Soapp, an app to promote hand hygiene during the COVID-19 pandemic. We used a longitudinal study design to test whether the associations between the pandemic trajectory and hand hygiene behavior were still present one year after the outbreak (primary outcome) and whether they impacted conclusions about the effectiveness of Soapp (secondary outcome). Participants (N = 216) were randomized to different versions of Soapp and used an electronic diary to self-report their hand hygiene behavior multiple times during the study. We considered the following indicators of the COVID-19 pandemic from the country of Switzerland in the period between March and August 2021: total cases/deaths, increases in recent new cases/deaths, new cases/deaths, and number of administered doses of vaccine. Data were analyzed using a multilevel approach. Results suggested that there were no significant associations between hand hygiene and the indicators of the pandemic trajectory. However, models including total cases/deaths impacted the conclusions about Soapp's effectiveness. Implications from this study are that the development and evaluation of hand hygiene interventions during a pandemic context should account for the trajectory indicators to maximize their effectiveness and control for confounding effects.
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Affiliation(s)
- Dario Baretta
- Department of Health Psychology and Behavioral Medicine, Institute of Psychology, University of Bern, Fabrikstrasse 8, 3012 Bern, Switzerland
| | - Jennifer Inauen
- Department of Health Psychology and Behavioral Medicine, Institute of Psychology, University of Bern, Fabrikstrasse 8, 3012 Bern, Switzerland
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Latrille C, Chapel B, Héraud N, Bughin F, Hayot M, Boiché J. An individualized mobile health intervention to promote physical activity in adults with obstructive sleep apnea: An intervention mapping approach. Digit Health 2023; 9:20552076221150744. [PMID: 36776408 PMCID: PMC9909081 DOI: 10.1177/20552076221150744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 12/26/2022] [Indexed: 02/10/2023] Open
Abstract
Objective Combining continuous positive airway pressure with physical activity (PA) might be a promising strategy to treat obstructive sleep apnea (OSA). This article describes how intervention mapping (IM) can guide the development, content, and mechanisms of action of a mobile application to promote PA in adults with OSA. Methods To develop the program, the IM approach was followed. This article presents the first three steps of IM to develop a mixed intervention (with interventionists and a digital application) aiming to: (1) assess patients' health problems and needs in a literature review to determine their expectations and perceived facilitators and barriers to PA behavior change and thus select the determinants of behavior; (2) formulate the expected intervention outcomes and objectives to be met to achieve the overall program goals; and (3) select and implement the behavior change techniques (BCTs) to achieve the change objectives. Results The literature review identified the relevant determinants (e.g., self-efficacy, coping, planning, and habit) of PA behavior using the health action process approach and multiprocess action control. These results were used to specify the program outcomes for PA adapted to physical, psychological, and social parameters. Overall, 11 performance objectives and 30 change objectives were defined. Lastly, BCTs and practical applications were identified. Conclusions The study provides a theoretical and methodological basis for researchers and practitioners given the current paucity of evidence-based PA interventions for adults with OSA. It addresses the lack of BCTs (framing and prompts/cue techniques) and meaningful behavioral determinants (identity and habit) in most interventions.
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Affiliation(s)
- Christophe Latrille
- EuroMov Digital Health in Motion, University of Montpellier, IMT Mines Ales, Montpellier, France,PhyMedExp, University of Montpellier, INSERM, CNRS, CHRU, Montpellier, France,Christophe Latrille, University of Montpellier, 700 avenue du Pic Saint-Loup, Montpellier 34090, France.
| | - Blandine Chapel
- Montpellier Research of Management MRM, University of Montpellier, Montpellier, France
| | - Nelly Héraud
- Direction de la recherche clinique et de l'innovation en santé, Korian SA, Lodève, France
| | - François Bughin
- PhyMedExp, University of Montpellier, INSERM, CNRS, CHRU, Montpellier, France
| | - Maurice Hayot
- PhyMedExp, University of Montpellier, INSERM, CNRS, CHRU, Montpellier, France
| | - Julie Boiché
- EuroMov Digital Health in Motion, University of Montpellier, IMT Mines Ales, Montpellier, France
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Buis L, Amrein MA, Bäder C, Ruschetti GG, Rüttimann C, Del Rio Carral M, Fabian C, Inauen J. Promoting Hand Hygiene During the COVID-19 Pandemic: Parallel Randomized Trial for the Optimization of the Soapp App. JMIR Mhealth Uhealth 2023; 11:e43241. [PMID: 36599056 PMCID: PMC9938438 DOI: 10.2196/43241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 12/20/2022] [Accepted: 12/20/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Hand hygiene is an effective behavior for preventing the spread of the respiratory disease COVID-19 and was included in public health guidelines worldwide. Behavior change interventions addressing hand hygiene have the potential to support the adherence to public health recommendations and, thereby, prevent the spread of COVID-19. However, randomized trials are largely absent during a pandemic; therefore, there is little knowledge about the most effective strategies to promote hand hygiene during an ongoing pandemic. This study addresses this gap by presenting the results of the optimization phase of a Multiphase Optimization Strategy of Soapp, a smartphone app for promoting hand hygiene in the context of the COVID-19 pandemic. OBJECTIVE This study aimed to identify the most effective combination and sequence of 3 theory- and evidence-based intervention modules (habit, motivation, and social norms) for promoting hand hygiene. To this end, 9 versions of Soapp were developed (conditions), and 2 optimization criteria were defined: the condition with the largest increase in hand hygiene at follow-up and condition with the highest engagement, usability, and satisfaction based on quantitative and qualitative analyses. METHODS This study was a parallel randomized trial with 9 intervention conditions defined by the combination of 2 intervention modules and their sequence. The trial was conducted from March to August 2021 with interested participants from the Swiss general population (N=232; randomized). Randomization was performed using Qualtrics (Qualtrics International Inc), and blinding was ensured. The duration of the intervention was 34 days. The primary outcome was self-reported hand hygiene at follow-up, which was assessed using an electronic diary. The secondary outcomes were user engagement, usability, and satisfaction assessed at follow-up. Nine participants were further invited to participate in semistructured exit interviews. A set of ANOVAs was performed to test the main hypotheses, whereas a thematic analysis was performed to analyze the qualitative data. RESULTS The results showed a significant increase in hand hygiene over time across all conditions. There was no interaction effect between time and intervention condition. Similarly, no between-group differences in engagement, usability, and satisfaction emerged. Seven themes (eg, "variety and timeliness of the task load" and "social interaction") were found in the thematic analysis. CONCLUSIONS The effectiveness of Soapp in promoting hand hygiene laid the foundation for the next evaluation phase of the app. More generally, the study supported the value of digital interventions in pandemic contexts. The findings showed no differential effect of intervention conditions involving different combinations and sequences of the habit, motivation, and social norms modules on hand hygiene, engagement, usability, and satisfaction. In the absence of quantitative differences, we relied on the results from the thematic analysis to select the best version of Soapp for the evaluation phase. TRIAL REGISTRATION ClinicalTrials.gov NCT04830761; https://clinicaltrials.gov/ct2/show/NCT04830761. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1136/bmjopen-2021-055971.
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Affiliation(s)
| | | | - Carole Bäder
- Institute of Psychology, University of Bern, Bern, Switzerland
| | | | | | | | - Carlo Fabian
- Institute for Social Work and Health, FHNW School of Social Work, Olten, Switzerland
| | - Jennifer Inauen
- Institute of Psychology, University of Bern, Bern, Switzerland
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Johnson C, Thout SR, Nidhuram S, Hart A, Hoek AC, Rogers K, Shivashankar R, Ide N, Chatterjee S, Webster J, Praveen D. Protocol for the implementation and evaluation of a community-based behavior change intervention to reduce dietary salt intake in India. J Clin Hypertens (Greenwich) 2023; 25:175-182. [PMID: 36639981 PMCID: PMC9903196 DOI: 10.1111/jch.14628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 12/22/2022] [Accepted: 12/23/2022] [Indexed: 01/15/2023]
Abstract
Excess dietary salt intake is well established as a leading cause of high blood pressure and associated cardiovascular disease, yet current salt intake in India is nearly 11 g per day, more than twice World Health Organization maximum recommended intake of 5 g per day. Although dietary survey data from India indicate that the main sources of dietary salt are salt added during cooking at home, and few salt reduction efforts have focused on interventions at the household level. As a result, there is little evidence of the effectiveness of behavior change programs to reduce salt intake at the household level. The study aims to develop and implement a community based behavioral change intervention to reduce salt intake delivered by front line community-based health volunteers; and evaluate the preliminary effectiveness, acceptability, and feasibility of delivering a salt reduction behavior change program and potential to support future scale-up. The study is a pre-post intervention design, and outcomes will be evaluated from a random sample of 1500 participants from 28 villages in two primary health centers in Siddipet, Telangana. Primary outcome is change in salt-related KAB (knowledge, attitude, and behavior) score, and secondary outcomes will be changes in salt intake measured by 24 h urinary sodium excretion and change in scores using the subscales of the COM-B ("capability", "opportunity", "motivation" and "behavior") tool. Findings will be used to inform future public health policies to support implementation of scalable community-based interventions to reduce salt intake and control hypertension, the leading-cause of death in India.
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Affiliation(s)
- Claire Johnson
- Food Policy DivisionThe George Institute for Global HealthSydneyAustralia,The School of Public Health and Community MedicineThe University of New South WalesSydneyAustralia
| | - Sudhir Raj Thout
- Research and Development DivisionThe George Institute for Global HealthHyderabadIndia,Indian Institute of Technology HyderabadKandi, SangareddyTelanganaIndia
| | - Spoorthi Nidhuram
- Research and Development DivisionThe George Institute for Global HealthHyderabadIndia
| | - Ashleigh Hart
- Food Policy DivisionThe George Institute for Global HealthSydneyAustralia
| | - Annet C. Hoek
- Food Policy DivisionThe George Institute for Global HealthSydneyAustralia
| | - Kris Rogers
- Food Policy DivisionThe George Institute for Global HealthSydneyAustralia,Graduate School of HealthThe University of Technology SydneySydneyAustralia
| | - Roopa Shivashankar
- Resolve to Save LivesAn Initiative of Vital StrategiesNew York CityNew YorkUSA,Indian Council of Medical ResearchNew DelhiIndia
| | - Nicole Ide
- Resolve to Save LivesAn Initiative of Vital StrategiesNew York CityNew YorkUSA
| | - Susmita Chatterjee
- Research and Development DivisionThe George Institute for Global HealthHyderabadIndia
| | - Jacqui Webster
- Food Policy DivisionThe George Institute for Global HealthSydneyAustralia
| | - Devarsetty Praveen
- Research and Development DivisionThe George Institute for Global HealthHyderabadIndia,University of New South WalesSydneyNSWAustralia,Prasanna School of Public HealthManipal Academy of Higher EducationManipalIndia
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Chater AM, Schulz J, Jones A, Burke A, Carr S, Kukucska D, Troop N, Trivedi D, Howlett N. Outcome evaluation of Active Herts: A community-based physical activity programme for inactive adults at risk of cardiovascular disease and/or low mental wellbeing. Front Public Health 2022; 10:903109. [PMID: 36159253 PMCID: PMC9500394 DOI: 10.3389/fpubh.2022.903109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 07/25/2022] [Indexed: 01/22/2023] Open
Abstract
Background A high proportion of UK adults are inactive, which can lead to a range of physical and mental health concerns. Active Herts is a community-based physical activity programme for inactive adults at risk of cardiovascular disease and/or low mental wellbeing. This paper provides a pragmatic evaluation of this programme. Method This longitudinal study observed 717 adults (68% female, mean age = 56.9 years) from the "Active Herts" programme. Programme users were provided with a 45-min consultation with a "Get Active Specialist," who talked them through an Active Herts self-help booklet and then signposted them to free or subsidized local exercise sessions. Programme users were followed up with a booster call 2 weeks later. The Get Active Specialist was a registered exercise professional (REPS Level 3), with additional training from the study team in motivational interviewing, health coaching, COM-B behavioral diagnosis and delivery of behavior change techniques (BCTs) in practice. The Active Herts booklet contained theoretically-driven and evidence-based BCTs to translate behavioral science into public health practice. Physical activity (Metabolic Equivalent Time [METs], measured using the International Physical Activity Questionnaire (IPAQ), perceived health (EQ-5D-5L) and mental wellbeing (Warwick-Edinburgh Mental Wellbeing Scale: WEMWBS) were measured at baseline, 3, 6 and 12 months. Results At the end of the 12-month programme, users showed sustained improvements in physical activity (by +1331 METS), exceeding weekly recommendations. Sitting (reducing by over an hour per day), sporting participation, and perceptions of health were also improved, with improvements in mental wellbeing in the first 3 months. Conclusion Designing and delivering a community-based physical activity programme that is theoretically-driven and evidence-based with frequent behavior change training and supervision can yield a significant increase in self-reported physical activity, reduction in sitting behavior and improvements to perceived health and mental wellbeing. Future research should extend this approach, utilizing a real-world, pragmatic evaluation. Trial registration ClinicalTrials.gov, identifier (NCT number): NCT03153098.
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Affiliation(s)
- Angel M. Chater
- Institute for Sport and Physical Activity Research, University of Bedfordshire, Bedford, United Kingdom,Centre for Behaviour Change, University College London, London, United Kingdom,*Correspondence: Angel M. Chater
| | - Joerg Schulz
- Department of Psychology, Sports, and Geography, University of Hertfordshire, Hatfield, United Kingdom
| | - Andy Jones
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Amanda Burke
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Shelby Carr
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Dora Kukucska
- Institute for Sport and Physical Activity Research, University of Bedfordshire, Bedford, United Kingdom
| | - Nick Troop
- Department of Psychology, Sports, and Geography, University of Hertfordshire, Hatfield, United Kingdom,School of Psychology, University of Plymouth, Plymouth, United Kingdom
| | - Daksha Trivedi
- Centre for Research in Public Health and Community Care, University of Hertfordshire, Hatfield, United Kingdom
| | - Neil Howlett
- Department of Psychology, Sports, and Geography, University of Hertfordshire, Hatfield, United Kingdom
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Buss VH, Varnfield M, Harris M, Barr M. A Mobile App for Prevention of Cardiovascular Disease and Type 2 Diabetes Mellitus: Development and Usability Study. JMIR Hum Factors 2022; 9:e35065. [PMID: 35536603 PMCID: PMC9131155 DOI: 10.2196/35065] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 02/26/2022] [Accepted: 03/26/2022] [Indexed: 01/16/2023] Open
Abstract
Background Cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM) are posing a huge burden on health care systems worldwide. Mobile apps can deliver behavior change interventions for chronic disease prevention on a large scale, but current evidence for their effectiveness is limited. Objective This paper reported on the development and user testing of a mobile app that aims at increasing risk awareness and engaging users in behavior change. It would form part of an intervention for primary prevention of CVD and T2DM. Methods The theoretical framework of the app design was based on the Behaviour Change Wheel, combined with the capability, opportunity, and motivation for behavior change system and the behavior change techniques from the Behavior Change Technique Taxonomy (version 1). In addition, evidence from scientific literature has guided the development process. The prototype was tested for user-friendliness via an iterative approach. We conducted semistructured interviews with individuals in the target populations, which included the System Usability Scale. We transcribed and analyzed the interviews using descriptive statistics for the System Usability Scale and thematic analysis to identify app features that improved utility and usability. Results The target population was Australians aged ≥45 years. The app included 4 core modules (risk score, goal setting, health measures, and education). In these modules, users learned about their risk for CVD and T2DM; set goals for smoking, alcohol consumption, diet, and physical activity; and tracked them. In total, we included 12 behavior change techniques. We conducted 2 rounds of usability testing, each involving 5 participants. The average age of the participants was 58 (SD 8) years. Totally, 60% (6/10) of the participants owned iPhone Operating System phones, and 40% (4/10) of them owned Android phones. In the first round, we identified a technical issue that prevented 30% (3/10) of the participants from completing the registration process. Among the 70% (7/10) of participants who were able to complete the registration process, 71% (5/7) rated the app above average, based on the System Usability Scale. During the interviews, we identified some issues related to functionality, content, and language and clarity. We used the participants’ feedback to improve these aspects. Conclusions We developed the app using behavior change theory and scientific evidence. The user testing allowed us to identify and remove technical errors and integrate additional functions into the app, which the participants had requested. Next, we will evaluate the feasibility of the revised version of the app developed through this design process and usability testing.
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Affiliation(s)
- Vera Helen Buss
- Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Herston, Australia.,Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
| | - Marlien Varnfield
- Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Herston, Australia
| | - Mark Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
| | - Margo Barr
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
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Thayabaranathan T, Andrew NE, Grimley R, Stroil-Salama E, Grabsch B, Hill K, Cadigan G, Purvis T, Middleton S, Kilkenny MF, Cadilhac DA. Understanding the Role of External Facilitation to Drive Quality Improvement for Stroke Care in Hospitals. Healthcare (Basel) 2021; 9:healthcare9091095. [PMID: 34574869 PMCID: PMC8471416 DOI: 10.3390/healthcare9091095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 08/18/2021] [Accepted: 08/20/2021] [Indexed: 11/18/2022] Open
Abstract
The use of external facilitation within the context of multicomponent quality improvement interventions (mQI) is growing. We aimed to evaluate the influence of external facilitation for improving the quality of acute stroke care. Clinicians from hospitals participating in mQI (Queensland, Australia) as part of the Stroke123 study were supported by external facilitators in a single, on-site workshop to review hospital performance against eight clinical processes of care (PoCs) collected in the Australian Stroke Clinical Registry (AuSCR) and develop an action plan. Remote support (i.e., telephone/email) after the workshop was provided. As part of a process evaluation for Stroke123, we recorded the number and mode of contacts between clinicians and facilitators; type of support provided; and frequency of self-directed, hospital-level stroke registry data reviews. Analysis: We measured the association between amount/type of external facilitation, (i) development of action plans, and (ii) adherence to PoCs before and after the intervention using AuSCR data from 2010 to 2015. In total, 14/19 hospitals developed an action plan. There was no significant difference in amount or type of external facilitator support provided between hospitals that did, and did not, develop an action plan. There was no relationship between the amount of external facilitation and change in adherence to PoCs. Most (95%) hospitals accessed stroke registry performance data. In the Stroke123 study, the amount or type of external facilitation did not influence action plan development, and the amount of support did not influence the changes achieved in adherence to PoCs. Remote support may not add value for mQI.
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Affiliation(s)
- Tharshanah Thayabaranathan
- School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC 3168, Australia; (N.E.A.); (R.G.); (T.P.); (M.F.K.); (D.A.C.)
- Correspondence: ; Tel.: +61-3-8572-2646; Fax: +61-3-9902-4245
| | - Nadine E. Andrew
- School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC 3168, Australia; (N.E.A.); (R.G.); (T.P.); (M.F.K.); (D.A.C.)
- Peninsula Clinical School, Central Clinical School, Monash University, Frankston, VIC 3199, Australia
| | - Rohan Grimley
- School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC 3168, Australia; (N.E.A.); (R.G.); (T.P.); (M.F.K.); (D.A.C.)
- Queensland State-Wide Stroke Clinical Network, Brisbane, QLD 4000, Australia;
- Sunshine Coast Clinical School, Griffith University, Birtinya, QLD 4575, Australia
| | - Enna Stroil-Salama
- Metro South Research, Metro South Health, Brisbane, QLD 4102, Australia;
| | - Brenda Grabsch
- Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC 3052, Australia;
| | - Kelvin Hill
- Stroke Foundation, Melbourne, VIC 3000, Australia;
| | - Greg Cadigan
- Queensland State-Wide Stroke Clinical Network, Brisbane, QLD 4000, Australia;
| | - Tara Purvis
- School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC 3168, Australia; (N.E.A.); (R.G.); (T.P.); (M.F.K.); (D.A.C.)
| | - Sandy Middleton
- Nursing Research Institute, St Vincent’s Health Network Sydney, St Vincent’s Hospital Melbourne, Australia and Australian Catholic University, Sydney, NSW 2010, Australia;
| | - Monique F. Kilkenny
- School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC 3168, Australia; (N.E.A.); (R.G.); (T.P.); (M.F.K.); (D.A.C.)
- Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC 3052, Australia;
| | - Dominique A. Cadilhac
- School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC 3168, Australia; (N.E.A.); (R.G.); (T.P.); (M.F.K.); (D.A.C.)
- Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC 3052, Australia;
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Rogers HL, Fernández SN, Pablo Hernando S, Sanchez A, Martos C, Moreno M, Grandes G. "My Patients Asked Me If I Owned a Fruit Stand in Town or Something." Barriers and Facilitators of Personalized Dietary Advice Implemented in a Primary Care Setting. J Pers Med 2021; 11:747. [PMID: 34442392 DOI: 10.3390/jpm11080747] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 07/23/2021] [Accepted: 07/26/2021] [Indexed: 12/16/2022] Open
Abstract
Primary care is especially well positioned to address prevention of non-communicable diseases. However, implementation of health promotion activities such as personalized dietary advice is challenging. The study aim was to understand barriers and facilitators of the personalized dietary advice component of a lifestyle intervention in primary care, as perceived by health center professionals and program participants. Thirteen focus groups were conducted with 49 professionals and 47 participants. Audio recordings were transcribed. Professional group text was coded using the Consolidated Framework for Implementation Research (CFIR). Participant group text was coded via an inductive approach with thematic analysis. Across most CFIR domains, both barriers and facilitators were equally present, except for ‘characteristics of individuals’, which were primarily facilitators. Intervention characteristics was the most important domain, with barriers in design and packaging (e.g., the ICT tool) and complexity. Facilitators included high evidence strength and quality, adaptability, and relative advantage. Participants described the importance of more personalized advice, the value of follow-up with feedback, and the need to see outcomes. Both professionals and patients stated that primary care was the place for personalized dietary advice intervention, but that lack of time, workload, and training were barriers to effective implementation. Implementation strategies targeting these modifiable barriers could potentially increase intervention adoption and intervention effectiveness.
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Das SK, Mason ST, Vail TA, Blanchard CM, Chin MK, Rogers GT, Livingston KA, Turgiss JL. Sustained Long-Term Effectiveness of an Energy Management Training Course on Employee Vitality and Purpose in Life. Am J Health Promot 2019; 34:177-188. [PMID: 31698916 PMCID: PMC7323763 DOI: 10.1177/0890117119883585] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Purpose: Programs designed to sustainably improve employee well-being are urgently needed but
insufficiently researched. This study evaluates the long-term effectiveness of a
commercial well-being intervention in a worksite setting. Design: A pre/postintervention repeated analysis with follow-up at 6, 12, and 18 months. Setting: Office-based worksites (for-profit, nonprofit, and mixed work-type; n = 8). Participants: One hundred sixty-three employees with a mean age of 47 (11) years (57% female). Intervention: A 2.5-day group-based behavioral program emphasizing vitality and purpose in life
(PiL). Measures: Rand Medical Outcomes Survey (MOS) 36-Item Short Form (SF-36) with a focus on vitality
(primary outcome), Ryff PiL Scale, Center for Epidemiologic Studies Depression Scale,
Profile of Mood States, Rand MOS Sleep Scale, physical activity, body weight, blood
pressure, and blood measures for glucose and lipids at baseline, 6, 12, and 18
months. Analysis: General linear models with repeated measures for mean values at baseline and
follow-up. Results: At 18-month follow-up, sustained improvements were observed for vitality, general
health, and mental health domains of SF-36 and PiL (P < .001 for all
measures). Sleep, mood, vigor, physical activity, and blood pressure were also improved
at 18 months (P < .05 for all measures). Conclusions: An intensive 2.5-day intervention showed sustained improvement in employee quality of
life, PiL, and other measures of well-being over 18 months.
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Affiliation(s)
- Sai Krupa Das
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
| | - Shawn T Mason
- Johnson & Johnson, Health and Wellness Solutions Inc, New Brunswick, NJ, USA
| | - Taylor A Vail
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
| | - Caroline M Blanchard
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
| | - Meghan K Chin
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
| | - Gail T Rogers
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
| | - Kara A Livingston
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
| | - Jennifer L Turgiss
- Johnson & Johnson, Health and Wellness Solutions Inc, New Brunswick, NJ, USA
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Das SK, Mason ST, Vail TA, Rogers GV, Livingston KA, Whelan JG, Chin MK, Blanchard CM, Turgiss JL, Roberts SB. Effectiveness of an Energy Management Training Course on Employee Well-Being: A Randomized Controlled Trial. Am J Health Promot 2018; 33:118-130. [PMID: 29807441 PMCID: PMC7323760 DOI: 10.1177/0890117118776875] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: Programs focused on employee well-being have gained momentum in recent years, but few
have been rigorously evaluated. This study evaluates the effectiveness of an
intervention designed to enhance vitality and purpose in life by assessing changes in
employee quality of life (QoL) and health-related behaviors. Design: A worksite-based randomized controlled trial. Setting: Twelve eligible worksites (8 randomized to the intervention group [IG] and 4 to the
wait-listed control group [CG]). Participants: Employees (n = 240) at the randomized worksites. Intervention: A 2.5-day group-based behavioral intervention. Measures: Rand Medical Outcomes Survey (MOS) 36-item Short-Form (SF-36) vitality and QoL
measures, Ryff Purpose in Life Scale, Center for Epidemiologic Studies questionnaire for
depression, MOS sleep, body weight, physical activity, diet quality, and blood measures
for glucose and lipids (which were used to calculate a cardiometabolic risk score)
obtained at baseline and 6 months. Analysis: General linear mixed models were used to compare least squares means or prevalence
differences in outcomes between IG and CG participants. Results: As compared to CG, IG had a significantly higher mean 6-month change on the SF-36
vitality scale (P = .003) and scored in the highest categories for 5 of
the remaining 7 SF-36 domains: general health (P = .014), mental health
(P = .027), absence of role limitations due to physical problems
(P = .026), and social functioning (P = .007). The
IG also had greater improvements in purpose in life (P < .001) and
sleep quality (index I, P = .024; index II, P = .021).
No statistically significant changes were observed for weight, diet, physical activity,
or cardiometabolic risk factors. Conclusion: An intensive 2.5-day intervention showed improvement in employee QoL and well-being
over 6 months.
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Affiliation(s)
- Sai Krupa Das
- 1 Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA
| | - Shawn T Mason
- 2 Johnson & Johnson, Health and Wellness Solutions Inc, New Brunswick, NJ, USA
| | - Taylor A Vail
- 1 Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA
| | - Gail V Rogers
- 1 Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA
| | - Kara A Livingston
- 1 Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA
| | - Jillian G Whelan
- 1 Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA
| | - Meghan K Chin
- 1 Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA
| | - Caroline M Blanchard
- 1 Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA
| | - Jennifer L Turgiss
- 2 Johnson & Johnson, Health and Wellness Solutions Inc, New Brunswick, NJ, USA
| | - Susan B Roberts
- 1 Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA
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11
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Zongrone AA, Menon P, Pelto GH, Habicht JP, Rasmussen KM, Constas MA, Vermeylen F, Khaled A, Saha KK, Stoltzfus RJ. The Pathways from a Behavior Change Communication Intervention to Infant and Young Child Feeding in Bangladesh Are Mediated and Potentiated by Maternal Self-Efficacy. J Nutr 2018; 148:259-266. [PMID: 29490102 PMCID: PMC6299133 DOI: 10.1093/jn/nxx048] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 10/11/2017] [Accepted: 11/17/2017] [Indexed: 11/23/2022] Open
Abstract
Background Although self-efficacy is a potential determinant of feeding and care behaviors, there is limited empirical analysis of the role of maternal self-efficacy in low- and middle-income countries. In the context of behavior change interventions (BCIs) addressing complementary feeding (CF), it is possible that maternal self-efficacy can mediate or enhance intervention impacts. Objective In the context of a BCI in Bangladesh, we studied the role of maternal self-efficacy for CF (MSE-CF) for 2 CF behaviors with the use of a theoretically grounded empirical model of determinants to illustrate the potential roles of MSE-CF. Methods We developed and tested a locally relevant scale for MSE-CF and included it in a survey (n = 457 mothers of children aged 6-24 mo) conducted as part of a cluster-randomized evaluation. Qualitative research was used to inform the selection of 2 intervention-targeted behaviors: feeding green leafy vegetables in the last 24 h (GLV) and on-time introduction of egg (EGG) between 6 and 8 mo of age. We then examined direct, mediated, and potentiated paths of MSE-CF in relation to the impacts of the BCI on these behaviors with the use of regression and structural equation modeling. Results GLV and EGG were higher in the intensive group than in the nonintensive control group (16.0 percentage points for GLV; P < 0.001; 11.2 percentage points for EGG; P = 0.037). For GLV, MSE-CF mediated (β = 0.345, P = 0.010) and potentiated (β = 0.390, P = 0.038) the effect of the intensive group. In contrast, MSE-CF did not mediate or potentiate the effect of the intervention on EGG. Conclusions MSE-CF was a significant mediator and potentiator for GLV but not for EGG. The divergent findings highlight the complex determinants of individual specific infant and young child feeding behaviors. The study shows the value of measuring behavioral determinants, such as MSE-CF, that affect a caregiver's capability to adopt intervention-targeted behaviors.
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Affiliation(s)
- Amanda A Zongrone
- Poverty, Health, and Nutrition Division, International Food Policy Research
Institute, Washington, DC
| | - Purnima Menon
- Poverty, Health, and Nutrition Division, International Food Policy Research
Institute, Washington, DC
| | - Gretel H Pelto
- Division of Nutritional Sciences, Charles H Dyson School of Applied Economics
and Management, and Cornell Statistical Consulting Unit, Cornell University, Ithaca,
NY
| | - Jean-Pierre Habicht
- Division of Nutritional Sciences, Charles H Dyson School of Applied Economics
and Management, and Cornell Statistical Consulting Unit, Cornell University, Ithaca,
NY
| | - Kathleen M Rasmussen
- Division of Nutritional Sciences, Charles H Dyson School of Applied Economics
and Management, and Cornell Statistical Consulting Unit, Cornell University, Ithaca,
NY
| | - Mark A Constas
- Division of Charles H Dyson School of Applied Economics and Management, and
Cornell Statistical Consulting Unit, Cornell University, Ithaca, NY
| | - Francoise Vermeylen
- Division of Cornell Statistical Consulting Unit, Cornell University, Ithaca,
NY
| | - Adiba Khaled
- Poverty, Health, and Nutrition Division, International Food Policy Research
Institute, Washington, DC
| | - Kuntal K Saha
- Department of Nutrition for Health and Development, WHO, Geneva,
Switzerland
| | - Rebecca J Stoltzfus
- Division of Nutritional Sciences, Charles H Dyson School of Applied Economics
and Management, and Cornell Statistical Consulting Unit, Cornell University, Ithaca,
NY
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12
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Hornsby WC, Bailey W, Braun PA, Weiss K, Heichelbech J. Busting the Baby Teeth Myth and Increasing Children's Consumption of Tap Water: Building Public Will for Children's Oral Health in Colorado. Front Public Health 2017; 5:238. [PMID: 28955704 PMCID: PMC5601903 DOI: 10.3389/fpubh.2017.00238] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 08/22/2017] [Indexed: 11/13/2022] Open
Abstract
QUESTION Can a multifaceted statewide communications campaign motivate behavior change in low-income Colorado families to limit children's fruit juice consumption and increase children's consumption of tap water to prevent tooth decay? PURPOSE Caries is the most common chronic disease of childhood, affecting 40% of kindergartners and 55% of third graders in Colorado. Frequent consumption of 100% fruit juice is linked to childhood caries. The purpose of this campaign, "Cavities Get Around," was to motivate families to limit children's fruit juice consumption and increase consumption of tap water to protect baby teeth from caries, while also building public will for children's oral health. METHODS The campaign included targeted media, promotores/organizers, and family education. We focused on fruit juice because audience research showed many families view fruit juice as healthy, and it is also a common beverage among young children up to age of 6 years. We also focused on low-socioeconomic status families because data show higher childhood tooth decay rates in this population. To evaluate progress, we conducted identical pre- and post-surveys, each of 600 random low-income parents contacted by landline, mobile telephone, and Internet, allowing for comparative data. RESULTS Significant progress was achieved compared to 2014 baseline results. Findings from a November 2015 statewide survey of parents included the following: (1) 22-point increase from 2014 in percentage of children regularly drinking tap water (from 41 to 63%). (2) 29-point decrease from 2014 in percentage of respondents who considered fruit juice consumption important to their child's health and nutritional needs (from 72 to 43%). (3) 19-point reduction in fruit juice consumption among young children (from 66% in 2014 to 47% in 2015). (4) 6-point reduction in percentage of parents considering baby teeth "less important" than adult teeth (from 21% in 2014 to 15% in 2015). The campaign also played a role in new state rules prohibiting childcare centers from serving sugar-sweetened beverages and capping 100% juice to twice per week. CONCLUSION The campaign development, strategies, and evaluation results are instructive for others working on health promotion, childhood nutrition, and education interventions.
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Affiliation(s)
- Wyatt C Hornsby
- Delta Dental of Colorado Foundation, Denver, CO, United States
| | - William Bailey
- School of Dental Medicine, University of Colorado, Aurora, CO, United States
| | - Patricia A Braun
- School of Medicine, University of Colorado Anschutz School of Medicine, Denver, CO, United States
| | - Karl Weiss
- HealthCare Research, Inc., Denver, CO, United States
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13
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Meslot C, Gauchet A, Allenet B, François O, Hagger MS. Theory-Based Interventions Combining Mental Simulation and Planning Techniques to Improve Physical Activity: Null Results from Two Randomized Controlled Trials. Front Psychol 2016; 7:1789. [PMID: 27899904 PMCID: PMC5110541 DOI: 10.3389/fpsyg.2016.01789] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 10/31/2016] [Indexed: 11/13/2022] Open
Abstract
Interventions to assist individuals in initiating and maintaining regular participation in physical activity are not always effective. Psychological and behavioral theories advocate the importance of both motivation and volition in interventions to change health behavior. Interventions adopting self-regulation strategies that foster motivational and volitional components may, therefore, have utility in promoting regular physical activity participation. We tested the efficacy of an intervention adopting motivational (mental simulation) and volitional (implementation intentions) components to promote a regular physical activity in two studies. Study 1 adopted a cluster randomized design in which participants (n = 92) were allocated to one of three conditions: mental simulation plus implementation intention, implementation intention only, or control. Study 2 adopted a 2 (mental simulation vs. no mental simulation) × 2 (implementation intention vs. no implementation intention) randomized controlled design in which fitness center attendees (n = 184) were randomly allocated one of four conditions: mental simulation only, implementation intention only, combined, or control. Physical activity behavior was measured by self-report (Study 1) or fitness center attendance (Study 2) at 4- (Studies 1 and 2) and 19- (Study 2 only) week follow-up periods. Findings revealed no statistically significant main or interactive effects of the mental simulation and implementation intention conditions on physical activity outcomes in either study. Findings are in contrast to previous research which has found pervasive effects for both intervention strategies. Findings are discussed in light of study limitations including the relatively small sample sizes, particularly for Study 1, deviations in the operationalization of the intervention components from previous research and the lack of a prompt for a goal intention. Future research should focus on ensuring uniformity in the format of the intervention components, test the effects of each component alone and in combination using standardized measures across multiple samples, and systematically explore effects of candidate moderators.
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Affiliation(s)
- Carine Meslot
- TIMC-IMAG UMR CNRS 5525, Grenoble Alpes UniversityGrenoble, France; Laboratoire Interuniversitaire de Psychologie, Grenoble Alpes UniversityGrenoble, France
| | - Aurélie Gauchet
- Laboratoire Interuniversitaire de Psychologie, Grenoble Alpes University Grenoble, France
| | - Benoît Allenet
- TIMC-IMAG UMR CNRS 5525, Grenoble Alpes UniversityGrenoble, France; Pharmacy Department, Grenoble University HospitalGrenoble, France
| | - Olivier François
- TIMC-IMAG UMR CNRS 5525, Grenoble Alpes University Grenoble, France
| | - Martin S Hagger
- Health Psychology and Behavioural Medicine Research Group, School of Psychology and Speech Pathology, Curtin University, PerthWA, Australia; Department of Sport Sciences, Faculty of Sport and Health Sciences, University of JyväskyläJyväskylä, Finland
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14
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Loy LS, Wieber F, Gollwitzer PM, Oettingen G. Supporting Sustainable Food Consumption: Mental Contrasting with Implementation Intentions (MCII) Aligns Intentions and Behavior. Front Psychol 2016; 7:607. [PMID: 27199840 PMCID: PMC4850472 DOI: 10.3389/fpsyg.2016.00607] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 04/12/2016] [Indexed: 11/30/2022] Open
Abstract
With growing awareness that sustainable consumption is important for quality of life on earth, many individuals intend to act more sustainably. In this regard, interest in reducing meat consumption is on the rise. However, people often do not translate intentions into actual behavior change. To address this intention-behavior gap, we tested the self-regulation strategy of mental contrasting with implementation intentions (MCII). Here, people identify and imagine a desired future and current obstacles standing in its way. They address the obstacles with if-then plans specifying when, where, and how to act differently. In a 5-week randomized controlled experimental study, we compared an information + MCII intervention with an information-only control intervention. As hypothesized, only MCII participants’ intention of reducing their meat consumption was predictive of their actual reduction, while no correspondence between intention and behavior change was found for control participants. Participants with a moderate to strong intention to reduce their meat consumption reduced it more in the MCII than in the control condition. Thus, MCII helped to narrow the intention-behavior gap and supported behavior change for those holding moderate and strong respective intentions.
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Affiliation(s)
- Laura S Loy
- Media Psychology Division, School of Communication, University of HohenheimStuttgart, Germany; Social Psychology and Motivation Division, Department of Psychology, University of KonstanzKonstanz, Germany
| | - Frank Wieber
- Social Psychology and Motivation Division, Department of Psychology, University of KonstanzKonstanz, Germany; Centre for Health Sciences, School of Health Professions, Zurich University of Applied SciencesWinterthur, Switzerland
| | - Peter M Gollwitzer
- Social Psychology and Motivation Division, Department of Psychology, University of KonstanzKonstanz, Germany; Motivation Lab, Psychology Department, New York UniversityNew York, NY, USA
| | - Gabriele Oettingen
- Motivation Lab, Psychology Department, New York UniversityNew York, NY, USA; Educational Psychology and Motivation Division, Department of Psychology, University of HamburgHamburg, Germany
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15
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Ciro CA, Smith P. Improving Personal Characterization of Meaningful Activity in Adults with Chronic Conditions Living in a Low-Income Housing Community. Int J Environ Res Public Health 2015; 12:11379-95. [PMID: 26378559 PMCID: PMC4586681 DOI: 10.3390/ijerph120911379] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 08/21/2015] [Accepted: 09/07/2015] [Indexed: 11/16/2022]
Abstract
Purpose: To understand how adults living in a low-income, public housing community characterize meaningful activity (activity that gives life purpose) and if through short-term intervention, could overcome identified individual and environmental barriers to activity engagement. Methods: We used a mixed methods design where Phase 1 (qualitative) informed the development of Phase 2 (quantitative). Focus groups were conducted with residents of two low-income, public housing communities to understand their characterization of meaningful activity and health. From these results, we developed a theory-based group intervention for overcoming barriers to engagement in meaningful activity. Finally, we examined change in self-report scores from the Meaningful Activity Participation Assessment (MAPA) and the Engagement in Meaningful Activity Survey (EMAS). Results: Health literacy appeared to impact understanding of the questions in Phase 1. Activity availability, transportation, income and functional limitations were reported as barriers to meaningful activity. Phase 2 within group analysis revealed a significant difference in MAPA pre-post scores (p =0.007), but not EMAS (p =0.33). Discussion: Health literacy should be assessed and addressed in this population prior to intervention. After a group intervention, participants had a change in characterization of what is considered healthy, meaningful activity but reported fewer changes to how their activities aligned with their values.
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Affiliation(s)
- Carrie A Ciro
- Occupational Therapy Program, College of Allied Health, University of Oklahoma, 1200 N. Stonewall Avenue, Oklahoma City, OK 73117, USA.
| | - Patsy Smith
- College of Nursing, University of Oklahoma, 1100 N Stonewall Ave, Oklahoma City, OK 73117, USA.
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16
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Abstract
When people engage in mind wandering they drift away from a task toward their inner thoughts and feelings. These thoughts often circle around people's personal futures. One assumed function of mind wandering is that it aids problem solving and planning for the future. We will discuss different forms of mind wandering and their effects on problem solving and behavior change. While solely fantasizing about a desired future leads to poor problem solving and little behavior change, mind wandering in the form of mental contrasting leads to skilled problem solving and substantial behavior change. In mental contrasting, people first envision the desired future and then imagine the obstacles that need to be surmounted to reach said future. Mental contrasting instigates behavior change by modulating the strength of associations between future and reality and between reality and instrumental action. Intervention research shows that mental contrasting can be taught as a cost- and time-effective self-regulation strategy of behavior change. The findings have implications for research on mind wandering, problem solving, and on creating effective interventions of behavior change.
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Affiliation(s)
- Gabriele Oettingen
- Psychology Department, New York University New York, NY, USA ; Department of Psychology, University of Hamburg Hamburg, Germany
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17
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Gotsis M, Wang H, Spruijt-Metz D, Jordan-Marsh M, Valente TW. Wellness partners: design and evaluation of a web-based physical activity diary with social gaming features for adults. JMIR Res Protoc 2013; 2:e10. [PMID: 23611986 PMCID: PMC3628151 DOI: 10.2196/resprot.2132] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Revised: 06/16/2012] [Accepted: 12/29/2012] [Indexed: 01/23/2023] Open
Abstract
Background The United States is currently in an age of obesity and inactivity despite increasing public awareness and scientific knowledge of detrimental long-term health effects of this lifestyle. Behavior-tracking diaries offer an effective strategy for physical activity adherence and weight management. Furthermore, Web-based physical activity diaries can engage meaningful partners in people’s social networks through fun online gaming interactions and generate motivational mechanisms for effective behavioral change and positive health outcomes. Objective Wellness Partners (WP) is a Web-based intervention in the form of a physical activity diary with social networking and game features. Two versions were designed and developed for the purpose of this study—“Diary” only and “Diary+Game”. The objectives of this study included pilot testing the research process of this intervention design, implementation, evaluation, and exploring the effectiveness of social gaming features on adult participants’ physical activity and anthropometric measures. Methods We conducted a field experiment with randomized crossover design. Assessments occurred at baseline, first follow-up (FU, 5-8 weeks after using one version of WP), and second FU (5-8 weeks of using the other version of WP). In the control condition, participants started with the “Diary” version of WP while in the experimental condition, participants started with the “Diary+Game” version of WP. A total of 54 adults (egos) ages 44-88, and their family and friends (alters) ages 17-69 participated in the study in ego-network groups. Both egos and their alters completed online surveys about their exercise habits. In addition, egos completed anthropometric measurements of BMI, fat percentage, and fat mass by bioimpedance. Results From October 2009 to May 2010, flyers, emails, and Web advertisements yielded 335 volunteers who were screened. Rolling recruitment resulted in enrollment of 142 qualified participants in 54 ego-network groups, which were randomly assigned to a study condition. The final analytic sample included 87 individuals from 41 groups. Data were collected from December 2009 to August 2010, and data analysis was completed in 2011. Overall, the participants were given access to the intervention for 10-13 weeks. Statistical analysis suggested an increase in self-reported exercise frequency (mean days per week) from baseline (2.57, SD 1.92) to first FU (3.21, SD 1.74) in both conditions. Stronger effects were seen in the condition where Diary+Game was played first, especially in network groups with larger age variation between the alters and egos. Overall, the decrease in egos’ BMI was statistically significant from baseline to first FU, with greater decrease for those in the Diary+Game first condition (-0.26 vs -0.16 in the Diary first condition). Conclusions The Wellness Partners program increased physical activity among participants and resulted in health benefits among the egos. Web-based diary interventions designed with social gaming features hold potential to promote active lifestyles for middle-age adults and people in their social networks.
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Affiliation(s)
- Marientina Gotsis
- Creative Media & Behavioral Health Center, Interactive Media Division, School of Cinematic Arts, University of Southern California, Los Angeles, CA, United States.
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