Process evaluations of health-promotion interventions in sports settings: a systematic review.

Sports settings have been identified as an ideal place to conduct complex multi-level health-promotion interventions, with the potential to engage a broad audience. Whilst the benefits of delivering health-promotion interventions in sports settings are well documented, such interventions' real-world implementation and success must be better understood. Process evaluations can be conducted to provide information related to an intervention's fidelity, replication, scaling, adoption, and the underlying mechanisms driving outcomes. This systematic review summarizes how process evaluations of health-promotion interventions are conducted in sports settings and highlight facilitators and barriers to health-promotion intervention delivery using narrative synthesis. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, searches included original peer-reviewed articles from inception-January 2023. We searched eight electronic databases: Academic Search Complete; MEDLINE, PsycARTICLES; PsycINFO; SPORTSDiscus with Full Text; MEDLINE; SCOPUS; Pub Med, and Pro Quest Central. Thirty-two studies were included. Findings suggest that most process evaluations of health-promotion interventions have acknowledged the inherent complexity of sports settings, and investigated factors that explain their intervention's success (e.g. trust building, engagement). However, poor use of process evaluation frameworks or guidelines resulted in wide variations of how process evaluations are conducted and reported, which made findings difficult to integrate and standardize with consistency. Accordingly, this review provides a guide on how future process evaluations can be conducted to improve health-promotion interventions' transparency, replicability and reliability in real-world settings.

Exploring Continuum and Categorical Conceptualisations of Mental Health and Mental Illness on Australian Websites: A Systematic Review and Content Analysis.

It is important to explore the types of conceptualisations and causes presented in online mental health promotion given the implications that these presentations may have on mental health stigma. This study systematically reviewed 92 Australian webpages focused on either mental health, mental illness, depression, or schizophrenia, to explore the types of conceptualisations and aetiologies presented. A minority of mental health and mental illness webpages (n = 8, 8.70%) explicitly presented continuum conceptualisations, with none providing explicit categorical conceptualisations. No depression or schizophrenia webpages presented explicit conceptualisations of any kind. All four webpage foci had a greater proportion of continuum than categorical conceptualisations. Moreover, both depression and schizophrenia webpages presented many mixed conceptualisations which included both continuum and categorical messaging. Most webpages mentioned biological and social causes equally across webpage foci. These findings suggest that Australian mental health websites predominantly present continuum conceptualisations of mental health and mental illness.

Is prosocial behaviour a missing link between green space quality and child health-related outcomes?

BACKGROUND: This study aimed to investigate prosocial behaviour-those behaviours that benefit others or enhance relationships with others-as a mediator of the associations between green space quality and child health-related outcomes (physical activity, mental health, and health-related quality of life (HRQOL)). METHODS: This study involved data from 4983 children with 10-year follow-up (2004-2014) retrieved from the Longitudinal Study of Australian Children. Green space quality (the exposure), prosocial behaviour (the candidate mediator), and child health-related outcomes were assessed biennially based on caregiver reports. Causal mediation analysis was used, with four mediation models developed for each outcome. RESULTS: Mediation by prosocial behaviour appeared in the late childhood mediation model with higher mediation proportions reported compared to models of earlier and middle childhood. Prosocial behaviour had moderate mediation consistency for the association between green space quality and physical activity enjoyment, but no mediation was evident for other physical activity variables. Prosocial behaviour had low mediation consistency for child mental health (internalising and externalising subscales). Similarly, low mediation consistency of prosocial behaviour was also evident for all HRQOL variables, such as physical, emotional, social, school functioning, psychosocial health, and total quality of life (QOL). CONCLUSION: Prosocial behaviour partially mediated the association between green space quality and child health-related outcomes (physical activity enjoyment, mental health, and HRQOL). Improving the quality of neighbourhood green space that supports the development of prosocial behaviour may result in better child health-related outcomes. Other physical activity variables might not specifically relate to social interactions, and therefore, no mediation by prosocial behaviour was apparent.

Association between green space quality and prosocial behaviour: A 10-year multilevel longitudinal analysis of Australian children.

BACKGROUND: Current evidence from studies on green space and child prosocial behaviour suggests a paucity of studies investigating the plausible role of green space quality in shaping the development of prosocial behaviour. This study aimed to examine longitudinal association between green space quality and prosocial behaviour among children. METHODS: We analysed 10-year longitudinal data (2004-2014) from the Longitudinal Study of Australian Children (LSAC), a nationally representative cohort study. Prosocial behaviour that covers positive behaviours (e.g. sharing, helping) was measured using a prosocial scale from Goodman's Strengths and Difficulties Questionnaire (SDQ). Parents' perceptions on the availability of "good" parks, playgrounds, and play space in the neighbourhood assessed green space quality. Multilevel linear regression models were used to examine potential changes in prosocial behaviour across childhood in relation to green space quality. A two-way interaction term between green space and age was fitted to assess potential differences in the effect of green space quality by age. Sensitivity analyses by child's sex and history of residential movement were also performed. RESULTS: From the analysis of 24,418 observations nested in 4969 children, prosocial behaviour was relatively high (mean = 8.13 out of 10; SD = 1.79) and about balanced proportions between girls (48.74%) and boys (51.26%) were included. Prosocial behaviour was higher among children whose parents agreed (ß = 0.10; 95%CI = 0.04, 0.16) and strongly agreed (ß = 0.20; 95%CI = 0.13, 0.27) to having quality green space in their neighbourhood. The benefit of exposure to favourable green space on prosocial behaviour was similar among both children who changed and did not change neighbourhood, but reported higher among boys than girls. Younger compared with older children or adolescents tended to benefit more by the presence of quality green space. CONCLUSION: Green space quality was positively associated with child prosocial behaviour. Boys and younger children tended to benefit more from quality green space. Future research might seek to identify preferred characteristics of quality green spaces, and to understand how these preferences vary by gender and age, to best support the development of prosocial behaviour across childhood and adolescence.

Profiles of mental health help seeking among Australian adolescent males.

INTRODUCTION: Adolescent males are at increased risk of mental illness and are reluctant to engage in treatment. This study aims to identify subgroups of help-seeking intentions among a sample of Australian male adolescents. METHODS: A sample of 1038 male adolescent sport participants in Australia (age M = 14.69 years, SD = 1.35) reported help-seeking intentions from ten sources and from 'no one'. Latent profile analysis was conducted based on these 11 items. Identified profiles were then compared across mental health measures. RESULTS: Four latent profiles were identified: Low general help-seekers (10.5%), Moderate general help-seekers (46.8%), High general help-seekers (25.5%), High family and friends help-seekers (17.2%). Low, Moderate, and High general help-seekers had uniformly low, moderate, and high intentions to seek help from all sources, respectively. High family and friends help-seekers reported high endorsement of intentions to seek help from intimate partners, friends, parents, and other relatives, but low intentions for other sources. Low general help-seekers had lower intentions to seek help from parents compared to all other profiles. They also had significantly lower perceived family support and higher psychological distress. CONCLUSIONS: Low general help-seekers were particularly reluctant to seek help from all sources and at high risk of experiencing psychological difficulties. Their distinct profile offers potential to identify this high-risk group through the use of ratings on the parent help-seeking intentions item. Further research should investigate the predictive utility of this item on help-seeking and mental health, and should consider the influence of masculinity and previous experiences of help-seeking.

Extraversion development in childhood, adolescence and adulthood: Testing the role of sport participation in three nationally-representative samples.

This research sought to test whether sport participation relates to the development of trait extraversion across three life phases. Sport participation and extraversion were measured in children aged 10.5 ± 0.5 years (n = 3600), in adolescents aged 14.5 ± 0.5 years (n = 3463), and in adults with a mean age of 49.4 ± 18.0 years (n = 12,280), with corresponding data collected four years earlier. There were small mean-level decreases in extraversion during childhood and adulthood, and a large decrease in extraversion during adolescence. Four-year rank-order stability in extraversion was .58 in childhood, .61 in adolescence and .76 in adulthood. Sport participation was associated with higher extraversion in all three samples. After controlling for sociodemographic factors, children and adolescents who dropped out of sport showed greater decreases in extraversion than those who continued participation in sport. Sport participation was unrelated to mean-level change in extraversion during adulthood. Sport participation was also associated with greater intra-individual stability in extraversion for children, adolescents and adults. There were no significant sex moderation effects for mean-level change or individual-level stability. These findings provide evidence that sport participation might have an important role in trait extraversion stability and change across the lifespan.

A Matched Control Trial of a Mental Health Literacy Intervention for Parents in Community Sports Clubs.

This controlled trial evaluated the effectiveness of a mental health literacy intervention for parents delivered through community sport clubs. In total, 540 parents (321 females, 219 males) of adolescent athletes participated in a brief educational workshop on youth mental health (n = 352) or a community-matched control group (n = 188). Generalised linear mixed models revealed no significant improvements in the intervention group compared to control in the primary mental health literacy outcomes, at 1 month follow-up. However, parents in the intervention group were more likely to seek formal help for themselves, had increased confidence and knowledge to help someone experiencing a mental health disorder, experienced reduced psychological distress, and perceived more support from other parents in their sport club, relative to the control group. Overall, the findings suggest that a brief educational intervention delivered through community sports clubs can positively affect some components of parents' mental health literacy.

Prospective Associations between Sport Participation and Indices of Mental Health across Adolescence.

Youth sport offers physical and psychosocial components that may be beneficial for adolescents' mental health, but the prospective directionality between sport participation and mental health has not been clearly established. The current study examined longitudinal associations between sport participation (individual and team sport) and mental health indices (depressive symptoms, anxiety symptoms, emotional symptoms, hyperactivity symptoms, conduct problems, peer problems, and prosocial behavior) across adolescence (ages 12-17) in a nationally representative Australian sample of 3956 participants at T1 (Mage = 12.41 years, SD = 0.49; 49% female), 3537 at T2 (Mage = 14.41 years, SD = 0.49; 49% female), and 3089 at T3 (Mage = 16.46 years, SD = 0.51; 49% female). Using random intercept cross-lagged panel modeling, several significant within-person effects were found. Notably, greater participation in team sport prospectively predicted fewer symptoms of depression and anxiety at subsequent timepoints. This study increases the understanding of how sport participation may relate to mental health among adolescents and provides critical evidence to inform policy.

Longitudinal associations of physical activity and modified organized sport participation with executive function and psychosocial health in preschoolers.

To examine the longitudinal associations of objectively measured physical activity and modified organized sport participation with executive functions and psychological health in preschoolers. One hundred and eighty-five preschool children, mean age 4.2 ± 7.68; (years:months), 34% girls were followed for one year. Physical activity was measured using accelerometery, examining light, moderate, vigorous, moderate-to-vigorous, and total physical activity. Parents reported children's participation in modified organized sport. Direct assessment of children's executive functions (working memory, inhibition and shifting) and educator-reported psychosocial difficulties were also collected. Associations were examined using linear regression adjusting for covariates, baseline developmental outcomes and preschool clustering. Vigorous physical activity at baseline was positively associated with children's shifting performance (b = 0.245; 95% CI: 0.006, 0.485, p =.045) at follow-up, while the association for moderate-to-vigorous physical activity approached significance (b = 0.119; 95% CI: -0.001, 0.239, p =.051). Children not participating in modified organized sport at baseline demonstrated better inhibition scores 12-months later compared to sports participants (Mdiff 0.06; CI: 0.00, 0.13, p =.046). Increasing time spent in higher intensity physical activity among preschool children may be a viable target for supporting their later cognitive development, although there was no clear benefit of early participation in modified organized sport.

A Systematic Review of Parent and Caregiver Mental Health Literacy.

This study aimed to systematically review the current body of research on parent and caregiver mental health literacy. Electronic databases were searched in January 2018 with 21 studies meeting inclusion criteria. A narrative synthesis of quantitative and qualitative studies was conducted. Findings across studies suggest that parents and caregivers had limited mental health knowledge. Factors associated with help-seeking included cultural and religious beliefs, financial and knowledge barriers, fear and mistrust of treatment services, and stigma. Notable limitations include non-representative samples, cross-sectional research designs, and use of inconsistent and non-validated study measures. Research would benefit from more diverse samples, an increased focus on prevention, and controlled trials of educational programmes targeting mental health literacy.

Adolescent Sport Participation and Symptoms of Anxiety and Depression: A Systematic Review and Meta-Analysis.

Sport may protect against symptoms of mental disorders that are increasingly prevalent among adolescents. This systematic review explores the relationship between adolescent organized sport participation and self-reported symptoms of anxiety and depression. From 9,955 records screened, 29 unique articles were selected that included 61 effect sizes and 122,056 participants. Effects were clustered into four categories based on the operationalization of sport involvement: absence or presence of involvement, frequency of involvement, volume of involvement, and duration of participation. Results from the random-effects meta-analyses indicated that symptoms of anxiety and depression were significantly lower among sport-involved adolescents than in those not involved in sport, although this effect size was small in magnitude. Meta-regression was used to identify how age and sex explained heterogeneity in effects. Although these results do not signify a causal effect, they do support theorizing that sport participation during adolescence may be a protective environment against anxiety and depressive symptoms.

Motivational-general arousal imagery does not improve decision-making performance in elite endurance cyclists.

Emotions are predicted to influence judgement and decision-making across a range of performance contexts. This experiment tested whether motivational-general arousal imagery can improve the decision-making performance of elite endurance cyclists. In total, 54 cyclists (38 men, 16 women) were assigned to either a positive imagery condition (where positive images associated with the affective experience of winning were encouraged) or a negative imagery condition (where negative images associated with poor performance were encouraged). The cyclists were read one of two scripts designed to elicit positive or negative images during a 20-min maximal sustainable interval on a cycle ergometer. A decision-making task (colour-word match Stroop) was performed before and immediately after the maximal sustainable power interval. Results showed that the manipulation was successful with cyclists in the positive imagery condition reporting more positive affective states (higher levels of happiness and lower levels of dejection) than those in the negative imagery condition. However, there was no significant difference between the two groups in their decision-making performance under physiological duress. These findings indicate that while motivational-general arousal imagery might be a useful method to induce positive emotions during exercise, it is unlikely to improve the decision-making performance of cyclists in performance-relevant conditions.

Response: Sports participation and interventions to reduce risk of mental health problems during childhood: a response to Crowell (2018).

One of the most salient purposes of examining the potential existence and predictors of distinct trajectories of mental health during childhood is to enable effective prevention and intervention strategies. More specifically, the aim is to inform an understanding of the types of prevention and intervention strategies that may be effective in reducing risk, as well the time period in which such strategies are going to be most beneficial.

Trajectories and predictors of risk for mental health problems throughout childhood.

BACKGROUND: Children fluctuate in their risk for mental health-related problems. While children have demonstrated consistent trajectories for various types of mental health problems, the existence of developmental trajectories of overall risk of mental health problems has not been explored. This study aimed to identify distinct trajectories of overall mental health risk among children from ages 4-12 years. A secondary objective was to identify predictors of the mental health risk trajectories. METHOD: Data from the first five waves of the Longitudinal Study of Australian Children (LSAC) were used to assess mental health risk and potential predictors. The primary parent (n = 3717) completed questionnaires, time-use diaries, and face-to-face interviews over the five waves. Growth mixture modeling was used to identify distinct latent trajectories of mental health risk. Multinomial logistic regression was used to identify predictors of the trajectories. RESULTS: Six distinct trajectories of mental health risk were identified: Low Difficulty (72.9%), Improvers (9.7%), Decliners (7.9%), Early Decliners/Late Improvers (4.7%), Early Improvers/Late Decliners (2.7%), and High Difficulty (2.2%). Child sex, sociability, parental warmth, sports participation, and household income were identified as significant predictors of mental health trajectories. CONCLUSIONS: There are distinct trajectories of overall risk for mental health problems during childhood. Research should focus on the High Difficulties group and the Early Improvers/Late Decliners group to address the predictors and improve access to early mental health services.

Ahead of the game protocol: a multi-component, community sport-based program targeting prevention, promotion and early intervention for mental health among adolescent males.

BACKGROUND: There is a recognised need for targeted community-wide mental health strategies and interventions aimed specifically at prevention and early intervention in promoting mental health. Young males are a high need group who hold particularly negative attitudes towards mental health services, and these views are detrimental for early intervention and help-seeking. Organised sports provide a promising context to deliver community-wide mental health strategies and interventions to adolescent males. The aim of the Ahead of the Game program is to test the effectiveness of a multi-component, community-sport based program targeting prevention, promotion and early intervention for mental health among adolescent males. METHODS: The Ahead of the Game program will be implemented within a sample drawn from community sporting clubs and evaluated using a sample drawn from a matched control community. Four programs are proposed, including two targeting adolescents, one for parents, and one for sports coaches. One adolescent program aims to increase mental health literacy, intentions to seek and/or provide help for mental health, and to decrease stigmatising attitudes. The second adolescent program aims to increase resilience. The goal of the parent program is to increase parental mental health literacy and confidence to provide help. The coach program is intended to increase coaches' supportive behaviours (e.g., autonomy supportive behaviours), and in turn facilitate high-quality motivation and wellbeing among adolescents. Programs will be complemented by a messaging campaign aimed at adolescents to enhance mental health literacy. The effects of the program on adolescent males' psychological distress and wellbeing will also be explored. DISCUSSION: Organised sports represent a potentially engaging avenue to promote mental health and prevent the onset of mental health problems among adolescent males. The community-based design, with samples drawn from an intervention and a matched control community, enables evaluation of adolescent males' incremental mental health literacy, help-seeking intentions, stigmatising attitudes, motivation, and resilience impacts from the multi-level, multi-component Ahead of the Game program. Notable risks to the study include self-selection bias, the non-randomised design, and the translational nature of the program. However, strengths include extensive community input, as well as the multi-level and multi-component design. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12617000709347 . Date registered 17 May 2017. Retrospectively registered.

The psychology of elite cycling: a systematic review.

This systematic review sought to synthesise what is currently known about the psychology of elite cycling. Nine electronic databases were searched in March 2017 for studies reporting an empirical test of any psychological construct in an elite cycling sample. Fourteen studies (total n = 427) met inclusion criteria. Eight studies were coded as having high risk of bias. Themes extracted included mood, anxiety, self-confidence, pain, and cognitive function. Few studies had similar objectives meaning that in many instances findings could not be synthesised in a meaningful way. Nevertheless, there was some cross-study evidence that elite cyclists have more positive mood states (relative to normative scores), pre-race anxiety impairs performance (among male cyclists), and associative strategies are perceived as helpful for pain management. Among single studies coded as having low risk of bias, evidence suggests that implicit beliefs affect decision making performance, elite cyclists are less susceptible to mental fatigue (than non-elite cyclists), and better leadership skills relates to greater social labouring. Limitations include non-standardisation of measures, lack of follow-up data, small sample sizes, and overall poor research quality. The findings of this systematic review might be used to inform research and theory development on the psychology of elite endurance cycling.

Adherence to 24-Hour Movement Guidelines for the Early Years and associations with social-cognitive development among Australian preschool children.

BACKGROUND: The new Australian 24-Hour Movement Guidelines for the Early Years recommend that, for preschoolers, a healthy 24-h includes: i) ≥180 min of physical activity, including ≥60 min of energetic play, ii) ≤1 h of sedentary screen time, and iii) 10-13 h of good quality sleep. Using an Australian sample, this study reports the proportion of preschool children meeting these guidelines and investigates associations with social-cognitive development. METHODS: Data from 248 preschool children (mean age = 4.2 ± 0.6 years, 57% boys) participating in the PATH-ABC study were analyzed. Children completed direct assessments of physical activity (accelerometry) and social cognition (the Test of Emotional Comprehension (TEC) and Theory of Mind (ToM)). Parents reported on children's screen time and sleep. Children were categorised as meeting/not meeting: i) individual guidelines, ii) combinations of two guidelines, or iii) all three guidelines. Associations were examined using linear regression adjusting for child age, sex, vocabulary, area level socio-economic status and childcare level clustering. RESULTS: High proportions of children met the physical activity (93.1%) and sleep (88.7%) guidelines, whereas fewer met the screen time guideline (17.3%). Overall, 14.9% of children met all three guidelines. Children meeting the sleep guideline performed better on TEC than those who did not (mean difference [MD] = 1.41; 95% confidence interval (CI) = 0.36, 2.47). Children meeting the sleep and physical activity or sleep and screen time guidelines also performed better on TEC (MD = 1.36; 95% CI = 0.31, 2.41) and ToM (MD = 0.25; 95% CI = -0.002, 0.50; p = 0.05), respectively, than those who did not. Meeting all three guidelines was associated with better ToM performance (MD = 0.28; 95% CI = -0.002, 0.48, p = 0.05), while meeting a larger number of guidelines was associated with better TEC (3 or 2 vs. 1/none, p < 0.02) and ToM performance (3 vs. 2, p = 0.03). CONCLUSIONS: Strategies to promote adherence to the 24-Hour Movement Behaviour Guidelines for the Early Years among preschool children are warranted. Supporting preschool children to meet all guidelines or more guidelines, particularly the sleep and screen time guidelines, may be beneficial for their social-cognitive development.

Performing under pressure: Exploring the psychological state underlying clutch performance in sport.

Clutch performance is improved performance under pressure. However, little research has examined the psychological state experienced by athletes in these situations. Therefore, this study qualitatively examined the subjective experience underlying clutch performance across a range of sports (e.g., team, individual) and standards (Olympic to recreational athletes). Sixteen athletes (Mage = 27.08 years; SD = 6.48) took part in in-depth, semi-structured interviews primarily after an exceptional performance (M = 4.38 days later; SD = 3.14). Data were analysed inductively and thematically. Clutch states involved 12 characteristics, including heightened and deliberate concentration, intense effort, and heightened awareness, which distinguished the experience of clutch from other optimal psychological states such as flow. Other characteristics, such as perceptions of control, were also reported and supported previous experimental research on clutch. These findings present in-depth qualitative insights into the psychological state underlying clutch performance, and are discussed in relation to the existing literature on optimal psychological states in sport.

Social climate profiles in adolescent sports: Associations with enjoyment and intention to continue.

This study explored whether adolescent sports participants' perceptions of the social climate fall into distinct profiles, and whether these profiles are related to enjoyment and intention to continue. A Latent Profile Analysis using 313 Australian sports participants (Mage = 13.03 years) revealed four distinct profiles: positive social climate (45.1%), diminished social climate (19.8%), positive coach relationship quality (19.8%), and positive friendship quality (15.3%). Individuals within the positive social climate and the positive coach relationship quality profiles reported relatively higher levels of enjoyment and intention to continue than individuals in the diminished social climate and the positive friendship quality profiles. Indirect path analyses found the social climate profiles were linked with intention to continue through enjoyment. Results highlight the value of investigating multiple dimensions of the social climate and suggest that the coach may be of particular importance in this age group. Findings have implications for understanding youth sports participation and preventing dropout.

Trajectories and Predictors of Health-Related Quality of Life during Childhood.

OBJECTIVE: To identify distinct trajectories of health-related quality of life (HRQOL) during childhood, along with their predictors. STUDY DESIGN: A nationally representative sample of 2700 children aged 4-5 years at baseline was followed up every 24 months through to age 12-13 years. Parents reported the children's HRQOL and data on potential predictors at each wave (5 in total) as part of the Longitudinal Study of Australian Children. RESULTS: Growth mixture modeling identified 5 distinct trajectories of HRQOL during childhood. Eighty-five percent of children had consistently high levels of HRQOL from age 4-5 years to 12-13 years (healthy); 8% of children had a significant and continuous decrease in HRQOL over time (high risk); and a further 5.3% of children had decreases in HRQOL from age 4-5 years to 8-9 years, followed by increases through to 12-13 years (rebound). Finally, a small percentage (1.6%) of children had extremely low levels of HRQOL at age 4-5 years that increased over time (recovery). Maternal smoking, lower household income, living in a non-English speaking household, and nonparticipation in organized sports were predictive of poorer HRQOL trajectories when compared with children in the healthy trajectory. CONCLUSION: There are distinct trajectories of HRQOL during childhood. Most children (85%) have a healthy, stable pattern, but the remaining children have trajectories indicative of poor HRQOL. Participation in sports, maternal smoking, lower family income, and language spoken at home distinguish among these trajectories. Of these, participation in organized sports has received relatively little attention as a preventative health priority.