What are Digital Public Health Interventions? First Steps Toward a Definition and an Intervention Classification Framework.

Digital public health is an emerging field in population-based research and practice. The fast development of digital technologies provides a fundamentally new understanding of improving public health by using digitalization, especially in prevention and health promotion. The first step toward a better understanding of digital public health is to conceptualize the subject of the assessment by defining what digital public health interventions are. This is important, as one cannot evaluate tools if one does not know what precisely an intervention in this field can be. Therefore, this study aims to provide the first definition of digital public health interventions. We will merge leading models for public health functions by the World Health Organization, a framework for digital health technologies by the National Institute for Health and Care Excellence, and a user-centered approach to intervention development. Together, they provide an overview of the functions and areas of use for digital public health interventions. Nevertheless, one must keep in mind that public health functions can differ among different health care systems, limiting our new framework's universal validity. We conclude that a digital public health intervention should address essential public health functions through digital means. Furthermore, it should include members of the target group in the development process to improve social acceptance and achieve a population health impact.

Digitization and Health in Germany: Cross-sectional Nationwide Survey.

BACKGROUND: Digital technologies are shaping medicine and public health. OBJECTIVE: The aim of this study was to investigate the attitudes toward and the use of digital technologies for health-related purposes using a nationwide survey. METHODS: We performed a cross-sectional study using a panel sample of internet users selected from the general population living in Germany. Responses to a survey with 28 items were collected using computer-assisted telephone interviews conducted in October 2020. The items were divided into four topics: (1) general attitudes toward digitization, (2) COVID-19 pandemic, (3) physical activity, and (4) perceived digital health (eHealth) literacy measured with the eHealth Literacy Scale (eHEALS; sum score of 8=lowest to 40=highest perceived eHealth literacy). The data were analyzed in IBM-SPSS24 using relative frequencies. Three univariate multiple regression analyses (linear or binary logistic) were performed to investigate the associations among the sociodemographic factors (age, gender, education, and household income) and digital technology use. RESULTS: The participants included 1014 internet users (n=528, 52.07% women) aged 14 to 93 years (mean 54, SD 17). Among all participants, 66.47% (674/1014) completed up to tertiary (primary and secondary) education and 45.07% (457/1017) reported a household income of up to 3500 Euro/month (1 Euro=US $1.18). Over half (579/1014, 57.10%) reported having used digital technologies for health-related purposes. The majority (898/1014, 88.56%) noted that digitization will be important for therapy and health care, in the future. Only 25.64% (260/1014) reported interest in smartphone apps for health promotion/prevention and 42.70% (433/1014) downloaded the COVID-19 contact-tracing app. Although 52.47% (532/1014) reported that they come across inaccurate digital information on the COVID-19 pandemic, 78.01% (791/1014) were confident in their ability to recognize such inaccurate information. Among those who use digital technologies for moderate physical activity (n=220), 187 (85.0%) found such technologies easy to use and 140 (63.6%) reported using them regularly (at least once a week). Although the perceived eHealth literacy was high (eHEALS mean score 31 points, SD 6), less than half (43.10%, 400/928) were confident in using digital information for health decisions. The use of digital technologies for health was associated with higher household income (odds ratio [OR] 1.28, 95% CI 1.11-1.47). The use of digital technologies for physical activity was associated with younger age (OR 0.95, 95% CI 0.94-0.96) and more education (OR 1.22, 95% CI 1.01-1.46). A higher perceived eHealth literacy score was associated with younger age (ß=-.22, P<.001), higher household income (ß=.21, P<.001), and more education (ß=.14, P<.001). CONCLUSIONS: Internet users in Germany expect that digitization will affect preventive and therapeutic health care in the future. The facilitators and barriers associated with the use of digital technologies for health warrant further research. A gap exists between high confidence in the perceived ability to evaluate digital information and low trust in internet-based information on the COVID-19 pandemic and health decisions.

Mediating Effects of Mental Health Problems in a Clinical Sample of Adolescents with Obesity.

INTRODUCTION: The prevalence rates of obesity have increased in recent decades; despite leveling off in recent German studies among children and adolescents, obesity rates remain high. Psychosocial factors have an adverse impact on the maintenance of obesity. Hence, this study examined the mediating effects of mental health problems on the relation between the body mass index standard deviation score (BMI-SDS) and global health-related quality of life (HRQoL) among adolescent inpatients with obesity while controlling for gender and age-group. METHODS: Three simple mediation analyses with gender and age-group as covariates were conducted for n = 313 adolescents with obesity (nfemale = 193, 61.7%) aged 12-17 (M = 14.19, SD = 1.52; BMI-SDS: M = 2.67, SD = 0.52). The adolescents were asked to report their global HRQoL at admission, and their parents estimated the children's mental health problems at home prior to inpatient rehabilitation. RESULTS: Emotional, peer-related, and conduct problems mediated the unfavorable effects of BMI-SDS on global HRQoL, showing high, moderate, and small effect sizes, respectively (completely standardized indirect effect of emotional problems: ß = -0.09, SE = 0.03, 95% B-CI = -0.15 to -0.04; conduct problems: ß = -0.03, SE = 0.02, 95% B-CI = -0.06 to -0.01; peer-related problems: ß = -0.10, SE = 0.03, 95% B-CI = -0.16 to -0.05). CONCLUSION: Mental health problems may be one salient pathway through which BMI-SDS impairs global HRQoL among adolescents with obesity. Hence, inpatient rehabilitation programs for adolescents with obesity should increase their focus more on the development of psychosocial skills. Thus, the promotion of emotion regulation and social-emotional competencies is suggested.

Implementing Health Apps for Digital Public Health - An Implementation Science Approach Adopting the Consolidated Framework for Implementation Research.

Apps are becoming an increasingly important component of modern Public Health and health care. However, successful implementation of apps does not come without challenges. The Consolidated Framework for Implementation Research (CFIR) provides a central typology to support the development of implementation theories and the examination of what works where and why in different contexts. The framework offers a reasonable structure for managing complex, interacting, multi-level, and transient states of constructs in the real world: It draws on constructs from other implementation theories and might be used to conduct formative evaluations or build a common body of knowledge for implementation thru various studies and settings. In a synthesis of the original English language text describing the CFIR, an attempt was made to break the constructs down into the shortest possible concise descriptions for the implementation of health care apps in a structured, selective process. The listed key constructs should help to develop successful implementation plans and models for health apps and show the complexity of a successful implementation. As a perspective article, the aim of the current piece is to present a viewpoint on using the CFIR as a potential support for implementing health apps.

An 8-Week Study on Social-Cognitive Variables for Physical Activity and Fruit and Vegetable Intake: Are there Stage Transitions?

BACKGROUND: Health behavior change can be modelled in terms of stages, and outcomes of transitions between stages can be categorized into progression, regression, and stagnation. Based on the Health Action Process Approach this study tested whether changes in social-cognitive variables are associated with transitions between stages regarding physical activity (PA) and fruit and vegetable intake (FVI). METHODS: N = 132 participants (M = 50.86 years, SD = 13.17, 61.4% women) were assessed at baseline and 8 weeks later. Data were analysed using multivariate analyses of variance (MANOVA) and post-hoc comparisons. RESULTS: Changes in motivational self-efficacy (η2  = 0.081), maintenance self-efficacy (η2  = 0.119), and recovery self-efficacy (η2  = 0.049) as well as positive outcome expectancies (η2  = 0.070), negative outcome expectancies (η2  = 0.055), and coping planning (η2  = 0.065) were associated with FVI stage progression. For PA, changes were not associated with stage progression. CONCLUSION: To facilitate behavior change effectively, at least for FVI, it is essential to consider underlying mechanisms such as several aspects of self-efficacy in performing the desired health behaviors, outcome expectations, and planning how to overcome barriers. Additionally, the adoption of a stage approach may be a useful starting point to develop stage-matched interventions.

[Contact-Tracing Apps in Contact Tracing of COVID-19]. / Contact-Tracing-Apps als unterstützende Maßnahme bei der Kontaktpersonennachverfolgung von COVID-19.

Contact tracing is currently one of the most effective measures to contain the COVID-19 pandemic. In order to identify persons that would otherwise not be known or remembered and to keep the time delay when reporting an infection and when contacting people as short as possible, digital contact tracing using smartphones seems to be a reasonable measure additional to manual contact tracing. Although first modelling studies predicted a positive effect in terms of prompt contact tracing, no empirically reliable data are as yet available, neither on the population-wide benefit nor on the potential risks of contact tracing apps. Risk-benefit assessment of such an app includes investigating whether such an app fulfils its purpose, as also research on the effectiveness, risks and side effects, and implementation processes (e. g. planning and inclusion of different participants). The aim of this article was to give an overview of possible public health benefits as well as technical, social, legal and ethical aspects of a contact-tracing app in the context of the COVID-19 pandemic. Furthermore, conditions for the widest possible use of the app are presented.

Long-term physical activity in people with multiple sclerosis: exploring expert views on facilitators and barriers.

Purpose: To explore the views of experts on facilitators and barriers of long-term physical activity among people with multiple sclerosis living in different European countries.Methods: We conducted semi-structured telephone or face to face interviews with twelve multiple sclerosis and physical activity experts (scientists, practitioners, patient representatives) from five European countries. Interviews were audio-recorded, transcribed verbatim and analyzed using thematic analysis.Results: We identified 20 themes and categorized them into environmental and personal factors. The most frequently mentioned and intensively discussed themes were environmental factors. The themes were structured according to possible intervention level: organizational, interpersonal and intrapersonal level themes. Themes at the organizational level comprised availability, access and quality of exercise/physical activity options; health system characteristics like services and organization, health professionals and information provision. The interpersonal level comprised social support and peer support. Disease related factors were the most frequently mentioned intrapersonal level theme. In our study, more codes were obtained for environmental factors than for personal factors.Conclusions: The results suggested that environmental factors may need to be addressed in particular to increase long-term physical activity adherence. This study will inform the design of a survey questionnaire assessing possible barriers and facilitators among people with multiple sclerosis. Implications for rehabilitationLong-term physical activity among people with multiple sclerosis is subject to a number of modifiable determinants: personal and environmental factors.Multiple sclerosis exercise experts emphasized the importance of environmental factors on the organizational and interpersonal level.Future physical activity interventions should be guided by a social-ecological perspective.Addressing environmental and personal factors simultaneously to reach optimal long-term outcomes should be considered in future interventions.

[Psychological Measures and BMI-SDS among Adolescents with Obesity and Different Motivational Stages in Inpatient Rehabilitation]. / Psychologische Kennwerte und BMI-SDS bei Jugendlichen mit Adipositas und unterschiedlichen Motivationsstadien in der stationären Rehabilitation.

PURPOSE: Obesity is strongly represented in adolescents, showing a high persistency until adulthood. Previous studies displayed short term effects of inpatient rehabilitation, but failed to demonstrate sustainability. Long-term effects might be expected when taking the motivational stage of adolescents into account. However, there is no evidence regarding motivational stages in obese adolescents in German inpatient rehabilitation. The current study investigated psychological measures and the Body-Mass-Index-standard deviation score (BMI-SDS) in obese adolescents related to motivational stages and age. METHODS: A total sample of n=127 adolescents were included in this cross-sectional study during their inpatient rehabilitation intake. Differences in BMI-SDS and self-reported psychological health were analyzed using 2-way analysis of covariance with the factors motivational stage (intender vs. actor) and age (12-14 vs. 15-17 years), and the covariate gender. Motivational stages were assessed using the newly developed questionnaire to classify motivational stages (Fragebogen zur Einteilung in Motivationsstadien; MoS). RESULTS: Intenders reported unfavorable disease management and volitional parameters. Younger participants reported a lower BMI-SDS as well as lower motivational and volitional parameters. A risk profile emerged for younger intenders which was characterized by psychological problems. CONCLUSION: The results provide important insights for the design of motivational stage-based training programs and underpin the need for age-specific therapies during adolescence.

Communication and patient safety in gynecology and obstetrics - study protocol of an intervention study.

BACKGROUND: Patient safety is a key target in public health, health services and medicine. Communication between all parties involved in gynecology and obstetrics (clinical staff/professionals, expectant mothers/patients and their partners, close relatives or friends providing social support) should be improved to ensure patient safety, including the avoidance of preventable adverse events (pAEs). Therefore, interventions including an app will be developed in this project through a participatory approach integrating two theoretical models. The interventions will be designed to support participants in their communication with each other and to overcome difficulties in everyday hospital life. The aim is to foster effective communication in order to reduce the frequency of pAEs. If communication is improved, clinical staff should show an increase in work satisfaction and patients should show an increase in patient satisfaction. METHODS: The study will take place in two maternity clinics in Germany. In line with previous studies of complex interventions, it is divided into three interdependent phases. Each phase provides its own methods and data. Phase 1: Needs assessment and a training for staff (n = 140) tested in a pre-experimental study with a pre/post-design. Phase 2: Assessment of communication training for patients and their social support providers (n = 423) in a randomized controlled study. Phase 3: Assessment of an app supporting the communication between staff, patients, and their social support providers (n = 423) in a case-control study. The primary outcome is improvement of communication competencies. A range of other implementation outcomes will also be assessed (i.e. pAEs, patient/treatment satisfaction, work satisfaction, safety culture, training-related outcomes). DISCUSSION: This is the first large intervention study on communication and patient safety in gynecology and obstetrics integrating two theoretical models that have not been applied to this setting. It is expected that the interventions, including the app, will improve communication practice which is linked to a lower probability of pAEs. The app will offer an effective and inexpensive way to promote effective communication independent of users' motivation. Insights gained from this study can inform other patient safety interventions and health policy developments. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03855735; date of registration: February 27, 2019.

Work-Related Medical Rehabilitation in Cancer: A Cluster-Randomized Multicenter Study.

BACKGROUND: Current guidelines recommend rehabilitative measures to alleviate dis- turbances resulting from cancer and its treatment. To give cancer survivors further assistance in getting back to work, work-related medical rehabilitation is currently being tested in Germany. In this cluster-randomized, multicenter trial, we studied the efficacy of work-related medical rehabilitation compared with conventional medical rehabilitation (trial no. DRKS00007770 in the German Clinical Trials Registry). METHODS: A total of 484 cancer survivors of working age who were candidates for rehabilitation were recruited and assigned at random to either the intervention group (IG; work-related medical rehabilitation) or the control group (CG). The primary end- point was self-assessed function in a role one year after the end of rehabilitation, as evaluated with the health-related quality of life questionnaire of the European Organisation for Research and Treatment of Cancer (EORTC QLQ-C30). Further endpoints included symptom and function scales, subjective ability to work, coping with illness, and return to work. Neither the medical personnel nor the subjects were blinded. RESULTS: One year after the end of rehabilitation, data from 379 subjects who par- ticipated in the last follow-up survey were evaluated. The intervention and control groups did not differ significantly either in the primary endpoint of role function (IG = 60.8 vs. CG = 57.6 out of a maximum of 100 points; p = 0.204) or in any of the secondary endpoints. A last observation carried forward analysis yielded com- parable results. At 12 months, 28.5% of the subjects in the IG and 25.3% of those in the CG were still unable to work. CONCLUSION: This study did not reveal any significant clinically relevant advantage of work-related medical rehabilitation at one year. Future studies should determine whether a second period of rehabilitation might be helpful and whether selected subjects might benefit from the assistance of case managers beyond the period of rehabilitation.

Profiles of physical activity biographies in relation to life and aging satisfaction in older adults: longitudinal findings.

BACKGROUND: While there is substantial evidence on the relationship between life satisfaction and present physical activity (PA), less is known about which specific PA biographies are associated with a high quality of life and aging satisfaction. Our objective was to identify classes of PA biographies that may be associated with life and aging satisfaction. METHODS: In this longitudinal study, PA biographies were assessed retrospectively as a baseline, followed by assessments of life and aging satisfaction at six and twelve months in 418 adults aged 60-95. Subgroups with different PA biographies were identified using latent class analysis. RESULTS: Four distinct PA biographies emerged: increasingly active (35%; n = 147); consistently active (25%; n = 103); consistently inactive (18%; n = 75); and decreasingly active (22%; n = 94). Being consistently active was related to life satisfaction (ß = .17) and consistent inactivity was associated with aging dissatisfaction (ß = -.20) when accounting for current PA levels. CONCLUSIONS: In addition to current PA, our findings emphasize the value of PA biographies for life and aging satisfaction, which could inform lifespan theories of PA and health promotion.

Work-related medical rehabilitation in patients with cancer-Postrehabilitation results from a cluster-randomized multicenter trial.

BACKGROUND: Effective multidisciplinary rehabilitation programs supporting the return to work have become increasingly relevant for cancer survivors. In Germany, inpatient work-related medical rehabilitation programs consider treatment modules of work-related diagnostics, work-related functional capacity training, psychosocial groups, and intensified social counseling. The authors tested the effectiveness of a work-related medical rehabilitation program compared with conventional medical rehabilitation using a cluster-randomized multicenter trial (German Clinical Trial Register: DRKS00007770). METHODS: In total, 484 patients with cancer were recruited at 4 rehabilitation centers. Patients at a center who started their rehabilitation in the same week represented a cluster. These clusters were randomly assigned using computer-generated randomization schedules either to an intervention group (IG) or to a control group (CG). The primary outcome was role functioning. Secondary outcomes were other quality-of-life domains and the return to work. RESULTS: In total, 425 patients (210 in the IG) were included in the analysis at the 3-month follow-up. There was no significant difference between the IG and CG in role functioning (b = 3.55; 95% CI, -1.18 to 8.29; P = .142). Participants in the IG reported better physical functioning (b = 5.99; 95% CI, 3.33-8.65; P < .001), less physical fatigue (b = -5.09; 95% CI, -9.62 to -0.56; P = .028), and less pain (b = -6.24; 95% CI, -11.24 to -1.23; P = .015). CONCLUSIONS: Work-related medical rehabilitation had no effect on the primary outcome compared with conventional medical rehabilitation but may enhance physical functioning and reduce physical fatigue and pain.

Development and implementation of work-related medical rehabilitation in cancer patients using organizational ethnography and action research methodology.

OBJECTIVES: To develop a work-related medical rehabilitation (WMR) program for cancer patients based on the best available evidence, the expertise of rehabilitation professionals and the perspective of the patients, to ensure the fidelity of its implementation and to prepare its subsequent outcome evaluation. MATERIAL AND METHODS: The implementation study was based on organizational ethnography and action research, and followed a multimethod, participatory and iterative approach to data collection and analysis. The authors carried out observations in 4 rehabilitation centers and conducted focus groups with rehabilitation professionals and patients. The obtained data were subjected to qualitative content analysis. All findings were discussed promptly with the rehabilitation centers at feedback meetings that contributed to the further development of the program. RESULTS: The following WMR modules were defined based on the findings: additional work-related diagnostics, multi-professional team meetings, an introductory session, work-related functional capacity training, work-related psychological groups and intensified social counseling. Process descriptions for the subsequent evaluation of the program via a cluster-randomized trial were also developed, containing, e.g., instructions for patient information and recruitment. CONCLUSIONS: Implementation studies can help to prepare for valid trials as they facilitate ensuring the feasibility, acceptability and fidelity of program implementation and evaluation. Organizational ethnography and action research are suitable methods for carrying out such studies. Int J Occup Med Environ Health. 2019;32(2):217-28.

[Work-Related Medical Rehabilitation in Cancer Rehabilitation - Short-Term Results from a Cluster-Randomized Multicenter-Trial]. / Medizinisch-beruflich orientierte Rehabilitation für onkologische Rehabilitanden ­ kurzfristige Ergebnisse einer clusterrandomisierten Multicenterstudie.

BACKGROUND: Rehabilitation programs that support return to work become increasingly relevant for cancer survivors. In Germany, such programs were established as work-related medical rehabilitation (WMR). The study investigated whether WMR leads to better results compared to medical rehabilitation (MR). We report effects on secondary outcomes when the rehabilitation program was completed. METHODS: Clusters of participants were randomly assigned to WMR or MR. Patients of working age and an elevated risk of not returning to work were included. The grade of implementation was assessed by dose delivered and dose received. Study outcomes were assessed using scales measuring functioning and symptoms, coping with illness as well as self-reported work ability. Treatment effects were estimated using mixed linear models. RESULTS: From 232 planned randomized intervention groups, 165 (71%) were realized. In total, 476 patients were included. Mean age of participants was 50.7 years (SD=7.3). Most frequent primary diagnoses were malignant neoplasms of the breast. Participants in the WMR program reported significantly better outcomes regarding quality of life (SMD=0.17-0.25), fatigue (SMD=0.18-0.27), coping with illness (SMD=0.17-0.22), and self-reported work-ability (SMD=0.16) compared to participants in MR program (all p<0.05). CONCLUSION: The results indicate a positive effect in favor of WMR for cancer patients with an elevated risk of not returning to work at the end of their treatment.

Latent user groups of an eHealth physical activity behaviour change intervention for people interested in reducing their cardiovascular risk.

EHealth behaviour change interventions that help participants to adhere to professional physical activity recommendations can help to prevent future events of cardiovascular diseases (CVD). Therefore, identifying user groups of such interventions based on stages of health behaviour change is of great importance to provide tailored content to users instead of one-size-fits-all approaches. Our study used Latent Class Analysis (LCA) to identify underlying classes of users of an eHealth behaviour change intervention based on stages of change and associated variables. We compared participants' self-allocated stage with their latent class stage membership to display the correlation and mean differences between the two approaches. This was done by analysing baseline data of N = 310 people interested in reducing their CVD risk. LCA identified a three-class solution: (non-)intenders (19.4%), non-habituated actors (43.2%) and habituated actors (37.4%). The interrelation between self-allocated and latent class stage membership was moderate (ρ(308) = .49, p < .001). Significant mean differences for (non-)intenders and non-habituated actors were found in social-cognitive variables. Results showed that self-allocated stage outcomes represent a pseudo stage model - linear trends can be reported for stage-associated social-cognitive variables. The study provides information on the validity of stage measures, which can inform future interventions.

Evaluation of a Web-Based Intervention for Multiple Health Behavior Changes in Patients With Coronary Heart Disease in Home-Based Rehabilitation: Pilot Randomized Controlled Trial.

BACKGROUND: Web-based and theory-based interventions for multiple health behaviors appears to be a promising approach with respect to the adoption and maintenance of a healthy lifestyle in cardiac patients who have been discharged from the hospital. Until now, no randomized controlled trials have tested this assumption among Chinese rehabilitation patients with coronary heart disease using a Web-based intervention. OBJECTIVE: The study aim was to evaluate the effect of an 8-week Web-based intervention in terms of physical activity (PA), fruit and vegetable consumption (FVC), lifestyle changes, social-cognitive outcomes, and health outcomes compared with a waiting control group in Chinese cardiac patients. The intervention content was theory-based on the health action process approach. Self-reported data were evaluated, including PA, FVC, healthy lifestyle (the synthesis of PA and FVC), internal resources (combination of intention, self-efficacy, and planning), and an external resource (social support) of PA and FVC behaviors, as well as perceived health outcomes (body mass index, quality of life, and depression). METHODS: In a randomized controlled trial, 136 outpatients with coronary heart disease from the cardiac rehabilitation center of a hospital in China were recruited. After randomization and exclusion of unsuitable participants, 114 patients were assigned to 1 of the 2 groups: (1) the intervention group: first 4 weeks on PA and subsequent 4 weeks on FVC and (2) the waiting control group. A total of 2 Web-based assessments were conducted, including 1 at the beginning of the intervention (T1, N=114), and 1 at the end of the 8-week intervention (T2, N=83). The enrollment and follow-up took place from December 2015 to May 2016. RESULTS: The Web-based intervention outperformed the control condition for PA, FVC, internal resources of PA and FVC, and an external resource of FVC, with an eta-squared effect size ranging from 0.06 to 0.43. Furthermore, the intervention effect was seen in the improvement of quality of life (F1,79=16.36, P<.001, η2=.17). When predicting a healthy lifestyle at follow-up, baseline lifestyle (odds ratio, OR 145.60, 95% CI 11.24-1886; P<.001) and the intervention (OR 21.32, 95% CI 2.40-189.20; P=.006) were found to be significant predictors. Internal resources for FVC mediated the effect of the intervention on the adoption of a healthy lifestyle (R2adj=.29; P=.001), indicating that if the intervention increased the internal resource of behavior, the adoption of a healthy lifestyle was more likely. CONCLUSIONS: Patients' psychological resources such as motivation, self-efficacy, planning, and social support as well as lifestyle can be improved by a Web-based intervention that focuses on both PA and FVC. Such an intervention enriches extended rehabilitation approaches for cardiac patients to be active and remain healthy in daily life after hospital discharge. TRIAL REGISTRATION: ClinicalTrials.gov NCT01909349; https://clinicaltrials.gov/ct2/show/NCT01909349 (Archived by WebCite at http://www.webcitation.org/6pHV1A0G1).

The Mediating Role of Perceived Social Support Between Physical Activity Habit Strength and Depressive Symptoms in People Seeking to Decrease Their Cardiovascular Risk: Cross-Sectional Study.

BACKGROUND: Regular physical activity treatment has been advocated for the prevention and rehabilitation of patients at risk of cardiovascular diseases and depressive symptoms. How physical activity is related to depressive symptoms is widely discussed. OBJECTIVE: The aim of this internet-based study was to investigate the role of perceived social support in the relationship between physical activity habit strength and depressive symptoms. METHODS: In total, 790 participants (mean 50.9 years, SD 12.2, range 20-84 years) who were interested in reducing their cardiovascular risk were recruited in Germany and the Netherlands. Data collection was conducted via an internet-based questionnaire addressing physical activity habit strength, depressive symptoms, and perceived social support. Cross-sectional data analysis was done with SPSS version 24 using the Macro PROCESS version 2 16.3 by Hayes with bootstrapping (10,000 samples), providing 95% CIs. RESULTS: Physical activity habit strength was negatively related to depressive symptoms (r=-.13, P=.006), but this interrelation disappeared when controlling for perceived social support (beta=-.14, SE 0.09, P=.11). However, there was an indirect relationship between physical activity habit strength and depressive symptoms, which was mediated via perceived social support (beta=-.13; SE 0.04, 95% CI -0.21 to 0.06). The negative relationship between physical activity habit strength and depressive symptoms was fully mediated by perceived social support. CONCLUSIONS: We suggest that physical activity treatment in people interested in reducing their cardiovascular risk should also embed social support to target depressive symptoms. Internet-based interventions and electronic health may provide a good option for doing so. TRIAL REGISTRATION: ClinicalTrials.gov NCT01909349; https://clinicaltrials.gov/ct2/show/NCT01909349 (Archived by WebCite at http://www.webcitation.org/73Y9RfdiY).

Understanding the Positive Associations of Sleep, Physical Activity, Fruit and Vegetable Intake as Predictors of Quality of Life and Subjective Health Across Age Groups: A Theory Based, Cross-Sectional Web-Based Study.

Background: Due to the increase in unhealthy lifestyles and associated health risks, the promotion of healthy lifestyles to improve the prevention of non-communicable diseases is imperative. Thus, research aiming to identify strategies to modify health behaviors has been encouraged. Little is known about addressing multiple health behaviors across age groups (i.e., young, middle-aged, and older adults) and the underlying mechanisms. The theoretical framework of this study is Compensatory Carry-Over Action Model which postulates that different health behaviors (i.e., physical activity and fruit and vegetable intake) are interrelated, and they are driven by underlying mechanisms (more details in the main text). Additionally, restful sleep as one of the main indicators of good sleep quality has been suggested as a mechanism that relates to other health behaviors and well-being, and should therefore also be investigated within this study. The present study aims to identify the interrelations of restful sleep, physical activity, fruit and vegetable intake, and their associations with sleep quality as well as overall quality of life and subjective health in different age groups. Methods: A web-based cross-sectional study was conducted in Germany and the Netherlands. 790 participants aged 20-85 years filled in the web-based baseline questionnaire about their restful sleep, physical activity, fruit and vegetable intake, sleep quality, quality of life, and subjective health. Descriptive analysis, multivariate analysis of covariance, path analysis, and multi-group analysis were conducted. Results: Restful sleep, physical activity, and fruit and vegetable intake were associated with increased sleep quality, which in turn was associated with increased overall quality of life and subjective health. The path analysis model fitted the data well, and there were age-group differences regarding multiple health behaviors and sleep quality, quality of life, and subjective health. Compared to young and older adults, middle-aged adults showed poorest sleep quality and overall quality of life and subjective health, which were associated with less engagement in multiple health behaviors. Conclusion: A better understanding of age-group differences in clustering of health behaviors may set the stage for designing effective customized age-specific interventions to improve health and well-being in general and clinical settings. Trial Registration: A clinical trial registration was conducted with ClinicalTrials.gov (NCT01909349) https://clinicaltrials.gov/ct2/show/NCT01909349.