Mediation of improvements in sun protective and skin self-examination behaviours: results from the healthy text study.

OBJECTIVE: Melanoma is on the rise, especially in Caucasian populations exposed to high ultraviolet radiation such as in Australia. This paper examined the psychological components facilitating change in skin cancer prevention or early detection behaviours following a text message intervention. METHODS: The Queensland-based participants were 18 to 42 years old, from the Healthy Text study (N = 546). Overall, 512 (94%) participants completed the 12-month follow-up questionnaires. Following the social cognitive model, potential mediators of skin self-examination (SSE) and sun protection behaviour change were examined using stepwise logistic regression models. RESULTS: At 12-month follow-up, odds of performing an SSE in the past 12 months were mediated by baseline confidence in finding time to check skin (an outcome expectation), with a change in odds ratio of 11.9% in the SSE group versus the control group when including the mediator. Odds of greater than average sun protective habits index at 12-month follow-up were mediated by (a) an attempt to get a suntan at baseline (an outcome expectation) and (b) baseline sun protective habits index, with a change in odds ratio of 10.0% and 11.8%, respectively in the SSE group versus the control group. CONCLUSIONS: Few of the suspected mediation pathways were confirmed with the exception of outcome expectations and past behaviours. Future intervention programmes could use alternative theoretical models to elucidate how improvements in health behaviours can optimally be facilitated.

The cost-effectiveness of the MobileMums intervention to increase physical activity among mothers with young children: a Markov model informed by a randomised controlled trial.

OBJECTIVES: To determine the cost-effectiveness of the MobileMums intervention. MobileMums is a 12-week programme which assists mothers with young children to be more physically active, primarily through the use of personalised SMS text-messages. DESIGN: A cost-effectiveness analysis using a Markov model to estimate and compare the costs and consequences of MobileMums and usual care. SETTING: This study considers the cost-effectiveness of MobileMums in Queensland, Australia. PARTICIPANTS: A hypothetical cohort of over 36 000 women with a child under 1 year old is considered. These women are expected to be eligible and willing to participate in the intervention in Queensland, Australia. DATA SOURCES: The model was informed by the effectiveness results from a 9-month two-arm community-based randomised controlled trial undertaken in 2011 and registered retrospectively with the Australian Clinical Trials Registry (ACTRN12611000481976). Baseline characteristics for the model cohort, treatment effects and resource utilisation were all informed by this trial. MAIN OUTCOME MEASURES: The incremental cost per quality-adjusted life year (QALY) of MobileMums compared with usual care. RESULTS: The intervention is estimated to lead to an increase of 131 QALYs for an additional cost to the health system of 1.1 million Australian dollars (AUD). The expected incremental cost-effectiveness ratio for MobileMums is 8608 AUD per QALY gained. MobileMums has a 98% probability of being cost-effective at a cost-effectiveness threshold of 64 000 AUD. Varying modelling assumptions has little effect on this result. CONCLUSIONS: At a cost-effectiveness threshold of 64 000 AUD, MobileMums would likely be a cost-effective use of healthcare resources in Queensland, Australia. TRIAL REGISTRATION NUMBER: Australian Clinical Trials Registry; ACTRN12611000481976.

Living Well with Diabetes: a randomized controlled trial of a telephone-delivered intervention for maintenance of weight loss, physical activity and glycaemic control in adults with type 2 diabetes.

BACKGROUND: By 2025, it is estimated that approximately 1.8 million Australian adults (approximately 8.4% of the adult population) will have diabetes, with the majority having type 2 diabetes. Weight management via improved physical activity and diet is the cornerstone of type 2 diabetes management. However, the majority of weight loss trials in diabetes have evaluated short-term, intensive clinic-based interventions that, while producing short-term outcomes, have failed to address issues of maintenance and broad population reach. Telephone-delivered interventions have the potential to address these gaps. METHODS/DESIGN: Using a two-arm randomised controlled design, this study will evaluate an 18-month, telephone-delivered, behavioural weight loss intervention focussing on physical activity, diet and behavioural therapy, versus usual care, with follow-up at 24 months. Three-hundred adult participants, aged 20-75 years, with type 2 diabetes, will be recruited from 10 general practices via electronic medical records search. The Social-Cognitive Theory driven intervention involves a six-month intensive phase (4 weekly calls and 11 fortnightly calls) and a 12-month maintenance phase (one call per month). Primary outcomes, assessed at 6, 18 and 24 months, are: weight loss, physical activity, and glycaemic control (HbA1c), with weight loss and physical activity also measured at 12 months. Incremental cost-effectiveness will also be examined. Study recruitment began in February 2009, with final data collection expected by February 2013. DISCUSSION: This is the first study to evaluate the telephone as the primary method of delivering a behavioural weight loss intervention in type 2 diabetes. The evaluation of maintenance outcomes (6 months following the end of intervention), the use of accelerometers to objectively measure physical activity, and the inclusion of a cost-effectiveness analysis will advance the science of broad reach approaches to weight control and health behaviour change, and will build the evidence base needed to advocate for the translation of this work into population health practice. TRIAL REGISTRATION: ACTRN12608000203358.

Randomized trial of three strategies to promote physical activity in general practice.

OBJECTIVE: To evaluate three strategies for promoting physical activity (PA) in a primary care setting. METHOD: Data were collected between 2002 and 2004 from 136 patients attending two general practices in Brisbane, Australia. Inactive patients (50-70 years) were randomly allocated to one of three hierarchical intervention groups: the general practitioner (GP) group received 'brief' advice; the GP+ES group also received behavior change advice from an exercise scientist (ES); and the GP+ES+P group also received a pedometer. Self-reported PA and its determinants were measured at baseline and weeks 12 and 24. Cardio-respiratory variables were measured at baseline and week 12. RESULTS: Overall, mean PA time increased by 84 and 128 min/week at weeks 12 and 24 (p<.01) with no significant group differences. Small improvements in blood pressure and post-exercise heart rate were observed. At week 24, the GP+ES+P group were more likely to report meeting PA guidelines than the GP group (OR=2.39 95% CI: 1.01, 5.64). CONCLUSION: PA levels can be increased in mid- to older-age adults, either by brief advice from motivated GPs alone, or from collaboration between GPs and ESs. The most intense intervention (GP+ES+P) showed the most promising results.

Exploring the meaning of, the barriers to and potential strategies for promoting physical activity among urban Indigenous Australians.

ISSUE ADDRESSED: There is evidence that many of the chronic lifestyle-related problems faced by Australia's Indigenous population are related to physical inactivity. However, little is known as to how to introduce physical activity programs that will be meaningful, relevant and acceptable to Australia's Indigenous people. METHODS: Seventeen focus groups involving 96 Indigenous adult participants, explored the meaning of, the barriers to, and potential strategies for promoting physical activity among urban Indigenous Australians. Indigenous researchers moderated the groups and data were transcribed verbatim and analysed independently. RESULTS: The relationship between physical activity and health was well understood by participants. Commonly reported activities undertaken by participants included walking, domestic chores and specific sports. Barriers to activity included being judged by others when in public spaces, cost and accessibility. Family engagement and group-based activities were strong motivators for participation. CONCLUSIONS: Attempts to increase physical activity among urban Indigenous Australians must engage the community from the outset, and focus on increased opportunities for family-orientated activities, and/or group walking programs; cost and safety must also be addressed.

Assessment of sedentary behavior with the International Physical Activity Questionnaire.

PURPOSE: This study explored definitions of sedentary behavior and examined the relationship between sitting time and physical inactivity using the sitting items from the International Physical Activity Questionnaire (IPAQ). METHODS: Participants (N = 289, 44.6% male, mean age = 35.93) from 3 countries completed self-administered long- and short-IPAQ sitting items. Participants wore accelerometers; were classified as inactive (no leisure-time activity), insufficiently active, or meeting recommendations; and were classified into tertiles of sitting behavior. RESULTS: Reliability of sitting time was acceptable for men and women. Correlations between total sitting and accelerometer counts/min <100 were significant for both long (r = .33) and short (r = .34) forms. There was no agreement between tertiles of sitting and the inactivity category (kappa = .02, P = .68). CONCLUSION: Sedentary behavior should be explicitly measured in population surveillance and research instead of being defined by lack of physical activity.

Physical activity in women with young children: how can we assess "anything that's not sitting"?

Current physical activity (PA) questionnaires fail to assess accurately daily activities typically undertaken by women, particularly women with young children (WYC). The aims of this study were to explore perceptions of PA and daily activities, and to identify methods for improving self-report PA questionnaires for WYC. Data were collected from 69 WYC (mean age = 35 +/- 5 yrs) via seven focus groups. Facilitators asked questions about perceptions of PA and factors related to self-reporting activities. Two independent researchers thematically analyzed the focus group transcripts. Most participants perceived differences in the meaning of PA and exercise, but many reported difficulty categorizing discrete activities related to childcare, household and occupational tasks because they were often being performed simultaneously and in short bouts. Recommendations for improving physical activity questionnaires for WYC included: the use of interview-administered questionnaires, clarifying category definitions in questionnaire instructions, assessing sedentary and low-intensity activities, providing multiple, relevant examples of activities for each activity category and assessing activities separately for weekdays and weekend days.

Screening for physical activity in family practice: evaluation of two brief assessment tools.

BACKGROUND: Physical activity (PA) is relevant to the prevention and management of many health conditions in family practice. There is a need for an efficient, reliable, and valid assessment tool to identify patients in need of PA interventions. METHODS: Twenty-eight family physicians in three Australian cities assessed the PA of their adult patients during 2004 using either a two- (2Q) or three-question (3Q) assessment. This was administered again approximately 3 days later to evaluate test-retest reliability. Concurrent validity was evaluated by measuring agreement with the Active Australia Questionnaire, and criterion validity by comparison with 7-day Computer Science Applications, Inc. (CSA) accelerometer counts. RESULTS: A total of 509 patients participated, with 428 (84%) completing a repeat assessment, and 415 (82%) accelerometer monitoring. The brief assessments had moderate test-retest reliability (2Q k=58.0%, 95% confidence interval [CI]=47.2-68.8%; 3Q k=55.6%, 95% CI=43.8-67.4%); fair to moderate concurrent validity (2Q k=46.7%, 95% CI=35.6-57.9%; 3Q k=38.7%, 95% CI=26.4-51.1%); and poor to fair criterion validity (2Q k=18.2%, 95% CI=3.9-32.6%; 3Q k=24.3%, 95% CI=11.6-36.9%) for identifying patients as sufficiently active. A four-level scale of PA derived from the PA assessments was significantly correlated with accelerometer minutes (2Q rho=0.39, 95% CI=0.28-0.49; 3Q rho=0.31, 95% CI=0.18-0.43). Physicians reported that the assessments took 1 to 2 minutes to complete. CONCLUSIONS: Both PA assessments were feasible to use in family practice, and were suitable for identifying the least active patients. The 2Q assessment was preferred by clinicians and may be most appropriate for dissemination.

Prospective study of physical activity and depressive symptoms in middle-aged women.

BACKGROUND: Although many studies support an inverse association between physical activity (PA) and depressive symptoms, prospective relationships between these variables have been confounded by pre-existing psychological and physical health problems. METHODS: This study examined the dose-response relationships between self-reported PA and depressive symptoms, using cross-sectional and prospective data from a population-based cohort of middle-aged women who participated in the Australian Longitudinal Study on Women's Health (ALSWH) between 1996 and 2001. Participants completed three mailed surveys (S1, 1996; S2, 1998; S3, 2001), which included questions about time spent in walking, moderate- and vigorous-intensity PA, and measures of psychological health (Center for Epidemiologic Studies Depression scale [CESD-10], and Mental health [MH] subscale of the Short Form 36 survey). Relationships between previous (S1, S2), current (S3), and habitual (S1, S2, S3) PA and "depressive symptoms" were examined, adjusting for sociodemographic and health-related variables (n=9207). RESULTS: Mean CESD-10 scores decreased, and MH scores increased with increasing levels of previous, current, and habitual activity. Odds ratios for CESD-10 scores > or =10 or MH scores < or =52 at S3 were 30% to 40% lower among women who reported the equivalent of > or =60 minutes of moderate-intensity PA per week, compared with those who reported less PA than this. Women who were in the lowest PA category at S1, but who subsequently reported > or =240 metabolic equivalent minutes (MET.mins) per week had lower odds of CESD-10 scores of > or =10 or MH scores < or =52 at S3 than those who remained in the very low PA category. CONCLUSIONS: These data suggest that there is a clear relationship between increasing PA and decreasing depressive symptoms in middle-aged women, independent of pre-existing physical and psychological health.

Physical activity promotion in primary care: bridging the gap between research and practice.

BACKGROUND: While a growing literature supports the effectiveness of physical activity interventions delivered in the primary care setting, few studies have evaluated efforts to increase physician counseling on physical activity during routine practice (i.e., outside the context of controlled research). This paper reports the results of a dissemination trial of a primary care-based physical activity counseling intervention conducted within the context of a larger, multi-strategy, Australian community-based, physical activity intervention, the 10,000 Steps Rockhampton Project. METHODS: All 23 general practices and 66 general practitioners (GPs, the Australian equivalent of family physicians) were invited to participate. Practice visits were made to consenting practices during which instruction in brief physical activity counseling was offered, along with physical activity promotion resources (print materials and pedometers). The evaluation, guided by the RE-AIM framework, included collection of process data, as well as pre- and post-intervention data from a mailed GP survey, and data from the larger project's random-digit-dialed, community-based, cross-sectional telephone survey that was conducted in Rockhampton and a comparison community. RESULTS: Ninety-one percent of practices were visited by 10,000 Steps staff and agreed to participate, with 58% of GPs present during the visits. General practitioner survey response rates were 67% (n =44/66 at baseline) and 71% (n =37/52, at 14-month follow-up). At follow-up, 62% had displayed the poster, 81% were using the brochures, and 70% had loaned pedometers to patients, although the number loaned was relatively small. No change was seen in GP self-report of the percentage of patients counseled on physical activity. However, data from the telephone surveys showed a 31% increase in the likelihood of recalling GP advice on physical activity in Rockhampton (95% confidence interval [CI]=1.11-1.54) compared to a 16% decrease (95% CI=0.68-1.04) in the comparison community. CONCLUSIONS: This dissemination study achieved high rates of GP uptake, reasonable levels of implementation, and a significant increase in the number of community residents counseled on physical activity. These results suggest that evidence-based primary care physical activity counseling protocols can be translated into routine practice, although the initial and ongoing investment of time to develop partnerships with relevant healthcare organizations, and the interest generated by the overall 10,000 Steps program should not be underestimated.

International physical activity questionnaire: 12-country reliability and validity.

BACKGROUND: Physical inactivity is a global concern, but diverse physical activity measures in use prevent international comparisons. The International Physical Activity Questionnaire (IPAQ) was developed as an instrument for cross-national monitoring of physical activity and inactivity. METHODS: Between 1997 and 1998, an International Consensus Group developed four long and four short forms of the IPAQ instruments (administered by telephone interview or self-administration, with two alternate reference periods, either the "last 7 d" or a "usual week" of recalled physical activity). During 2000, 14 centers from 12 countries collected reliability and/or validity data on at least two of the eight IPAQ instruments. Test-retest repeatability was assessed within the same week. Concurrent (inter-method) validity was assessed at the same administration, and criterion IPAQ validity was assessed against the CSA (now MTI) accelerometer. Spearman's correlation coefficients are reported, based on the total reported physical activity. RESULTS: Overall, the IPAQ questionnaires produced repeatable data (Spearman's rho clustered around 0.8), with comparable data from short and long forms. Criterion validity had a median rho of about 0.30, which was comparable to most other self-report validation studies. The "usual week" and "last 7 d" reference periods performed similarly, and the reliability of telephone administration was similar to the self-administered mode. CONCLUSIONS: The IPAQ instruments have acceptable measurement properties, at least as good as other established self-reports. Considering the diverse samples in this study, IPAQ has reasonable measurement properties for monitoring population levels of physical activity among 18- to 65-yr-old adults in diverse settings. The short IPAQ form "last 7 d recall" is recommended for national monitoring and the long form for research requiring more detailed assessment.