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.

Randomized Controlled Trial of an Improved Version of MobileMums, an Intervention for Increasing Physical Activity in Women with Young Children.

BACKGROUND: Women with young children (<5 years) are an important group for physical activity intervention. PURPOSE: The objective of the study was to evaluate the feasibility, acceptability, and efficacy of MobileMums-a physical activity intervention for women with young children. METHODS: Women were randomized to MobileMums (n = 133) or a control group (n = 130). MobileMums was delivered primarily via individually tailored text messages. Moderate to vigorous physical activity (MVPA) was measured by self-report and an accelerometer at baseline, end of the intervention (13 weeks), and 6 months later (9 months). Changes were analyzed using repeated-measures models. RESULTS: MobileMums was feasible to deliver and acceptable to women. Self-reported MVPA duration (minutes/week) and frequency (days/week) increased significantly post-intervention (13-week intervention effect 48.5 min/week, 95 % credible interval (CI) [13.4, 82.9] and 1.6 days/week, 95 % CI [0.6, 2.6]). Intervention effects were not maintained 6 months later. No effects were observed in accelerometer-derived MVPA. CONCLUSIONS: MobileMums increased women's self-reported MVPA immediately post-intervention. Future investigations need to target sustained physical activity improvements (ACTRN12611000481976).

Can skin cancer prevention and early detection be improved via mobile phone text messaging? A randomised, attention control trial.

OBJECTIVE: To test the impact of a theory-based, SMS (text message)-delivered behavioural intervention (Healthy Text) targeting sun protection or skin self-examination behaviours compared to attention control. METHOD: Overall, 546 participants aged 18-42 years were randomised using a computer-generated number list to the skin self-examination (N=176), sun protection (N=187), or attention control (N=183) text messages group. Each group received 21 text messages about their assigned topic over 12 months (12 weekly messages for 3 months, then monthly messages for the next 9 months). Data were collected via telephone survey at baseline, 3, and 12 months across Queensland from January 2012 to August 2013. RESULTS: One year after baseline, the sun protection (mean change 0.12; P=0.030) and skin self-examination groups (mean change 0.12; P=0.035) had significantly greater improvement in their sun protection habits (SPH) index compared to the attention control group (reference mean change 0.02). The increase in the proportion of participants who reported any skin self-examination from baseline to 12 months was significantly greater in the skin self-examination intervention group (103/163; 63%; P<0.001) than the sun protection (83/173; 48%) or attention control (65/165; 36%) groups. There was no significant effect of the intervention for participants' self-reported whole-body skin self-examination, sun tanning, or sunburn behaviours. CONCLUSION: The Healthy Text intervention was effective in inducing significant improvements in sun protection and any type of skin self-examination behaviours. TRIAL REGISTRATION: The Australian and New Zealand Clinical Trials register (ACTRN12612000577819). FUNDING: Cancer Australia 1011999.

Moving MobileMums forward: protocol for a larger randomized controlled trial of an improved physical activity program for women with young children.

BACKGROUND: Women with young children (under 5 years) are a key population group for physical activity intervention. Previous evidence highlights the need for individually tailored programs with flexible delivery mechanisms for this group. Our previous pilot study suggested that an intervention primarily delivered via mobile phone text messaging (MobileMums) increased self-reported physical activity in women with young children. An improved version of the MobileMums program is being compared with a minimal contact control group in a large randomised controlled trial (RCT). METHODS/DESIGN: This RCT will evaluate the efficacy, feasibility and acceptability, cost-effectiveness, mediators and moderators of the MobileMums program. Primary (moderate-vigorous physical activity) and secondary (intervention implementation data, health service use costs, intervention costs, health benefits, theoretical constructs) outcomes are assessed at baseline, 3-months (end of intervention) and 9-months (following 6-month no contact: maintenance period).The intervention commences with a face-to-face session with a behavioural counsellor to initiate rapport and gather information for tailoring the 12-week text message program. During the program participants also have access to a: MobileMums Participant Handbook, MobileMums refrigerator magnet, MobileMums Facebook© group, and a MobileMums website with a searchable, on-line exercise directory. A nominated support person also receives text messages for 12-weeks encouraging them to offer their MobileMum social support for physical activity. DISCUSSION: Results of this trial will determine the efficacy and cost-effectiveness of the MobileMums program, and the feasibility of delivering it in a community setting. It will inform the broader literature of physical activity interventions for women with young children and determine whether further investment in the translation of the program is warranted. TRIAL REGISTRATION: The trial is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12611000481976).

Active adults recall their physical activity differently to less active adults: test-retest reliability and validity of a physical activity survey.

ISSUE ADDRESSED: This paper determined the test-retest reliability and criterion validity of a modified version of the Active Australia Survey (AAS) and whether these properties varied across participants' activity levels. METHODS: Participants (n=63) responded to repeat administrations of the AAS and wore an accelerometer for 7 days. Analyses used Spearman's rho (rs,) or weighted kappa (κ) and Bland-Altman methods. Variation in mean difference and 95% limits of agreement (LOA) across average levels of activity were tested by linear regression. RESULTS: Reliability correlations (rs; 95% confidence intervals (CI)) for minutes per week ranged from 0.40 (0.16, 0.59) to 0.80 (0.68, 0.87). For days per week, the agreement (κ; 95% CI) between administrations ranged from 0.43 (0.34, 0.73) to 0.83 (0.61, 0.93). There was a small mean difference between administrations (-8.46 moderate-vigorous minutes per week); 95% LOA widened as participants' average activity levels increased. Validity correlations (rs; 95% CI) for minutes per week ranged from 0.50 (0.28, 0.66) to 0.61 (0.43, 0.75). For days per week, the agreement (κ; 95% CI) ranged from 0.35 (0.10, 0.50) to 0.61 (0.29, 0.87). The mean difference between the AAS and accelerometer and 95% LOA both varied with participants' activity levels. CONCLUSIONS: The reliability and validity of the modified AAS were better than those of previously published versions, but varied according to participants' activity levels. So what? In this study, participants who engaged in more activity had more measurement error than less active participants. This proportionality will have important implications for cross-sectional and intervention studies. This phenomenon needs to be examined for other self-reported physical activity measures.

Iterative development of MobileMums: a physical activity intervention for women with young children.

BACKGROUND: To describe the iterative development process and final version of 'MobileMums': a physical activity intervention for women with young children (<5 years) delivered primarily via mobile telephone (mHealth) short messaging service (SMS). METHODS: MobileMums development followed the five steps outlined in the mHealth development and evaluation framework: 1) conceptualization (critique of literature and theory); 2) formative research (focus groups, n= 48); 3) pre-testing (qualitative pilot of intervention components, n= 12); 4) pilot testing (pilot RCT, n= 88); and, 5) qualitative evaluation of the refined intervention (n= 6). RESULTS: Key findings identified throughout the development process that shaped the MobileMums program were the need for: behaviour change techniques to be grounded in Social Cognitive Theory; tailored SMS content; two-way SMS interaction; rapport between SMS sender and recipient; an automated software platform to generate and send SMS; and, flexibility in location of a face-to-face delivered component. CONCLUSIONS: The final version of MobileMums is flexible and adaptive to individual participant's physical activity goals, expectations and environment. MobileMums is being evaluated in a community-based randomised controlled efficacy trial (ACTRN12611000481976).

MobileMums: a randomized controlled trial of an SMS-based physical activity intervention.

BACKGROUND: Postnatal women (<12 months postpartum) are at increased risk of physical inactivity. PURPOSE: To evaluate the efficacy and feasibility of a theory-based physical activity (PA) intervention delivered to postnatal women primarily via mobile telephone short message service (SMS). METHODS: Eighty-eight women were randomized to the intervention (n = 45) or minimal contact control (n = 43) condition. The 12-week intervention consisted of a face-to-face PA goal-setting consultation, a goal-setting magnet, three to five personally tailored SMS/week and a nominated support person who received two SMS per week. SMS content targeted constructs of social cognitive theory. Frequency (days/week) and duration (min/week) of PA participation and walking for exercise were assessed via self-report at baseline, 6 and 13 weeks. RESULTS: Intervention participants increased PA frequency by 1.82 days/week (SE +/- 0.18) by 13 weeks (F ((2,85)) = 4.46, p = 0.038) and walking for exercise frequency by 1.08 days/week (SE +/- 0.24) by 13 weeks (F ((2,85)) = 5.38, p = 0.02). Positive trends were observed for duration (min/week) of PA and walking for exercise. CONCLUSIONS: Intervention exposure resulted in increased frequency of PA and walking for exercise in postnatal women.

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.

How does MobileMums work? Mediators of a physical activity intervention.

Objectives: To establish which Social Cognitive Theory constructs mediated effects of the MobileMums (MMP) program on increased duration and frequency of moderate-vigorous physical activity (MVPA) in women with young children (<5 years). Methods: This secondary data analysis is from a community-based randomised controlled trial. Over 12 weeks, intervention participants received a minimum of 52 individually tailored text messages, one face-to-face and one telephone-delivered session with a trained behavioural counsellor. Participants identified a support person who also received 12 weeks of individually tailored text messages. Control participants received minimal intervention contact. Data were collected pre- and post-program. Five potential mediators were assessed: barrier self-efficacy, goal setting skills, outcome expectancies, perceived environmental opportunity for physical activity and social support for physical activity. Results: Improvements in MVPA frequency were mediated by improvements in barrier self-efficacy, goal setting skills, outcome expectancies and perceived social support. Improvements in MVPA duration resulting from the MMP were mediated by improvements in women's barrier self-efficacy and goal setting skills. Conclusions: MMP improved targeted theoretical constructs and this led to changes in women's MVPA. These findings are valuable for refinement and translation of the MMP and for further research to create theory- and evidence-based physical activity behaviour change programs for women with young children.

Randomized trial of a neighborhood environment-focused physical activity website intervention.

OBJECTIVE: To evaluate the use of a local neighborhood environment-focused physical activity website and its effects on walking and overall physical activity in middle-aged adults. METHOD: One-hundred and six (72% women) inactive adults aged 52+/-4.6 years were randomly allocated to receive access to a neighborhood environment-focused website, (Neighborhood group, n=52) or a motivational-information website (Comparison group n=54). Participants also received eleven emails over the 26 weeks. Study outcomes were objectively-monitored website use, and self-reported total walking (min/wk), total physical activity (min/wk) and neighborhood walking (min/wk) collected at baseline, 12 and 26 weeks. The study was conducted between August 2005 and February 2006 in Brisbane, Australia. RESULTS: Website use was significantly greater among Neighborhood participants (p=0.01). Statistically significant increases in walking and total physical activity were observed in both groups. There was also a statistically significant interaction effect for total physical activity, with Neighborhood group participants maintaining more of their initial increase in physical activity at week-26 (p<0.05). Further, those in the Neighborhood group who used the website more often reported significantly more walking along the community trail at week-26 (p=0.05) compared with those who did not. CONCLUSIONS: A local neighborhood-environment focused physical activity website was more effective at engaging participants than a motivational-information website. Moreover, its use resulted in meaningful increases in physical activity relative to the comparison website.

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.

Knowledge of and preferred sources of assistance for physical activity in a sample of urban Indigenous Australians.

BACKGROUND: To examine urban Indigenous Australians' knowledge of the current Physical Activity Guidelines (PAG) and identify their preferred sources of assistance or advice regarding physical activity. METHOD: Self-completed questionnaire data were collected from 194 participants; the questionnaires sought information on standard demographics including an assessment of their perceived physical activity level relative to peers. Outcome measures were agreement with five statements from the current PAG and indicators of preferred sources of assistance or advice regarding physical activity. RESULTS: Most participants demonstrated excellent knowledge of the current PAG, with 92% to 88% of participants agreeing with the statements. Significantly more older participants (> 44 years) identified that 'blocks of 10 minutes of activity are OK' compared to younger participants (aged 18-44 years: 60%; X2 = 6.23; p = .04). Significantly more higher educated participants agreed (96%) that 'brisk walking for half an hour most days was good for health' compared to the less educated participants (85%; X2 = 8.08; p = .02). The most preferred source of physical activity advice identified by men was the GP/health professional (62% vs. 53%; men and women respectively, NS), while for women it was a group to be active with (60% vs. 42%; women and men respectively; X2 = 6.09; p = .01). CONCLUSION: Urban Indigenous Australians have similar levels of knowledge regarding the PAG to non-Indigenous Australians. However, the option of accumulating 10-minute activity bouts needs to be better communicated to younger Indigenous people. Most participants expressed a preference for advice about physical activity to be delivered via health professionals, and groups to be active with. Indigenous and age-specific resources that promote the unique aspects of the current PAG (e.g., that vigorous exercise is not essential for health and blocks of 10 minutes of activity are OK) should be developed and disseminated.

Comparison of the effects of a home-based and group-based resistance training program on functional ability in older adults.

PURPOSE: To compare the effectiveness of home- and group-based, progressive resistance training programs and a group walking program in improving functional performance in older adults. DESIGN: A quasi-experimental trial, in which retirement villages were assigned to one of three groups: home-based resistance training, group-based resistance training, and group-based walking. SUBJECTS: One hundred sixty-seven retirement village residents aged 65 to 96 years. INTERVENTION: Nine resistance training exercises, using graded exercise bands and body weight, two balance exercises, and 10 stretches. Home-based participants were given an exercise booklet, 8 hours of instruction, and telephone support. Instructors supervised the group-based resistance training and walking programs. Each group exercised twice weekly for 20 weeks. MEASURES: Functional performance (strength, aerobic endurance, flexibility, and agility/ dynamic balance) was assessed using the Senior Fitness Test. ANALYSIS: Intervention effects were evaluated using mixed-model, repeated measures analysis of variance. RESULTS: Significant between-group differences were observed only for the lower-body flexibility test. Group resistance training participants improved, but home resistance training and walking participants did not. However, strength, lower-body flexibility, and agility/dynamic balance improved in the group-based resistance training participants, and strength and upper-body flexibility improved in the home-based participants. No improvements were observed in the walking group. CONCLUSION: Findings support the implementation of both home- and group-based resistance training programs in retirement villages. Encouraging residents to adopt and maintain a resistance training program remains a research priority.

Comparative effects of home- and group-based exercise on balance confidence and balance ability in older adults: cluster randomized trial.

BACKGROUND: Exercise can modify fall risk factors such as balance and mobility impairments. However, can exercise improve balance confidence? In one strength-training study, researchers reported that a change in balance confidence was not uniformly associated with changes in objective measures of fall risk or physical performance. In fact, some participants' balance confidence decreased while their physical abilities increased and vice versa. OBJECTIVE: The aim of this study was to compare changes in balance confidence and balance ability resulting from three exercise interventions (home-based resistance and balance training (RBT), group-based RBT and group-based walking), and the concomitant relationships between change in balance confidence and change in ability. It was hypothesized that participants in the group-based RBT program would improve their balance confidence and performance more than those in the home-based or walking programs. METHODS: In a cluster-randomized design, nine retirement villages were assigned to one of the three exercise groups. One hundred and sixty-seven independent-living residents (aged 65-96 years) participated. Each group exercised twice weekly for 20 weeks. Objective balance ability was measured using timed tandem and one-leg stands (static balance), and the 8-foot (2.5 m) up-and-go test (dynamic balance/agility). Balance confidence was assessed using the self-report Activities-specific Balance Confidence (ABC) Scale. RESULTS: Participants in the group-based RBT program improved their static balance scores more than those in the home-based program; however, improvements in balance confidence were greater among participants in the home-based program (all p < 0.05). Discordance between static balance and balance confidence change scores was evident for up to 20% of participants. Change in ABC score was weakly correlated with a change in the up-and-go test score. CONCLUSIONS: Exercise training can improve balance confidence and balance ability in retirement village residents. However, as has been shown previously, this study found that exercise interventions may improve balance ability without associated increases in balance confidence and vice versa. Whether the ABC score and balance ability can be enhanced by providing a tailored intervention to improve balance confidence in combination with a RBT program requires further study.

Reliability and validity of a modified self-administered version of the Active Australia physical activity survey in a sample of mid-age women.

OBJECTIVE: To assess the test-retest reliability and validity of a modified self-administered version of the Active Australia physical activity survey. METHODS: One hundred and fifty-nine mid-age women (54-59 years) completed a mailed physical activity questionnaire before recording daily pedometer step counts for seven consecutive days. A random subsample (n=44) also wore an accelerometer during this period. Participants then completed the physical activity questionnaire again. Spearman's rho and per cent agreement were used to assess test-retest reliability. Self-reported physical activity data (time 2) were compared with pedometer and accelerometer data using box plots and Spearman's correlations to assess validity. RESULTS: Median time between surveys was 13 days. Median frequency and duration of moderate and vigorous physical activity were the same at both surveys, but median walking frequency was slightly higher at time 2 than time 1. Reliability coefficients for frequency/time in each domain of physical activity ranged from 0.56-0.64 and per cent agreement scores ranged from 40% to 65% for the physical activity categories; agreement was 76% for 'meeting guidelines'. Correlations (p) between self-reported physical activity and 1) weekly pedometer steps and 2) accelerometer data for duration of at least moderate intensity physical activity were 0.43 and 0.52 respectively. CONCLUSIONS: The measurement properties of this modified self-administered physical activity survey are similar to those reported for the original computer assisted telephone interview survey. IMPLICATIONS: This modified version of the Active Australia survey is suitable for use in self-administered format.

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.

Validation of a 24-h physical activity recall in indigenous and non-indigenous Australian adolescents.

The purpose of this study was to evaluate the concurrent validity of a modified version of the widely used previous day physical activity recall (PDPAR-24) self-report instrument in a diverse sample of Australian adolescents comprising Aboriginal and Torres Strait Islanders (A&TSI) and non-indigenous high school students. A sample of 63 A&TSI and 59 non-indigenous high school students (N=122) from five public secondary schools participated in the study. Participants completed the PDPAR-24 after wearing a sealed electronic pedometer on the previous day. Significant positive correlations were observed between the self-reported physical activity variables (mean MET level, blocks of vigorous activity, and blocks of moderate-to-vigorous physical activity) and 24-h step counts. Validity coefficients (rho) ranged from 0.29 to 0.34 (p<0.05). A significant inverse correlation was observed for self-reported screen time and 24-h step count (rho=-0.19, p<0.05). Correlations for A&TSI students were equal to or greater than those observed for non-indigenous students. The PDPAR-24 instrument is a quick, unobtrusive, and cost-effective assessment tool that would be useful for evaluating physical activity and sedentary behaviour in population-based studies.

Preventive Health Behavior Change Text Message Interventions: A Meta-analysis.

CONTEXT: Existing evidence shows that text message interventions can produce short-term health behavior change. However, understanding is limited regarding intervention characteristics moderating this effect or the long-term effectiveness of text message interventions on behavior change after contact stops. EVIDENCE ACQUISITION: MEDLINE, PubMed Central, ERIC, PsycINFO, and Web of Science were searched for articles published between April 2008 and December 2014 that evaluated an intervention targeting preventive health behaviors, delivered primarily by text message. EVIDENCE SYNTHESIS: Intervention development and design characteristics and research outcomes were evaluated for 51 studies. Thirty-five studies were included in a meta-analysis (conducted in 2015) examining overall effect size and moderators of effect size. The overall pooled effect of interventions was d=0.24 (95% CI=0.16, 0.32, p<0.001) using outcome data collected most proximal to intervention cessation. Seven studies collected data following a no-intervention maintenance period and showed a small but significant pooled maintenance effect (d=0.17, 95% CI=0.03, 0.31, p=0.017, k=7). Few variables significantly moderated intervention efficacy. Interventions that did not use a theoretic basis, used supplementary intervention components, and had a duration of 6-12 months were most effective. The specific behavior being targeted was not associated with differences in efficacy nor was tailoring, targeting, or personalization of text message content. CONCLUSIONS: Text message interventions are capable of producing positive change in preventive health behaviors. Preliminary evidence indicates that these effects can be maintained after the intervention stops. The moderator analysis findings are at odds with previous research, suggesting a need to examine moderators at the behavior-specific level.

Retention, adherence and compliance: important considerations for home- and group-based resistance training programs for older adults.

Reports on the efficacy of physical activity intervention trials usually only include discussion of the primary outcomes. However, assessing factors such as participant retention, adherence and compliance can assist in the accurate interpretation of the overall impact of a program in terms of reach and appeal. A quasi-randomised trial was carried out to assess and compare retention and adherence rates, and compliance with, a twice weekly resistance training program provided either individually at home or in a group format. Retirement villages (n=6) were assigned to either 'Have A Try' (HAT, home-based) or 'Come Have A Try' (CHAT, group-based); both programs included nine strength and two balance exercises. The program involved a 20-week Intervention Phase a 24-week Maintenance Phase and a 20-week On-going Maintenance Phase. One hundred and nineteen participants (mean age 80+/-6 years) were recruited (HAT=38, CHAT=81). There was no difference in retention rates at the end of the Intervention Phase, but significantly more HAT than CHAT participants had dropped out of the study (p<0.01) after the Maintenance Phase and the On-going Maintenance Phase. During the Intervention Phase, over half the HAT and CHAT participants completed > or =75% of the prescribed activity sessions, but adherence was significantly greater in CHAT than HAT during the Maintenance Phase (p<0.01). Participants in CHAT were significantly more compliant than HAT participants (p<0.05). Both home- and group-based formats were successful over the short-term, but, in retirement villages, the group program had better adherence and compliance in the longer-term.

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.