Field Test of an m-Health Worksite Health Promotion Program to Increase Physical Activity in Taiwanese Employees: A Cluster-Randomized Controlled Trial.

BACKGROUND: Occupational health nurses in workplaces aim to offer evidence-based interventions to increase physical activity among employees to promote health. Mobile health (m-health) interventions have demonstrated effectiveness in increasing physical activity, and the application of m-health solutions in workplaces warrants investigation. We examined the effectiveness of a cell phone/smart device and web-based (m-health) intervention in motivating the employees at financial enterprise firms to increase physical activity. METHODS: This study included employees from 16 banks (n = 194) who were randomly assigned to either (a) an experimental group (6 banks, n = 89), which received an intervention that integrated the Theory of Planned Behavior (TPB)-based tailored Short Message Service (SMS) with web-based knowledge or (b) a comparison group (10 banks, n = 105), which received web-based messages alone. Outcomes included psychosocial variables (attitude toward physical activity, normative beliefs, and control beliefs) and the level of physical activity. Data were collected at baseline, immediately after the intervention, and 3 months after the intervention. FINDINGS: The level of physical activity significantly increased in the experimental group (p < .05). TPB variables such as perceived social norms (p < .01) and behavioral control (p < .05) also significantly improved in the experimental group. However, all the effects had a small size (=.05) and diminished in 12 weeks. CONCLUSIONS: In addition to internet-based information, the use of mobile phones/smart devices to encourage employees to exercise for 8 weeks effectively increased employees' physical activity level. More research, specifically addressing workplace culture, is warranted to establish methods for sustaining healthy behaviors to increase physical activity.

The Influence of Breastfeeding Educational Interventions on Breast Engorgement and Exclusive Breastfeeding: A Systematic Review and Meta-Analysis.

BACKGROUND: Breast engorgement and breast pain are the most common reasons for the early cessation of exclusive breastfeeding by mothers. RESEARCH AIMS: (1) To examine the influence of breastfeeding educational interventions on breast engorgement, breast pain, and exclusive breastfeeding; and (2) to identify effective components for implementing breastfeeding programs. METHODS: Randomized controlled trials of breastfeeding educational interventions were searched using five English and five Chinese databases. Eligible studies were independently evaluated for methodological quality, and data were extracted by two investigators. In total, 22 trials were identified, and 3,681 participants were included. A random-effects model was used to pool the results, and a subgroup analysis and meta-regression analysis were conducted. RESULTS: Breastfeeding education had a significant influence on reducing breast engorgement at postpartum 3 days (odds ratio [OR]: 0.27, 95% CI [0.15, 0.48] p < .001), 4 days (OR: 0.16, 95% CI [0.11, 0.22], p < .001), and 5-7 days (OR: 0.24, 95% CI [0.08, 0.74], p = .013) and breast pain (standardized mean difference: -1.33, 95% CI [-2.26, -0.40]) at postpartum 4-14 days. Participants who received interventions had higher odds of exclusive breastfeeding. Breastfeeding educational interventions provided through lecture combined with skills practical effectively reduced breast engorgement (OR: 0.21; 95% CI [0.15, 0.28]; p = .001) and improved exclusive breastfeeding at postpartum 1-6 weeks (OR: 2.16; 95% CI [1.65, 2.83]; p = .001). CONCLUSIONS: Breastfeeding educational interventions have been effective in reducing breast engorgement, breast pain, and improved exclusive breastfeeding. A combination of knowledge and skill-based education has been beneficial for sustaining exclusive breastfeeding by mothers.

Effectiveness of an integrated breastfeeding education program to improve self-efficacy and exclusive breastfeeding rate: A single-blind, randomised controlled study.

BACKGROUND: Low self-efficacy affects new mothers' ability to sustain breastfeeding. Interventions that increase self-efficacy could improve sustained breastfeeding. OBJECTIVES: To develop an integrated breastfeeding education program based on self-efficacy theory, and evaluate the effect of the intervention on first-time mothers' breastfeeding self-efficacy and attitudes. DESIGN: A single-blind, randomised controlled trial. SETTING: A prenatal clinic of a teaching hospital. PARTICIPANTS: First-time mothers with a singleton pregnancy (12-32 weeks' gestation) and their support partners were selected by convenience sampling (N = 104) and allocated by block-randomization to an intervention or control group. METHODS: A 3-week breastfeeding intervention program was developed based on self-efficacy theory. The intervention group received the breastfeeding program; the control group received standard care. Data between groups were compared for scores on breastfeeding self-efficacy, infant feeding attitude, and breastfeeding practice, which were assessed using the Breastfeeding Self-Efficacy Scale-Short Form, the Iowa Infant Feeding Attitude Scale, and a structured questionnaire, respectively. Repeated data measurements were collected at baseline, 36-weeks' gestation, and postpartum at 1-week, and 1-, 3-, and 6-months. RESULTS: Ninety-three mothers completed the study. Data were compared for the self-efficacy intervention group (n = 50) with the control group (n = 43). Baseline measures did not differ between groups. The intervention group had significantly higher breastfeeding self-efficacy at 36 weeks' gestation (mean difference (MD): 7.3, p < .001), and postpartum at 1-week (p < .001), 1-month (p < .001) and 3-months (p < .01) with MD: 6.7, 7.9, and 8.1, respectively; differences in scores from baseline were also significantly greater from 36 weeks' gestation to 3-months (MD from 9.1~9.9, p < .001) and 6-months postpartum (MD: 7.0, p < .05). Infant feeding attitude scores significantly improved from 36 weeks' gestation to 6-months postpartum for the intervention group (MD from 3.5~7.4, p < .05). Rates for exclusive and predominant breastfeeding postpartum were significantly higher for the intervention group vs control (p < .02) at 1-week (98% vs. 86%), 1-month (100% vs. 90.7%), and 3-months (94% vs. 76.7%). Odds ratio (OR) postpartum for exclusive and predominant breastfeeding was greater for the intervention group at 3-months (OR = 4.7, 95% Confidence interval (CI), 1.2 -18.6; p = .05) and for exclusive breastfeeding at 6-months (OR: 2.82, 95% CI 1.0-8.1; p = .05). CONCLUSIONS: The breastfeeding education intervention improved breastfeeding self-efficacy, infant feeding attitudes, and exclusive breastfeeding rates. The breastfeeding education program could be effective for sustaining breastfeeding in new mothers. TRIAL REGISTRATION: Registered with www.clinicaltrials.gov (NCT03807726).

Personality traits and subjective well-being among fathers of preterm infants in Taiwan: a cross-sectional study.

OBJECTIVE: This study examined the association of personality traits and paternal/infant background characteristics with subjective well-being (SWB) among fathers of preterm infants. BACKGROUND: While studies of parental care of preterm infants have focused on mothers or both parents, studies focusing specifically on fathers are relatively rare. In this study, we provide new information on the personality traits and paternal/infant background characteristics and their association with SWB among fathers of preterm infants. METHODS: This study used a cross-sectional design. Participants included fathers of preterm infants hospitalised in the neonatal intensive care unit, neonatal intermediate care nursery, or postpartum ward of a medical centre in northern Taiwan within 5 days of birth. The Personality Inventory Scale and Subjective Well-being Scale were administered and background characteristics of fathers and preterm infants were measured. RESULTS: A total of 104 fathers participated, of whom 73.1% showed a moderate level of SWB. Fathers with higher extraversion and openness exhibited higher SWB, while fathers with higher neuroticism exhibited lower SWB. SWB was also predicted by age, infant weight, family structure, and paternal education level. These factors cumulatively accounted for 48% of the variance in SWB. CONCLUSION: Fathers' SWB was associated with extraversion, openness, neuroticism, age, education, family structure, and infant weight. The personality traits of fathers should be considered when developing plans for family support after following preterm infant birth. In addition to focusing on maternal well-being, programmes to increase paternal well-being would benefit the families of preterm infants.

Web-based intervention to promote physical activity in Taiwanese children.

PURPOSE: This study investigated the effectiveness of a theory-based, technology-integrated website in promoting the physical activity of schoolchildren. DESIGN AND METHODS: A website designed using a self-management strategy and supplemented with a geographical information system (GIS) mapping function was used to increase children's physical activity levels. A total of 524 students from six elementary schools in Taipei City completed surveys at three times during 2010 and were assigned to one of three groups: (1) a self-management group, using a website employing a goal-setting strategy and a storytelling schema based on a classical Chinese novel; (2) a knowledge-only group that was given only access to the website; or (3) a control group that was only given lectures and not allowed to access the website. RESULTS: After adjustment for the effects of the pretest, the self-management and knowledge-only groups were found to be more physically active and have higher self-efficacy than the control group. Moreover, the self-management group had higher scores for these two variables than the knowledge-only group. Furthermore, the intervention was more effectives for male students than female students. CONCLUSION: Overall, the self-management website proved to be effective in promoting schoolchildren's physical activity. The positive correlation of self-efficacy with the ability to handle the difficulties inherent in physical activity continued for 3 months after the intervention was completed.

Development and Validation of the Self-Awareness of Falls in Elderly Scale Among Elderly Inpatients.

The objectives of this study were to develop the Self-Awareness of Falls in Elderly (SAFE) scale and test its reliability and validity among elderly inpatients. A cross-sectional study design and convenience sampling were used to test the validity and reliability of the SAFE scale. Explanatory factor analysis and confirmatory factor analysis yielded an acceptable goodness of model fit, confirming the 21 items in the SAFE scale that were distributed among four factors: awareness of activity safety and environment, awareness of physical functions, awareness of medication, and awareness of cognitive behavior. The values of interrater reliability and Cronbach's alpha were at least .70, indicating that reliability of the SAFE scale was acceptable. The SAFE scale is the first instrument to measure self-awareness of fall risk among high-risk groups. Further management and fall prevention can then be designed to reduce the incidence of falls among elderly people in clinical care.

Effects of Home-Based Supportive Care on Improvements in Physical Function and Depressive Symptoms in Patients With Stroke: A Meta-Analysis.

OBJECTIVE: To examine the effects of home-based supportive care on improvements in physical function and depressive symptoms in home-dwelling patients after stroke. DATA SOURCES: Seven electronic databases (eg, MEDLINE, PubMed, CINAL, EMBASE, the Cochrane Central Register of Controlled Trials, ProQuest, and Google Scholar) and 4 Chinese databases (eg, WANFANG MED ONLINE, Chinese Electronic Periodical Services, China Academic Journals Full-text Database, and National Central Library) were fully searched for all relevant articles up to June 25, 2016. STUDY SELECTION: Randomized controlled trials examining the effects of home-based supportive care on physical function and depressive symptoms in home-dwelling patients after stroke were included. Finally, 16 articles in Chinese (n=4) and English (n=12) met the inclusion criteria. DATA EXTRACTION: Data on patient characteristics, study characteristics, intervention details, and outcome were extracted. Two reviewers independently extracted data and assessed methodological quality using the Cochrane risk of bias tool. DATA SYNTHESIS: Home-based supportive care had a small size effect on physical function (Hedges' g=.17; 95% confidence interval, .09-.26) and a moderate size effect on depressive symptoms (Hedges' g=-.44; 95% confidence interval, -.83 to -.05) in home-dwelling patients after stroke. The moderator analysis revealed that some components of study participants and intervention programs improved the effects on physical function and depressive symptoms; however, no significant moderators were further identified to have superiorly improved physical function and depressive symptoms. CONCLUSIONS: Regular performance of home-based supportive interventions should be considered for inclusion as routine care for managing and improving physical function and depressive symptoms in home-dwelling patients after stroke. The present findings provide further evidence with which to design appropriate supportive interventions for home-dwelling stroke survivors.

Validation and Cross-Cultural Adaptation of a Chinese Version of the Emotional and Social Dysfunction Questionnaire in Stroke Patients.

The objectives of this study were to develop a cross-cultural Chinese version of the Emotional and Social Dysfunction Questionnaire (ESDQ-C) and test its validity and reliability among Chinese-speaking stroke patients. Various methods were used to develop the ESDQ-C. A cross-sectional study was used to examine the validity and reliability of the developed questionnaire, which consists of 28 items belonging to six factors, anger, helplessness, emotional dyscontrol, indifference, inertia and fatigue, and euphoria. Satisfactory convergence and known-group validities were confirmed by significant correlations of the ESDQ-C with the Profile of Mood States-Short Form ( p < .05) and with the Hospital Anxiety and Depression Scale ( p < .05). The internal consistency was represented by Cronbach's alpha, which was .96 and .79 to .92 for the entire scale and subscales, respectively. Appropriate application of the ESDQ-C will be helpful to identify critical adjustment-related types of distress and patients who experience difficulty coping with such distress.

Time-Varying Effects of Psychological Distress on the Functional Recovery of Stroke Patients.

OBJECTIVE: To explore the temporal effects of psychological distress on the functional recovery of stroke survivors. DESIGN: A longitudinal follow-up study. All participants were interviewed at 5 days after stroke onset, and at 1, 2, 3, and 6 months after discharge from acute care hospitals. SETTING: Neurology inpatient and outpatient departments and rehabilitation clinics. PARTICIPANTS: First-time stroke participants (N=62) without cognitive impairment, psychiatric disorders, or cancer were recruited. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Measurements consisted of demographic characteristics, disease severity, social support, the Chinese version of the Emotional and Social Dysfunction Questionnaire (ESDQ_C), and the Barthel Index. RESULTS: Our findings showed that psychological distress had a dynamic effect on functional recovery over time, and as the total ESDQ_C score increased by 1 point, the concurrent functional recovery decreased by .23 points (P<.001). Additionally, 5 subscales of the ESDQ_C including anger, emotional dyscontrol, helplessness, indifference, and euphoria also had dynamic effects on functional recovery over time (P<.05). Regardless of when a single form or various forms of psychological distress occurred over time from stroke onset, the functional recovery over time was simultaneously affected. CONCLUSIONS: The time-varying effect of psychological distress on functional recovery was significant. Adopting comprehensive instruments and regular assessments for the early detection of various psychological distresses while under clinical care is needed. Effective interventions targeting both physical and mental functions would further improve the functional recovery and overall health of stroke patients.

Influential Factors for and Outcomes of Hospitalized Patients with Suicide-Related Behaviors: A National Record Study in Taiwan from 1997-2010.

BACKGROUND: Investigating the factors related to suicide is crucial for suicide prevention. Psychiatric disorders, gender, socioeconomic status, and catastrophic illnesses are associated with increased risk of suicide. Most studies have typically focused on the separate influences of physiological or psychological factors on suicide-related behaviors, and have rarely used national data records to examine and compare the effects of major physical illnesses, psychiatric disorders, and socioeconomic status on the risk of suicide-related behaviors. OBJECTIVES: To identify the characteristics of people who exhibited suicide-related behaviors and the multiple factors associated with repeated suicide-related behaviors and deaths by suicide by examining national data records. DESIGN: This is a cohort study of Taiwan's national data records of hospitalized patients with suicide-related behaviors from January 1, 1997, to December 31, 2010. PARTICIPANTS: The study population included all people in Taiwan who were hospitalized with a code indicating suicide or self-inflicted injury (E950-E959) according to the International Classification of Disease, Ninth Revision, Clinical Modification. RESULTS: Self-poisoning was the most common method of self-inflicted injury among hospitalized patients with suicide-related behaviors who used a single method. Those who were female, had been hospitalized for suicide-related behaviors at a younger age, had a low income, had a psychiatric disorder (i.e., personality disorder, major depressive disorder, bipolar disorder, schizophrenia, alcohol-related disorder, or adjustment disorder), had a catastrophic illness, or had been hospitalized for suicide-related behaviors that involved two methods of self-inflicted injury had a higher risk of hospitalization for repeated suicide-related behaviors. Those who were male, had been hospitalized for suicide-related behaviors at an older age, had low income, had schizophrenia, showed repeated suicide-related behaviors, had a catastrophic illness, or had adopted a single lethal method had an increased risk of death by suicide. CONCLUSIONS: High-risk factors should be considered when devising suicide-prevention strategies.

Nursing Students' Willingness to Care for Older Adults in Taiwan.

BACKGROUND: The possibilities that nurses will take care of persons 65 years of age or older in hospitals and communities are increasing due to a growing aged population. Nursing students should be prepared to face the challenges of their future practice. Therefore, factors associated with nursing students' willingness to care for older adults need to be identified. AIM: This study aimed to explore Taiwanese nursing students' willingness to work with older persons and factors associated with this. METHODS: A cross-sectional research design was used. Stratified sampling was applied to recruit participants from seven nursing schools in northern, central, southern, and eastern areas of Taiwan. There were 612 nursing students who successful completed the questionnaire including demographic data, the Attitudes Toward the Elderly Scale, and the Willingness Toward the Elderly Care Scale. Data were collected between November 2012 and January 2013. A stepwise regression analysis was conducted to identify predictors of nursing students' willingness to care for older adults. FINDINGS: The mean score of nursing students' attitudes toward older people was 73.86 (SD = 8.9), with a range of 44-106. The mean score on the willingness to care for older adults was 55.01 (SD = 6.4), with a range of 36-75. The length of time with older adults per week (r = 0.12, p = .003) and grandparents having served as caregivers during the students' childhood (t = -2.147, ß = .032) were both positively associated with the willingness to care for older adults. The best predictors of nursing students' willingness to care for older adults were students' attitudes toward older adults (ß = 0.38, p < .001), paying attention to issues related to older adults (ß = 0.24, p < .001), and having the experience of being a volunteer who served older people (ß = 0.10, p = .005), which explained 26.8% of the total variance. CONCLUSIONS: Taiwanese undergraduate nursing students had neutral to slightly favorable attitudes toward working with older adults. Nursing students' positive attitudes about older adults, paying attention to issues related to older adults, and having been a volunteer that served older people were predictors of their willingness to care for older persons. Appropriate and practical strategies should be developed for students in order to increase their preference for caring for older people. CLINICAL RELEVANCE: The findings of this study can provide information for faculty members and clinical preceptors for designing curricula and related activities or arranging practicum in the future.

The mediating effect of psychological distress on functional dependence in stroke patients.

AIMS AND OBJECTIVES: To explore varied forms of psychological distress and to determine the mediating influence of psychological distress on functional outcomes in stroke patients. BACKGROUND: Previous studies attest to the influence of depression on poststroke functional recovery. While there is evidence for neuropathological deficits that occur after stroke to be associated with psychological distress, few studies have explored the effect of various types of psychological distress on functional recovery. DESIGN: A cross-sectional study was used. METHODS: Data were collected from 178 first-time stroke patients. Study variables included demographic and disease characteristics (stroke location and stroke syndrome classification), psychological distress (the Chinese language version of the Emotional and Social Dysfunction Questionnaire) and functional outcome (Barthel index). Regression and mediation models were used to evaluate the effect of psychological distress on functional outcome. RESULTS: Results revealed that stroke patients experience various forms of mild psychological distress, including anger, helplessness, emotional dyscontrol, indifference, inertia and euphoria, after stroke. Regression and mediation analyses further confirmed that various forms of psychological distress significantly mediated the effect of severe stroke syndromes on functional dependence. CONCLUSION: The various forms of psychological distress after stroke might play a mediating role in functional recovery and explain how stroke severity affects functional dependence. RELEVANCE TO CLINICAL PRACTICE: By understanding the nature of various forms of psychological distress, healthcare professionals should adopt appropriate assessment instruments and design effective interventions to help improve mental and physical function of stroke patients.

Gender and age differences among youth, in utilization of mental health services in the year preceding suicide in Taiwan.

The primary objective of this study was to explore gender and age differences in the use of medical services during the year preceding suicide. Data were obtained from the mortality dataset of Department of Health and National Health Insurance Database. Included in the sample were 862 persons aged 12-24 years who committed suicide in Taiwan between 2001 and 2004. We compared the records of medical service utilization of adolescents (ages 12-18 years) with young adults (ages 19-24 years). Persons in both age groups contacted general practitioners more often than other types of medical providers in the year preceding suicide, with the exception of the month before suicide. Females made greater use of medical services than males in both age groups. Suicide prevention strategies should increase the emphasis in training non-psychiatric medical practitioners to identify and treat young persons at suicide risk.

Effects of a community prevention intervention on public awareness, knowledge, and risk perception of club drug use by youth in Taiwan.

This study evaluated the effects of mobilizing community coalitions and implementing prevention intervention concerning public awareness, knowledge, and perception of the risks associated with club drug use by Taiwanese urban youth. A quasi-experimental design was used. Three communities in Taipei city were included in the present study. A total of 328 residents successfully participated in the baseline survey (April 2008), and 276 residents were successfully interviewed for the follow-up survey (September 2008). The generalized estimating equation (GEE) method was used. The percentage of the intervention respondents who reported having seen or heard antidrug messages increased significantly between the time of the baseline survey (63.7%) and the follow-up survey (77.4%), while the percentage of attendance at antidrug events increased from 23.1% to 38.7% during the same time interval. In addition, community knowledge and perception of the problem of club drug use by youth rose significantly between the baseline and the follow-up in the intervention communities. The study's limitations are noted.

Significant effects of implementation of health-promoting schools on schoolteachers' nutrition knowledge and dietary intake in Taiwan.

OBJECTIVE: Although teachers are the key participants in health-promoting schools (HPS) programme delivery, it is still unknown whether teachers are appropriate health information resources and role models for students with respect to healthy diets. The present study aimed to investigate the effects of implementing HPS programmes on teachers' nutrition knowledge and diets. DESIGN: One HPS programme aiming at dietary intervention (HP-D) and one HPS not aiming at dietary intervention (HP-ND) were selected, along with two non-health-promoting (NHP) schools matched for school size and urbanization level with the two HPS. All 361 teachers in the four schools were invited to participate, yielding a 78.4 % overall valid response rate. A structured, self-reported questionnaire was administered, with regression models used for statistical analysis. RESULTS: Teachers in the HP-D group had a mean score of 21.1 on a range of 0-30 for nutrition knowledge, which was significantly higher than the mean scores of 18.5 in the HP-ND group and 19.1 in the NHP group (P < 0.001). Better dietary behaviours were also observed among HP-D teachers. Further, being a 'health education' course instructor was associated with significantly higher scores on nutrition knowledge (beta = 2.6, P < 0.001) and vegetable and fruit consumption (beta = 1.4, P = 0.02) in the HP-D group than in the NHP group. The HP-ND and NHP groups exhibited similar patterns of non-significant differences compared with the HP-D group. CONCLUSIONS: Implementation of a coordinated HPS framework on nutrition and diet was positively correlated with schoolteachers' nutrition knowledge and dietary intake.