A qualitative investigation of demands, resources and self-regulation during Navy deployment.

Creating a sustainable workplace for Navy personnel is vital for their wellbeing and retention. This qualitative study explores the interplay between job and personal demands, resources, and stress self-regulation strategies affecting psychological strain among Navy personnel during deployment. We conducted semi-structured key informant interviews with 25 Navy personnel (68% male) to determine the demands and resources at sea that affect psychological strain. The findings identified that individual differences in coping strategies (e.g., recovery management), abilities (i.e. ability to make social connections), and their mind-set about deployment (e.g., sense of purpose) were perceived to play a role in the experience of strain. Additionally, the presence of supportive peers and leaders was identified as a key resource, whereas external stressors (e.g., family crisis) and social tension onboard, amplified by confined spaces, were commonly reported demands. Our findings also contribute to a growing body of research suggesting a nuanced interaction between individual coping strategies and job design. Formal organizational support was identified as enabling adaptive self-regulation strategies, while the capacity to form and maintain positive relationships helped foster a sense of belonging, countering isolation. Another key contribution was the individual differences in the appraisal of resources offered by the organization and the potential importance of resource appraisal in how effective resources were perceived to be for addressing shipboard demands. We provide recommendations relating to targets for personnel training, interventions, and leadership in terms of communication, supporting day-to-day and equal opportunity for recovery, resource access, maintaining morale, and shaping the evaluation of demands.

Road to referral success in COPD: Enhancing patient engagement through dedicated conversations about pulmonary rehabilitation programs.

RESEARCH QUESTION: From the perspectives of healthcare professionals (HCPs) and people with chronic obstructive pulmonary disease (COPD) known to tertiary care, what influences successful referrals to a pulmonary rehabilitation program (PRP)? METHODS: This cross-sectional qualitative study was informed by a critical realist perspective. We purposively sampled people with COPD and HCPs who deliver COPD care and used semi-structured interviews and focus groups to explore determinants of a successful referral to a PRP. Interviews were recorded, transcribed verbatim and analysed using reflexive thematic analysis. RESULTS: Data were available on 38 HCPs and 15 people with COPD. We generated three core themes pertaining to successful referrals. The first theme was that HCPs should be mindful of how professional responsibilities (such as their personal value and interest in a PRP, their degree of understanding of PRPs, and the organisational culture the PRPs are embedded within) shape decision-making during a therapeutic interaction. The second theme, there's more to me than my COPD, characterised psychological perceptions that shape a person's readiness to engage in a PRP. The third theme, communication is a two-way street that requires careful navigation, characterised the interpersonal dynamic between HCP and patient, and how dedicated conversations about PRPs can encourage successful referrals. CONCLUSION: Therapeutic interactions that include dedicated conversations about PRPs can foster successful referrals among people with COPD. During these interactions, HCPs should take the time to understand and carefully unpack psychological perceptions whilst imparting value, interest and enthusiasm for PRPs. Doing so can shape patient engagement toward referral success.

Interventions with a clear focus on achieving behaviour change are important for maintaining training-related gains in people with chronic obstructive pulmonary disease: a systematic review.

QUESTIONS: In people with chronic obstructive pulmonary disease (COPD) who complete an exercise training program (ETP) offered at a sufficient dose to result in training-related gains, to what extent are these gains maintained 12 months after program completion? Do variables such as the application of behaviour change techniques moderate the maintenance of these training-related gains? DESIGN: Systematic review, meta-analysis and meta-regression of randomised controlled trials. PARTICIPANTS: People with stable COPD. INTERVENTION: Trials were included if they applied ≥ 4 weeks of a whole-body ETP and reported outcome data immediately following program completion and 12 months after initial program completion. The control group received usual care that did not include a formal exercise training component. OUTCOME MEASURES: Exercise tolerance, health-related quality of life and dyspnoea during activities of daily living. DATA SOURCES: EMBASE, PEDro, PubMed and the Cochrane Library. RESULTS: Nineteen randomised trials with 2,103 participants were found, of which 12 had a sufficiently similar design to be meta-analysed. At 12 months after ETP completion, compared with the control group, the experimental group demonstrated better exercise tolerance (SMD 0.48, 95% CI 0.19 to 0.77) and quality of life (SMD 0.22, 95% CI 0.03 to 0.41) with no clear effect on dyspnoea. Meta-regression using data from all 19 trials demonstrated that the magnitude of between-group differences at the 12-month follow-up was moderated by: behaviour change being a core aim of the strategies implemented following completion of the ETP; the experimental group receiving more behaviour change techniques during the program; and the magnitude of between-group change achieved from the program. CONCLUSION: At 12 months after completion of an ETP of ≥ 4 weeks, small gains were maintained in exercise tolerance and health-related quality of life. Applying behaviour change techniques with a clear focus on participants integrating exercise into daily life beyond initial program completion is important to maintain training-related gains. REGISTRATION: CRD42020193833.

Psychosocial predictors of doping intentions and use in sport and exercise: a systematic review and meta-analysis.

OBJECTIVE: To conduct a meta-analytic review of psychosocial predictors of doping intention, doping use and inadvertent doping in sport and exercise settings. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Scopus, Medline, Embase, PsychINFO, CINAHL Plus, ProQuest Dissertations/Theses and Open Grey. ELIGIBILITY CRITERIA: Studies (of any design) that measured the outcome variables of doping intention, doping use and/or inadvertent doping and at least one psychosocial determinant of those three variables. RESULTS: We included studies from 25 experiments (N=13 586) and 186 observational samples (N=3 09 130). Experimental groups reported lower doping intentions (g=-0.21, 95% CI (-0.31 to -0.12)) and doping use (g=-0.08, 95% CI (-0.14 to -0.03), but not inadvertent doping (g=-0.70, 95% CI (-1.95 to 0.55)), relative to comparators. For observational studies, protective factors were inversely associated with doping intentions (z=-0.28, 95% CI -0.31 to -0.24), doping use (z=-0.09, 95% CI -0.13 to to -0.05) and inadvertent doping (z=-0.19, 95% CI -0.32 to -0.06). Risk factors were positively associated with doping intentions (z=0.29, 95% CI 0.26 to 0.32) and use (z=0.17, 95% CI 0.15 to 0.19), but not inadvertent doping (z=0.08, 95% CI -0.06 to 0.22). Risk factors for both doping intentions and use included prodoping norms and attitudes, supplement use, body dissatisfaction and ill-being. Protective factors for both doping intentions and use included self-efficacy and positive morality. CONCLUSION: This study identified several protective and risk factors for doping intention and use that may be viable intervention targets for antidoping programmes. Protective factors were negatively associated with inadvertent doping; however, the empirical volume is limited to draw firm conclusions.

Stepping back or stepping in: A qualitative investigation of self-distanced versus self-immersed stressor reflections with competitive swimmers.

High performance sport consists of stressor events which can disrupt an athletes' functioning and negatively influence performance. The way in which one reflects upon stressor events and develops insights regarding how they coped is essential to overcoming similar experiences in the future. We conducted a pilot randomised controlled trial with a qualitative analysis to explore the coping insights among 48 highly trained/national level swimmers in the lead up to major swimming competitions, who reflected on stressor events from self-distanced or self-immersed perspectives over a 3-week period. Using the self-reflection and coping insight framework as a guideline, we captured divers coping insights across both groups. Irrespective of the group to which they were assigned, athletes showed positive signs towards re-interpreting their stressor experience and embracing the stressor event, whereas consideration of individual values and adoption of a future-focus viewpoint were areas lacking. The emotionality described by athletes in their written reflections varied across both groups and influenced the development of coping insights. Our findings indicate a necessity to examine the emotionality associated with unique stressor events and consider integrating reflection strategies, while also enhancing the operational definitions within conceptual models of stress reflection protocols.

Quantifying uptake and completion of pulmonary rehabilitation programs in people with chronic obstructive pulmonary disease known to tertiary care.

BACKGROUND: People with symptomatic chronic obstructive pulmonary disease (COPD) benefit from pulmonary rehabilitation programs (PRPs), but program attrition is common. METHODS: For people with COPD who presented to tertiary care and appeared appropriate for a PRP, we prospectively mapped their PRP journey, explored factors influencing attendance to pre-program assessment and captured program attrition. RESULTS: Of the 391 participants, 31% (95% CI 27 to 36) were referred to a PRP (n = 123; age 68 ± 10years, 62 males [50%], FEV1 45 ± 19%predicted). Of those referred, 94 (76% [69 to 84]) attended a pre-program assessment. Ex-smokers and those who had a healthcare professional (HCP) explain they would be referred were more likely to attend a pre-program assessment (odds ratio [95%CI]; 2.6 [1.1 to 6.1]; and 4.7 [1.9 to 11.7], respectively). Of the 94 who attended, 63 (67% [58 to 77]) commenced; and of those who commenced, 35 (56% [43 to 68]) completed a PRP. All who completed (n = 35, 100%) were provided at least one strategy to maintain training-related gains. CONCLUSION: Attrition occurs throughout the PRP journey. Interactions with HCPs about PRPs positively influenced attendance. Understanding how HCPs can best contextualise PRPs to encourage referral acceptance and uptake is an important area for further work.

Autonomous motivation promotes goal attainment through the conscious investment of effort, but mental contrasting with implementation intentions makes goal striving easier.

People with autonomous motives (e.g., personal importance) may use automated strategies to effortlessly sustain goal-directed behavior and overcome obstacles. We investigated whether conscious effort, ease of goal striving, physiological effort, and the number of obstacles encountered mediate relations between motives and goal attainment for a competitive cycling goal. Additionally, half the participants (n = 57) were trained in Mental Contrasting with Implementation Intentions (MCII) - a technique that facilitates development of goal-directed behavior - with remaining participants (n = 54) treated as controls. Conscious investment of effort mediated relations between autonomous motives and goal attainment. Subjective ease of goal striving and physiological effort did not. This result indicates that successful goal striving is not perceived as effortless for autonomously motivated individuals working on competitive goals. Conversely, MCII predicted a reduction in obstacles, which in turn was associated with easier goal striving but not goal attainment. Although MCII did not support goal attainment in the current study, its ability to minimize the influence of obstacles may still be useful for other types of goals or for sustaining long-term goal pursuit.

Health behaviour profiles in young Australian adults in relation to physical and mental health: The Raine Study.

ISSUES ADDRESSED: We aimed to identify latent health behaviour profiles of young adults and examine their associations with physical and mental health outcomes. We also characterised the profiles by socio-demographic characteristics. METHODS: Data were collected between 2012 and 2014. Participants (N = 476) were young adults (M age [SD] = 22.1 [.57] years) from Generation 2 of the Raine Study longitudinal cohort. Health behaviours were measured via ActiGraph GT3X waist monitors (physical activity, sedentary behaviour) and questionnaires (diet quality, alcohol, smoking and sleep). Physical and mental health were measured using clinical health assessments, blood biomarkers, and questionnaires. Latent Profile Analysis using Mplus (8.2) was employed to identify profiles. RESULTS: Four latent profiles were identified: 'heavy drinkers with moderately unhealthy eating habits' (high takeaway foods; n = 135), 'unhealthy food abstainers' (low takeaway foods; n = 138), 'moderately sedentary alcohol abstainers' (n = 139) and 'physically active drinkers with unhealthy eating habits' (high takeaway foods and sugary drinks; n = 64). 'Physically active drinkers with unhealthy eating habits' had the poorest (physical and mental) health outcomes, yet the lowest insulin resistance. 'Unhealthy food abstainers' had the most favourable health outcomes (adiposity, health perceptions, blood pressure). Sex differed among the profiles. CONCLUSIONS: The profiles identified among young adults are different to profiles with general adult populations. A novel finding was that 'physically active drinkers with unhealthy eating habits' had low insulin resistance. The findings also suggest that future interventions may need to be sex specific. SO WHAT: Our findings suggest that health behaviour interventions for young adults should be targeted to distinct profile characteristics.

A Mixed-Methods Feasibility Study of a Gamified Therapy Prescription App for Children with Neurodisability.

AIM: Determine the feasibility of a gamified therapy (occupational therapy, physiotherapy, speech pathology) prescription app developed for children with neurodisability for delivering school and home therapy programs (the Zingo app). METHOD: A mixed-methods feasibility study was conducted with children (and their parents, therapists, and teachers) with neurodisability (n = 8, female= 5) who were prescribed a 4-week individualized therapy program by their usual treating therapist using Zingo. Primary outcome measures were program adherence, engagement, app quality, and user experience, collected with quantitative and qualitative methods. RESULTS: Mean adherence to the program was 58.0% (SD 27.2). Our combined Engagement Index (EI) score was 74.4% (SD 11.7). App quality measured using Mobile Application Rating Scale- User version was 4.6/5 (SD 0.7, n = 6) for parents, 4.6/5 (SD 0.5, n = 5) for teachers, and 4.4/5 (SD 0.6, n = 6) for therapists. Thematic analysis of semi-structured interviews yielded a primary theme of "app as motivator" for therapy. CONCLUSIONS: Adherence findings were affected by COVID-19 outbreak however remain comparable with other studies in this cohort. EI findings compared favorably with other studies. The findings are supportive of the feasibility of Zingo for delivering home and school therapy programs for children with neurodisability and was found to motivate therapy program completion.

Examining the roles of experiential avoidance and cognitive fusion on the effects from mindfulness to athlete burnout: A longitudinal study.

OBJECTIVES: Athlete burnout is a maladaptive outcome that is potentially detrimental for performance and wellbeing. Cross-sectional evidence suggests that mindfulness might be associated with athlete burnout via experiential avoidance and cognitive fusion. In the current study, we extend knowledge of these hypothesized mediational pathways using a longitudinal design. METHODS: Data was collected at three occasions with a three-month interval. A final sample of 280 elite Chinese athletes aged 15-32 years (Mage = 19.13; SD = 2.92; Female = 130) reported their mindfulness at Time 1, experiential avoidance and cognitive fusion at Time 2, and athlete burnout at Time 3. Structural equation modelling was adopted to examine the mediating roles of experiential avoidance and cognitive fusion on the effects from mindfulness to athlete burnout. RESULTS: We found statistically meaningful directs effects from mindfulness (Time 1) to experiential avoidance and cognitive fusion (Time 2), which in turn influenced athlete burnout (Time 3). However, the direct effect from mindfulness at Time 1 to athlete burnout at Time 3 was non-significant. The indirect effects of experiential avoidance and cognitive fusion on the effects from mindfulness to athlete burnout were significant, providing longitudinal evidence that these two variables contribute meaningfully to the mindfulness-burnout pathway. CONCLUSION: With initial evidence for the mediating effects of experiential avoidance and cognitive fusion, future studies could consider using experimental designs to examine the potential changing mechanisms of mindfulness on reducing athlete burnout.

Intraindividual variability in sleep among athletes: A systematic review of definitions, operationalizations, and key correlates.

Via systematic review with narrative synthesis of findings, we aimed to document the ways by which researchers have defined, operationalized, and examined sleep variability among athletes. We identified studies in which scholars examined intraperson variability in sleep among athletes via a search of six databases (Web of Science, Embase, Medline, PsycINFO, CINHAL Plus, and ProQuest Dissertations and Theses Global) using a protocol that included keywords for the target outcome (sleep*), population (athlet* OR sport*), and outcome operationalization (variability OR variation OR "standard deviation" OR fluctuate OR fluctuation OR stability OR instability OR reactivity OR IIV OR intraindividual). We complemented this primary search with citation searching of eligible articles. Assessments of study quality captured eight core elements, namely aims/hypotheses, sample size justification, sample representativeness, number of days sleep assessed, measures of sleep and its correlates, missing data, and inferences and conclusions. From a total of 1209 potentially relevant papers, we identified 16 studies as meeting our eligibility criteria. Concept definitions of variability were notably absent from this work and where available were vague. Quantitative deviations from one's typical level of target sleep metrics reflected the essence by which all but one of the research teams operationalized sleep variability. We assessed the overall quality of empirical work as moderate in nature. We propose a working definition of sleep variability that can inform knowledge generation on the temporal, day-to-day dynamics of sleep functioning that is required for personalized interventions for optimizing sleep health.

Applying the behavioural change wheel to guide the implementation of a biopsychosocial approach to musculoskeletal pain care.

Achieving high value, biopsychosocial pain care can be complex, involving multiple stakeholders working synergistically to support the implementation of quality care. In order to empower healthcare professionals to assess, identify and analyse biopsychosocial factors contributing to musculoskeletal pain, and describe what changes are needed in the whole-of-system to navigate this complexity, we aimed to: (1) map established barriers and enablers influencing healthcare professionals' adoption of a biopsychosocial approach to musculoskeletal pain against behaviour change frameworks; and (2) identify behaviour change techniques to facilitate and support the adoption and improve pain education. A five-step process informed by the Behaviour Change Wheel (BCW) was undertaken: (i) from a recently published qualitative evidence synthesis, barriers and enablers were mapped onto the Capability Opportunity Motivation-Behaviour (COM-B) model and Theoretical Domains Framework (TDF) using "best fit" framework synthesis; (ii) relevant stakeholder groups involved in the whole-of-health were identified as audiences for potential interventions; (iii) possible intervention functions were considered based on the Affordability, Practicability, Effectiveness and Cost-effectiveness, Acceptability, Side-effects/safety, Equity criteria; (iv) a conceptual model was synthesised to understand the behavioural determinants underpinning biopsychosocial pain care; (v) behaviour change techniques (BCTs) to improve adoption were identified. Barriers and enablers mapped onto 5/6 components of the COM-B model and 12/15 domains on the TDF. Multi-stakeholder groups including healthcare professionals, educators, workplace managers, guideline developers and policymakers were identified as target audiences for behavioural interventions, specifically education, training, environmental restructuring, modelling and enablement. A framework was derived with six BCTs identified from the Behaviour Change Technique Taxonomy (version 1). Adoption of a biopsychosocial approach to musculoskeletal pain involves a complex set of behavioural determinants, relevant across multiple audiences, reflecting the importance of a whole-of-system approach to musculoskeletal health. We proposed a worked example on how to operationalise the framework and apply the BCTs. Evidence-informed strategies are recommended to empower healthcare professionals to assess, identify and analyse biopsychosocial factors, as well as targeted interventions relevant to various stakeholders. These strategies can help to strengthen a whole-of-system adoption of a biopsychosocial approach to pain care.

Predictors of intentions of adults over 35 years to participate in walking sport programs: A social-ecological mixed-methods approach.

There is a growing need to identify acceptable and feasible opportunities to engage adults over 35 years in physical activity. Walking sports may be a potential means to engage adults in sport; however, there is limited evidence regarding appeal and feasibility to support its implementation and delivery. Using a two-step mixed-methods approach, we aimed (1) to quantitively identify significant predictors of intentions of adults over 35 years to participate in walking sports and (2) to understand why and how these identified predictors may be contextually relevant to the target group. In phase one, 282 adults over 35 years (Mage = 46.08, SD = 9.75) without prior experience of walking sports completed an online questionnaire assessing personal, psychosocial, program-related, and environmental predictors, and intentions to participate in walking sports. Hierarchical multiple linear regressions showed that perceived health status, attitudes, subjective norms, and distance of venue were significant predictors of intentions. In phase two, interviews with a subset of 17 participants indicated that, when implementing walking sport programs, program labeling, fear of the unknown, and individual differences in the appeal of walking sport warrant consideration. Together, these findings offer insight into the complex interplay of personal, psychosocial, program-related, and environmental predictors of adults' intentions to participate in walking sports. Addressing these elements of a walking sport program would make such programs more appealing to potential participants, and ultimately, more feasible and sustainable to conduct in the long run.

The effectiveness of self-distanced versus self-immersed reflections among adults: Systematic review and meta-analysis of experimental studies.

Stressor events can be highly emotional and disruptive to our functioning, yet they also present opportunities for learning and growth via self-reflections. Self-distanced reflections in which one reasons about target events in ways that maximise their removal of the current self from the experiential reality are said to facilitate this reflective process. We tested the expectation that self-distanced reflections offer an advantage over self-immersed vistas via a pre-registered systematic review of seven electronic databases (Scopus, Medline, Web of Science, PsycInfo, CINAHL Plus, Embase, and ProQuest Dissertations and Theses Global) to identify experimental tests with adults aged 18-65 years where the focus of the reflection was a stressor or adverse event that participants had already experienced. A three-level, random effects meta-analysis of 25 experiments (N = 2,397, 68 effects) revealed a small-to-moderate advantage of self-distanced reflections (g = 0.19, SE = 0.07, 95% CI [0.05, 0.33]) and were most effective when they targeted a stressor experience that emphasised one's emotional state or lifetime. Nevertheless, our assessment of the overall quality of evidence including risk of bias suggested uncertainty regarding the benefit of this pragmatic self-regulatory tactic and therefore the need for future high-powered, high-quality experiments.

Stressor reflections, sleep, and psychological well-being: A pre-registered experimental test of self-distanced versus self-immersed reflections.

Evidence supports the effectiveness of cuing people to analyse negative autobiographical experiences from self-distanced rather than self-immersed perspectives. However, the evidence on which this expectation resides is limited largely to static snapshots of mean levels of cognitive and emotional factors. Via a pre-registered, randomised controlled trial (N = 257), we examined the differential effectiveness of self-distanced relative to self-immersed reflections on mean levels and within-person variability of sleep duration and quality as well as psychological well-being over a 5-day working week. Except for sleep quality, we found that reflecting from a psychologically distanced perspective, overall, was no more effective for mean levels and within-person variability of sleep duration, well-being, and stress-related factors than when the current self is fully immersed in the experiential reality of the event. We consider several substantive and methodological considerations (e.g., dosage, salience of stressor event) that require interrogation in future research via experimental and longitudinal observational methods.

"More than just a walk in the park": A multi-stakeholder qualitative exploration of community-based walking sport programmes for middle-aged and older adults.

In spite of the large-scale growth of walking sport (WS) programmes globally, limited research has explored the experiences of the key stakeholders involved in such programmes (i.e. decision-makers, facilitators, and players). We aimed to explore stakeholder experiences of community-based WS programmes to better understand the appeal of such sport options for middle-aged and older adults, and propose tentative recommendations for the feasibility and sustainability of these types of programmes. We conducted semi-structured interviews with 21 stakeholders who were involved with WS programmes in Australia as decision-makers, facilitators, and/or players. Data were analysed with reflexive thematic analysis. Four key themes pertaining to the WS experience were identified - 'a renewed lease of life', 'navigating ageing stereotypes', 'tension between organisational demands and players' needs', and 'WS facilitators as catalysts of success'. Specifically, we found that WS participation enabled a positive ageing discourse for middle-aged and older adults. WS players had to negotiate stereotypes that, at times, were perceived as participation barriers. We also noted some tensions between the demands of sport organisations and the needs of middle-aged and older adults regarding sport participation. Finally, we also noted the importance of the facilitators' role in increasing accessibility of, and long-term participation in, such programmes. We suggest that to offer feasible and sustainable community-based WS programmes across Australia, incompatibilities across various stakeholders' perspectives need to be addressed.

Enhancing functional recovery for young people recovering from first episode psychosis via sport-based life skills training: outcomes of a feasibility and pilot study.

Early intervention within First Episode Psychosis (FEP) recovery efforts support functional recovery in several ways, including increasing levels of (1) physical activity (2) life skills, and (3) social connectivity. Sport has been proposed as an ideal platform to target these three goals simultaneously. The primary aims were to assess the feasibility of utilising sport-based life skills within FEP recovery efforts and test intervention components. The secondary aim was to evaluate the potential recovery benefits. Seven young people (aged 15-25 years) with FEP participated in a six-week sport programme alongside their support workers (community and peer workers) from the service, including peer workers with a lived experience of psychosis. The programme consisted of various sporting activities, which were designed to promote physical activity, maximise social connectivity, and teach life-skills (e.g. motivation, emotional regulation, and goal-setting) that are relevant and transferrable to other contexts (e.g. school, employment, independent living). The support participants engaged with the programme at the same level as the young people, with the role of providing support and normalising/modelling engagement. The young and support participants provided feedback during and after the programme via questionnaires and interviews. Young participants self-reported physical activity levels, psychological needs, recovery dimensions, and life skills pre- and post- intervention using established psychometric tools. We used thematic analysis to analyse the qualitative data and compared this information with other data collected (e.g. attendance, feedback, quantitative measurements). The study culminated with a process evaluation. The results indicated that, despite challenges with engagement for young people with FEP, sport-based life skills programming may be a feasible and useful recovery outlet. In addition, the results highlighted specific intervention components that were useful to promote engagement and recovery benefits. This study serves as a critical foundation for future sport-based work within FEP recovery.

Intervention Mapping of a Gamified Therapy Prescription App for Children With Disabilities: User-Centered Design Approach.

BACKGROUND: Mobile health (mHealth) apps for children are increasing in availability and scope. Therapy (physiotherapy, speech pathology, and occupational therapy) prescription apps to improve home or school program adherence work best when developed to be highly engaging for children and when they incorporate behavior change techniques (BCTs) within their design. OBJECTIVE: The aim of this study was to describe the development of a user-centered therapy prescription app for children (aged 6-12 years) with neurodevelopmental disabilities (eg, cerebral palsy, autism spectrum disorder, and intellectual disability) incorporating intervention mapping (IM) and gamified design. METHODS: We used an iterative, user-centered app development model incorporating the first 3 steps of IM. We conducted a needs analysis with user feedback from our previous mHealth app study, a literature review, and a market audit. Change objectives were then specified in alignment with the psychological needs of autonomy, competence, and relatedness identified in self-determination theory. From these objectives, we then selected BCTs, stipulating parameters for effectiveness and how each BCT would be operationalized. A gamification design was planned and implemented focusing on maximizing engagement in children. In total, 2 rounds of consultations with parents, teachers, and therapists and 1 round of prototype app testing with children were conducted to inform app development, with a final iteration developed for further testing. RESULTS: The IM process resulted in the specification of app elements, self-determination theory-informed BCTs, that were embedded into the app design. The gamification design yielded the selection of a digital pet avatar with a fantasy anime visual theme and multiple layers of incentives earned by completing prescribed therapy activities. Consultation groups with professionals working with children with disabilities (4 therapists and 3 teachers) and parents of children with disabilities (n=3) provided insights into the motivation of children and the pragmatics of implementing app-delivered therapy programs that informed the app development. User testing with children with disabilities (n=4) highlighted their enthusiasm for the app and the need for support in the initial phase of learning the app. App quality testing (Mobile Application Rating Scale-user version) with the children yielded means (out of 5) of 4.5 (SD 0.8) for engagement, 3.3 (SD 1.6) for function, 3.3 (SD 1.7) for aesthetics, and 4.3 (SD 1.1) for subjective quality. CONCLUSIONS: mHealth apps designed for children can be greatly enhanced with a systematic yet flexible development process considering the specific contextual needs of the children with user-centered design, addressing the need for behavior change using the IM process, and maximizing engagement with gamification and strong visual design.

Quantifying the Effect of Monitor Wear Time and Monitor Type on the Estimate of Sedentary Time in People with COPD: Systematic Review and Meta-Analysis.

In studies that have reported device-based measures of sedentary time (ST) in people with chronic obstructive pulmonary disease (COPD), we explored if the monitor type and monitor wear time moderated the estimate of this measure. Five electronic databases were searched in January 2021. Studies were included if >70% of participants had stable COPD, and measures of ST (min/day) were collected using wearable technology. Meta-regression was used to examine the influence of moderators on ST, monitor type, and wear time. The studies identified were a total of 1153, and 36 had usable data for meta-analyses. The overall pooled estimate of ST (mean [95% CI]) was 524 min/day [482 to 566] with moderate heterogeneity among effect sizes (I2 = 42%). Monitor wear time, as well as the interaction of monitor wear time and monitor type, were moderators of ST (p < 0.001). The largest difference (−318 min; 95% CI [−212 to −424]) was seen between studies where participants wore a device without a thigh inclinometer for 24 h (and removed sleep during analysis) (675 min, 95% CI [589 to 752]) and studies where participants wore a device with a thigh inclinometer for 12 h only (356 min; 95% CI [284 to 430]). In people with COPD, the monitor wear time and the interaction of the monitor wear time and the monitor type moderated the estimate of ST.

An Evaluation of Factors That Influence Referral to Pulmonary Rehabilitation Programs Among People With COPD.

BACKGROUND: Pulmonary rehabilitation programs (PRP) are important for people with symptomatic COPD. RESEARCH QUESTIONS: What proportion of people with COPD who are suitable for a PRP go on to be referred? Do clinical or sociodemographic characteristics influence the odds of whether those who are suitable for a PRP go on to be referred? What factors influence people's interest in participating in a pulmonary rehabilitation program? STUDY DESIGN AND METHODS: People with COPD who appeared appropriate for a PRP were sequentially recruited from three tertiary hospitals in Australia. Variables such as age, sex, lung function, smoking status, and interest in participating in a PRP were collected through interviews and reviewing the medical records. Referrals to PRPs were prospectively tracked through the electronic referral system, medical records, and discussion with the participant or the physiotherapists responsible for coordinating the PRPs. RESULTS: Six hundred eighty-two people with COPD were approached, 468 consented, and data were available on 391 (No. [%] or mean ± SD; 215 males [55%], age 69 ± 10 years, FEV1 49 ± 19 %predicted). Of the 156 participants deemed suitable for a PRP, 74 (47%, 95% vCI, 40-55) were referred to a PRP. Among participants who were deemed suitable for a PRP, the only variable that separated those who were from those who were not referred was interest in attending a PRP (mean difference in interest on the visual analog scale [VAS]; 22 units, 95% CI, 12-32). Introverted personality traits and feelings of unworthiness reduced interest in attending a PRP. INTERPRETATION: Among people with COPD who were suitable for a PRP, referral from the tertiary hospital setting was suboptimal. Suitable participants who were not referred showed lower interest in attending a PRP. There were novel complex individual barriers that reduced one's interest in participating in a PRP.