Characterizing and Comparing Adverse Drug Events Documented in 2 Spontaneous Reporting Systems in the Lower Mainland of British Columbia, Canada: Retrospective Observational Study.

BACKGROUND: Robust adverse drug event (ADE) reporting systems are crucial to monitor and identify drug safety signals, but the quantity and type of ADEs captured may vary by system characteristics. OBJECTIVE: We compared ADEs reported in 2 different reporting systems in the same jurisdictions, the Patient Safety and Learning System-Adverse Drug Reaction (PSLS-ADR) and ActionADE, to understand report variation. METHODS: This retrospective observational study analyzed reports entered into PSLS-ADR and ActionADE systems between December 1, 2019, and December 31, 2022. We conducted a comprehensive analysis including all events from both reporting systems to examine coverage and usage and understand the types of events captured in both systems. We calculated descriptive statistics for reporting facility type, patient demographics, serious events, and most reported drugs. We conducted a subanalysis focused on adverse drug reactions to enable direct comparisons between systems in terms of the volume and events reported. We stratified results by reporting system. RESULTS: We performed the comprehensive analysis on 3248 ADE reports, of which 12.4% (375/3035) were reported in PSLS-ADR and 87.6% (2660/3035) were reported in ActionADE. Distribution of all events and serious events varied slightly between the 2 systems. Iohexol, gadobutrol, and empagliflozin were the most common culprit drugs (173/375, 46.2%) in PSLS-ADR, while hydrochlorothiazide, apixaban, and ramipril (308/2660, 11.6%) were common in ActionADE. We included 2728 reports in the subanalysis of adverse drug reactions, of which 12.9% (353/2728) were reported in PSLS-ADR and 86.4% (2357/2728) were reported in ActionADE. ActionADE captured 4- to 6-fold more comparable events than PSLS-ADR over this study's period. CONCLUSIONS: User-friendly and robust reporting systems are vital for pharmacovigilance and patient safety. This study highlights substantial differences in ADE data that were generated by different reporting systems. Understanding system factors that lead to varying reporting patterns can enhance ADE monitoring and should be taken into account when evaluating drug safety signals.

Factors associated with physical activity policy and practice implementation in British Columbia's childcare settings: a longitudinal study.

BACKGROUND: In 2016-17, the government of British Columbia (BC) enacted a mandatory policy outlining Active Play Standards (AP Standards) alongside a capacity building initiative (Appetite to Play) focused on implementing policies and practices to support physical activity in childcare centres. We aimed to identify factors at the provider and organizational levels as well as attributes of the Standards hypothesized to influence implementation (i.e., changes in policies and practices). METHODS: We conducted surveys before (2016-2017) and after (2018-2019) enforcement of the AP Standards among 146 group childcare centres across BC. The 2018-19 surveys measured theoretically based constructs associated with implementation of policies and practices (9 childcare- and 8 provider- level characteristics as well as 4 attributes of the licensing standards). Characteristics that were associated in simple regression models were entered in multivariable regression models to identify factors associated with policy and practice changes related to fundamental movement skills (FMS), screen time, total amount of active play (AP) and total amount of outdoor AP from baseline to follow-up. RESULTS: In multivariable analyses, higher staff capacity (OR = 2.1, 95% 1.2, 3.7) and perceived flexibility of the standards (OR: 3.3, 95% 1.5, 7.1) were associated with higher odds of a policy change related to FMS. Higher staff commitment to the AP standards was associated with a higher odds of policy changes related to screen time (OR = 1.6, 95% CI: 1.1, 2.4) and amount of AP (OR: 1.5, 95% 1.0, 2.3). Higher institutionalization of PA policies was associated with a higher odds of policy changes related to the amount of AP (OR: 5.4, 95% CI: 1.5, 20). Higher self-efficacy was associated with a higher odds of policy changes related to outdoor AP (OR = 2.9, 95% 1.1, 7.8). Appetite to Play training was a positively associated with practice changes related to FMS (ß = 0.5, 95% CI: 0.1, 0.9). CONCLUSIONS: A hierarchy of theoretically defined factors influenced childcare providers' implementation of the AP Standards in BC. Future research should test the feasibility of modifying these factors to improve the implementation of PA policy and practice interventions in this setting.

An external facilitation intervention to increase uptake of an adverse drug event reporting intervention.

Background: Adverse drug events (ADEs) are a leading cause of emergency department visits and hospital admissions in Canada. ActionADE prevents repeat ADEs by enabling clinicians to document and communicate standardized ADE information across care settings. We used an external facilitation intervention to promote the uptake of ActionADE in four hospitals in British Columbia, Canada. This study examined whether, how and in what context external facilitation influenced the uptake of ActionADE. Methods: In this convergent-parallel mixed-methods study, an external facilitator used a four-step iterative process to support site champions using context-specific implementation strategies to increase the ADE reporting rate at their sites. We extracted archival data to assess implementation determinants before and after the implementation of the external facilitation and implementation strategies. We also retrieved data on the mean monthly counts of reported ADEs for each user from the ActionADE server. Zero-inflated Poisson models were used to examine changes in mean monthly counts of reported ADEs per user between pre-intervention (June 2021 to October 2021) and intervention (November 2021 to March 2022) periods. Results: The external facilitator and site champions co-created three functions: (1) educate pharmacists about what and how to report in ActionADE, (2) educate pharmacists about the impact of ActionADE on patient outcomes, and (3) provide social support for pharmacists to integrate ADE reporting into clinical workflows. Site champions used eight forms to address the three functions. Peer support and reporting competition were the two common strategies used by all sites. Sites' responses to external facilitation varied. The rate of mean monthly counts of reported ADEs per user significantly increased during the intervention period compared to the pre-intervention period at LGH (RR: 3.74, 95% CI 2.78 to 5.01) and RH (RR: 1.43, 95% CI 1.23 to 1.94), but did not change at SPH (RR: 0.68, 95% CI: 0.43 to 1.09) and VGH (RR: 1.17, 95% CI 0.92 to 1.49). Leave of absence of the clinical pharmacist champion and failure to address all identified functions were implementation determinants that influenced the effectiveness of external facilitation. Conclusion: External facilitation effectively supported researchers and stakeholders to co-create context-specific implementation strategies. It increased ADE reporting at sites where clinical pharmacist champions were available, and where all functions were addressed.

Social Prescribing Outcomes for Trials (SPOT): Protocol for a modified Delphi study on core outcomes.

PURPOSE: This is a study protocol to co-create with knowledge users a core outcome set focused on middle-aged and older adults (40 years+) for use in social prescribing research. METHODS: We will follow the Core Outcome Measures in Effectiveness Trials (COMET) guide and use modified Delphi methods, including collating outcomes reported in social prescribing publications, online surveys, and discussion with our team to finalize the core outcome set. We intentionally center this work on people who deliver and receive social prescribing and include methods to evaluate collaboration. Our three-part process includes: (1) identifying published systematic reviews on social prescribing for adults to extract reported outcomes; and (2) up to three rounds of online surveys to rate the importance of outcomes for social prescribing. For this part, we will invite people (n = 240) who represent the population experienced in social prescribing, including researchers, members of social prescribing organizations, and people who receive social prescribing and their caregivers. Finally, we will (3) convene a virtual team meeting to discuss and rank the findings and finalize the core outcome set and our knowledge mobilization plan. CONCLUSION: To our knowledge, this is the first study designed to use a modified Delphi method to co-create core outcomes for social prescribing. Development of a core outcome set contributes to improved knowledge synthesis via consistency in measures and terminology. We aim to develop guidance for future research, and specifically on the use of core outcomes for social prescribing at the person/patient, provider, program, and societal-level.

Long-term usage of a commercial mHealth app: A "multiple-lives" perspective.

Background: Emerging evidence suggests that individuals use mHealth apps in multiple disjointed ways in the real-world-individuals, for example, may engage, take breaks, and re-engage with these apps. To our knowledge, very few studies have adopted this 'multiple-live' perspective to analyze long-term usage of a physical activity (PA) app. This study aimed to examine the duration of use, as well as the frequency, length, and timing of streaks (uninterrupted periods of use) and breaks (uninterrupted periods of non-use) within a popular commercial PA app called Carrot Rewards over 12 months. We also examined sociodemographic correlates of usage. Method: This retrospective observational study analyzed data from 41,207 Carrot Rewards users participating in the "Steps" walking program from June/July 2016 to June/July 2017. We measured four usage indicators: duration of use, frequency and length of streaks and breaks, time to first break, and time to resume second streak. We also extracted information regarding participants' age, gender, province, and proxy indicators of socioeconomic status derived from census data. We used descriptive statistics to summarize usage patterns, Kaplan-Meier curves to illustrate the time to first break and time to resume second streak. We used linear regressions and Cox Proportional Hazard regression models to examine sociodemographic correlates of usage. Results: Over 60% of the participants used Carrot Rewards for ≥6 months and 29% used it for 12 months (mean = 32.59 ± 18.435 weeks). The frequency of streaks and breaks ranged from 1 to 9 (mean = 1.61 ± 1.04 times). The mean streak and break length were 20.22 ± 18.26 and 16.14 ± 15.74 weeks, respectively. The median time to first break was 18 weeks across gender groups and provinces; the median time for participants to resume the second streak was between 12 and 32 weeks. Being female, older, and living in a community with greater post-secondary education levels were associated with increased usage. Conclusion: This study provides empirical evidence that long-term mHealth app usage is possible. In this context, it was common for users to take breaks and re-engage with Carrot Rewards. When designing and evaluating PA apps, therefore, interventionists should consider the 'multiple-lives' perspective described here, as well as the impact of gender and age.

Does an active play standard change childcare physical activity and healthy eating policies? A natural policy experiment.

BACKGROUND: In 2017, the provincial government of British Columbia (BC) implemented a mandatory policy outlining Active Play Standards (AP Standards) to increase physical activity (PA) levels, sedentary and motor skills among children attending licensed childcare centers. Concurrently, a capacity-building initiative was launched to help implement policies and practices supporting both PA and healthy eating (HE) in the early years. This study evaluated differences in center-level PA and HE policies and practices before and after the enforcement of the new provincial AP Standards. METHODS: Using a repeat cross-sectional design, surveys were distributed to managers and staff of licensed childcare facilities serving children aged 2-5 years before (2016-2017 or 'time 1') and after (2018-2019 or 'time 2') implementation of the AP Standards across BC. The total sample included 1,459 respondents (910 and 549 respondents at time 1 and time 2, respectively). Hierarchical mixed effects models were used to examine differences in 9 and 7 PA/sedentary policies and practices, respectively, as well as 11 HE policies between time 1 and time 2. Models controlled for childcare size and area-level population size, education, and income. RESULTS: Compared to centers surveyed at time 1, centers at time 2 were more likely to report written policies related to: fundamental movement skills, total amount of Active Play (AP) time, staff-led AP, unfacilitated play/free play, total amount of outdoor AP time, limiting screen time, breaking up prolonged sitting, staff role modeling of PA, and training staff about PA (P < 0.01 for all 9 policies examined). Compared to time 1, centers at time 2 reported more frequent practices related to ensuring children engaged in at least 120 min of AP, 60 min of outdoor AP daily, and limiting screen time (P < 0.01 for 3 out of 7 practices examined). Despite no additional policy intervention related to HE, centers were more likely to report having written policies related to: HE education for children, encouraging new foods, having family-style meals, offering only milk or water, limiting the amount of juice served, staff role modeling of HE, limiting the types of foods at parties/celebrations and foods brought from home (P < 0.05 for 9 out of 11 HE policies). CONCLUSION: Approximately a year after the implementation of a governmental policy targeting PA supported by a capacity-building initiative, childcare centers reported positive changes in all 9 PA/sedentary policies examined, all 3 out of 7 PA/sedentary practices and 9 out of 11 HE policies evaluated at the center-level.

An Evaluation of a Commercialized mHealth Intervention to Promote Physical Activity in the Workplace.

Background: UPnGO with ParticipACTION (UPnGO) was a commercialized 12-month workplace physical activity intervention, aimed at encouraging employees to sit less and move more at work. Its design took advantage of the ubiquitous nature of mobile fitness trackers and aimed to be implemented in any office-based workplace in Canada. The program was available at cost from June 2017 to April 2020. The objectives of this study are to evaluate the program and identify key lessons from the commercialization of UPnGO. Methods: Using a quasi-experimental design over 3 time points: baseline, 6 months, 12 months, five evaluation indicators were measured as guided by the RE-AIM framework. Reach was defined as the number and percentage of employees who registered for UPnGO and the number and percentage of sedentary participants registered. Effectiveness was assessed through average daily step count. Adoption was determined by workplace champion and senior leadership responses to the off-platform survey. Implementation was assessed as the percentage of participants who engaged with specific program elements at the 3-evaluation time points. Maintenance was assessed by the number of companies who renewed their contracts for UPnGO. Results: Reach across 17 organizations, 1980 employees participated in UPnGO, with 27% of participants identified as sedentary at baseline. Effectiveness Daily step count declined from 7,116 ± 3,558 steps at baseline to 6,969 ± 6,702 (p = <0.001) at 12 months. Adoption Workplace champion and senior leadership engagement declined from 189 to 21 and 106 to 5 from baseline to 12 months, respectively. Maintenance Two companies renewed their contracts beyond the first year. Conclusions: The commercialization of UPnGO was an ambitious initiative that met with limited success; however, some key lessons can be generated from the attempt. The workplace remains an important environment for PA interventions but effective mHealth PA programs may be difficult to implement and sustain long-term.

Prevalence and Relationships among Physical Activity Policy, Environment, and Practices in Licensed Childcare Centers from a Manager and Staff Perspective.

Physical activity (PA) is critical to early childhood health and development, and childcare is a key setting for establishing physically active play. In British Columbia (BC), a provincial standard for active play in childcare was enacted, identified here as the Active Play (AP) standard. Pragmatic constraints limit real-world data collection for evaluating policy impact. We explored whether information about policies, practices, and the environment varied when it was collected from managers or staff. Surveys were distributed to BC childcare centers before AP standard enactment to ascertain current PA and fundamental movement skill policies and practices. The full sample (n = 1037 from 625 facilities) and a subsample of paired managers and staff (n = 261 centers) were used to explore agreement across managers and staff in reported prevalence and relationships among indicators. The policy prevalence and relationships for active play and outdoor play variables were relatively similar for manager and staff data, although the matched data had modest agreement and less than optimal intraclass correlations. The prevalence of manager-reported PA policies ranged from 47% for screen-time limits to 77% for fundamental movement skill activities. The manager and staff data highlighted indoor and outdoor space as a primary factor in AP standard adherence. With reliance on sampling staff unfeasible, it appears that the manager data may adequately describe the policies and practices of childcare providers with some notable issues.

Factors that influence implementation at scale of a community-based health promotion intervention for older adults.

BACKGROUND: Despite the many known benefits of physical activity (PA), relatively few older adults are active on a regular basis. Older adult PA interventions delivered in controlled settings showed promising results. However, to achieve population level health impact, programs must be effectively scaled-up, and few interventions have achieved this. To effectively scale-up it is essential to identify contextual factors that facilitate or impede implementation at scale. Our aim is to describe factors that influence implementation at scale of a health promotion intervention for older adults (Choose to Move). This implementation evaluation complements our previously published study that assessed the impact of Choose to Move on older adult health indicators. METHODS: To describe factors that influenced implementation our evaluation targeted five distinct levels across a socioecological continuum. Four members of our project team conducted semi-structured interviews by telephone with 1) leaders of delivery partner organizations (n = 13) 2) recreation managers (n = 6), recreation coordinators (n = 27), activity coaches (n = 36) and participants (n = 42) [August 2015 - April 2017]. Interviews were audio-recorded and professionally transcribed and data were analyzed using framework analysis. RESULTS: Partners agreed on the timeliness and need for scaled-up evidence-based health promotion programs for older adults. Choose to Move aligned with organizational priorities, visions and strategic directions and was deemed easy to deliver, flexible and adaptable. Partners also noted the critical role played by our project team as the support unit. However, partners noted availability of financial resources as a potential barrier to sustainability. CONCLUSIONS: Even relatively simple evidence-based interventions can be challenging to scale-up and sustain. To ensure successful implementation it is essential to align with multilevel socioecological perspectives and assess the vast array of contextual factors that are at the core of better understanding successful implementation.

Protective or risky? The longitudinal association of team sports participation and health-related behaviours in Canadian adolescent girls.

OBJECTIVES: Female sport participation is a prioritized action area in the 2018 Canadian federal budget for improving health and well-being. This study examined team sport participation prevalence and longitudinal associations with health-related behaviours among Canadian adolescent girls. METHODS: We analyzed data from the COMPASS study. Participants included 1978 female secondary-school students who self-reported the following information at all measurement time-points (grades 9, 10, 11, and 12): socio-demographic, team sport participation status (consistent, intermittent and non-participator), moderate-to-vigorous physical activity (MVPA), dietary behaviours, smoking, cannabis use and binge drinking. Linear mixed models and generalized estimating equation models were used to examine team sport participation status in association with changes in health-related behaviours across grades. RESULTS: The prevalence of team sport participation declined by an average of 38.4% between grades 9 and 12. Proportions of participants being categorized as consistent, intermittent and non-participators were 25.7%, 36.4% and 37.9%, respectively. Compared to non-participators, consistent participators reported significantly greater decline in MVPA (ß = - 2.77, 95% CI - 5.36, - 0.18), and the increase in odds of becoming more frequent cannabis users (OR 1.11, 95% CI 1.00, 1.26) and binge drinkers (OR 1.13, 95% CI 1.04, 1.23) was significantly greater. Girls' team sport participation had no significant longitudinal association with dietary behaviours and smoking status. CONCLUSION: Team sport participation outside of school settings is risky for prospective health-related behaviours in adolescent girls. Our findings highlight the need for investing in tailored participation initiatives that also consider how to prevent harmful substance use.

The Intervention Effect of SMS Delivery on Chinese Adolescent's Physical Activity.

To examine the effects of short messaging service (SMS) frequency and timing on the efficacy of an SMS-intervention for Hong Kong Chinese adolescents, sixty nine students aged between 12 and 16 (mean age 13.75 ± 0.90) were recruited from five schools in Hong Kong. Participants were randomly assigned into one of five groups: high-frequency + self-selected timing (HST), low-frequency + self-selected timing (LST), high-frequency + assigned timing (HAT), low-frequency + assigned timing (LAT) and the control group. The total duration of the intervention was four weeks. No significant intervention effects were detected in adolescent's PA among the five groups (F = 1.14, p = 0.346). No significant differences were observed in the stage movement among the five groups (χ² = 6.18, p = 0.627). No significant differences appeared in the exercise benefits, barriers and benefits/barriers differential scores. However, a growth trend in the exercise benefits score in the LST and HAT groups was found in contrast to the downswing in the control group. The exercise barriers score in the HST group showed the largest reduction after intervention. The benefits/barriers differential score in all the intervention groups increased, whereas it decreased in the control group. Although an increase is demonstrated in the high dosage SMS frequency and timing, no significant intervention effects were found among the five groups in PA behavior, stage of change and exercise benefits and barriers among Hong Kong Chinese adolescents.

Program implementation and effectiveness of a national workplace physical activity intervention: UPnGO with ParticipACTION.

INTERVENTION: UPnGO with ParticipACTION (UPnGO) is a 6-week workplace physical activity (PA) initiative aiming to increase habitual PA (steps) during the workday. Core intervention components included (1) self-monitoring of steps and action planning behaviours using a Web/mobile app with incentives and (2) organizational support, which included senior management's role modeling and endorsement of the program. RESEARCH QUESTION: What is the effectiveness and levels of implementation of the UPnGO intervention? What is the relationship between effectiveness and levels of implementation? METHODS: A single-arm, pre-/post-test study design was used. Participants were 660 employees from nine organizations who had valid step data and complete socio-demographic information at baseline. The primary outcome (mean daily steps) was assessed by Garmin VivoFit. Using the usage data from the UPnGO web-based system, a composite score for levels of implementation was calculated based on participant's compliance with the self-monitoring component and senior management's role modeling. Associations of interest were analyzed using linear mixed-effects models. RESULTS: Levels of implementation were highly variable across organizations (mean = 68.22% ± 18.75, range = 19.8 to 100%). A significant Time × Implementation (IM) status interaction effect was observed. When stratified by IM status, a significant increase in mean daily steps at week 6 was found among participants in the high (ß = 540.01 ± 202.69, p = 0.011) but not low (ß = - 81.54 ± 291.96, p = 0.78) implementation group. CONCLUSION: Findings suggest significant intervention effects in increasing average daily steps among participants who were exposed to optimal levels of implementation (~ 70%). UPnGO may be a scalable workplace PA intervention at a national level, although this needs further verification with more rigorous study designs.

The Protective Effects of School Connectedness on Substance Use and Physical Activity.

PURPOSE: Cross-sectional evidence suggests that school connectedness is an important correlate of health-related behaviors among adolescents, but prospective studies are needed to strengthen the case for a causal relationship. This study investigated the prospective relationship between school connectedness and four health-related behaviors: cigarette smoking, marijuana use, binge drinking, and physical activity. METHODS: We analyzed 4 years of data from the COMPASS study. Participants included in this analysis were 33,313 students who provided information on sociodemographic, school connectedness, and the four health-related behaviors for at least two consecutive years. Generalized Estimating Equation models were used to examine whether the change in school connectedness scores predicted the change in an individual child's trajectory of health-related behaviors across 9th, 10th, 11th, and 12th grades. RESULTS: As students moved to higher grades, school connectedness decreased, and the likelihood of being a less frequent smoker, marijuana user, and binge drinker, and meeting physical activity guidelines declined. An increase in school connectedness scores was associated with an increased likelihood of meeting physical activity recommendations (OR = 1.06, p < .01), being a less frequent smoker, marijuana user, and binge drinker (OR = 1.30, 1.17, 1.10, respectively; p's < .0001) across the 4 years. CONCLUSIONS: This study provides prospective evidence supporting the protective effects of school connectedness on substance abuse and physical activity, and highlights the importance of fostering school connectedness to support healthy adolescent development.

Feasibility and Effectiveness of a Wearable Technology-Based Physical Activity Intervention in Preschoolers: A Pilot Study.

The purpose of this pilot study was to evaluate the feasibility and the effectiveness of an intervention that employed a technology-based physical activity (PA) monitoring system and teacher-regulated strategies to promote PA in preschoolers. A total of 93 preschoolers (53% girls, 4.7 years) from 5 child care centers were recruited for a one-week intervention and randomly assigned into control (2 centers, n = 45) or intervention (3 centers, n = 48) group. Key intervention components included: (1) wearable device-based, real-time monitoring of children's PA by classroom teachers and (2) teacher-regulated strategies for providing more opportunities for PA. Sedentary behavior (SED) and PA were measured using accelerometers. Overall, children in the intervention group showed significantly lower level of SED (31.6 vs. 33.6 min/h) and higher level of total PA (28.4 vs. 26.4 min/h) than children in the control group, after adjusting for age, sex, race, parent education level, parent perception of their child's PA, BMI, and childcare centers. Teachers in the intervention group reported that the intervention was highly feasible to be implemented in their current classroom settings. In conclusion, we observed high acceptability and initial effectiveness of the current intervention. Subsequent research at larger-scale is warranted to fully evaluate the effectiveness of the intervention strategies tested in this study.

Changes in Physical Activity in the School, Afterschool, and Evening Periods During the Transition From Elementary to Middle School.

BACKGROUND: We examined longitudinal changes in children's physical activity during the school day, afterschool, and evening across fifth, sixth, and seventh grades. METHODS: The analytical sample included children who had valid accelerometer data in fifth grade and at least one other time-point, and provided complete sociodemographic information (N = 768, 751, and 612 for the 3 time-periods studied). Accelerometer-derived total physical activity (TPA) and moderate-to-vigorous physical activity (MVPA) were expressed in minutes per hour for the school day (∼7:45 am to 3:30 pm), afterschool (∼2:25 to 6:00 pm), and evening (6:00 to 10:00 pm) periods. We used growth curve analyses to examine changes in TPA and MVPA. RESULTS: School day TPA and MVPA declined significantly; we observed a greater decrease from fifth to sixth grades than from sixth to seventh grades. Afterschool TPA declined significantly, but MVPA increased significantly among girls and remained stable for boys. Evening TPA decreased significantly and MVPA declined significantly in girls and remained stable among boys. CONCLUSIONS: To inform the development of effective intervention strategies, research should focus on examining factors associated with the decline in physical activity during the transition from elementary to middle school, particularly during the hours when children are in school.

A Pilot Study of the Attractive Features of Active Videogames Among Chinese Primary School Children.

OBJECTIVE: The present study (1) explored the attractive features that affect Chinese primary school children's preferences of active videogames (AVGs) and (2) contrasted these findings with those in the Western literature. PARTICIPANTS AND METHODS: A total of 22 Chinese primary school children were recruited and interviewed. Four AVGs (Wii "Boxing," "Wii Fit™ Plus Obstacle Run"; "EyeToy Knockout", "EyeToy Keep ups") from two commercial consoles (Nintendo® Wii™ and Sony PlayStation® 2 "EyeToy®") were employed. Participants used four selected AVGs for 3 minutes each. After each play period, children (1) described the strengths and weaknesses of each game as well as rated the attractive features of each game based on a 16-item questionnaire and (2) rated up to 5 items that were most influential regarding their AVG preferences. RESULTS: Participants indicated that control was the most significant feature, followed by feedback, goal, and graphics. The top five rated features imply that the perception of competence was the most appealing aspect and expected outcome of Chinese children who play AVGs. CONCLUSIONS: Compared with the Western findings regarding attractive AVG features, the present study found certain similarities as well as significant differences among Chinese AVG players. Based on the present study, control, feedback, goal, and graphics are the most significant features that attract Chinese children to play AVGs. Physical exertion, social interaction, competition, and learning outcomes, which are valued according to Western studies, were not mentioned as significant features by Chinese children. These findings demonstrate a need to investigate the effect of cultural background in AVG study design.

Factors influencing implementation of a preschool-based physical activity intervention.

Examining factors that influence implementation of key program components that underlie an intervention's success provides important information to inform the development of effective dissemination strategies. We examined direct and indirect effects of preschool capacity, quality of prevention support system and teacher characteristics on implementation levels of a component, called Move Outside (i.e., preschool classroom teachers to provide at least 40 min of outdoor recess per day), that was fundamental to the success of a preschool-based physical activity intervention. Level of implementation, defined as the percent of daily goal met for the Move Outside component, was assessed via direct observation. Items assessing preschool capacity, quality of prevention support system and teacher characteristics were selected from surveys and an environmental checklist completed by preschool directors and teachers. Preschool classroom was used as the unit of analysis (Year 1: n = 19; Year 2: n = 17). Results from Bayesian path analyses showed that the three factors were not significantly associated with level of implementation in Year 1, but preschool capacity was directly associated with level of implementation in Year 2 (ß= 0.528, 95% CI: 0.134, 0.827). The current findings suggest that factors that influence level of implementation appear to differ as an intervention evolved over time.

Factors Influencing Implementation of a Physical Activity Intervention in Residential Children's Homes.

The Environmental Intervention in Children's Homes (ENRICH) study was the first published physical activity intervention undertaken in residential children's homes (RCHs). The study revealed differences in implementation across the homes, which may be a key factor that affects program effectiveness. The purpose of this study was to examine the direct and indirect effects of organizational capacity, provider characteristics, and quality of prevention support system on level of implementation of the ENRICH intervention. This study analyzed the ENRICH process evaluation data collected from 24 RCHs. Bayesian Path analysis was used to examine the direct and indirect effects of organizational capacity, provider characteristics, and quality of prevention support system on level of implementation. Level of implementation across RCHs was variable, ranging from 38 to 97 % (M = 68.3, SD = 14.45). Results revealed that organizational capacity and provider characteristics had significant direct associations with level of implementation. Neither direct nor indirect associations between quality of prevention support system and level of implementation reached statistical significance. Conducting formative assessments on organizational capacity and provider characteristics and incorporating such information in implementation planning may increase the likelihood of achieving higher levels of implementation in future studies.

Does dose matter in reducing gestational weight gain in exercise interventions? A systematic review of literature.

OBJECTIVES: The purpose of this review was to examine the relationship between exercise dose and reductions in weight gain during pregnancy in exercise interventions. DESIGN: Systematic literature review. METHODS: Four electronic research databases (PubMed, Web of Science, CINAHL, and Academic Search Premiere) were used to identify exercise interventions conducted with pregnant women. Eligible articles must have satisfied the following criteria: inclusion of a control condition, exercise as a major intervention component, weight gain measured and reported for each experimental condition, description of exercise dose (frequency, intensity and duration), and utilized an adequate number of control conditions to assess independent effects of exercise on weight gain. RESULTS: The literature search identified 4837 articles. Of these, 174 abstracts were screened and 21 intervention studies (18 exercise-only, 3 exercise/diet) were eligible for review. Only 38% of the interventions achieved statistically significant reductions in gestational weight gain. Successful interventions possessed higher adherence and lower attrition rates and were predominantly conducted among normal weight populations. No clear patterns or consistencies of exercise dose and reductions in weight gain were evident. CONCLUSIONS: An exercise dose associated with reductions in weight gain was unquantifiable among these interventions. Adherence and retention rates were strong contributors to the success of exercise interventions on gestational weight gain. It is strongly suggested that future researchers investigate methods to increase adherence and compliance, especially among overweight and obese women, and utilize objective measurement tools to accurately evaluate exercise dose performed by the participants and the impact on body composition and weight gain.