The impact of action plans on habit and intention strength for physical activity in a web-based intervention: is it the thought that counts?

OBJECTIVE: Action planning is a common approach used in physical activity interventions. The aim of this study was to assess the association of frequency, consistency and content of action planning with physical activity behaviour, intention strength and habit strength. METHODS AND MEASURES: Within a 3-month web-based, computer-tailored physical activity intervention, participants (N = 115; 68.7% female, M age =43.9; range = 22-73 years) could create 6 rounds of action plans for 4 activities each (24 total). RESULTS: Consistency of action planning during the intervention was associated with change in physical activity at 9-months, and intention and habit strength at 3-months and 9-months. Frequency of action planning was negatively associated with intention at 3-months and 9-months. The effect of action planning consistency on physical activity behaviour was no longer significant when accounting for change in intention and habit strength. CONCLUSION: Consistency of how, where, when and with whom people plan their physical activity may translate into stronger physical activity habits. Interventions should avoid encouraging making many distinct action plans, but rather encourage stable contexts through consistent action planning.

Does matching a personally tailored physical activity intervention to participants' learning style improve intervention effectiveness and engagement?

This study aims to compare the effectiveness, engagement, usability, and acceptability of a web-based, computer-tailored physical activity intervention (provided as video or text) between participants who were matched or mismatched to their self-reported learning style (visual and auditory delivery through video or text-based information). Generalised linear mixed models were conducted to compare time (baseline, 3 months) by group (matched, mismatched) on ActiGraph-GT3X+measured moderate-to-vigorous physical activity (MVPA) and steps. Generalised linear models were used to compare group (matched and mismatched) on session completion, time-on-site, usability, and acceptability. MVPA and steps improved from baseline to 3-months, however this did not differ between participants whose learning styles were matched or mismatched to the intervention they received. Session completion, time-on-site, usability, and acceptability did not differ between matched and mismatched participants. Therefore, aligning intervention delivery format to learning style is unlikely to influence intervention effectiveness or engagement.

Relationships Between Physical Activity, Boredom Proneness, and Subjective Well-Being Among U.K. Adults During the COVID-19 Pandemic.

This investigation sought to examine physical activity (PA) as a potential determinant of chronic boredom and associated well-being within the context of COVID-related restrictions. A representative sample of U.K. adults (N = 1,521) completed a survey on June 1, 2020. Bivariate analyses demonstrated that individuals who met guidelines and maintained or increased PA scored higher on life satisfaction, worthwhileness, and happiness and lower on anxiety (i.e., indicators of well-being) and boredom proneness (d = 0.13-0.43). Boredom proneness was correlated with all indicators of well-being (r = .38-.54). A series of regression models revealed that PA predicted lower boredom proneness and better life satisfaction, worthwhileness, and happiness. Boredom proneness accounted for the covariance between PA and well-being. Prospective research is needed to confirm causality of the observed relationships.

Associations between objectively-measured and self-reported neighbourhood walkability on adherence and steps during an internet-delivered pedometer intervention.

BACKGROUND: Accumulating evidence suggests that the built environment is associated with physical activity. The extent to which the built environment may support adherence to physical activity interventions is unclear. The aim of this study was to investigate whether the neighbourhood built environment constrains or facilitates adherence and steps taken during a 12-week internet-delivered pedometer-based physical activity intervention (UWALK). METHOD: The study was undertaken in Calgary (Canada) between May 2016 and August 2017. Inactive adults (n = 573) completed a telephone survey measuring sociodemographic characteristics and perceived neighbourhood walkability. Following the survey, participants were mailed a pedometer and instructions for joining UWALK. Participants were asked to report their daily pedometer steps into the online program on a weekly basis for 12 weeks (84 days). Walk Score® estimated objective neighbourhood walkability and the Neighbourhood Environment Walkability Scale-Abbreviated (NEWS-A) measured participants self-reported neighbourhood walkability. Regression models estimated covariate-adjusted associations of objective and self-reported walkability with: 1) adherence to the UWALK intervention (count of days with steps reported and count of days with 10000 steps reported), and; 2) average daily pedometer steps. RESULTS: On average, participants undertook 8565 (SD = 3030) steps per day, reported steps on 67 (SD = 22.3) of the 84 days, and achieved ≥10000 steps on 22 (SD = 20.5) of the 84 days. Adjusting for covariates, a one-unit increase in self-reported walkability was associated on average with 45.76 (95CI 14.91, 76.61) more daily pedometer steps. Walk Score® was not significantly associated with steps. Neither objective nor self-reported walkability were significantly associated with the UWALK adherence outcomes. CONCLUSION: The neighbourhood built environment may support pedometer-measured physical activity but may not influence adherence to pedometer interventions. Perceived walkability may be more important than objectively-measured walkability in supporting physical activity during pedometer interventions.

Flow and Grit by Design: Exploring Gamification in Facilitating Adherence to Swallowing Therapy.

PURPOSE: Delivery of swallowing therapy is faced with challenges regarding access to in-clinic services and adherence to prescribed home programs. Mobile health (mHealth) technologies are being developed at a rapid pace to address these difficulties. Whereas some benefits to using these modern tools for therapy are obvious (e.g., electronic reminders), other advantages are not as well understood. One example is the potential for mHealth devices and apps to enhance adherence to treatment regimens. METHOD: This article introduces a number of psychological concepts that relate to adherence and that can be leveraged by mHealth. Elements that contribute to flow (optimal experience) during an activity and those that reinforce grit (perseverance to achieve a long-term goal) can be used to engage patients in their own rehabilitation. RESULTS: The experience of flow can be targeted by presenting the rehabilitation exercise as an optimally challenging game, one that offers a match between challenge and ability. Grit can be supported by reinforcing routine and by varying the therapy experience using different games. CONCLUSIONS: A combination of hardware and software design approaches have the potential to transform uninteresting and repetitive activities, such as those that make up swallowing therapy regimens, into engaging ones. The field of gamification, however, is still developing, and gamified mHealth apps will need to withstand scientific testing of their claims and demonstrate effectiveness in all phases of outcome research.

Using online computer tailoring to promote physical activity: a randomized trial of text, video, and combined intervention delivery modes.

Website-delivered interventions are increasingly used to deliver physical activity interventions, yet problems with engagement and retention result in reduced effectiveness. Hence, alternative modes of online intervention delivery need to be explored. Therefore, this study aimed to evaluate the acceptability and effectiveness of a computer-tailored physical activity intervention delivered on the Internet in 3 delivery modes: video, text, or both. Australian adults (N = 803), recruited through e-mail, were randomized into the three delivery modes and received personal physical activity advice. Intervention content was identical across groups. Repeated measures analyses of variance were used to compare the three groups regarding acceptability, website usability, and physical activity. Participants in the video group accepted the content of the physical activity advice significantly better (F = 5.59; p < .01), and spent significantly more time on the website (F = 21.19; p < .001) compared with the text and combination groups. Total physical activity improved significantly over time in all groups (F = 3.95; p < .01). Although the combination group increased physical activity the most, few significant differences between groups were observed. Providing video-tailored feedback has advantages over the conventional text-tailored interventions; however, this study revealed few behavioral differences. More studies, examining alternative delivery modes, that can overcome the limitations of the present study, are needed.

Characteristics of consumers using 'better for you' front-of-pack food labelling schemes - an example from the Australian Heart Foundation Tick.

OBJECTIVE: The Heart Foundation Tick aims to help consumers make healthier food choices and overcome confusion in understanding food labels. Little is known about what factors differentiate frequent from infrequent users and the effectiveness of this scheme in helping Australians make healthier food choices. DESIGN: A cross-sectional survey was used to explore use of the Tick and associations with a range of individual characteristics. SETTING: A national panel of Australians, living in each state and territory, completed an online survey (n 1446). SUBJECTS: Adult men (41 %) and women participated in the study. RESULTS: Most trusted the Heart Foundation (79 %), and used the Tick at least occasionally (19 % regularly, 21 % often, 35 % occasionally, 24 % never). A majority was classified as overweight/obese (60 %), 3·5 % were diagnosed with CHD, 5·2 % with diabetes and 23 % with hypertension. Many did not meet recommendations for the consumption of red meat (30 %), processed meat (23 %), vegetables (78 %), fruit (43 %) and fast foods (47 %). Female frequent users tended to have hypertension, be married/de facto, older than 45 years, rural dwellers, and limit their intake of fast foods. Male frequent users tended to have hypertension, meet recommendations for fruit, vegetables and processed meats, but not have a tertiary education. CONCLUSIONS: The Heart Foundation Tick is a highly trusted, highly recognizable food labelling scheme and helpful to consumers who are motivated to make healthier food choices. More inter-sector collaboration is required to incorporate these schemes into public health campaigns to help consumers make healthier food choices.

An extended theory of planned behavior intervention for older adults with type 2 diabetes and cardiovascular disease.

A randomized controlled trial evaluated the effectiveness of a 4-wk extended theory of planned behavior (TPB) intervention to promote regular physical activity and healthy eating among older adults diagnosed with Type 2 diabetes or cardiovascular disease (N = 183). Participants completed TPB measures of attitude, subjective norm, perceived behavioral control, and intention, as well as planning and behavior, at preintervention and 1 wk and 6 wk postintervention for each behavior. No significant time-by-condition effects emerged for healthy eating. For physical activity, significant time-by-condition effects were found for behavior, intention, planning, perceived behavioral control, and subjective norm. In particular, compared with control participants, the intervention group showed short-term improvements in physical activity and planning, with further analyses indicating that the effect of the intervention on behavior was mediated by planning. The results indicate that TPB-based interventions including planning strategies may encourage physical activity among older people with diabetes and cardiovascular disease.

Morphine administration by Paramedics: an application of the Theory of Planned Behaviour.

Timely and appropriate pain management in the pre-hospital environment is paramount to effective patient care. Experts agree that there are many factors that hinder the delivery of adequate pain management to patients with pain. The purpose of this study was to use the Theory of Planned Behaviour (TPB) model to identify the factors influencing Ambulance Paramedics' intention to administer morphine to patients with pain. Participants of this study were Advanced Care and Intensive Care Paramedics who were deemed competent in morphine administration. Data were collected by means of a questionnaire that used the constructs of the TPB, including subjective norm, perceived behavioural control and attitude. Whilst participants reported strong intentions to administer morphine they also reported negative attitudes towards the behaviour. The constructs of the TPB explained 26% of the variance in intention to administer morphine with subjective norm being the strongest significant predictor. The findings related to specific attitudes and normative pressures provide an understanding into Paramedic's pain management behaviour.

The association between job related factors, short sleep and obesity.

Epidemiological studies have found a consistent inverse relationship between increased body mass index (BMI) and sleep duration. These studies have not controlled for the role that job related factors such as shift work and working hours may have on this relationship. A cross sectional survey of shift and day workers (N=346; 292 males and 59 females) was employed to investigate the association between obesity, job related factors and sleep duration. Mean age for the overall sample was 41.1 yr (+/-11.1). Mean BMI was significantly higher in shift workers than in day workers (p<.001). Mean BMI (12.60 h+/-0.41) was also significantly (p<.001) higher in the group working long daily hours followed by medium working hours (10.95 h+/-0.56) and short working hours (8.72 h+/-0.56). Obese individuals worked significantly longer hours (p<.001) and slept 18 min less per day (p<.06) compared to those with a normal BMI. The adjusted odds ratio (OR) indicated the most significant predictor of obesity was long working hours (OR=2.82, CI: 1.10-7.19), followed by being older (OR=2.05, CI: 1.17-3.59) and short sleep duration (OR=1.92, CI: 1.03-3.55). The limitations of the study are discussed.

Mediating relationship between body mass index and the direct measures of the Theory of Planned Behaviour on physical activity intention.

This research examines (a) the interrelationships between body mass index (BMI), the direct measures of the Theory of Planned Behaviour (TPB) and physical activity intention and (b) the potential mediation effects of the direct measures of the TPB in the relationship between BMI and physical activity intention in a sample of Australian adults. A total sample of 1,062 respondents participated in a computer-assisted telephone-interview (CATI) survey comprised of a standardised introduction; questions regarding TPB and physical activity; and standard demographic questions. BMI for each participant was calculated from self-reported height and weight. Separate regression analyses were performed to examine the mediating effects of each of the direct measures of the TPB on the predictive relationship between the BMI and physical activity intention, as proposed by Baron and Kenny (Journal of Personality and Social Psychology, 51(6), 1173 - 1182, 1986). Findings indicated that the direct measure of attitude and perceived behavioural control mediated the relationship between BMI and physical activity intention. However, the direct measure of subjective norm failed to act as a mediating mechanism. To date there has been no research that has examined the mechanism by which body mass may affect physical activity behaviour. Given the current focus for health promotion specialists on promoting physical activity as a strategy for reducing overweight and obesity, a theoretical understanding of weight-related barriers to physical activity may aid in the development of future interventions and community physical activity programs, particularly those targeting overweight and obese populations.

Nurse-initiated defibrillation? Reality or rhetoric.

Evidence indicates that hospital nurse-initiated defibrillation improves survival following cardiac arrest. Accordingly, hospitals are changing their policies to permit nurses to initiate defibrillation. However, if nurse-initiated defibrillation is to be successful implemented, nurses' beliefs about this practice need to be understood. Therefore, the aim of this study was to explore the attitudes of rural nurses towards defibrillation to assist in the development of nurse-initiated defibrillation programmes. This cross-sectional study examined the defibrillation beliefs of registered nurses in rural areas. A proportionally stratified sample of registered nurses (n = 436) were drawn from 51 rural acute care hospitals in Australia. Most (n = 224; 52%) of the participants were not permitted to initiate defibrillation. A one-way between-groups multivariate analysis of variance showed that nurses who were permitted to initiate defibrillation held stronger positive beliefs towards defibrillation than nurses not permitted (10,410) = 13.88, p < 0.001. Nurses not permitted were more concerned about the challenge of learning rhythms, incurring litigation and harming the patient or themselves. If it is accepted that defibrillation will become an essential part of all nurses' roles, these beliefs should be explored and integrated into educational programmes as inappropriate beliefs about defibrillation may impede implementation and skills development.

Correlates of pedometer use: results from a community-based physical activity intervention trial (10,000 Steps Rockhampton).

BACKGROUND: Pedometers have become common place in physical activity promotion, yet little information exists on who is using them. The multi-strategy, community-based 10,000 Steps Rockhampton physical activity intervention trial provided an opportunity to examine correlates of pedometer use at the population level. METHODS: Pedometer use was promoted across all intervention strategies including: local media, pedometer loan schemes through general practice, other health professionals and libraries, direct mail posted to dog owners, walking trail signage, and workplace competitions. Data on pedometer use were collected during the 2-year follow-up telephone interviews from random population samples in Rockhampton, Australia, and a matched comparison community (Mackay). Logistic regression analyses were used to determine the independent influence of interpersonal characteristics and program exposure variables on pedometer use. RESULTS: Data from 2478 participants indicated that 18.1% of Rockhampton and 5.6% of Mackay participants used a pedometer in the previous 18-months. Rockhampton pedometer users (n = 222) were more likely to be female (OR = 1.59, 95% CI: 1.11, 2.23), aged 45 or older (OR = 1.69, 95% CI: 1.16, 2.46) and to have higher levels of education (university degree OR = 4.23, 95% CI: 1.86, 9.6). Respondents with a BMI > 30 were more likely to report using a pedometer (OR = 1.68, 95% CI: 1.11, 2.54) than those in the healthy weight range. Compared with those in full-time paid work, respondents in 'home duties' were significantly less likely to report pedometer use (OR = 0.18, 95% CI: 0.06, 0.53). Exposure to individual program components, in particular seeing 10,000 Steps street signage and walking trails or visiting the website, was also significantly associated with greater pedometer use. CONCLUSION: Pedometer use varies between population subgroups, and alternate strategies need to be investigated to engage men, people with lower levels of education and those in full-time 'home duties', when using pedometers in community-based physical activity promotion initiatives.

Development and process evaluation of an internet-based physical activity behaviour change program.

OBJECTIVES: Limited research exists addressing issues of website development and attitudes towards websites that promote physical activity. This paper describes the design and process evaluation of a physical activity intervention, from a randomised trial (RT) that examined the effectiveness of delivery modes (face-to-face, Internet-mediated (combined Internet and face-to-face) and Internet-only). METHODS: Evaluation surveys were completed at the end of the RT intervention (n=159), and a random sample (n=23) participated in focus group discussions. Differences were assessed using ANOVA, t-tests, and qualitative analysis. RESULTS: Face-to-face participants were more satisfied with their group allocation than the Internet groups. Internet groups reported accessing the Internet at home, and that they liked the self-paced nature of the website. Difficulties associated with time and motivation were raised by the Internet groups. No differences were found for content acceptability and credibility. Website usability scores were high for both Internet groups. CONCLUSION: These findings support the use of the Internet in terms of content satisfaction and usability; however, issues were raised regarding the acceptability of an Internet-based program when traditional face-to-face delivery options are available. PRACTICE IMPLICATIONS: Identifying avenues to support user perceptions of 'motivation', and mechanisms for enhancing engagement and retention, and user acceptability are required.

General practitioner advice on physical activity--who gets it?

PURPOSE: To evaluate the prevalence and characteristics of patients who received physical activity counseling from a general practitioner. METHODS: Data presented are from a cross-sectional survey of approximately 2000 Queensland (Australia) adults conducted as part of a multi-strategy, community-based, physical activity intervention (10,000 Steps Rockhampton). The survey included self-reported receipt of general practitioner advice on physical activity as well as demographic, medical, and physical activity questions. RESULTS: Receipt of advice on physical activity was reported by 24.2% of respondents, with advice more likely to be given to males, overweight/obese people, those with chronic conditions, and those more frequently visiting their general practitioners. DISCUSSION: Rates of physical activity advice and characteristics of patients receiving advice are similar to those reported overseas and suggest that while there is room for improvement, general practitioners are targeting their advice to patients most in need.

Psychosocial mediators of group cohesion on physical activity intention of older adults.

Considerable evidence has indicated that group-based physical activity may be a promising approach to reducing and preventing age-related illness. However, this research has not examined the mechanisms by which cohesion may impact on behaviour. The purpose of the present research was to utilise the theory of planned behaviour to investigate the mechanism by which group cohesion may affect physical activity intention. Participants were recruited from an existing physical activity intervention studying the effects of group cohesion on physical activity behaviour. The outcomes of this intervention are reported elsewhere. This paper presents data from a sub-sample of the intervention population (N=74) that examined the mediating relationships between the theory of planned behaviour and group cohesion on physical activity intention. Analyses showed that attitude and perceived behavioural control mediated the relationship between specific group cohesion concepts and physical activity intention. The direct measure of subjective norm failed to display a mediating relationship. The mediating relationships displayed between attitude and perceived behavioural control and physical activity intention provide insight into potential mechanisms by which group cohesion may affect behaviour.

A comparison of health behaviours in lonely and non-lonely populations.

Loneliness can be defined as perceived social isolation and appears to be a relatively common experience in adults. It carries a significant health risk and has been associated with heart disease, depression and poor recovery after coronary heart surgery. The mechanisms that link loneliness and morbidity are unclear but one of the mechanisms may be through poor health beliefs and behaviours. The aims of this cross-sectional survey of 1289 adults were to investigate differences in health behaviours (smoking, overweight, BMI, sedentary, attitudes towards physical activity) in lonely and non-lonely groups. Lonely individuals were more likely to be smokers and more likely to be overweight - obese. The lonely group had higher body mass index scores controlling for age, annual income, gender, employment and marital status. Logistic regression revealed no differences in sedentary lifestyles. Lonely individuals were significantly less likely to believe it was desirable for them to lose weight by walking for recreation, leisure or transportation. The findings provide support for an association between health behaviours, loneliness and excess morbidity reported in previous studies.

Social capital, age and religiosity in people who are lonely.

AIMS AND OBJECTIVES: The aims of the study were to (i) investigate age and loneliness, (ii) investigate the association between religiosity and loneliness, and (iii) and explore the relationship between social capital and loneliness. BACKGROUND: Loneliness is the subjective experience of social isolation and is a risk factor for a wide range of health problems including heart disease and depression. Poor self-rated health, domestic violence and poor economic conditions are associated with greater loneliness. DESIGN: The study was a cross-sectional survey of a random sample of adults aged 18 years and over. METHODS: A random sample of 1289 subjects was interviewed by computer-assisted telephone interviewing. This interview included the Loneliness Scale and items from the Social Capital Module of the General Household Survey. FINDINGS: Loneliness is more common in men and people without strong religious beliefs. An income-loneliness gradient is evident. Little support was found for the association between social capital and loneliness. CONCLUSION: The prevalence of loneliness is relatively stable in this population. Loneliness is linked to income and unemployment and as such pathways between socio-economic factors, loneliness and health need to guide interventions and future research. RELEVANCE TO CLINICAL PRACTICE: Loneliness is linked to a range of social and economic factors. Current Health Visiting practice recognizes the importance of tackling the effects of poverty and social deprivation and places community building at the core of much Health Visiting practice. This broad community level approach can usefully transfer into all community nursing and health promotion activity.

Dog ownership and human health-related physical activity: an epidemiological study.

ISSUES ADDRESSED: The presence of a household dog may be of benefit to the health of the owners. One reason may be because of increased physical activity through regular dog walking. We sought to build on existing dog walking research with more detailed examination of the characteristics of both dogs and owners in relation to the owners' physical activity. METHODS: A population-based sample (n=1,237) of residents in central Queensland, Australia, were interviewed by computer-aided telephone interview to collect dog-related and physical activity data. RESULTS: Results showed that the simple presence of a household dog displayed no relationship to the acquisition of sufficient levels of physical activity in the overall population. This finding was mediated, in terms of recreational walking, by dog size, with respondents in households with medium or large dogs displaying significantly more minutes of recreational walking per week than those with small dogs, or no dog at all. In addition, respondents who were involved in walking their household's dog were more likely to meet established physical activity guidelines than those who did not. CONCLUSIONS: Dog ownership appears to offer the promise of affecting physical activity, but more work needs to be done to determine the contribution of ownership, dog type, and dog-walking frequency with regard to achieving health-related, physical activity guidelines.