Short-term psychological outcomes of Australia's 2019/20 bushfire season.

OBJECTIVE: We investigated how Australian community members (N = 318) indirectly and/or directly exposed to Australia's 2019/20 bushfire season differed in terms of psychological distress, posttraumatic growth, coping, physical health, and COVID-19 anxiety. METHOD: This was a cross-sectional study with a nonequivalent groups design. Participants were over 18 years old, English proficient, and Australian permanent residents or citizens living in Australia at some point between June 2019 and February 2020. Participants completed a 10-minute anonymous online survey 5 to 8 weeks following the bushfires. RESULTS: A descriptive discriminant analysis revealed a statistically significant difference between bushfire exposure groups when considering our dependent variables of interest simultaneously and adjusting for prior mental health assistance and prior exposure to natural disasters: F(10, 624) = 2.83, p = .002; V = .087, partial η² = .043. The group centroid for the indirect-only exposure group (-.374) was substantially lower than that for the other 2 groups (direct only: .137; direct + indirect: .224), indicating that the indirect-only exposure group could be differentiated by the fact that they more frequently reported avoidant coping strategies and endorsed lower posttraumatic growth scores than the direct-only and direct + indirect exposure groups. The variance accounted for by these discriminant variables was 8.4%, indicating a very small effect. CONCLUSION: Our results point to a need to tailor and/or expand disaster preparedness, response, and recovery efforts such that they might benefit community members both directly and indirectly exposed to bushfire events in Australia. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Precision health in behaviour change interventions: A scoping review.

Precision health seeks to optimise behavioural interventions by delivering personalised support to those in need, when and where they need it. Conceptualised a decade ago, progress toward this vision of personally relevant and effective population-wide interventions continues to evolve. This scoping review aimed to map the state of precision health behaviour change intervention research. This review included studies from a broader precision health review. Six databases were searched for studies published between January 2010 and June 2020, using the terms 'precision health' or its synonyms, and including an intervention targeting modifiable health behaviour(s) that was evaluated experimentally. Thirty-one studies were included, 12 being RCTs (39%), and 17 with weak study design (55%). Most interventions targeted physical activity (27/31, 87%) and/or diet (24/31, 77%), with 74% (23/31) targeting two to four health behaviours. Interventions were personalised via human interaction in 55% (17/31) and digitally in 35% (11/31). Data used for personalising interventions was largely self-reported, by survey or diary (14/31, 45%), or digitally (14/31, 45%). Data was mostly behavioural or lifestyle (20/31, 65%), and physiologic, biochemical or clinical (15/31, 48%), with no studies utilising genetic/genomic data. This review demonstrated that precision health behaviour change interventions remain dependent on human-led, low-tech personalisation, and have not fully considered the interaction between behaviour and the social and environmental contexts of individuals. Further research is needed to understand the relationship between personalisation and intervention effectiveness, working toward the development of sophisticated and scalable behaviour change interventions that have tangible public health impact.

Gamification in a Physical Activity App: What Gamification Features Are Being Used, by Whom, and Does It Make a Difference?

Background: Gamification is purported to enhance engagement with health behavior apps, ultimately improving their effectiveness. This study aimed to examine (1) whether the inclusion of gamification features in a physical activity smartphone app was associated with improved app usage and goal adherence, describe (2) use of the gamification features, and (3) by whom, and determine (4) whether engagement was associated with increased physical activity. Methods: Data from community-dwelling adult participants (mean age 42.1 years, standard deviation [SD 11.9], 74% female) in the gamified (n = 134) and nongamified (n = 155) conditions from a three-group randomized controlled trial were analyzed. Physical activity was assessed at baseline and 9 months using a survey and accelerometers. App usage (number of days steps were logged), goal adherence (number of days step count was ≥10,000), and behavioral engagement with gamification features were obtained from server logs. Multilevel modeling was used to examine the study aims. Results: Participants who received the gamified app showed more days of usage than those who received the nongamified app (M = 113 days [SD 88] vs. M = 81 days [SD 54], P = 0.006), whereas goal adherence did not differ between groups. The leaderboard and "status" gamification features were the most frequently used gamification features (M = 83 [SD 114] and M = 50 [SD 67] views, respectively). Older age (P = 0.008) and lower body mass index (P = 0.004) were associated with more status views. Participants who reported higher stress symptoms sent more gifts (P = 0.04). The use of gamification features was associated with increased physical activity (P = 0.04). Conclusion: The gamified app was used substantially longer than the nongamified app. Use of gamification features was positively associated with change in physical activity. Leaderboards promoting social comparison may be a promising form of gamification. Research on different forms of gamification is warranted.

Individual differences and changes in lifestyle behaviours predict decreased subjective well-being during COVID-19 restrictions in an Australian sample.

BACKGROUND: Due to the coronavirus disease 2019 (COVID-19) pandemic, social distancing practices were introduced to curb infection rates in many countries. The purpose of this study was to assess the effects of these restrictions on behaviours and well-being and whether individual differences predict changes in well-being. METHODS: Australian adults participated in a cross-sectional, online survey during May 2020. The survey captured demographic information; health behaviours; personality traits; life satisfaction and COVID-19-related attitudes, financial concerns, perceived risks and impacts. RESULTS: In total, 3745 (86.8% of 4313) participants completed all items. Participants were mostly female (85.7%) and 56.4 years (standard deviation [SD] = 12.6) on average. Over 95.0% of the sample indicated they had been social distancing or isolating. Health behaviours and well-being had generally worsened, with social connections being the most negatively affected. Life satisfaction was significantly lower since restrictions. For changes in life satisfaction, extroversion was a risk factor and openness to experience was a protective factor. CONCLUSIONS: Overall, well-being was negatively impacted by the COVID-19 pandemic and associated social distancing particularly in this sample containing mainly older women. In future, it will be crucial to understand why and who may be differentially affected, to encourage behaviours that are protective of well-being.

Co-design of a digital dietary intervention for adults at risk of type 2 diabetes.

BACKGROUND: Co-design has the potential to create interventions that lead to sustainable health behaviour change. Evidence suggests application of co-design in various health domains has been growing; however, few public-facing digital interventions have been co-designed to specifically address the needs of adults at risk of Type 2 diabetes (T2D). This study aims to: (1) co-design, with key stakeholders, a digital dietary intervention to promote health behaviour change among adults at risk of T2D, and (2) evaluate the co-design process involved in developing the intervention prototype. METHODS: The co-design study was based on a partnership between nutrition researchers and designers experienced in co-design for health. Potential end-users (patients and health professionals) were recruited from an earlier stage of the study. Three online workshops were conducted to develop and review prototypes of an app for people at risk of T2D. Themes were inductively defined and aligned with persuasive design (PD) principles used to inform ideal app features and characteristics. RESULTS: Participants were predominantly female (range 58-100%), aged 38 to 63 years (median age = 59 years), consisting of a total of 20 end-users and four experts. Participants expressed the need for information from credible sources and to provide effective strategies to overcome social and environmental influences on eating behaviours. Preferred app features included tailoring to the individual's unique characteristics, ability to track and monitor dietary behaviour, and tools to facilitate controlled social connectivity. Relevant persuasive design principles included social support, reduction (reducing effort needed to reach target behaviour), tunnelling (guiding users through a process that leads to target behaviour), praise, rewards, and self-monitoring. The most preferred prototype was the Choices concept, which focusses on the users' journey of health behaviour change and recognises progress, successes, and failures in a supportive and encouraging manner. The workshops were rated successful, and feedback was positive. CONCLUSIONS: The study's co-design methods were successful in developing a functionally appealing and relevant digital health promotion intervention. Continuous engagement with stakeholders such as designers and end-users is needed to further develop a working prototype for testing.

Co-Design Practices in Diet and Nutrition Research: An Integrative Review.

Co-design, the method of involving users, stakeholders, and practitioners in the process of design, may assist to improve the translation of health evidence into tangible and acceptable intervention prototypes. The primary objective of this review was to identify and describe co-design techniques used in nutrition research. The secondary objective was to identify associations between co-design techniques and intervention effectiveness. An integrative review was performed using the databases Emcare, MEDLINE, PsycINFO and Google Scholar. Eligible studies included those that: (1) utilised participatory research or co-design techniques, (2) described development and/or evaluation of interventions aimed at improving dietary behaviours or nutrition, and (3) targeted community-dwelling adults aged ≥18 years. We identified 2587 studies in the initial search and included 22 eligible studies. There were 15 studies that utilised co-design techniques, with a strong focus on engagement of multiple stakeholder types and use of participatory research techniques. No study implemented a complete co-design process. Most studies (14/15) reporting outcomes reported positive health (maximum p < 0.001) or health behaviour outcomes attributed to the intervention; hence, associations between co-design techniques and effectiveness could not be determined. Currently published intervention studies have used participatory research approaches rather than co-design methods. Future research is required to explore the effectiveness of co-design nutrition interventions.

Trends and gaps in precision health research: a scoping review.

OBJECTIVE: To determine progress and gaps in global precision health research, examining whether precision health studies integrate multiple types of information for health promotion or restoration. DESIGN: Scoping review. DATA SOURCES: Searches in Medline (OVID), PsycINFO (OVID), Embase, Scopus, Web of Science and grey literature (Google Scholar) were carried out in June 2020. ELIGIBILITY CRITERIA: Studies should describe original precision health research; involve human participants, datasets or samples; and collect health-related information. Reviews, editorial articles, conference abstracts or posters, dissertations and articles not published in English were excluded. DATA EXTRACTION AND SYNTHESIS: The following data were extracted in independent duplicate: author details, study objectives, technology developed, study design, health conditions addressed, precision health focus, data collected for personalisation, participant characteristics and sentence defining 'precision health'. Quantitative and qualitative data were summarised narratively in text and presented in tables and graphs. RESULTS: After screening 8053 articles, 225 studies were reviewed. Almost half (105/225, 46.7%) of the studies focused on developing an intervention, primarily digital health promotion tools (80/225, 35.6%). Only 28.9% (65/225) of the studies used at least four types of participant data for tailoring, with personalisation usually based on behavioural (108/225, 48%), sociodemographic (100/225, 44.4%) and/or clinical (98/225, 43.6%) information. Participant median age was 48 years old (IQR 28-61), and the top three health conditions addressed were metabolic disorders (35/225, 15.6%), cardiovascular disease (29/225, 12.9%) and cancer (26/225, 11.6%). Only 68% of the studies (153/225) reported participants' gender, 38.7% (87/225) provided participants' race/ethnicity, and 20.4% (46/225) included people from socioeconomically disadvantaged backgrounds. More than 57% of the articles (130/225) have authors from only one discipline. CONCLUSIONS: Although there is a growing number of precision health studies that test or develop interventions, there is a significant gap in the integration of multiple data types, systematic intervention assessment using randomised controlled trials and reporting of participant gender and ethnicity. Greater interdisciplinary collaboration is needed to gather multiple data types; collectively analyse big and complex data; and provide interventions that restore, maintain and/or promote good health for all, from birth to old age.

Identifying modifiable factors that could arrest progression to type 2 diabetes: A cluster analysis of Australian adults.

Lifestyle-based disease prevention and self-management strategies play an important role in the mitigation of health, social, and economic burdens associated with type 2 diabetes mellitus (T2DM) and other chronic diseases. However, there are significant implementation and translational challenges associated with the design and delivery of effective interventions. In this study, data-driven techniques for the identification of optimal target audiences and intervention targets for T2DM prevention interventions were applied. Australian adults (N = 3159) with differing T2DM status (no diabetes diagnosis, pre-diabetes, or T2DM) completed self-report assessments of diet quality, physical activity, psychological distress, future orientation, health literacy, and socio-demographic characteristics. K-medoids cluster analysis was conducted to identify homogenous groups within the research sample and proportional odds ordinal logistic regressions conducted to identify signficant predictors of T2DM status within each cluster. Results identified a two-factor optimal solution that stratified participants based on sex (male/female). Within each cluster, psychosocial variables explained approximately 25% of the variance in T2DM status, with future orientation identified as a significant modifiable predictor of T2DM. For the male cluster, health literacy was also significant (p ≤0.01). Findings indicate that men and women should be targeted separately in T2DM prevention or management programs and that future interventional research targeting future orientation is warranted.

Identifying critical features of type two diabetes prevention interventions: A Delphi study with key stakeholders.

AIMS: This study aims to identify critically important features of digital type two diabetes mellitus (T2DM) prevention interventions. METHODS: A stakeholder mapping exercise was undertaken to identify key end-user and professional stakeholders, followed by a three-round Delphi procedure to generate and evaluate evidence statements related to the critical elements of digital T2DM prevention interventions in terms of product (intervention), price (funding models/financial cost), place (distribution/delivery channels), and promotion (target audiences). RESULTS: End-user (n = 38) and professional (n = 38) stakeholders including patients, dietitians, credentialed diabetes educators, nurses, medical doctors, research scientists, and exercise physiologists participated in the Delphi study. Fifty-two critical intervention characteristics were identified. Future interventions should address diet, physical activity, mental health (e.g. stress, diabetes-related distress), and functional health literacy, while advancing behaviour change support. Programs should be delivered digitally or used multiple delivery modes, target a range of population subgroups including children, and be based on collaborative efforts between national and local and government and non-government funded organisations. CONCLUSIONS: Our findings highlight strong support for digital health to address T2DM in Australia and identify future directions for T2DM prevention interventions. The study also demonstrates the feasibility and value of stakeholder-led intervention development processes.

Challenges and successes to the implementation of a zoo conservation-education program.

Zoo conservation-education programs have potential to address biodiversity loss, although evidence of their effectiveness to encourage social change is in its infancy. Moreover, how a program is implemented may influence program efficacy, yet there is little evidence of the factors that shape this process in zoos. Accordingly, through a process evaluation of Zoos Victoria's 'When Balloons Fly" (WBF) conservation-education program against marine debris, we identified barriers and enablers to the implementation of the program which can be addressed to improve future initiatives. Between April-May 2018, 24 Zoos Victoria professionals completed an online survey focussed on identifying challenges and successes in implementing WBF. Four participants additionally completed a follow-up telephone interview. Themes were identified and organised according to the model of diffusion in service organisations (Greenhalgh, Robert, Macfarlane, Bate, & Kyriakidou, 2004). Our results illuminate that features of the organisation (e.g., structure, culture) rather than features of individuals (e.g., skills, motivation) or characteristics of the conservation-education program itself (e.g., messaging), were most influential to implementation success. Based on these findings, attention to the organisational context is critical for promoting and evaluating the success of conservation-education programs and must be given significant attention alongside program characteristics and staff capability to deliver them.

Defining precision health: a scoping review protocol.

INTRODUCTION: Precision health is a nascent field of research that would benefit from clearer operationalisation and distinction from adjacent fields like precision medicine. This clarification is necessary to enable precision health science to tackle some of the most complex and significant health problems that are faced globally. There is a pressing need to examine the progress in human precision health research in the past 10 years and analyse this data to first, find similarities and determine discordances in how precision health is operationalised in the literature and second, identify gaps and future directions for precision health research. METHODS AND ANALYSIS: To define precision health and map research in this field, a scoping review will be undertaken and reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses - Scoping Review Extension guidelines. Systematic searches of scientific databases (Medline, Embase, Scopus, Web of Science and PsycINFO) and grey literature sources (Google Scholar, Google Patents) identified 8053 potentially eligible articles published from 1 January 2010 to 30 June 2020. Following removal of duplicates, a total of 3190 articles were imported for screening. Article data will be extracted using a customised extraction template on Covidence and analysed descriptively using narrative synthesis. ETHICS AND DISSEMINATION: Ethics approval is not required. Findings will be disseminated through professional networks, conference presentations and publication in a scientific journal.

Can Instagram be used to deliver an evidence-based exercise program for young women? A process evaluation.

BACKGROUND: Instagram provides an opportunity to deliver low cost, accessible and appealing physical activity content. This study evaluated the feasibility of delivering an exercise program for young women using Instagram. METHODS: A single-group pre- and post-intervention trial examined the feasibility and preliminary efficacy of a 12-week Instagram-delivered program with young inactive women (n = 16; M = 23 years), which prescribed running and body weight exercises to complete three times per week. Daily Instagram posts delivered the exercises, video demonstrations and motivational content. Feasibility was evaluated by examining exposure (Instagram posts viewed per week), engagement (likes, comments and tags on Instagram posts; number of exercise sessions completed per week; retention, defined as completion of the online survey at weeks 6 and 12), and acceptability [whether the program increased participants' motivation to exercise (1 = strongly disagree-5 = strongly agree); satisfaction with the program (1 = not satisfied-5 = very satisfied)]. Preliminary efficacy was evaluated by comparing baseline and 12-week self-reported physical activity (IPAQ short-form) and fitness (cardiorespiratory and muscle strength; 1 = very poor-5 = very good, International Fitness Scale) using the Exact sign test. RESULTS: On average, participants reported seeing six posts in their Instagram feed per week. Posts received an average of five likes (IQR = 3-6). A total of four comments and one tag were observed across all posts. On average, participants reported completing two exercise sessions per week. Retention was 88% at 6 weeks but dropped to 56% at 12 weeks. Participants reported increased motivation to exercise (Mdn = 4, IQR = 3-4) and were satisfied with the program (Mdn = 4, IQR = 3-4). Only self-reported cardiorespiratory fitness showed a meaningful, though nonsignificant, improvement (MdnΔ = 1, IQR = 0-1, p = .06). CONCLUSIONS: Although Instagram has the potential to deliver a low cost, convenient exercise program for young women, additional research is needed to identify methods of improving engagement (interaction with the Instagram content, exercise sessions completed, and retention in the program). Future research could examine the use of behaviour change theory and provide information that enables participants to tailor the exercises to their interests and needs. Additionally, the use of objective assessments of physical activity and fitness among a larger participants sample is needed.

A Social Networking and Gamified App to Increase Physical Activity: Cluster RCT.

INTRODUCTION: Appealing approaches to increasing physical activity levels are needed. This study evaluated whether a social and gamified smartphone app (Active Team) could be one such approach. STUDY DESIGN: A 3-group cluster RCT compared the efficacy of Active Team with a basic self-monitoring app and waitlist control group. SETTING/PARTICIPANTS: Australian adults (N=444, mean age of 41 years, 74% female) were recruited in teams (n=121) and randomly assigned (1:1:1) to the Active Team (n=141, 39 teams), self-monitoring app (n=160, 42 teams), or waitlist group (n=143, 40 teams). Data were collected in 2016-2017, and analysis was conducted in 2018-2019. INTERVENTION: Active Team is a 100-day app-based, gamified, online social networking physical activity intervention. MAIN OUTCOME MEASURES: The primary outcome was change in objective physical activity from baseline to 3-month follow-up. Secondary outcomes included objective physical activity at 9 months and self-reported physical activity, quality of life, depression, anxiety and stress, well-being, and engagement. RESULTS: Mixed models indicated no significant differences in objective physical activity between groups at 3 (F=0.17, p=0.84; Cohen's d=0.03, 95% CI= -0.21, 0.26) or 9 months (F=0.23, p=0.92; d=0.06, 95% CI= -0.17, 0.29) and no significant differences for secondary outcomes of quality of life, depression, anxiety and stress, or well-being. Self-reported moderate-to-vigorous physical activity was significantly higher in the Active Team group at the 9-month follow-up (F=3.05, p=0.02; d=0.50, 95% CI=0.26, 0.73). Engagement was high; the Active Team group logged steps on an average of 72 (SD=35) days and used the social and gamified features an average of 89 (SD=118) times. CONCLUSIONS: A gamified, online social networking physical activity intervention did not change objective moderate-to-vigorous physical activity, though it did increase self-reported moderate-to-vigorous physical activity and achieve high levels of engagement. Future work is needed to understand if gamification, online social networks, and app-based approaches can be leveraged to achieve positive behavior change. TRIAL REGISTRATION: This study is registered at Australian and New Zealand Clinical Trial Registry (protocol: ANZCTR12617000113358).

User Engagement and Attrition in an App-Based Physical Activity Intervention: Secondary Analysis of a Randomized Controlled Trial.

BACKGROUND: The success of a mobile phone app in changing health behavior is thought to be contingent on engagement, commonly operationalized as frequency of use. OBJECTIVE: This subgroup analysis of the 2 intervention arms from a 3-group randomized controlled trial aimed to examine user engagement with a 100-day physical activity intervention delivered via an app. Rates of engagement, associations between user characteristics and engagement, and whether engagement was related to intervention efficacy were examined. METHODS: Engagement was captured in a real-time log of interactions by users randomized to either a gamified (n=141) or nongamified version of the same app (n=160). Physical activity was assessed via accelerometry and self-report at baseline and 3-month follow-up. Survival analysis was used to assess time to nonuse attrition. Mixed models examined associations between user characteristics and engagement (total app use). Characteristics of super users (top quartile of users) and regular users (lowest 3 quartiles) were compared using t tests and a chi-square analysis. Linear mixed models were used to assess whether being a super user was related to change in physical activity over time. RESULTS: Engagement was high. Attrition (30 days of nonuse) occurred in 32% and 39% of the gamified and basic groups, respectively, with no significant between-group differences in time to attrition (P=.17). Users with a body mass index (BMI) in the healthy range had higher total app use (mean 230.5, 95% CI 190.6-270.5; F2=8.67; P<.001), compared with users whose BMI was overweight or obese (mean 170.6, 95% CI 139.5-201.6; mean 132.9, 95% CI 104.8-161.0). Older users had higher total app use (mean 200.4, 95% CI 171.9-228.9; F1=6.385; P=.01) than younger users (mean 155.6, 95% CI 128.5-182.6). Super users were 4.6 years older (t297=3.6; P<.001) and less likely to have a BMI in the obese range (χ22=15.1; P<.001). At the 3-month follow-up, super users were completing 28.2 (95% CI 9.4-46.9) more minutes of objectively measured physical activity than regular users (F1,272=4.76; P=.03). CONCLUSIONS: Total app use was high across the 100-day intervention period, and the inclusion of gamified features enhanced engagement. Participants who engaged the most saw significantly greater increases to their objectively measured physical activity over time, supporting the theory that intervention exposure is linked to efficacy. Further research is needed to determine whether these findings are replicated in other app-based interventions, including those experimentally evaluating engagement and those conducted in real-world settings. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12617000113358; https://www.anzctr.org.au/ACTRN12617000113358.aspx.

Research methods and reporting practices in zoo and aquarium conservation-education evaluation.

Zoos and aquariums are increasingly incorporating conservation education into their mission statements and visitor experiences to address global biodiversity loss. To advance knowledge and practice in the field, research is being conducted to evaluate the effect of zoo conservation-education experiences on visitor psychosocial outcomes (e.g., knowledge, attitude, emotions, motivations, behavior). Following recent discussions among scholars and practitioners concerning logistical and methodological challenges that likely undermine the conclusions of such research, we identified and reviewed the methods and reporting practices in peer-reviewed articles published in English from May 1998 to June 2016 that focused on adult visitor samples (47 articles, 48 studies). We examined elements of internal, external, construct, and statistical conclusion validity. Methodological quality of quantitative methods and reporting practices was determined using the Effective Public Health Practice Project Quality Assessment Tool. Each study was coded as either strong (no weak ratings), moderate (1 weak rating), or weak (≥2 weak ratings). The quantitative methods of 83.3% of studies were weak. The remaining 16.7% had methods of moderate quality. Using an existing checklist, we also assessed the quality and rigor of qualitative methods and reporting practices and found that some aspects of these methods were reported more comprehensively than others. For example, 69.6% of articles discussed methods for identifying key themes from the data, whereas only 34.8% reported how data verification was performed. We suggest increased application of intensive longitudinal methods (e.g., daily diary) to strengthen self-reported data, experimental and repeated-measures designs, and mixed-methods approaches. Our findings and recommendations could strengthen and guide the research and evaluation agenda for the field and ultimately enhance the contribution zoos make to global biodiversity conservation.