Telepresence Robots in Long-Term Care Settings in British Columbia During the COVID-19 Pandemic: Analyzing the Experiences of Residents and Family Members.

Telepresence robots are being increasingly used in long-term care (LTC) homes for virtual visits between families and residents. This study investigated the impacts and experiences of residents and their families using a telepresence robot (Double 3) for 4 to 12 months during the COVID-19 pandemic. A total of 51 participants were recruited through purposive sampling, including 9 residents, 15 family members, and 27 staff from 4 LTC homes in British Columbia, Canada. Conversational interviews were conducted with residents and family members. Focus groups and one-to-one interviews were held with frontline staff. Thematic analysis was performed, with five themes identified: (1) Stay connected, (2) Regain autonomy, (3) Relieve caregiver burden, (4) Environmental and technical issues, and (5) Scheduling concerns. In conclusion, telepresence robots helped maintain social connections between residents and families, despite the COVID-19 restrictions.

Walking soccer: A systematic review of a modified sport.

BACKGROUND: Walking soccer (football) is an emerging modified sport gaining recognition globally. OBJECTIVES: To synthesize current evidence for walking soccer and provide a summary of global walking soccer organizations. DATA SOURCES: We searched for studies published across all years and all languages within multiple databases for studies focused on walking soccer (football) in adults (18 + years). Two authors independently screened citations at Level 1 and 2. We also conducted a forward citation search and reviewed the reference lists for included studies. We searched the gray literature to identify walking soccer organizations. We conducted the last database search in December 2019. STUDY APPRAISAL AND SYNTHESIS METHODS: We conducted a standard systematic review following established guidelines. We also summarized findings from a limited search for walking soccer organizations. For peer-reviewed literature, we used the Mixed Methods Appraisal Tool (MMAT) to assess methodological quality and conducted a narrative synthesis of the evidence. RESULTS: We identified nine peer-reviewed studies (with 117 participants). Most studies included small sample sizes and interventions with short duration. Walking soccer is an emerging modified sport that is popular across the United Kingdom (UK), with its reach extending to other countries. CONCLUSIONS: Limited published evidence exists for walking soccer, despite is global popularity. For the studies identified, generalizability was limited to predominately older men from the UK. Based on preliminary findings, walking soccer has the potential to confer health benefits and build social connections.

Factors influencing sedentary behaviours after stroke: findings from qualitative observations and interviews with stroke survivors and their caregivers.

BACKGROUND: Stroke survivors are more sedentary than healthy, age-matched controls, independent of functional capacity. Interventions are needed to encourage a reduction in overall sedentary time, and regular breaks in prolonged periods of sedentary behaviour. This study captured the views and experiences of stroke survivors and their caregivers related to sedentary behaviour after stroke, to inform the development of an intervention to reduce sedentary behaviour. METHODS: Mixed-methods qualitative study. Non-participant observations were completed in two stroke services, inclusive of inpatient and community settings in the United Kingdom. Semi-structured interviews were conducted with stroke survivors and their caregivers (if available) at six- or nine-months post-stroke. Underpinned by the capability, opportunity and motivation (COM-B) model of behaviour change, observational data (132 h) were analysed thematically and interview data (n = 31 stroke survivors, n = 12 caregivers) were analysed using the Framework approach. RESULTS: Observation participants differed in functional ability whereas stroke survivor interviewees were all ambulant. Six themes related to sedentary behaviour after stroke were generated: (1) sedentary behaviour levels and patterns after stroke; (2) the physical and social environment in the stroke service and in the home; (3) standing and movement capability after stroke; (4) emotion and motivation after stroke; (5) caregivers' influence on, and role in influencing stroke survivors' sedentary behaviour; and (6) intervening to reduce sedentary behaviour after stroke. Capability, opportunity and motivation were influenced by the impact of the stroke and caregivers' inclination to support sedentary behaviour reduction. Stroke survivors reported being more sedentary than they were pre-stroke due to impaired balance and co-ordination, increased fatigue, and reduced confidence in mobilising. Caregivers inclination to support stroke survivors to reduce sedentary behaviour depended on factors including their willingness to withdraw from the caregiver role, and their perception of whether the stroke survivor would act on their encouragement. CONCLUSIONS: Many stroke survivors indicate being open to reducing sedentary behaviour, with appropriate support from stroke service staff and caregivers. The findings from this study have contributed to an intervention development process using the Behaviour Change Wheel (BCW) approach to develop strategies to reduce sedentary behaviour after stroke.

A feasibility study of 'The StepSmart Challenge' to promote physical activity in adolescents.

BACKGROUND: Inactive lifestyles are becoming the norm and creative approaches to encourage adolescents to be more physically active are needed. Little is known about how gamification techniques can be used in physical activity interventions for young people. Such approaches may stimulate interest and encourage physical activity behaviour. The study investigated the feasibility of implementing and evaluating a physical activity intervention for adolescents which included gamification techniques within schools. We tested recruitment and retention strategies for schools and participants, the use of proposed outcome measures, and explored intervention acceptability. METHODS: This school-based feasibility study of a randomised cluster trial recruited adolescents aged 12-14 years (n = 224) from five schools (three intervention; two control) in Belfast, Northern Ireland. The 22-week intervention (The StepSmart Challenge) informed by self-determination theory and incorporating gamification strategies involved a school-based pedometer competition. Outcomes, measured at baseline, and post-intervention (at 22 weeks post-baseline and 52 weeks post-baseline) included daily minutes of moderate to vigorous physical activity (MVPA) (measured using ActiGraph accelerometer), mental wellbeing (Warwick-Edinburgh Mental Wellbeing Scale), social support for physical activity, time preference (for delayed and larger rewards or immediate and smaller rewards), pro-social behaviour (Strengths and Difficulties Questionnaire (SDQ)) and the influence of social networks. The intervention's acceptability was explored in focus groups. RESULTS: We invited 14 schools to participate; eight showed interest in participating. We recruited the first five who responded; all five completed the trial. Of the 236 pupils invited, 224 participated (94.9%): 84.8% (190/224) provided valid MVPA (minutes/day) at baseline and 57.2% (123/215) at 52 weeks. All other outcomes were well completed apart from the SDQ (65% at baseline). Qualitative data highlighted that participants and teachers found The StepSmart Challenge to be an acceptable intervention. CONCLUSIONS: The level of interest and high recruitment and retention rates provide support for the feasibility of this trial. The intervention, incorporating gamification strategies and the recruitment methods, using parental opt-out procedures, were acceptable to participants and teachers. Teachers also suggested that the implementation of The StepSmart Challenge could be embedded in a lifelong learning approach to health within the school curriculum. As young people's lives become more intertwined with technology, the use of innovative gamified interventions could be one approach to engage and motivate health behavioural change in this population. TRIAL REGISTRATION: NCT02455986 (date of registration: 28 May 2015).

A protocol for a systematic review of process evaluations of interventions investigating sedentary behaviour in adults.

INTRODUCTION: Sedentary behaviour is defined as any waking behaviour characterised by low energy expenditure ≤1.5 metabolic equivalents while in a sitting, lying or reclining posture. The expanding evidence base suggests that sedentary behaviour may have a detrimental effect on health, well-being and is associated with an increased risk of all-cause mortality. We aim to review process evaluations of randomised controlled trials (RCTs) which included a measure of sedentary behaviour in adults in order to develop an understanding of intervention content, mechanisms of impact, implementation and delivery approaches and contexts, in which interventions were reported to be effective or effective. A secondary aim is to summarise participants, family and staff experiences of such interventions. METHODS AND ANALYSIS: Ten electronic databases and reference lists from previous similar reviews will be searched. Eligible studies will be process evaluations of RCTs that measure sedentary behaviour as a primary or secondary outcome in adults. As this review will contribute to a programme to develop a community-based intervention to reduce sedentary behaviour in stroke survivors, interventions delivered in schools, colleges, universities or workplaces will be excluded. Two reviewers will perform study selection, data extraction and quality assessment. Disagreements between reviewers will be resolved by a third reviewer. Process evaluation data to be extracted include the aims and methods used in the process evaluation; implementation data; mechanisms of impact; contextual factors; participant, family and staff experiences of the interventions. A narrative approach will be used to synthesise and report qualitative and quantitative data. Reporting of the review will be informed by Preferred Reporting Items for Systematic Review and Meta-Analysis guidance. ETHICS AND DISSEMINATION: Ethical approval is not required as it is a protocol for a systematic review. Findings will be disseminated through peer-reviewed publications and conference presentations. PROSPERO REGISTRATION NUMBER: CRD42018087403.

Exploring the use of a gamified intervention for encouraging physical activity in adolescents: a qualitative longitudinal study in Northern Ireland.

OBJECTIVE: To explore the temporal changes of adolescents' views and experiences of participating in a gamified intervention to encourage physical activity behaviour and associated processes of behaviour change. DESIGN: A qualitative longitudinal design was adopted whereby focus groups were conducted with the same participants in each intervention school (n=3) at four time-points (baseline, end of each of two intervention phases and 1-year follow-up). The framework method was used to thematically analyse the data. SETTING: Secondary schools (n=3), Belfast (Northern Ireland). PARTICIPANTS: A subsample (n=19 at four time-points) of individuals aged 12-14 years who participated in the StepSmart Challenge, a gamified intervention involving a pedometer competition and material rewards to encourage physical activity behaviour change. RESULTS: Three core themes were identified: (1) competition; (2) incentives and (3) influence of friends. Participants indicated that a pedometer competition may help initiate physical activity but suggested that there were a number of barriers such as participants finding it 'boring', and feeling as though they had a remote chance of 'winning'. 'Incentives' were viewed favourably, although there were participants who found not winning a prize 'annoying'. Friends were a motivator to be more physically active, particularly for girls who felt encouraged to walk more when with a friend. CONCLUSIONS: The intervention in general and specific gamified elements were generally viewed positively and deemed acceptable. Results suggest that gamification may have an important role to play in encouraging adolescents to engage in physical activity and in creating interventions that are fun and enjoyable. The longitudinal approach added additional depth to the analysis as themes were refined and tested with participants over time. The findings also suggest that gamified Behaviour Change Techniques align well with core concepts of Self-determination Theory and that various game elements may require tailoring for specific populations, for example, different genders. TRIAL REGISTRATION NUMBER: NCT02455986; Pre-results.

Behavioural incentive interventions for health behaviour change in young people (5-18 years old): A systematic review and meta-analysis.

Physical inactivity, an unhealthy diet, smoking, and alcohol consumption are key determinants of morbidity and mortality. These health behaviours often begin at a young age and track into adulthood, emphasising a need for interventions in children and young people. Previous research has demonstrated the potential effectiveness of behavioural incentive (BI) interventions in adults. However, little is known about their effectiveness in children and adolescents. Eight bibliographic databases were searched. Eligibility criteria included controlled trials using behavioural incentives (rewards provided contingent on successful performance of the target behaviour) as an intervention component for health behaviour change in children and adolescents. Intervention effects (standardised mean differences or odds ratios) were calculated and pooled by health behaviour, using a random effects model. Twenty-two studies were included (of n = 8392 identified), 19 of which were eligible for meta-analysis: physical activity (n = 8); healthier eating (n = 3); and smoking (n = 8). There was strong evidence that behavioural incentives may encourage healthier eating behaviours, some evidence that behavioural incentives were effective for encouraging physical activity behaviour, and limited evidence to support the use of behavioural incentives for smoking cessation and prevention in adolescents. Findings suggest that behavioural incentives may encourage uptake and initiation of healthy eating and physical activity in young people. However, this is a limited evidence base and a wide range of incentive designs have yet to be explored. Future research should further investigate the acceptability of these intervention approaches for young people.

Network methods to support user involvement in qualitative data analyses: an introduction to Participatory Theme Elicitation.

BACKGROUND: While Patient and Public Involvement (PPI) is encouraged throughout the research process, engagement is typically limited to intervention design and post-analysis stages. There are few approaches to participatory data analyses within complex health interventions. METHODS: Using qualitative data from a feasibility randomised controlled trial (RCT), this proof-of-concept study tests the value of a new approach to participatory data analysis called Participatory Theme Elicitation (PTE). Forty excerpts were given to eight members of a youth advisory PPI panel to sort into piles based on their perception of related thematic content. Using algorithms to detect communities in networks, excerpts were then assigned to a thematic cluster that combined the panel members' perspectives. Network analysis techniques were also used to identify key excerpts in each grouping that were then further explored qualitatively. RESULTS: While PTE analysis was, for the most part, consistent with the researcher-led analysis, young people also identified new emerging thematic content. CONCLUSIONS: PTE appears promising for encouraging user led identification of themes arising from qualitative data collected during complex interventions. Further work is required to validate and extend this method. TRIAL REGISTRATION: ClinicalTrials.gov, ID: NCT02455986 . Retrospectively Registered on 21 May 2015.

Time to 're-think' physical activity promotion for young people? Results from a repeated cross-sectional study.

BACKGROUND: The aim of this study was to investigate the relationship between knowledge of the current UK physical activity (PA) guidelines and amount of daily PA using a sample population of 11-16 year olds in Northern Ireland. METHODS: Cross-sectional survey data from the 2010 and 2013 Young Persons' Behaviour and Attitudes Survey of 10,790 young people provided information on PA, knowledge of guidelines and socio-demographic characteristics. Multinomial logistic regression was used to investigate the associations between knowledge and amount of daily PA. RESULTS: Results from 2013 showed 67.0% of respondents were aware of PA guidelines with 15.4% reporting meeting them. Males were more likely to meet PA guidelines than females (OR 3.36, 95% CI 2.47, 4.59). Males who were active for 60 min or more, 7 days per week were less likely to be aware of guidelines (OR = 1.51, 95% CI 1.02, 2.24). For females, knowledge of PA guidelines had no significant association with amount of daily PA (OR = 1.74, 95% CI 0.99, 3.07). Those who did not enjoy being active were less likely to meet the guidelines (OR = 0.05, 95% CI 0.02, 0.12). CONCLUSIONS: Knowledge did not appear to be an important predictor of PA in young people. Consequently, threshold based messaging containing recommended minimum PA guideline information may not be appropriate for this age group. Re-branding PA promotion to include the use of humour may offer a new direction for public health messaging based around fun and enjoyment.