A two-arm non-randomised trial of MedEx IMPACT: a community-based, physical activity behaviour change intervention for survivors of cancer.

PURPOSE: This two-arm non-randomised trial examined the short- and long-term effects of a usual care (UC) community-based exercise programme (MedEx Move On (MMO)), and UC combined with a physical activity (PA) behaviour change (BC) intervention (MedEx IMproved PA after Cancer Treatement (MedEx IMPACT)) on PA levels, cardiorespiratory fitness (CRF) and quality of life (QoL) among survivors of cancer. METHODS: Cancer survivors referred to MMO were recruited (n = 191; mean age (± SD) 56 (± 10y), 73% female). Eighty-seven participants were assigned to UC, and 104 participants were assigned to the MedEx IMPACT intervention group (MI). UC and MI both received twice-weekly supervised exercise classes for 12-weeks. MI also received an independent PA programme, 4 PA information sessions and a 1:1 exercise consultation during the 12-week programme. Assessments of physical and psycho-social health, including 6-day accelerometry, the 6-min time trial and the Functional Assessment of Cancer Therapy-General QoL questionnaire, were conducted at baseline (T1), post-intervention (T2) and 3 months following programme completion (T3). RESULTS: Linear mixed-model analyses of variance demonstrated significant main effects for time for both groups from T1 to T2 with increases in objectively measured daily steps (p < 0.05), CRF (p < .001) and QoL (p < .01), which were maintained for CRF (p < .001) at T3. MI participants also maintained increases achieved at T2, in steps and QoL, at T3 (p < 0.01). CONCLUSION: Twelve weeks of twice-weekly supervised exercise was effective in increasing PA, CRF and QoL among survivors of cancer. MI resulted in the maintenance of all improvements achieved 3 months following programme completion.

Compression-based Facies Modelling.

Simple object- or pixel-based facies models use facies proportions as the constraining input parameter to be honored in the output model. The resultant interconnectivity of the facies bodies is an unconstrained output property of the modelling, and if the objects being modelled are geometrically representative in three dimensions, commonly-available methods will produce well-connected facies when the model net:gross ratio exceeds about 30%. Geological processes have more degrees of freedom, and facies in high net:gross natural systems often have much lower connectivity than can be achieved by object-based or common implementations of pixel-based forward modelling. The compression method decouples facies proportion from facies connectivity in the modelling process and allows systems to be generated in which both are defined independently at input. The two-step method first generates a model with the correct connectivity but incorrect facies proportions using a conventional method, and then applies a geometrical transform to scale the model to the correct facies proportions while retaining the connectivity of the original model. The method, and underlying parameters, are described and illustrated using examples representative of low and high connectivity geological systems.

Vertical Stacking Statistics of Multi-facies Object-Based Models.

Equations describing facies proportions and amalgamation ratios are derived for randomly placed objects belonging to two or three foreground facies embedded in a background facies, as a function of the volume fractions and object thicknesses of independent facies models combined in a stratigraphically meaningful order. The equations are validated using one-dimensional continuum models. Evaluation of the equations reveals a simple relationship between an effective facies proportion and an effective amalgamation ratio, both measured as a function only of the facies in question and the background facies. This relationship provides a firm analytical basis for applying the compression algorithm to multi-facies object-based models. A set of two-dimensional cross-sectional models illustrates the approach, which allows models to be generated with realistic object stacking characteristics defined independently for each facies in a multi-facies object-based model.

Public awareness and knowledge of sepsis: a cross-sectional survey of adults in Canada.

BACKGROUND: Sepsis is a life-threatening complication of the body's response to infection. The financial, medical, and psychological costs of sepsis to individuals and to the healthcare system are high. Most sepsis cases originate in the community, making public awareness of sepsis essential to early diagnosis and treatment. There has been no comprehensive examination of adult's sepsis knowledge in Canada. METHODS: We administered an online structured survey to English- or French-literate adults in Canada. The questionnaire comprised 28 questions in three domains: awareness, knowledge, and information access. Sampling was stratified by age, sex, and geography and weighted to 2016 census data. We used descriptive statistics to summarize responses; demographic differences were tested using the Rao-Scott correction for weighted chi-squared tests and associations using multiple variable regression. RESULTS: Sixty-one percent of 3200 adults sampled had heard of sepsis. Awareness differed by respondent's residential region, sex, education, and ethnic group (p < 0.001, all). The odds of having heard of sepsis were higher for females, older adults, respondents with some or completed college/university education, and respondents who self-identified as Black, White, or of mixed ethnicity (p < 0.01, all). Respondent's knowledge of sepsis definitions, symptoms, risk factors, and prevention measures was generally low (53.0%, 31.5%, 16.5%, and 36.3%, respectively). Only 25% of respondents recognized vaccination as a preventive strategy. The strongest predictors of sepsis knowledge were previous exposure to sepsis, healthcare employment, female sex, and a college/university education (p < 0.001, all). Respondents most frequently reported hearing about sepsis through television (27.7%) and preferred to learn about sepsis from healthcare providers (53.1%). CONCLUSIONS: Sepsis can quickly cause life-altering physical and psychological effects and 39% of adults sampled in Canada have not heard of it. Critically, a minority (32%) knew about signs, risk factors, and strategies to lower risk. Education initiatives should focus messaging on infection prevention, employ broad media strategies, and use primary healthcare providers to disseminate evidence-based information. Future work could explore whether efforts to raise public awareness of sepsis might be bolstered or hindered by current discourse around COVID-19, particularly those centered on vaccination.

A patient-led, peer-to-peer qualitative study on the psychosocial relationship between young adults with inflammatory bowel disease and food.

BACKGROUND: Inflammatory bowel diseases (IBDs) are chronic gastrointestinal diseases that negatively affect the enjoyment of food and engagement in social and cultural gatherings. Such experiences may promote psychosocial challenges, an aspect of IBD often overlooked and under-supported in clinical settings and research. OBJECTIVES: This study explored the psychosocial experiences that young adults with IBD have with food via a qualitative patient-led research process. METHODS: Trained patient researchers conducted this study by engaging peers via semi-structured interviews and focus groups in a three-step co-design process. Participants (n = 9) identified the research topic (SET), explored the topic and identified emerging themes (COLLECT), refined themes and made recommendations for healthcare system change (REFLECT). RESULTS: Themes that emerged included: 'Experimenting with Food', 'Evolution Over Time', 'Diet Changes are Emotional' and 'Role of Stigma'. Participants identified the significance and frustrations of repeated testing and experimenting with food compatibility, and noted nuances in food relationships as they gain knowledge and experience over time. They emphasized the importance of maintaining a sense of hope throughout and wished to impart this to newly diagnosed patients. CONCLUSION: Participants experience numerous psychosocial challenges as they strive to manage their diet, noting gaps in support available from IBD practitioners. Participants made practical recommendations for healthcare system change to improve patient outcomes, highlighting the importance of sharing stories and collaboratively including patients in the development of new services and protocols. Authors recommend further research in this area to build a body of knowledge and support that helps IBD patients maintain hope while navigating challenges with food. PATIENT OR PUBLIC CONTRIBUTION: The first four authors on this paper were the lead researchers in this study's design and analysis and identify as patients; they conducted the research with this identity at the forefront following a peer-to-peer research model. These authors were mentored by patient researchers who also contributed to the manuscript, and the research process itself was co-lead and directed by other patient participants and consultants. Results and recommendations coming from this paper came directly from patient participants.

Study protocol for the investigation of the clinical effectiveness of a physical activity behaviour change intervention for individuals living with and beyond cancer.

Most individuals living with and beyond cancer are not sufficiently active to achieve the health benefits associated with regular physical activity (PA). The purpose of this study was to describe the study protocol for a two-arm non-randomised comparison trial conducted within a community-based setting, which aimed to investigate the clinical effectiveness of a cancer-specific PA behaviour change (BC) intervention, namely MedEx IMPACT (IMprove Physical Activity after Cancer Treatment), compared to a general exercise rehabilitation programme, among survivors of cancer. Individuals who had completed active-cancer treatment who were referred to a community-based exercise rehabilitation programme were invited to participate in the trial. Participants in the control group (CG) attended twice-weekly supervised exercise classes for 12 weeks. Classes were delivered as part of a chronic illness exercise rehabilitation programme. Participants in the MedEx IMPACT intervention group (IG) also attended the twice-weekly supervised exercise classes for 12 weeks and received cancer-specific materials, namely an independent PA programme, 4 PA information sessions and a 1:1 exercise consultation. The primary outcome was PA levels measured by 6-day accelerometry and self-report PA. Secondary outcomes included cardiorespiratory fitness (CRF), quality of life (QoL) and sedentary behaviour. Outcomes were measured at baseline and months 3, 6 and 12. Few effective PA BC interventions for individuals living with and beyond cancer have been identified. The results of this study will have implications for the planning and provision of community-based exercise oncology rehabilitation programmes for individuals living with and beyond cancer.

Perceptions of wellbeing and quality of life following participation in a community-based pre-operative exercise programme in men with newly diagnosed prostate cancer: A qualitative pilot study.

BACKGROUND: Men with a newly diagnosed prostate cancer are often treated by surgery. The time window between cancer diagnosis and surgery causes high levels of uncertainty and stress, which negatively impact quality of life (QoL). We previously reported a larger intervention pilot study which demonstrated that participation in a community-based pre-operative exercise programme significantly improved physical fitness and health-related quality of life in men with prostate cancer prior to surgery. The aim of the current pilot study was to get an insight into men's perceptions of wellbeing and QoL following completion of the pre-operative exercise programme. METHODS: From November 2017 to June 2018, men scheduled for prostate cancer surgery were recruited and took part in a prescribed community-based pre-operative exercise programme in the time available between referral and surgery. Following completion of the pre-operative exercise programme (within 1 week before surgery), participants took part in one semi-structured interview which explored four broad QoL domains: physical, psychological, social, and spiritual wellbeing. Data were analysed using thematic analysis (a bottom up/inductive analysis). RESULTS: Eleven men were recruited: mean standard deviation (SD) age was 60 ± 7 years. Data supported four main themes. Participation in the community-based pre-operative exercise training programme (over a mean (SD) of 4 ± 2 weeks) provided participants with: 1) a teachable moment; 2) a journey of preparation; 3) a sense of optimism; and 4) social connectedness prior to surgery. CONCLUSION: This study provides an insight into how the exercise programme impacted wellbeing and QoL in men preparing for prostate cancer surgery. These findings highlight the important role that exercise prehabilitation plays for men preparing for prostate cancer surgery. Such exercise programmes can be easily implemented into standard cancer pathways by establishing relationships between hospital teams and community exercise programmes.

Telehealth for delivery of haemophilia comprehensive care during the COVID-19 pandemic.

INTRODUCTION: The COVID-19 pandemic caused an unprecedented impact to haemophilia healthcare delivery. In particular, rapid implementation of telehealth solutions was required to ensure continued access to comprehensive care. AIMS: To explore patient and healthcare provider (HCP) experience of telehealth in a European Haemophilia Comprehensive Care Centre. METHOD: A systematic evaluation was performed to survey patient and HCP experience and compare clinical activity levels with telehealth to in-person attendances. RESULTS: Public health measures implemented in March 2020 to reduce COVID-19 spread resulted in a 63% decrease in medical/nursing clinic consultation activity compared to the same period in 2019. Implementation of digital care pathways resulted in marked increase in activity (52% greater than 2019). Importantly, enhanced patient engagement was noted, with a 60% reduction in non-attendance rates. Survey of patients who had participated in medical/nursing teleconsultations demonstrated that teleconsultations improved access (79%), reduced inconvenience (82%), was easy to use (94%) and facilitated good communication with the HCP (97%). A survey exploring the telemedicine experience of HCPs, illustrated that HCPs were satisfied with teleconsultation and the majority (79%) would like to continue to offer teleconsultation as part of routine patient care. In addition to medical/nursing reviews, continued access to physiotherapy with virtual exercise classes for people with haemophilia and teleconsultation for acute dental issues was equally successful. CONCLUSION: During an unprecedented public health emergency, telehealth has enabled continued access to specialized haemophilia comprehensive care. Our novel findings show that this alternative is acceptable to both patients and HCPs and offers future novel opportunities.

The Development of the MedEx IMPACT Intervention: A Patient-Centered, Evidenced-Based and Theoretically-Informed Physical Activity Behavior Change Intervention for Individuals Living With and Beyond Cancer.

Regular physical activity (PA) can address many of the negative side effects experienced by individuals following cancer treatment and support the optimization of physical and psychosocial well-being. However, many survivors of cancer are not sufficiently active to achieve these health benefits. The purpose of this study was to describe the development of a physical activity behavior change (PABC) intervention, MedEx IMPACT (IMprove Physical Activity after Cancer Treatment), which aims to increase cancer survivors' PA levels. A review of the literature and focus groups with survivors of cancer were conducted in order to generate recommendations to inform the intervention development process. This process was guided and informed by: (1) the Medical Research Council's (MRC) framework for the development, evaluation, and implementation of complex interventions, (2) the Behaviour Change Wheel (BCW), and (3) the Theoretical Domains Framework (TDF). Recommendations for strategies to support habitual PA and adherence to community-based exercise programs, generated by survivors of cancer who participated in 7 focus groups (n = 41), were synthesized with 13 statements of findings that were generated from 10 studies included within the review of the literature. Detailed mapping exercises are presented which outline the link between these sources, the MRC framework, the BCW and TDF, and the intervention content. MedEx IMPACT is the first PABC intervention for survivors of cancer to be developed through the application of the MRC framework, BCW, and TDF. The next phase in this research is to test the acceptability and effectiveness of MedEx IMPACT.

Physical Activity Across the Cancer Journey: Experiences and Recommendations From People Living With and Beyond Cancer.

BACKGROUND: The majority of individuals living with and beyond cancer are not sufficiently active to achieve health benefits. OBJECTIVE: The aim of this study was to explore individuals' experiences of physical activity (PA) behavior across the cancer journey and to ask individuals living with and beyond cancer to identify strategies to support habitual PA. DESIGN: An exploratory, descriptive, qualitative design was used. METHODS: Purposive sampling methods were used to recruit individuals living with and beyond cancer who had been referred to, and/or participated in, a community-based exercise program or were attending a cancer support center. The focus group discussions were audio recorded, transcribed verbatim, and analyzed using a thematic analysis approach. RESULTS: Seven focus groups were conducted with 41 participants. Many individuals reported that regular PA provided a vehicle for recovery that created a sense of "self-power," defined as taking ownership and control of one's health to increase well-being. Barriers to PA participation included environmental-, patient-, and treatment-related challenges. Recommendations to support long-term adherence to PA included completion of fitness assessments at regular intervals and provision of a home exercise program. LIMITATIONS: The benefits and barriers to PA participation for individuals diagnosed with cancers that were not represented may not have been identified. The strategies recommended to support habitual PA may be salient only to individuals whose cancer diagnoses were represented. CONCLUSIONS: Exercise is seen as a vehicle for recovery from cancer but long-term adherence for individuals is complex. The findings from this study can inform the development of exercise oncology rehabilitation programs and could support a greater likelihood of program success, thereby optimizing the health, well-being, and quality of life of survivors of cancer.

Street Medics: An innovative learning opportunity for UK medical students in a primary care outreach setting.

It is well known that recruitment into general practice (GP) is low, particularly in deprived areas. Undergraduate medical students are encouraged to learn about health inequalities.However, teaching on this area has been perceived by some as uninspiring. Innovative teaching opportunities can engage students but more research is needed regarding exposure to deprived inner-city settings. Street Medics is an extra-curricular, educational initiative which enables students to join GPs doing street-outreach work. The aim of the study was to understand what motivates undergraduate medical students to engage with Street Medics and the impact of the experience. Focus group data were collected and thematically analysed. Motivating factor themes: appetite to explore; previous exposure including observation of perceived sub-optimal care to marginalised patients; perceived lack of exposure personally and in undergraduate teaching. Experience and impact themes: increased understanding of social determinants of health; change in perception; influence on career intentions; desire to incorporate into curriculum. Opportunities like Street Medics can supplement the undergraduate curriculum and not only challenge students' perceptions of marginalised patients but also ignite their enthusiasm for pursuing GP. By understanding the factors driving students' engagement in innovative educational opportunities, effective methods can be shared across undergraduate courses.

The development and codesign of the PATHway intervention: a theory-driven eHealth platform for the self-management of cardiovascular disease.

Cardiovascular diseases (CVDs) are a leading cause of premature death worldwide. International guidelines recommend routine delivery of all phases of cardiac rehabilitation (CR). Uptake of traditional CR remains suboptimal, as attendance at formal hospital-based CR programs is low, with community-based CR rates and individual long-term exercise maintenance even lower. Home-based CR programs have been shown to be equally effective in clinical and health-related quality of life outcomes and yet are not readily available. The aim of the current study was to develop the PATHway intervention (physical activity toward health) for the self-management of CVD. Increasing physical activity in individuals with CVD was the primary behavior. The PATHway intervention was theoretically informed by the behavior change wheel and social cognitive theory. All relevant intervention functions, behavior change techniques, and policy categories were identified and translated into intervention content. Furthermore, a person-centered approach was adopted involving an iterative codesign process and extensive user testing. Education, enablement, modeling, persuasion, training, and social restructuring were selected as appropriate intervention functions. Twenty-two behavior change techniques, linked to the six intervention functions and three policy categories, were identified for inclusion and translated into PATHway intervention content. This paper details the use of the behavior change wheel and social cognitive theory to develop an eHealth intervention for the self-management of CVD. The systematic and transparent development of the PATHway intervention will facilitate the evaluation of intervention effectiveness and future replication.

Computerized decision support for beneficial home-based exercise rehabilitation in patients with cardiovascular disease.

BACKGROUND: Exercise-based rehabilitation plays a key role in improving the health and quality of life of patients with Cardiovascular Disease (CVD). Home-based computer-assisted rehabilitation programs have the potential to facilitate and support physical activity interventions and improve health outcomes. OBJECTIVES: We present the development and evaluation of a computerized Decision Support System (DSS) for unsupervised exercise rehabilitation at home, aiming to show the feasibility and potential of such systems toward maximizing the benefits of rehabilitation programs. METHODS: The development of the DSS was based on rules encapsulating the logic according to which an exercise program can be executed beneficially according to international guidelines and expert knowledge. The DSS considered data from a prescribed exercise program, heart rate from a wristband device, and motion accuracy from a depth camera, and subsequently generated personalized, performance-driven adaptations to the exercise program. Communication interfaces in the form of RESTful web service operations were developed enabling interoperation with other computer systems. RESULTS: The DSS was deployed in a computer-assisted platform for exercise-based cardiac rehabilitation at home, and it was evaluated in simulation and real-world studies with CVD patients. The simulation study based on data provided from 10 CVD patients performing 45 exercise sessions in total, showed that patients can be trained within or above their beneficial HR zones for 67.1 ±â€¯22.1% of the exercise duration in the main phase, when they are guided with the DSS. The real-world study with 3 CVD patients performing 43 exercise sessions through the computer-assisted platform, showed that patients can be trained within or above their beneficial heart rate zones for 87.9 ±â€¯8.0% of the exercise duration in the main phase, with DSS guidance. CONCLUSIONS: Computerized decision support systems can guide patients to the beneficial execution of their exercise-based rehabilitation program, and they are feasible.

Electronic Health Physical Activity Behavior Change Intervention to Self-Manage Cardiovascular Disease: Qualitative Exploration of Patient and Health Professional Requirements.

BACKGROUND: Cardiovascular diseases are a leading cause of premature death worldwide. International guidelines recommend routine delivery of all phases of cardiac rehabilitation. Uptake of traditional cardiac rehabilitation remains suboptimal, as attendance at formal hospital-based cardiac rehabilitation programs is low, with community-based cardiac rehabilitation rates and individual long-term exercise maintenance even lower. Home-based cardiac rehabilitation programs have been shown to be equally effective in clinical and health-related quality of life outcomes and yet are not readily available. OBJECTIVE: Given the potential that home-based cardiac rehabilitation programs have, it is important to explore how to appropriately design any such intervention in conjunction with key stakeholders. The aim of this study was to engage with individuals with cardiovascular disease and other professionals within the health ecosystem to (1) understand the personal, social, and physical factors that inhibit or promote their capacity to engage with physical activity and (2) explore their technology competencies, needs, and wants in relation to an eHealth intervention. METHODS: Fifty-four semistructured interviews were conducted across two countries. Interviews were audiotaped, transcribed verbatim, and analyzed using thematic analysis. Barriers to the implementation of PATHway were also explored specifically in relation to physical capability and safety as well as technology readiness and further mapped onto the COM-B model for future intervention design. RESULTS: Key recommendations included collection of patient data and use of measurements, harnessing hospital based social connections, and advice to utilize a patient-centered approach with personalization and tailoring to facilitate optimal engagement. CONCLUSIONS: In summary, a multifaceted, personalizable intervention with an inclusively designed interface was deemed desirable for use among cardiovascular disease patients both by end users and key stakeholders. In-depth understanding of core needs of the population can aid intervention development and acceptability.

Measuring a new facet of post traumatic growth: Development of a scale of physical post traumatic growth in men with prostate cancer.

PURPOSE: This study developed a measure of physical post traumatic growth (physical post traumatic growth inventory; P-PTGI) in men with prostate cancer. METHODS: A pool of items was created from themes identified in a qualitative study. A quantitative study was then conducted to assess the psychometric properties of the P-PTGI in a sample of 693 prostate cancer survivors. RESULTS: Tests of dimensionality revealed that the 20-item P-PTGI contained two factors: Health Autonomy and Health Awareness. Results demonstrated that scale score reliability for the P-PTGI and its subscales was excellent. In support of the scale's convergent validity, scores on the P-PTGI correlated positively with mindfulness and quality of life, and correlated negatively with depression and anxiety. A statistically significant correlation between the P-PTGI and another robust indicator of post traumatic growth attests to its concurrent validity. CONCLUSIONS: While further investigation of the P-PTGI's psychometric properties is required, preliminary findings are promising.

What predicts emotional response in men awaiting prostate biopsy?

BACKGROUND: Incidence of prostate cancer is increasing as opportunistic screening becomes widespread and life expectancy rises. Despite screening availability, research reveals conflicting results on medical outcomes, for example, disease specific mortality. However the gold standard in early diagnosis of potentially curable organ confined prostate cancer is transrectal ultrasound-guided systematic prostate biopsy (TRUS-BX). While focus has been given to medical sequalae there is a paucity of research on the psychological impact of biopsy. Awaiting biopsy may be inherently stressful but no studies to date, have assessed men's perception of stress and its impact on emotional response. This study, therefore, examines the role of stress and also personal resources namely, self-efficacy and sense of coherence in emotional adjustment in men awaiting a prostate biopsy. METHODS: Men attending a Rapid Access Prostate Cancer Clinic for a transrectal prostate biopsy (N = 114) participated in the study. They completed self report questionnaires on perceived stress (PSS), generalised self-efficacy (GSES), and sense of coherence (SOC). Adjustment was measured by the Profile of Mood States (POMS-B) which assesses tension, depression, anger, fatigue, confusion and vigour. RESULTS: Hierarchical regression analyses demonstrated that the set of predictors accounted for 17%-34% of variance across six mood states and predicted 46% of total mood disturbance. Perceived stress explained variance on all domains (11%-26%) with high stress linked to poor functioning. CONCLUSION: Perceived stress was the strongest and most consistent predictor of emotional adjustment. This is an important finding as stress appraisal has not been examined previously in this context and suggests that stress management is an important target to enhance emotional wellbeing of men attending for a prostate biopsy.

A Model to Predict Psychological- and Health-Related Adjustment in Men with Prostate Cancer: The Role of Post Traumatic Growth, Physical Post Traumatic Growth, Resilience and Mindfulness.

Background: Post traumatic growth (PTG) can be defined as positive change following a traumatic event. The current conceptualization of PTG encompasses five main dimensions, however, there is no dimension which accounts for the distinct effect of a physical trauma on PTG. The purpose of the present research was to test the role of PTG, physical post traumatic growth (PPTG), resilience and mindfulness in predicting psychological and health related adjustment. Method: Ethical approval was obtained from relevant institutional ethics committees. Participants (N = 241), who were at least 1 year post prostate cancer treatment, were invited to complete a battery of questionnaires either through an online survey or a paper and pencil package received in the post The sample ranged in age from 44 to 88 years (M = 64.02, SD = 7.76). Data were analysis using confirmatory factor analysis and structural equation modeling. Results: The physical post traumatic growth inventory (P-PTGI) was used to evaluate the role of PPTG in predicting adjustment using structural equation modeling. P-PTGI predicted lower distress and improvement of quality of life, whereas conversely, the traditional PTG measure was linked with poor adjustment. The relationship between resilience and adjustment was found to be mediated by P-PTGI. Conclusion: Findings suggest the central role of PTG in the prostate cancer survivorship experience is enhanced by the inclusion of PPTG. Adjusting to a physical trauma such as illness (internal transgressor) is unlike a trauma with an external transgressor as the physical trauma creates an entirely different framework for adjustment. The current study demonstrates the impact of PPTG on adjustment. This significantly adds to the theory of the development of PTG by highlighting the interplay of resilience with PTG, PPTG, and adjustment.

MedFit App, a Behavior-Changing, Theoretically Informed Mobile App for Patient Self-Management of Cardiovascular Disease: User-Centered Development.

BACKGROUND: The MedFit app is designed to facilitate participation of people with cardiovascular disease (CVD) in an exercise-based rehabilitation program remotely. This paper details the development for the MedFit app. OBJECTIVE: The aim of this research was to develop a behavior change, theoretically informed exercise rehabilitation mobile app for adults with CVD by following the early stages of the formative research: development and feasibility testing. METHODS: Adhering to the mobile health (mHealth) development evaluation framework, the stages of the formative research process including (1) development and (2) feasibility were undertaken. The content and format of the MedFit app were developed based on (1) theory, (2) usability testing, and (3) content design. RESULTS: A systematic review of the literature was undertaken to identify the most appropriate theories from which to develop the app. This led to the creation of the MedFit app. The app went through iterative rounds of usability focus group testing with adults with CVD to provide feedback on the app. This process was framed by the unified theory of acceptance and use of technology model. Feedback was then translated into feasible technical improvements to be executed through close collaboration with the technical team, who adapted and made modifications to the app based on this codesign process. CONCLUSIONS: The formative research process of the app development involved theoretical underpinning, usability testing, and content design. mHealth interventions may play a key role in the future of health care, potentially addressing the barriers to participation in cardiac rehabilitation. This work will provide guidance for future research aiming to develop mobile apps by incorporating a best practice framework for mHealth intervention development and a user-centered design approach.

Embedding a user-centred approach in the development of complex behaviour change intervention to improve outcomes for young adults living with type 1 diabetes: The D1 Now Study.

Background: Type 1 diabetes (T1D) is an auto-immune condition which requires intensive self-management. Diabetes self-management is challenging, especially during young adulthood. Effective interventions to improve outcomes for young adults with T1D are needed. This paper describes the development of the D1 Now intervention, employing a user-centred approach to engage with stakeholders in parallel with the application of theory. Methods: Intervention development consisted of 4 phases: 1) the formation of a public and patient involvement (PPI) Young Adult Panel (YAP); 2) a systematic review to synthesise evidence regarding the effectiveness of interventions aimed at improving outcomes for young adults with T1D; 3) understand young adults' diabetes self-management behaviour through engagement with key stakeholders; and 4) an expert consensus meeting to discuss self-management strategies identified in Phase 1 and 3 that would form the core components of the D1 Now intervention. Results: The YAP resulted in meaningful involvement between young adults, researchers and service providers. The systematic review highlighted a lack of quality intervention studies. Qualitative findings highlighted how young adult self-management is driven by complex interactions between external resources, which influence capability, and motivation. The expert panel in Phase 4 highlighted focus areas to improve outcomes for young adults and implementation strategies. Subsequent to these 4 phases, 3 intervention components have been identified: 1) a key worker to liaise with the young adult; 2) an online portal to facilitate relationship building between staff and young adults; and 3) an agenda setting tool to facilitate joint decision-making. Conclusions: This study described the systematic development of an intervention underpinned by theoretical frameworks and PPI, and has identified components for the D1 Now intervention. The resulting intervention content will now be subject to an intervention optimisation process.