Identifying spatial neglect - an updated systematic review of the psychometric properties of assessment tools in adults post-stroke.

Spatial neglect commonly occurs after a stroke, resulting in diverse impacts depending on the type and severity. There are almost 300 tools for assessing neglect, yet there is a lack of knowledge on the psychometric properties of these tools. The objective of this systematic review, registered on Prospero (CRD42021271779), was to determine the quality of the evidence for assessing spatial neglect, categorized by neglect subtype. The following databases were searched on 3rd May 2022 from database inception: Ovid Emcare, Embase, Ovid MEDLINE, APA PsycINFO, Web of Science (SCI-EXPANDED; SSCI; A&HCI; ESCI) and Scopus. All primary peer-reviewed studies (>5 participants) of adults post stroke, reporting any psychometric property of 33 commonly used neglect assessment tools were included. The COSMIN (COnsensus-based Standards for the selection of health Measurement INstruments) risk of bias tool was used to assess the methodological quality of the studies and summarize the psychometric properties of each tool. 164 articles were included, with a total of 12,463 people with stroke. The general quality of the evidence was poor and no one tool had high-quality evidence of both validity and reliability. Eleven tools show some promise as they meet the minimum criteria for good measurement properties for both validity and reliability.

Individual placement and support: A qualitative investigation of carers' experiences supporting someone experiencing mental illness into employment.

BACKGROUND: Unemployment rates for people living with mental illness remain persistently high. Individual Placement Support (IPS) is an evidence-based employment model that supports people with severe mental illness to gain employment. Although carers provide emotional and instrumental support for people with mental illness, there is limited research exploring carers' perspectives of IPS. AIMS: To explore carers' perspectives of their experience as caregivers of individuals living with mental illness who have participated in IPS. METHODS: This qualitative descriptive study gained carers' perspectives through semi-structured interviews. A convenience sample of eight carers was recruited via a community mental health service in Adelaide. Data were analysed thematically. FINDINGS: Three main themes were identified: (1) employment benefits, (2) factors that may impact on employment, and (3) knowledge and opinions of IPS. Within each theme, four sub-themes emerged. CONCLUSIONS: This study addresses a gap in research and provides insights into carers' experiences of IPS. Increased communication and involvement of carers in IPS may benefit IPS participants and staff as carers provide invaluable additional insight into supporting individuals through their employment journey.

Employment interventions to assist people who experience borderline personality disorder: A scoping review.

BACKGROUND: Employment is an important social determinant of health and is associated with positive health outcomes. However, individuals who have been diagnosed with borderline personality disorder (BPD) are significantly underrepresented in the workforce. Whilst there is an array of evidence based therapeutic interventions, there remains a gap in knowledge regarding the most effective ways to enhance employment outcomes for people with a diagnosis of BPD. AIM: To explore employment interventions for people with BPD, map the available evidence and identify key concepts and knowledge gaps. METHODS: A scoping review was conducted to identify and map the relevant literature. Findings were summarised using a narrative approach. Consultation was provided by a reference group including peer support workers with lived experience of BPD and mental health clinicians. RESULTS: Seven articles met the inclusion criteria, including non-randomised and case study/series designs and a randomised controlled trial protocol, with participant numbers generally low. All programmes combined a psychotherapeutic component with work related goals; however, there were notable differences in relation to the conceptual/theoretical approach of the psychotherapeutic component and delivery of the work-related components. Barriers and enablers to programme participation and success are explored. CONCLUSIONS: This review provides important insights into the characteristics of vocational rehabilitation interventions for people diagnosed with BPD. The findings will inform the co-production of approaches to support people with BPD to engage in employment.

Mental health outcome measures in the Australian context: what is the problem represented to be?

BACKGROUND: There is growing interest in the use of routine outcome measures (ROM) in mental health services worldwide. Australia has been at the forefront of introducing ROM in public mental health services, with the aim of improving services and consumer outcomes. METHODS: An in-depth policy and document analysis was conducted using Carol Bacchi's 'What is the problem represented to be?' approach to critically analyse the use of ROM. This approach was used to identify and analyse the problem representations relating to the need for, and the choice of, outcome measures in Australian public mental health services, and the potential consequences of policy and practice. Data included in the analysis were seven policy documents, four reports on the introduction of outcome measures in Australia, the Australian Mental Health Outcomes and Classifications Network website, and the content of the outcome measures themselves. RESULTS: Two dominant representations of the 'problem' were identified: 1) the 'problem' of mental health service quality and accountability, relating to the need for mental health outcome measures; and 2) the 'problem' of addressing deficits in biopsychosocial functioning of mental health consumers, which relates to the choice of outcome measures. Framing the 'problem' of mental health outcomes in these ways locates the problem within individual health providers, services, and consumers, ignoring the broader socioeconomic conditions underpinning mental health and effective service provision. CONCLUSIONS: This critical analysis of the introduction and use of ROM in public mental health services in Australia highlights the need to consider the role of the social determinants of mental health, mental health service funding, and recovery-oriented care in ensuring services are meeting consumer needs and expectations. Broader governmental engagement is central to genuine change and opportunities.

A qualitative exploration of the physical and psychological wellbeing of family carers of veterans in Australia.

Family carers of veterans have a tendency not to seek support for their own wellbeing concerns. Understanding the barriers and enablers that family carers face in attending to their own wellbeing and in their caring role generally, is key to supporting family carers of veterans. This qualitative study sought to explore family carers' experiences and perceptions of their caring role, using semi-structured interviews. Questions were designed to capture concepts related to the barriers and enablers family carers face in attending to their own wellbeing. Twenty-two family carers participated in interviews. Thematic analysis facilitated the identification of key themes including the impact of the caring role; a perceived lack of recognition or appreciation of the caring role; expressed preferences for support; and consideration of the family unit. Findings suggest a need for accessible and multi-faceted support services for family carers of veterans, that target the drivers of physical and psychological wellbeing.

A realist evaluation of weighted modalities as an alternative to pro re nata medication for mental health inpatients.

Implementing psychosocial approaches into mental health inpatient settings continues to be challenging. This is despite mental health policies prioritizing trauma-informed and recovery-orientated care approaches. This study reports on an interdisciplinary project that implemented and examined the uptake of weighted modalities in a psychiatric inpatient rehabilitation setting. While over-reliance on pro re nata (PRN) medication in these settings has been reported, weighted modalities are a sensory approach that can be self-initiated by consumers as an alternative to use of PRN to manage distress and agitation. A mixed-methods realist approach was used to determine what works, for whom, and in what circumstances weighted modalities were offered by clinicians and used by consumers. Additionally, we were interested in determining whether there was an associated change in PRN use during the trial. Data included in-depth interviews with consumers (n = 12) and clinicians (n = 11), and extraction of PRN medication use preceding, throughout, and following implementation. Statistical analysis revealed a significant increase in PRN rates in the first 3 months of implementation (mean difference from baseline = 29.5, P = 0.047) but a significant decrease in the second three-month period following implementation (mean difference from baseline = -30.7, P = 0.036). Qualitative findings highlighted the key components of successful implementation as being environmental restructuring (availability/accessibility and visibility of weighted modalities) and social influences. Strategies to enhance these components are discussed.

Caring for carers: Understanding the physical and psychological well-being of carers of veterans in Australia.

Carers of veterans tend to put their own physical and psychological well-being needs behind the needs of the person they are caring for and often do not seek assistance for their own physical and psychological well-being. Combined, these factors lead to increased risk of acute and chronic illness and mental health issues. It is acknowledged that physical activity independently contributes to improved physical and mental health and may be a driver for mental well-being in carers. The aim of this pilot research was to understand how movement behaviour and health behaviours of carers of veterans in Australia relate to carers' physical and psychological well-being. Assessment occurred between February and July 2019 and included objective, validated measures to examine physical and psychological well-being. To assess the association between physical and psychological factors, correlational analyses were performed. Twenty-eight carers participated in the pilot study (96% female, mean age 61.6 years). Exercise capacity varied, and 84% of carers met the recommended 150 min of physical activity per week, with carers spending 8.6% of their time in moderate-to-vigorous physical activity; and 37.9% of the day sedentary. Psychological health outcomes reflect a population with high distress levels and lower than average mental well-being, but with normal resilience scores. Carers with higher levels of resilience had greater exercise capacity, covering further distance in the 6-min walk test, and as resilience increased, number of sedentary bouts decreased. This research demonstrates that there is a relationship between health behaviours and psychological well-being in carers of veterans and serving personnel. Based on the findings of this pilot study, programmes to support family carers should include information about physical activity, reducing sedentary time, and increasing resilience. Interventions designed to improve physical and psychological well-being should be trialled and evaluated for effectiveness.

Facilitating practices to support children's self-regulation in classrooms: a scoping review protocol.

OBJECTIVE: The objective of this scoping review is to describe practices for supporting children's self-regulation in the classroom. INTRODUCTION: Self-regulation is an integral component of children's well-being and learning in the classroom. Self-regulation is a broad concept that encompasses behavioral, emotional, cognitive, or sensory regulation processes. Children often struggle to self-regulate in class and teachers have difficulty supporting them, which affects children's participation and academic achievement, as well as teachers' self-efficacy and well-being. INCLUSION CRITERIA: This review will consider studies that include mainstream primary school children regardless of diagnosis or disability, classroom teachers, and allied health professionals who provide services in mainstream public or private school settings. Self-regulation support practices may include pedagogical, classroom- or curriculum-based practices, environmental modifications, class-management strategies, adult-child relationships, and trauma-informed classroom practices. METHODS: The review will be conducted using the JBI three-step search strategy. The databases to be searched include MEDLINE, PsycINFO, Scopus, CINAHL, OTSeeker, and ERIC. Documents from 2010 to the present in English will be included. Data will be extracted and charted by two reviewers using a data extraction tool based on JBI recommendations. Study findings will be presented in tabular or diagrammatic format that aligns with the objective, and a narrative summary will be provided.

What are the effects of scuba diving-based interventions for clients with neurological disability, autism or intellectual disability? A systematic review.

INTRODUCTION: Recreational scuba diving has existed for over 70 years with organisations emerging that teach individuals with disabilities to dive. It is unclear what the physical and psychosocial effects of scuba interventions might be. This systematic review explores evidence for the effects of scuba diving in individuals with neurological disability, intellectual disability and autism. METHODS: The databases Medline, EMBASE, Ovid Emcare, and SportDiscus were searched. Included papers described a scuba-based intervention for clients with a neurological disability, intellectual disability and autism, with physical or psychosocial outcomes explored in the paper. Quality of the included papers was assessed using the McMaster Appraisal Tools, with descriptive data synthesis completed to explore the physical and psychosocial effects of the interventions. RESULTS: Four papers met the inclusion criteria: a cross-sectional investigation, a phenomenological study, a case-control study and a multiple case study. The quality of the papers was low to moderate. Papers addressed the psychosocial effects of scuba diving, including motivation to participate, participant experiences, the effect on cognition and physical self-concept. One study reported an increase in self-concept for the majority of participants. An increase in understanding instructions and in visual attention was reported in another. Enjoyment of the activity was reported and motivators to be involved in scuba diving for people with disabilities included fun and excitement. No papers addressed functional outcomes. CONCLUSIONS: Whilst scuba diving interventions appear to enhance physical self-concept and are enjoyable, conclusive evidence regarding effectiveness could not be determined. Research in this area is extremely limited.

Spatial Neglect Subtypes, Definitions and Assessment Tools: A Scoping Review.

Objective: The objective of this scoping review was to capture the reported definitions for the subtypes of neglect post stroke and map the range of assessment tools employed for each neglect subtype. Methods: EMBASE, Emcare, Medline, and psychINFO were searched from database inception. Searching included all allied terms and mesh headings for stroke, spatial neglect, measurement, screening tools, psychometric properties. Two reviewers independently screened studies for inclusion. Primary studies with documented protocols of a spatial neglect tool for adults post stroke, with some aspect of validity or reliability were included. Two reviewers independently reviewed the documented protocols of each tool to determine the underlying subtypes and disagreements were resolved through discussion. Results: There were 371 articles included with 292 tools used for the screening or diagnosis of neglect. The majority of studies (67%) included a tool that did not specify the neglect subtype being assessed, therefore an analysis of the underlying subtypes for each tool is presented. Conclusions: There is no consistency with the terms used to refer to the syndrome of spatial neglect with over 200 different terms used within the included studies to refer to the syndrome as a whole or one of its subtypes. It is essential to unify the terminology and definition for each neglect subtype. There are hundreds of neglect tools available, however many are not able to differentiate presenting subtypes. It is important for clinicians and researchers to critically evaluate the neglect tools being used for the screening and diagnosis of neglect.

Water-Based Interventions for People With Neurological Disability, Autism, and Intellectual Disability: A Scoping Review.

The purpose of this study was to produce a descriptive overview of the types of water-based interventions for people with neurological disability, autism, and intellectual disability and to determine how outcomes have been evaluated. Literature was searched through MEDLINE, EMBASE, Ovid Emcare, SPORTDiscus, Google Scholar, and Google. One hundred fifty-three papers met the inclusion criteria, 115 hydrotherapy, 62 swimming, 18 SCUBA (self-contained underwater breathing apparatus), and 18 other water-based interventions. Common conditions included cerebral palsy, spinal cord injury, Parkinson's disease, and intellectual disability. Fifty-four papers explored physical outcomes, 36 psychosocial outcomes, and 24 both physical and psychosocial outcomes, with 180 different outcome measures reported. Overall, there is a lack of high-quality evidence for all intervention types. This review provides a broad picture of water-based interventions and associated research. Future research, guided by this scoping review, will allow a greater understanding of the potential benefits for people with neurological disability, autism, and intellectual disability.

Consumer, health professional and employment specialist experiences of an individual placement and support programme.

BACKGROUND: Individuals with severe mental illness (SMI) are under-represented in the workforce. The Individual Placement and Support (IPS) programme is an evidence-based intervention that co-locates an Employment Specialist in a community mental health team to support individuals with a SMI with their goal of finding work. Previous research predominantly explored IPS programme outcomes rather than stakeholder experiences. AIM: To explore programme stakeholder perspectives and experiences during the early stages of IPS programme implementation. METHODS: Qualitative descriptive methodology explored consumers (n = 11), health professionals and employment specialist (n = 11) perceptions and experiences of the IPS programme. Semi-structured interviews were conducted and thematically analysed. RESULTS: Three main themes emerged: enacting core care philosophies, IPS programme process and catalyst for supportive environments and relationships. The combination of IPS programme relationships, enactment of core care philosophies, and programme process promoted development of supportive environments and relationships for consumers participating in the programme. CONCLUSION: Findings suggest IPS processes promoted the enactment of person-centred and recovery-oriented care approaches and positively influenced care planning practices and service culture. SIGNIFICANCE: IPS directly tackles the compounding disadvantage resulting from unemployment for people with a SMI. At a service level, IPS can foster positive changes to care practices and service culture.

Barriers and enablers to implementing mental well-being programs through Australian rural football clubs-A qualitative descriptive study.

ISSUE ADDRESSED: Suicide rates in rural Australia are almost twice as high as those in urban areas. In rural communities, football clubs are often the 'hub' of the community and are being explored as an avenue to deliver mental health and well-being promotion. The aim of this study was to explore barriers and enablers for programs promoting mental health and well-being through rural Australian football clubs. METHOD: This qualitative descriptive study included 12 individuals of 10 rural clubs affiliated with the South Australian National Football League. Recruitment occurred via emails to club secretaries/presidents. Semi-structured telephone interviews explored mental health and well-being issues experienced in clubs, previous involvement with mental well-being programs and potential barriers/enablers for future programs. Interviews were transcribed verbatim and analysed thematically. RESULTS: Thematic analysis identified three themes encompassing barriers and enablers: (1) more than a football club, (2) attitudes towards mental health and (3) what is needed to implement a program. The third theme had subthemes of resources, importance of timing, mental health initiatives and components of a program. CONCLUSION: Key barriers included difficulty getting people involved due to individual attitudes towards mental health, and not having the finances/resources to implement a program. Major enablers included the important role the football club serves in the community, the inclusion of speakers with credibility and making the program engaging. SO WHAT?: This study identifies key factors which may impact on community engagement and program effectiveness for mental health and well-being programs delivered via rural football clubs.

How Qualitative Case Study Methodology Informs Occupational Therapy Practice: A Scoping Review.

Qualitative case study methodology (QCSM) is a useful research approach that has grown in popularity within the social sciences; however, it has received less attention in the occupational therapy literature. The current scoping review aims to explore how studies utilizing a QCSM help inform occupational therapy knowledge and practice. Electronic searches were conducted in April 2017, and the resultant 388 publications were screened by three reviewers in Covidence. In all, 27 publications met the inclusion criteria and were included in the scoping review. Case studies in the occupational therapy literature have explored phenomena relating to the delivery of intervention, theoretical concepts, clinical reasoning, and education and research methods and were situated in a range of different practice areas and contexts. QCSM is a valuable approach in occupational therapy research that contributes to the body of knowledge and theory that informs occupational therapy practice.

Effectiveness of a Facebook-Delivered Physical Activity Intervention for Postpartum Women: A Randomized Controlled Trial.

BACKGROUND: Facebook has over 1.8 billion users and offers unique opportunities for health intervention delivery due to its popularity, flexibility, high engagement, and social connectedness. METHODS: This study aimed to determine the effectiveness of the Mums Step It Up (MSIU) Facebook app, a team-based, 50-day physical activity intervention for postpartum women. A total of 120 postpartum women were recruited and randomly allocated to 1 of 3 conditions: MSIU (n = 41), pedometer only (n = 39), and control (n = 40). Assessments were completed at baseline, 6 weeks, and 6 months. Primary outcomes were accelerometer moderate to vigorous physical activity and self-reported walking. Analyses were undertaken on an intention to treat basis using random effects mixed modeling (P ≤ .05). Compliance and engagement with the MSIU app were analyzed, descriptively. RESULTS: There were no significant differences in changes in moderate to vigorous physical activity (P = .81, 6 wk; P = .91, 6 mo) or self-reported walking (P = .55, 6 wk; P = .90, 6 mo) across the 3 conditions. High engagement with the MSIU app was evident, with participants on average visiting the app 26 times and logging steps for 48/50 days. CONCLUSION: Although engagement with the MSIU app was promising, the nonsignificant results suggest that further work needs to be done to enhance efficacy for postpartum women.

Posts, pics, or polls? Which post type generates the greatest engagement in a Facebook physical activity intervention?

Social networking websites have attracted considerable attention as a delivery platform for physical activity interventions. Current evidence highlights a need to enhance user engagement with these interventions to actualize their potential. The purpose of this study was to determine which post type generates the most engagement from participants and whether engagement was related to change in physical activity in an intervention delivered via Facebook. Subgroup analysis of the intervention condition of a randomized controlled trial was conducted. The group moderator posted a new message to the private Facebook group each day of the program. The Facebook posts (n = 118) were categorized into the following types: moderator-initiated running program, multimedia, motivational, opinion polls, or discussion question and participant-initiated experience shares, or questions. Four metrics were used to measure volume of engagement with each post type, "likes," "comments," "poll votes," and "photo uploads." One-way ANOVA was used to determine whether engagement differed by post type and an independent samples t-test to determine differences in engagement between moderator and participant-initiated posts. Pearson correlation was used to examine associations between total engagement and change in physical activity. Engagement varied by post type. Polls elicited the greatest engagement (p ≤ .01). The most common form of engagement was "likes," and engagement was higher for moderator-initiated rather than participant-initiated posts (mean = 8.0 [SD 6.8] vs. 5.3 [SD 3.2]; p ≤ .01). Total engagement with the Facebook group was not directly associated with change in physical activity (r = -.13, p = .47). However, engagement was associated with compliance with the running program (r = .37, p = .04) and there was a nonsignificant positive association between compliance and change in physical activity (r = .32, p = .08). Posts requiring a simple response generated the most engagement. Intervention moderators should facilitate familiarity between participants at the intervention outset, to encourage engagement between participants. Engagement was related to change in physical activity, and these recommendations should be incorporated to enhance engagement and efficacy of interventions.

A Web-Based, Social Networking Beginners' Running Intervention for Adults Aged 18 to 50 Years Delivered via a Facebook Group: Randomized Controlled Trial.

BACKGROUND: Online social networks continue to grow in popularity, with 1.7 billion users worldwide accessing Facebook each month. The use of social networking sites such as Facebook for the delivery of health behavior programs is relatively new. OBJECTIVE: The primary aim of this study was to determine the effectiveness of a Web-based beginners' running program for adults aged 18 to 50 years, delivered via a Facebook group, in increasing physical activity (PA) and cardiorespiratory fitness. METHODS: A total of 89 adults with a mean age of 35.2 years (SD 10.9) were recruited online and via print media. Participants were randomly allocated to receive the UniSA Run Free program, an 8-week Web-based beginners' running intervention, delivered via a closed Facebook group (n=41) that included daily interactive posts (information with links, motivational quotes, opinion polls, or questions) and details of the running sessions; or to the control group who received a hard copy of the running program (n=48). Assessments were completed online at baseline, 2 months, and 5 months. The primary outcome measures were self-reported weekly moderate to vigorous physical activity (MVPA) and objectively measured cardiorespiratory fitness. Secondary outcomes were social support, exercise attitudes, and self-efficacy. Analyses were undertaken using random effects mixed modeling. Compliance with the running program and engagement with the Facebook group were analyzed descriptively. RESULTS: Both groups significantly increased MVPA across the study period (P=.004); however, this was significantly higher in the Facebook group (P=.04). The Facebook group increased their MVPA from baseline by 140 min/week versus 91 min for the control at 2 months. MVPA remained elevated for the Facebook group (from baseline) by 129 min/week versus a 50 min/week decrease for the control at 5 months. Both groups had significant increases in social support scores at 2 months (P=.02); however, there were no group by time differences (P=.16). There were no significant changes in the other outcomes. A process evaluation revealed relatively high levels of engagement with the Facebook group during the 8-week intervention (eg, mean number of interactions 35 [SD 41]). CONCLUSIONS: An 8-week beginners' running program delivered through Facebook produced sizable and sustained changes in weekly MVPA and received strong engagement and positive feedback from participants. Future research investigating this intervention approach is warranted in other populations and health behaviors. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12616001500448; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371607&isReview=true (Archived by WebCite at http://www.webcitation.org/6xSAuz4NW).

Does gamification increase engagement with online programs? A systematic review.

BACKGROUND: Engagement in online programs is difficult to maintain. Gamification is the recent trend that offers to increase engagement through the inclusion of game-like features like points and badges, in non-game contexts. This review will answer the following question, 'Are gamification strategies effective in increasing engagement in online programs?' METHOD: Eight databases (Web of Science, PsycINFO, Medline, INSPEC, ERIC, Cochrane Library, Business Source Complete and ACM Digital Library) were searched from 2010 to the 28th of October 2015 using a comprehensive search strategy. Eligibility criteria was based on the PICOS format, where "population" included adults, "intervention" involved an online program or smart phone application that included at least one gamification feature. "Comparator" was a control group, "outcomes" included engagement and "downstream" outcomes which occurred as a result of engagement; and "study design" included experimental studies from peer-reviewed sources. Effect sizes (Cohens d and 95% confidence intervals) were also calculated. RESULTS: 1017 studies were identified from database searches following the removal of duplicates, of which 15 met the inclusion criteria. The studies involved a total of 10,499 participants, and were commonly undertaken in tertiary education contexts. Engagement metrics included time spent (n = 5), volume of contributions (n = 11) and occasions visited to the software (n = 4); as well as downstream behaviours such as performance (n = 4) and healthy behaviours (n = 1). Effect sizes typically ranged from medium to large in direct engagement and downstream behaviours, with 12 out of 15 studies finding positive significant effects in favour of gamification. CONCLUSION: Gamification is effective in increasing engagement in online programs. Key recommendations for future research into gamification are provided. In particular, rigorous study designs are required to fully examine gamification's effects and determine how to best achieve sustained engagement.

Test-retest reliability of the English version of the Edinburgh Postnatal Depression Scale.

Test-retest reliability of the English version of the Edinburgh Postnatal Depression Scale (EPDS) has not been established. This study aimed to address this gap in psychometrics by examining test-retest reliability in a sample of 118 Australian mothers with babies aged under 12 months, with a mean of 2.82 (SD 1.38) days between test occasions. The EPDS was found to have a high level of test-retest reliability for total scores (ICC = 0.92) and PND risk categories (90.7 % agreement).

Usability testing and piloting of the Mums Step It Up program--a team-based social networking physical activity intervention for women with young children.

BACKGROUND: Women's physical activity levels decline during their transition to parenthood. Facebook is widely used by Australian mothers and provides the opportunity to target social networks in order to maintain and increase physical activity. METHOD: This mixed method study aimed to pilot and assess the usability of the Mums Step It Up Facebook app, a new team-based physical activity intervention for mothers with young children. A purposive sample of five "Captain" women with young children, were recruited through personal contacts. These women used the app to recruit 3-7 Facebook friends (with children under 5) to join their respective teams (total n = 25). The app encourages women to take 10,000 steps a day measured by a pedometer. Women used the app for 28 days to log steps, interact with team mates and monitor progress. Physical activity was assessed at two time points (baseline and final week) using the Active Australia Survey. Usability testing with the five "Captain" women took place over two one hour face-to-face sessions. A questionnaire seeking feedback on the app was completed at time point two. RESULTS: Participants' total physical activity increased by an average of 177 minutes per week (p = 0.01). The complexity of the team forming process and issues using the Facebook environment, where a variety of devices and software platforms are used, was highlighted. DISCUSSION: A team-based Facebook app shows considerable promise for the recruitment and retention of participants to a social network-based physical activity intervention. A randomised controlled trial to further evaluate the effectiveness of the intervention is warranted.