Project MENTOR+ : Mentor-led exercise with cognitive-behavioral therapy to improve perceived competence, reduce social anxiety, and increase physical activity in overweight adolescents.

Overweight adolescents are at increased risk for peer victimization and avoidance of physical activity, thus perpetuating overweight status and peer victimization. Avenues of intervention include (1) reducing avoidance through increased perceived competence for physical activity and (2) bolstering protective factors including familial support and problem-focused coping to minimize the negative impact of victimization. The purpose of the current pilot study was to assess an intervention designed to improve perceived competence for activity through mentor-led exercise and improve perceived social support and problem-focused coping skills through group-based skills training. The present pilot study, a randomized clinical trial with waitlist control, examined the impact of MENTOR alone versus MENTOR+CBT on physical and psychological outcomes at post treatment (12 weeks) and 4-month follow-up (28 weeks). Twenty-four overweight Caucasian and African American adolescents were assigned either to MENTOR (n = 11) or MENTOR+CBT (n = 13). All participants completed the Physical Appearance Related Teasing Scale, the Children and Youth Physical Self-Perception Profile, and accelerometry. The MENTOR+CBT group also completed the Social Anxiety Scale for Adolescents and Multidimensional Scale of Perceived Social Support. Repeated measures Analysis of Variance revealed a statistically significant change in perceived athletic competence by time, F(2, 44) = 4.32, p = .019, [eta][subscript]p² = .164. However, this did not result in significant changes in physical activity across time, F(2, 46) = 1.846, p = .169, [eta][subscript]p² = .074. There were no statistically significant changes in social anxiety or perceived social support nor were there differences in outcomes by group. While findings did not support the hypothesis that mentor-led exercise plus group-based skills training would improve social anxiety and social support as well as increase physical activity beyond the exercise program alone, differences in outcomes by ethnicity and a floor effect due to low baseline scores on psychosocial measures limit interpretation of these findings. Additional randomized clinical trials which include adolescents experiencing weight-related teasing and control for ethnicity are needed to compare both levels of treatment with control and more accurately determine the value of this intervention.Ph.D

Exploring Resilience and Adaptation in Adolescents with Sickle Cell Disease

Living with sickle cell disease (SCD) can be a significant adversity due to disease-related symptoms and complications. Compounding these challenges, SCD predominantly affects ethnic minority populations already vulnerable to societal stigmatization, discrimination, and health disparities. It is important to recognize the negative impact of this chronic illness on psychosocial functioning; however, there is value in utilizing a strengths-based approach to determine how to promote adaptation to a challenging life-long disease. The current study explored the association among pain characteristics, adolescent, caregiver, and family protective factors, and functioning outcomes. Another primary aim of this study was to apply the protective factor model of resilience based in resilience theory to pediatric SCD by evaluating the moderating effect of adolescent, caregiver, and family protective factors on the relation between SCD pain burden and functioning outcomes. 93 12- to 18-year-olds with SCD and their caregivers were recruited from a large Southeastern children’s hospital. Adolescents completed measures assessing pain intensity and frequency, general and pain-specific protective factors, and functional outcomes. Caregivers completed measures assessing demographic and disease variables, psychological flexibility, and family functioning. Correlation analyses revealed that the majority of variables were related in expected directions and supported previous research. Adolescent protective factors were generally associated with one another and increased functional ability and quality of life. With the exception of family functioning, caregiver and family variables were not related to primary outcomes. After controlling for demographic, pain, and disease variables, moderation analyses showed that adolescent pain acceptance buffered the relation between SCD pain burden and quality of life. Contrary to hypotheses, moderating effects were not significant for the remaining adolescent, caregiver, and family protective factors. Findings highlight the importance of continuing to identify individual, caregiver, family, and broader environmental protective factors and evaluate resilience mechanisms among adolescents with SCD. Pain acceptance may also be a critical variable to target in future pain-focused interventions. Utilizing a strengths-based approach might lead to novel clinical avenues to empower youth to positively adapt to a chronic illness characterized by pain

University Students\u27 Involvement in a Health Promoting Lifestyle: Influencing Factors of the Health Promotion Model

Abstract: This is a correlational study utilizing Nola Pender’s Health Promotion Model (HPM) for examining the key influential factors regarding involvement in a health promoting lifestyle (HPL) among undergraduate students at Pittsburg State University. Ninety-six (96) undergraduate students enrolled in general psychology courses at Pittsburg State University completed the Health Promoting Lifestyle Profile-II (HPLP-II; Walker, Sechrist, & Pender, 1987), the Exercise Benefits/Barriers Scale (EBBS; Pender, Walker, & Sechrist, 1987), the Self-Efficacy for Exercise Scale (SEE Scale; Resnick & Jenkins, 2000), and the Physical Activity Stages of Change Questionnaire (Marcus, Selby, Niaura, & Rossi, 1992). Spearman Correlation coefficients (one-tailed tests), were used to identify significant characteristics of those participating in an HPL. These analyses revealed the students in this sample who engaged to a greater degree in an HPL, were more physically active, and also had a heightened sense of perceived self-efficacy pertaining to exercise. The highly efficacious students also identified fewer barriers to engaging in health promoting behaviors, and more benefits, as compared to their less active peers, and were currently in a more progressed physical activity stage of change. Because obesity on college campuses today has become an epidemic, negatively impacting both the physical and mental health of students, these findings encourage dialogue among those in helping roles at a university setting to come up with ways to assist and encourage students to engage in an HPL by addressing perceived barriers and strengthening perceived self-efficacy. Through discovering what increases the likelihood of students living an HPL, interventions to promote overall well-being and health in various domains can be designed and implemented across college campuses today. This could help universities produce more successful, motivated, and persistent young adults as they transition from academia to the workforce

Perspectives of Family Management from School-Aged Children with Chronic Health Conditions: Through the Eyes of the Children

Families play a significant role in condition management processes. They influence how children interpret their Chronic Health Conditions (CHC) and interact with others at home and in social settings as well as how others interact with them. A gap currently exists in understanding children\u27s perspectives about family management of their CHCs. It is, therefore, important to elicit children\u27s perspectives and use them to inform future family management models. A qualitative, descriptive study was conducted among 8 to 13 year old children who had a variety of CHCs. They were asked to (a) describe family management of their CHCs within the home; (b) describe family management of their CHCs in social settings (i.e., at school, at extracurricular events, in health care settings, and within peer and adult social networks); (c) describe their own roles, responsibilities, and decision-making processes in a condition management context. Content analysis of their responses (N=32) to semi-structured interviews deepened the current understanding of children\u27s perspectives regarding what family management means to them, how it impacts their daily lives, and how roles and responsibilities are distributed among parents and children during middle childhood. The school-aged children discussed condition management from a family perspective as well as from their own individual perspectives. The findings complement the Family Management Style Framework and broaden our understanding of condition management by adding the perspectives of the children about themselves and their families. Recommendations for future modifications of the framework include reconsideration of child identity and parent mutuality dimensions. Improvements in condition management among families and children have the potential to decrease both acute exacerbations and the use of health care resources while improving quality of life for children and their families. This research provides a foundation for future studies to identify related measures, interventions and policy changes related to school-aged children with CHCs and their families

Profiling Patients With Heart Failure and Testing a Motivational Interviewing Intervention to Improve Heart Failure Self-Care

Background: Heart failure (HF) is the fastest growing cardiovascular syndrome in the United States and the most common reason for hospitalization of Medicare recipients. HF is prevalent, costly to society and complex to manage. The purpose of this body of work was to strengthen the evidence base for self-care by studying understudied aspects of HF self-care maintenance. Methods/Results: This body of work entails four discrete studies. The first study identified modifiable predictors of patients who are at risk of consuming a diet higher in sodium than recommended by the 2010 Heart Failure Society of America guidelines. The second study identified two unique patterns of sodium intake, very high (mean 4.5 g/day) and generally adherent (mean 2.4 g/day). Predictors of the very high sodium intake group were being obese, having diabetes mellitus and less than 65 years old. The third study identified unique patterns of inflammation and myocardial stress in a sample of patients with HF from the Heart Failure: A Controlled Trial Investigating Outcomes of Exercise TraiNing (HF-ACTION) clinical trial. Predictors of the worst biomarker pattern were identified and exercise was protective for being in the worst biomarker pattern. In response to these studies, the Motivational Interviewing Tailored Interventions for Heart Failure patients (MITI-HF) randomized controlled trial was designed and conducted to test the efficacy of a tailored motivational interviewing approach to improve self-care, physical HF symptoms and quality of life in patients with HF. Motivational interviewing was a successful approach for improving self-care maintenance, but there were no differences between groups for self-care management, self-care confidence, physical HF symptoms or quality of life. Conclusions: In the context of the rising prevalence of HF within an environment of increasing cost-conscious appropriation of healthcare resources, this body of work provides evidence for targeting self-care interventions to patients who are at highest risk of poor outcomes. It also provides evidence that motivational interviewing is a successful approach for improving self-care maintenance behaviors, specifically eating a lower sodium diet and exercising

DEVELOPMENT OF A COMPREHENSIVE PRIMARY CARE ALGORITHM TO MANAGE CHILDREN WHO ARE OVERWEIGHT OR OBESE

ABSTRACT Almeida-Trujillo, Erika LeAnn. Development of a comprehensive primary care algorithm to manage children who are overweight and obese. Unpublished Doctor of Nursing Practice Scholarly Research Project, University of Northern Colorado, 2023. Childhood obesity is an epidemic that continues to increase not only in the United States but also worldwide. For children aged 5-19 years, being overweight is considered a body mass index greater than one standard deviation above the growth reference median and obesity is defined as excess body fat that contributes to functional loss and life-threatening comorbidities. The literature indicated that previous population-based obesity prevention efforts have only been moderately successful and might not reflect the complex needs and preferences of some children and families. Thus, there was a need for individualized interventions that supported children who are overweight or obese in developing healthier practices that persist into adulthood. Primary care providers administer everything from prenatal to end-of-life care and are in a key position to monitor the health and wellbeing of children. However, many primary care providers serving pediatric populations lack a flexible set of guidelines to inform their care of children who are overweight or obese. Having a systematic yet localized approach might streamline the intervention process and improve patient outcomes. Clinical tools such as algorithms might guide providers toward evidence-based interventions and utilization of local services. The purpose of this Doctor of Nursing Practice scholarly project was to develop and evaluate a treatment algorithm for children identified as being overweight or obese designed for use in the primary care setting using published evidence and a panel of clinical experts. Using the Delphi method, a panel of nine clinical experts provided feedback on increasingly refined drafts of a iv proposed algorithm. The Stetler (2001) model was utilized as a theoretical framework throughout the project. After two rounds of feedback and revisions, broad consensus among the panel was achieved. Findings from this scholarly project also included a proposal for future pilot testing of the final draft algorithm in a family practice or pediatric clinical setting. Keywords: childhood obesity, obese, epidemic, comorbidities, intervention, algorith

State of Health Equity Movement, 2011 Update Part C: Compendium of Recommendations DRA Project Report No. 11-03

State of Health Equity Movement, 2011 Update Part C: Compendium of Recommendations DRA Project Report No. 11-0

Design perspectives on diabetes management games

For decades, there has been scholarly interest in the use of serious digital games to assist individuals suffering from diabetes with the self-management of that disease. However, previous research in this area has not effectively integrated the knowledge of the expert game designer. This dissertation aims to further understandings of design approaches to serious games for diabetics by confronting both the arguments of the diabetes games literature and the diabetes games themselves with the experiences and opinions of expert game designers. The arguments of the diabetes games literature were synthesized into a design template composed of twenty-four interrelated desirable elements. This template was then used by three focus groups consisting of a total of twelve expert game designers to both evaluate six diabetes self-management games and respond to the assertions of the diabetes games literature. The findings from these three empirical studies indicate both that the diabetes games themselves are of uniformly unsuitable quality and that the diabetes games literature is rife with what the expert game designers consider to be problematic assumptions. The problems identified by the focus groups include those that fundamentally cripple the functionality of the game artifact, those that are embedded in a game’s rules and themes, and those to those that exist at superficial levels. Furthermore, the focus groups had an overall negative reaction to the arguments about games that they found to be deeply embedded in the design template’s elements. Tensions exist, however, between the reasons for the diabetes games literature’s demand for certain game features and the beliefs of the expert game designers. The findings strongly suggest that additional research is necessary and that an interdisciplinary effort, including both health care professionals and expert game designers, is necessary for the development of new, superior design scenarios for diabetes self-management games.Informatio

Evaluating Acceptability, Feasibility and Efficacy of a Diabetes Care Support Program Facilitated by Cellular-Enabled Glucose Meters: A Dissertation

Background. Diabetes requires significant disease management, patient-provider communication, and interaction between patients, family members, caregivers, and care teams. Emerging patient-facing technologies, such as cellular-enabled glucose meters, can facilitate additional care support and improve diabetes self-management. This study evaluated patient acceptability, feasibility, and efficacy of a diabetes care support program facilitated by cellular-enabled glucose meters. Methods. A two-phase study approach was taken. Get In Touch – Phase 1 (GIT-1) was a 1-month pilot involving patients with type 1 and type 2 diabetes. Get In Touch – Phase 2 (GIT-2) was a 12-month randomized controlled crossover trial involving patients with poorly-controlled type 2 diabetes. Results from GIT-1 and preliminary results from GIT-2 are presented. Results. GIT-1 participants with type 1 (n=6) and type 2 (n=10) diabetes reported the intervention and cellular-enabled glucose meter were easy to use and useful while identifying potential areas of improvement. GIT-2 participants in both the intervention (n=60) and control (n=60) groups saw significant improvements in treatment satisfaction and A1c change, with intervention participants experiencing slightly greater improvements in each after 6 months (p=0.09 and p=0.16, respectively) compared to control participants. Conclusions. Patients reported favorable acceptability of the intervention. Preliminary results from a randomized trial demonstrated potential of intervention to improve patient-reported and physiological health outcomes. Future studies should evaluate feasibility and efficacy over a longer period of time, with a greater number of participants, and targeting different populations of patients with diabetes. Provider perspectives and changes in provider behavior, clinical work flow, and caregiver burden should also be assessed