A qualitative study of factors related to cardiometabolic risk in rural men

Abstract Background Rural men are known to have poor health behaviors, which contribute to their elevated burden of cardiometabolic disorders in the United States. Although regular physical activity, healthy eating, and avoiding tobacco can reduce cardiometabolic risk, little is known about how to engage rural men in health promotion programs. To bridge this gap in evidence, we investigate knowledge of modifiable cardiometabolic risk factors among rural men in the western United States, identify their concerns related to heart health and motivation to reduce risk, and explore individual, social, and community-level influences on heart-healthy behaviors, specifically diet, physical activity, and tobacco use. Methods We conducted seven focus groups with 54 sedentary, overweight/obese men (mean body mass index [BMI] = 31.3 ± 4.6) aged 43–88 residing in government-designated “medically underserved” rural Montana towns in September and October 2014. All sessions were audio-recorded and transcribed verbatim. Transcripts were coded and analyzed thematically using Nvivo software. Participants also completed a brief questionnaire about personal characteristics and health behaviors. These data were explored descriptively. Results Despite being classified as overweight/obese and sedentary, no participants reported to be in poor health. Many men described health relative to self-reliance and the ability to participate in outdoor recreation; concern with health appeared to be related to age. Participants were generally knowledgeable of heart-healthy behaviors, but many felt fatalistic about their own risk. Catalysts for behavior change included a serious medical event in the household and desire to reduce aging-associated functional decline. Barriers to adopting and maintaining healthy eating and physical activity habits and abstaining from tobacco included normative beliefs around masculinity and individual liberty, the limited social universe of small towns, winter weather, time constraints, and preferences for unhealthy foods. Facilitators included behavioral self-monitoring, exercising with a partner, and opportunities for preferred activities, such as hunting and team sports. Conclusions These findings provide important insight about influences on rural men’s health behaviors and provide guidance for possible intervention strategies to promote cardiometabolic health. Trial registration ClinicalTrials.gov NCT02499731 . Registered 1 July 2015

Young Adult Experiences with a Mobile Smoking Cessation Application: A Qualitative Evaluation of Crush the Crave

Canada has had tremendous success with reducing smoking prevalence among its population. However, the decline in rates is not observed equitably among various sub-populations and tobacco continues to cause preventable disease, disability, and death. Young adults have the highest smoking rate compared to all other age groups and many are interested in smoking cessation. Nonetheless, a challenge remains as many young adults perceive traditional smoking cessation resources negatively and prefer not to use pharmacotherapy, counselling, and/or quitline services. Not surprisingly, young adults are also the largest population group who utilize mobile technologies. Mobile applications (apps) are an emerging, tailored intervention that hold promise for health behaviour change. These are known as mobile health (mHealth) technologies. Currently, many applications for smoking cessation exist. However, little is known about Canadian young adults’ use and experiences with apps for smoking cessation. To address this research gap, this study evaluated Crush the Crave (CTC), an evidence-based smoking cessation app created specifically for young adults. Semi-structured qualitative interviews were conducted with 15 Canadian young-adult users of CTC in order to capture experiences and use of the app. Interviews lasted 70 minutes on average and were recorded, transcribed verbatim, and then subsequently analyzed using thematic analysis through NVivo 10 software. Results were presented by the following categories which encompassed various sub-themes: young adults’ reasons and experience with smoking, experiences with the use of alternate quitting resources, experiences with the features of CTC, and mechanisms associated with utilizing CTC. Across the interviews, participants found that the app provided an important tracking mechanism that gave the ability to self-monitor progress while quitting. Further, the app provided an important sense of control and was easily accessible by users when needed. However, participants discussed the need for constant reminders and that the constant need to access data or a Wi-Fi network in order to use the app was a barrier. Additionally, it was found that social support via social media was not used by participants as cessation experiences were considered to be private and individuals did not like to broadcast such details on social media. These findings demonstrate the need for continual research and improvement of mHealth technologies among the intended users. There is also a need for more flexible and dynamic apps that keep users engaged and provide a tailored experience. This thesis contributes to the limited literature on the usability of mHealth apps. Recommendations are discussed, followed by contributions, limitations, and future directions

Public policy, social marketing and neuromarketing: from addressing the consumer behaviour to addressing the social behaviour - a study on the assessment of Public Service Announcements’ efficacy by neuro-metric indexes and techniques

The overall aim of this thesis is to investigate to what extent marketing can be a useful science for the public policy in developing effective Public Service Announcements (PSAs). In particular, hereby a specific discipline will be taken in consideration: the one that merges marketing with neuroscience, that is the so-called ‘neuromarketing’, which - in order to assess the advertising efficacy - adopts biometric and neurometric indexes. The objective of this work is to gain insights into the above-mentioned fields (marketing, neuroscience and public policy) by: - reviewing previous studies, as well as topical literature; - exploring the latest case studies and best practises; - examining the traditional methods’ results for the assessment of the PSAs (i.e. polls, surveys, focus groups) in their evolutionary path (till arriving to birth of the the neurometric methods) Such kind of research has the purpose to identify the factors that are considered relevant to answer the ultimate research question: is it possible today, by using state-of-the-art neurometric indexes and techniques, to provide policymakers with precise guidelines for developing effective PSAs, so that marketing will be able to address no more just the consumer behaviour, but also the social behaviour? In fact, the goal of any advertising campaign is to convey a specific message and reach a specific audience: the consumers. But, when talking about PSAs, many things changes: the KPIs for the assessment of their efficacy are no longer the commercial ones (GRP, reach etc.), but rather the gain obtained in public health after the airing of the campaign. Consequently, the specific message will be a different ‘call-to-action’: no more an invite to purchase, but rather to change a (wrong) social behaviour or adopt a (right) civil conscience. Given these premises, it is possible that marketing could be invested with a precise responsibility in terms of lives saved and public health. The practical and managerial implications of the research are the following: EU policymakers and local governments will have the opportunity to dispose of scientific data and information about the society that might be transformed in guidelines for producing effective PSAs based on the inner audience’s insights. The originality of this research resides in having framed the new neuromarketing protocols in the traditional Consumer Behaviour theory, combining thus future and past of the marketing research

It’s Not All About Price: Factors associated with roll-your-own tobacco use among young people - a qualitative study

Background: Smoking prevalence in Ireland is falling in all age groups, but the prevalence of roll-your-own (RYO) tobacco use is rising among young people. This qualitative study aims to explore and understand the factors associated with young people\u27s use of RYO products. Methods: Semi-structured individual and focus group interviews were conducted with young people aged 16-22 years. Participants were recruited from a higher education institution and youth organisations working with early school leavers across Dublin. In total, there were 62 participants in the study, consisting of 22 individual interviews and eight focus group interviews with 40 participants. Categoric and thematic data analysis was used to generate the findings. Results: We identified two broad themes, incentivising and disincentivising factors. The lower cost of RYO products compared to pre-manufactured cigarettes was the most important incentive for users. However, other product characteristics, such as the artisanal factors associated with RYO products were also found. Social and environmental influences were apparent, in which certain groups and environments facilitated and normalised RYO practices. Amenities and facilities often provided smokers with normalised spaces which could be dedicated to the enactment of rolling practices and to the creation and maintenance of social bonds with other users. Disincentives included negative features related to the product itself, adverse health effects, and the effects of tobacco denormalisation. Conclusions: While the lower cost of RYO products is very important for young smokers, other product characteristics and influences also incentivise and disincentivise use. A more comprehensive understanding of the multi-dimensional appeal of these products will assist policymakers to target strategies to reduce the attractiveness to young smokers of these products

Social features of Web Assisted Tobacco Interventions (WATIS) : case studies

textWeb Assisted Tobacco Interventions (WATIs) are proliferating due to their cost effectiveness and their compatibility with a fast-paced lifestyle that needs to be time and space detached. Following a general trend in web assisted interventions, WATIs are increasingly incorporating social media features. Often though, because they are added post-facto to a solid preexisting foundation that privileges information delivery, the social media and the informational sections are developed independently: the social component has no impact on the informational content. This forms the basis of this study, which proposes to do a detailed analysis of a WATI recommended by a panel of experts in the area of smoking cessation. An emphasis will be given to the visibility of social media features and the degree to which content from the social media component contributed by users impacts the informational component generated by content experts. This analysis will be supported by instruments for data collection especially adapted/designed for this study. This dissertation proposal is at the cusp of disciplinary boundaries as its theoretical underpinnings are in the intersections of three domains: design, health, and social media. This interdisciplinary approach is necessarily reflected in the study's conceptual vii framework, which draws from constructs such as "design with intent", tailored health interventions, and social networks for participatory culture. As a result of the detailed analysis, and the author's own expertise in social media across other fields, a set of recommendations will be proposed for the design of WATIs with social features aiming at a greater impact of these on the evidence-based informational content.Radio-Television-Fil

M-health review: joining up healthcare in a wireless world

In recent years, there has been a huge increase in the use of information and communication technologies (ICT) to deliver health and social care. This trend is bound to continue as providers (whether public or private) strive to deliver better care to more people under conditions of severe budgetary constraint

Increasing Enrollment of Cardiac Rehabilitation for Eligible Patients in the Outpatient Setting: A Toolkit

Background: Heart disease is the leading cause of death worldwide. It is responsible for serious cardiac events that can be fatal. When a patient experiences one cardiac event, they are more likely to have a second event. Therefore, secondary prevention programs such as cardiac rehabilitation (CR) have been proven to reduce mortality in these patients and enhance quality of life; however, they are severely underutilized. Purpose: The purpose of this integrative review and DNP project was to educate outpatient providers about the immense value of cardiac rehabilitation to eligible patients and develop a toolkit targeted to help providers recognize eligible patients, educate them and expedite enrollment. Methods: An educational intervention was virtually presented with a pre- and post-survey completed by 9 staff members of an outpatient cardiology office. Feedback was collected to determine efficacy of the presentation, change in provider perceptions, and the utility of the toolkit. Data was input into Excel and SPSS to determine statistical significance and organization of feedback. Results: By using the Health Belief Model as a framework, the Wilcoxon Signed Ranks Test determined that there was statistically significant (p=0.026) increase in perceived seriousness, susceptibility, and benefit after the educational intervention indicating that participants’ attitudes and beliefs about the importance of cardiac rehabilitation (CR) and can be affected with education, leading to the increased interest in improving referral rates for eligible patients. Conclusion: This project should serve as a tool to continue to educate outpatient providers of the value of CR, while the toolkit may be utilized to expedite enrollment and help reach national goals of increasing cardiac rehabilitation participation to 70%