Group versus individual approach? A meta-analysis of the effectiveness of interventions to promote physical activity

The purpose of the study was to conduct a meta-analysis to empirically compare the relative merits of different contexts typically employed in the physical activity intervention literature for five categories of outcomes: adherence, social interaction, quality of life, physiological effectiveness, and functional effectiveness. \ud Four contexts were examined: home-based programmes not involving contact from researchers or health-care professionals, home-based programmes that involved some contact, standard exercise classes, and exercise classes where group-dynamics principles were used to increase cohesiveness (‘true groups’). Standard literature searches produced 44 relevant studies containing 214 effect sizes. Results revealed a common trend across dependent variables; exercising in a true group was superior to exercising in a standard exercise class, which in turn, did not differ from exercising at home with contact. Furthermore, exercising at home with contact was superior to exercising at home without contact. These results have implications for practitioners in terms of the importance of contact and social support in physical activity interventions

Brief fruit and vegetable messages integrated within a community physical activity program successfully change behaviour

BACKGROUND: Consumption of the recommended amounts of fruits and vegetables is associated with several health benefits. Currently less than 25% of the American population meets the minimum recommendation of five servings a day. In order to change this health behaviour, interventions should be based on theory and include community-wide social support. METHODS: A low intensity intervention was developed in which participants (n = 86) were randomly assigned to either the fruit and vegetable intervention (FVI) or standard control condition. The intervention was integrated into an ongoing community physical activity program and study participants were drawn from the sample of community members enrolled in the program. The FVI consisted of brief social cognitive theory-based messages delivered in nine weekly newsletters designed to improve participant outcome and self-efficacy expectations related to fruit and vegetable consumption. RESULTS: Participants in the FVI condition increased in their fruit and vegetable consumption by approximately one to one and one-third servings per day. The control condition showed no change in consumption. The effect of the intervention was enhanced when examined by the extent to which it was adopted by participants (i.e., the number of newsletters read). Those participants who read seven or more newsletters showed an increase of two servings per day. CONCLUSION: This intervention was effective at improving fruit and vegetable consumption among adults. Minimal interventions, such as newsletters, have the ability to reach large audiences and can be integrated into ongoing health promotion programs. As such, they have potential for a strong public health impact

Incentive Design to Enhance the Reach of Weight Loss Program

This study employed stated-preference methods to elicit individuals’ program participation preference towards different financial incentive attributes. The results of this study show promise for the use of carefully designed incentive programs to raise participation in weight loss programs. Results show that a fungible payment form is important for the incentive to be effective in reach (i.e., cash and grocery gift-cards are preferred over gym passes and waivers of insurance co-payments). Furthermore, immediate payment is preferred over delayed payment.Financial Incentives, Program Reach, Random Parameter Logit, Health Economics and Policy, F10, F13,

Chiral dynamics in form factors, spectral-function sum rules, meson-meson scattering and semilocal duality

In this work, we perform the one-loop calculation of the scalar and pseudoscalar form factors in the framework of U(3) chiral perturbation theory with explicit tree level exchanges of resonances. The meson-meson scattering calculation from Ref.[1] is extended as well. The spectral functions of the nonet scalar-scalar (SS) and pseudoscalar-pseudoscalar (PP) correlators are constructed by using the corresponding form factors. After fitting the unknown parameters to the scattering data, we discuss the resonance content of the resulting scattering amplitudes. We also study spectral-function sum rules in the SS-SS, PP-PP and SS-PP sectors as well as semi-local duality from scattering. The former relate the scalar and pseudoscalar spectra between themselves while the latter mainly connects the scalar spectrum with the vector one. Finally we investigate these items as a function of Nc for Nc > 3. All these results pose strong constraints on the scalar dynamics and spectroscopy that are discussed. They are successfully fulfilled by our meson-meson scattering amplitudes and spectral functions.Comment: 45 pages, 17 figures and 4 tables. To match the published version in PRD: a new paragraph is added in the Introduction and two new references are include

Resonances from meson-meson scattering in U(3) CHPT

In this work, the complete one loop calculation of meson-meson scattering amplitudes within U(3)\otimes U(3) chiral perturbation theory with explicit resonance states is carried out for the first time. Partial waves are unitarized from the perturbative calculation employing a non-perturbative approach based on the N/D method. Once experimental data are reproduced in a satisfactory way we then study the resonance properties, such as the pole positions, corresponding residues and their N_C behaviors. The resulting N_C dependence is the first one in the literature that takes into account the fact that the \eta_1 becomes the ninth Goldstone boson in the chiral limit for large N_C. Within this scheme the vector resonances studied, \rho(770), K^*(892) and \phi(1020), follow an N_C trajectory in agreement with their standard \bar{q}q interpretation. The scalars f_0(1370), a_0(1450) and K^*(1430) also have for large N_C a \bar{q}q pole position trajectory and all of them tend to a bare octet of scalar resonances around 1.4 GeV. The f_0(980) tends asymptotically to the bare pole position of a singlet scalar resonance around 1 GeV. The \sigma, \kappa and a_0(980) scalar resonances have a very different N_C behavior. The case of the \sigma resonance is analyzed with special detail.Comment: 50 pages, 15 figures, 1 table. Enlarged version with more detail comparisons with previous results in the literature. To match with accepted version for publicatio

Advancing the argument for validity of the Alberta Context Tool with healthcare aides in residential long-term care

<p>Abstract</p> <p>Background</p> <p>Organizational context has the potential to influence the use of new knowledge. However, despite advances in understanding the theoretical base of organizational context, its measurement has not been adequately addressed, limiting our ability to quantify and assess context in healthcare settings and thus, advance development of contextual interventions to improve patient care. We developed the Alberta Context Tool (the ACT) to address this concern. It consists of 58 items representing 10 modifiable contextual concepts. We reported the initial validation of the ACT in 2009. This paper presents the second stage of the psychometric validation of the ACT.</p> <p>Methods</p> <p>We used the <it>Standards for Educational and Psychological Testing </it>to frame our validity assessment. Data from 645 English speaking healthcare aides from 25 urban residential long-term care facilities (nursing homes) in the three Canadian Prairie Provinces were used for this stage of validation. In this stage we focused on: (1) advanced aspects of internal structure (e.g., confirmatory factor analysis) and (2) relations with other variables validity evidence. To assess reliability and validity of scores obtained using the ACT we conducted: Cronbach's alpha, confirmatory factor analysis, analysis of variance, and tests of association. We also assessed the performance of the ACT when individual responses were aggregated to the care unit level, because the instrument was developed to obtain unit-level scores of context.</p> <p>Results</p> <p>Item-total correlations exceeded acceptable standards (> 0.3) for the majority of items (51 of 58). We ran three confirmatory factor models. Model 1 (all ACT items) displayed unacceptable fit overall and for five specific items (1 item on <it>adequate space for resident care </it>in the Organizational Slack-Space ACT concept and 4 items on use of electronic resources in the Structural and Electronic Resources ACT concept). This prompted specification of two additional models. Model 2 used the 7 scaled ACT concepts while Model 3 used the 3 count-based ACT concepts. Both models displayed substantially improved fit in comparison to Model 1. Cronbach's alpha for the 10 ACT concepts ranged from 0.37 to 0.92 with 2 concepts performing below the commonly accepted standard of 0.70. Bivariate associations between the ACT concepts and instrumental research utilization levels (which the ACT should predict) were statistically significant at the 5% level for 8 of the 10 ACT concepts. The majority (8/10) of the ACT concepts also showed a statistically significant trend of increasing mean scores when arrayed across the lowest to the highest levels of instrumental research use.</p> <p>Conclusions</p> <p>The validation process in this study demonstrated additional empirical support for construct validity of the ACT, when completed by healthcare aides in nursing homes. The overall pattern of the data was consistent with the structure hypothesized in the development of the ACT and supports the ACT as an appropriate measure for assessing organizational context in nursing homes. Caution should be applied in using the one space and four electronic resource items that displayed misfit in this study with healthcare aides until further assessments are made.</p

SCOPE: Safer care for older persons (in residential) environments: A study protocol

BACKGROUND: The current profile of residents living in Canadian nursing homes includes elder persons with complex physical and social needs. High resident acuity can result in increased staff workload and decreased quality of work life. AIMS: Safer Care for Older Persons [in residential] Environments is a two year (2010 to 2012) proof-of-principle pilot study conducted in seven nursing homes in western Canada. The purpose of the study is to evaluate the feasibility of engaging front line staff to use quality improvement methods to integrate best practices into resident care. The goals of the study are to improve the quality of work life for staff, in particular healthcare aides, and to improve residents' quality of life. METHODS/DESIGN: The study has parallel research and quality improvement intervention arms. It includes an education and support intervention for direct caregivers to improve the safety and quality of their care delivery. We hypothesize that this intervention will improve not only the care provided to residents but also the quality of work life for healthcare aides. The study employs tools adapted from the Institute for Healthcare Improvement's Breakthrough Series: Collaborative Model and Canada's Safer Healthcare Now! improvement campaign. Local improvement teams in each nursing home (1 to 2 per facility) are led by healthcare aides (non-regulated caregivers) and focus on the management of specific areas of resident care. Critical elements of the program include local measurement, virtual and face-to-face learning sessions involving change management, quality improvement methods and clinical expertise, ongoing virtual and in person support, and networking. DISCUSSION: There are two sustainability challenges in this study: ongoing staff and leadership engagement, and organizational infrastructure. Addressing these challenges will require strategic planning with input from key stakeholders for sustaining quality improvement initiatives in the long-term care sector