What Works and for Whom? Outcome Evaluation of an E-mail Walking Program Delivered Through Cooperative Extension

Introduction: Get WalkIN’ is a 12-week, e-mail-based walking promotion program. The purpose of this study was to (1) compare sociodemographics of participants who enrolled versus completed the program; and (2) evaluate program feasibility/acceptability from perspectives of program participants and county-based Extension Educators who implemented the program. Methods: Participants (N = 875), recruited by county-based Extension Educators, were asked Likert-scale questions (eg, ease of reading the e-mails and frequency of e-mails) to assess program acceptability and open-ended questions regarding improvements. Educators (N = 55) were asked Likert-scale and open-ended questions regarding program training, recruitment, strengths, and areas for improvement. Descriptive statistics summarized participant characteristics, acceptability, and feasibility data. Open-ended responses were analyzed using thematic analysis. Results: There were no significant sociodemographic differences between participants (N = 875) who started the program and completed the program (n = 438). Participants reported intervention e-mails were easy to read (mean = 4.5 ± 0.7), understand (mean = 4.5 ± 0.7), and encouraged more walking (mean = 4.1 ± 0.9). Participants would like to connect/interact with other participants/Educators, have more monitoring tools for accountability, and more visuals/videos embedded within e-mails. Educators reported program training was adequate, e-mail messages were helpful and easy to use, and requested more visuals (eg, videos) to help with recruitment. Educators thought adding a social component (eg, kick-off walk or walking group) would be helpful. Conclusions: This Extension-delivered walking program is acceptable to participants and feasible to deliver. However, participants and Educators reported they would like more interaction, even if virtual. Future e-mailbased programs should consider ways to incorporate social interaction among users as well as provide a wide variety of recruitment resources

Statewide Dissemination of an Evidenced-Based Email Walking Program Delivered Through Cooperative Extension

Using the RE-AIM framework, this study evaluates the statewide dissemination of an evidenced-based, email-delivered physical activity intervention implemented through Cooperative Extension. The Get WalkIN\u27 program is comprised of 16 email messages sent over 12 weeks. Email messages target social cognitive theory constructs of self-efficacy, goal-setting, self-monitoring, and social support. Program reach, effectiveness, adoption, implementation, and maintenance were assessed with quantitative measures in a pre-post design. Findings indicate that within the Extension system, program adoption was high and program maintenance was moderate. Program effectiveness was demonstrated with an increase of 77.1 ± 49.9 min in weekly walking post-program. This increase in walking was maintained 3 months post-program. Capturing data on the implementation process was challenging. Overall, the results indicate success in program adoption and maintenance with further efforts needed to improve follow-up data collection from participants

Is Marital Quality Related to Physical Activity Across the Life Course for Men and Women?

Objectives: Although physical activity is linked to multiple health outcomes, a majority of Americans do not meet physical activity guidelines, often with precipitous declines among older adults. Marital quality is a less-explored, but important, factor that may influence physical activity, as spouses often influence each other’s health behaviors. Methods: We use nationally representative panel data to investigate whether positive and negative dimensions of marital quality influence physical activity, and whether age and gender moderate these relationships. Results: We find that both marital support and strain are related to higher odds of more frequent active exercise and walking, pointing to the complex influence of marital quality. Marital support became increasingly important to higher levels of walking frequency as men aged. Discussion: This study provides new information on the ways in which both positive and negative dimensions of marital quality may contribute to trajectories of physical activity across the life course

A Longitudinal Examination of the Impact of Major Life Events on Physical Activity

Background: Despite promotion of physical activity guidelines, less than one third of U.S. adults are sufficiently active and an even larger number of older adults fail to meet guidelines. To address this major public health issue, it is essential to broadly consider determinants of physical activity. Aims: This study explores how physical activity behavior is impacted by the experience of major life events and considers the stress experienced due to these events across the life course. Methods: Nationally representative panel data from the American’s Changing Lives survey (1986-2012) was used to analyze a growth model with age-based trajectories to examine the relationship between major life events and physical activity overall and separately by gender and race. Results: In the overall sample, retiring was associated with greater physical activity at baseline. As respondents aged, entering into retirement was associated with decreased physical activity, while a parent or friend dying were associated with greater physical activity. Differences by gender and race were also seen over time. Conclusions: Results show that when considering physical activity trajectories, experiencing these major life events is not always detrimental, and in some cases may be beneficial. Considering these impacts is important in planning effective health promotion interventions to increase and promote maintenance of physical activity, while paying attention to specific differences by gender and race

Identifying sources of patient dissatisfaction when seeking care for a chronic and complex disease

Patients’ evaluations of healthcare often rely on patient satisfaction and encounter-specific approaches. Instead, valuable information can be gained by focusing on patient dissatisfaction with healthcare over time. This study examined patients’ sources of care dissatisfaction when seeking healthcare for a long-term chronic and complex disease (CCD). Participants with a CCD called polycystic kidney disease (N=387) completed an online questionnaire with an open-ended question about dissatisfying experiences. Content analysis was used to analyze responses. The coded data resulted in conceptual codes related to dissatisfaction with information, support, and care management. Analysis revealed the type of healthcare provider is often mentioned, and that more than one type of dissatisfaction can occur at the same time. Patients with CCDs are experiencing a variety of types of dissatisfaction when seeking healthcare, which may point to ongoing communication gaps between patients and the healthcare providers they see over time for their disease. Providers who see patients with CCDs should remember these patients may see multiple providers over time and have unique support needs. Providers can potentially improve care experiences by helping patients manage their care across both providers and experiences, as well as encourage patients to ask questions and express their concerns. Experience Framework This article is associated with the Patient, Family & Community Engagement lens of The Beryl Institute Experience Framework (https://theberylinstitute.org/experience-framework/). Access other PXJ articles related to this lens. Access other resources related to this lens

Intact goal-driven attentional capture in autistic adults

Background: Autistic individuals have been found to show increased distractibility by salient irrelevant information, yet reduced distractibility by information of personal motivational salience. Here we tested whether these prior discrepancies reflect differences in the automatic guidance of attention by top-down goals. Methods: Autistic (self-reported diagnoses, confirmed with scores on the Social Responsiveness Scale) and non-autistic adults, without intellectual disability (IQ > 80 on Wechsler Abbreviated Scale of Intelligence), searched for a color-defined target object (e.g., red) among irrelevant color objects. Spatially uninformative cues, matching either the target color or a nontarget/irrelevant color, were presented prior to each display. Results: Replicating previous work, only target color cues reliably captured attention, delaying responses when invalidly versus validly predicting target location. Crucially, this capture was robust for both autistic and neurotypical participants, as confirmed by Bayesian analysis. Limitations: While well powered for our research questions, our sample size precluded investigation of the automatic guidance of attention in a diverse group of autistic people (e.g. those with a range of cognitive abilities). Conclusions: Our findings imply that key mechanisms underlying the automatic implementation of top-down attentional goals are intact in autism, challenging theories of reduced top-down control

A Validated Method for Identifying Unplanned Pediatric Readmission

Objective To validate the accuracy of pre-encounter hospital designation as a novel way to identify unplanned pediatric readmissions and describe the most common diagnoses for unplanned readmissions among children. Study design We examined all hospital discharges from 2 tertiary care children's hospitals excluding deaths, normal newborn discharges, transfers to other institutions, and discharges to hospice. We performed blinded medical record review on 641 randomly selected readmissions to validate the pre-encounter planned/unplanned hospital designation. We identified the most common discharge diagnoses associated with subsequent 30-day unplanned readmissions. Results Among 166 994 discharges (hospital A: n = 55 383; hospital B: n = 111 611), the 30-day unplanned readmission rate was 10.3% (hospital A) and 8.7% (hospital B). The hospital designation of “unplanned” was correct in 98% (hospital A) and 96% (hospital B) of readmissions; the designation of “planned” was correct in 86% (hospital A) and 85% (hospital B) of readmissions. The most common discharge diagnoses for which unplanned 30-day readmissions occurred were oncologic conditions (up to 38%) and nonhypertensive congestive heart failure (about 25%), across both institutions. Conclusions Unplanned readmission rates for pediatrics, using a validated, accurate, pre-encounter designation of “unplanned,” are higher than previously estimated. For some pediatric conditions, unplanned readmission rates are as high as readmission rates reported for adult conditions. Anticipating unplanned readmissions for high-frequency diagnostic groups may help focus efforts to reduce the burden of readmission for families and facilities. Using timing of hospital registration in administrative records is an accurate, widely available, real-time way to distinguish unplanned vs planned pediatric readmissions

The impact of the mixing properties within the Antarctic stratospheric vortex on ozone loss in spring

Calculations of equivalent length from an artificial advected tracer provide new insight into the isentropic transport processes occurring within the Antarctic stratospheric vortex. These calculations show two distinct regions of approximately equal area: a strongly mixed vortex core and a broad ring of weakly mixed air extending out to the vortex boundary. This broad ring of vortex air remains isolated from the core between late winter and midspring. Satellite measurements of stratospheric H2O confirm that the isolation lasts until at least mid-October. A three-dimensional chemical transport model simulation of the Antarctic ozone hole quantifies the ozone loss within this ring and demonstrates its isolation. In contrast to the vortex core, ozone loss in the weakly mixed broad ring is not complete. The reasons are twofold. First, warmer temperatures in the broad ring prevent continuous polar stratospheric cloud (PSC) formation and the associated chemical processing (i.e., the conversion of unreactive chlorine into reactive forms). Second, the isolation prevents ozone-rich air from the broad ring mixing with chemically processed air from the vortex core. If the stratosphere continues to cool, this will lead to increased PSC formation and more complete chemical processing in the broad ring. Despite the expected decline in halocarbons, sensitivity studies suggest that this mechanism will lead to enhanced ozone loss in the weakly mixed region, delaying the future recovery of the ozone hole