Question order in the assessment of misperception of physical activity

Abstract Background People often have misperceptions (overestimation or underestimation) about the health-related behaviours they engage in, which may have adverse consequences for their susceptibility to behavioural change. Misperception is usually measured by combining and comparing quantified behavioural self-reports with subjective classification of the behaviour. Researchers assume that such assessments of misperception are not influenced by the order of the two types of measurement, but this has never been studied. Based on the precaution adoption model and the information processing theory, it might be expected that taking the subjective measurement after a detailed quantified behavioural self-report would improve the accuracy of the subjective measurement because the quantified report urges a person to think more in detail about their own behaviour. Methods In an experiment (n = 521), quantified self-report and subjective assessment were manipulated in a questionnaire. In one version, the quantified self-report was presented before the subjective assessment, whereas in the other version, the subjective assessment came first. Results Neither subjective assessment nor overestimation of physical activity were biased by the order of the questions. Underestimation was more prevalent among subgroups of the group which answered the subjective assessment after the quantified self-report. Conclusion Question order in questionnaires does not seem to influence misperceptions concerning physical activity in groups relevant for health education (overestimators: those who do not meet the guidelines for physical activity while rating their physical activity as sufficient or high). The small order effect found in underestimators is less relevant for health education because this subgroup already meets the guideline and therefore does not need to change behaviour.</p

The working mechanisms of an environmentally tailored physical activity intervention for older adults: a randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>The aim of this study was to explore the working mechanisms of a computer tailored physical activity intervention for older adults with environmental information compared to a basic tailored intervention without environmental information.</p> <p>Method</p> <p>A clustered randomized controlled trial with two computer tailored interventions and a no-intervention control group was conducted among 1971 adults aged ≥ 50. The two tailored interventions were developed using Intervention Mapping and consisted of three tailored letters delivered over a four-month period. The basic tailored intervention targeted psychosocial determinants alone, while the environmentally tailored intervention additionally targeted environmental determinants, by providing tailored environmental information. Study outcomes were collected with questionnaires at baseline, three and six months and comprised total physical activity (days/week), walking (min/week), cycling (min/week), sports (min/week), environmental perceptions and use and appreciation of the interventions.</p> <p>Results</p> <p>Mediation analyses showed that changes in cycling, sports and total physical activity behaviour induced by the environmentally tailored intervention were mediated by changes in environmental perceptions. Changes in environmental perceptions did not mediate the effect of the basic tailored intervention on behaviour. Compared with the basic tailored intervention, the environmentally tailored intervention significantly improved cycling behaviour (τ = 30.2). Additionally, the tailored letters of the environmentally tailored intervention were better appreciated and used, although these differences did not mediate the intervention effect.</p> <p>Discussion</p> <p>This study gave some first indications of the relevance of environmental perceptions as a determinant of changing physical activity behaviours and the potential effectiveness of providing environmental information as an intervention strategy aimed at enhancing physical activity behaviour among older adults.</p

The Active plus protocol: systematic development of two theory- and evidence-based tailored physical activity interventions for the over-fifties

<p>Abstract</p> <p>Background</p> <p>Limited data are available on the development, implementation and evaluation processes of physical activity promotion programmes among older adults. More integrative insights into interventions describing the planned systematic development, implementation and evaluation are needed.</p> <p>Methods and design</p> <p>The purpose of this study is to give an integrative insight into the development of the Active <it>plus </it>programme applying the six-step Intervention Mapping protocol. The Active <it>plus </it>programme consisted of two theory- and evidence-based tailored physical activity promotion interventions, both comprising three tailored letters delivered over four months and aimed at raising awareness of insufficient physical activity, and stimulating physical activity initiation and maintenance among the over-fifties.</p> <p>The first intervention, the basic tailored intervention, provided tailored letters that intervened on the psychosocial determinants of physical activity. The second intervention, the intervention <it>plus</it>, provided the same tailored information but additionally provided tailored information about physical activity opportunities in the specific environment in which the older adults lived. This environment-based component also provided access to a forum and e-buddy system on a website. A plan for implementation and evaluation is also described.</p> <p>Discussion</p> <p>The planned development of the Active <it>plus </it>programme resulted in two theory- and evidence-based tailored physical activity interventions targeted at the over-fifties.</p> <p>Trial Registration</p> <p>Dutch Trial Register NTR 920</p

Learners’ evaluation of a navigation support tool in distance education

Bolman, C., Tattersall, C., Waterink, W., Janssen, J., Van den Berg, B., Van Es, R., et al. (2007). Learner’s evaluation of a navigation support tool in distance education. Journal of Computer Assisted Learning, 23 (5), 384-392.This article investigates the usability of a navigation support tool developed to guide learners in a lifelong learning environment. The navigation support tool generates advice on the best next step to take in an e-learning course following completion of a course module, and was evaluated in a largescale experimental study based around an online Internet skills course. This article follows on from the experimental study and examines learners’ evaluation of the navigational support. It uses automatically generated logs of completion of course modules and learners’ answers to online questionnaires to give insight into learners’ evaluation, learners’ adherence to the advice and selfefficacy information. The article describes the theoretical underpinnings of the work, the experimental setup and results, and draws conclusions to refine the navigation tool and to increase adherence to the advice

Patient Education and Counseling 56 (2005) 240-248 Long-term efficacy of a checklist to improve patient education in cardiology

Abstract In a randomised controlled trial a Frequently Asked Questions (FAQ) checklist intended to prepare coronary artery disease (CAD) outpatients for a medical check-up visit at the cardiologist was evaluated. The checklist was mailed to patients in preparation to their visits after 1, 4 and 10 months following patients&apos; discharge from hospitalisation for CAD. It was hypothesised that the intervention would result in lower state anxiety, better patient-doctor communication, more knowledge of CAD and greater patient satisfaction, while it would not result in longer visits. Repeated measurements analyses of covariance showed that experimental patients (N = 46) were less anxious before the first visit. This visit was shorter than in the controls, though the third visit was longer. Control patients (N = 59) showed more CAD knowledge than experimental patients at the first and third visit. Experimental patients found the checklist useful, though its value diminished at subsequent visits. Using the checklist thus decreased anxiety prior to the first visit and the duration of that visit, while negatively affecting knowledge. No conclusions about long-term effects could be drawn, due to the likelihood of type II and type III errors. Process evaluation indicated that the approach used is not sufficiently stimulating for patients to use as a preparation to every visit

Long-term health outcomes and cost-effectiveness of a computer-tailored physical activity intervention among people aged over fifty:modelling the results of a randomized controlled trial

Background: Physical inactivity is a significant predictor of several chronic diseases, becoming more prevalent as people age. Since the aging population increases demands on healthcare budgets, effectively stimulating physical activity (PA) against acceptable costs is of major relevance. This study provides insight into long-term health outcomes and cost-effectiveness of a tailored PA intervention among adults aged over fifty. Methods: Intervention participants (N= 1729) received tailored advice three times within four months, targeting the psychosocial determinants of PA. The intervention was delivered in different conditions (i.e. print delivered versus Web based, and with or without additional information on local PA opportunities). In a clustered RCT, the effects of the different intervention conditions were compared to each other and to a control group. Effects on weekly Metabolic Equivalents (MET) hours of PA obtained one year after the intervention started were extrapolated to long-term outcomes (5 year, 10 year and lifetime horizons) in terms of health effects and quality-adjusted life years (OALYs) and its effect on healthcare costs, using a computer simulation model. Combining the model outcomes with intervention cost estimates, this study provides insight into the long-term cost-effectiveness of the intervention. Incremental cost-effectiveness ratios (ICERs) were calculated. Results: For all extrapolated time horizons, the printed and the Web based intervention resulted in decreased incidence numbers for diabetes, colon cancer, breast cancer, acute myocardial infarctions, and stroke and increased QALYs as a result of increased PA. Considering a societal Willingness-to-Pay of 20,000/QALY, on a lifetime horizon the printed (ICER =E7,500/QALY) as well as the Web based interventions (ICER = E10,100/QALY) were cost-eftective. On a 5-year time horizon, the Web based intervention was preferred over the printed intervention. On a 10 year and lifetime horizon, the printed intervention was the preferred intervention condition, since the monetary savings of the Web based intervention did no longer outweigh its lower effects. Adding environmental information resulted in a lower cost-effectiveness. Conclusion: A tailored PA intervention in a printed delivery mode, without environmental information, has the most potential for being cost-effective in adults aged over 50

Intentional and unintentional medication non-adherence in psoriasis: The role of patients’ medication beliefs and habit strength

Medication non-adherence is a missed opportunity for therapeutic benefit. We assessed “real-world” levels of self-reported non-adherence to conventional and biologic systemic therapies used for psoriasis and evaluated psychological and biomedical factors associated with non-adherence using multivariable analyses. Latent profile analysis was used to investigate whether patients can be categorized into groups with similar medication beliefs. Latent profile analysis categorizes individuals with similar profiles on a set of continuous variables into discrete groups represented by a categorical latent variable. Eight hundred and eleven patients enrolled in the British Association of Dermatologists Biologic Interventions Register were included. Six hundred and seventeen patients were using a self-administered systemic therapy; 22.4% were classified as “non-adherent” (12% intentionally and 10.9% unintentionally). Patients using an oral conventional systemic agent were more likely to be non-adherent compared to those using etanercept or adalimumab (29.2% vs. 16.4%; P ≤ 0.001). Latent profile analysis supported a three-group model; all groups held strong beliefs about their need for systemic therapy but differed in levels of medication concerns. Group 1 (26.4% of the sample) reported the strongest concerns, followed by Group 2 (61%), with Group 3 (12.6%) reporting the weakest concerns. Group 1 membership was associated with intentional non-adherence (odds ratio = 2.27, 95% confidence interval = 1.16−4.47) and weaker medication-taking routine or habit strength was associated with unintentional non-adherence (odds ratio = 0.92, 95% confidence interval = 0.89−0.96). Medication beliefs and habit strength are modifiable targets for strategies to improve adherence in psoriasis