Behavioral Counseling Training for Primary Care Providers: Immersive Virtual Simulation as a Training Tool

Behavioral counseling represents an efficacious approach for improving health behaviors on a population level, and the primary care setting is an appropriate context in which to implement this approach. However, evidence suggests that the utilization of behavioral counseling techniques in primary care, including those informed by motivational interviewing, is sub-optimal. Insufficient training has been cited as a barrier to utilizing counseling in the primary care setting. Recent work has evaluated the effectiveness of virtual simulations that can provide access to “virtual” patients while retaining the scalability inherent to a digital medium. However, these educational interventions have been limited to simulations delivered through a two-dimensional screen. More immersive simulations delivered through a head-mounted display can create a realistic practice environment that encompasses a learner's entire field of view, which may confer additional benefits with respect to training outcomes. The purpose of this short article is to briefly review the relevant literature across disciplines to conceptualize the potential effectiveness of this technology as a training tool for behavioral counseling. Immersive virtual simulations are designed to induce a psychological phenomenon referred to as presence, whereby a learner perceives themselves as existing within the virtual environment. As such, immersive virtual simulations can provide opportunities for practice, coaching, and feedback in an environment that closely approximates the clinical setting in which counseling will be delivered. Through its effects on presence, this technology may be particularly useful for developing empathy, which is an important component of counseling. Recommendations for future research are also provided

The Physical Activity–Related Barriers and Facilitators Perceived by Men Living in Rural Communities

Men, especially those living in rural areas, experience chronic disease at higher rates than the general population. Physical activity is a well-established protective factor against many chronic diseases; however, only a small fraction of men are meeting national guidelines for physical activity. The purpose of this study was to examine the perceived physical activity–related barriers and facilitators experienced by men living in rural areas in Canada. Participants completed a paper-and-pencil or online survey and asked to select personally relevant physical activity-related barriers and facilitators from a list of 9 and 10 choices, respectively. A total of 149 men completed the survey (50.3% between the ages of 18 and 55 years; 43.0% older than 55 years). Participants were predominantly from rural areas and smaller communities. Overall, the response options “I’m too tired,” “I don’t have enough time,” and “I think I get enough exercise as work” were the three most frequently cited barriers to regular physical activity. The response options “Personal motivation to be healthy,” “I enjoy it,” and “Support from family and/or friends” were the three most often cited facilitators to physical activity. Results are similar to those shown in other populations. Results can be used to inform the development of policies and programs that aim to increase the physical activity levels of men living in rural areas and small communities

Barriers to recruiting men into chronic disease prevention and management programs in rural areas: Perspectives of program delivery staff

Chronic disease is becoming increasingly prevalent in Canada. Many of these diseases could be prevented by adoption of healthy lifestyle habits including physical activity and healthy eating. Men, especially those in rural areas, are disproportionately affected by chronic disease. However, men are often underrepresented in community-based chronic disease prevention and management (CDPM) programs, including those that focus on physical activity and/or healthy eating. The purpose of this study was to explore the experiences and perceptions of program delivery staff regarding the challenges in recruitment and participation of men in physical activity and healthy eating programs in rural communities, and suggestions for improvement. Semistructured interviews were conducted by telephone with 10 CDPM program delivery staff from rural communities in Southwest Ontario, Canada. Time and travel constraints, relying on spouses, and lack of male program leaders were cited as barriers that contributed to low participation levels by men in CDPM programs. Hiring qualified male instructors and engaging spouses were offered as strategies to increase men’s participation. The results of this study highlight many of the current issues faced by rural health organizations when offering CDPM programming to men. Health care organizations and program delivery staff can use the recommendations in this report to improve male participation levels

The purpose, adaptability, confidence, and engrossment model: A novel approach for supporting professional trainees’ motivation, engagement, and academic achievement

Trainees often decide to pursue a career in the professions because they see it as a means to attain their life goals: to become the kind of person they want to be, to live the kind of life they want to lead, and to make the kind of impact they want to have on the world. The life goals trainees pursue through a professional career are derived from their conception of their ideal self and are thus the most important and self-defining goals that they possess. In this article, we propose a novel approach for designing training activities to harness the motivational potential of professional trainees’ life goals, toward supporting their deep engagement in training activities. We propose that activities can be designed to help trainees make links between (1) the concepts and skills covered in an activity, (2) the professional practice behaviors that an activity prepares them to enact, and (3) the life goals that are served by enacting these professional practice behaviors. Informed by Control Theory and Self-Determination Theory, we predict that this design may promote trainees’ adoption of activity-specific goals that emphasize deep understanding, long-term retention, and transfer, and enhance their autonomous motivation to attain their goals. However, there are some situations when this design may be less effective for, or even harmful to, trainees’ motivation. Specifically, we predict that helping trainees establish a purpose for learning by linking an activity to their life goals may be most effective when they can adapt an activity to best align with their purpose, when they are confident in their ability to attain their activity-specific goal, and when they become engrossed in an activity because it affords interest- and curiosity-stimulating actions. We package our theoretical analysis into the PACE model of motivational design. When our predictions are supported by more empirical evidence, the model can help educators set the PACE for trainees, thereby motivating them to engage deeply in training activities

HealtheSteps™ Study Protocol: a pragmatic randomized controlled trial promoting active living and healthy lifestyles in at-risk Canadian adults delivered in primary care and community-based clinics

Abstract Background Physical inactivity is one of the leading causes of chronic disease in Canadian adults. With less than 50% of Canadian adults reaching the recommended amount of daily physical activity, there is an urgent need for effective programs targeting this risk factor. HealtheSteps™ is a healthy lifestyle prescription program, developed from an extensive research base to address risk factors for chronic disease such as physical inactivity, sedentary behaviour and poor eating habits. HealtheSteps™ participants are provided with in-person lifestyle coaching and access to eHealth technologies delivered in community-based primary care clinics and health care organizations. Method/Design To determine the effectiveness of Healthesteps™, we will conduct a 6-month pragmatic randomized controlled trial with integrated process and economic evaluations of HealtheSteps™ in 5 clinic settings in Southwestern Ontario. 110 participants will be individually randomized (1:1; stratified by site) to either the intervention (HealtheSteps™ program) or comparator (Wait-list control). There are 3 phases of the HealtheSteps™ program, lasting 6 months each. The active phase consists of bi-monthly in-person coaching with access to a full suite of eHealth technology supports. During the maintenance phase I, the in-person coaching will be removed, but participants will still have access to the full suite of eHealth technology supports. In the final stage, maintenance phase II, access to the full suite of eHealth technology supports is removed and participants only have access to publicly available resources and tools. Discussion This trial aims to determine the effectiveness of the program in increasing physical activity levels and improving other health behaviours and indicators, the acceptability of the HealtheSteps™ program, and the direct cost for each person participating in the program as well as the costs associated with delivering the program at the different community sites. These results will inform future optimization and scaling up of the program into additional community-based primary care sites. Trial registration NCT02413385 (Clinicaltrials.gov). Date Registered: April 6, 2015

Greenspace to facilitate the positive physical activity and mental health outcomes of older adults in Canada

The link between physical inactivity and poor health outcomes is well established. Older adults are especially at risk for many health conditions, and are one of the most inactive populations in Canada. Increasing levels of neighbourhood greenness has shown a positive relationship with walking and exercise behaviours, which in turn affects both mental and physical health. Currently in Ontario, the provincial Planning Act outlines the process of parkland dedication that individual municipalities are responsible for carrying out. This policy brief will discuss the inadequacies of the current system in effectively creating greenspace for older adults, and will propose several recommendations to resolve these issues

Nature-Based Physical Activity Advertising: Recommendations Based on Attention Restoration Theory and Psychoevolutionary Theory

Recent research has suggested that physical activity in natural areas may provide benefits that exceed those in other settings. Additional benefits include increased self-esteem and enjoyment of the activity, and decreased negative mood states and blood pressure. Therefore, encouraging nature-based physical activities may play an important role in the promotion of health and wellness. Advertising has been cited as an important component of a health promotion campaign; although to date no study has recommended strategies for designing advertising specific to nature-based physical activities. The purpose of this article is to review two prominent human-nature interaction frameworks, Attention Restoration Theory (ART) and Psychoevolutionary Theory (PET), and based on their tenets, recommend strategies for message design. The two recommendations proposed are: (1) to include natural images that meet the restorative criteria outlined in both theories; and (2) to explicitly feature the additional benefits of exercising in natural spaces in advertisements. Adhering to these recommendations in the advertisement design process may increase the effectiveness of the message

The purpose, adaptability, confidence, and engrossment model: A novel approach for supporting professional trainees’ motivation, engagement, and academic achievement

Trainees often decide to pursue a career in the professions because they see it as a means to attain their life goals: to become the kind of person they want to be, to live the kind of life they want to lead, and to make the kind of impact they want to have on the world. The life goals trainees pursue through a professional career are derived from their conception of their ideal self and are thus the most important and self-defining goals that they possess. In this article, we propose a novel approach for designing training activities to harness the motivational potential of professional trainees’ life goals, toward supporting their deep engagement in training activities. We propose that activities can be designed to help trainees make links between (1) the concepts and skills covered in an activity, (2) the professional practice behaviors that an activity prepares them to enact, and (3) the life goals that are served by enacting these professional practice behaviors. Informed by Control Theory and Self-Determination Theory, we predict that this design may promote trainees’ adoption of activity-specific goals that emphasize deep understanding, long-term retention, and transfer, and enhance their autonomous motivation to attain their goals. However, there are some situations when this design may be less effective for, or even harmful to, trainees’ motivation. Specifically, we predict that helping trainees establish a purpose for learning by linking an activity to their life goals may be most effective when they can adapt an activity to best align with their purpose, when they are confident in their ability to attain their activity-specific goal, and when they become engrossed in an activity because it affords interest- and curiosity-stimulating actions. We package our theoretical analysis into the PACE model of motivational design. When our predictions are supported by more empirical evidence, the model can help educators set the PACE for trainees, thereby motivating them to engage deeply in training activities

Presentation_1_The purpose, adaptability, confidence, and engrossment model: A novel approach for supporting professional trainees’ motivation, engagement, and academic achievement.pdf

Trainees often decide to pursue a career in the professions because they see it as a means to attain their life goals: to become the kind of person they want to be, to live the kind of life they want to lead, and to make the kind of impact they want to have on the world. The life goals trainees pursue through a professional career are derived from their conception of their ideal self and are thus the most important and self-defining goals that they possess. In this article, we propose a novel approach for designing training activities to harness the motivational potential of professional trainees’ life goals, toward supporting their deep engagement in training activities. We propose that activities can be designed to help trainees make links between (1) the concepts and skills covered in an activity, (2) the professional practice behaviors that an activity prepares them to enact, and (3) the life goals that are served by enacting these professional practice behaviors. Informed by Control Theory and Self-Determination Theory, we predict that this design may promote trainees’ adoption of activity-specific goals that emphasize deep understanding, long-term retention, and transfer, and enhance their autonomous motivation to attain their goals. However, there are some situations when this design may be less effective for, or even harmful to, trainees’ motivation. Specifically, we predict that helping trainees establish a purpose for learning by linking an activity to their life goals may be most effective when they can adapt an activity to best align with their purpose, when they are confident in their ability to attain their activity-specific goal, and when they become engrossed in an activity because it affords interest- and curiosity-stimulating actions. We package our theoretical analysis into the PACE model of motivational design. When our predictions are supported by more empirical evidence, the model can help educators set the PACE for trainees, thereby motivating them to engage deeply in training activities.</p