Nurses as role models in health promotion: a concept analysis

There are national and international expectations that nurses are healthy role models but there is a lack of clarity about what this concept means. This study used concept analysis methodology to provide theoretical clarity for the concept of role models in health promoting behaviour for registered nurses and students. The framework included analysis of literature and qualitative data from six focus groups and one interview. Participants (n=39) included pre-registration students (Adult field), nurse lecturers and registered nurses (RNs), working in NHS Trusts across London and South East London. From the findings, being a role model in health promoting behaviour involves being an exemplar, portraying a healthy image (being fit and healthy), and championing health and wellness. Personal attributes of a role model in health promoting behaviour include being: caring, non-judgemental, trustworthy, inspiring and motivating, self-caring, knowledgeable and self-confident, innovative, professional and having a deep sense of self

Mixed method evaluation of a community-based physical activity program using the RE-AIM framework: practical application in a real-world setting

BACKGROUND: Communities are a pivotal setting in which to promote increases in child and adolescent physical activity behaviours. Interventions implemented in these settings require effective evaluation to facilitate translation of findings to wider settings. The aims of this paper are to i) present findings from a RE-AIM evaluation of a community-based physical activity program, and ii) review the methodological challenges faced when applying RE-AIM in practice. METHODS: A single mixed-methods case study was conducted based on a concurrent triangulation design. Five sources of data were collected via interviews, questionnaires, archival records, documentation and field notes. Evidence was triangulated within RE-AIM to assess individual and organisational-level program outcomes. RESULTS: Inconsistent availability of data and a lack of robust reporting challenged assessment of all five dimensions. Reach, Implementation and setting-level Adoption were less successful, Effectiveness and Maintenance at an individual and organisational level were moderately successful. Only community-level Adoption was highly successful, reflecting the key program goal to provide community-wide participation in sport and physical activity. CONCLUSIONS: This research highlighted important methodological constraints associated with the use of RE-AIM in practice settings. Future evaluators wishing to use RE-AIM may benefit from a mixed-method triangulation approach to offset challenges with data availability and reliability

The use of behavioural evidence in physical activity policy

This chapter explores the how behavioural theory and evidence are reflected in a range of physical activity policies. Examples of four different policy types are considered; Monitoring and Surveillance through examining the National Child Measurement Programme, Offering Support through the provision of brief advice in primary care and exercise referral services, Health Messaging through social marketing and workplace campaigns to promote active transport, and Financial or Economic Approaches through incentives schemes. We examine how far such policies can go in supporting people’s motivation, self-efficacy and opportunities for social support, given that physical activity can increasingly be avoided in daily life and requires active ‘opting in’. Throughout the chapter, the match between behavioural evidence and policies is scrutinised in relation to their content, targeting and implementation

Predicting Students’ Physical Activity and Health-Related Well-Being: A Prospective Cross-Domain Investigation of Motivation Across School Physical Education and Exercise Settings \ud

A three-wave prospective design was used to assess a model of motivation guided by self-determination theory (Ryan & Deci, 2008) spanning the contexts of school physical education (PE) and exercise. The outcome variables examined were health-related quality of life (HRQoL), physical self-concept (PSC), and 4 days of objectively assessed estimates of activity. Secondary school students (n = 494) completed questionnaires at three separate time points and were familiarized with how to use a sealed pedometer. Results of structural equation modeling supported a model in which perceptions of autonomy support from a PE teacher positively predicted PE-related need satisfaction (autonomy, competence, and relatedness). Competence predicted PSC, whereas relatedness predicted HRQoL. Autonomy and competence positively predicted autonomous motivation toward PE, which in turn positively predicted autonomous motivation toward exercise (i.e., 4-day pedometer step count). Autonomous motivation toward exercise positively predicted step count, HRQoL, and PSC. Results of multisample structural equation modeling supported gender invariance. Suggestions for future work are discussed.\ud \u

Maintaining adolescents’ involvement in exercise and quality of life:A Self Determination Theory approach

Adolescence is a time during which physical activity is reported to decline steeply, putting both current and future health and wellbeing at risk. The four studies included in this thesis were designed to contribute to our understanding of why participation in leisure time exercise declines during adolescence. In particular, the studies aimed to test a proposed pathway of effects between negative body or weight related self perceptions and engagement in volitional exercise through the application of self determination theory (SDT; Deci & Ryan, 2000). The roles of extrinsic goal content, need satisfaction and motivation on leisure time exercise (LTE) were tested at both a crosssectional and longitudinal level, and analysed in detail through a qualitative study. A final experimental study was then conducted to test the degree to which some of these observed constructs are open to change, and to explore whether focusing adolescents on exercising for goals of physical appearance in a single exercise session (PE) would be facilitative of involvement in PE through heightening its relevance, or inhibitive of self determined motivation through the pathway of effects predicted for extrinsic goals by SDT. Weight related physical self perceptions (WRPSPs) were found to compromise need satisfaction and motivation to predict poorer LTE and quality of life one year later, suggesting that the reduction of, or distraction from WRPSPs would form a useful basis for exercise interventions. Adolescents showed resilience to extrinsic goals and motives for exercise, which were found to have a positive additive effect on behaviour, motivation and perceived value of activities when present in combination with intrinsic goals and motives for exercise. These findings indicated that a hierarchy of goals exists, such that goals for individual bouts of exercise are less important in determining the outcomes an adolescent will experience, than goals for exercise overall. The findings divert somewhat from SDT to suggest that when combined with a basis of intrinsic motivation towards exercise, the introduction of a highly relevant, yet extrinsic goals may be useful in initiating (although not necessarily maintaining) effortful goal directed behaviour in adolescence.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Parents’ Perceptions and Responses to the UK Soft Drinks Industry Levy

Objective: To record parents’ awareness of the UK Soft Drinks Industry Levy (SDIL), and explore associations between negative psychological reactance to the levy and motivation and intentions to change consumption and purchasing.Methods: A cross-sectional online survey with UK-based parents of 5-11 year old children (n=237). Regression analyses were used to test associations between psycho-social responses to the levy and behavioural intentions to change family consumption and purchasing. Results: 92% of responding parents were aware of the SDIL. 57% supported its aims, but 29% felt it threatened their freedom of choice. 41% expressed intention to change shopping habits or restrict their child’s intake as a result. Reactance and motivation were poorer in low income families, and intentions to change positively predicted by motivation. Conclusions and implications: This snapshot suggests the UK Soft Drinks Industry Levy is largely supported by parents and associated with intentions to change their children’s intake

Can evolutionary mismatch help generate interest in health promotion messages?

Background: Generating interest in health interventions is an important first step towards engagement with health promotion and effecting behaviour change. This study explored whether framing health information about physical activity and diet from an evolutionary mismatch perspective could help to generate interest in health promotion among overweight and inactive adults. Evolutionary mismatch theory proposes that human cultural evolution has occurred too rapidly for biological evolution to keep up, creating a mismatch between genes and lifestyles that gives rise to chronic diseases such as type 2 diabetes. Method: A total of 18 adults completed interviews in which they viewed and discussed a variety of mismatch-framed health information resources. Follow-up questions assessed if and what participants had thought about the information in the week after the interview. Transcripts were thematically analysed. Results: Participants found the evolutionary perspective to be novel and interesting. It also provided a meaningful rationale for behaviour change. However, there was some evidence of negative elaboration, which would need to be managed if implementing this approach. Conclusion: Adopting a mismatch perspective can help to engage audiences with important health information.</p

A qualitative exploration of patient and healthcare-professional perspectives on barriers and facilitators to foot self-care behaviours in diabetes

INTRODUCTION: Diabetic foot ulcers contribute significantly to morbidity and mortality associated with diabetes, but are preventable with good foot self-care. This study sought to explore the perspectives of patients and healthcare professionals (HCPs) on barriers and/or facilitators to foot self-care behaviors in diabetes and areas of consensus and/or tension between patient and HCP perspectives. RESEARCH DESIGN AND METHODS: This was a sequential, qualitative study that used a hermeneutic phenomenological approach. Phase I involved nine in-depth, semi-structured patient interviews. Phase II involved seven in-depth semi-structured interviews with HCPs (podiatrists, diabetes nurses, foot health practitioners (FHPs) and general practitioners (GPs)). In phase III, findings from phases I and II were brought back to two patient interview groups (five patients in total) to try and identify any areas of consensus and tension between HCP and patient perspectives. RESULTS: Patient and HCP perspectives had several areas of alignment: concerns over consequences of diabetes complications; the importance of patient education and frustrations around aspects of health service delivery. There were also some notable tensions identified: mixed messaging from HCPs around whose responsibility patient foot health is; and who patients should initially consult following the development of a foot problem. Overall, patients expressed that motivation to undertake good foot self-care behaviors was generated from their lived experiences, and was enhanced when this aligned with the information they received from HCPs. HCPs appeared to attribute lack of patient motivation to lack of knowledge, which was not raised by patients. CONCLUSIONS: This study has identified points of misalignment between the views of patients and practitioners that may help to explain why adherence to foot self-care among patients with diabetes is low. Our results suggest that better outcomes may stem from HCPs focusing on supporting autonomous motivation for self-care and enhancing the rationale through referencing patients’ own experience rather than focussing on increasing patient knowledge. Renewed focus on consistency of messaging by HCPs around the roles and responsibilities relating to foot health in diabetes, and the benefit of foot-specific training being provided to non-foot specialist HCPs may also help to improve uptake and adherence to foot self-care behaviors in diabetes