The tribulations of trials: Lessons learnt recruiting 777 older adults into REtirement in ACTion (REACT), a trial of a community, group-based active ageing intervention targeting mobility disability

© The Author(s) 2020. Published by Oxford University Press on behalf of The Gerontological Society of America. BACKGROUND: Challenges of recruitment to randomized controlled trials (RCTs) and successful strategies to overcome them should be clearly reported to improve recruitment into future trials. REtirement in ACTion (REACT) is a United Kingdom-based multicenter RCT recruiting older adults at high risk of mobility disability to a 12-month group-based exercise and behavior maintenance program or to a minimal Healthy Aging control intervention. METHODS: The recruitment target was 768 adults, aged 65 years and older scoring 4-9 on the Short Physical Performance Battery (SPPB). Recruitment methods include the following: (a) invitations mailed by general practitioners (GPs); (b) invitations distributed via third-sector organizations; and (c) public relations (PR) campaign. Yields, efficiency, and costs were calculated. RESULTS: The study recruited 777 (33.9% men) community-dwelling, older adults (mean age 77.55 years (SD 6.79), mean SPPB score 7.37 (SD 1.56)), 95.11% white (n = 739) and broadly representative of UK quintiles of deprivation. Over a 20-month recruitment period, 25,559 invitations were issued. Eighty-eight percent of the participants were recruited via GP invitations, 5.4% via the PR campaign, 3% via word-of-mouth, and 2.5% via third-sector organizations. Mean recruitment cost per participant was £78.47, with an extra £26.54 per recruit paid to GPs to cover research costs. CONCLUSIONS: REACT successfully recruited to target. Response rates were lower than initially predicted and recruitment timescales required adjustment. Written invitations from GPs were the most efficient method for recruiting older adults at risk of mobility disability. Targeted efforts could achieve more ethnically diverse cohorts. All trials should be required to provide recruitment data to enable evidence-based planning of future trials

A community-based physical activity intervention to prevent mobility-related disability for retired older people (REtirement in ACTion (REACT)): Study protocol for a randomised controlled trial

© 2018 The Author(s). Background: The REtirement in ACTion (REACT) study is a multi-centre, pragmatic, two-arm, parallel-group randomised controlled trial (RCT) with an internal pilot phase. It aims to test the effectiveness and cost-effectiveness of a community, group-based physical activity intervention for reducing, or reversing, the progression of functional limitations in older people who are at high risk of mobility-related disability. Methods/design: A sample of 768 sedentary, community-dwelling, older people aged 65 years and over with functional limitations, but who are still ambulatory (scores between 4 and 9 out of 12 in the Short Physical Performance Battery test (SPPB)) will be randomised to receive either the REACT intervention, delivered over a period of 12 months by trained facilitators, or a minimal control intervention. The REACT study incorporates comprehensive process and economic evaluation and a nested sub-study which will test the hypothesis that the REACT intervention will slow the rate of brain atrophy and of decline in cognitive function assessed using magnetic resonance imaging (MRI). Outcome data will be collected at baseline, 6, 12 and 24 months for the main study, with MRI sub-study data collected at baseline, 6 and 12 months. The primary outcome analysis (SPPB score at 24 months) will be undertaken blinded to group allocation. Primary comparative analyses will be on an intention-to-treat (ITT) basis with due emphasis placed on confidence intervals. Discussion: REACT represents the first large-scale, pragmatic, community-based trial in the UK to target the non-disabled but high-risk segment of the older population with an intervention to reduce mobility-related disability. A programme that can successfully engage this population in sufficient activity to improve strength, aerobic capacity, coordination and balance would have a major impact on sustaining health and independence. REACT is also the first study of its kind to conduct a full economic and comprehensive process evaluation alongside the RCT. If effective and cost-effective, the REACT intervention has strong potential to be implemented widely in the UK and elsewhere

Development of a peer support intervention to encourage dietary behaviour change towards a Mediterranean diet in adults at high cardiovascular risk.

BACKGROUND: Mediterranean diet (MD) interventions are demonstrated to significantly reduce cardiovascular disease (CVD) risk but are typically resource intensive and delivered by health professionals. There is considerable interest to develop interventions that target sustained dietary behaviour change and that are feasible to scale-up for wider public health benefit. The aim of this paper is to describe the process used to develop a peer support intervention to encourage dietary behaviour change towards a MD in non-Mediterranean adults at high CVD risk. METHODS: The Medical Research Council (MRC) and Behaviour Change Wheel (BCW) frameworks and the COM-B (Capability, Opportunity, Motivation, Behaviour) theoretical model were used to guide the intervention development process. We used a combination of evidence synthesis and qualitative research with the target population, health professionals, and community health personnel to develop the intervention over three main stages: (1) we identified the evidence base and selected dietary behaviours that needed to change, (2) we developed a theoretical basis for how the intervention might encourage behaviour change towards a MD and selected intervention functions that could drive the desired MD behaviour change, and (3) we defined the intervention content and modelled outcomes. RESULTS: A theory-based, culturally tailored, peer support intervention was developed to specifically target behaviour change towards a MD in the target population. The intervention was a group-based program delivered by trained peer volunteers over 12-months, and incorporated strategies to enhance social support, self-efficacy, problem-solving, knowledge, and attitudes to address identified barriers to adopting a MD from the COM-B analysis. CONCLUSIONS: The MRC and BCW frameworks provided a systematic and complementary process for development of a theory-based peer support intervention to encourage dietary behaviour change towards a MD in non-Mediterranean adults at high CVD risk. The next step is to evaluate feasibility, acceptability, and diet behaviour change outcomes in response to the peer support intervention (change towards a MD and nutrient biomarkers) using a randomized controlled trial design

Nurses' perceptions of aids and obstacles to the provision of optimal end of life care in ICU

Contains fulltext : 172380.pdf (publisher's version ) (Open Access

Let the people decide? Support for referenda since the New Zealand flag change referendums

The number of referenda taking place in established democracies has been increasing, but oftentimes the use of referenda is controversial. This paper utilises two New Zealand national probability mail surveys collected before (2015; n = 901) and after (2016; n = 1350) the controversial flag change referendums initiated by Prime Minister John Key. We found that support for referenda increased from 54.5% in 2015 to 70.7% in 2016. We examined how demographics, party vote, political attitudes, and support for changing the flag related to change in support for referenda Younger age groups and those with moderate levels of education had larger increases in support for referenda. We did not find any evidence of 'loser effects' as National voters and flag change supporters were just as likely to increase in support for referenda as other voters and those opposing change, respectively. In summary, the results of this paper show that despite controversy, referenda have become more popular, especially among certain groups

Comparing pansexual- and bisexual-identified participants on demographics, psychological well-being, and political ideology in a New Zealand national sample

Pansexuality, characterized by attraction to people regardless of their gender, is an emerging sexual identity. Research has started to explore the differences between those who identify as pansexual and those who identify as bisexual, typically defined as being attracted to both men and women. This article extends past research by testing for differences between those who identify as pansexual (n\ua0=\ua052) and bisexual (n\ua0=\ua0497) in a nationally representative sample. We used the New Zealand Attitudes and Values Study (NZAVS) to test for differences in demographic variables, psychological well-being, and political ideology. We found that pansexual participants were younger, more likely to be gender diverse (transgender or nonbinary), and more likely to be from the indigenous Māori ethnic group than bisexual participants. Pansexual participants also reported higher psychological distress and were more politically liberal than bisexual participants. These results suggest that people who identify as pansexual are, on average, quantifiably different from those who identify as bisexual; this study adds to a new but growing body of research on emerging plurisexual identities

Investigating inappropriate and missing sexual orientation question responses in a New Zealand national survey

Questions about sexual orientation are increasingly utilized in population-based surveys. The New Zealand Attitudes and Values Study (NZAVS), a national probability longitudinal panel, used an open-ended measure which asked participants to describe their sexual orientation in their own words. The resulting data allowed us to explore 3 waves of missing responses in the NZAVS (Ns = 13,944 -18,261). We examined the demographics, attitudes, and sexual orientation identities of those who provided an answer outside of the scope of the question (8.9%), or did not answer the question (10.8%). Encouragingly, we found that missing data decreased 5.5% over 2 years. Those who were coded as missing at 1 wave but provided an answer on others tended to identify as heterosexual at higher rates than the rest of the sample. Additionally, the vast majority of those with missing data at all 3 time points reported that they were in relationships with someone of a different gender. Finally, we found that gender, ethnicity, nation of birth, response mode, education, parental status, socioeconomic status, and support for marriage equality predicted differences in response type. Our results suggest that there are systematic differences between those willing to answer sexual orientation questions and those who cannot or will not

The predictors of Māori electoral roll choice and knowledge: rangatahi Māori voter enrolment in a representative New Zealand youth survey

ABSTRACTEvery five years and when initially enrolling to vote, Māori have the choice between the Māori roll or the general roll. Research has explored the predictors of roll choice for older adults, but this paper presents the first exploration of roll choice for rangatahi Māori (Māori youth; aged 13–18), and the predictors of rangatahi not understanding the difference between rolls. We draw on Māori data (n = 1528) from Youth19 which surveyed students from a random sample of schools from Tai Tokerau, Tāmaki Makaurau, and Waikato. We find those Māori who also identify as Pākehā (New Zealand European) are less likely to opt for the Māori roll, but those who know their Iwi, are comfortable in Māori social surroundings, feel a spiritual connection to land and the presence of their ancestors in their lives, or feel the drive to be respected as Indigenous, are more likely to choose the Māori roll. Older rangatahi are more likely to say they understand the question, as are those with study plans post-secondary school, and who say they are comfortable in Māori social settings. These results contribute to a body of knowledge valuable for those seeking to increase voter enrolment and enrolment on the Māori roll.Glossary of Māori words: Hapū: kinship group, generally smaller than Iwi; sometimes translated to sub-tribe; hui: meeting; Iwi: broader tribal unit or grouping; nation; kaitiaki: guardian, steward, trustee; kanohi-ki-te-kanohi: face to face/in person; kapa haka: Māori performing arts; traditional performance; Kura Kaupapa Māori: Māori language/Māori medium schools; mana whenua: Māori group(s) who have authority, power, or rights over a certain area of land; marae: meeting house and the area surrounding it; mātauranga Māori: Māori ways of knowing/knowledge; Pākehā: New Zealanders of European descent; rangatahi: youth; rohe: area, region; tangata whenua: Indigenous peoples of Aotearoa New Zealand; people(s) of the land; te reo Māori: the Māori language; te Tiriti o Waitangi: the Māori language version of the Treaty of Waitangi; tīpuna/tupuna: ancestors; waka ama: canoe sport; wānanga: meetings for discussion, deliberation, forums; whanau: family, extended family, or family-like group; whanaungatanga relationship, kinship, sense of family-like connections between people