Understanding for whom, under what conditions, and how group-based physical activity interventions are successful: a realist review Health behavior, health promotion and society

Background: Participation in group-based physical activity (GBPA) interventions has been found to result in higher levels of exercise adherence and program compliance. However, previous reviews of GBPA programs have provided limited insight regarding \u27for whom\u27, \u27under what conditions\u27, and \u27how\u27 these interventions increase physical activity behavior. Methods: A realist review was conducted by following the seven recommended iterative and overlapping steps (J Health Serv Res Policy 10S1:21-34, 2005). The review was limited to group dynamics-based interventions for adults (\u3e17 years of age). The search was conducted in PubMed, PsychInfo, and Web of Science search engines associated with the Science Citation Index Expanded, Social Sciences Citation Index, Arts & Humanities Citation Index, and MEDLINE. Results: Using a realist review approach, data from 52 studies were synthesized. Of those, 92 % (n∈=∈48) reported significant increases in participant physical activity. The synthesis resulted in three main observations and recommendations. Discussion: GBPA interventions have worked for a variety of populations, including those who are hard to reach; however, more research is needed on moderating factors to determine for whom different GBPA programs may be effective. Second, previous interventions have varied in the duration, frequency, and number of group-based strategies used, and comparative effectiveness research may be necessary to isolate the mechanisms of effect. Third, these interventions have been conducted in a diverse range of settings, using a variety of research designs and analytical approaches. Less information is known about the costs or sustainability of these programs in their intended settings. Conclusion: The results of this realist review have important implications for practice, refining trial designs, and replication across diverse populations and settings

Understanding for whom, under what conditions, and how group-based physical activity interventions are successful: a realist review Health behavior, health promotion and society

Background: Participation in group-based physical activity (GBPA) interventions has been found to result in higher levels of exercise adherence and program compliance. However, previous reviews of GBPA programs have provided limited insight regarding \u27for whom\u27, \u27under what conditions\u27, and \u27how\u27 these interventions increase physical activity behavior. Methods: A realist review was conducted by following the seven recommended iterative and overlapping steps (J Health Serv Res Policy 10S1:21-34, 2005). The review was limited to group dynamics-based interventions for adults (\u3e17 years of age). The search was conducted in PubMed, PsychInfo, and Web of Science search engines associated with the Science Citation Index Expanded, Social Sciences Citation Index, Arts & Humanities Citation Index, and MEDLINE. Results: Using a realist review approach, data from 52 studies were synthesized. Of those, 92 % (n∈=∈48) reported significant increases in participant physical activity. The synthesis resulted in three main observations and recommendations. Discussion: GBPA interventions have worked for a variety of populations, including those who are hard to reach; however, more research is needed on moderating factors to determine for whom different GBPA programs may be effective. Second, previous interventions have varied in the duration, frequency, and number of group-based strategies used, and comparative effectiveness research may be necessary to isolate the mechanisms of effect. Third, these interventions have been conducted in a diverse range of settings, using a variety of research designs and analytical approaches. Less information is known about the costs or sustainability of these programs in their intended settings. Conclusion: The results of this realist review have important implications for practice, refining trial designs, and replication across diverse populations and settings

Prosocial exercise : does exercising for charity result in greater well-being and physical activity?

Physical inactivity is a prevalent problem, with few Canadians active enough to accrue the health-related benefits associated with exercise (Colley et al., 2011). In response to ineffective physical activity promotion efforts, recent work suggests focussing on well-being as an outcome of exercise to better promote such behaviour (Segar, Eccles, Richardson, 2011; Segar & Richardson, 2014). While hedonic well-being has been reliably linked to increased physical activity behaviour (Rhodes, Fiala, & Conner, 2009), less is understood about the possible effects of eudaimonic well-being on exercise engagement. As prosocial behaviour has been linked to increased hedonic and eudaimonic well-being, and as prosocial motivation has been identified as a powerful means of behaviour change, prosocial exercise (engaging in physical activity to benefit others) may produce increases in well-being and future physical activity behaviour. In order to test this hypothesis, participants were recruited to take part in a six-week experiment, whereby half of the participants were randomly assigned to a prosocial exercise condition (and used the prosocial exercise app, ‘Charity Miles’), and half were randomly assigned to a personal exercise condition (and utilized a standard exercise app, Nike+ Running). Participants’ eudaimonic and hedonic well-being was assessed at baseline, two weeks following baseline, and before and after each use of the exercise app (i.e., at the bout-level). Exercise behaviour was assessed at baseline, two and six weeks following baseline, and after each use of the exercise app. It was hypothesized that the participants in the prosocial exercise condition would report greater exercise engagement and eudaimonic and hedonic well-being compared to participants in the personal exercise condition. Multilevel modelling analyses involving data at the bout-level revealed that participants in the prosocial exercise condition reported greater well-being and exercise behaviour compared to those in the personal exercise condition; however, this relationship was only evident when participation occurred in the winter, and not the summer months. As such, this study pointed to the potential effectiveness of utilizing prosocial exercise interventions when environmental barriers to physical activity engagement are present.Education, Faculty ofKinesiology, School ofGraduat

Working through a pandemic: The mediating effect of nurses' health on the relationship between working conditions and turnover intent

Abstract Aim While research has demonstrated that nurses' health and working conditions are important predictors of turnover in COVID‐19, the relationship between these factors is not well understood. Our study investigated the mechanism through which working conditions and nurses' physical and mental health could impact intent to leave the nursing profession. Design Secondary data from a cross‐sectional survey of 3478 nurses in British Columbia administered in May 2021 were analysed using structural equation modelling. Methods Two models were assessed utilizing workplace conditions as the predictor, nurses' health as the mediator, and reported turnover intent (Model 1), and anticipated time to turnover (Model 2) as the outcomes. Results Nurses' health partially mediated the relationship between working conditions and turnover intent, where poorer workplace conditions were directly and indirectly associated with greater likelihood of leaving the profession. Nurses' health fully mediated the relationship between working conditions and nurses' anticipated time to turnover, after controlling for age. The findings from this study underscore the importance of enhancing working conditions and improving nurses' mental health and safety on the job. Patient or Public Contribution The British Columbia Nurses' Union provided the data for this study; survey data from 3478 nurses were utilized in our study

Impact of the single site order in LTC : exacerbation of an overburdened system

Background: The long-term care (LTC) sector has been at the epicentre of COVID-19 in Canada. This study aimed to understand the impact that the Single Site Order (SSO) had on staff and leadership in four LTC homes in the Lower Mainland of British Columbia, Canada. Methods A mixed method study was conducted by analyzing administrative staffing data. Overtime, turnover, and job vacancy data were extracted and analyzed from four quarters before (April 2019 – March 2020) and four quarters during the pandemic (April 2020 – March 2021) using scatterplots and two-part linear trendlines across total direct care nursing staff and by designation (i.e., registered nurses (RNs), licenced practical nurses (LPNs) and care aids (CAs)). Virtual interviews were conducted with a purposive sample of leadership (10) and staff (18) from each of the four partner care homes (n = 28). Transcripts were analyzed in NVivo 12 using thematic analysis. Results Quantitative data indicated that the total overtime rate increased from before to during the pandemic, with RNs demonstrating the steepest rate increase. Additionally, while rates of voluntary turnover showed an upward trend before the pandemic for all direct care nursing staff, the rate for LPNs and, most drastically, for RNs was higher during the pandemic, while this rate decreased for CAs. Qualitative analysis identified two main themes and sub-themes: (1) overtime (loss of staff, mental health, and sick leave) and (2) staff turnover (the need to train new staff, and gender/race) as the most notable impacts associated with the SSO. Conclusions The results of this study indicate that the outcomes due to COVID-19 and the SSO are not equal across nursing designations, with the RN shortage in the LTC sector highly evident. Quantitative and qualitative data underscore the substantial impact the pandemic and associated policies have on the LTC sector, namely, that staff are over-worked and care homes are understaffed.Applied Science, Faculty ofMedicine, Faculty ofNon UBCFamily Practice, Department ofNursing, School ofReviewedFacultyResearcherGraduateUnknow

A Mixed Methods Study to Implement the Synergy Tool and Evaluate Its Impact on Long-Term Care Residents

Background: There are ongoing workforce challenges with the delivery of long-term care (LTC), such as staffing decisions based on arbitrary standards. The Synergy tool, a resident-centered approach to staffing, provides objective, real-time acuity and dependency scores (Synergy scores) for residents. The purpose of this study was to implement and evaluate the impact of the Synergy tool on LTC delivery. Methods: A longitudinal mixed methods study took place within two publicly funded LTC homes in British Columbia, Canada. Quantitative data included weekly Synergy scores for residents (24 weeks), monthly aggregated resident falls data (18 months) and a six-month economic evaluation. Qualitative data were gathered from family caregivers and thematically analyzed. Results: Quantitative findings from Synergy scores revealed considerable variability for resident acuity/dependency needs within and across units; and falls decreased during implementation. The six-month economic evaluation demonstrated some cost savings by comparing Synergy tool training and implementation costs with savings from resident fall rate reductions. Qualitative analyses yielded three positive impact themes (improved care delivery, better communication, and improved resident-family-staff relationships), and two negative structural themes (language barrier and staff shortages). Conclusions: The Synergy tool provides useful data for enhancing a ‘fit’ between resident needs and available staff.Applied Science, Faculty ofMedicine, Faculty ofPharmaceutical Sciences, Faculty ofNon UBCNursing, School ofReviewedFacultyResearche

Additional file 2: of Understanding for whom, under what conditions, and how group-based physical activity interventions are successful: a realist review

References. Supplemental Reference List: Articles included in realist review, not referenced in text. All articles included in realist review, if not referenced within the text. (PDF 100 kb

The relationship between outpatient service use and emergency department visits among people treated for mental and substance use disorders: analysis of population-based administrative data in British Columbia, Canada

Background Research findings on the association between outpatient service use and emergency department (ED) visits for mental and substance use disorders (MSUDs) are mixed and may differ by disorder type. Methods We used population-based linked administrative data in British Columbia, Canada to examine associations between outpatient primary care and psychiatry service use and ED visits among people ages 15 and older, comparing across people treated for three disorder categories: common mental disorders (MDs) (depressive, anxiety, and/or post-traumatic stress disorders), serious MDs (schizophrenia spectrum and/or bipolar disorders), and substance use disorders (SUDs) in 2016/7. We used hurdle models to examine the association between outpatient service use and odds of any ED visit for MSUDs as well count of ED visits for MSUDs, stratified by cohort in 2017/8. Results Having had one or more MSUD-related primary care visit was associated with lower odds of any ED visit among people treated for common MDs and SUDs but not people treated for serious MDs. Continuity of primary care was associated with slightly lower ED use in all cohorts. One or more outpatient psychiatrist visits was associated with lower odds of ED visits among people treated for serious MDs and SUDs, but not among people with common MDs. Conclusion Findings highlight the importance of expanded access to outpatient specialist mental health services, particularly for people with serious MDs and SUDs, and collaborative models that can support primary care providers treating people with MSUDs.Medicine, Faculty ofNon UBCPopulation and Public Health (SPPH), School ofPsychiatry, Department ofReviewedFacultyResearche