Reliable and valid NEWS for Chinese seniors: measuring perceived neighborhood attributes related to walking

Background : The effects of the built environment on walking in seniors have not been studied in an Asian context. To examine these effects, valid and reliable measures are needed. The aim of this study was to develop and validate a questionnaire of perceived neighborhood characteristics related to walking appropriate for Chinese seniors (Neighborhood Environment Walkability Scale for Chinese Seniors, NEWS-CS). It was based on the Neighborhood Environment Walkability Scale - Abbreviated (NEWS-A), a validated measure of perceived built environment developed in the USA for adults. A secondary study aim was to establish the generalizability of the NEWS-A to an Asian high-density urban context and a different age group. Methods : A multidisciplinary panel of experts adapted the original NEWS-A to reflect the built environment of Hong Kong and needs of seniors. The translated instrument was pre-tested on a sample of 50 Chinese-speaking senior residents (65+ years). The final version of the NEWS-CS was interviewer-administered to 484 seniors residing in four selected Hong Kong districts varying in walkability and socio-economic status. Ninety-two participants completed the questionnaire on two separate occasions, 2-3 weeks apart. Test-rest reliability indices were estimated for each item and subscale of the NEWS-CS. Confirmatory factor analysis was used to develop the measurement model of the NEWS-CS and cross-validate that of the NEWS-A. Results : The final version of the NEWS-CS consisted of 14 subscales and four single items (76 items). Test-retest reliability was moderate to good (ICC > 50 or % agreement > 60) except for four items measuring distance to destinations. The originally-proposed measurement models of the NEWS-A and NEWS-CS required 2-3 theoretically-justifiable modifications to fit the data well. Conclusions : The NEWS-CS possesses sufficient levels of reliability and factorial validity to be used for measuring perceived neighborhood environment in Chinese seniors. Further work is needed to assess its construct validity and generalizability to other Asian locations. In general, the measurement model of the original NEWS-A was generalizable to this study context, supporting the feasibility of cross-country and age-group comparisons of the effect of the neighborhood environment on walking using the NEWS-A as a tool to measure the perceived built environment

Creative Arts-Based Therapies for Stroke Survivors: A Qualitative Systematic Review

Background: Stroke is a life-threating cerebrovascular disease. Without proper and immediate treatment, it can cause long-term disabilities and even death. While current rehabilitation focuses on functional needs, it does not fully address the psychosocial issues. Creative arts-based therapies, however, may have the potential to be of assistance.Methods: A systematic review was conducted to synthesize the qualitative findings of the stroke survivors' positive and negative experiences in participating in creative arts-based therapies. A systematic literature search was conducted across diverse databases. A thematic synthesis was adopted to analyze the results from different qualitative studies and mix-method studies.Results: Among the 367 studies extracted from various databases, 11 studies met the inclusion criteria and were of acceptable quality. The following five analytical themes were identified: functional restoration, psychological support, social engagement, spiritual experience, and short-comings and barriers.Conclusion: Creative arts-based therapies have demonstrated their strengths in addressing psychosocial needs for stroke survivors. Different art modalities are perceived to be useful in achieving different therapeutic goals. Therapies based on a single art modality or combined modalities have different specialties and characteristics. Further research is needed to demonstrate the differential benefits or special advantages of using single or multiple art modalities as well as having qualified therapists in creative arts-based therapies

Measuring walking within and outside the neighborhood in Chinese elders: reliability and validity

Background : Walking is a preferred, prevalent and recommended activity for aging populations and is influenced by the neighborhood built environment. To study this influence it is necessary to differentiate whether walking occurs within or outside of the neighborhood. The Neighborhood Physical Activity Questionnaire (NPAQ) collects information on setting-specific physical activity, including walking, inside and outside one\u27s neighborhood. While the NPAQ has shown to be a reliable measure in adults, its reliability in older adults is unknown. Additionally its validity and the influence of type of neighborhood on reliability and validity have yet to be explored. Methods : The NPAQ walking component was adapted for Chinese speaking elders (NWQ-CS). Ninety-six Chinese elders, stratified by social economic status and neighborhood walkability, wore an accelerometer and completed a log of walks for 7 days. Following the collection of valid data the NWQ-CS was interviewer-administered. Fourteen to 20 days (average of 17 days) later the NWQ-CS was re-administered. Test-retest reliability and validity of the NWQ-CS were assessed. Results : Reliability and validity estimates did not differ with type of neighborhood. NWQ-CS measures of walking showed moderate to excellent reliability. Reliability was generally higher for estimates of weekly frequency than minutes of walking. Total weekly minutes of walking were moderately related to all accelerometry measures. Moderate-to-strong associations were found between the NWQ-CS and log-of-walks variables. The NWQ-CS yielded statistically significantly lower mean values of total walking, weekly minutes of walking for transportation and weekly frequency of walking for transportation outside the neighborhood than the log-of-walks. Conclusions : The NWQ-CS showed measurement invariance across types of neighborhoods. It is a valid measure of walking for recreation and frequency of walking for transport. However, it may systematically underestimate the duration of walking for transport in samples that engage in high levels of this type of walking

The effects of socio-economic status on physical activity participation in Hong Kong adolescents

Purpose: There is evidence that socio-economic status (SES) is associated with physical activity (PA) participation. Lower SES is predictive of lower levels of leisure-time PA. However, most of this research has been conducted in the West and on adults. SES inequalities in PA among youth and Asian populations remain are underexplored. Thus, the main aims of this study were (1) to examine SES differences in PA among Hong Kong adolescents and (2) explore the moderating effects of SES on the relationships between environmental factors and PA participation. Methods: A sample of 148 adolescents (12-18) was recruited from 32 Hong Kong neighborhoods varying in SES (median household income) and objectively-measured walkability (dwelling density and street connectivity). PA was measured both using accelerometers (N=77) and a validated questionnaire (N=148). Individual-level SES was measured using household income as reported by parents, while arealevel SES was defined as the Census-based median household income in a neighborhood. PA-related environmental characteristics of schools and neighborhoods were assessed via self-report and GIS. Results: Household income was positively related with weekly minutes of self-reported and objectively-measured moderate-to-vigorous PA (MVPA). Household income moderated the relationships of either self-reported or objectively-measured MVPA and availability of commercial and cultural destinations, greenness, slippery/wet footpaths, and land use mix. Area-level SES moderated the relationships of MVPA with traffic safety, physical barriers to walking, hilliness and land use mix. Conclusion: The effect of the built environment on PA differs between age and SES groups. Environmental interventions need to take into account these differential effects

The effects of socio-economic status on physical activity participation in Hong Kong adolescents: asocial ecological approach

Motivations: Socio-economic status (SES) is a major source of health disparities. Those who lived in resource-deficient social and physical environments and with low individual income have been found to be at increased risk of physical inactivity. In Hong Kong there is virtually no research on the effect of SES on adolescent physical activity (PA). It is therefore important to explore the SES differentials in PA among Hong Kong adolescents and identify the mechanisms underlying such differentials. It is also important to examine the extent to which SES acts as a moderator and mediator of associations between various potential determinants of adolescent PA. Methods: A hundred eighty-one adolescents aged 12-18 were recruited in the study. This study applied an ecological framework to study the SES effects on adolescents’ PA participation. Physical activity was measured both objectively using accelerometers and subjectively using self-reports. Individual, social and school environment factors were assessed by validated self-report measures. Neighborhood built environmental factors were assessed using Geographic Information Systems (GIS) data. Individual-level SES was based on parents’ report of monthly household income, while area-level SES was based on census data on median household income of selected study neighborhoods. Generalized linear models with robust standard errors were used to assess associations of individual, social and environmental factors with adolescents’ PA. They were also used to assess the moderating of SES and mediators of SES-PA relationships. Results: The results supported the hypothesis that individual, social and environmental factors would all contribute to the explanation of adolescents’ PA. Moderation analyses showed that the PA level of adolescents living in low SES areas might have been negatively affected by the presence of steep streets in the neighborhood environment and the lack of sports facilities. These effects were not observed in adolescents living in high SES areas. In contrast, only adolescents living in high-SES areas showed positive associations of school-based social support and school PA-related environment with PA. Mediation analyses showed that SES differences in adolescents PA participation could be explained by social support from family and access to sports/recreational facilities in/around the school. Significance: The current findings would imply that environmental interventions at the neighborhood level might benefit low-SES groups of adolescents as they seem to be more influenced by aspects of the neighborhood environment. By contrast, high-SES adolescents might be more reactive to school-based environmental interventions. To narrow the SES gap in PA participation among Hong Kong adolescents, interventions should encourage low-SES families to provide more support to their children by widening the available range of opportunities for PA, encouraging their children to participate in PA, and acting as role models. The findings from this study also suggest that the provision of more PA facilities in/around school neighborhood in low-SES areas could contribute to increasing PA participation among the adolescent population of such areas and, thus, narrow the gap between high- and low-SES groups of adolescents.published_or_final_versionHuman PerformanceMasterMaster of Philosoph

Understanding Outdoor Gyms in Public Open Spaces: A Systematic Review and Integrative Synthesis of Qualitative and Quantitative Evidence

(1) Background: An outdoor gym (OG) is environmental infrastructure built in a public open space to promote structured physical activity. The provision of OGs is increasingly seen as an important strategy to realize public health agendas promoting habitual physical activity. A systematic review was conducted to synthesize characteristics of OG and OG users’ experiences and perceptions in different cultural contexts; (2) Methods: Online searches of multidisciplinary databases were conducted in health, sport and recreation, and urban planning disciplines. Characteristics of OGs were synthesized by integrating evidence from quantitative, qualitative, and mix-methods studies. The experiences and perceptions of OG users from both qualitative data and survey responses were synthesized through framework analysis; (3) Results: Nine studies met the inclusion criteria (three quantitative studies, four mixed-methods studies, and two pure qualitative studies). None were excluded on the basis of quality. OGs mainly serve adult and older adult population groups. Their size, design, and instructional support vary across studies. The inclusion of functional types of equipment did not have a unified standard. Regarding experiences and perceptions of OGs, five major themes emerged: “health”, “social connectedness”, “affordable”, “support”, and “design and promotion”; (4) Conclusions: The OG characteristics synthesis guides the direction in further studies regarding exploration of design parameters. The qualitative and quantitative synthesis revealed that health was a central theme of users’ experiences. OGs are also spaces where community-dwellers can find social connectedness while participating in structured physical activity at no cost. Findings from this review create knowledge support for OG as environmental infrastructure for further research and facilitate the understanding of users’ experiences and perceptions of OGs in different cultural contexts

The association of technology acceptance and physical activity on frailty in older adults during the COVID-19 pandemic period

Abstract Background Physical activity was known to be the protective factor against frailty. Technology acceptance is associated with behavioural intention to technology usage. Technology has been effective in promoting healthy behaviour of physical activity. The purposes of this study were to examine the association between physical activity and technology acceptance with frailty and examine the moderation effect of technology acceptance on physical activity and frailty. We hypothesize that 1) physical activity and technology acceptance are associated with frailty, and 2) technology acceptance moderates the association of physical activity with frailty. Methods This study employed a cross-sectional design and was conducted in the community settings of Hong Kong in 2021. Eligible participants were old people aged ≥60 and were community-dwelling. Key variables included physical activity measured by Rapid Assessment of Physical Activity (RAPA), social network measured by Lubben Social Network Scale-Six items (LSNS-6); depressive symptoms measured by Patient Health Questionnaire-Nine items (PHQ-9), technology acceptance measured by Senior Technology Acceptance Model-14 items (STAM-14) and frailty measured by Fatigue, Resistance, Ambulation, Illnesses, & Loss of Weight scale (FRAIL). Ordinal logistic regression was employed to test the hypotheses. The moderation effect was examined by introducing an interaction term formed by the multiplication of an independent variable (i.e., physical activity) and a moderating variable (i.e., technology acceptance). Results This study recruited 380 eligible participants with a mean age of 66.5 years. Technology acceptance (Beta = − 0.031, p < 0.001, Pseudo-R 2 = 0.087) and physical activity (Beta = − 0.182, p = 0.003, Pseudo-R 2 = 0.027) were associated with frailty in the unadjusted models. Technology acceptance (Beta = − 0.066, p < 0.001) and physical activity (Beta = − 1.192, p < 0.001) were also associated with frailty in the fully adjusted model (Pseudo-R 2 = 0.352). Interaction term formed by the multiplication of technology acceptance and physical activity (Beta = 0.012, p = 0.001) was associated with frailty. Physical activity was significantly associated with frailty in the lower technology acceptance subgroup (Beta = − 0.313, p = 0.002) in the subgroup analysis. However, in the subgroup of higher technology acceptance, the association of physical activity (Beta = 0.104, p = 408) on frailty became positive but not significant. Conclusions This study showed that physical activity and technology acceptance were associated with frailty, and technology acceptance moderated the association of physical activity with frailty. This study recommends engaging older adults in physical activity to combat frailty preferentially in those with a lower level of technology acceptance