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

L’intégration des évaluations de l’apprentissage autorégulé dans les activités d’évaluation dans les professions de la santé : un appel à l’action

How well have healthcare professionals and trainees been prepared for the inevitable demands for new learning that will arise in their future? Given the rapidity with which ‘core healthcare knowledge’ changes, medical educators have a responsibility to audit whether trainees have developed the capacity to effectively self-regulate their learning. Trainees who engage in effective self-regulated learning (SRL) skilfully monitor and control their cognition, motivation, behaviour, and environment to adaptively meet demands for new learning. However, medical curricula rarely assess trainees’ capacity to engage in this strategic process. In this position paper, we argue for a paradigm shift toward assessing SRL more deliberately in undergraduate and postgraduate programs, as well as in associated licensing activities. Specifically, we explore evidence supporting an innovative blend of principles from the science on SRL, and on preparation for future learning (PFL) assessments. We propose recommendations for how program designers, curriculum developers, and assessment leads in undergraduate and postgraduate training programs, and in licensing bodies can work together to develop integrated assessments that measure how and how well trainees engage in SRL. Claims about lifelong learning in health professions education have gone unmatched by responsive curricular changes for far too long. Further neglecting these important competencies represents a disservice to medical trainees and a potential risk to the future patients they will care for.Dans quelle mesure les professionnels de la santé et les étudiants ont-ils été préparés aux exigences inévitables de nouveaux apprentissages qui se présenteront à eux à l’avenir? Étant donné la rapidité avec laquelle les « connaissances de base en matière de soins de santé » évoluent, les enseignants en médecine ont la responsabilité de vérifier si les étudiants ont développé la capacité d’autoréguler adéquatement leurs apprentissages. Ceux qui pratiquent efficacement l’apprentissage autorégulé (AAR) surveillent et contrôlent habilement leur cognition, leur motivation, leur comportement et leur environnement pour s’adapter à la nécessité de nouveaux apprentissages. Cependant, les programmes d’études médicales évaluent rarement la capacité des étudiants à s’engager dans ce processus stratégique. Dans cet exposé de position, nous plaidons en faveur d’un changement de paradigme vers une évaluation plus ciblée de l’AAR dans les formations doctorale et postdoctorale, ainsi que pour les activités d’évaluation. Plus précisément, nous explorons les résultats convaincants de l’emploi d’un mélange innovant de principes issus de la recherche en matière d’AAR et d’évaluations de la préparation à l’apprentissage futur. Nous proposons des recommandations pour une collaboration entre les responsables de la conception de programmes d’études, ceux de l’élaboration du cursus, ceux chargés de l’évaluation dans les programmes d’études prédoctorales et postdoctorales et les organismes responsables de l’octroi d’un titre de compétence en vue de créer des évaluations intégrées qui mesurent la méthode et la qualité de l’AAR chez les étudiants. Les programmes d’études tardent encore à traduire dans la pratique la reconnaissance de l’importance de l’apprentissage tout au long de la vie dans l’éducation médicale. Continuer à négliger ces compétences importantes ne ferait que nuire aux étudiants en médecine et potentiellement à leurs futurs patients

Engaging men in chronic disease prevention and management programs: A scoping review

Chronic disease has become one of the largest health burdens facing the developed world. Men are at a higher risk of being diagnosed with chronic disease than women. Although lifestyle interventions have been shown to reduce the risk of chronic disease in participants, men are often underrepresented in such programs. The purpose of this study was to explore the individual-level and program-specific factors that affect male participation rates in chronic disease prevention and management (CDPM) programs. A scoping review methodology was selected, and 25 studies met the criteria for inclusion in the review. Results showed that traditional group-based programs that focused on topics such as nutrition and physical activity were often seen by men as inherently feminine, which served as a barrier for participation. Program-specific factors that attracted men to participate in interventions included a group component with like-minded men, the use of humor in the delivery of health information, the inclusion of both nutrition and physical activity components, and the presence of some manner of competition. A past negative health event, personal concern for health status, and motivation to improve physical appearance were cited by men as facilitators to CDPM program participation. Gaps in the research are identified, and results of this study can be used to inform the development of CDPM programs that will improve the engagement and participation of men

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

The Influence of Diet on Fertility and the Implications for Public Health Nutrition in the United States

Despite growing evidence of the impact of diet on human fertility, few studies have examined the public health implications of this association in the United States (U.S.). This narrative review summarizes current scientific evidence on associations between dietary intake and fertility, discusses challenges in the public health landscape surrounding infertility, and proposes evidence-based recommendations to address these issues. Diets high in unsaturated fats, whole grains, vegetables, and fish have been associated with improved fertility in both women and men. While current evidence on the role of dairy, alcohol, and caffeine is inconsistent, saturated fats, and sugar have been associated with poorer fertility outcomes in women and men. Furthermore, women and men with obesity [body mass index (BMI) ≥ 30 kg/m2] have a higher risk of infertility. This risk is extended to women who are underweight (BMI <20 kg/m2). Diet and BMI influence outcomes during clinical treatment for infertility. Further, women in the U.S. who belong to an underrepresented minority group, have low income, or have low educational attainment, have significantly higher rates of infertility outcomes as compared to women who are non-Hispanic white, have high income, or have high educational attainment. Given this, it may be prudent to integrate nutrition counseling into both clinical guidelines for infertility as well as national dietary guidelines for individuals of reproductive age. Further studies on diet and reproductive health may enhance our ability to improve existing fertility programs across the U.S. and to deliver tailored care to women and men within at-risk groups

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