PhD

dissertationThe purpose of this study is to develop a critical perspective which can be used to address the social reality of nursing. The study uses the tradition of the Frankfurt School and critical theory as the primary intellectual frameworks for developing this perspective. The investigation is primarily an exploratory, reflective study which seeks to develop a critical consciousness about nursing. The methodology used in this study differs significantly from empirical-analytic modes of inquiry. The investigation proceeds via the process of reflection. Radical reflection, the method used in this study, contains five stages or steps. They include: bracketing, historical recovery, critique, dialectical imagination and negotiation. The study proceeds in an exploratory way through each of these steps. As in other forms of reflection, findings produced in this study take the form of hypotheses. The study generates insights or interpretive hypotheses about the social construction of reality in nursing. As in other examples of reflection, these are hypotheses whose confirmation depends upon continued negotiation among nurses. Specific findings generated in this study include 1) a critique of scientistic consciousness in nursing, 2) a critique of bourgeois professional ideology in nursing and 3) a critique of sexism in nursing

Comparability of accelerometer- and IPAQ-derived physical activity and sedentary time in South Asian women: A cross-sectional study

Background: There is limited research documenting objectively measured physical activity (PA) and sedentary (ST) in South Asian (SA) women, with no published evidence of the validity of self-report methods for assessment of PA/ST in SA. The purpose of this study was to compare accelerometer- and IPAQ-derived PA/ST among SA women in the United Kingdom (UK) via a mixed methods approach. Methods: 140 SA women wore an accelerometer for 7 consecutive days; a sub-sample (n=50) completed the IPAQ-Short form (IPAQ-SF) and a brief structured interview. Results: Accelerometer-derived MET.min.wk-1 MVPA (mean+/-SD) for the full sample was 793.94(+/-519.44) and mean accelerometer-derived STwk was 530.20(+/-81.76). IPAQ-SF derived MVPA (MET.min.wk-1) was 636.80(+/-2113.56) and mean STwk was 315.31(+/-266.98). Pearson correlations were not significant between accelerometer- and IPAQ-SF-assessed MVPA (r=-.119, p=.579), and ST (r=-.140, p=.229). Major themes synthesized from interviews included inability to recall sitting time, and limited general knowledge of real-life examples of MVPA. Conclusions: These results suggest that the IPAQ-SF may not accurately measure PA/ST in UK SA women. These findings are supported by qualitative evidence indicating several issues with interpretation and recall of PA/ST as assessed via this questionnaire

Objectively measured physical activity and sedentary time in south Asian women: a cross-sectional study

Background South Asian (SA) women in the United Kingdom (UK) are known to be at high risk for developing chronic diseases, and to have low levels of physical activity (PA). Increasing levels of PA and reducing sedentary time (ST) are recognized as factors to target in an effort to curb chronic disease morbidity and mortality. There is limited evidence documenting objectively measured PA/ST and their correlates in SA women. Therefore the purpose of this cross-sectional study was to objectively measure and report patterns of PA/ST among SA women in the UK and examine potential socio-demographic correlates of PA/ST. Methods 140 UK SA women (Pakistani and Bangladeshi) wore an accelerometer for 7 consecutive days. Anthropometric measurements and self-reported socio-demographic information were taken. Results Mean daily moderate-to-vigorous PA (MVPA) was 34.66 ± 21.52 minutes and mean daily ST was 530.20 ± 81.76 minutes, with an inverse correlation (r = -.270, N = 140, p < .001) showing that higher ST was associated with lower MVPA. The same was seen for light intensity PA (LPA) (r = -.610, N = 140, p < .001). MVPA was significantly higher for younger women (18–64.5 yrs), with 64.7% of older women (≥65 yrs) failing to meet PA guidelines (t = 3.101, p < 0.05). Overweight/obese women had lower levels of LPA, MVPA and higher ST (p < .001). Multiple linear regression analyses indicated 14.9% of the variance in MVPA was explained by age and waist circumference (F(2,138) = 6.41, p < 0.002). LPA and ST were significantly higher on weekend days than weekdays (p < .001), and MVPA was significantly higher on weekdays than weekend days. Conclusions Results indicate higher levels of PA in this sample than previously assumed. High levels of LPA in this sample indicate the need for health promotion interventions to target not only duration, but also intensity of activity in this population to achieve PA recommendations

The association between nutrient intake, nutritional status and physical function of community-dwelling ethnically diverse older adults

Background: There are limited longitudinal data regarding nutrient intake, nutritional status and physical function in community-dwelling ethnically diverse older adults. This study explored these variables and their relationship at baseline (n = 100) and 8-months' follow-up (n = 81) among community-dwelling ethnically diverse older adults (≥60 years) in Birmingham, United Kingdom. Methods: Multiple-pass 24-h dietary recalls and the Mini Nutritional Assessment-Short Form assessed nutritional intake and status, respectively. Short Physical Performance Battery (SPPB) and handgrip strength measured physical function. Linear and multinomial regressions were used to predict relationships between physical function, nutritional status and nutrient intake. Results: Complete data were collected at baseline (n = 100) and 8-months' follow-up (n = 81). Mean (SD) age was 70 (8.1) years (60% male), with 62% being obese. Statistically significant decreases in intakes of vitamin B6, vitamin B1, iron, folate, and magnesium occurred over time. Daily intake of all micronutrients except vitamin B12, phosphorus and manganese were below the Recommended Nutrient Intakes (RNI). SPPB (Z = -4.01, p < 0.001) and nutritional status (Z = -2.37, p = 0.018) declined over time. Higher SPPB scores at baseline (OR = 0.54 95% CI 0.35, 0.81) were associated with a slower decline in nutritional status. Conclusion: The observed declines and inadequate nutrient intakes in the absence of weight loss in just 8 months may pose serious challenges to healthy ageing, identifying an urgent need to re-evaluate and tailor appropriate dietary advice for this population. Additionally, the associations of nutrition and physical function observed in this study serves as an essential resource to design and implement community/faith-based interventions targeting early screening of nutritional status and physical function to ensure most older adults are assessed and treated accordingly

Physical activity interventions for treatment of social isolation, loneliness or low social support in older adults: A systematic review and meta-analysis of randomised controlled trials

Objectives This article reviews the effects of physical activity (PA) interventions on social isolation, loneliness or low social support in older adults. Design Systematic review and meta-analysis of randomised controlled trials (RCTs). Method MEDLINE, EMBASE, PsycINFO, the Cochrane CENTRAL, CINAHL, were screened up to February 2017. RCTs comparing PA versus non-PA interventions or control (sedentary) condition were included. Risk of bias was assessed using the 12 criteria Cochrane Review Book Group risk of bias. The outcome measures were: social isolation, loneliness, social support, social networks, and social functioning. Standardised mean differences (SMDs) with associated 95% confidence intervals (CIs) were calculated for continuous outcomes. Meta-analysis was performed using a random effects model. Results The search strategy identified 38 RCTs, with a total of 5288 participants, of which 26 had a low risk of bias and 12 had a high risk of bias. Meta-analysis was performed on 23 RCTs. A small significant positive effect favouring the experimental condition was found for social functioning (SMD = 0.30; 95% CI, 0.12 to 0.49; P = 0.001) with strongest effects obtained for PA interventions, diseased populations, group exercise setting, and delivery by a medical healthcare provider. No effect of PA was found for loneliness, social support, or social networks. Conclusion This review shows, for social functioning, the specific aspects of PA interventions can successfully influence social health. PA did not appear to be effective for loneliness, social support and social networks

Physical Activity Intervention for Loneliness (PAIL) in community-dwelling older adults: protocol for a feasibility study

Background Low-quality social relationships in older adults are strongly associated with feelings of loneliness. Physical activity interventions could reduce loneliness and improve psychological well-being, among other health benefits. The aim of this study is to examine the feasibility of a Physical Activity Intervention for Loneliness (PAIL) in community-dwelling older adults at risk for loneliness. Methods/design This feasibility study is a two-arm randomised controlled trial (RCT) with a wait-list control group using a mixed-methods research design. The primary aim of the feasibility study is to estimate recruitment, retention and adherence rates; the appropriateness of the intervention design and its practicality; the acceptability of the intervention by participants; and the set of instruments and measures and primary outcome measures to inform a future large-scale randomised trial. After eligibility screening, randomisation will be conducted using computer-based random sequence generation. Baseline and post-intervention assessments for intervention and control groups will include height, weight, body mass index, resting blood pressure, physical activity using accelerometry, loneliness, social support, social networks, anxiety and depression, self-efficacy for exercise, satisfaction with social contacts, and expected outcomes and barriers for exercise using questionnaires. Focus groups will be conducted at the mid-point and post-intervention period using a phenomenological approach to analyse the participants’ experiences of taking part in PAIL. Discussion This trial will provide important information regarding the feasibility of PAIL in community-dwelling older adults at risk for loneliness using a mixed-methods approach combining quantitative and qualitative research methods

Development of scales to assess children's perceptions of friend and parental influences on physical activity

<p>Abstract</p> <p>Background</p> <p>Many children do not meet physical activity guidelines. Parents and friends are likely to influence children's physical activity but there is a shortage of measures that are able to capture these influences.</p> <p>Methods</p> <p>A new questionnaire with the following three scales was developed: 1) <it>Parental influence on physical activity</it>; 2) <it>Motives for activity with friends </it>scale; and 3) <it>Physical activity and sedentary group normative values</it>. Content for each scale was informed by qualitative work. One hundred and seventy three, 10-11 year old children completed the new questionnaire twice, one week apart. Participants also wore an accelerometer for 5 days and mean minutes of moderate to vigorous physical activity, light physical activity and sedentary time per day were obtained. Test-retest reliability of the items was calculated and Principal Component analysis of the scales performed and sub-scales produced. Alphas were calculated for main scales and sub-scales. Correlations were calculated among sub-scales. Correlations between each sub-scale and accelerometer physical activity variables were calculated for all participants and stratified by sex.</p> <p>Results</p> <p>The Parental influence scale yielded four factors which accounted for 67.5% of the variance in the items and had good (α > 0.7) internal consistency. The Motives for physical activity scale yielded four factors that accounted for 66.1% and had good internal consistency. The Physical activity norms scale yielded 4 factors that accounted for 67.4% of the variance, with good internal consistency for the sub-scales and alpha of .642 for the overall scale. Associations between the sub-scales and physical activity differed by sex. Although only 6 of the 11 sub-scales were significantly correlated with physical activity there were a number of associations that were positively correlated >0.15 indicating that these factors may contribute to the explanation of children's physical activity.</p> <p>Conclusion</p> <p>Three scales that assess how parents, friends and group normative values may be associated with children's physical activity have been shown to be reliable and internally consistent. Examination of the extent to which these new scales improve our understanding of children's physical activity in datasets with a range of participant and family characteristics is needed.</p

Physical activity and sedentary behaviour typologies of 10-11 year olds

<p>Abstract</p> <p>Background</p> <p>Targeted interventions may be more effective at increasing children's physical activity. The aim of this study was to identify clusters of children based on physical activity and sedentary patterns across the week.</p> <p>Methods</p> <p>Participants were 761, 10-11 year old children. Participant's self-reported time spent in eight physical activity and sedentary contexts and wore an accelerometer. Cluster analysis was conducted on the time spent in the self-reported physical activity and sedentary contexts. Mean minutes of accelerometer derived of moderate to vigorous physical activity (MVPA) and sedentary time were derived for the entire week, weekdays only, weekend days and four different time periods across each type (weekend or weekday) of days. Differences in the physical activity patterns of the groups derived from the cluster analysis were assessed for overall physical activity as well as for the four time periods on weekdays and weekend days.</p> <p>Results</p> <p>Three clusters emerged: 1) High active/Low sedentary; 2) Low active/Moderate sedentary; and 3) High Active/High sedentary. Patterns of activity differed across the week for each group and the High Active/High sedentary obtained the most minutes of MVPA.</p> <p>Conclusions</p> <p>Patterns of physical activity and sedentary time differed across the week for each cluster. Interventions could be targeted to the key periods when each group is inactive.</p