Anna van Wersch

Changing physical activity behavior in type 2 diabetes: a systematic review and meta-analysis of behavioral interventions

OBJECTIVE Behavioral interventions targeting “free-living” physical activity (PA) and exercise that produce long-term glycemic control in adults with type 2 diabetes are warranted. However, little is known about how clinical teams should support adults with type 2 diabetes to achieve and sustain a physically active lifestyle. RESEARCH DESIGN AND METHODS We conducted a systematic review of randomized controlled trials (RCTs) (published up to January 2012) to establish the effect of behavioral interventions (compared with usual care) on free-living PA/exercise, HbA1c, and BMI in adults with type 2 diabetes. Study characteristics, methodological quality, practical strategies for increasing PA/exercise (taxonomy of behavior change techniques), and treatment fidelity strategies were captured using a data extraction form. RESULTS Seventeen RCTs fulfilled the review criteria. Behavioural interventions showed statistically significant increases in objective (standardized mean difference [SMD] 0.45, 95% CI 0.21–0.68) and self-reported PA/exercise (SMD 0.79, 95% CI 0.59–0.98) including clinically significant improvements in HbA1c (weighted mean difference [WMD] –0.32%, 95% CI –0.44% to –0.21%) and BMI (WMD –1.05 kg/m2, 95% CI –1.31 to –0.80). Few studies provided details of treatment fidelity strategies to monitor/improve provider training. Intervention features (e.g., specific behavior change techniques, interventions underpinned by behavior change theories/models, and use of ≥10 behaviour change techniques) moderated effectiveness of behavioral interventions. CONCLUSIONS Behavioral interventions increased free-living PA/exercise and produced clinically significant improvements in long-term glucose control. Future studies should consider use of theory and multiple behavior change techniques associated with clinically significant improvements in HbA1c, including structured training for care providers on the delivery of behavioural interventions.

Progress Toward Construct Validation of the Sports Mental Toughness Questionnaire (SMTQ)

This study examines the construct validity of an original self-report instrument for the assessment of mental toughness: the Sports Mental Toughness Questionnaire (SMTQ). Two independent studies supported a three-factor (Confidence, Constancy, and Control) 14-item model for the SMTQ. With a sample of 633 athletes (427 males, 206 females; M age = 21.5 years; SD = 5.48), drawn from 25 sport classifications, and competing at international, national, county and provincial, or club and regional standards, the first study utilized item development and exploratory factor analytic techniques to establish the psychometric properties of the SMTQ. Study 2 employed confirmatory factor analytic techniques with an independent sample of 509 sports performers (351 males, 158 females; M age = 20.2 years; SD = 3.35), competing at the aforementioned standards, and representative of 26 sports. Confirmatory analysis using structural equation modeling confirmed the overall structure. A single factor underlying mental toughness...

A comparison of multi-item Likert and visual analogue scales for the assessment of transactionally defined coping function

Summary: The evaluation and monitoring of interventions that are designed to alleviate psychosocial stress rely largely on subjective assessments of coping as primary outcome measures. The pros and cons of different response formats used to measure coping variables are unexplored; yet arguably, response format is a very important methodological issue for the clinical application and evaluation of psychosocial interventions. This study compared the levels of functional coping and transactional coping patterns assessed with multi-item 7-point Likert Scales (LS) and 65mm Visual Analogue Scales (VAS), within the framework of the Functional Dimensions of Coping (FDC) Scale developed by Ferguson and Cox, 1997. LS yielded significantly higher levels of functional coping for all four subscales, and captured a wider range of transactional coping patterns for the approach, emotion, and avoidance coping functions, than VAS. The authors recommend the use of LS for baseline assessments of transactionally defined copin...

Evaluating the factor structure of the Psychological Performance Inventory.

This study assesses the construct validity of a measure of mental toughness, Loehrs Psychological Performance Inventory. Performers (N = 408, 303 men, 105 women, M age = 24.0 yr., SD = 6.7) drawn from eight sports (artistic roller-skating, basketball, canoeing, golf, rugby league, rugby union, soccer, swimming), and competing at either international, national, county and provincial, or club and regional standards. They completed the 42-item Psychological Performance Inventory during training camps. Principal components analysis provided minimal support for the factor structure. Instead, the exploratory analysis yielded a 4-factor 14-item model (PPIA). A single factor underlying mental toughness (GMT) was identified with higher-order exploratory factor analysis using the Schmid-Leiman procedure. Psychometric analysis of the model, using confirmatory analysis techniques, fitted the data well. Collectively satisfying absolute and incremental fit index benchmarks, the inventory possesses satisfactory psychometric properties, with adequate reliability and convergent and discriminant validity. The results lend preliminary support to the factorial validity and reliability of the model; however, further investigation of its stability is required before recommending practitioners use changes in scores as an index for evaluating effects of training in psychological skills.

Stigma, Sexually Transmitted Infections and Attendance at the GUM Clinic: An Exploratory Study with Implications for the Theory of Planned Behaviour

A gap in the literature regarding understanding of peoples health care seeking behaviours in relation to sexually transmitted infections is identified. Employing both deductive and inductive methods, 10 patients (five female, five male) were interviewed to explore the psychosocial, motivational and attitudinal factors associated with attendance at a Genito-Urinary Medicine (GUM) clinic in a close-knit community in the north of England. Seven stigma-related themes were identified as salient issues surrounding perceptions of sexual health screening and included: (1)prejudice surrounding STIs; (2)fear of exposure; (3)isolation; (4)reluctance to attend; (5)contamination; (6)relationship issues; and (7)perceived invulnerability. Within these themes distinct gender differences were identified. Implications for the theory of planned behaviour (TPB) are discussed against the factors identified.

A Review of Parental Involvement in Sex Education: The Role for Effective Communication in British Families.

A review of recent literature (2000—2006) has been undertaken to investigate the role of sex education within the family context, in order to engage with the problems of sexual health in British society. The findings which emerged were categorized under the following five themes: (1) Parental roles regarding sex education; (2) The importance of effective communication in the family; (3) Parent—child interaction: differences in gender and communication style; (4) Content of sex education; and (5) Parents as primary sexual educators. The findings highlighted the importance of communication, and showed a tendency of children and adolescents wanting to learn about sexual matters from their parents. Studies on communication of sexual issues emphasized the role of gender, psychological factors and family dynamics in the effectiveness of sex education. Although the majority of communication on sexual subjects has been found to come from the mother, boys feel that the content is mainly steered towards the experience of girls. Consequently, boys use other sources (peers, the media and the Internet) to educate themselves about sexual related issues. Even though parents want to talk to their children about topics related to sexual behaviours, they feel embarrassed, uncomfortable and have neither the skills nor the knowledge to do so. A need for sex and relationship education (SRE) parent programmes has been identified to ensure that the information being taught at school can be reinforced in the family home. Thoughts for enhancing SRE within the family are presented.

The well-being of young people who care for a dependent relative: An interpretative phenomenological analysis

Developing health care systems have placed an emphasis on unpaid, informal care giving from family members as a community health resource. It is estimated that there are between 19,000 and 51,000 young carers in the UK who are at increased risk of physical and psychological ill health. Therefore, the aim of this study was to explore the personal experiences of young carers in relation to their well-being using interpretative phenomenological analysis (IPA). Semi-structured interviews were carried out with five young carers and the verbatim transcripts served as the data for an IPA. Three themes emerged: (1) what caring means; (2) isolation and distancing from others; and (3) integrating caring. The participants struggled to make sense of caring, found it relentless, overwhelming and frustrating. They experienced stigma, which led to secrecy and withdrawal, cutting them off from their social worlds and the benefit of social support. They actively sought to integrate caring into their emerging sense of self and identity, and derived a sense of pride from caring and used this to combat feelings of uncertainty and isolation.

Predictors of the psychosocial impact of being a carer of people living with Parkinson's disease: A systematic review

INTRODUCTION Caring for a person with Parkinsons disease (PwP) can have a variety of negative consequences that may challenge their ability to continue their caring role. It is still unknown why some individuals adapt better than others in response to such burdens. This review is the first to synthesize and evaluate the evidence on the predictive factors of psychosocial outcomes in PwP carers. METHODS Studies which identified predictors of psychosocial outcomes for unpaid carers were included. PsychINFO, EMBASE, AMED, BNI and CINAHL databases were searched, supplemented by scanning of references lists of included studies and relevant journals from 2008 onwards. Quality was assessed using the NICE methodology checklist for prognostic studies. RESULTS Twenty-nine studies were included in the review, providing a low-level of evidence. Carer burden was investigated in 18 studies and mental health and quality of life (QoL) in seven studies each. PwP non-motor symptoms and QoL and carer depression were consistently identified as predictors for at least one psychosocial outcome. Demographics and disease factors were consistently found not to be predictors. Carer involvement and protective factors (e.g. social support, personality) demonstrated promising findings but studies were too few or factors measured inconsistently. CONCLUSION Confident conclusions could not be drawn regarding the most important predictors that should be targeted in psychosocial interventions due to methodological weaknesses and lack of theoretical testing across the current literature. Future research should build upon psychological theory to gain a better understanding of the mechanisms that explain how carers adapt to caregiving.

Treatment decision making in breast cancer: A longitudinal exploration of women's experiences

OBJECTIVES To explore the lived experience of breast cancer in relation to the treatment decision-making process over time. DESIGN Adopting a hermeneutic phenomenological approach, semi-structured interviews were undertaken at three points in time during the year following diagnosis. METHODS After ethical approval had been obtained, 20 women who were recently diagnosed with breast cancer were recruited from a Symptomatic Breast Cancer Unit in the North East of England. RESULTS Four themes emerged: role in the treatment decision-making process; acceptance of medical opinions; getting rid of it; and cancer schemas. The majority of women reported a passive role in the surgical treatment decision-making process and all women did so in relation to subsequent treatment decisions. However, women adopted this role consciously and consequently were not disengaged from the process but maintained a sense of ownership and control over their health. The women did not describe experiencing decisional regret at any point in the year following diagnosis and rarely revisited the decisions made, only doing so in a positive manner. Trust in the abilities and experience of healthcare professionals and maximizing chances of survival were cited as reasons for not having had greater involvement. Despite being given information about treatment options, many women made the decision not to attend to this information perceiving this to be anxiety provoking. CONCLUSIONS The findings from this study suggest a need for eliciting more specific psycho-social interactions in the treatment decision-making process in order to identify ways in which women can be supported throughout their experience.

The acceptance of a computerised decision-support system in primary care: a preliminary investigation

Within the framework of technology acceptance modelling (Davis 1993), this study investigated the acceptance of a computerised decision-support system in primary care. Thirty general practitioners (GP) completed a questionnaire that detailed potential advantages of the system. A majority (70%) of GPs intended to use the system with a 2-min increase in consultation times (for proportion of GPs intending to use, CI0.95 = [0.54; 0.85]) and eight advantages of the system were predictors of intention to use (RL 2 = 0.51, p < 0.05). However, a majority (77%) did not intend to use the system with a 5-min increase in consultation time (CI0.95 = [0.12; 0.42]). Furthermore, a majority of 90% preferred the system to be used by non-physicians (CI0.95 = [0.78; 0.98]). These results confirm relationships between acceptance factors in a new domain, but most importantly they indicate the need to consider the balance of perceived advantages, or benefits, and disadvantages, or costs, of a new system in technology acceptance modelling. Implications for the design of a prototype system and further research are discussed.