Claire Cleland

Validity of the Global Physical Activity Questionnaire (GPAQ) in assessing levels and change in moderate-vigorous physical activity and sedentary behaviour

BackgroundFeasible, cost-effective instruments are required for the surveillance of moderate-to-vigorous physical activity (MVPA) and sedentary behaviour (SB) and to assess the effects of interventions. However, the evidence base for the validity and reliability of the World Health Organisation-endorsed Global Physical Activity Questionnaire (GPAQ) is limited. We aimed to assess the validity of the GPAQ, compared to accelerometer data in measuring and assessing change in MVPA and SB.MethodsParticipants (n = 101) were selected randomly from an on-going research study, stratified by level of physical activity (low, moderate or highly active, based on the GPAQ) and sex. Participants wore an accelerometer (Actigraph GT3X) for seven days and completed a GPAQ on Day 7. This protocol was repeated for a random sub-sample at a second time point, 3–6 months later. Analysis involved Wilcoxon-signed rank tests for differences in measures, Bland-Altman analysis for the agreement between measures for median MVPA and SB mins/day, and Spearman’s rho coefficient for criterion validity and extent of change.Results95 participants completed baseline measurements (44 females, 51 males; mean age 44 years, (SD 14); measurements of change were calculated for 41 (21 females, 20 males; mean age 46 years, (SD 14). There was moderate agreement between GPAQ and accelerometer for MVPA mins/day (r = 0.48) and poor agreement for SB (r = 0.19). The absolute mean difference (self-report minus accelerometer) for MVPA was −0.8 mins/day and 348.7 mins/day for SB; and negative bias was found to exist, with those people who were more physically active over-reporting their level of MVPA: those who were more sedentary were less likely to under-report their level of SB. Results for agreement in change over time showed moderate correlation (r = 0.52, p = 0.12) for MVPA and poor correlation for SB (r = −0.024, p = 0.916).ConclusionsLevels of agreement with objective measurements indicate the GPAQ is a valid measure of MVPA and change in MVPA but is a less valid measure of current levels and change in SB. Thus, GPAQ appears to be an appropriate measure for assessing the effectiveness of interventions to promote MVPA.

Spatial scale, time and process in mega-events: The complexity of host community perspectives on neighbourhood change

A focus on the ‘mega’ aspect of hallmark events can divert attention from the micro – those local communities who are most impacted by the event. Similarly, attention to the ‘event’ aspect underplays the long process of bidding and preparation before any putative legacy of urban transformation for local people. This paper uses qualitative data to unpack the complex and multi-layered views of local residents, living in a deprived neighbourhood beside the Glasgow 2014 Commonwealth Games site in Scotland. They reflect on five years of intensive urban regeneration, evaluate the experience of ‘lockdown’ at Games time, and consider their hopes and fears for the future of the community. Interviewing a mixture of lifelong, established, new and returning residents, we found considerable common ground across the different groups in terms of hopes for a new, mixed community in the area. However, findings also highlight concerns around urban governance practices and the limitations of a market-led approach to regeneration.

Integrating Evidence From Systematic Reviews, Qualitative Research, and Expert Knowledge Using Co-Design Techniques to Develop a Web-Based Intervention for People in the Retirement Transition

Background Integrating stakeholder involvement in complex health intervention design maximizes acceptability and potential effectiveness. However, there is little methodological guidance about how to integrate evidence systematically from various sources in this process. Scientific evidence derived from different approaches can be difficult to integrate and the problem is compounded when attempting to include diverse, subjective input from stakeholders. Objective The intent of the study was to describe and appraise a systematic, sequential approach to integrate scientific evidence, expert knowledge and experience, and stakeholder involvement in the co-design and development of a complex health intervention. The development of a Web-based lifestyle intervention for people in retirement is used as an example. Methods Evidence from three systematic reviews, qualitative research findings, and expert knowledge was compiled to produce evidence statements (stage 1). Face validity of these statements was assessed by key stakeholders in a co-design workshop resulting in a set of intervention principles (stage 2). These principles were assessed for face validity in a second workshop, resulting in core intervention concepts and hand-drawn prototypes (stage 3). The outputs from stages 1-3 were translated into a design brief and specification (stage 4), which guided the building of a functioning prototype, Web-based intervention (stage 5). This prototype was de-risked resulting in an optimized functioning prototype (stage 6), which was subject to iterative testing and optimization (stage 7), prior to formal pilot evaluation. Results The evidence statements (stage 1) highlighted the effectiveness of physical activity, dietary and social role interventions in retirement; the idiosyncratic nature of retirement and well-being; the value of using specific behavior change techniques including those derived from the Health Action Process Approach; and the need for signposting to local resources. The intervention principles (stage 2) included the need to facilitate self-reflection on available resources, personalization, and promotion of links between key lifestyle behaviors. The core concepts and hand-drawn prototypes (stage 3) had embedded in them the importance of time use and work exit planning, personalized goal setting, and acceptance of a Web-based intervention. The design brief detailed the features and modules required (stage 4), guiding the development of wireframes, module content and functionality, virtual mentors, and intervention branding (stage 5). Following an iterative process of intervention testing and optimization (stage 6), the final Web-based intervention prototype of LEAP (Living, Eating, Activity, and Planning in retirement) was produced (stage 7). The approach was resource intensive and required a multidisciplinary team. The design expert made an invaluable contribution throughout the process. Conclusions Our sequential approach fills an important methodological gap in the literature, describing the stages and techniques useful in developing an evidence-based complex health intervention. The systematic and rigorous integration of scientific evidence, expert knowledge and experience, and stakeholder input has resulted in an intervention likely to be acceptable and feasible.

Supporting the transition from weight loss to maintenance: development and optimisation of a face-to-face behavioural intervention component

ABSTRACT After weight loss, most individuals regain lost weight. Interventions to support the transition from successful loss to weight loss maintenance (WLM), regardless of the method of prior weight loss, are needed. The aims of this study were to (1) develop a face-to-face behavioural intervention session to support overweight and obese individuals who have recently lost a clinically significant amount of weight in the transition to WLM; (2) to assess the single-session intervention for acceptability and feasibility prior to its use in a larger, 12-month, multi-component trial; and (3) to optimise the intervention session for future use based on participant feedback. Participants with a Body Mass Index of ≥25 kg/m2 prior to a ≥5% weight loss in the previous 12 months were recruited via the local government authority and community-based advertisements. Each attended the one-hour session with a trained facilitator, which focused on setting maintenance-relevant weight, eating, and physical activity goals. Semi-structured interviews were carried out immediately post-session to obtain feedback on the acceptability of this intervention component. Data were used to generate recommendations for changes to the session, which were discussed by the team, and used to optimise the session. Seventeen participants (13 female; median WL = 13%) were recruited. All participants evaluated the intervention session positively; 11 participants suggested improvements including reducing information provision in favour of greater focus on identifying and coping with barriers, and the inclusion of practical examples. The systematic refinement and optimisation process resulted in an acceptable and feasible face-to-face behavioural intervention session (described here), which will be tested as part of a multi-component intervention. We anticipate the session could be used to supplement existing support including online services, and has the potential to benefit people who have lost a clinically significant amount of weight to achieve WLM over the long term.

Home truths: are housing-related events more important for residents’ health compared with other life events?

Abstract Moving home and home improvements are significant life events, but their health impacts are rarely studied in relation to other life events that occur relatively frequently in deprived populations. This article examines both housing and personal life events over a three year period among a study group living in deprived areas of Glasgow, in order to consider their impacts upon the health and well-being of residents. Housing-related events are the most frequently occurring life events, with relatively minor negative impacts upon physical and mental health and mental well-being; the effects of housing events are attenuated when other life events are taken into account. The largest negative effects on health are associated with serious health episodes, crime victimisation and relationship break-up, with the largest positive effects associated with getting a job. There is a case for holistic regeneration which offers personal support for life events and seeks positive interactive effects.

P38 The impact of urban renewal on engagement in physical activity in a socio-economically disadvantaged population: a qualitative evaluation

Background Most adults in Europe lead sedentary lives; their physical inactivity is associated with a rising prevalence of obesity and is considered to contribute significantly to health inequalities. A recent NICE (2006) review concluded that, “there is an urgent need to conduct research into the effectiveness of environmental interventions, particularly within socially excluded sectors of the population who have the highest prevalence of physical inactivity”. Objective To investigate and utilise the community “knowledge” of individuals living in a socio-economically deprived community and of relevant stakeholders in statutory and voluntary organisations, regarding the design of community-based initiatives on increasing physical activity (PA) levels. Setting The Connswater Community Greenway is a £32 million investment in East Belfast. The aim of the Greenway is to provide a safe and accessible area which increases PA and improves the peoples quality of life. Method Semi-structured interviews with leading community representatives were conducted regarding (i) the nature and extent to which there are specific groups of residents who would benefit from increased PA, (ii) the nature and provision of PA initiatives, and (iii) practical advice regarding the selection of focus group participants from “Physical Activity Need Groups”. Transcriptions were audio recorded and transcribed verbatim. Interim thematic analysis was conducted after each interview to inform the primary questions for subsequent interviews. Findings were validated by a second researcher. Results Preliminary analysis identified emerging themes relating to the design of successful initiatives. These include the perceived relationship between PA and health, financial and community support, access to facilities, programme content and current service provision. Participants acknowledged that promoting PA has associated health benefits but attributed higher priority to interventions focused on social issues. Short-term funding was a problem for sustaining initiatives and a need for volunteer support was identified. Participants reported local physical and social barriers to community engagement and emphasised the need to involve the local community in planning, to ensure relevance of possible components of interventions to the locality. Perceived needs of particular groups for PA promotion related both to their individual health needs and the geographical area in which they lived. The extent to which groups were perceived as being “hard to reach” influenced the provision of current services. Conclusion The promotion of PA in a socio-economically deprived area is a complex issue. Results will inform focus group discussions with community representatives and theory-based Intervention Mapping to guide the design of PA initiatives.

Study protocol: healthy urban living and ageing in place (HULAP): an international, mixed methods study examining the associations between physical activity, built and social environments for older adults the UK and Brazil

BackgroundThe ability to ‘age in place’ is dependent on a range of inter-personal, social and built environment attributes, with the latter being a key area for potential intervention. There is an emerging body of evidence that indicates the type of built environment features that may best support age friendly communities, but there is a need to expand and consolidate this, while generating a better understanding of how on how research findings can be most effectively be translated in to policy and practice.MethodsThe study is based on two case study cities, Curtiba (Brazil) and Belfast (UK), which have highly contrasting physical, social and policy environments. The study deploys a mix methods approach, mirrored in each city. This includes the recruitment of 300 participants in each city to wear GPS and accelerometers, a survey capturing physical functioning and other personal attributes, as well as their perception of their local environment using NEWS-A. The study will also measure the built environments of the cities using GIS and develop a tool for auditing the routes used by participants around their neighbourhoods. The study seeks to comparatively map the policy actors and resources involved in healthy ageing in the two cities through interviews, focus groups and discourse analysis. Finally, the study has a significant knowledge exchange component, including the development of a tool to assess the capacities of both researchers and research users to maximise the impact of the research findings.DiscussionThe HULAP study has been designed and implemented by a multi-disciplinary team and integrates differing methodologies to purposefully impact on policy and practice on healthy ageing in high and low-middle income countries. It has particular strengths in its combination of objective and self-reported measures using validated tools and the integration of GPS, accelerometer and GIS data to provide a robust assessment of ‘spatial energetics’. The strong knowledge exchange strand means that the study is expected to also contribute to our understanding of how to maximise research impact in this field and create effective evidence for linking older adult’s physical activity with the social, built and policy environments.

Intervening to improve wellbeing retirement: The LiveWell programme

Background: Many psycho-oncology studies use posttraumatic growth (PTG) measures designed for general trauma experiences, and as such they may not take into account life changes associated with a health-related context. Method: Study 1, a thematic analysis of written narratives (N = 209), emphasised cancer survivors’ newfound compassion. Study 2, with 504 prostate cancer survivors, measured the Posttraumatic Growth Inventory including five additional items derived from Study 1 to represent increased compassion. Findings: A Principal Components Analysis revealed a six-component structure after deleting eight items. Components related to compassion, new possibilities, relating to others, personal strength, appreciation of life, and spiritual change. Compassion accounted for 48.9% of variance, with the overall model accounting for 79.9% of variance. Strong factorability, internal consistency, and convergent validity were demonstrated. Discussion: The salience of newfound compassion after cancer was demonstrated. This research has important implications for accurately assessing the post-diagnosis trajectory of adjustment after cancer.Special Issue: Abstracts supplement: “Well-being, quality of life and caregiving” : 27th Conference of the European health psychology society, Bordeaux, France, 16th – 20th July 2013Background: Self-affirmation (i.e., focusing on a valued aspect of the self-concept) can promote health behaviour change. This study aimed to see if self-affirmation increased physical activity (PA) regardless of threat level presented in health messages. Methods: Sixty-eight participants were randomly allocated to condition in a 2 (self-affirmation, no affirmation) x 2 (high threat, low threat) between-participants design. Participants completed the Godin Leisure-Time Exercise Questionnaire at baseline and one week later to assess PA. Findings: A two-way ANCOVA with affirmation condition and threat level as predictor variables, controlling for baseline PA, was performed on follow up PA. Baseline PA was a significant predictor (F(1,63) = 399.63, p<0.001) and the main effect of affirmation condition approached significance (F(1,63) = 3.55, p=0.06). There were no other significant effects. Discussion: This study provides further evidence that self-affirmation can increase PA, but found no interaction between self-affirmation and threat level presented in health messages.Background: Contemporary alcohol research suggests that implicit attitudes are important predictors of drinking behaviour and there is growing interest surrounding factors influencing them. Research suggests that evaluative conditioning (EC) influences implicit attitudes and at a population level the most obvious and prolific use of EC is advertising. Methods: Participants (n= 51, mean age= 22.43) completed alcohol- and chocolate-related Implicit Association Tests (IAT) before viewing an advertisement for either chocolate or beer. Participants then completed post-test IATs before being provided with chocolate and beer products and asked to consume as much as they wanted. Findings: Viewing a beer advertisement produced a significant positive shift in alcohol-related implicit attitudes from pre- to post-test. No other significant effects on implicit attitudes or behaviour were found. Discussion: Alcohol advertisements are effective in changing alcohol-related implicit attitudes; however the influence on behaviour requires further investigation. Implications for the manipulation of alcohol-related implicit attitudes are discussed.Background: Recent research has highlighted the importance of automatic processes in predicting impulsive health risk behaviour. This has led to the creation of health behaviour models such as the Prototype Willingness Model (PWM) which take into account dual processes when predicting health behaviour. The current research argues that individuals are more likely to engage in impulsive drinking behaviour on a weekend as opposed to a weekday as there are fewer constraints placed upon drinking behaviour. Methods: Participants (n= 61, mean age= 22) completed an alcohol Implicit Association Test as well as a questionnaire assessing variables on the PWM and drinking behaviour. Findings: More positive alcohol-related automatic cognitions were significantly related to increased levels of both frequency and quantity of self-reported weekend drinking behaviour but were not significantly related to weekday drinking behaviour. Discussion: Automatic processes successfully predicted drinking behaviour when there were fewer constraints placed upon individuals.Background: The Prototype Willingness Model (PWM) suggests that there are two separate antecedents to behaviour: intention and willingness. Whereas intention is suggested to be rational and deliberative, willingness is more automatic and impulsive. The current study used a cross-cultural sample in order to examine the differing predictive power of the PWM for drinking behaviour. Methods: A sample of 193 individuals from Australia (n=108) and Singapore (n=85) completed a questionnaire measuring alcohol consumption and variables on the PWM. Findings: Willingness to drink significantly predicted alcohol consumption in Singaporeans. Both willingness and intention to drink significantly predicted frequency of alcohol consumption Discussion: The antecedents of the PWM differentially predict alcohol consumption in culturally different samples. Implications for health interventions aimed to reduce drinking across cultures are discussed.Background. Parenting has been associated with child weight status. This study aims to evaluate the effects on parenting skills and BMI-SDS of the BBOFT+ overweight prevention program, compared to care-as-usual (CAU). Method. In a cluster-randomized trial, 2500 parents participated. Parent-reported weight and length were used. Parenting was measured with subscales control and reinforcement of the parenting strategies for eating and activity scale (PEAS) and the warmth subscale from the Child Rearing Questionnaire. Results. The first univariate analyses show that at age 15 months, no statistically significant differences in BMI- SDS, parental control, reinforcement or warmth were found between the BBOFT+ and the CAU group. Further cluster analyses need to be conducted. Results from age 36 months will be presented during the conference, which will include all subscales of the PEAS and an assessment of parenting styles. Conclusion. The intervention does not seem to have an effect on BMI-SDS or parenting.Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. 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