Darren Flynn

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.

The ‘stages of change’ model in health promotion: Science and Ideology

The transtheoretical or ‘stages of change’ model has greatly influenced health promotion practice in the USA, Australia and the UK since the late 1980s. Application of the model has shaped service planning, provision and implementation. ‘Stages of change’ also has impacted on training agendas at local, regional and national levels. Associated areas of motivational interviewing and brief intervention have led health promotion initiatives in areas such as smoking cessation and alcohol-reduction policies. A number of critiques have recently challenged the ‘stages of change’ model and health promotion orthodoxy. This review examines these critiques, with a focus on the ‘scientific’ status of ‘stages of change’. The review also examines a data-based approach to stages of change, model adequacy, the social and ideological context of change theories in health promotion contexts, levels of explanation and prediction in the ‘stages of change’ framework. Some reasons are offered for the apparent popularity of the model amongst health promotion workers. Recommendations are made about alternative conceptual frameworks.

Developing a virtual reality based methodology for people with dementia: a feasibility study

The aim of this study was to examine the feasibility of virtual reality (VR) technology for use by persons with dementia (PWD). Data were obtained directly from six PWD regarding their experiences with a virtual environment (VE) of a large outdoor park. A user-centered method was developed to assess: (a) presence; (b) user inputs; (c) display quality; (d) simulation fidelity; and (e) overall system usability. The extent to which PWD could perform four functional activities in the VE was also investigated (e.g., mailing a letter). In addition, physical and psychological well-being of PWD while interacting with the VE was assessed objectively by recording heart rate during the VR sessions and subjectively with discrete questionnaire items and real-time prompts. Symptom profiles associated with simulator sickness were assessed with an adapted version of the Simulator Sickness Questionnaire. The study found that PWD to some extent experienced presence; perceived that objects were realistic and moved naturally; generally felt in control of the interaction; and demonstrated little difficulty using a joystick for navigation. The study also demonstrated that VR is an appropriate medium for assessing functional behavior within the context of an ecologically valid VE. PWD did not experience any significant increase in symptoms associated with simulator sickness, or detriments to their psychological and physical well-being. These findings demonstrated that it is feasible to work in VEs with PWD.

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...

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.

A Time Series Evaluation of the FAST National Stroke Awareness Campaign in England

Objective In February 2009, the Department of Health in England launched the Face, Arm, Speech, and Time (FAST) mass media campaign, to raise public awareness of stroke symptoms and the need for an emergency response. We aimed to evaluate the impact of three consecutive phases of FAST using population-level measures of behaviour in England. Methods Interrupted time series (May 2007 to February 2011) assessed the impact of the campaign on: access to a national stroke charitys information resources (Stroke Association [SA]); emergency hospital admissions with a primary diagnosis of stroke (Hospital Episode Statistics for England); and thrombolysis activity from centres in England contributing data to the Safe Implementation of Thrombolysis in Stroke UK database. Results Before the campaign, emergency admissions (and patients admitted via accident and emergency [A&E]) and thrombolysis activity was increasing significantly over time, whereas emergency admissions via general practitioners (GPs) were decreasing significantly. SA webpage views, calls to their helpline and information materials dispatched increased significantly after phase one. Website hits/views, and information materials dispatched decreased after phase one; these outcomes increased significantly during phases two and three. After phase one there were significant increases in overall emergency admissions (505, 95% CI = 75 to 935) and patients admitted via A&E (451, 95% CI = 26 to 875). Significantly fewer monthly emergency admissions via GPs were reported after phase three (−19, 95% CI = −29 to −9). Thrombolysis activity per month significantly increased after phases one (3, 95% CI = 1 to 6), and three (3, 95% CI = 1 to 4). Conclusions Phase one had a statistically significant impact on information seeking behaviour and emergency admissions, with additional impact that may be attributable to subsequent phases on information seeking behaviour, emergency admissions via GPs, and thrombolysis activity. Future campaigns should be a0ccompanied by evaluation of impact on clinical outcomes such as reduced stroke-related morbidity and mortality.

The utility of a multimedia education program for prostate cancer patients: a formative evaluation.

A multimedia program (MMP) was developed to educate patients with prostate cancer about their disease. A within-subjects design was used to investigate the changes in levels of cancer-related knowledge, psychosocial functioning, treatment decision-making role and information needs immediately after browsing the MMP. The participants were 67 men recently diagnosed with prostate cancer. Psychosocial functioning was assessed with 20 items describing common emotional states and coping strategies employed by cancer patients. Treatment decision-making role was assessed with the Control Preference Scale. A principle component analysis of the 20 psychosocial items yielded three components: distress, positive approach and nonacceptance. After browsing the MMP significant increases in knowledge and reductions in distress were reported. Marital status was significantly associated with knowledge gain. Married men and those attending the study session with their spouse displayed a significant shift towards a more active role in treatment decisions. The majority of information needs were fulfilled by the MMP; however, information related to the likelihood of a cure, treatment side effects, coping strategies and aetiology were not completely satisfied by the MMP. Implications of the findings and suggestions for future work on the design and evaluation of the MMP are discussed.

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.

Successful behavioural strategies to increase physical activity and improve glucose control in adults with Type 2 diabetes

To explore which behaviour change techniques and other intervention features are associated with increased levels of physical activity and improved HbA1c in adults with Type 2 diabetes.

Influence of illness script components and medical practice on medical decision making.

Illness scripts are knowledge structures composed of consequences, enabling conditions, and faults. The effects of illness script components--consequences and enabling conditions--and physician factors on referral decisions for gastrointestinal disorders were investigated. The hypothesis that consequences and enabling conditions increase the likelihood of referral was confirmed and several interactions between consequences and enabling conditions were found. The hypothesis that physician factors moderate the effect of enabling conditions was also confirmed, but (contrary to illness script theory) evidence was also found for moderation of consequences. Both enabling conditions and consequences were found to be moderated by physician factors to a larger extent than previously assumed by illness script theory.