Kyra Hamilton

Fewer Emergency Readmissions and Better Quality of Life for Older Adults at Risk of Hospital Readmission: A Randomized Controlled Trial to Determine the Effectiveness of a 24-Week Exercise and Telephone Follow-Up Program

OBJECTIVES: To evaluate the effect of an exercise‐based model of hospital and in‐home follow‐up care for older people at risk of hospital readmission on emergency health service utilization and quality of life.

The role of action control and action planning on fruit and vegetable consumption

Globally, fruit and vegetable intake is lower than recommended despite being an important component to a healthy diet. Adopting or maintaining a sufficient amount of fruit and vegetables in ones diet may require not only motivation but also self-regulatory processes. Action control and action planning are two key volitional determinants that have been identified in the literature; however, it is not fully understood how these two factors operate between intention and behavior. Thus, the aim of the current study was to explore the roles of action control and action planning as mediators between intentions and dietary behavior. A longitudinal study with three points in time was conducted. Participants (N = 286) were undergraduate students and invited to participate in a health behavior survey. At baseline (Time 1), measures of intention and fruit and vegetable intake were assessed. Two weeks later (Time 2), action control and action planning were assessed as putative sequential mediators. At Time 3 (two weeks after Time 2), fruit and vegetable consumption was measured as the outcome. The results revealed action control and action planning to sequentially mediate between intention and subsequent fruit and vegetable intake, controlling for baseline behavior. Both self-regulatory constructs, action control and action planning, make a difference when moving from motivation to action. Our preliminary evidence, therefore, suggests that planning may be more proximal to fruit and vegetable intake than action control. Further research, however, needs to be undertaken to substantiate this conclusion.

Investigating mothers’ decisions about their child’s sun-protective behaviour using the Theory of Planned Behaviour:

This study tested the utility of the Theory of Planned Behaviour (TPB) to predict mothers’ decisions to ensure their child engages in sun-protective behaviours. Mothers (N = 162) of children aged four or five years completed standard TPB items (attitude, subjective norm, perceived behavioural control, intention) and additional variables of role construction, mothers’ own sun safe behaviour, planning and past behaviour. One week later, participants (N = 116) reported their behaviour. Results found support for the TPB constructs, role construction, past behaviour and the mediating role of planning. These findings can inform strategies to prevent skin cancer.

A randomised controlled trial to prevent hospital readmissions and loss of functional ability in high risk older adults: a study protocol

BackgroundOlder people have higher rates of hospital admission than the general population and higher rates of readmission due to complications and falls. During hospitalisation, older people experience significant functional decline which impairs their future independence and quality of life. Acute hospital services comprise the largest section of health expenditure in Australia and prevention or delay of disease is known to produce more effective use of services. Current models of discharge planning and follow-up care, however, do not address the need to prevent deconditioning or functional decline. This paper describes the protocol of a randomised controlled trial which aims to evaluate innovative transitional care strategies to reduce unplanned readmissions and improve functional status, independence, and psycho-social well-being of community-based older people at risk of readmission.Methods/DesignThe study is a randomised controlled trial. Within 72 hours of hospital admission, a sample of older adults fitting the inclusion/exclusion criteria (aged 65 years and over, admitted with a medical diagnosis, able to walk independently for 3 meters, and at least one risk factor for readmission) are randomised into one of four groups: 1) the usual care control group, 2) the exercise and in-home/telephone follow-up intervention group, 3) the exercise only intervention group, or 4) the in-home/telephone follow-up only intervention group. The usual care control group receive usual discharge planning provided by the health service. In addition to usual care, the exercise and in-home/telephone follow-up intervention group receive an intervention consisting of a tailored exercise program, in-home visit and 24 week telephone follow-up by a gerontic nurse. The exercise only and in-home/telephone follow-up only intervention groups, in addition to usual care receive only the exercise or gerontic nurse components of the intervention respectively. Data collection is undertaken at baseline within 72 hours of hospital admission, 4 weeks following hospital discharge, 12 weeks following hospital discharge, and 24 weeks following hospital discharge. Outcome assessors are blinded to group allocation. Primary outcomes are emergency hospital readmissions and health service use, functional status, psychosocial well-being and cost effectiveness.DiscussionThe acute hospital sector comprises the largest component of health care system expenditure in developed countries, and older adults are the most frequent consumers. There are few trials to demonstrate effective models of transitional care to prevent emergency readmissions, loss of functional ability and independence in this population following an acute hospital admission. This study aims to address that gap and provide information for future health service planning which meets client needs and lowers the use of acute care services.Trial Registration NoAustralian & New Zealand Clinical Trials Registry ACTRN12608000202369

Using a Single-Item Physical Activity Measure to Describe and Validate Parents' Physical Activity Patterns.

The accurate measurement of health-related physical activity (PA), often interpreted as either 150 min/ week of at least moderate-intensity PA (U.S. Department of Health and Human Services, 2008) or at least 30 min of at least moderate-intensity PA on 5 or more days per week (Australian Government Department of Health and Ageing [AGDHA], 2005; Haskell et al., 2007), is critical for determining current PA levels and monitoring compliance with PA guidelines (Bauman, Phongsavan, Schoeppe, & Owen, 2006). Measurement instruments need to be valid, reliable, and practical (Sallis & Saelens, 2000). It has been noted that, to evaluate total PA levels, it is necessary to include indicators of intensity, duration, frequency, energy expenditure, and activity type (Bauman et al., 2006). These more comprehensive PA measures, which often assess activity in various domains, give a detailed assessment of people’s activity levels (see e.g., Craig et al., 2003; International Physical Activity Questionnaire, 2005). However, it may not be feasible to use these instruments when there are time constraints and/or limitations on research resources. Single-item PA measures, which have been examined against longer self-report measures of PA for evidence of validity, have been suggested as an alternative way to gather information about PA (Milton, Bull, & Bauman, 2010). Brief single-item measures can reduce the burden on respondents and be more readily incorporated into other data collection systems where there may be a lack of knowledge about people’s PA behavior (Milton et al., 2010). However, in their review of 14-single item measures, Milton et al. found a lack of suitable measures that allow for classifying people’s PA against current guidelines and a lack of validity testing of these tools against objective measurements. Parents of young children are at risk for inactivity (Bellows-Riecken & Rhodes, 2008); however, little is known about their PA-related behaviors. Furthermore, there is no consensus about a standard for assessing parental PA (Collins, Marshall, & Miller, 2007). Parents are a unique target group for assessing PA, as the activities performed preparenthood often change postparenthood; as such, leisure-time activities (e.g., sports) are frequently replaced with household (e.g., washing, cleaning) and childcare (e.g., bathing, feeding, playing with children, pushing prams) activities (Bellows-Riecken & Rhodes, 2008; Hamilton & White, 2010). Many self-report instruments do not assess household, childcare, and occupational activities inclusively (Sallis & Saelens, 2000). Assessing this wider range of activities may provide a more accurate PA assessment and, given that some activities (e.g., vacuum cleaning, washing windows, pushing prams) can be of sufficient intensity to confer health benefits associated with doing moderate-intensity activity (Brown, Ringuet, Trost, & Jenkins, 2001), should be considered when measuring parental PA (Ainsworth, 2000; Collins et al., 2007). However, more comprehensive measurements, which assess total PA across all domains, often indicate that populations meet the recommended 150 min of moderate PA each week (Craig et al., 2003). Craig et al. Using a Single-Item Physical Activity Measure to Describe and Validate Parents’ Physical Activity Patterns

Social Influences and the Physical Activity Intentions of Parents of Young-Children Families: An Extended Theory of Planned Behavior Approach

Evidence within Australia and internationally suggests parenthood as a risk factor for inactivity; however, research into understanding parental physical activity is scarce. Given that active parents can create active families and social factors are important for parents’ decision making, the authors investigated a range of social influences on parents’ intentions to be physically active. Parents (N = 580; 288 mothers and 292 fathers) of children younger than 5 years completed an extended Theory of Planned Behavior questionnaire either online or paper based. For both genders, attitude, control factors, group norms, friend general support, and an active parent identity predicted intentions, with social pressure and family support further predicting mothers’ intentions and active others further predicting fathers’ intentions. Attention to these factors and those specific to the genders may improve parents’ intentions to be physically active, thus maximizing the benefits to their own health and the healthy lifestyle practices for other family members.

Identifying Parents’ Perceptions about Physical Activity A Qualitative Exploration of Salient Behavioural, Normative and Control Beliefs among Mothers and Fathers of Young Children

Drawing on the belief-based framework of the Theory of Planned Behaviour, this study employs qualitative methodology involving individual and group interviews to examine the beliefs associated with regular physical activity performance among parents of young children (N = 40). The data were analysed using thematic content analysis. A range of advantages (e.g. improves parenting practices), disadvantages (e.g. interferes with commitments), barriers (e.g. time), and facilitators (e.g. social support) to performing physical activity are identified. Normative pressures are also identified as affecting parents’ activity behaviour. These identified beliefs can be used to inform interventions to challenge inactivity among this at-risk group.

Predictive modelling: parents’ decision making to use online child health information to increase their understanding and/or diagnose or treat their child’s health

BackgroundThe quantum increases in home Internet access and available online health information with limited control over information quality highlight the necessity of exploring decision making processes in accessing and using online information, specifically in relation to children who do not make their health decisions. The aim of this study was to understand the processes explaining parents’ decisions to use online health information for child health care.MethodsParents (N = 391) completed an initial questionnaire assessing the theory of planned behaviour constructs of attitude, subjective norm, and perceived behavioural control, as well as perceived risk, group norm, and additional demographic factors. Two months later, 187 parents completed a follow-up questionnaire assessing their decisions to use online information for their child’s health care, specifically to 1) diagnose and/or treat their child’s suspected medical condition/illness and 2) increase understanding about a diagnosis or treatment recommended by a health professional.ResultsHierarchical multiple regression showed that, for both behaviours, attitude, subjective norm, perceived behavioural control, (less) perceived risk, group norm, and (non) medical background were the significant predictors of intention. For parents’ use of online child health information, for both behaviours, intention was the sole significant predictor of behaviour. The findings explain 77% of the variance in parents’ intention to treat/diagnose a child health problem and 74% of the variance in their intentions to increase their understanding about child health concerns.ConclusionsUnderstanding parents’ socio-cognitive processes that guide their use of online information for child health care is important given the increase in Internet usage and the sometimes-questionable quality of health information provided online. Findings highlight parents’ thirst for information; there is an urgent need for health professionals to provide parents with evidence-based child health websites in addition to general population education on how to evaluate the quality of online health information.

Self-efficacy, planning and action control in an oral self-care intervention

To evaluate a theory-guided intervention on oral self-care and examine the possible mechanisms among self-regulatory factors, two brief intervention arms were compared, an information-based education treatment and a self-regulation treatment focusing on planning and action control. Young adults (N = 284; aged 18-29 years) were assessed at baseline and 1 month later. The self-regulation intervention improved levels of oral self-care, dental planning and action control. Moreover, a moderated mediation model with planning as the mediator between experimental conditions and dental outcome, and self-efficacy as well as action control as moderators elucidated the mechanism of change. More self-efficacious participants in the self-regulation condition benefitted in terms of more planning, and those who monitored their actions yielded higher levels of oral hygiene. Dental self-efficacy, dental planning and action control are involved in the improvement of oral self-care. Their joint consideration may contribute to a better understanding of health behavior change.

A longitudinal investigation of older adults’ physical activity: Testing an integrated dual-process model

Objective: To assess the effects of conscious and non-conscious processes for prediction of older adults’ physical activity (PA), we tested a dual-process model that integrated motivational (behavioural intention) and volitional (action planning and coping planning) processes with non-conscious, automatic processes (habit). Method: Participants (N = 215) comprised community-dwelling older adults (M = 73.8 years). A longitudinal design was adopted to investigate direct and indirect effects of intentions, habit strength (Time 1), and action planning and coping planning (Time 2) on PA behaviour (Time 3). Structural equation modelling was used to evaluate the model. Results: The model provided a good fit to the data, accounting for 44% of the variance in PA behaviour at Time 3. PA was predicted by intentions, action planning, and habit strength, with action planning mediating the intention-behaviour relationship. An effect of sex was also found where males used fewer planning strategies and engaged in more PA than females. Conclusions: By investigating an integration of conscious and non-conscious processes, this study provides a novel understanding of older adults’ PA. Interventions aiming to promote PA behaviour of older adults should target the combination of psychological processes.