Lynne Halley Johnston

A systematic review of the relationship between socio-economic position and physical activity

Objective The aim of the present review was to examine epidemiological evidence to determine if there is strong evidence of a positive gradient of increasing physical activity across the socio-economic strata, and how relationships are affected by socio-economic measurement. Design Systematic review. Method A search of major databases was conducted to identify published studies that reported physical activity in relation to socio-economic position (SEP) in adults. Results Twenty-eight cross-sectional and five longitudinal studies met the inclusion criteria. Approximately half of these were American. Consequently education and income were most commonly used to represent SEP. The majority of studies were secondary analyses of existing health survey data, which could explain the generally large sample sizes and methodological weaknesses in physical activity and SEP measurement. There was consistent evidence of a higher prevalence or higher levels of leisure-time or moderate-vigorous intensity physical activity in those at the top of the socio-economic strata compared with those at the bottom. Evidence for positive gradients across the socio-economic strata was less consistent. Education produced the most stable relationships, less susceptible to confounding effects of ethnicity and the environment. Conclusion Those at the top of the socio-economic scale appear to perform more leisure-time activity than those at the bottom. Diverse and often crude physical activity and socio-economic measurement made it difficult to distinguish between artefact and true effect in a relationship with so many potential confounding influences. Further studies using up-to-date methods of socio-economic and physical activity measurement are necessary to further explore this relationship and its confounders.

Maximizing Transparency in a Doctoral Thesis1: The Complexities of Writing About the Use of QSR*NVIVO Within a Grounded Theory Study

This article discusses the challenges of how to provide a transparent account of the use of the software program QSR*NVIVO (QSR, 2000) within a grounded theory framework (Glaser and Strauss, 1967; Strauss and Corbin, 1998). Psychology students are increasingly pursuing qualitative research projects to such an extent that the UK Economic and Social Research Council (ESRC) advise that students should have skill in the use of computer assisted qualitative data analysis software (CAQDAS) (Economic and Social Research Council, 2001). Unlike quantitative studies, rigid formulae do not exist for writing-up qualitative projects for doctoral theses. Most authors, however, agree that transparency is essential when communicating the findings of qualitative research. Sparkes (2001) recommends that evaluative criteria for qualitative research should be commensurable with the aims, objectives, and epistemological assumptions of the research project. Likewise, the use of CAQDAS should vary according to the research methodology followed, and thus researchers should include a discussion of how CAQDAS was used. This article describes how the evolving process of coding data, writing memos, categorizing, and theorizing were integrated into the written thesis. The structure of the written document is described including considerations about restructuring and the difficulties of writing about an iterative process within a linear document.

Using QSR‐NVivo to facilitate the development of a grounded theory project: an account of a worked example

This paper demonstrates how the software package QSR‐NVivo can be used to faciitate a grounded theory approach. Recent research evidence has questioned the methodological quality of many studies that claim to utilise grounded theory. This paper argues that qualitative data analysis software can be used to encourage good quality grounded theory research by facilitating many of the key processes and characteristics associated with this approach. To achieve this, the paper identifies a number of grounded theory characteristics, common to all revisions of the methodology. It then describes the development of a recent study, which examined how people successfully maintain long‐term physical activity behaviour change. The purpose of this is to demonstrate how different functions of QSR‐NVivo may be used in conjunction with the key grounded theory characteristics. In summary, QSR‐NVivo is a powerful tool that, if used appropriately, can facilitate many aspects of the grounded theory process from the design and early sampling procedures, through to the analysis of data, theoretical development and presentation of findings.

Physical Activity Behavior Change Interventions Based on the Transtheoretical Model: A Systematic Review:

This review critically examines Transtheoretical Model (TTM)—based interventions for physical activity (PA) behavior change. It has been suggested that the TTM may not be the most appropriate theoretical model for applications to PA behavior change. However, previous reviews have paid little or no attention to how accurately each intervention represents the TTM. Findings comprise two sections: sample characteristics of each intervention reviewed and a summary outlining the use of the TTM to develop the interventions. Results reveal numerous inconsistencies regarding the development and implementation/application of TTM-based interventions. Specifically, the majority of interventions reported to be based on the TTM fail to accurately represent all dimensions of the model. Therefore, until interventions are developed to accurately represent the TTM, the efficacy of these approaches and the appropriateness of the underpinning theoretical model cannot be determined.

Factors associated with physical activity referral uptake and participation.

Abstract The aim of this study was to examine participant and scheme characteristics in relation to access, uptake, and participation in a physical activity referral scheme (PARS) using a prospective population-based longitudinal design. Participants (n = 3762) were recruited over a 3-year period. Logistic regression analyses identified the factors associated with the outcomes of referral uptake, participation, and completion (≥80% attendance). Participants age, sex, referral reason, referring health professional, and type of leisure provider were the independent variables. Based on binary logistic regression analysis (n = 2631), only primary referral reason was associated with the PARS coordinator making contact with the participants. In addition to the influence of referral reason, females were also more likely (odds ratio 1.250, 95% confidence interval 1.003 – 1.559, P = 0.047) to agree to be assigned to a leisure provider. Referral reason and referring health professional were associated with taking up a referral opportunity. Older participants (1.016, 1.010 – 1.023, P < 0.001) and males were more likely to complete the referral. In conclusion, the PARS format may be less appropriate for those more constrained by time (women, young adults) and those with certain referral reasons (overweight/obesity, mental health conditions). More appropriate targeting at the point of referral could improve participation rates by revealing or addressing barriers that might later result in dropout.

Attendance of exercise referral schemes in the UK: A systematic review

Objective The aim of this review was to explore attendance of UK exercise referral schemes (ERS), who attends them, why participants drop out of schemes and to compare evaluations of existing ERS with randomised controlled trials (RCTs). Design Systematic review. Method A search of major databases was conducted to identify studies investigating ERS interventions that were based in primary care in the UK, reported attendance-related outcomes and were published in peer- reviewed journals. Results Five evaluations of existing ERS and four RCTs met the inclusion criteria. Method of participant recruitment was the only marked difference between the two types of study. In RCTs and evaluations, rates of referral uptake and attendance were varied but comparable. Attendance was generally poor; approximately eighty per cent of participants who took up referral dropped out before the end of programmes. More women than men took up referral (60 vs. 40 per cent) but there was no evidence of higher attendance in women. None of the participant characteristics reported were consistently associated with attendance. Most of the reasons for attrition and negative comments from participants related to practical problems associated with attending leisure facilities. Conclusion The present review highlighted a high level of attrition in ERS. However, poor measurement and reporting of attendance, and inadequate participant profiling, prevented us from identifying which sections of the population were most likely to attend or drop out. Adequate data collection regimens, beginning at the point of referral would enable us to learn whom exactly ERS are proving successful for.

Uptake and Participation in Physical Activity Referral Schemes in the UK: An Investigation of Patients Referred with Mental Health Problems

The study compared outcomes of uptake, attendance, and completion between two patient groups (mental health, n = 134 and physical health, n = 2767) in a physical activity referral scheme in the UK during 2000 to 2003. Despite similar rates for the physical health and mental health groups for initial progression (94% vs. 90%), referral uptake (60% vs. 69%; p < 0.001) and programme completion (22% vs. 34%; p < 0.001) were significantly lower in the mental health referrals. In conclusion, physical activity referral schemes appear to be less well suited to the needs of the mental health patient. Further research is recommended.

A critical evaluation of training needs for child protection in UK sport

Child protection is a relatively new topic in sport about which there was no professional education until the mid-1990s. This paper presents the findings from a study of delegates attending 12, regional, one-day National Coaching Foundation courses for policy makers in sport during 1997 and 1998 ( n = 235). The course was designed to give delegates a basic awareness of the different forms of child abuse and protection and was intended to help them develop appropriate policies and procedures for child protection. This paper identified key issues facing policy makers, administrators, practising sports coaches and volunteers. Results point to a serious training gap around child protection in sport. Sports personnel, at both junior and senior levels, are committed to improving child protection policy and practice; however, they appear to lack the confidence, knowledge or organizational systems for doing this effectively. Conclusions are drawn about further research and training needs identified by this study.

The perceived knowledge and attitudes of governing body chartered physiotherapists towards the psychological aspects of rehabilitation

Abstract Objectives . This study investigated the knowledge and attitudes of governing body chartered physiotherapists towards the psychological aspects of rehabilitation, their perceived need for training and reported access to an accredited sport psychologist or chartered clinical psychologist for onward referral. Methodological Approach . The methodological approach adopted was a constructionist revision of the Grounded Theory approach. Semi-structured interviews were conducted with 19 governing body chartered physiotherapists. QSR N-Vivo (Fraser 1999) was employed to assist with the mechanical aspects of text coding, search, retrieval and theoretical modelling. A Grounded model was developed to represent the key themes. Results . Results concur with previous research, demonstrating an unequivocal and important role for practitioners in the psychological support provided to the injured athletes. Although practitioners reported conflicts regarding the nature and depth of this role, they are assuming responsibility for the provision of psychological support, even if not self-acknowledging this role. Practitioners have an extensive implicit knowledge base on the psychology of the injured athlete garnered through experiential learning. This implicit knowledge is not supported by an understanding of underpinning psychological theory, or formal education and training in psychology or psychology of sport and sports injury. Conclusions . Questions exist regarding the efficacy of psychological support in clinical practice. Professional training and application of reflective and evidence based practice principles to this area of clinical practice are strongly recommended.

Factors associated with physical activity referral completion and health outcomes

Abstract Participant socio-demographic characteristics and referral reason were investigated in relation to completion and health outcomes in a Primary Care Physical Activity Referral Scheme using a prospective population-based longitudinal design. Participants (n = 1735) were recruited over a 2-year period. A three-stage binary logistic regression analysis identified the factors associated with the outcomes of completion (model 1), body mass reduction (model 2) and blood pressure reduction (model 3). Participants age, gender, ethnicity, occupation and referral reason were the independent variables for model 1, with the variables of completion added in model 2 and completion and body mass reduction added in model 3. Logistic regression analysis revealed that increasing age is associated with the likelihood of completion (Odds Ratio, OR = 1.019; Confidence Interval, CI = 1.008–1.030; P = 0.001). Participants with a pulmonary condition are less likely to complete (OR = 0.546; CI = 0.346–0.860; P < 0.01) compared to those referred for cardiovascular conditions. For ethnicity, in comparison to the white category, patients in the mixed category are significantly more likely to achieve a reduction in body mass (OR = 3.991; CI = 1.191–13.373; P < 0.05). Those who complete are more likely to achieve a reduction in body mass (OR = 3.541; CI = 2.721–4.608; P < 0.001). When compared to the unemployed category, the skilled manual category had an increased likelihood of achieving a reduction in blood pressure (OR = 1.875; CI = 1.044–3.227; P < 0.05). Participants who completed also demonstrated an increased likelihood of a reduction in blood pressure (OR = 1.680; CI = 1.250–2.003; P < 0.001). Furthermore, those participants who achieved a reduction in body mass had an increased likelihood of achieving a reduction in blood pressure (OR = 1.292; CI = 1.008–1.641; P < 0.05). Completion is associated with health outcomes of reduced body mass and blood pressure.