Sharyn Lymer

Effect of Australia's Walk to Work Day campaign on adults' active commuting and physical activity behavior.

Purpose. To determine whether Australias Walk to Work Day media campaign resulted in behavioral change among targeted groups. Methods. Pre- and postcampaign telephone surveys of a cohort of adults aged 18 to 65 years (n = 1100, 55% response rate) were randomly sampled from Australian major metropolitan areas. Tests for dependent samples were applied (McNemar χ2 or paired t-test). Results. Among participants who did not usually actively commute to work was a significant decrease in “car only” use and an increase in walking combined with public transport. Among those who were employed was a significant increase in total time walking (+16 min/wk; t [780] = 2.04, p < .05) and in other moderate physical activity (+l20 min/wk; t [1087] = 4.76, p < .005), resulting in a significant decrease in the proportion who were “inactive” (χ2 (1) = 6.1, p < .05). Conclusion. Although nonexperimental, the Walk to Work Day initiative elicited short-term changes in targeted behaviors among target groups. Reinforcement by integrating worksite health promotion strategies may be required for sustained effects.

A Comparison of Recruitment Methods for an mHealth Intervention Targeting Mothers: Lessons from the Growing Healthy Program

Background Mobile health (mHealth) programs hold great promise for increasing the reach of public health interventions. However, mHealth is a relatively new field of research, presenting unique challenges for researchers. A key challenge is understanding the relative effectiveness and cost of various methods of recruitment to mHealth programs. Objective The objectives of this study were to (1) compare the effectiveness of various methods of recruitment to an mHealth intervention targeting healthy infant feeding practices, and (2) explore factors influencing practitioner referral to the intervention. Methods The Growing healthy study used a quasi-experimental design with an mHealth intervention group and a concurrent nonrandomized comparison group. Eligibility criteria included: expectant parents (>30 weeks of gestation) or parents with an infant <3 months old, ability to read and understand English, own a mobile phone, ≥18 years old, and living in Australia. Recruitment to the mHealth program consisted of: (1) practitioner-led recruitment through Maternal and Child Health nurses, midwives, and nurses in general practice; (2) face-to-face recruitment by researchers; and (3) online recruitment. Participants’ baseline surveys provided information regarding how participants heard about the study, and their sociodemographic details. Costs per participant recruited were calculated by taking into account direct advertising costs and researcher time/travel costs. Practitioner feedback relating to the recruitment process was obtained through a follow-up survey and qualitative interviews. Results A total of 300 participants were recruited to the mHealth intervention. The cost per participant recruited was lowest for online recruitment (AUD

Assessing User Engagement of an mHealth Intervention: Development and Implementation of the Growing Healthy App Engagement Index

14) and highest for practice nurse recruitment (AUD

Preventing obesity in infants: the Growing healthy feasibility trial protocol

586). Just over half of the intervention group (50.3%, 151/300) were recruited online over a 22-week period compared to practitioner recruitment (29.3%, 88/300 over 46 weeks) and face-to-face recruitment by researchers (7.3%, 22/300 over 18 weeks). No significant differences were observed in participant sociodemographic characteristics between recruitment methods, with the exception that practitioner/face-to-face recruitment resulted in a higher proportion of first-time parents (68% versus 48%, P=.002). Less than half of the practitioners surveyed reported referring to the program often or most of the time. Key barriers to practitioner referral included lack of time, difficulty remembering to refer, staff changes, lack of parental engagement, and practitioner difficulty in accessing the app. Conclusions Online recruitment using parenting-related Facebook pages was the most cost effective and timely method of recruitment to an mHealth intervention targeting parents of young infants. Consideration needs to be given to addressing practitioner barriers to referral, to further explore if this can be a viable method of recruitment.

Lessons learned from the introduction of an electronic safety net to enhance test result management in an Australian mothers' hospital

Background Childhood obesity is an ongoing problem in developed countries that needs targeted prevention in the youngest age groups. Children in socioeconomically disadvantaged families are most at risk. Mobile health (mHealth) interventions offer a potential route to target these families because of its relatively low cost and high reach. The Growing healthy program was developed to provide evidence-based information on infant feeding from birth to 9 months via app or website. Understanding user engagement with these media is vital to developing successful interventions. Engagement is a complex, multifactorial concept that needs to move beyond simple metrics. Objective The aim of our study was to describe the development of an engagement index (EI) to monitor participant interaction with the Growing healthy app. The index included a number of subindices and cut-points to categorize engagement. Methods The Growing program was a feasibility study in which 300 mother-infant dyads were provided with an app which included 3 push notifications that was sent each week. Growing healthy participants completed surveys at 3 time points: baseline (T1) (infant age ≤3 months), infant aged 6 months (T2), and infant aged 9 months (T3). In addition, app usage data were captured from the app. The EI was adapted from the Web Analytics Demystified visitor EI. Our EI included 5 subindices: (1) click depth, (2) loyalty, (3) interaction, (4) recency, and (5) feedback. The overall EI summarized the subindices from date of registration through to 39 weeks (9 months) from the infant’s date of birth. Basic descriptive data analysis was performed on the metrics and components of the EI as well as the final EI score. Group comparisons used t tests, analysis of variance (ANOVA), Mann-Whitney, Kruskal-Wallis, and Spearman correlation tests as appropriate. Consideration of independent variables associated with the EI score were modeled using linear regression models. Results The overall EI mean score was 30.0% (SD 11.5%) with a range of 1.8% - 57.6%. The cut-points used for high engagement were scores greater than 37.1% and for poor engagement were scores less than 21.1%. Significant explanatory variables of the EI score included: parity (P=.005), system type including “app only” users or “both” app and email users (P<.001), recruitment method (P=.02), and baby age at recruitment (P=.005). Conclusions The EI provided a comprehensive understanding of participant behavior with the app over the 9-month period of the Growing healthy program. The use of the EI in this study demonstrates that rich and useful data can be collected and used to inform assessments of the strengths and weaknesses of the app and in turn inform future interventions.

The Population Cost-Effectiveness of Weight Watchers with General Practitioner Referral Compared with Standard Care: Weight Watchers Population Cost-Effectiveness

Introduction Early childhood is an important period for establishing behaviours that will affect weight gain and health across the life course. Early feeding choices, including breast and/or formula, timing of introduction of solids, physical activity and electronic media use among infants and young children are considered likely determinants of childhood obesity. Parents play a primary role in shaping these behaviours through parental modelling, feeding styles, and the food and physical activity environments provided. Children from low socio-economic backgrounds have higher rates of obesity, making early intervention particularly important. However, such families are often more difficult to reach and may be less likely to participate in traditional programs that support healthy behaviours. Parents across all socio-demographic groups frequently access primary health care (PHC) services, including nurses in community health services and general medical practices, providing unparalleled opportunity for engagement to influence family behaviours. One emerging and promising area that might maximise engagement at a low cost is the provision of support for healthy parenting through electronic media such as the Internet or smart phones. The Growing healthy study explores the feasibility of delivering such support via primary health care services. Methods This paper describes the Growing healthy study, a non-randomised quasi experimental study examining the feasibility of an intervention delivered via a smartphone app (or website) for parents living in socioeconomically disadvantaged areas, for promoting infant feeding and parenting behaviours that promote healthy rather than excessive weight gain. Participants will be recruited via their primary health care practitioner and followed until their infant is 9 months old. Data will be collected via web-based questionnaires and the data collected inherently by the app itself. Ethics and dissemination This study received approval from the University of Technology Sydney Ethics committee and will be disseminated via peer-reviewed publications and conference presentations.

Preventing obesity in infancy : outcomes of the growing healthy m-health intervention

This study describes the implementation and impact of an electronic test result acknowledgement (RA) system in the Mater Mothers’ Hospital in Brisbane, Australia. The Verdi application electronically records clinicians’ acknowledgement of the review of results. Hospital data (August 2011–August 2012) were extracted to measure clinicians’ acknowledgement practices. There were 27 354 inpatient test results for 6855 patients. All test results were acknowledged. 60% (95% CI 59% to 61%) of laboratory and 44% (95% CI 40% to 48%) of imaging results were acknowledged within 24 h. The median time between report availability and acknowledgement was 18.1 h for laboratory and 1 day 18 h for imaging results. The median time from when a result was first viewed to its acknowledgement was 7 min for laboratory and 1 min for imaging results. The longest recorded time to acknowledgement was 38 days. Electronic RA provides a safety net to enhance test result management.

RECRUITING SOCIOECONOMICALLY DISADVANTAGED PARENTS TO AN MHEALTH INTERVENTION: LESSONS FROM THE GROWING HEALTHY PROGRAM

This study aimed to assess population‐level cost‐effectiveness of the Weight Watchers (WW) program with doctor referral compared with standard care (SC) for Australian adults with overweight and obesity.

Predicting The Need For Aged Care Services At The Small Area Level: The CAREMOD Spatial Microsimulation Model

A systematic review of randomized controlled trials studying the preventive effects of physical exercise, manual and behavioural treatments in acute low back pain and neck painIntroduction: The global financial crisis has left governments struggling to reduce their budget deficits. Loans and taxes are two important financial instruments for governments to close their budget gaps. According to models of temporal discounting and expected utility individuals should experience loans as a greater loss than taxes, depleting psychological resources and reducing individuals’ capacity to cope with stressors. The present research examined patterns of cardiovascular (CV) reactivity associated with exposure to loans or taxes. Methods: We randomised 73 students to one of three groups: loans, taxes, control (baseline). Participants in the experimental groups imagined finishing university with debts and having to repay the sums outstanding as a proportion of their salaried income over the next 30 years either via a loan repayment, or via taxes. Participants in the control group imagined finishing university, and then working in salaried employment over the next 30 years. All participants then performed a variant of the Trier Social Stress Test (TSST), whilst CV responses were monitored [BP (blood pressure), ECG (electrocardiogram), ICG (impedance cardiogram)]. Results: Compared to the control group, participants in the loan group exhibited maladaptive CV responses during the stress task (higher BP and higher total peripheral resistance [TPR]). Conversely, participants in the taxes group exhibited more adaptive CV responses and did not differ from the control group. Conclusions: Economic considerations have dominated debates surrounding macro-financial performance. The present research highlights the need to consider the psychological costs and benefits of tax-based and loan-based financial instruments.

Development of CareMod/05

A systematic review of randomized controlled trials studying the preventive effects of physical exercise, manual and behavioural treatments in acute low back pain and neck painIntroduction: The global financial crisis has left governments struggling to reduce their budget deficits. Loans and taxes are two important financial instruments for governments to close their budget gaps. According to models of temporal discounting and expected utility individuals should experience loans as a greater loss than taxes, depleting psychological resources and reducing individuals’ capacity to cope with stressors. The present research examined patterns of cardiovascular (CV) reactivity associated with exposure to loans or taxes. Methods: We randomised 73 students to one of three groups: loans, taxes, control (baseline). Participants in the experimental groups imagined finishing university with debts and having to repay the sums outstanding as a proportion of their salaried income over the next 30 years either via a loan repayment, or via taxes. Participants in the control group imagined finishing university, and then working in salaried employment over the next 30 years. All participants then performed a variant of the Trier Social Stress Test (TSST), whilst CV responses were monitored [BP (blood pressure), ECG (electrocardiogram), ICG (impedance cardiogram)]. Results: Compared to the control group, participants in the loan group exhibited maladaptive CV responses during the stress task (higher BP and higher total peripheral resistance [TPR]). Conversely, participants in the taxes group exhibited more adaptive CV responses and did not differ from the control group. Conclusions: Economic considerations have dominated debates surrounding macro-financial performance. The present research highlights the need to consider the psychological costs and benefits of tax-based and loan-based financial instruments.