Evaluating a community lifestyle intervention: adherence and the role of perceived support

Background Interventions that increase participation in physical activity and positive dietary changes may improve the health of the community through modifying the lifestyle contribution to preventable disease. However, previous evaluations have identified concerns about inequitable and unsustainable uptake, adherence and retention within healthy lifestyle schemes.

Intervention study The intervention evaluated here was designed to be a 12-week intervention for participants, offering free testing of physiological indicators of health, one-to-one health advice and a range of exercise, activity and cookery classes, at no or reduced cost, at local venues throughout the community. This paper reports the findings from a small qualitative study undertaken to explore the experiences and reflections of those who took part in the intervention to different extents, including those who fully and partially participated as well as those who dropped out or declined to take part.

Method Sixteen respondents took part in semi-structured interviews (5 male, 11 female; 8 black, 8 white; age range 25–85).

Findings The findings suggest that participants assessed the healthy lifestyle intervention in terms of how well it met their pre-existing needs and opportunities for change, and that they selected the aspects of the scheme that suited them, interested them and were perceived as delivering salient results. There is also evidence for a stronger role of perceived support in influencing uptake and maintenance of lifestyle changes, and that support was conceptualised by participants as one of the services offered by the scheme. Perceived support and related perceptions of reliance on the scheme to sustain lifestyle changes also suggested that in some cases full adherence to a scheme is not as likely to produce long-term adherence to lifestyle changes as compared to partial, but more realistic adherence and smaller lifestyle changes. Implications for delivering and evaluating healthy lifestyle interventions are also discussed.

An index of diet and eating patterns is a valid measure of diet quality in an Australian population

Diet indices represent an integrated approach to assessing eating patterns and behaviors. The aim of this study was to develop a comprehensive food-based dietary index to reflect adherence to healthy eating recommendations, evaluate the construct validity of the index using nutrient intakes, and evaluate this index in relation to sociodemographic factors, health behaviors, risk factors, and self-assessed health status. Data were analyzed from adult participants of the Australian National Nutrition Survey who completed a 108-item FFQ and a food habits questionnaire (n = 8220). The dietary guideline index (DGI) consisted of 15 items reflecting the dietary guidelines, including dietary indicators of vegetables and legumes, fruit, total cereals, meat and alternatives, total dairy, beverages, sodium, saturated fat, alcoholic beverages, and added sugars. Diet quality was incorporated using indicators relating to whole-grain cereals, lean meat, reduced/low fat dairy, and dietary variety. We investigated associations between the DGI score, sociodemographic factors, health behaviors, chronic disease risk factors, and nutrient intakes. We found associations between the DGI scores and sex, age, income, area-level socioeconomic disadvantage, smoking, physical activity, waist:hip ratio, systolic blood pressure (males only), and self-assessed health status (females only) (all P < 0.05). Higher DGI scores were associated with lower intakes of energy, total fat, and saturated fat and higher intakes of fiber, β-carotene, vitamin C, folate, calcium, and iron (P < 0.05). This food-based dietary index is able to discriminate across a variety of sociodemographic factors, health behaviors, and self-assessed health and reflects intakes of key nutrients.

Investigative interviewers' perceptions of the value of different training Tasks on their adherence to open-ended questions with children

Prior research has highlighted the considerable difficulties investigative interviewers have in adhering to open-ended questions in child abuse interviews. Although improvements in interviewing can be achieved by providing training that incorporates multiple practice opportunities and feedback, currently little is known about the way in which these elements are best administered. The current study extends debate and research on this issue by examining the perceptions of 15 trainee interviewers (police as well as social workers) regarding the relative value of various practical training exercises experienced in a recent training program. The findings indicated that although practice in interviewing was deemed essential, not all tasks were perceived to be equally beneficial. The two most favoured exercises were (a) simulated interviews involving trained actors playing the role of the child, and (b) self-evaluation of a transcribed interview using an objective coding protocol. A summary of the participants' perceptions is provided along with a discussion of the implications for trainers and researchers.

The effect of intellectual disability on the adherence of child witnesses to a “story grammar” framework

BackgroundThis study examined the ability of 78 children (aged 9–12 years) with an intellectual disability (ID) to provide a narrative account of a staged event they had participated in four days earlier.
MethodThe children were interviewed using open‐ended questions. The quality of their responses (using a story grammar framework) was compared with that of two control groups: mainstream children matched for mental and chronological age.
ResultsWhile the children with an ID and those matched for mental age provided narratives of similar length and used similar proportions of each story grammar element, the ID group was less likely than both control groups to provide a narrative account at all. Among those children with an ID who did provide a narrative account, their accounts included proportionately fewer story grammar elements than those of both control groups.
ConclusionChildren with an ID are disadvantaged as witnesses with respect to their ability to provide a detailed and coherent narrative account of events under optimal investigative interviewing conditions.

A guideline for the nursing assessment and management of urinary retention in elderly hospitalised patients

The objective of this project was to develop a guideline for the nursing assessment and management of urinary retention in hospitalised older adults. The guideline was developed from a review of the literature and from consultation with a multidisciplinary expert panel. These experts provided feedback through a structured process known as the Delphi technique. Based on findings from both sources, a final guideline was developed which provides a framework for the nursing assessment and management of urinary retention in hospitalised older adults. This foundational work provides the basis for further research and evaluation of the management of urinary retention.

Guideline for the non-surgical management of hip and knee osteoarthritis

Introduction: Chronic disease is a major public health burden on Australian society. An increasing proportion of the population has risk factors for, or at least one, chronic disease, leading to increasing public health costs. Health service policy and delivery must not only address acute conditions, it must also effectively respond to the wide range of health and public service requirements of people with chronic illness.^1,2 Strong primary health care policy is an important foundation for a successful national health delivery system and long term management of public health, and is linked to practical outcomes including lower mortality, decreased hospitalisation and improved health outcomes.¹ National strategic health policy has recently given increased recognition to the importance of chronic disease management, with the Australian Federal Government endorsement of a number of initiatives for the prevention (or delay in onset), early detection and evidence based management of chronic disease, including osteoarthritis.^1,3
Chronic musculoskeletal conditions, including arthritis, account for over 4% of the national disease burden in terms of disability adjusted life years. Over 6 million Australians (almost one-third of the population) are estimated to have a chronic musculoskeletal disease; chronic musculoskeletal disease represents the main cause of long term pain and physical disability. In Australia, osteoarthritis is self reported by more than 1.4 million people (7.3% of the population4) and is the tenth most commonly managed problem in general practice.5 This number is set to rise as the elderly population grows. Osteoarthritis exerts a significant burden on the individual and the community through reduction in quality of life, diminished employment capacity and an increase in health care costs. For further details, refer to the Evidence to support the National Action Plan for Osteoarthritis, Rheumatoid Arthritis and Osteoporosis: Opportunities to improve health-related quality of life and reduce the burden of disease and disability (2004).⁶
As such, federal government health policy has identified arthritis as a National Health Priority Area and adopted a number of initiatives aimed at decreasing the burden of chronic disease and disability; raising awareness of preventive disease factors; providing access to evidence based knowledge; and improving the overall management of arthritis within the community.4 In 2002, all Australian health ministers designated arthritis and musculoskeletal conditions as Australia’s seventh National Health Priority Area. In response, a National Action Plan was developed in 2004 by the National Arthritis and Musculoskeletal Conditions Advisory Group (NAMSCAG).6 The aim of this document was to provide a blueprint for national initiatives to improve the health related quality of life of people living with osteoarthritis, rheumatoid arthritis and osteoporosis; reduce the cost and prevalence of these conditions; and reduce the impact on individuals, their carers and their communities within Australia. The National Action Plan was developed to complement both the National Chronic Disease Strategy – which is broader – and the National Service Improvement Framework for Osteoarthritis, Rheumatoid Arthritis and Osteoporosis, in addition to other national and state/ territory structures.

Relationship of heart failure patients' knowledge, perceived barriers, and attitudes regarding low-sodium diet recommendations to adherence.

The purposes of this study were to describe heart failure patient perceptions regarding instructions received for following a low-sodium diet and the benefits, barriers, and ease and frequency of following the diet. A total of 246 patients with heart failure referred from academic medical centers in the United States and Australia participated in the study. A subset of 145 patients provided 24-hour urine samples for sodium excretion assessment. While most (80%) patients reported receiving recommendations to follow a low-sodium diet, their recall of specific instructions was poor. Although the majority (75%) reported following a low-sodium diet most or all of the time, 24-hour urine sodium excretion indicated that only 25% of patients were adherent. Patients who reported being more adherent, however, had lower urine sodium excretion levels. Attitudes regarding difficulty in and perceived benefits of following the diet were not related to sodium excretion. Data on attitudes and barriers provided guidance for strategies to improve adherence.

The relationship between job status, interviewing experience, gender, and police officers' adherence to open-ended questions

Purpose : The current study examined whether several factors related to the job and demographic profile of police officers are associated with adherence to best-practice guidelines when interviewing children.

Method : One hundred and seventy-eight police officers completed a standardized (simulated) interview regarding an allegation of abuse by a 5-year-old child. Immediately prior to this interview, details were obtained from the officers' regarding their job status, gender, interview experience, the timing and nature of prior training/supervision, and experience outside the policing profession with young children.

Results : The results showed that timing of training was the only factor that related to interview performance. The proportion of open-ended questions among participants who completed their interviewer training course less than 1 month prior to the simulated interview was better than those who completed the training earlier. Interestingly, the performance of the latter group was identical to that of a group of participants who had not yet received any formal interview training. The implications of the findings are discussed, along with directions for future research.