Cardiovascular disease self-management: pilot testing of an mHealth healthy eating program

Cardiac rehabilitation (CR) is crucial in the management of cardiovascular disease (CVD), yet attendance is poor. Mobile technology (mHealth) offers a potential solution to increase reach of CR. This paper presents two development studies to determine mobile phone usage in adults with CVD and to evaluate the acceptability of an mHealth healthy eating CR program. Methods: CR attendees were surveyed to determine mobile phone usage rates. A second single-subject pilot study investigated perceptions of a 4-week theory-based healthy eating mHealth program and explored pre-post changes in self-efficacy. Results: 74 adults with CVD completed the survey (50/74 male; mean age 63 ± 10). Nearly all had mobile phones (70/74; 95%) and used the Internet (69/74; 93%), and most were interested in receiving CR by text message (57/74; 77%). 20 participants took part in the healthy eating pilot study. Participants read all/most of the text messages, and most (19/20) thought using mobile technology was a good way to deliver the program. The website was not widely used as visiting the website was reported to be time consuming. Exploratory t-tests revealed an increase in heart healthy eating self-efficacy post program, in particular the environmental self-efficacy subset (Mean = 0.62, SD = 0.74, p = 0.001). Conclusions: Text messaging was seen as a simple and acceptable way to deliver nutrition information and behavior change strategies; however, future research is needed to determine the effectiveness of such programs.

Brief reminiscence activities improve state well-being and self-concept in young adults: a randomised controlled experiment

Reminiscence-based psychotherapies have been demonstrated to have robust effects on a range of therapeutic outcomes. However, little research has been conducted on the immediate effects of guided activities they are composed of, or how these might differ dependent on the type of reminiscence. The current study utilised a controlled experimental design, whereby 321 young adults (mean age = 25.5 years, SD = 3.0) were randomised to one of four conditions of online reminiscence activity: problem-solving (successful coping experiences), identity (self-defining events contributing to a meaningful and continuous personal identity), bitterness revival (negative or adverse events), or a control condition (any memory from their past). Participants recalled autobiographical memories congruent with the condition, and answered questions to facilitate reflection on the memories. The results indicated that problem-solving and identity reminiscence activities caused significant improvements in self-esteem, meaning in life, self-efficacy and affect, whereas no effects were found in the bitterness revival and control conditions. Problem-solving reminiscence also caused a small effect in increasing perceptions of a life narrative/s. Differences between the conditions did not appear to be explained by the positive-valence of memories. These results provide evidence for the specific effects of adaptive types of problem-solving and identity reminiscence in young adults.

Text message and internet support for coronary heart disease self-management: results from the text4heart randomized controlled trial

BACKGROUND: Mobile technology has the potential to deliver behavior change interventions (mHealth) to reduce coronary heart disease (CHD) at modest cost. Previous studies have focused on single behaviors; however, cardiac rehabilitation (CR), a component of CHD self-management, needs to address multiple risk factors. OBJECTIVE: The aim was to investigate the effectiveness of a mHealth-delivered comprehensive CR program (Text4Heart) to improve adherence to recommended lifestyle behaviors (smoking cessation, physical activity, healthy diet, and nonharmful alcohol use) in addition to usual care (traditional CR). METHODS: A 2-arm, parallel, randomized controlled trial was conducted in New Zealand adults diagnosed with CHD. Participants were recruited in-hospital and were encouraged to attend center-based CR (usual care control). In addition, the intervention group received a personalized 24-week mHealth program, framed in social cognitive theory, sent by fully automated daily short message service (SMS) text messages and a supporting website. The primary outcome was adherence to healthy lifestyle behaviors measured using a self-reported composite health behavior score (≥3) at 3 and 6 months. Secondary outcomes included clinical outcomes, medication adherence score, self-efficacy, illness perceptions, and anxiety and/or depression at 6 months. Baseline and 6-month follow-up assessments (unblinded) were conducted in person. RESULTS: Eligible patients (N=123) recruited from 2 large metropolitan hospitals were randomized to the intervention (n=61) or the control (n=62) group. Participants were predominantly male (100/123, 81.3%), New Zealand European (73/123, 59.3%), with a mean age of 59.5 (SD 11.1) years. A significant treatment effect in favor of the intervention was observed for the primary outcome at 3 months (AOR 2.55, 95% CI 1.12-5.84; P=.03), but not at 6 months (AOR 1.93, 95% CI 0.83-4.53; P=.13). The intervention group reported significantly greater medication adherence score (mean difference: 0.58, 95% CI 0.19-0.97; P=.004). The majority of intervention participants reported reading all their text messages (52/61, 85%). The number of visits to the website per person ranged from zero to 100 (median 3) over the 6-month intervention period. CONCLUSIONS: A mHealth CR intervention plus usual care showed a positive effect on adherence to multiple lifestyle behavior changes at 3 months in New Zealand adults with CHD compared to usual care alone. The effect was not sustained to the end of the 6-month intervention. A larger study is needed to determine the size of the effect in the longer term and whether the change in behavior reduces adverse cardiovascular events. TRIAL REGISTRATION: ACTRN 12613000901707; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=364758&isReview=true (Archived by WebCite at http://www.webcitation.org/6c4qhcHKt).

Improving coronary heart disease self-management using mobile technologies (Text4Heart): a randomised controlled trial protocol

BACKGROUND: Cardiac rehabilitation (CR) is a secondary prevention program that offers education and support to assist patients with coronary heart disease (CHD) make lifestyle changes. Despite the benefits of CR, attendance at centre-based sessions remains low. Mobile technology (mHealth) has potential to reach more patients by delivering CR directly to mobile phones, thus providing an alternative to centre-based CR. The aim of this trial is to evaluate if a mHealth comprehensive CR program can improve adherence to healthy lifestyle behaviours (for example, physically active, fruit and vegetable intake, not smoking, low alcohol consumption) over and above usual CR services in New Zealand adults diagnosed with CHD.

METHODS/DESIGN: A two-arm, parallel, randomised controlled trial will be conducted at two Auckland hospitals in New Zealand. One hundred twenty participants will be randomised to receive a 24-week evidence- and theory-based personalised text message program and access to a supporting website in addition to usual CR care or usual CR care alone (control). The primary outcome is the proportion of participants adhering to healthy behaviours at 6 months, measured using a composite health behaviour score. Secondary outcomes include overall cardiovascular disease risk, body composition, illness perceptions, self-efficacy, hospital anxiety/depression and medication adherence.

DISCUSSION: This study is one of the first to examine an mHealth-delivered comprehensive CR program. Strengths of the trial include quality research design and in-depth description of the intervention to aid replication. If effective, the trial has potential to augment standard CR practices and to be used as a model for other disease prevention or self-management programs.

Text message-based diabetes self-management support (SMS4BG): study protocol for a randomised controlled trial.

BACKGROUND: Addressing the increasing prevalence, and associated disease burden, of diabetes is a priority of health services internationally. Interventions to support patients to effectively self-manage their condition have the potential to reduce the risk of costly and debilitating complications. The utilisation of mobile phones to deliver self-management support allows for patient-centred care at the frequency and intensity that patients desire from outside the clinic environment. Self-Management Support for Blood Glucose (SMS4BG) is a novel text message-based intervention for supporting people with diabetes to improve self-management behaviours and achieve better glycaemic control and is tailored to individual patient preferences, demographics, clinical characteristics, and culture. This study aims to assess whether SMS4BG can improve glycaemic control in adults with poorly controlled diabetes. This paper outlines the rationale and methods of the trial. METHODS/DESIGN: A two-arm, parallel, randomised controlled trial will be conducted across New Zealand health districts. One thousand participants will be randomised at a 1:1 ratio to receive SMS4BG, a theoretically based and individually tailored automated text message-based diabetes self-management support programme (intervention) in addition to usual care, or usual care alone (control). The primary outcome is change in glycaemic control (HbA1c) at 9 months. Secondary outcomes include glycaemic control at 3 and 6 months, self-efficacy, self-care behaviours, diabetes distress, health-related quality of life, perceived social support, and illness perceptions. Cost information and healthcare utilisation will also be collected as well as intervention satisfaction and interaction. DISCUSSION: This study will provide information on the effectiveness of a text message-based self-management support tool for people with diabetes. If found to be effective it has the potential to provide individualised support to people with diabetes across New Zealand (and internationally), thus extending care outside the clinic environment. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry: ACTRN12614001232628 .

Effects of message framing on breast-cancer-related beliefs and behaviours: the role of mediating factors

The effects of gain-loss message framing on breast-cancer-related cognitions and behaviors were assessed among 539 women aged 30 to 70 years. The design involved a prebrochure telephone interview, followed by a brochure mailout, and a postbrochure telephone interview. The brochures contained information about breast cancer and the risk of family history. Recommended behaviors were framed to emphasize gains, losses, or were neutral; and statistical risk information was presented either positively or negatively. Measures included demographics, family history, breast self-examination (BSE) performance, BSE intention, self-efficacy in performing BSE, perceived early detection risk of breast cancer, perceived susceptibility to breast cancer, and anxiety about breast cancer. A loss-framed message led to greater positive change in BSE behavior. Interactions between framing effects and variables of issue involvement, perceived early detection risk, and self-efficacy indicated effects on behavior, but not beliefs.

Gender stereotypes and drinking cognitions as indicators of moderate and high risk drinking among young women and men

The study examined differences in gender stereotypes, restrained drinking and self-efficacy for alcohol refusal between moderate and high risk drinkers among a university sample of 301 women and 118 men. Both female and male high risk drinkers displayed a response conflict, typified by high scores on restrained drinking but low scores on self-efficacy. This pattern of response conflict was more pronounced for high risk drinking women, who also identified poorly with feminine traits (e.g. ‘nurturing’, ‘love children’, ‘appreciative’). The findings are discussed in relation to society's double standard that accepts intoxication in men but condemns it in women.

An investigation of psychological, social and environmental correlates of obesity and weight gain in young women

Objectives: This study explored the biological, psychological, social and environmental correlates of young women's current weight and retrospective 2-year weight change. Methods: A total of 790 young women (mean age 26.8 years), sampled from the Australian Longitudinal Study on Women's Health, provided self-reported data on their height and weight, sociodemographics and a range of biological, psychological, social and environmental variables. Results: Several variables from all domains (biological, psychological, social support and environmental) were correlated with higher body mass index, and less strongly greater 2-year weight change. Key correlates included the tendency to never put on weight, no matter what; self-efficacy for avoiding weight gain, and for healthy eating; attention paid to weight; family support and friends' support/sabotage of physical activity/healthy eating; and perceived difficulty of taking the stairs rather than the elevator as part of the daily routine. Conclusions: Intervention strategies aimed at reducing weight gain and obesity may need to focus on social and environmental, as well as psychological factors; however, further research is necessary to confirm these findings given that a number of hypothesized associations were not observed.

Student and supervisor perspectives in a computer-mediated research relationship

A brief narrative description of the journal article, document, or resource. This paper presents the reflective perspectives of the student and supervisor in a successful computer-mediated research relationship at Deakin University (Australia). Key contributing factors are discussed in a dialog format covering the role of computer-mediated communication (CMC), the projection of social presence, student self-efficacy beliefs, the role of information and communication technology (ICT), and interaction in online professional networks. Drawing on relevant theory, inherent challenges are addressed, informing some concluding suggestions as to how supervision might become more responsive to the emergent forms of research learning being experienced by escalating numbers of postgraduate students studying at a distance via ICT.

A comparative analysis of personal values of international postgraduate students from Asia studying in Australian universities: a cross cultural study

The rising expectations of university students with regard to quality, service and value for money, and the growing diversity of student populations have challenged universities to become increasingly student focused. Marketing theory suggests that a clear understanding of customer needs and expectations is central to being customer focused and to facilitate targeting of products and services to appropriate segments. The process requires the marketer to have insights into the cultural backgrounds of customers where the study of personal values becomes a critical component in understanding consumer needs and preferences. The results of this study indicate that personal values are useful in explaining differences amongst the student cohorts with regard to age, gender and nationality. Recommendations are made with regard to developing the educational product for the international student, based on underlying value domains of Self-efficacy and Hedonism.

Dealing constructively with negatively evaluated emotional situations: the key to understanding the different reactions of teachers with high and low levels of emotional intelligence

Recent work on the distinctive features of emotions appraised as either negative or positive has links to the investigation of differences in levels of emotional intelligence. In a study with experienced teachers as participants, it was found that emotional reactions to positive or negative situations was moderated by level of emotional intelligence. The reactions to positively charged emotional situations involving students and peers were similar for teachers with high and low levels of emotional intelligence, although the low level group showed somewhat lower likelihood of making an “emotionally intelligent” response compared to the high level group. A much sharper contrast in response likelihood was found for negatively charged emotional situations involving students and peers. Teachers with high levels of emotional intelligence responded quite differently to those with low levels of emotional intelligence. The results indicate the prospect of clarifying a neglected area of exploration of differences in the likely behaviour of teachers differing in levels of emotional intelligence.

Personal, social and environmental determinants of educational inequalities in walking: a multilevel study

Objective: To investigate the contribution of personal, social and environmental factors to mediating socioeconomic (educational) inequalities in women’s leisure-time walking and walking for transport.
Methods: A community sample of 1282 women provided survey data on walking for leisure and transport; educational level; enjoyment of, and self-efficacy for, walking; physical activity barriers and intentions; social support for physical activity; sporting/recreational club membership; dog ownership; and perceived environmental aesthetics and safety. These data were linked with objective environmental data on the density of public open space and walking tracks in the women’s local neighbourhood, coastal proximity and street connectivity.
Results: Multilevel modelling showed that different personal, social and environmental factors were associated with walking for leisure and walking for transport. Variables from all three domains explained (mediated) educational inequalities in leisure-time walking, including neighbourhood walking tracks; coastal proximity; friends’ social support; dog ownership; self-efficacy, enjoyment and intentions. On the other hand, few of the variables examined explained educational variations in walking for transport, exceptions being neighbourhood, coastal proximity, street connectivity and social support from family.
Conclusions: Public health initiatives aimed at promoting, and reducing educational inequalities in, leisure-time walking should incorporate a focus on environmental strategies, such as advocating for neighbourhood walking tracks, as well as personal and social factors. Further investigation is required to better understand the pathways by which education might influence walking for transport.

Effectiveness of staff training programs to manage behavioural problems of dementia

Purpose : Behavioural problems among older people with dementia are a major concern in nursing homes. This study was designed to evaluate the effectiveness of staff training programs on both staff and residents.
Methodology : Two programs (standard dementia care, individualised behaviour therapy) were compared to a control condition. A total of 90 staff and 113 aged care residents participated in the study.
Findings: The results demonstrated an improvement in the self-efficacy of staff who received either training program at post-intervention, and at three- and six-month follow-up. Facility managers also rated an improvement in the performance of staff who received behaviour therapy at post-intervention and at follow-up. There were no changes in behaviours or quality of life for residents in any group.
Implications: Staff education programs may not assist in the management of behavioural symptoms of dementia, but can improve staff attitudes. Other explanations and suggestions for future research are discussed.

Health behaviors among individuals with schizophrenia and depression

This article presents findings from a study that evaluated the utility of Protection Motivation Theory to explain cardiovascular health behaviors among people with schizophrenia (n = 83) and depression (n = 70). Results indicated that the prevalence of overweight, cigarette smoking and a sedentary lifestyle were greater among people with a mental illness compared to individuals without a mental illness. Major predictors were high levels of fear of cardiovascular disease, lack of knowledge of correct dietary principles, lower self-efficacy, limited social support and psychiatric symptoms. Implications of these results are discussed in designing education and preventive health programs for individuals with schizophrenia and Mental Depressive Disorder (MDD).

Barriers to effective management of depression in general practice

Objective: The aim of this study was to investigate the effects of prior general practice training in mental health and practice location on general practitioner (GP) attitudes toward depression, self-confidence in assessing and treating depressed patients, identification of doctor, patient and practice barriers to the effective care of depressed patients in general medical practice and GP-reported current clinical practice.

Method: Fifty-two (out of 123) Divisions of General Practice that responded to an invitation to participate in the study distributed 608 anonymous surveys to a representative sample of GPs; 420 (69%) were returned. The questionnaire focused on current clinical practice, perceived barriers to care of depressed patients and doctors' self-efficacy for assessing and treating depressed patients. It also consisted of two scales, based upon previous research, designed to assess doctors' attitudes towards depression and depressed patients.

Results: General practitioners who had undertaken mental health education and training more often used non-pharmacological treatments (p = 0.00), as did female GPs (p = 0.00). Male GPs (p = 0.00) and those in rural settings (p = 0.01) more often prescribed medication for depression. Those without mental health training more often identified incomplete knowledge about depression as a barrier to its effective management (p = 0.00). Urban-based GPs (p = 0.04) and those with prior mental health training (p = 0.00) were more confident in the use of non-pharmacological treatments. Female GPs without mental health training were the least confident in the use of these methods (p = 0.01). Overall, GPs with mental health training were more positive in their attitudes toward depression and their treatment of these patients (p = 0.00). Female GPs appeared more positive in their attitudes toward depression than male GPs (p = 0.01), although the results were not entirely consistent.

Conclusions: Participation in mental health training by GPs appears to be related to their attitudes toward depressed patients and to their confidence and abilities to diagnose and manage the common mental disorders effectively.