A parallel-group, randomised controlled trial of a multimedia, self-directed, coping skills training intervention for patients with cancer and their partners: design and rationale

Introduction:

A health promotion intervention can affect diet quality in early childhood

Initiatives to promote children’s nutrition and prevent childhood obesity are vital. Dietary patterns are a useful way to characterize whole diets, though no previous early childhood health promotion trial has assessed intervention impact using this approach. This research aimed to assess the effect on young children’s dietary patterns of a healthy eating and physical activity intervention. The Melbourne Infant Feeding Activity and Nutrition Trial (InFANT) Program was a health promotion cluster-randomized controlled trial involving 542 families. Child diets were assessed by multiple 24-hour recalls post-intervention, at approximately 18 months of age. An Obesity Protective Dietary Index was created, and dietary patterns were also assessed by principal components analysis. These outcomes were used to compare intervention and control participants to test the effectiveness of the intervention. Children in the intervention arm scored significantly higher (15.6 ± 5.9) than those in the control arm (14.5 ± 6.7) for the Obesity Protective Dietary Index (scores out of 30, p=0.01). Three dietary patterns were identified by principal components analysis, however, scores were not significantly different between intervention and control arms. In conclusion, this paper presents novel results in both the evaluation of an early childhood health promotion intervention and in the assessment of child dietary patterns. The results highlight the capacity for such an initiative to improve child diets, and the need for further research in this area.

The impact of a brief lifestyle intervention delivered by generalist community nurses (CN SNap trial)

Background
The risk factors for chronic disease, smoking, poor nutrition, hazardous alcohol consumption, physical inactivity and weight (SNAPW) are common in primary health care (PHC) affording opportunity for preventive interventions. Community nurses are an important component of PHC in Australia. However there has been little research evaluating the effectiveness of lifestyle interventions in routine community nursing practice. This study aimed to address this gap in our knowledge.

Methods
The study was a quasi-experimental trial involving four generalist community nursing (CN) services in New South Wales, Australia. Two services were randomly allocated to an ‘early intervention’ and two to a ‘late intervention’ group. Nurses in the early intervention group received training and support in identifying risk factors and offering brief lifestyle intervention for clients. Those in the late intervention group provided usual care for the first 6 months and then received training. Clients aged 30–80 years who were referred to the services between September 2009 and September 2010 were recruited prior to being seen by the nurse and baseline self-reported data collected. Data on their SNAPW risk factors, readiness to change these behaviours and advice and referral received about their risk factors in the previous 3 months were collected at baseline, 3 and 6 months. Analysis compared changes using univariate and multilevel regression techniques.

Results
804 participants were recruited from 2361 (34.1%) eligible clients. The proportion of clients who recalled receiving dietary or physical activity advice increased between baseline and 3 months in the early intervention group (from 12.9 to 23.3% and 12.3 to 19.1% respectively) as did the proportion who recalled being referred for dietary or physical activity interventions (from 9.5 to 15.6% and 5.8 to 21.0% respectively). There was no change in the late intervention group. There a shift towards greater readiness to change in those who were physically inactive in the early but not the comparison group. Clients in both groups reported being more physically active and eating more fruit and vegetables but there were no significant differences between groups at 6 months.

Conclusion
The study demonstrated that although the intervention was associated with increases in advice and referral for diet or physical activity and readiness for change in physical activity, this did not translate into significant changes in lifestyle behaviours or weight. This suggests a need to facilitate referral to more intensive long-term interventions for clients with risk factors identified by primary health care nurses.

Policy and practice impacts of applied research: a case study analysis of the New South Wales Health Promotion Demonstration Research Grants Scheme 2000-2006

Background
Intervention research provides important information regarding feasible and effective interventions for health policy makers, but few empirical studies have explored the mechanisms by which these studies influence policy and practice. This study provides an exploratory case series analysis of the policy, practice and other related impacts of the 15 research projects funded through the New South Wales Health Promotion Demonstration Research Grants Scheme during the period 2000 to 2006, and explored the factors mediating impacts.

Methods
Data collection included semi-structured interviews with the chief investigators (n = 17) and end-users (n = 29) of each of the 15 projects to explore if, how and under what circumstances the findings had been used, as well as bibliometric analysis and verification using documentary evidence. Data analysis involved thematic coding of interview data and triangulation with other data sources to produce case summaries of impacts for each project. Case summaries were then individually assessed against four impact criteria and discussed at a verification panel meeting where final group assessments of the impact of research projects were made and key influences of research impact identified.

Results
Funded projects had variable impacts on policy and practice. Project findings were used for agenda setting (raising awareness of issues), identifying areas and target groups for interventions, informing new policies, and supporting and justifying existing policies and programs across sectors. Reported factors influencing the use of findings were: i) nature of the intervention; ii) leadership and champions; iii) research quality; iv) effective partnerships; v) dissemination strategies used; and, vi) contextual factors.

Conclusions
The case series analysis provides new insights into how and under what circumstances intervention research is used to influence real world policy and practice. The findings highlight that intervention research projects can achieve the greatest policy and practice impacts if they address proximal needs of the policy context by engaging end-users from the inception of projects and utilizing existing policy networks and structures, and using a range of strategies to disseminate findings that go beond traditional peer review publications.

ICT Interventions for Schoolgirls Do Matter! Understanding the Factors Influencing ICT Career Intentions through Partial Least Squares Analysis.

Intervention programs aimed at promoting study and work opportunities in the Information and Communications Technology (ICT) field to schoolgirls (Interventions) have been encouraged to combat a decline in the interest among girls to study ICT at school. The goal of our study is to investigate the influence of Interventions on schoolgirls’ intentions to choose a career in the ICT field by analysing the  comprehensive survey data (n = 3577), collected during four interventions in Australia, using the Partial Least Squares method. Our study is also aimed at identifying other factors influencing ICT career intentions. We found that the attitude towards interventions has an indirect influence on ICT career intentions by affecting interest in ICT. Our results also challenge several existing theoretical studies by showing that factors that had previously been suggested as influencers were found to have little or no impact in this study, these being same-sex education and computer usage.

Fundamental Movement Skill Interventions in Youth: A Systematic Review and Meta-analysis

BACKGROUND
Fundamental movement skill (FMS) proficiency is positively associated with physical activity and fitness levels. The objective of this study was to systematically review evidence for the benefits of FMS interventions targeting youth.

METHODS
A search with no date restrictions was conducted across 7 databases. Studies included any school-, home-, or community-based intervention for typically developing youth with clear intent to improve FMS proficiency and that reported statistical analysis of FMS competence at both preintervention and at least 1 other postintervention time point. Study designs included randomized controlled trials (RCTs) using experimental and quasi-experimental designs and single group pre-post trials. Risk of bias was independently assessed by 2 reviewers.

RESULTS
Twenty-two articles (6 RCTs, 13 quasi-experimental trials, 3 pre-post trials) describing 19 interventions were included. All but 1 intervention were evaluated in primary/elementary schools. All studies reported significant intervention effects for ≥1 FMS. Meta-analyses revealed large effect sizes for overall gross motor proficiency (standardized mean difference [SMD] = 1.42, 95% confidence interval [CI] 0.68–2.16, Z = 3.77, P < .0002) and locomotor skill competency (SMD = 1.42, 95% CI 0.56–2.27, Z = 3.25, P = .001). A medium effect size for object control skill competency was observed (SMD = 0.63, 95% CI 0.28–0.98, Z = 3.53, P = .0004). Many studies scored poorly for risk of bias items.

CONCLUSIONS
School- and community-based programs that include developmentally appropriate FMS learning experiences delivered by physical education specialists or highly trained classroom teachers significantly improve FMS proficiency in youth.

Psychosocial working conditions in a representative sample of working Australians 2001–2008: an analysis of changes in inequalities over time

Background A number of widely prevalent job stressors have been identified as modifiable risk factors for common mental and physical illnesses such as depression and cardiovascular disease, yet there has been relatively little study of population trends in exposure to job stressors over time. The aims of this paper were to assess: (1) overall time trends in job control and security and (2) whether disparities by sex, age, skill level and employment arrangement were changing over time in the Australian working population. Methods Job control and security were measured in eight annual waves (2000–2008) from the Australian nationally-representative Household Income and Labour Dynamics of Australia panel survey (n=13 188 unique individuals for control and n=13 182 for security). Observed and model-predicted time trends were generated. Models were generated using population-averaged longitudinal linear regression, with year fitted categorically. Changes in disparities over time by sex, age group, skill level and employment arrangement were tested as interactions between each of these stratifying variables and time. Results While significant disparities persisted for disadvantaged compared with advantaged groups, results suggested that inequalities in job control narrowed among young workers compared with older groups and for casual, fixed-term and self-employed compared with permanent workers. A slight narrowing of disparities over time in job security was noted for gender, age, employment arrangement and occupational skill level. Conclusions Despite the favourable findings of small reductions in disparities in job control and security, significant cross-sectional disparities persist. Policy and practice intervention to improve psychosocial working conditions for disadvantaged groups could reduce these persisting disparities and associated illness burdens.

The effect of an early childhood obesity intervention on father's obesity risk behaviors: the Melbourne InFANT program

Background
To investigate the effect of an early childhood obesity prevention intervention, incorporating a parent modelling component, on fathers’ obesity risk-related behaviours.

Methods
Cluster randomized-controlled trial in the setting of pre-existing first-time parents groups organised by Maternal and Child Health Nurses in Victoria, Australia. Participants were 460 first-time fathers mean age = 34.2 (s.d.4.90) years. Dietary pattern scores of fathers were derived using principal component analysis, total physical activity and total television viewing time were assessed at baseline (infant aged three to four months) and after 15 months.

Results
No significant beneficial intervention effect was observed on fathers’ dietary pattern scores, total physical activity or total television viewing time.

Conclusion
Despite a strong focus on parent modelling (targeting parents own diet, physical activity and television viewing behaviours), and beneficial impact on mothers’ obesity risk behaviours, this intervention, with mothers as the point of contact, had no effect on fathers’ obesity risk-related behaviours. Based on the established links between children’s obesity risk-related behaviors and that of their fathers, a need exists for research testing the effectiveness of interventions with a stronger engagement of fathers.

Cost-effectiveness of reducing salt intake in the Pacific Islands: protocol for a before and after intervention study

Background
There is broad consensus that diets high in salt are bad for health and that reducing salt intake is a cost-effective strategy for preventing chronic diseases. The World Health Organization has been supporting the development of salt reduction strategies in the Pacific Islands where salt intakes are thought to be high. However, there are no accurate measures of salt intake in these countries. The aims of this project are to establish baseline levels of salt intake in two Pacific Island countries, implement multi-pronged, cross-sectoral salt reduction programs in both, and determine the effects and cost-effectiveness of the intervention strategies.

Methods/Design
Intervention effectiveness will be assessed from cross-sectional surveys before and after population-based salt reduction interventions in Fiji and Samoa. Baseline surveys began in July 2012 and follow-up surveys will be completed by July 2015 after a 2-year intervention period.

A three-stage stratified cluster random sampling strategy will be used for the population surveys, building on existing government surveys in each country. Data on salt intake, salt levels in foods and sources of dietary salt measured at baseline will be combined with an in-depth qualitative analysis of stakeholder views to develop and implement targeted interventions to reduce salt intake.

Discussion
Salt reduction is a global priority and all Member States of the World Health Organization have agreed on a target to reduce salt intake by 30% by 2025, as part of the global action plan to reduce the burden of non-communicable diseases. The study described by this protocol will be the first to provide a robust assessment of salt intake and the impact of salt reduction interventions in the Pacific Islands. As such, it will inform the development of strategies for other Pacific Island countries and comparable low and middle-income settings around the world.

A qualitative evaluation of online chat groups for women completing a psychological intervention for female sexual dysfunction

Because of the embarrassment that can surround female sexual dysfunctions, online interventions offer an anonymous and private treatment alternative. Recently, an online cognitive-behavioral treatment for female sexual dysfunctions was evaluated. Although significant improvements were observed in sexual functioning, the treatment was primarily a behavioral intervention because of difficulties with engaging participants in cognitive therapy over e-mail. To address this limitation, the use of chat groups was incorporated into a new online treatment for female sexual dysfunctions—the PursuingPleasure program. Thirty-eight women participated in the PursuingPleasure chat groups. The goals of the chat groups were to address and overcome challenges as women progressed through PursuingPleasure and to create a social support network where group therapy processes could be used. The chat groups aimed to address misunderstandings, monitor changes, and receive feedback. A qualitative analysis of the chat groups revealed that they helped to facilitate the cognitive-affective aspects of the program, as well as fulfill their other intended functions. This study demonstrates how the use of chat groups in the online treatment of female sexual dysfunctions is a useful addition to Internet-based treatment. Feedback suggests that the chat groups were one of the most helpful aspects of the program, although a small group of women reported finding the groups unhelpful.

Assessing and intervening on OSH programmes : effectiveness evaluation of the Wellworks-2 intervention in 15 manufacturing worksites

To develop a transparent and broadly applicable method for assessing occupational safety and health (OSH) programmes or management systems; (2) to assess OSH programmes in a sample of manufacturing worksites; and (3) to determine whether a management focused occupational health intervention results in greater improvement in OSH programmes compared to minimal intervention controls. OSH programmes were assessed using an adaptation of the US Occupational Safety & Health Administration's 1995 Program Evaluation Profile. Scores were generated from 91 binary indicator variables grouped under four "Essential Elements". Essential Element scores were weighted to contribute to an overall programme score on a 100 point scale. Seventeen large manufacturing worksites were assessed at baseline; 15 sites completed the 16 month intervention and follow up assessments. There was considerable variation in Essential Element scores across sites at baseline as judged by our instrument, particularly in "management commitment and employee participation" and "workplace analysis". Most sites scored highly on "hazard prevention and control" and "training and education". For overall OSH programme scores, most sites scored in the 60-80% range at baseline, with four sites scoring below 60%, suggesting weak programmes. Intervention sites showed greater improvements than controls in the four programme elements and in overall programme scores, with significantly greater improvements in "management commitment and employee participation". The OSH programme assessment method used is broadly applicable to manufacturing work settings, and baseline profiles suggest needs for improvement in OSH programmes in most such worksites. Despite a small sample size, results showed that sustained management focused intervention can result in improvement in these OSH programme measures.

A meta-analysis of the effects of measuring theory of planned behaviour constructs on behaviour within prospective studies

Measurement reactivity effects, such as the mere measurement effect, have been proposed as a reason for behavioural changes in a number of theory of planned behaviour intervention studies. However, it is unclear whether such changes are the result of the mere measurement effect or of other artefacts of intervention study design. The aim of this study is to determine the size and direction of changes in health behaviours from baseline to follow-up in prospective studies using the theory of planned behaviour. Electronic databases were searched for the theory of planned behaviour studies which measured health behaviours at two or more time points. Change in behaviour was calculated for all studies. Sixty-six studies were included. Mean effect sizes across all studies were small and negative (d = -.03). Effect size was moderated by behaviour, behaviour type and follow-up length. Subgroup analyses showed significant decreases in socially undesirable behaviour (d = -.28), binge drinking (d = -.17), risk driving (d = -.20), sugar snack consumption (d = -.43) and sun-protective behaviour (d = -.18). Measurement of intention at baseline resulted in significant decreases in undesirable behaviour. Changes in undesirable behaviours reported in other studies may be the result of the mere measurement effect.

A qualitative evaluation of an intervention for parents of adolescents with mental disorders: the parenting challenging adolescents seminar

This qualitative study describes parents’ responses to a targeted and brief educational seminar (known as ‘Parenting Challenging Adolescents’), and provides recommendations for brief parenting interventions designed to engage adolescents in mental health treatment. The 2-h intervention was designed to assist parents who were concerned about their adolescents and in the identification of mental disorders. Participants were invited to attend the seminars conducted in a community setting on the basis of local advertising and promotion of the event with community health services and schools. Any parent of a young person aged 12–25 interested in the seminar material was eligible to attend. Sixteen parents completed measures of parent and youth mental health and family satisfaction and were also interviewed using semi-structured telephone interviews 4 weeks after the seminar. Interpretational phenomenological analysis of interviews suggested that most parents valued the chance to connect with others in similar situations and appreciated knowing about local services available for mental health disorders. Many parents also reported positive changes to communication and family dynamics following the seminar. Another common theme was an increased knowledge of mental disorders and appropriate treatments, along with the desire to receive more specific, targeted information. Overall the findings suggest that even a single session of educational material designed for parents may be useful, engaging and potentially encourage improved service usage for adolescents with mental disorders.

Adipokines as emerging depression biomarkers: a systematic review and meta-analysis

Adiponectin, leptin and resistin may play a role in the pathophysiology of major depressive disorder (MDD). However, differences in peripheral levels of these hormones are inconsistent across diagnostic and intervention studies. Therefore, we performed meta-analyses of diagnostic studies (i.e., MDD subjects versus healthy controls) and intervention investigations (i.e., pre-vs. post-antidepressant treatment) in MDD. Adiponectin (N=1278; Hedge's g=-0.35; P=0.16) and leptin (N=893; Hedge's g=-0.018; P=0.93) did not differ across diagnostic studies. Meta-regression analyses revealed that gender and depression severity explained the heterogeneity observed in adiponectin diagnostic studies, while BMI and the difference in BMI between MDD individuals and controls explained the heterogeneity of leptin diagnostic studies. Subgroup analyses revealed that adiponectin peripheral levels were significantly lower in MDD participants compared to controls when assayed with RIA, but not ELISA. Leptin levels were significantly higher in individuals with mild/moderate depression versus controls. Resistin serum levels were lower in MDD individuals compared to healthy controls (N=298; Hedge's g=-0.25; P=0.03). Leptin serum levels did not change after antidepressant treatment. However, heterogeneity was significant and sample size was low (N=108); consequently meta-regression analysis could not be performed. Intervention meta-analyses could not be performed for adiponectin and resistin (i.e., few studies met inclusion criteria). In conclusion, this systematic review and meta-analysis underscored that relevant moderators/confounders (e.g., BMI, depression severity and type of assay) should be controlled for when considering the role of leptin and adiponectin as putative MDD diagnostic biomarkers.

A multifaceted pharmacist intervention to improve antihypertensive adherence: a cluster-randomized, controlled trial (HAPPy trial)

About half of all patients taking antihypertensives discontinue treatment by 12 months. There is potential for substantial health gains at both individual and population levels through improved treatment adherence. The objective was to evaluate a community pharmacist intervention to improve adherence with antihypertensive medicines with a view to improving blood pressure (BP) control.