Adoption and maintenance of gym-based strength training in the community setting in adults with excess weight or type 2 diabetes: a randomized controlled trial

BACKGROUND: Participant adoption and maintenance is a major challenge in strength training (ST) programs in the community-setting. In adults who were overweight or with type 2 diabetes (T2DM), the aim of this study was to compare the effectiveness of a standard ST program (SST) to an enhanced program (EST) on the adoption and maintenance of ST and cardio-metabolic risk factors and muscle strength. METHODS: A 12-month cluster-randomized controlled trial consisting of a 6-month adoption phase followed by a 6-month maintenance phase. In 2008-2009, men and women aged 40-75 years (n = 318) with T2DM (n = 117) or a BMI >25 (n = 201) who had not participated in ST previously were randomized into either a SST or an EST program (which included additional motivationally-tailored behavioral counselling). Adoption and maintenance were defined as undertaking ≥ 3 weekly gym-based exercise sessions during the first 6-months and from 6-12 months respectively and were assessed using a modified version of the CHAMPS (Community Healthy Activity Models Program for Seniors) instrument. RESULTS: Relative to the SST group, the adjusted odds ratio (OR) of adopting ST for all participants in the EST group was 3.3 (95 % CI 1.2 to 9.4). In stratified analyses including only those with T2DM, relative to the SST group, the adjusted OR of adopting ST in the EST group was 8.2 (95 % CI 1.5-45.5). No significant between-group differences were observed for maintenance of ST in either pooled or stratified analyses. In those with T2DM, there was a significant reduction in HbA1c in the EST compared to SST group during the adoption phase (net difference, -0.13 % [-0.26 to -0.01]), which persisted after 12-months (-0.17 % [-0.3 to -0.05]). CONCLUSIONS: A behaviorally-focused community-based EST intervention was more effective than a SST program for the adoption of ST in adults with excess weight or T2DM and led to greater improvements in glycemic control in those with T2DM. TRIAL REGISTRATION: Registered at ACTRN12611000695909 (Date registered 7/7/2011).

The work-based predictors of job engagement and job satisfaction experienced by community health professionals

Background: Job engagement represents a critical resource for community-based health care agencies to achieve high levels of effectiveness. However, studies examining the organisational sources of job engagement among health care professionals have generally overlooked those workers based in community settings.
Purpose: This study drew on the demand-control model, in addition to stressors that are more specific to community health services (e.g., unrewarding management practices), to identify conditions that are closely associated with the engagement experienced by a community health workforce. Job satisfaction was also included as a way of assessing how the predictors of job engagement differ from those associated with other job attitudes.
Methodology/Approach: Health and allied health care professionals (n = 516) from two
Australian community health services took part in the current investigation. Responses from the two organisations were pooled and analysed using linear multiple regression.
Findings: The analyses revealed that three working conditions were predictive of both job engagement and job satisfaction (i.e., job control, quantitative demands and unrewarding management practices). There was some evidence of differential effects with cognitive demands being associated with job engagement, but not job satisfaction.
Practice Implications: The results provide important insights into the working conditions that, if addressed, could play key roles in building a more engaged and satisfied community health workforce. Further, working conditions like job control and management practices are amenable to change and thus represent important areas where community health services could enhance the energetic and motivational resources of their employees.

Linking human and ecosystem health: the benefits of community involvement in conservation groups

This study explored the health, well-being, and social capital benefits gained by community members who are involved in the management of land for conservation in six rural communities across Victoria. A total of 102 people participated in the study (64 males; 38 females) comprising 51 members of a community-based land management group and 51 controls matched by age and gender. Mixed methods were employed, including the use of an adapted version of Buckner’s (1988) Community Cohesion Scale. The results indicate that involvement in the management of land for conservation may contribute to both the health and well-being of members, and to the social capital of the local community. The members of the land management groups rated their general health higher, reported visiting the doctor less often, felt safer in the local community, and utilized the skills that they have acquired in their lifetime more frequently than the control participants. Male members reported the highest level of general health, and the greatest satisfaction with daily activities. Members also reported a greater sense of belonging to the local community and a greater willingness to work toward improving their community than their control counterparts. Of equal importance is evidence that involvement in voluntary conservation work constitutes a means of building social capital in rural communities which may help reduce some of the negative aspects of rural life.

'Motor magic' : evaluation of a community capacity-building approach to supporting the development of preschool children (part 2)

Background and Aims: This paper is the second in a series of two that presents and discusses an exploratory evaluation study of the 'Motor Magic' program conducted in Adelaide, South Australia.

Methods: A realist evaluation approach was used, and two focus groups (one with parents and one with kindergarten staff) were held to identify program outcomes and to develop and refine key hypotheses about how these outcomes occurred.

Results and Conclusions: Results for kindergarten staff involved in the program are presented and discussed in this paper, including improved early identification and early intervention for children with, or at risk of, fine motor developmental difficulties; increased confidence in the effectiveness of their practice with these children; improved practice of kindergarten staff with both targeted and all children; improved empathy with, and support for, parents; and increased interagency links and ongoing advocacy for further resources. These results suggest that the program provides an effective model for building the capacity of kindergarten staff to support children with, or at risk of, developmental difficulties.

Addressing the potential adverse effects of school-based BMI assessments on children

Introduction. Do child obesity prevention research and intervention measures have the potential to generate adverse concerns about body image by focussing on food, physical activity and body weight? Research findings now demonstrate the emergence of body image concerns in children as young as 5 years. In the context of a large school-community-based child health promotion and obesity prevention study, we aimed to address the potential negative effects of height and weight measures on child wellbeing by developing and implementing an evidence-informed protocol to protect and prevent body image concerns. fun 'n healthy in Moreland! is a cluster randomised controlled trial of a child health promotion and obesity prevention intervention in 23 primary schools in an inner urban area of Melbourne, Australia. Body image considerations were incorporated into the study philosophies, aims, methods, staff training, language, data collection and reporting procedures of this study. This was informed by the published literature, professional body image expertise, pilot testing and implementation in the conduct of baseline data collection and the intervention. This study is the first record of a body image protection protocol being an integral part of the research processes of a child obesity prevention study. Whilst we are yet to measure its impact and outcome, we have developed and tested a protocol based on the evidence and with support from stakeholders in order to minimise the adverse impact of study processes on child body image concerns.

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.

Southeast Asia: a community of diversity

The region known as the Southeast provides the basis for a broad political community characterized by cultural and ethnic diversity, disparities in economic performance, and differences in regime and constitutional foundations. In recent years, the Association of Southeast Asian Nations (ASEAN) group of nations has made strides toward building a community based on respect for these differences. Despite a growing acceptance for democratic processes and human rights, the influence of these values over existing institutions and state behavior remains incomplete. The future development of the ASEAN region, and the nations that comprise it, is likely to be based on the strength and character of the relationships these states forge with one another and with more powerful external actors.

Exploring the feasibility and acceptability of using internet technology to promote physical activity within a defined community

ISSUE ADDRESSED: To explore the feasibility of using the Internet and e-mail to promote physical activity in a defined community.

METHODS: An online survey was conducted through a community-based Internet Service Provider (ISP). ISP clients were recruited via electronic newsletter and direct e-mail. Data were collected on preferred sources of assistance for physical activity advice and stage of motivational readiness for physical activity.

RESULTS: Valid surveys were completed by 797 (9% response rate). Participants were: 55% men; 56% aged >45 years; 57% worked full time; mean BMI was 28+/-8. Thirty-six per cent were in the early stages of motivational readiness for physical activity. More than 70% were somewhat to extremely interested in having access to a physical activity website.

CONCLUSION: Promoting physical activity via the Internet and e-mail is feasible and appealing to some people. Expanding the reach, appeal and use of this technology to deliver physical activity programs will be a challenge.

The overt behaviour scale (OBS): a tool for measuring challenging behaviours following ABI in community settings

OBJECTIVES: The Overt Behaviour Scale (OBS) was designed as a comprehensive measure of common challenging behaviours observed after acquired brain injury (ABI) in community settings. The OBS comprises 34 items in nine categories that measure aggression, inappropriate sexual behaviour, perseveration, wandering, inappropriate social behaviour and lack of initiation. The aim of the current study was to determine the reliability, validity and responsiveness of the OBS. METHOD: Two adult community-based samples of people with ABI were recruited. Sample 1 (n= 30) were concurrently evaluated on the OBS by two raters and again 1 week later to test stability. Other validating scales were also administered. Sample 2 (n= 28) were clients of the ABI Behaviour Consultancy who were treated for challenging behaviours and were administered the OBS before treatment commenced and then again 4 months later. RESULTS: Inter-rater reliability and stability coefficients for the OBS total score was strong (0.97 and 0.77, respectively). Initial evidence of convergent and divergent validity was shown by the differential pattern of correlations with other measures. Moderate-to-strong coefficients (range 0.37-0.66) were observed between the OBS and other measures that had behavioural content (i.e. Mayo-Portland Adaptability Inventory, Current Behaviour Scale, Neurobehavioural Rating Scale-Revised). Divergent validity was shown by the lack of correlation between the OBS and the sub-scales of these tools that do not measure challenging behaviour. Finally, responsiveness was demonstrated with a significant decrease in OBS scores in the expected direction over the 4-month period. This improvement was confirmed by corroborating evidence from key informants. CONCLUSION: The OBS shows promise as a reliable, valid and responsive measure that can be used for the systematic assessment of challenging behaviours in community settings.

Better-practice approaches for culture-based fisheries development in Asia

"Culture based fisheries are an effective way of increasing supplies of fish in rural areas. Farmers with relatively little experience in fish culture can productively engage, manage and benefit from culture based fisheries around lakes and reservoirs. This manual will provide guidance to development workers and program planners for integrating community based fisheries into rural development plans"--ACIAR website.

Community group volunteer perceptions and awareness of Victorian marine protected areas

In 2004, a Community Based Monitoring (CBM) program for Victoria’s Marine National Parks and Marine Sanctuaries was developed. A key performance area for Victoria’s Marine Protected Area (MPA) Management Strategy is community engagement. This program was developed to incorporate the key performance principles of community education, participation and engagement. CBM involves scientific protocols to monitor different habitat types in a MPA. As part of the CBM project, perceptions and values of MPAs were investigated through a pilot survey of 125 community group volunteers from 4 volunteer groups. Surveys were sent to all community group members which included participants and non-participants in the CBM program. Questions sought qualitative and quantitative information, focusing on personal values of MPAs. The surveys included questions associated with CBM, MPA management and environmental issues affecting the marine environment. Responses from the pilot study indicated that 50% of the volunteers participated in CBM to learn more about scientific research, and 30% wanted to work close to nature. This pilot study will form the basis of a larger-scale study to investigate community group perceptions of MPAs and identifying how to maintain volunteer enthusiasm, interest and motivation in a CBM program.

Challenging behaviour profiles of people with acquired brain injury living in community settings

Primary objective: To determine the type and severity of challenging behaviours among a cohort of brain-injured persons referred to a community-based behaviour management service; and to determine whether different behaviour profiles were associated with aetiology of brain injury.
Methods and procedures: A sample of clients (n= 190) referred to the ABI Behaviour Consultancy for assessment and treatment of challenging behaviours was evaluated using the Overt Behaviour Scale (OBS) and other measures of disability and support needs.
Main outcomes and results: The most common challenging behaviour categories were, in order of frequency: verbal aggression, inappropriate social behaviours and lack of initiation. Clients typically exhibited four categories of challenging behaviour and multiple kinds of the behaviours represented by each category. There was some evidence of differences in occurrence of specific behaviours associated with aetiology of brain injury, particularly for hypoxia and alcohol-related brain injury.
Conclusions: A systematic assessment of challenging behaviours in community settings has revealed the profiles of broad behavioural disturbance that can occur following ABI. Assessing the breadth of disturbance is important in understanding a client's presentation and thus planning appropriate behaviour management interventions.

Personality-based typology of adolescent sexual offenders using the Millon Adolescent Clinical Inventory

Previous research suggests that identifying specific subgroups amongst the population of adolescent sexual offenders may contribute to understanding the aetiology of their offending. Such knowledge may also help to improve the treatment outcomes for this group. The Millon Adolescent Clinical Inventory (MACI) profiles of 25 adolescent male sexual offenders aged 13 to 17 in a community-based treatment sample were analysed to determine if this measure could be used to identify different subtypes of offenders based on personality variables. Three groups were identified by cluster analysis: one group of antisocial and externalising types (n = 11), another group of withdrawn, socially inadequate types (n = 7) and a third group displaying few traits of clinically significant elevation (n = 7). Support was also shown for the hypothesis that adolescent sexual offenders exhibit personality profiles similar to those of delinquent non-sexual offenders. The observed typology suggests potentially different etiological pathways and different treatment needs.

Specific risk assessment based on victim type in children sexual offenders

Actuarial instruments for assessing sex offender recidivism have limited utility for specific risk assessment questions, such as the risk posed to particular types of victim. In order to obtain variables that discriminate between offenders with different classes of victim, data were coded from 324 files of child sexual offenders from a community-based sexual offender treatment program. Offenders with single or multiple victims were compared, as were offenders who did or did not offend against victims of both genders, and offenders with only intra-familial or extra-familial victims versus offenders with victims in both relationship categories. Variables that discriminated single-victim and multiple-victim offenders were similar to those identified in actuarial risk assessment scales, with the exception of history of childhood sexual abuse. With the exception of physical abuse history, the same variables discriminated specific offender groups according to victim gender and victim relationship, although in different combinations. There was limited support for the notion of specific risk variables.