A cluster-randomised, controlled trial to assess the impact of a workplace osteoporosis prevention intervention on the dietary and physical activity behaviours of working women: study protocol

Background Osteoporosis is a debilitating disease and its risk can be reduced through adequate calcium consumption and physical activity. This protocol paper describes a workplace-based intervention targeting behaviour change in premenopausal women working in sedentary occupations. Method/Design A cluster-randomised design was used, comparing the efficacy of a tailored intervention to standard care. Workplaces were the clusters and units of randomisation and intervention. Sample size calculations incorporated the cluster design. Final number of clusters was determined to be 16, based on a cluster size of 20 and calcium intake parameters (effect size 250 mg, ICC 0.5 and standard deviation 290 mg) as it required the highest number of clusters. Sixteen workplaces were recruited from a pool of 97 workplaces and randomly assigned to intervention and control arms (eight in each). Women meeting specified inclusion criteria were then recruited to participate. Workplaces in the intervention arm received three participatory workshops and organisation wide educational activities. Workplaces in the control/standard care arm received print resources. Intervention workshops were guided by self-efficacy theory and included participatory activities such as goal setting, problem solving, local food sampling, exercise trials, group discussion and behaviour feedback. Outcomes measures were calcium intake (milligrams/day) and physical activity level (duration: minutes/week), measured at baseline, four weeks and six months post intervention. Discussion This study addresses the current lack of evidence for behaviour change interventions focussing on osteoporosis prevention. It addresses missed opportunities of using workplaces as a platform to target high-risk individuals with sedentary occupations. The intervention was designed to modify behaviour levels to bring about risk reduction. It is the first to address dietary and physical activity components each with unique intervention strategies in the context of osteoporosis prevention. The intervention used locally relevant behavioural strategies previously shown to support good outcomes in other countries. The combination of these elements have not been incorporated in similar studies in the past, supporting the study hypothesis that the intervention will be more efficacious than standard practice in osteoporosis prevention through improvements in calcium intake and physical activity.

From institutional care to living in South Australia: intercountry adoption

The adoptees' narratives have illustrated the difficulties that they were confronted with when transitioning to a new world. Their remarkable use of self-efficacy enabled them in overcoming deprivation and abuse and leading a better life in Australia. The quality of the post-institutional care was directly related to the adoption outcomes.

The road map to building new dreams : raising a child with developmental delay or disability

Research on early childhood education emphasises the importance of quality in early childhood intervention. This study examines the quality of Early Childhood Intervention Services based on parents’ experiences raising a child with developmental delay or disability. The study builds on the philosophy of Family-Centred Practice and professionals’ experiences with family-centred interventions. A qualitative case study approach was adopted to gain insight about families who are raising a child with additional needs. Nine in-depth parent-interviews and three focus groups with professionals were conducted in the first two terms of 2010. The case explicates the experiences of parents and professionals who were associated with Specialist Children’s Services in a metropolitan region of Victoria. The research concentrated on the first point of entry to early intervention, the referrals process and the waiting list. It also addressed parents' experiences, priorities and expectations. As a small-scale study, it examined parents’ and children’s needs as well as children’s access to therapy in early intervention. It also investigated community support and parent-professional relationships in the context of early childhood intervention services. The study found that family-centred intervention is beneficial to both parents and children with developmental delay or disability. However, to implement an effective family-centred approach, practitioner support in the form of professional development, supervision and peer mentorship is required to develop professionals’ reflexivity and self-efficacy in family-centred interventions. The study also identified strategies to promote effective practice, gaps in universal and specialised services, and implications for policy.

A longitudinal study of the effect of psychosocial factors on exclusive breastfeeding duration

Objective
to examine the effect of psychosocial factors on exclusive breastfeeding duration to six months postpartum

Design
longitudinal, prospective questionnaire based study.

Setting
participants were recruited from a publically funded antenatal clinic located in the western metropolitan region of Melbourne, Victoria, Australia and asked to complete questionnaires at three time points; 32 weeks pregnancy, two months postpartum and six months postpartum.

Participants
the participants were 125 pregnant women aged 22–44 years.

Measurements and findings
psychosocial variables such as breastfeeding self-efficacy, body attitude, psychological adjustment, attitude towards pregnancy, intention, confidence and motivation to exclusively breastfeed and importance of exclusive breastfeeding were assessed using a range of psychometrically validated tools. Exclusive breastfeeding behaviour up to six months postpartum was also measured. At 32 weeks gestation a woman׳s confidence to achieve exclusive breastfeeding was a direct predictor of exclusive breastfeeding duration to six months postpartum. At two months postpartum, psychological adjustment and breastfeeding self-efficacy were predictive of exclusive breastfeeding duration. Finally, at six months postpartum, psychological adjustment, breastfeeding self-efficacy, confidence to maintain and feeling fat were directly predictive of exclusive breastfeeding duration.

Community social capital and entrepreneurship : analyzing the links

This study examines the effects of community social capital on entrepreneurial intentions (EIs) in rural communities in a developing country. Entrepreneurship, in the form of business start-ups, is widely recognized as an integral component of local economic development programs designed to address poverty and limited livelihood opportunities, especially among poor and marginalized communities in rural areas in developing countries. Using a survey of 496 individuals residing in five rural communities in the Philippines, and drawing from the theory of planned behavior and social capital theory, we examine the direct and indirect effects of community social capital (CSC) on an individual’s EIs. The findings show that CSC largely influences EI by shaping an individual’s perceived self-efficacy (PSE) to engage in entrepreneurship, perceived desirability of entrepreneurship (PDE), and perceived social norms toward entrepreneurship (PSNE). High levels of PSE, PDE, and PSNE have a positive influence on an individual’s EI. These findings offer more nuanced explanations of how social capital within a community can facilitate entrepreneurship as a means of community economic development. Implications of the findings and areas for future research are discussed.

Psychosocial correlates of exclusive breastfeeding duration to six months postpartum

 In Australia 17% of infants are exclusively breastfed to six months postpartum. This thesis examined the effect of psychosocial factors on women’s ability to maintain exclusive breastfeeding. The thesis demonstrated the paucity of research in this area and the importance of psychosocial factors such as breastfeeding self-efficacy and psychological adjustment in women’s exclusive breastfeeding outcomes.

Exploring associations between parental and peer variables, personal variables and physical activity among adolescents: a mediation analysis

This study aimed to investigate how parental and peer variables are associated with moderate- to-vigorous intensity physical activity (MVPA) on week- and weekend days among Australian adolescents (13-15 y), and whether perceived internal barriers (e.g. lack of time), external barriers (e.g. lack of others to be physically active with) and self-efficacy mediated these associations.

Health-related empowerment in cancer: validity of scales from the health education impact questionnaire

Empowerment refers to an individual's feelings of being able to manage the challenges of the cancer experience and of having a sense of control over one's life. However, empowerment questionnaires that have been validated for the cancer setting are lacking. The objective of this study was to validate scales from the Health Education Impact Questionnaire (heiQ), which assesses the effects of health education programs among individuals with chronic conditions. The heiQ scales Social integration and support, Health service navigation, Constructive attitudes and approaches, Skill and technique acquisition, and Emotional distress were identified as key dimensions of empowerment for the cancer context.

An RCT to evaluate the utility of a clinical protocol for staff in the management of behavioral and psychological symptoms of dementia in residential aged-care settings

Objectives: Behavioral and psychological symptoms of dementia (BPSD) cause significant stress and distress to both aged-care residents and staff. This study evaluated a training program to assist staff to manage BPSD in residential care. Method: A randomised controlled trial (RCT) was employed. The study was included in the Australian and New Zealand Clinical Trial Register residential care facilities. Staff (n = 204) and residents (n = 187) were from 16 residential care facilities. Facilities were recruited and randomly assigned to four staff training conditions: (1) training in the use of a BPSD-structured clinical protocol, plus external clinical support, (2) a workshop on BPSD, plus external clinical support, (3) training in the use of the structured clinical protocol alone, and (4) care as usual. Staff and resident outcome measures were obtained pre-intervention, three months and six months post-intervention. The primary outcome was changes in BPSD, measured using the Cohen-Mansfield Agitation Inventory (CMAI) as well as frequency and duration of challenging behaviors. Secondary outcomes were changes in staff adjustment. Results: There were improvements in challenging behaviors for both intervention conditions that included training in the BPSD instrument, but these were not maintained in the condition without clinical support. The training/support condition resulted in sustained improvements in both staff and resident variables, whereas the other conditions only led to improvement in some of the measured variables. Conclusion: These results demonstrate the effectiveness of the BPSD protocol in reducing BPSD and improving staff self-efficacy and stress.

Psychosocial risk factors for excessive gestational weight gain: a systematic review

BACKGROUND: Excessive weight gain during pregnancy can have adverse health outcomes for mother and infant throughout pregnancy. However, few studies have identified the psychosocial factors that contribute to women gaining excessive weight during pregnancy. AIM: To review the existing literature that explores the impact of psychosocial risk factors (psychological distress, body image dissatisfaction, social support, self-efficacy and self-esteem) on excessive gestational weight gain. METHODS: A systematic review of peer-reviewed English articles using Academic Search Complete, Cumulative Index to Nursing and Allied Health Literature, MEDLINE Complete, PsycINFO, Informit, Web of Science, and Scopus was conducted. Quantitative studies that investigated psychosocial factors of excessive GWG, published between 2000 and 2014 were included. Studies investigating mothers with a low risk of mental health issues and normally-developing foetuses were eligible for inclusion. From the total of 474 articles located, 12 articles were identified as relevant and were subsequently reviewed in full. FINDINGS: Significant associations were found between depression, body image dissatisfaction, and social support with excessive gestational weight gain. No significant relationships were reported between anxiety, stress, self-efficacy, or self-esteem and excessive gestational weight gain. CONCLUSION: The relationship between psychosocial factors and weight gain in pregnancy is complex; however depression, body dissatisfaction and social support appear to have a direct relationship with excessive gestational weight gain. Further research is needed to identify how screening for, and responding to, psychosocial risk factors for excessive gestational weight gain can be successfully incorporated into current antenatal care.

Negative appraisals of insulin therapy are common among adults with Type 2 diabetes using insulin: results from diabetes MILES - Australia cross-sectional survey

AIM: To identify insulin therapy appraisals among adults with Type 2 diabetes using insulin and how negative appraisals relate to clinical, self-care and psychosocial outcomes. METHODS: Diabetes MILES - Australia 2011 was a national survey of adults with diabetes, focused on behavioural and psychosocial issues. Subgroup analyses were conducted on the responses of 273 adults with Type 2 diabetes using insulin (46% women; mean ± sd age: 59 ± 9 years; diabetes duration: 12 ± 7 years; years using insulin: 4 ± 4). They completed validated measures of insulin therapy appraisals (ITAS), depression (PHQ-9), anxiety (GAD-7), diabetes distress (PAID) and diabetes-specific self-efficacy (DES-SF). RESULTS: Insulin was perceived to be very important, and its benefits (e.g. improves health) were endorsed by most (82%). Fifty-one per cent believed that taking insulin means their diabetes has become worse; 51% that insulin causes weight gain; 39% that they have 'failed to manage' their diabetes. Those with the greatest and least 'ITAS negative' scores did not differ by diabetes duration or years using insulin, or by average number of insulin injections or blood glucose checks per day. Those with more negative insulin appraisals were significantly younger (Mean Diff. = 5 years, P < 0.001), less satisfied with recent blood glucose levels (P < 0.001, d = 0.63), had reduced diabetes-specific self-efficacy (P < 0.001, d = 0.7), and were more likely to report depressive symptoms, anxiety or diabetes distress (all P < 0.001, d = 0.65-1.1). CONCLUSIONS: Negative insulin therapy appraisals are common among adults with Type 2 diabetes using insulin, and are associated with lower general and diabetes-specific emotional well-being, reduced diabetes-specific self-efficacy and satisfaction with blood glucose.

Outreach programmes to attract girls into computing: how the best laid plans can sometimes fail

This article presents a reflective analysis of an outreach programme called the Digital Divas Club. This curriculum-based programme was delivered in Australian schools with the aim of stimulating junior and middle school girls’ interest in computing courses and careers. We believed that we had developed a strong intervention programme based on previous literature and our collective knowledge and experiences. While it was coordinated by university academics, the programme content was jointly created and modified by practicing school teachers. After four years, when the final data were compiled, it showed that our programme produced significant change to student confidence in computing, but the ability to influence a desire to pursue a career path in computing did not fully eventuate. To gain a deeper insight in to why this may be the case, data collected from two of the schools are interrogated in more detail as described in this article. These schools were at the end of the expected programme outcomes. We found that despite designing a programme that delivered a multi-layered positive computing experience, factors beyond our control such as school culture and teacher technical self-efficacy help account for the unanticipated results. Despite our best laid plans, the expectations that this semester long programme would influence students’ longer term career outcomes may have been aspirational at best.

Protocol for a randomised controlled trial of a web-based healthy relationship tool and safety decision aid for women experiencing domestic violence (I-DECIDE)

BACKGROUND: Domestic violence is a serious problem affecting the health and wellbeing of women globally. Interventions in health care settings have primarily focused on screening and referral, however, women often may not disclose abuse to health practitioners. The internet offers a confidential space in which women can assess the health of their relationships and make a plan for safety and wellbeing for themselves and their children. This randomised controlled trial is testing the effectiveness of a web-based healthy relationship tool and safety decision aid (I-DECIDE). Based broadly on the IRIS trial in the United States, it has been adapted for the Australian context where it is conducted entirely online and uses the Psychosocial Readiness Model as the basis for the intervention. METHODS/DESIGN: In this two arm, pragmatic randomised controlled trial, women who have experienced abuse or fear of a partner in the previous 6 months will be computer randomised to receive either the I-DECIDE website or a comparator website (basic relationship and safety advice). The intervention includes self-directed reflection exercises on their relationship, danger level, priority setting, and results in an individualised, tailored action plan. Primary self-reported outcomes are: self-efficacy (General Self-Efficacy Scale) immediately after completion, 6 and 12 months post-baseline; and depressive symptoms (Centre for Epidemiologic Studies Depression Scale, Revised, 6 and 12 months post-baseline). Secondary outcomes include mean number of helpful actions for safety and wellbeing, mean level of fear of partner and cost-effectiveness. DISCUSSION: This fully-automated trial will evaluate a web-based self-information, self-reflection and self-management tool for domestic violence. We hypothesise that the improvement in self-efficacy and mental health will be mediated by increased perceived support and awareness encouraging positive change. If shown to be effective, I-DECIDE could be easily incorporated into the community sector and health care settings, providing an alternative to formal services for women not ready or able to acknowledge abuse and access specialised services. TRIAL REGISTRATION: Trial registered on 15(th) December 2014 with the Australian New Zealand Clinical Trials Registry ACTRN12614001306606.