Reinforcement sensitivity theory (RST) and body change behaviour in males

According to the unrevised Reinforcement Sensitivity Theory two motivational systems shape personality: a behavioural approach system (BAS) that determines sensitivity to rewards, and a behavioural inhibition system (BIS) that determines sensitivity to punishments. The role of reinforcement sensitivity in body change behaviour in males was explored with a non-clinical sample of 120 men aged 18–40 years. Self-reported symptoms of unhealthy weight loss (weight preoccupation, fasting, bingeing/purging) and body development (muscle/size preoccupation, obligatory exercise, use of chemical supplements) were regressed on measures of BAS and BIS sensitivity. Significant relationships were observed between BAS sensitivity and body development, and between BIS sensitivity and weight loss. These relationships were mediated by internalization of the athletic/muscular ideal, body comparisons, the importance of achieving one’s ideal or ‘best possible’ body (in the case of BAS but not BIS), and body dissatisfaction (in the case of BIS but not BAS). These results support the proposition that body development in males is influenced by sensitivity to rewards associated with achieving a certain body shape, and that weight loss is influenced by sensitivity to punishments associated with possessing an unsatisfactory body shape.

Knowledge enhancement in the change process : social marketing and attitude change leading to improved environmental behaviour

The complexity of relationships between social change and natural resource management has generated interest in the identification of indicators that might provide more streamlined means of monitoring and planning control programmes. This case study highlights the marketing paradigms of benchmarking and social marketing in a not-for-profit governmental environment. Publicly funded programs that require individual and community participation need to be marketed with a view to optimising involvement and commitment of the various stakeholders. A mail survey with a representative sample of 608 respondents was conducted to evaluate the effectiveness of a social marketing program. This study highlights the use of social marketing in a program to overcome an environmental issue by a governmental agency. Changing attitudes and beliefs takes time and often the target audience may not even know they have a problem that needs fixing. This process influences the focus of the social marketing effort which might be organised into three phases: • Raise awareness and knowledge.   •Change attitudes.  • Encourage action. The research conducted in this study illustrates how the various stages in the social marketing process were achieved through knowledge enhancement in an environmental management case study.

Outcome data from the LEAP (Live, Eat and Play) trial: a randomized controlled trial of a primary care intervention for childhood overweight/mild obesity

OBJECTIVES: To reduce gain in body mass index (BMI) in overweight/mildly obese children in the primary care setting.
DESIGN: Randomized controlled trial (RCT) nested within a baseline cross-sectional BMI survey.
SETTING: Twenty nine general practices, Melbourne, Australia.
PARTICIPANTS: (1) BMI survey: 2112 children visiting their general practitioner (GP) April-December 2002; (2) RCT: individually randomized overweight/mildly obese (BMI z-score <3.0) children aged 5 years 0 months-9 years 11 months (82 intervention, 81 control).
INTERVENTION: Four standard GP consultations over 12 weeks, targeting change in nutrition, physical activity and sedentary behaviour, supported by purpose-designed family materials.
MAIN OUTCOME MEASURES: Primary: BMI at 9 and 15 months post-randomization. Secondary: Parent-reported child nutrition, physical activity and health status; child-reported health status, body satisfaction and appearance/self-worth.
RESULTS: Attrition was 10%. The adjusted mean difference (intervention-control) in BMI was -0.2 kg/m(2) (95% CI: -0.6 to 0.1; P=0.25) at 9 months and -0.0 kg/m(2) (95% CI: -0.5 to 0.5; P=1.00) at 15 months. There was a relative improvement in nutrition scores in the intervention arm at both 9 and 15 months. There was weak evidence of an increase in daily physical activity in the intervention arm. Health status and body image were similar in the trial arms.
CONCLUSIONS: This intervention did not result in a sustained BMI reduction, despite the improvement in parent-reported nutrition. Brief individualized solution-focused approaches may not be an effective approach to childhood overweight. Alternatively, this intervention may not have been intensive enough or the GP training may have been insufficient; however, increasing either would have significant cost and resource implications at a population level.

Change of perspective: a measurable and desired outcome of chronic disease self-management intervention programs that violates the premise of preintervention/postintervention assessment

Objective: To determine if participants in chronic disease self-management courses have a change of perspective of their health status (a response shift), and if this is measurable with a paper-based questionnaire.

Methods: Nine items were developed to measure potential benefits of self-management courses. These were based on the constructs of a previous questionnaire, the Health Education Impact Questionnaire (HEI-Q). Cognitive interviews elicited spontaneous statements about the reasons for paper-based answers. Sensitivity, specificity, and overall accuracy of items were calculated using the interview as a relative gold standard. Response shift can be negative (i.e., after the course, participants realize that, before the course, they were worse than they thought they were), positive (i.e., participants now realize they were better than they thought they were), or absent (no change).

Results: Interviews (n = 39) reflected that true response shift occurred in approximately half the replies to questionnaire items. Of these, 31% were negative response shift, 20% were positive response shift. Response shift was absent in 32% of replies. Presence or absence of response shift could not be determined in 17% of replies across items. Significant concordance between questionnaires and cognitive interviews (average overall accuracy 0.79) indicated that the HEI-Q Perspective questionnaire detects response shift in participants of self-management courses. The questionnaire revealed that 87% of participants had response shift in at least 1 item.

Conclusion: This study suggests that preintervention/postintervention assessments of interventions such as self-management courses are confounded by a change in perspective of a large proportion of respondents. It also indicates response shift is a valuable outcome of self-management courses that can be measured with a paper-based questionnaire.

Outcomes and costs of primary care surveillance and intervention for overweight or obese children : the LEAP 2 randomised controlled trial

Objective To determine whether ascertainment of childhood obesity by surveillance followed by structured secondary prevention in primary care improved outcomes in overweight or mildly obese children.

Design Randomised controlled trial nested within a baseline cross sectional survey of body mass index (BMI). Randomisation and outcomes measurement, but not participants, were blinded to group assignment.

Setting 45 family practices (66 general practitioners) in Melbourne, Australia.

Participants 3958 children visiting their general practitioner in May 2005-July 2006 were surveyed for BMI. Of these, 258 children aged 5 years 0 months up to their 10th birthday who were overweight or obese by International Obesity Taskforce criteria were randomised to intervention (n=139) or control (n=119) groups. Children who were very obese (UK BMI z score 3.0) were excluded.

Intervention Four standard consultations over 12 weeks targeting change in nutrition, physical activity, and sedentary behaviour, supported by purpose designed family materials.

Main outcomes measures Primary measure was BMI at 6 and 12 months after randomisation. Secondary measures were mean activity count/min by 7-day accelerometry, nutrition score from 4-day abbreviated food frequency diary, and child health related quality of life. Differences were adjusted for socioeconomic status, age, sex, and baseline BMI.

Results Of 781 eligible children, 258 (33%) entered the trial; attrition was 3.1% at 6 months and 6.2% at 12 months. Adjusted mean differences (intervention – control) at 6 and 12 months were, for BMI, –0.12 (95% CI –0.40 to 0.15, P=0.4) and –0.11 (–0.45 to 0.22, P=0.5); for physical activity in counts/min, 24 (–4 to 52, P=0.09) and 11 (–26 to 49, P=0.6); and, for nutrition score, 0.2 (–0.03 to 0.4, P=0.1) and 0.1 (–0.1 to 0.4, P=0.2). There was no evidence of harm to the child. Costs to the healthcare system were significantly higher in the intervention arm.

Conclusions Primary care screening followed by brief counselling did not improve BMI, physical activity, or nutrition in overweight or mildly obese 5-10 year olds, and it would be very costly if universally implemented. These findings are at odds with national policies in countries including the US, UK, and Australia.

Readiness to change a problem behaviour : a conceptual framework

The thesis study aims to develop a model of readiness to enter treatment to change problem behaviour by addressing the limitations of previous models. The research shows that a model consisting of personal and social factors, mediated by problem recognition and desire for help accurately assesses readiness to enter treatment. The portfolio examines the broad framework of the Multifactor Offender Readiness Model (MORM) which assesses an offender's readiness to engage in treatment. Four case studies are presented.

Factors influencing quality of behaviour support plans and the impact of plan quality on restrictive intervention use

Background: The quality and effectiveness of the support provided to people with disability who show challenging behaviour can be influenced by the design and content of their behaviour support plans (BSPs). This study examined some of the factors that might influence the quality of behaviour support plans and the impact of quality of BSPs on the use of restrictive intervention.

Method: An audit of the quality of a sample of BSPs submitted to the Senior Practitioner in Victoria in the years 2009 and 2010 was conducted using the Behavior Support Plan Quality Evaluation, 2nd Edition (BSP-QE II).

Results: Factors found to positively influence quality of BSPs included: involvement of behaviour consultants and involvement of clinicians from the Office of the Senior Practitioner (Office). Overall quality of plans was also negatively related to restrictive intervention use over time.

Conclusions: The findings support the need for behaviour intervention and provision of clinical support. The findings also provide tentative support for the notion that the inclusion of evidence-based quality components into behaviour support plan formats may reduce the use of restrictive interventions.

Using formative research to develop CHANGE! : a curriculum-based physical activity promoting intervention

Background : Low childhood physical activity levels are currently one of the most pressing public health concerns. Numerous school-based physical activity interventions have been conducted with varied success. Identifying effective child-based physical activity interventions are warranted. The purpose of this formative study was to elicit subjective views of children, their parents, and teachers about physical activity to inform the design of the CHANGE! (Children's Health, Activity, and Nutrition: Get Educated!) intervention programme.

Methods : Semi-structured mixed-gender interviews (group and individual) were conducted in 11 primary schools, stratified by socioeconomic status, with 60 children aged 9-10 years (24 boys, 36 girls), 33 parents (4 male, 29 female) and 10 teachers (4 male, 6 female). Questions for interviews were structured around the PRECEDE stage of the PRECEDE-PROCEDE model and addressed knowledge, attitudes and beliefs towards physical activity, as well as views on barriers to participation. All data were transcribed verbatim. Pen profiles were constructed from the transcripts in a deductive manner using the Youth Physical Activity Promotion Model framework. The profiles represented analysis outcomes via a diagram of key emergent themes.

Results : Analyses revealed an understanding of the relationship between physical activity and health, although some children had limited understanding of what constitutes physical activity. Views elicited by children and parents were generally consistent. Fun, enjoyment and social support were important predictors of physical activity participation, though several barriers such as lack of parental support were identified across all group interviews. The perception of family invested time was positively linked to physical activity engagement.

Conclusions : Families have a powerful and important role in promoting health-enhancing behaviours. Involvement of parents and the whole family is a strategy that could be significant to increase children's physical activity levels. Addressing various perceived barriers to such behaviours therefore, remains imperative.

A comprehensive worksite cancer prevention intervention : behavior change results from a randomized controlled trial

Workplace cancer prevention initiatives have been least successful with blue-collar workers. This study assesses whether an intervention integrating health promotion with occupational health and safety results in significant and meaningful increases in smoking cessation and consumption of fruits and vegetables, compared to a standard health promotion intervention, for workers overall and for blue-collar workers in particular. Methods: A randomized controlled design was used, with 15 manufacturing worksites assigned to a health promotion (HP) or a health promotion plus occupational health and safety intervention (HP/OHS), and compared from baseline (1997) to final (1999). The response rates to the survey were 80% at baseline (n = 9019) and 65% at final (n = 7327). Both groups targeted smoking and diet; the HP/OHS condition additionally incorporated reduction of occupational exposures. Results: Smoking quit rates among blue-collar workers in the HP/OHS condition more than doubled relative to those in the HP condition (OR=2.13, p=0.04), and were comparable to quit rates of white-collar workers. No statistically significant differences between groups were found for mean changes in fruits and vegetables. Integration of occupational health and safety and health promotion may be an essential means of enhancing the effectiveness of worksite tobacco control initiatives with blue-collar workers.