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.

Dispositional and maturational development through a competency based training intervention : getting to the heart of the matter

Presents a formative perspective on vocational learning that proposes that vocational competence is dependent upon dispositional development, which in turn results in moves towards maturation. Further, that dispositional and maturational outcomes occur as a result of a lifetime goal-setting intervention employed prior to training Reports qualitative and quantitative research with unemployed adults engaging in vocational education that resulted in four findings. Firstly, that while Training Packages describe assessable outcomes in competency-referenced terms, trainees describe learning outcomes in non-competency referenced terms. Secondly, that vocational trainees describe their learning in terms of dispositional outcomes, that is, in terms of values, interests and attitudes. Thirdly, that dispositions can be categorised in terms of maturational concepts. Fourthly, in support of incremental theory, that trainees made moves towards maturation as a result of a lifetime goal-setting intervention employed prior to training.

The impact of using a pedometer on time spent walking in older adults with Type 2 diabetes

Purpose

The purpose of this study was to investigate the impact of using a pedometer on time spent walking, in sedentary and overweight adults with type 2 diabetes participating in a coaching intervention. It was hypothesized that participants using a pedometer would spend more time walking than would nonpedometer participants.

Method

A sample of 57 men and women with a mean age of 62 years participated in a randomized controlled trial in a community setting. Participants were allocated to either a pedometer and coaching (intervention) group or a coaching-only (control) group. Coaching for both groups involved education, goal setting, and supportive/ motivational strategies to increase time spent walking. The duration of the study was 6 months, with blood pressure, glycosylated hemoglobin, anthropometric, and fitness measurements assessed at baseline and at 3-month intervals.

Results

A repeated-measures analysis of variance indicated that the coaching-only group spent significantly more time walking than did the pedometer group. However, when an analysis of covariance with all the other variables as covariates was performed, group membership had no influence on time spent walking. Significant reductions in waist circumference and weight were achieved for both groups from baseline to 6 months. Cardiovascular fitness also increased significantly for both groups.

Conclusion

The study demonstrated that previously sedentary older adults with type 2 diabetes, supported with a coaching intervention, were able to achieve the physical activity targets known to be beneficial to health. However, using a pedometer added no further benefit. Further research on the impact of specific coaching strategies in diabetes management is warranted.

Preparing for flexible delivery in industry : learners and their workplaces

This thesis examines the learning preferences and learning strategies of apprentices, and the contexts within which they learn in their workplaces. Since the end of the 1980s Australian vocational education and training (VET) structures and processes have undergone radical change in attempts to develop skills in the workforce that will ensure enterprise, national, and international competitiveness. A major strategy in the national reforms has been the encouragement of flexible delivery as a means through which workplace-based learning can be accessed by a larger number of workers in ways that are cost-efficient, and that reduce the amount of time that workers spend away from their jobs. Although flexible delivery has been championed by governments and industry alike, there has been little attempt to identify the preparedness of either learners or their workplaces for the demands of flexible learning. The thesis examines the economic context for these changes to VET, and also examines the literature available on workplace learning. Additionally, the thesis examines the conceptualisations of flexible delivery that are available in the literature, pointing to the possibility that the wide range of meanings associated with the term ‘flexible delivery’ may result in quite different practices and expectations. The thesis also examines the literature on independent learning and self-directed learning, and explores the concept of ‘client-focused’ flexible delivery. The study of learner preferences uses data collected from apprentices over a period of some years, in the four occupational areas commanding the highest number of apprentices in Australia. These occupational areas are Metals and Machining, Building, Electrical, and Hairdressing. These data on learning preferences are collected using the commercially available Canfield Learning Styles Inventory (CLSI). The data from the sample of 389 apprentices are analysed statistically through analyses of variance, and indicate that variables such as age, gender, and occupational area are related to learning preferences. Apprentices are shown by this analysis to prefer structured programs of instruction that are instructor-led, and to not have a high preference for independent learning or the development of their own learning goals. Additionally, they are shown to have very low preferences for learning through reading, preferring instead to learn through direct hands-on experience. While these characteristics are largely common among the four occupational groups, the Hairdressing apprentices are shown to have a slightly higher preference for independent learning and goal setting. Females are shown to have a higher preference than males for learning qualitative material through reading. Interestingly, the younger apprentices are shown to have a higher preference than the older ones for self-directed learning. Some possibilities for that finding are discussed. The research also shows that the learning preferences displayed by different groups of apprentices in any one program are much the same over time, providing some confidence that data generated from one group of apprentices can be used to make instructional decisions for future groups in the same program. The data are also factor analysed to indicate three major factors underlying apprentice learning preferences. The first factor indicates a Verbal–Non-verbal preference factor, with apprentices clearly preferring to learn through non-verbal means. A second factor is described as Structure–Content, with apprentices showing a preference for learning from structured programs in a structured environment. A third factor, Self-directed–Social preference, indicates apprentices preferring to learn through socially mediated presentations and contexts rather than through more independent forms of learning. Qualitative data are also generated through interviewing eight apprentices, and focusing on the learning strategies they employ while constructing knowledge in the workplace. That component of the research uses a modification of the Marland, Patching and Putt (1992a, 1992b) stimulated recall technique, and a set of learning strategies derived from the work of O’Malley and Chamot (1990) and Billett (1996a). The eight apprentices are drawn from the Metals and Machining, Electrical, and Hairdressing trades. The findings indicate that the learning strategies most often used by apprentices in the workplace are those associated with the construction of knowledge that is structured and provided by the instructor or learning program, and those that include social mediation of learning. Additionally, the strategies associated with demonstration and hands-on practice are most favoured. The qualitative data are confirmatory of the quantitative data. The research also indicates, through the apprentice interviews, that support for apprentice’s learning in their workplace is typically unplanned and haphazard. Their experience was sometimes characterised by a reluctance on the part of the workplace to acknowledge learning needs such as trialling and practice of new knowledge, or pro-actively seeking understanding from other more skilled workers. The learning preferences and learning strategies findings for apprentices, coupled with the findings of typically poor or unplanned support in the workplace, indicate that effective flexible delivery of training to apprentices in the workplace provides a number of challenges. These challenges, it is argued, demand strategies to be developed and implemented to prepare both learners and workplaces for effective engagement with flexible delivery. Using as a theoretical framework Kember’s (1995) two-dimensional model of open learning for adults, the thesis integrates the findings into a proposed two-dimensional model of learner and workplace preparedness for flexible delivery. The model provides for a Learner Development Space, a Workplace Development Space, and a Strategy Space. Within the Learner Development Space, focuses for the development of learner preparedness are identified in terms of self-directed learning, skills developments, and effective participation in a community of practice. Focuses for workplace development identified in the Workplace Development Space are those associated with development of training policies, training structures, and trainer skills and abilities. The Strategy Space then provides detail of seventy-nine specific strategies developed to enhance learner and workplace preparedness within each of the focuses identified.

Vocational learners' dispositional and maturational development

Using three separate but interrelated studies with adult unemployed vocational learners, the research quantitatively and qualitatively investigated the effects of a pre-training intervention labelled Lifetime Goal-setting and Goal-getting. The research found learner dispositional development and statistically significant moves towards maturation empowering jobseeking learners to face the challenges of obtaining employment.

From continuous improvement to collaborative innovation : the next challenge in supply chain management

This paper considers the growing importance of inter-company collaboration, and develops the concept of intra-company continuous improvement through to what may be termed collaborative innovation between members of an extended manufacturing enterprise (EME). The importance of ICTs to such company networks is considered but research has shown that no amount of technology can overcome a lack of trust and ineffective goal setting between key partners involved in the cross-company projects. Different governance models may also impact on the success or otherwise of the network. This paper provides an overview of the main topics considered in this Special Issue

Motivating offenders to change in therapy: an organizing framework

Objectives. Motivating offenders to change in therapy is an important aspect of effective offender treatment, yet despite this, offenders' motivation to change has received little close attention in the academic and professional literature. This situation is a result of an over-emphasis on the risk management model of rehabilitation, and a consequent failure to construe motivation within an overarching theory of offender rehabilitation.

Method. We present a social cognitive model of offender motivation — the Good Lives Model (GLM) — that provides a framework for incorporating factors that have been shown to be of importance in enhancing offender motivation. This is based upon the notion that all humans strive to achieve primary goods that are intrinsically rewarding and essential to well-being. Where offenders are concerned, criminogenic problems relate, not to the goods offenders seek, but to the way they seek them. Any treatment approach should take this into account and focus positively on equipping people with the skills required to achieve goals rather than simply look to manage risk. The motivational construct that we use here is that of goals. In the GLM, goals are the less abstract depictions of primary human goods and it is with these that people are typically engaged in their day-to-day activities and lives. Looking at therapeutic goal-setting, methods and styles of therapy, and therapist approaches, we derive theoretically-based key issues in motivating offenders to change in therapy.

Conclusion. In conclusion, we present a summary of 12 strategies and techniques that will not only help practitioners enhance their therapeutic effectiveness, but hopefully also act as a catalyst in the development of research on offenders' motivation to change.

Life! in Australia : translating prevention research into a large-scale intervention

The increasing prevalence of type 2 diabetes is of great public health concern. In the state of Victoria, Australia, a group-based lifestyle intervention programme, Life! – Taking Action on Diabetes, was developed for people over the age of 50 years who are at high risk of diabetes. It aims to reduce the risk of diabetes by providing practical skills, including goal setting and problem solving, to encourage participants to adopt a healthy diet and active lifestyle. The programme is delivered by specially trained facilitators who have undergone an accredited three-stage training programme. A quality assurance process is also in place to ensure that it is delivered to a consistently high standard. The Life! program
is a direct progression from the Finnish randomised controlled trial and the Greater Green Triangle Diabetes Prevention Project implementation trial. This paper describes how a diabetes prevention programme was implemented at a state-wide level and the training of facilitators to conduct the group sessions. Future studies are needed to examine the cost effectiveness and development of specific programmes for diverse population groups.

Captured by the game : might a focus on the ‘therapeutic relationship’ diminish the attention we give to the client’s intimate network?

A recent project sought to clarify how psychotherapists and mental health workers understand psychosocial health and pathology. In this enquiry, I paid particular attention to the client’s interpersonal networks: did the professionals actively consider, and if so to what extent, ‘intimate social and family relationships’ in constructing their understanding of the presenting problem and in the process they used for goal setting. Twenty-two semi-structured interviews were undertaken, eleven with psychotherapists and eleven with mental health workers. Across both groups, interviewees tended not to see their clients as embedded, relational entities, but primarily, often quite exclusively, as autonomous beings. Second, interviewees accorded a high value to the importance of ‘the therapeutic relationship’. Is it possible that the emphasis practitioners place on ‘the therapeutic relationship’ has the effect of marginalising the attention that is given to the client’s significant-other network

How can the impact of cultural development work in local government be measured? Towards more effective planning and evaluation strategies

The field of cultural development in local government is relatively new, with most councils only having dedicated staff or teams within the last ten to fifteen years. Challenges are associated with that newness in the areas of planning, goal setting and formal evaluation of achievements in relation to goals. How can the best decisions be made about what is needed? How can the outcomes of that work be evaluated? What should be measured and how? This paper explores these challenges and presents some solutions. Program Logic is introduced as a methodology for effective planning and evaluation of cultural development work in local government. The need for both performance and outcome evaluation of cultural development work is discussed, as are the levels of evaluation required; considering the contribution of individual workers, departments, whole of council and the overall community outcomes. Factors beyond the influence of local government, which impact the outcomes of arts initiatives, are also considered in arguing that more sophisticated evaluation processes are required.

Cluster randomized controlled trial of a peer support program for people with diabetes: study protocol for the Australasian peers for progress study

Background
Well managed diabetes requires active self-management in order to ensure optimal glycaemic control and appropriate use of available clinical services and other supports. Peer supporters can assist people with their daily diabetes self-management activities, provide emotional and social support, assist and encourage clinical care and be available when needed.
Methods
A national database of Australians diagnosed with type 2 diabetes is being used to invite people in pre-determined locations to participate in community-based peer support groups. Peer supporters are self-identified from these communities. All consenting participants receive diabetes self-management education and education manual prior to randomization by community to a peer support intervention or usual care. This multi-faceted intervention comprises four interconnected components for delivering support to the participants. (1) Trained supporters lead 12 monthly group meetings. Participants are assisted to set goals to improve diabetes self-management, discuss with and encourage each other to strengthen linkages with local clinical services (including allied health services) as well as provide social and emotional support. (2) Support through regular supporter-participant or participant-participant contact, between monthly sessions, is also promoted in order to maintain motivation and encourage self-improvement and confidence in diabetes self-management. (3) Participants receive a workbook containing diabetes information, resources and community support services, key diabetes management behaviors and monthly goal setting activity sheets. (4) Finally, a password protected website contains further resources for the participants. Supporters are mentored and assisted throughout the intervention by other supporters and the research team through attendance at a weekly teleconference. Data, including a self-administered lifestyle survey, anthropometric and biomedical measures are collected on all participants at baseline, 6 and 12 months. The primary outcome is change in cardiovascular disease risk using the UKPDS risk equation. Secondary outcomes include biomedical, quality of life, psychosocial functioning, and other lifestyle measures. An economic evaluation will determine whether the program is cost effective.
Discussion
This manuscript presents the protocol for a cluster randomized controlled trial of group-based peer support for people with type 2 diabetes in a community setting. Results from this trial will contribute evidence about the effectiveness of peer support in achieving effective self-management of diabetes.

Primary prevention of gestational diabetes for women who are overweight and obese : a randomised controlled trial

Background: Gestational Diabetes Mellitus (GDM) has well recognised adverse health implications for the  mother and her newborn that are both short and long term. Obesity is a significant risk factor for developing GDM and the prevalence of obesity is increasing globally. It is a matter of public health importance that clinicians have evidence based strategies to inform practice and currently there is insufficient evidence regarding the impact of dietary and lifestyle interventions on improving maternal and newborn outcomes. The primary aim of this study is to measure the impact of a telephone based intervention that promotes positive lifestyle modifications on the incidence of GDM. Secondary aims include: the impact on gestational weight gain; large for gestational age babies; differences in blood glucose levels taken at the Oral Glucose Tolerance Test (OGTT) and selected factors relating to self-efficacy and psychological wellbeing. 

Great 'app-eal' but not there yet: a review of iPhone nutrition applications relevant to child weight management

Aims: There is increasing interest in the use of smartphone applications (apps) for delivering child obesity management interventions and supporting lifestyle behaviour change; however, there has been very little academic research on their development. Our aim is to review nutrition-related apps designed for children currently available in Australia for their usefulness in education or support behavioural interventions for child obesity. Methods: Apps available for download in iTunes Australia between 2 April and 3 June 2013 which were suitable for children >12 years were identified. Key words were chosen to identify apps applicable to children, focusing on nutrition. Results: A total of 27 apps were included. Most apps (24/27) were not based on evidence-informed recommendations. A third of apps were developed in the USA (n = 10; 37%) and were free (67%), nine apps required upfront payment, with a mean cost of $A2.80 (range $A0.99-$A7.49). The most common nutrition features were the promotion of energy balance (n = 12 apps) and guidance on appropriate portion size (n = 15). The most common behaviour change feature was goal setting (n = 15). The five apps that scored most highly against the characteristics reviewed were: Calorie Counter Pro by My Net Diary, Weight Watchers, Swap It Don't Stop It, Control My Weight by CalorieKing and Rate What I Ate-Photo Diet Tracker. Conclusions: Very few apps were identified that could be used in education or support behavioural interventions for child obesity. There is a need to harness this technology and evaluate the applicability and use within childhood obesity research interventions.