Effect and process evaluations of an early childhood obesity prevention intervention

The thesis develops a summative evaluation framework of the NOURISH Randomised Controlled Trial, and applies this to a selection of maternal feeding choice outcomes of the programme. The research is based on an ecological model of the complex set of factors that need to be acted upon to address childhood obesity. The novel approach extends the standard RCT effect evaluation, while also conducting an in-depth evaluation of the process of programme development and implementation. Research findings identify adaptations of intervention delivery that could improve its effectiveness and translatability, in a new cycle of the programme.

Action or inaction: bystander intervention in workplace sexual harassment

A promising approach to the persistent problem of workplace sexual harassment (SH) is encouraging interventions by bystanders. Adopting a typology developed by Bowes-Sperry and O'Leary-Kelly that considers the level of immediacy and involvement of bystander interventions, this study explored 74 detailed descriptions of SH events that occurred in Australian workplaces. The findings reveal that despite the hidden nature of SH, there is significant involvement of actors who are not direct targets but their actions are frequently delayed, temporary or ineffective. The study makes two contributions to the study and practice of HRM. First, it provides important evidence of the different ways that bystanders respond to SH in real workplaces and the relative likelihood of these actions. Second, the study points to relevant contextual features evident in the scenarios described which determine if and how bystanders intervene. We discuss the utility of the bystander framework for future research and practice, including the development of bystander interventions as a potentially innovative response to the persistent and damaging problem of workplace SH.

Defining the InstaBooth: Facilitating debate and content creation from situated users

Through ubiquitous computing and location-based social media, information is spreading outside the traditional domains of home and work into the urban environment. Digital technologies have changed the way people relate to the urban form supporting discussion on multiple levels, allowing more citizens to be heard in new ways (Fredericks et al. 2013; Houghton et al. 2014; Caldwell et al. 2013). Face-to-face and digitally mediated discussions, facilitated by tangible and hybrid interaction, such as multi-touch screens and media façades, are initiated through a telephone booth inspired portable structure: The InstaBooth. The InstaBooth prototype employs a multidisciplinary approach to engage local communities in a situated debate on the future of their urban environment. With it, we capture citizens’ past stories and opinions on the use and design of public places. The way public consultations are currently done often engages only a section of the population involved in a proposed development; the more vocal citizens are not necessarily the more representative of the communities (Jenkins 2006). Alternative ways to engage urban dwellers in the debate about the built environment are explored at the moment, including the use of social media or online tools (Foth 2009). This project fosters innovation by providing pathways for communities to participate in the decision making process that informs the urban form. The InstaBooth promotes dialogue and mediation between a bottom-up and a top-down approach to urban design, with the aim of promoting community connectedness with the urban environment. The InstaBooth provides an engagement and discussion platform that leverages a number of locally developed display and interaction technologies in order to facilitate a dialogue of ideas and commentary. The InstaBooth combines multiple interaction techniques into a hybrid (digital and analogue) media space. Through the InstaBooth, urban design and architectural proposals are displayed encouraging commentary from visitors. Inside the InstaBooth, visitors can activate a multi-touch screen in order to browse media, write a note, or draw a picture to provide feedback. The purpose of the InstaBooth is to engage with a broader section of society, including those who are often marginalised. The specific design of the internal and external interfaces, the mutual relationship between these interfaces with regards to information display and interaction, and the question how visitors can engage with the system, are part of the research agenda of the project.

Benefits and barriers to exercise in midlife women undertaking a web-based multi-modal lifestyle intervention for the primary prevention of chronic disease

Chronic diseases are a leading cause of death and disability, largely attributable to modifiable lifestyle risk factors. Many midlife Australian are getting insufficient physical activity for health and face a range of barriers to exercise. Results of this study provide evidence that benefits and barriers are an important predictor of exercise behaviour in midlife women and, that a 12 week nurse led health promotion program can effectively promote benefits and increase physical activity. This study provides evidence about benefits and barriers to exercise that will inform health promotion practice for chronic disease risk factor reduction in midlife women.

Education in stroke prevention: Efficacy of an educational counselling intervention to increase knowledge in stroke survivors

BACKGROUND Motivational interviewing and stages of change are approaches to increasing knowledge and effecting behavioural change. This study examined the application of this approach on stroke knowledge acquisition and changing individual lifestyle risk factors in an outpatient clinic. METHODS RCT in which 200 participants were allocated to an education-counselling interview (ECI) or a control group. ECI group participants mapped their individual risk factors on a stage of change model and received an appointment to the next group lifestyle class. Participants completed a stroke knowledge questionnaire at baseline (T1), post-appointment, and three months (T3) post-appointment. Passive to active changes in lifestyle behaviour were self-reported at three months. RESULTS There was a statistically significant difference between groups from T1 toT3 in stroke knowledge (p < 0.001). While there was a significant shift from a passive to active stage of change for the overall study sample (p < 0.000), there was no significant difference between groups on the identified risk factors. CONCLUSIONS Although contact with patients in ambulatory clinical settings is limited due to time constraints, it is still possible to improve knowledge and initiate lifestyle changes utilizing motivational interviewing and a stage of change model. Stroke nurses may wish to consider these techniques in their practice setting.

The YOU CALL-WE CALL randomized clinical trial: Impact of a multimodal support intervention after a mild stroke

Background Comparison of a multimodal intervention WE CALL (study initiated phone support/information provision) versus a passive intervention YOU CALL (participant can contact a resource person) in individuals with first mild stroke. Methods and Results This study is a single-blinded randomized clinical trial. Primary outcome includes unplanned use of health services (participant diaries) for adverse events and quality of life (Euroquol-5D, Quality of Life Index). Secondary outcomes include planned use of health services (diaries), mood (Beck Depression Inventory II), and participation (Assessment of Life Habits [LIFE-H]). Blind assessments were done at baseline, 6, and 12 months. A mixed model approach for statistical analysis on an intention-to-treat basis was used where the group factor was intervention type and occasion factor time, with a significance level of 0.01. We enrolled 186 patients (WE=92; YOU=94) with a mean age of 62.5±12.5 years, and 42.5% were women. No significant differences were seen between groups at 6 months for any outcomes with both groups improving from baseline on all measures (effect sizes ranged from 0.25 to 0.7). The only significant change for both groups from 6 months to 1 year (n=139) was in the social domains of the LIFE-H (increment in score, 0.4/9±1.3 [95% confidence interval, 0.1–0.7]; effect size, 0.3). Qualitatively, the WE CALL intervention was perceived as reassuring, increased insight, and problem solving while decreasing anxiety. Only 6 of 94 (6.4%) YOU CALL participants availed themselves of the intervention. Conclusions Although the 2 groups improved equally over time, WE CALL intervention was perceived as helpful, whereas YOU CALL intervention was not used.

Study protocol of the YOU CALL - WE CALL TRIAL: Impact of a multimodal support intervention after a "mild" stroke

Background More than 60% of new strokes each year are "mild" in severity and this proportion is expected to rise in the years to come. Within our current health care system those with "mild" stroke are typically discharged home within days, without further referral to health or rehabilitation services other than advice to see their family physician. Those with mild stroke often have limited access to support from health professionals with stroke-specific knowledge who would typically provide critical information on topics such as secondary stroke prevention, community reintegration, medication counselling and problem solving with regard to specific concerns that arise. Isolation and lack of knowledge may lead to a worsening of health problems including stroke recurrence and unnecessary and costly health care utilization. The purpose of this study is to assess the effectiveness, for individuals who experience a first "mild" stroke, of a sustainable, low cost, multimodal support intervention (comprising information, education and telephone support) - "WE CALL" compared to a passive intervention (providing the name and phone number of a resource person available if they feel the need to) - "YOU CALL", on two primary outcomes: unplanned-use of health services for negative events and quality of life. Method/Design We will recruit 384 adults who meet inclusion criteria for a first mild stroke across six Canadian sites. Baseline measures will be taken within the first month after stroke onset. Participants will be stratified according to comorbidity level and randomised to one of two groups: YOU CALL or WE CALL. Both interventions will be offered over a six months period. Primary outcomes include unplanned use of heath services for negative event (frequency calendar) and quality of life (EQ-5D and Quality of Life Index). Secondary outcomes include participation level (LIFE-H), depression (Beck Depression Inventory II) and use of health services for health promotion or prevention (frequency calendar). Blind assessors will gather data at mid-intervention, end of intervention and one year follow up. Discussion If effective, this multimodal intervention could be delivered in both urban and rural environments. For example, existing infrastructure such as regional stroke centers and existing secondary stroke prevention clinics, make this intervention, if effective, deliverable and sustainable.

Treatment of proximal interphalangeal joint flexion contracture: Combined static and dynamic orthotic intervention compared with other therapy intervention: randomized controlled trial

Purpose To test the effectiveness of static and dynamic orthoses using them as an exclusive treatment for proximal interphalangeal (PIP) joint flexion contracture compared with other hand therapy conservative treatments described in the literature. Methods 60 patients who used orthoses were compared with a control group that received other hand therapy treatments. Clinical assessments were measured before the experiment and 3 months after and included active PIP joint extension and function. Results A significant improvement in the extension active range of motion at the PIP joint in the second measurement was found in both groups, but it was significantly greater in the experimental group. Improvement in function (Disabilities of the Arm, Shoulder, and Hand score) between the first and second assessment was similar in the control and experimental groups. Conclusions Using night progressive static and daily dynamic orthoses as an exclusive treatment during the proliferative phase led to significant improvements in the PIP joint active extension, but the improvement did not correlate with increased function as perceived by the patient.

Translating training in the NYU Caregiver Intervention in Australia: Maintaining fidelity and meeting graduate standards in an online continuing professional education setting

The aim of this study was to develop an Internet-based self-directed training program for Australian healthcare workers to facilitate learning and competence in delivery of a proven intervention for caregivers of people with dementia: The New York University Caregiver Intervention (NYUCI). The NYUCI is a nonpharmacological, multicomponent intervention for spousal caregivers. It is aimed at maintaining well-being by increasing social support and decreasing family discord, thereby delaying or avoiding nursing home placement of the person with dementia. Training in the NYUCI in the United States has, until now, been conducted in person to trainee practitioners. The Internet-based intervention was developed simultaneously for trainees in the U.S. and Australia. In Australia, due to population geography, community healthcare workers, who provide support to older adult caregivers of people with dementia, live and work in many regional and rural areas. Therefore, it was especially important to have online training available to make it possible to realize the health and economic benefits of using an existing evidence-based intervention. This study aimed to transfer knowledge of training in, and delivery of, the NYUCI for an Australian context and consumers. This article details the considerations given to contextual differences and to learners’ skillset differences in translating the NYUCI for Australia.

Socioeconomic inequalities in diet and bodyweight: Evidence, causes, and intervention options

Diets low in fruits, vegetables, and whole grains, and high in saturated fat, salt, and sugar are the major contributors to the burden of chronic diseases globally. Previous research, and studies in this issue of Public Health Nutrition (PHN), show that unhealthy diets are more commonly observed among socioeconomically disadvantaged groups, and are key contributors to their higher rates of chronic disease. Most research examining socioeconomic inequalities in diet and bodyweight has been descriptive, and has focused on identifying the nature, extent, and direction of the inequalities. These types of studies are clearly necessary and important. We need however to move beyond description of the problem and focus much more on the question of why inequalities in diet and bodyweight exist. Furthering our understanding of this question will provide the necessary evidence-base to develop effective interventions to reduce the inequalities. The challenge of tackling dietary inequalities however doesn’t finish here: a maximally effective approach will also require equity-based policies that address the unequal population-distribution of social and economic resources, which is the fundamental root-cause of dietary and bodyweight inequalities.

The benefits of a self-management telephone based intervention for promoting exercise and healing rates for venous leg ulcer patients

Venous leg ulcers are a significant cause of chronic ill-health, whilst patients often experience reduced mobility and poor quality of life. This research investigated exercise as a tool for improving outcomes for adults with venous leg ulcers. The results showed that patients who adhere to an exercise program as an adjunct treatment to standard care are more likely to heal than those who do not adhere to an exercise program. This research has the potential to improve the health of venous leg ulcer patients and decrease health care costs.

A pilot study investigating the efficacy of an imagery-based motivational intervention for smoking cessation

This pilot study evaluated the potential efficacy of an imagery-based intervention called Functional Imagery Training (FIT) as a therapeutic approach to smoking cessation. FIT showed promising results in reducing cigarette use, managing craving, and promoting abstinence among smokers when compared to a control condition, and may play a role in maintaining smokers' motivation to quit. This study was the first of its kind, and paves the way for future investigations into FIT as a smoking cessation intervention.

pH testing for detecting the position of nasogastric tubes in adults and children (Intervention Protocol)

This is the protocol for a review and there is no abstract. The objectives are as follows: Our objective is to determine if there is sufficient evidence to recommend the use of pH testing (the intervention under scrutiny) for verification of correct placement of nasogastric tubes in adults and children. To this end, we will attempt to answer the following questions: 1. In adults and children, is pH testing an effective and safe method for determining whether nasogastric tubes are correctly positioned in the stomach before feeding (or delivery of any fluid) begins? 2. What evidence is there about the risk of adverse events in the case of incorrect placement? For this review, pH testing is defined as: litmus paper, pH indicator test strips, pH meters. These will be tested against other methods used for detecting placement of nasogastric tubes, including visual examination of aspirate, auscultation with insufflation of air, detection of air bubbles in a bowl of water, X-ray, ultrasonography, endoscopy, enzyme analysis of aspirate, capnography, and other methods that do not rely on measurement of pH.

Interventions targeting the elderly population to reduce emergency department utilisation: A literature review

Objective High utilisation of emergency department (ED) among the elderly is of worldwide concern. This study aims to review the effectiveness of interventions targeting the elderly population in reducing ED utilisation. Methods Major biomedical databases were searched for relevant studies. Qualitative approach was applied to derive common themes in the myriad interventions and to critically assess the variations influencing interventions’ effectiveness. Quality of studies was appraised using the Effective Public Health Practice Project (EPPHP) tool. Results 36 studies were included. Nine of 16 community-based interventions reported significant reductions in ED utilisation. Five of 20 hospital-based interventions proved effective while another four demonstrated failure. Seven key elements were identified. Ten of 14 interventions associated with significant reduction on ED use integrated at least three of the seven elements. All four interventions with significant negative results lacked five or more of the seven elements. Some key elements including multidisciplinary team, integrated primary care and social care often existed in effective interventions, while were absent in all significantly ineffective ones. Conclusions The investigated interventions have mixed effectiveness. Our findings suggest the hospital-based interventions have relatively poorer effects, and should be better connected to the community-based strategies. Interventions seem to achieve the most success with integration of multi-layered elements, especially when incorporating key elements such as a nurse-led multidisciplinary team, integrated social care, and strong linkages to the longer-term primary and community care. Notwithstanding limitations in generalising the findings, this review builds on the growing body of evidence in this particular area.

Current practice in nutrition diagnosis and intervention for the management of Parkinson's disease in Australia and Canada

Aim To document current practice by dietitians in Australia and Canada in the nutrition management of Parkinson's disease. This will help identify priority areas for review and development of practice guidelines and direct future research. Methods Current practice in the phases of the Nutrition Care Plan was captured using an online survey distributed to Dietitians Association of Australia members and Practice-Based Evidence in Nutrition subscribers through their email newsletters. The results of the diagnosis, intervention and monitoring phases are presented here. Results Eighty-four dietitians responded. There was consistency in practice for nutrition issues that are encountered in other populations, such as malnutrition and constipation. There was more variation in practice in the nutrition issues that are more specific to Parkinson's disease, such as nutrition and meal interactions with medication. A lack of awareness of emerging treatments, such as deep brain stimulation surgery, appears to exist in the responding dietitians. Conclusions The variation in practice that was present for the nutrition issues specific to Parkinson's disease may reflect the lack of quality evidence and subsequently evidence-based guidelines in these areas. Work to provide background information about treatment options and to translate current evidence for the nutrition issues that are specific to Parkinson's disease into practice recommendations should be completed.