Knowledge and skills of professional carers working with older people with depression

Objectives: The current study was designed to evaluate the knowledge, skills and self-efficacy of care providers from the perspective of professionals working in the aged-care industry.

Method: Participants were 21 professional carers, 10 General Practitioners and 7 aged-care managers. Focus groups, which involved the completion of a semi-structured interview related to knowledge, recognition, confidence, referral procedures and use of screening tools for the detection of depression, were conducted.

Results: The results showed that all groups of respondents recognised significant gap in the knowledge and awareness of depression among professional care staff working with older people in both the community and residential care-settings. Skills in the detection and monitoring of depression and the self-efficacy of these care staff were also seen to be a problem.

Discussion: The implications of these findings in terms of training programmes for professional carers working in the aged health care sector are discussed.

Depression training program for caregivers of elderly care recipients : implementation and qualitative evaluation

The prevalence of untreated depression is high among older adults who receive care in residential facilities or in their own omes and is associated with reduced quality of life and other medical conditions, Research has suggested a number of rea-p sons for the low detection and treatment rates for this problem, including lack of knowledge and efficacy among those who provide direct care and poor communication between these caregivers and senior staff, and between senior staff and genera practitioners. In this study, we report on the implementation of a training program for care staff that aims to address these issues. Focus groups with participants who completed the training indicated a high level of satisfaction with the program and reported improvements in knowledge, self-efficacy, and communication within services. It is recommended that the program be more systematically evaluated in relation to its longer term effects on care provider practices and the well-being of depressed elderly care recipients.

Mismatch between perceived and objective measures of physical activity environments

Objectives : This study investigated the correspondence between measures of physical activity facilities obtained through self-report and objective audits; and identified the socio-demographic, cognitive and behavioral characteristics of those who perceive their physical activity environment to be less supportive than objective measures indicate.
Methods : Self-report surveys were completed by 1540 women recruited from 45 neighborhoods in Melbourne, Australia. Women reported perceived access to physical activity facilities within 2 km from home, and also socio-demographic, cognitive and behavioral factors. Objective data on physical activity facilities within a 2 km pedestrian catchment area around women's homes were sourced.
Results : There was relatively poor agreement between measures of access to physical activity facilities obtained via self-report and objective assessment. Mismatch between perceived and objectively-assessed environments was more common amongst younger and older women, and women of low income, with low self-efficacy for physical activity, who were less active, who reported using fewer facilities and who had lived in the neighborhood for less than 2 years.
Conclusions : Future studies of environmental determinants of physical activity should consider incorporating objective indices of access to facilities, or accounting for the systematic bias that may result from relying on self-report perceptions as an indicator of the actual physical activity environment.

Weight, physical activity and dietary behavior change in young mothers : short term results of the HeLP-her cluster randomized controlled trial

Background
Preventing weight gain rather than treating established obesity is an important economic and public health response to the rapidly increasing rates of obesity worldwide. Treatment of established obesity is complex and costly requiring multiple resources. Preventing weight gain potentially requires fewer resources to reach broad population groups, yet there is little evidence for successful interventions to prevent weight gain in the community. Women with children are an important target group because of high rates of weight gain and the potential to influence the health behaviors in family members.

Methods
The aim of this cluster randomized controlled trial was to evaluate the short term effect of a community-based self-management intervention to prevent weight gain. Two hundred and fifty mothers of young children (mean age 40 years ± 4.5, BMI 27.9 kg/m2 ± 5.6) were recruited from the community in Melbourne, Australia. The intervention group (n = 127) attended four interactive group sessions over 4 months, held in 12 local primary schools in 2006, and was compared to a group (n = 123) receiving a single, non-interactive, health education session. Data collection included self-reported weight (both groups), measured weight (intervention only), self-efficacy, dietary intake and physical activity.

Results
Mean measured weight decreased significantly in the intervention group (-0.78 kg 95% CI; -1.22 to -0.34, p < 0.001). Comparing groups using self-reported weight, both the intervention and comparison groups decreased weight, -0.75 kg (95% CI; -1.57 to 0.07, p = 0.07) and -0.72 kg (95% CI; -1.59 to 0.14 p = 0.10) respectively with no significant difference between groups (-0.03 kg, 95% CI; -1.32 to 1.26, p = 0.95). More women lost or maintained weight in the intervention group. The intervention group tended to have the greatest effect in those who were overweight at baseline and in those who weighed themselves regularly. Intervention women who rarely self-weighed gained weight (+0.07 kg) and regular self-weighers lost weight (-1.66 kg) a difference of -1.73 kg (95% CI; -3.35 to -0.11 p = 0.04). The intervention reported increased physical activity although the difference between groups did not reach significance. Both groups reported replacing high fat foods with low fat alternatives and self-efficacy deteriorated in the comparison group only.

Conclusion
Both a single health education session and interactive behavioral intervention will result in a similar weight loss in the short term, although more participants in the interactive intervention lost or maintained weight. There were small non-significant changes to physical activity and changes to fat intake specifically replacing high fat foods with low fat alternatives such as fruit and vegetables. Self-monitoring appears to enhance weight loss when part of an intervention.

Effects of strategies to promote children's physical activity on potential mediators

The aim of this paper is to review evidence of the effectiveness of interventions that present physical activity outcomes and potential mediators of behavioural change among 4–12-year-old children. A systematic search of electronic databases for original research articles published in peer-review journals between January 1985 and the end of June 2006 was carried out. A total of 19 studies that reported intervention effects on physical activity and mediators of behavioural change were identified. The most common mediators reported included physical activity knowledge or beliefs (11 studies); self-efficacy (8 studies); and enjoyment or preference for physical activity (6 studies). Less frequently reported mediators included attitudes, behavioural capability, intentions, outcome expectancies, social norms, social support and self-concept. Seven of the 11 interventions that reported intervention effects on knowledge/beliefs stated positive changes in this mediator. Four of the eight studies that reported intervention effects on self-efficacy had significant improvements; however, only two out of six interventions reported significant improvements in physical activity enjoyment or preference. None of the studies reviewed reported whether changes in these constructs mediated changes in children's physical activity behaviours. Although more than half of the studies reviewed reported a positive intervention effect on children's physical activity, no study carried out a mediating analysis to attempt to identify the mechanisms of change. Future research should more clearly identify the mediators of behavioural change that are being targeted and whether this explains intervention effects.

Emotional intelligence and teaching : solving the puzzle

The emotional intelligence of educators has a major influence on how well they are able to help people to learn. Teachers with high levels of emotional intelligence always or usually adopt an appropriate emotionally intelligent response in both positive and negative situations. Teachers with low levels of emotional intelligence sometimes adopt an emotionally intelligent response in positive situations but seldom or never in negative situations. These differences have some significant implications. The authors' research shows that emotional intelligence and self-efficacy are different but related concepts. A teacher's level of emotional intelligence is linked to his or her sense of self-efficacy. A teacher with high levels of emotional intelligence is more likely to be able to work more effectively and persist longer because they have a belief in their own ability and feel that they are in control. The emotionally intelligent teacher is sensitive to his or her own emotions and the emotions of others and so is able to build positive relationships with colleagues and students. Beyond that, a teaching environment that is emotionally healthy and supportive will enhance the development of teachers' emotional intelligence.

Situational and dispositional indicators of performance : competing models in education

The attainment of high grades on the Victorian Certificate of Education (VCE) is critical to the future study and employment prospects of many Australian adolescents. Thus it is important to understand the factors that contribute to performance in the VCE. The aims of this study were twofold: the main aim was to test competing models of academic performance, subsuming a range of situational and dispositional variables based on a) self-efficacy theory, b) target and purpose goals, c) cognitive skills and self-regulatory strategies, and d) positive psychology. These models were each tested in terms of English performance and mathematics performance as these units contribute proportionally the most to overall VCE scores. In order to study whether pressures peculiar to the VCE impact on performance, the competing models were tested in a sample of Victorian students prior to the VCE (year 10) and then during the VCE (year 11). A preliminary study was conducted in order to develop and test four scales required for use in the major study, using an independent sample of 302 year nine students. The results indicated that these new scales were psychometrically reliable and valid. Three-hundred and seven Australian students participated in the year 10 and 11 study. These students were successively asked to provide their final years 9, 10 and 11 English and mathematics grades at times one, three and five and to complete a series of questionnaires at times two and four. Results of the year 10 study indicated that models based on self-efficacy theory were the best predictors of both English and mathematics performance, with high past grades, high self-efficacy and low anxiety contributing most to performance. While the year 10 self-efficacy models, target goal models, positive psychology models, self-regulatory models and cognitive skill based models were each robust in the sample in year 11, a substantial increase in explained variance was observed from year 10 to year 11 in the purpose goal models. Results indicated that students’ mastery goals and their performance-approach goals became substantially more predictive in the VCE than they were prior to the VCE. This result can be taken to suggest that these students responded in very instrumental ways to the pressures, and importance, of their VCE. An integrated model based on a combination of the variables from the competing models was also tested in the VCE. Results showed that these models were comparable, both in English and mathematics, to the self-efficacy models, but explained less variance than the purpose goal models. Thus in terms of parsimony the integrated models were not preferred. The implications of these results in terms of teaching practices and school counseling practices are discussed. It is recommended that students be encouraged to maintain a positive outlook in relation to their schoolwork and that they be encouraged to set their VCE goals in terms of a combination of self-referenced (mastery) and other-referenced (performance-approach) goals.

Cardiovascular health behaviours and health needs among people with psychiatric disabilities

Recent research in Australia has found that people with a mental illness experience higher mortality rates from preventable illnesses, such as cardiovascular disease, respiratory disease and diabetes compared to the general population. Lifestyle and other behavioural factors contribute significantly to these illnesses. Lifestyle behaviours that affect these illnesses include lack of physical activity, consumption of a poor diet and cigarette smoking. Research on the influence of these factors has been mainly directed towards the mainstream population in Australia. Consequently, there remains limited understanding of health behaviours among individuals with psychiatric disabilities, their health needs, or factors influencing their participation in protective health behaviours. This thesis presents findings from two studies. Study 1 evaluated the utility of the main components of Roger’s (1983) Protection Motivation Theory (PMT) to explain health behaviours among people with a mental illness. A clinical population of individuals with schizophrenia (N=83), Major Depressive Disorder (MDD) (N=70) and individuals without a mental illness (N=147) participated in the study. Respondents provided information on intentions and self-reported behaviour of engaging in physical activity, following a low-fat diet, and stopping smoking. Study 2 investigated the health care service needs of people with psychiatric disabilities (N=20). Results indicated that the prevalence of overweight, cigarette smoking and a sedentary lifestyle were significantly greater among people with a mental illness compared to that reported for individuals without a mental illness. Major predictors of the lack of intentions to adopt health behaviours among individuals with schizophrenia and MDD were high levels of fear of cardiovascular disease, lack of knowledge of correct dietary principles, lower self-efficacy, a limited social support network and a high level of psychiatric symptoms. In addition, findings demonstrated that psychiatric patients are disproportionately higher users of medical services, but they are under-users of preventive medical care services. These differences are primarily due to a lack of focus on preventive health, feelings of disempowerment and lower satisfaction of patient-doctor relationships. Implications of these results are discussed in terms of designing education and preventive programs for individuals with schizophrenia and MDD.

Severely compromised quality of life in women and those of lower socioeconomic status waiting for joint replacement surgery

Objective
To determine health-related quality of life (HRQOL), psychological distress, physical function, and self efficacy in persons waiting for lower-limb joint replacement surgery.

Methods
A total of 214 patients on a waiting list for unilateral primary total knee or hip replacement at a large Australian public teaching hospital completed questionnaires after entry to the list. HRQOL and psychological distress were compared with available population norms.

Results
Average HRQOL was extremely poor (mean ± SD 0.39 ± 0.24) and much lower (>2 SD) than the population norm. Near death-equivalent HRQOL or worse than death-equivalent HRQOL were reported by 15% of participants. High or very high psychological distress was up to 5 times more prevalent in the waiting list sample (relative risk 5.4 for participants ages 75 years and older; 95% confidence interval 3.3, 9.0). Women had significantly lower HRQOL, self efficacy, and physical function scores than men. After adjusting for age and sex, significant socioeconomic disparities were also found. Participants who received the lowest income had the poorest HRQOL; those with the least education or the lowest income had the highest psychological distress. Low self efficacy was moderately associated with poor HRQOL (r = 0.49, P < 0.001) and more strongly associated with high psychological distress (r = -0.55, P < 0.001).

Conclusion
Patients waiting for joint replacement have very poor HRQOL and high psychological distress, especially women and those from lower socioeconomic backgrounds. Lengthy waiting lists mean patients can experience extended and potentially avoidable morbidity. Interventions to address psychological distress and self efficacy could reduce this burden and should target women and lower socioeconomic groups.

Influence of the family environment on children's physical activity

This study examined the influence of the family environment on children's physical activity via four inter-related studies of over 1500 children. Findings indicated mothers' modelling of physical activity, barriers, family rules and restrictions, self-efficacy and physical features within the home environment were significant predictors of children's physical activity.

Psychological impact of DAFNE training in adults with Type 1 diabetes

This thesis investigated the psychological impact of an education intervention, Dose Adjustment for Normal Eating (DAFNE), in adults with type 1 diabetes. The results demonstrated that the education programme improved participants' subjective wellbeing, self-efficacy and reduced diabetes-related distress compared to a comparison group that engaged in usual care. The portfolio examined the use of mindfulness-based strategies, in particular Acceptance and Commitment Therapy (ACT) in four case studies which illustrated that the impact of the therapy is directly related to the the willingness of the client to engage in the practices.

Parental socialisation of preschool children's food preferences

The research examined parental socialisation of preschool children's food preferences. The findings indicated that parents' beliefs, child characteristics and parents' feeding behaviours contribute to children's food preferences. In particular, parents' self-efficacy beliefs and beliefs about why children reject foods on the one hand, and children's food neophobia on the other hand appear to influence children's everyday food preferences.

Effects of physical activity on depression and anxiety in children

This thesis study examined the direct and indirect effects of physical activity, self-efficacy and peer relations in depression and anxiety in children. No direct relationships between physical activity and symptoms of depression or anxiety were found for either sex. The portfolio, using four clinical health psychology case studies, provides an illustration of the clinical application of the transtheoretical model to four different health issues.

Readiness for substance abuse treatment amongst Victorian prisoners

The thesis examined treatment readiness in offender rehabilitation. Findings empirically refuted the notion that treatment readiness occurs in sequential progression through stages. Instead the study offered two treatment readiness models based on concurrent states of thought and behaviour. Furthermore, the treatment readiness models were found to be significantly predicted by offenders' cognitive styles and self-efficacy. The portfolio seeks to demonstrate, through four case studies, how different variables within the three-part ecological framework can either promote or constrain the reintegration process of ex-prisoners and ex-offenders.