Behavioral economics, wearable devices, and cooperative games: results from a population-based intervention to increase physical activity

Background: Health care literature supports the development of accessible interventions that integrate behavioral economics, wearable devices, principles of evidence-based behavior change, and community support. However, there are limited real-world examples of large scale, population-based, member-driven reward platforms. Subsequently, a paucity of outcome data exists and health economic effects remain largely theoretical. To complicate matters, an emerging area of research is defining the role of Superusers, the small percentage of unusually engaged digital health participants who may influence other members. Objective: The objective of this preliminary study is to analyze descriptive data from GOODcoins, a self-guided, free-to-consumer engagement and rewards platform incentivizing walking, running and cycling. Registered members accessed the GOODcoins platform through PCs, tablets or mobile devices, and had the opportunity to sync wearables to track activity. Following registration, members were encouraged to join gamified group challenges and compare their progress with that of others. As members met challenge targets, they were rewarded with GOODcoins, which could be redeemed for planet- or people-friendly products. Methods: Outcome data were obtained from the GOODcoins custom SQL database. The reporting period was December 1, 2014 to May 1, 2015. Descriptive self-report data were analyzed using MySQL and MS Excel. Results: The study period includes data from 1298 users who were connected to an exercise tracking device. Females consisted of 52.6% (n=683) of the study population, 33.7% (n=438) were between the ages of 20-29, and 24.8% (n=322) were between the ages of 30-39. 77.5% (n=1006) of connected and active members met daily-recommended physical activity guidelines of 30 minutes, with a total daily average activity of 107 minutes (95% CI 90, 124). Of all connected and active users, 96.1% (n=1248) listed walking as their primary activity. For members who exchanged GOODcoins, the mean balance was 4,000 (95% CI 3850, 4150) at time of redemption, and 50.4% (n=61) of exchanges were for fitness or outdoor products, while 4.1% (n=5) were for food-related items. Participants were most likely to complete challenges when rewards were between 201-300 GOODcoins. Conclusions: The purpose of this study is to form a baseline for future research. Overall, results indicate that challenges and incentives may be effective for connected and active members, and may play a role in achieving daily-recommended activity guidelines. Registrants were typically younger, walking was the primary activity, and rewards were mainly exchanged for fitness or outdoor products. Remaining to be determined is whether members were already physically active at time of registration and are representative of healthy adherers, or were previously inactive and were incentivized to change their behavior. As challenges are gamified, there is an opportunity to investigate the role of superusers and healthy adherers, impacts on behavioral norms, and how cooperative games and incentives can be leveraged across stratified populations. Study limitations and future research agendas are discussed.

How to be a fig wasp down under: the diversity and structure of an Australian fig wasp community

Endophytic insects and their parasitoids provide valuable models for community ecology. The wasp communities in inflorescences of fig trees have great potential for comparative studies, but we must first describe individual communities. Here, we add to the few detailed studies of such communities by describing the one associated with Ficus rubiginosa in Australia. First, we describe community composition, using two different sampling procedures. Overall, we identified 14 species of non-pollinating fig wasp (NPFW) that fall into two size classes. Small wasps, including pollinators, gallers and their parasitoids, were more abundant than large wasps (both galler and parasitoid species). We show that in figs where wasps emerge naturally, the presence of large wasps may partly explain the low emergence of small wasps. During fig development, large gallers oviposit first, before and around the time of pollination, while parasitoids lay eggs after pollination. We further show that parasitoids in the subfamily Sycoryctinae, which comprise the majority of all individual NPFWs, segregate temporally by laying eggs at different stages of fig development. We discuss our results in terms of species co-existence and community structure and compare our findings to those from fig wasp communities on other continents.

Constructing risk across timescales and trajectories: Gay men's stories of sexual encounters

This paper explores the way risk is constructed in the stories gay men tell of their sexual experiences. It focuses on how tellers use such stories to portray themselves both as rational actors and as legitimate members of their social groups by reconstructing the ‘orderliness’ of sexual encounters. An analysis of a corpus of stories derived from a diary study of gay male sexual behaviour in Hong Kong using current theories of discourse analysis reveals how narrators organize their experiences along two primary vectors of engagement: a sequential vector along which the trajectory of the sexual encounter is presented as a chain of occurrences, each occurrence contingent upon previous ones and warranting subsequent ones, and a hierarchical vector along which processes perceived on longer timescales are portrayed as exerting pressure on the ways processes on shorter timescales unfold. Examining how men portray these vectors in their accounts of risk behaviour can help us better understand both the situatedness of risk behaviour and the ways it is linked to larger social practices, identity projects and community histories

Applying GIS in physical activity research: community walkability and walking behaviours.

Physical activity provides many health benefits, including reduced risk of cardiovascular disease, Type II diabetes and some cancers. Environmental exposure factors (e.g., the built environment) are now receiving ever-increasing attention. Large-scale interdisciplinary studies on the association between attributes of local community environments and residents’ physical activity are being conducted. We will focus on findings from Australia - the Physical Activity in Localities and Community Environments (PLACE) study. PLACE is examining factors that may influence the prevalence and the social and spatial distribution of walking for transport and walking for recreation. A stratified two-stage cluster sampling strategy was used to select 32 urban communities (154 census collection districts), classified as high and low ‘walkable’ using a GISbased walkability index (dwelling density, intersection density, net retail area and land use mix) and matched for socio-economic status. We report data on a sub-sample of 1,216 residents who provided information on the perceived attributes of their community environments (e.g., dwelling density, access to services, street connectivity) and weekly minutes of walking for transport and for recreation. Moderate to strong associations were found between GIS indicators of walkability and the corresponding self-report measures. The walkability index explained the same amount of neighborhood-level variance in walking for transport as did the complete set of self-report measures. No significant associations were found with walking for recreation. Relevant GIS-based indices of walkability, for purposes other than transport need to be   developed.

Multiculturalism in arts education: engaging schools in effective and authentic pedagogies

Serious questions have been raised by arts educators and community members about the effectiveness of multiculturalism that is usually enacted in Australian school settings by multi-arts festivals and related classroom activities. By exploring resources available to teachers, snapshots can be created of school practices that purport to be multicultural. Often these are only thematically integrated interdisciplinary exercises that do not reflect the complexity and diversity of true multiculturalism. Australia has for some time positioned itself as part of the global community. How this has been enacted in schools' multi-arts practices demonstrates our changing understanding of multiculturalism. The recent Australian National Review of School Music Education (2005) exhorts us to recognise cultural diversity, encourage participation and engagement and form partnerships, connections and networks. To achieve this we need to demonstrate authentic practice. Tucker (1992) has created an authenticity checklist that argues that materials should be prepared with the involvement of someone within the culture and include cultural context. Without this, we risk stripping the arts of much of its meaning. The authors contend that it should be possible in 21st century Australia to create authentic, meaningful arts education practices in schools given the rich cultural mosaic that forms our contemporary society.

Cervical cancer services for Indigenous Women: Advocacy, Community-Based Research and Policy Change in Australia

Collaborative research undertaken in the state of Queensland, Australia, resulted in major changes in cervical cancer screening and treatment for Indigenous women. Guided by an Indigenous statewide reference group and with an Indigenous researcher playing a lead role, qualitative data were collected using interviews, focus groups, and larger community meetings; and case studies were conducted with health workers and community members from diverse rural, remote and urban communities, to explore the different cultural and structural factors affecting understanding and awareness of cervical cancer and Indigenous women's use of and access to health services for screening, diagnosis and treatment. These data were supplemented by an analysis of clinical data and health service checklists. We discuss the methodology and summarize the key social and structural factors that discourage women from presenting for screening or returning for follow-up. These include women's misunderstanding of cervical cancer screening, fear of cancer, distrust of health services, poor recall and follow-up systems, and the economic and social burden to women presenting for treatment. We describe how the research process and subsequent activities provided Indigenous women with a vehicle for their own advocacy, resulting in important policy and program changes.

Civic responsibility among Australian adolescents: testing two competing models

The development of civic responsibilitv is considered to be an important
component of healthy adolescent development. However, the study of its
development has been relatively neglected and few studies have attempted to ground understanding of its development in a theoretical framework. The present study operationalized civic responsibility as attitudes and behaviors relating to political and community issues that are beneficial to society and compared two theoretical causal models, the social development model (SDM) and a coping-competency model for their predictive value. Gender differences were also assessed. A total of 500 subjects, drawn from a longitudinal study (the Australian Temperament Project), participated in the study, using questionnaire and interview data. Approximately 1 in 5 adolescents actively engaged in behaviors reflecting community civic responsibility and less than 1 in 10 actively participated in the political arena. However, positive levels of social awareness were evident.

The value of community-based monitoring in marine protected areas

There is an increasing realisation of the importance of community or volunteer collected data for management programs that are otherwise limited by the availability of funds or resources. However, there are concerns regarding the reliability of scientific data collected by inexperienced people. We investigated the potential for community-based monitoring in Victoria’s newly established system of Marine Protected Areas. The main objectives for the study were to 1) develop a template for the scientific monitoring of marine habitats suitable for community groups, 2) assess data quality and data integrity collected by community volunteers and 3) determine a sustainable model for ongoing community participation in monitoring marine habitats. Three different habitats (subtidal, intertidal, and seagrass) were investigated and data collected by volunteers across these habitats was compared to that collected by scientists. Reliability of data collected by volunteers was dependent on habitat type and the type of measurement the volunteers were required to make. Qualitative estimates made by volunteers were highly variable across all three habitat sites, compared to quantitative data collection. Subtidal monitoring had the greatest inaccuracy for data collection, whereas intertidal reef monitoring was most reliable. Sustainability of community-based monitoring programs is dependent on adequate training for volunteers and the development of partnerships to foster greater community engagement.

Australian implementation and evaluation of active support

Background The implementation and evaluation of Active Support in Australia is reported, the first such formal evaluation outside the UK.

Method Residents and staff of five group homes participated. Active Support was introduced by training staff in one home at a time. Effectiveness was assessed using direct observation of resident engagement in activity and of staff help, as well as written assessments of resident outcomes.

Results Staff help and resident engagement increased in four of five group homes. There was significantly greater participation in a wider variety of domestic activities, as well as more frequent and varied community participation. Change in resident engagement was positively related to change in staff help, but not related to residents' level of adaptive behaviour.

Conclusions Most of our findings were consistent with earlier UK studies. There was evidence of the successful transfer of Active Support training skills to an Australian training team. Nonsignificant trends towards reduced depression and increased adaptive behaviour warrant further investigation.

Community development and ecology : exploring the links

This paper will explore connections between the concepts of community development and ecology. Initially the tendency was to think there should be a total melding of the principles and practices of community development with those of an ecological understanding but on reflection this has not and indeed is not necessarily the case. The relative epistemological positioning of two different groups, one strongly associating with social justice and the need for people to be at the centre of our economic, environmental and social understanding; and the other clearly seeing the plant and ecology/environment being paramount. While there are a myriad of connections the focus of much community development has been around human welfare based on principles of social, political and economic justice. This has at times been to the detriment of ecological sustainability. Conversely ecology and particularly aspects of deep ecology have focussed on the 'other than human' aspects of the planet and at times seemed almost 'anti 'human and overlooking the need to work with the social almost entirely. This paper briefly outlines the historical separation of the social from the ecological then goes on to explore alternative understandings that bring together principles of community development and ecology. Three examples are used to highlight the principles and practices that are being used across diverse contexts but all informed by common norms and values that are consistent with both community development and ecology. Concepts such as subsidiarity, participation and empowerment that form the basis of community development praxis are critical to the development of local sustainability. The combination of these aspects is evidenced in the three examples. Each is very clearly located in the local context and is built on sound ecological and community development understandings but each is also well aware that the need for a broader perspective is imperative to achieving global goals.

Anything new under the sun? Lessons learned from community based natural resource management

Involving community in natural resource management has occurred under a wide variety of approaches, ideologies and titles over the last 30 odd years, with equally wide variety of outcomes for both the community and natural resource management!. Community Based Natural Resource Management (CBNRM) is now a commonly used and promoted, if not always well defined, approach. Claims about the benefits of CBNRM cover wildlife management and biodiversity, sustainable utilisation and management of natural resources, poverty reduction, increased livelihoods outcomes, improved food security, as well as less material benefits of livelihood diversification, empowerment, increased gender equality, and better institutional relations. There are also some fairly convincing criticisms of CBNRM reflecting on assumptions of the nature of communities, institutional arrangements and both institutional and community expectations. This paper reflects on the changing nature of community engagement in natural resource management, the emergence of CBNRM as an approach and the lessons learned from promoting CBNRM across case studies in the developing world.

Consumer participation in designing community based consumer-directed disability care : lessons from a participatory action research-inspired project

User participation has been embraced worldwide as a means to provide better consumer outcomes in health and community care. However, methodologies to achieve effective consumer engagement at the programme design level have remained under-explored. The purpose of this study was to evaluate the impact of a Participatory Action Research (PAR)-inspired methodology used to develop a consumer-directed community care/individualised funding service model for people with disabilities. A retrospective analysis of case notes and internal reports for the first 6 years of an ongoing project were examined. The findings suggest that PAR methodologies need to take into account community development, group support, and capacity building as well as succession planning and risk management issues in order to facilitate the often lengthy policy and project development process. Drawing on these findings, this article discusses five lessons and their methodological implications for PAR in a health or social policy/programme design context.

Enhancing patient engagement in chronic disease self-management support initiatives in Australia : the need for an integrated approach

♦ Although emphasis on the prevention of chronic disease is important, governments in Australia need to balance this with continued assistance to the 77% of Australians reported to have at least one long-term medical condition.

♦ Self-management support is provided by health care and community services to enhance patients’ ability to care for their chronic conditions in a cooperative framework.

♦ In Australia, there is a range of self-management support initiatives that have targeted patients (most notably, chronic disease self-management education programs) and health professionals (financial incentives, education and training).

♦ To date, there has been little coordination or integration of these self-management initiatives to enhance the patient–health professional clinical encounter.

♦ If self-management support is to work, there is a need to better understand the infrastructure, systems and training that are required to engage the key stakeholders — patients, carers, health professionals, and health care organisations.

♦ A coordinated approach is required in implementing these elements within existing and new health service models to enhance uptake and sustainability.

Community efficacy and social capital

It has been suggested that the quantity and quality of a community’s social capital has a large impact on that community’s capacity to manage change. Despite many attempts, social capital remains notoriously difficult to measure. There is general consensus that social capital is the ‘property’ of a community or collective, yet in measurement frameworks social capital is normally aggregated up across individuals and different levels. Communities are not homogeneous; we argue that the differential capacity of various groups within the community to participate should be considered. Any measure of community social capital must take account of the diversity of the community and potentially unequal access of groups and individuals to community social capital: the nature and quality of opportunities is not uniform. Further, the validity of social capital depends in fact on its contextualisation – social capital resources that are effective in one context are not necessarily effective in another.

In this paper we present a new way of thinking about the social capital of a community, linked to the community’s capacity to deliver favourable outcomes for its members. We use the term community efficacy for this capacity to manage change and influence the future of the collective and community members. We present a framework that describes the nature and quality of the factors that influence community efficacy and are at the heart of a community’s social capital resources. The framework recognises that social capital resources are used at the point of interaction between community members; hence opportunities for interaction are important. We suggest that the framework can be applied to measure community efficacy in various contexts, and discuss how it can be applied to a rural community’s ability to foster successful transitions to young adulthood for its young people.