Ongoing physical activity advice by humans versus computers: The Community Health Advice by Telephone (CHAT) Trial.

Purpose: Given the prevalence of physical inactivity among American adults, convenient, low-cost interventions are strongly indicated. This study determined the 6- and 12-month effectiveness of telephone interventions delivered by health educators or by an automated computer system in promoting physical activity. Design: Initially inactive men and women age 55 years and older (N = 218) in stable health participated. Participants were randomly assigned to human advice, automated advice, or health education control. Measures: The validated 7-day physical activity recall interview was used to estimate minutes of moderate to vigorous physical activity. Physical activity differences by experimental arm were verified on a random subsample via accelerometry. Results: Using intention-to-treat analysis, at 6 months, participants in both interventions, although not differing from one another, showed significant improvements in weekly physical activity compared with controls. These differences were generally maintained at 12 months, with both intervention arms remaining above the target of 150 min per week of moderate to vigorous physical activity on average. Conclusion: Automated telephone-linked delivery systems represent an effective alternative for delivering physical activity advice to inactive older adults. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Telephone versus print delivery of an individualized motivationally tailored physical activity intervention: Project STRIDE.

Objective: Given that only 25% of Americans meet physical activity recommendations, there is a need to develop and disseminate effective, evidence-based interventions to promote physical activity. The authors tested 2 delivery channels, telephone and print, to determine whether one was more effective in promoting physical activity. Design: The authors randomly assigned 239 healthy, sedentary adults to (a) telephone-based individualized feedback, (b) print-based individualized feedback, or (c) contact control. Both intervention arms were guided by a motivationally tailored, theoretically driven computer expert system. Main outcome measures: Physical activity as measured by the 7-day Physical Activity Recall interview. Results: At 6 months, both telephone and print arms significantly increased in minutes of moderate intensity physical activity compared with control, with no differences between the intervention arms. At 12 months, print participants reported a significantly greater number of moderate intensity minutes than both telephone and control participants, who did not differ. Conclusion: Results suggest that both telephone and print enhance the adoption of physical activity among sedentary adults; however, print interventions may be particularly effective in maintaining physical activity in the longer term. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Does tailoring on additional theoretical constructs enhance the efficacy of a print-based physical activity promotion intervention?

Objective: To enhance a previously efficacious individually tailored physical activity (PA) promotion intervention by adding theoretical constructs to the tailored feedback. Design: We randomly assigned 248 healthy, underactive (moderate to vigorous physical activity [MVPA] min/week enhanced print). Main Outcome Measure: The 7-day physical activity recall administered at baseline, Month 6, and Month 12, with outcomes operationalized as percentage achieving 150 min/week of MVPA. Results: When controlling for covariates, there was a nonsignificant trend in favor of the enhanced print condition reflecting 46% and 50% greater odds of achieving 150 min/week of MVPA at Month 6 and Month 12, respectively. Conclusion: Enhanced tailoring based on additional theoretical constructs may result in marginal improvements in physical activity outcomes. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Volunteer facilitators assist community practices with enhancing cancer control

OBJECTIVE: To explore the feasibility of recruiting, training, and placing in the field volunteers to assist community practices in enhancing the provision of preventive care. DESIGN: A case series design followed up a cohort of volunteers prospectively as they were recruited, trained, and assigned to practices. SETTING: The New Hampshire Division of the American Cancer Society recruited and trained the volunteer facilitators. INTERVENTION: Assistance from the volunteers in implementing a preventive services office system served as the intervention for practices. Volunteers were trained and supported by professional staff and an implementation manual. MAIN OUTCOME MEASURES: Recruitment, training, and volunteer experiences in working with practices, as well as the costs of supporting the program, were assessed. RESULTS: Twenty-six volunteers were trained. Of the 15 assigned to practices, 11 had begun to assist their assigned practices to establish a preventive services office system. Extensive planning, patience, and support were required. CONCLUSION: Volunteers recruited and supported by an intermediary organization can provide assistance to practices in implementing a preventive services office system.     

Integrating peer support initiatives in a large healthcare organization.

The Veterans Health Administration (VHA) adopted a strategic plan for mental health that emphasizes implementation of recovery-oriented services, including peer support. To provide a baseline for assessing change, a national survey was conducted of peer service delivery for veterans with mental illness, including those with comorbid substance abuse or homelessness. The number of participating programs was small. However, responses indicate that existing VHA peer services can be categorized as partnership services. Program and position structures, such as goals and training requirements are each described. Role and administrative or systems processes, such as acquiring staff buy-in and liability are also described. Future areas of consideration include dissemination of peer support in VHA and other healthcare systems, with specific efforts to increase training protocols, evaluation, and payment options for peers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Results of the “Active by Choice Today” (ACT) randomized trial for increasing physical activity in low-income and minority adolescents.

Objective: This study reports the results of the “Active by Choice Today” (ACT) trial for increasing moderate-to-vigorous physical activity (MVPA) in low-income and minority adolescents. Design: The ACT program was a randomized controlled school-based trial testing the efficacy of a motivational plus behavioral skills intervention on increasing MVPA in underserved adolescents. Twenty-four middle schools were matched on school size, percentage minorities, percentage free or reduce lunch, and urban or rural setting before randomization. A total of 1,563 6th grade students (mean age, 11.3 years, 73% African American, 71% free or reduced lunch, 55% female) participated in either a 17-week (over one academic year) intervention or comparison after-school program. Main Outcome Measure: The primary outcome measure was MVPA based on 7-day accelerometry estimates at 2-weeks postintervention and an intermediate outcome was MVPA at midintervention. Results: At midintervention students in the intervention condition engaged in 4.87 greater minutes of MVPA per day (95% CI: 1.18 to 8.57) than control students. Students in intervention schools engaged in 9.11 min (95% CI: 5.73 to 12.48) more of MVPA per day than those in control schools during the program time periods; indicating a 27 min per week increase in MVPA. No significant effect of the ACT intervention was found outside of school times or for MVPA at 2-weeks postintervention. Conclusions: Motivational and behavioral skills programs are effective at increasing MVPA in low-income and minority adolescents during program hours, but further research is needed to address home barriers to youth MVPA. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

The long-term efficacy of two computer-tailored physical activity interventions for older adults: Main effects and mediators.

Objective: Low-cost (e.g., computer-tailored) interventions with sustained effects are needed to increase and maintain physical activity in older adults. This study examined the long-term efficacy of 2 computer-tailored physical activity interventions for older adults and its psychosocial and environmental mediators. Methods: A clustered randomized controlled trial (N = 1,971) was conducted that included 3 research arms: (a) basic computer-tailored print intervention, targeting psychosocial mediators; (b) environmentally computer-tailored print intervention, targeting psychosocial and environmental mediators; and (c) no-intervention control group. Interventions were developed using the intervention mapping approach and consisted of 3 computer-tailored letters delivered over 4 months. Questionnaires assessed the study outcomes (i.e., total weekly days and total weekly minutes of physical activity) at baseline and 12 months. Potential mediators (i.e., awareness, attitude, self-efficacy, intention, social influence, intrinsic motivation, self-regulation, and perceived environment) were assessed at baseline and at 3 or 6 months. Results: Multilevel regression analyses revealed that both interventions significantly changed total weekly days of physical activity compared with the control group, but only the environmentally computer-tailored print intervention significantly changed weekly minutes of physical activity. Multiple mediation models showed that the effects of both interventions on weekly days of physical activity were mediated by changes in awareness and intention. Conclusions: Computer-tailored interventions were effective in inducing long-term behavioral changes in physical activity behavior of older adults. Awareness and intention were found to be important mediators of changing daily physical activity and should be included in future computer-tailored intervention studies. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Social contagion of motivation between teacher and student: Analyzing underlying processes.

We examined (a) whether motivational orientation can spread from teachers to students during 2 consecutive teaching–learning sessions and (b) mechanisms underlying this phenomenon in a special physical education session delivered to high school students. Participants who were taught a sport activity by an allegedly paid instructor reported lower interest in learning and exhibited less persistence in a free-choice period than students taught by a supposedly volunteer instructor, despite receiving the same standardized lesson across experimental conditions. When participants taught the activity to their peers in a subsequent unconstrained learning session, lower levels of interest and behavioral persistence were also exhibited by learners who received the second lesson. A structural equation model confirmed that learners at the end of this educational chain made inferences about how intrinsically motivated their peer tutors were, on the basis of their teaching style (i.e., autonomy-supportive behaviors) and the positive affects they displayed. These inferences, in turn, affected the students' own intrinsic motivation for the activity. Results are interpreted in relation to self-determination theory, and practical implications of the findings are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relational and physical forms of peer victimization in preschool.

Recent studies of peer victimization have demonstrated the importance of studying relational as well as physical forms of peer maltreatment for understanding children's social-psychological adjustment problems. Studies in this area have been limited thus far by a focus on school-age children (9–12-year olds). Given the significance of early identification of children's social difficulties for intervention and prevention efforts, this research was designed to assess relational and physical peer victimization among preschool-age children (3–5-year-olds). Results indicated that boys were significantly more physically victimized than girls whereas girls were more relationally victimized. Both relational and physical victims experienced greater adjustment problems than did their peers. Relational victimization contributed unique information about adjustment beyond that provided by physical victimization. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Stability and change in patterns of participation in a parent–child program.

Investigated variations in participation in a neighborhood-based educational support program in 35 18–39 yr old low-income and working-class White mothers of young children who were involved in 6 different parent groups for 1 yr. 30 other Ss had dropped out of participation during this period. Interview data were collected every 6 mo, and staff members kept records of attendance and telephone interactions with Ss. Program participation indices were attendance, relations with program peers, and use of staff services during the 1st 12 mo of involvement. Results show that 8 Ss were peer oriented, 8 Ss were staff oriented, 9 Ss demonstrated increased staff use, and 10 Ss had low involvement. Ss in the 1st 2 groups moved quickly to establish relationships, while Ss in the last 2 groups took a longer time to use program resources. Findings suggest a need for longitudinal measurement of the treatment in evaluation research, a conceptualization of intensive interventions as multidimensional, and the potential usefulness of focusing on interpersonal ties in an intervention program when measuring the treatment. (15 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Health research literacy: a new approach to involving rural general practitioners in research and evaluation

The aim of this study was to determine the physical activity levels of a sample of young children. Data were collected using direct, continuous observation by trained observers. The observational method utilised a points system to differentiate intensity of physical activity. Observations were carried out during school break times, lunch times and physical education lessons and during free time outside of school. The sample consisted of 93 girls and 86 boys aged between 5 and 11 years. Only 38 children (21%) engaged in a sustained 20-min period of moderate to vigorous physical activity (MVPA), but nearly all children (95%) took part in a 5-min period of MVPA. The highest recordings of MVPA occurred during school break times but MVPA was less prominent during free time outside of school. One hundred and seventy eight children were observed during school physical education lessons. Sustained MVPA was particularly low during physical education lessons with only 13 children (8%) participating in at least one sustained 10-min period. There appeared to be no difference in activity levels between boys and girls or between children of differing ages. During all observation periods the main activity of the child was recorded. Soccer, brisk walking, general play and chasing games were the most common activities. The results are disturbing since preadolescent children appear to be engaging in very little sustained, playful physical activity during their free time outside of school. If childhood is considered to be the most active stage of life there must be concern for the future. There is a need for health professionals to promote active lifestyles from birth.     

Efficacy of elderly and adolescent volunteer counselors in a nursing home setting.

Reliance on the use of volunteers and lay paraprofessionals in human services delivery has increased with the rising demand and shortage of professional providers. We examined the effects of a volunteer training program on depression levels of nursing home residents. The Zung Self-Rating Depression Scale (SDS) was used to identify 60 moderately depressed residents. A total of 20 volunteer counselors (10 elderly, 10 adolescent) were trained in empathic listening, and 20 volunteer counselors (10 elderly, 10 adolescent) were only given information regarding the aging process. Counselors and nursing home residents met twice a week for 5 weeks. Zung SDS posttest results showed that residents who received a volunteer counselor significantly improved (p     

Mediators of physical activity behavior change: A multivariate approach.

Objective: Using a multivariate extension of the Baron and Kenny (1986) mediation framework, we examined the simultaneous effect of variables hypothesized to mediate the relationship between a motivationally tailored physical activity intervention, and 6-month physical activity behavior in 239 healthy, underactive adults (M age = 47.5; 82% women). Design: Participants were randomly assigned to (a) print-based feedback; (b) telephone-based feedback; or (c) contact control. Main Outcome Measures: Psychosocial variables, including self-efficacy, decisional balance, and processes of change. Results: All mediation criteria were satisfied for both intervention arms. A moderate indirect effect of print (0.39, 95% CI = 0.21, 0.57) was found due to increases in behavioral processes (0.54, 95% CI = 0.29, 0.80) being attenuated by decreases due to cognitive processes (-0.17, 95%CI = 0.31,-.03). A moderate indirect effect was observed for telephone (0.47, 95% CI = 0.28, 0.66), with increases due to behavioral processes (0.61, 95% CI = 0.34, 0.87) attenuated by decreases due to cognitive processes (0.15, 95% CI = -0.27, -0.02); self-efficacy and decisional balance mediational paths did not attain statistical significance. Conclusions: These findings highlight the importance of studies that deconstruct the theoretical components of interventions to determine which combination produces the greatest behavior changes at the lowest cost. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Early adolescent peer orientation and adjustment during high school.

The long-term consequences of early adolescents' orientation toward peers for their adjustment during high school were assessed. Approximately 1,200 adolescents completed questionnaires in the 7th grade and in the 10th or 12th grades; course grades were also obtained from the students' school records. Early adolescents who were willing to sacrifice their talents, school performance, and parents' rules engaged in greater problem behavior and evidenced lower academic achievement than did other adolescents during high school. The poorer adjustment of adolescents with this extreme orientation toward peers was mediated by their reported involvement in deviant peer groups. In contrast, a tendency to seek advice from peers more than from parents during early adolescence had little implication for later adjustment. Discussion focuses on the need to consider the role of peer dependence along with the effects of supportive friendships during adolescence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The residential therapeutic caring community.

The residential therapeutic caring community (RTCC) for adolescents combines psychotherapeutic principles of the professional model and self-help concept of the therapeutic community by using the collective resources of members to mobilize peer pressure. The RTCC is a safe, structured, supportive treatment environment that employs a confrontation, teaching, interpretative, and reasoning approach and uses the psychotherapeutic principles of reality therapy and existential thought. In the RTCC, the staff serve as mentors and role models, and they demonstrate their concern by maintaining high expectations for immediate improved behavior. The personal qualities necessary for a psychotherapist working in an RTCC are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Treatment of von Willebrand disease

When working well, internal forensic review boards generally: (1) have the support of the courts and communities; (2) consider and review effective individual treatment and public safety; (3) permit direct care treatment teams the opportunity to advocate for the patient; (4) focus clinical and security considerations on the individual patient rather than dwelling on system issues; (5) identify resource needs for inpatient and community care; (6) provide a foundation for monitoring patient adjustment to various levels of stressors, both in the hospital and the community; (7) provide a mechanism for timely crisis intervention for individual patients; (8) afford administrative and clinical staff a mechanism for peer review; (9) are cost effective compared with external review boards; (10) provide data and a tracking mechanism for quality improvement for the forensic system of care; and (11) provide an education/training function for direct care and professional staff.     

Telephone-based coping skills training for patients awaiting lung transplantation.

Impaired quality of life is associated with increased mortality in patients with advanced lung disease. Using a randomized controlled trial with allocation concealment and blinded outcome assessment at 2 tertiary care teaching hospitals, the authors randomly assigned 328 patients with end-stage lung disease awaiting lung transplantation to 12 weeks of telephone-based coping skills training (CST) or to usual medical care (UMC). Patients completed a battery of quality of life instruments and were followed for up to 3.4 years to assess all-cause mortality. Compared with UMC, CST produced lower scores on perceived stress, anxiety, depressive symptoms, and negative affect and improved scores on mental health functioning, optimism, vitality, and perceived social support. There were 29 deaths (9%) over a mean follow-up period of 1.1 year. Survival analyses revealed that there was no difference in survival between the 2 groups. The authors conclude that a telephone-based CST intervention can be effectively delivered to patients awaiting lung transplantation. Despite the severity of pulmonary disease in this patient population, significant improvements in quality of life, but not somatic measures or survival to transplant, were achieved. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A group-intensive peer support model of case management for supported housing.

A group-intensive peer support (GIPS) model of case management for supported housing initiatives is proposed. The principles behind the model and initial experiences with its implementation are described. To promote social reintegration and recovery, GIPS provides housing subsidies and is clinically based on group meetings as the default mode of case management, relying on individual community-based case management interventions on an as-needed basis. The process of finding and sustaining independent housing is articulated as a 21-step process in which peers coach and support one another in achieving each of the steps. The GIPS model has been implemented at the Connecticut VA by five full-time case managers serving approximately 80 veterans. Group meetings are conducted four times a week at various locations ranging in size from three to 25 clients per group. Groups helped maintain frequent contact with clients, minimized staff travel time, and fostered client information-sharing, peer support, and community adaptation. Case vignettes from three different phases of GIPS are used to illustrate the potential benefit for both client well-being and more efficient use of staff time. GIPS is a conceptually promising alternative approach that may be of special value in large multisite programs because it promotes peer support, staff efficiency, and client social reintegration. (PsycINFO Database Record (c) 2011 APA, all rights reserved)