Canadian men, especially those living in rural/remote regions, are at risk for a number of lifestyle-related chronic diseases (CD) including type 2 diabetes, high blood pressure, heart disease, stroke and some forms of cancer. CDs share many risk factors including overweight, physical inactivity, unhealthy diet, and smoking. Poor health outcomes suggest that Canadian men continue to fall short in adopting healthy lifestyles that could prevent CD. There are also alarming discrepancies in CD burden by geography, whereby rural residence increases the risk of developing CD and results in poorer health outcomes. The community-based Health e Steps TM program offers lifestyle prescriptions (exercise, healthy eating), coaching, and technology supports to help Canadians become more physically active, eat better, and improve their health. The Health e Steps TM program has been implemented in a variety of community settings, and more than 90% of the participants have been women. In addition, our community partners have reported challenges with regard to engaging men in group and individual health programs. The proposed presentation will cover two related studies conducted by the Health e Steps TM research team that explored factors influencing the participation of rural men in CD prevention and management (CDPM) programs. In the first study, 149 men living in SW Ontario completed a survey that measured health behaviours and perceptions of CDPM programs. The second study was a scoping review of academic and grey literature related to factors influencing the engagement of rural men in CDPM programs. Prominent themes that were uncovered in both studies include negative perceptions of group-based programs and the importance of considering psychosocial (e.g., the desire to appear masculine) and program-specific factors (e.g., program characteristics) when designing male-specific CDPM programs. Conflicting results between our survey findings and the literature review will also be discussed. Acknowledgments: The authors would like to acknowledge the Canadian Institutes of Health Research for funding this project, titled HealtheSteps: Strategies to Engage Rural Canadian Men in Chronic Disease Prevention and Management Programs (#129593)
Trainees often decide to pursue a career in the professions because they see it as a means to attain their life goals: to become the kind of person they want to be, to live the kind of life they want to lead, and to make the kind of impact they want to have on the world. The life goals trainees pursue through a professional career are derived from their conception of their ideal self and are thus the most important and self-defining goals that they possess. In this article, we propose a novel approach for designing training activities to harness the motivational potential of professional trainees’ life goals, toward supporting their deep engagement in training activities. We propose that activities can be designed to help trainees make links between (1) the concepts and skills covered in an activity, (2) the professional practice behaviors that an activity prepares them to enact, and (3) the life goals that are served by enacting these professional practice behaviors. Informed by Control Theory and Self-Determination Theory, we predict that this design may promote trainees’ adoption of activity-specific goals that emphasize deep understanding, long-term retention, and transfer, and enhance their autonomous motivation to attain their goals. However, there are some situations when this design may be less effective for, or even harmful to, trainees’ motivation. Specifically, we predict that helping trainees establish a purpose for learning by linking an activity to their life goals may be most effective when they can adapt an activity to best align with their purpose, when they are confident in their ability to attain their activity-specific goal, and when they become engrossed in an activity because it affords interest- and curiosity-stimulating actions. We package our theoretical analysis into the PACE model of motivational design. When our predictions are supported by more empirical evidence, the model can help educators set the PACE for trainees, thereby motivating them to engage deeply in training activities.
Background: Exposure to environmental tobacco smoke (ETS) presents substantial health risks for pregnant women and newborn infants. Measurements of ETS include invasive and expensive biochemical tests, as well as less invasive and lower-cost, self-reported exposure and avoidance measures. Better understanding of self-report measures will help to select ETS assessments for evaluation. Methods: This analysis was conducted within the context of a tailored video intervention to reduce tobacco smoking and ETS exposure during pregnancy and after delivery in the control group sample of 147 nonsmoking women. Measurements of salivary cotinine concentration, self-reported ETS exposure, and avoidance behaviors were captured at 32 weeks’ gestation and 6 months postpartum. Results: Salivary cotinine concentration was significantly related to ETS avoidance among pregnant nonsmokers at 32 weeks’ gestation, but not ETS exposure. At 6 months postpartum, both the reported ETS exposure of the infant and maternal avoidance behaviors to reduce her infant’s exposure were associated with the infant’s salivary cotinine concentration. At 32 weeks’ gestation and 6 months postpartum, avoidance behaviors decreased as exposure increased. Discussion: This study suggests that for nonsmoking women during pregnancy, reports of tobacco smoke avoidance are more valid than reports of exposure. After delivery, self-reported ETS exposure or avoidance are associated with each other and the biochemical measurement of salivary cotinine. These results provide researchers and clinicians with evidence to support the inclusion of avoidance behaviors in the selection of ETS measures.
If 'active learning' means 'anything other than passive', does it really have much meaning at all? The authors offer suggestions regarding how we might better conceptualize the term 'active learning' moving forward.
Abstract Background Process evaluation can illuminate barriers and facilitators to intervention implementation as well as the drivers of intervention outcomes. However, few obesity intervention studies have documented process evaluation methods and results. Community-based participatory research (CBPR) requires that process evaluation methods be developed to (a) prioritize community members’ power to adapt the program to local needs over strict adherence to intervention protocols, (b) share process evaluation data with implementers to maximize benefit to participants, and (c) ensure partner organizations are not overburdened. Co-designed with low-income parents using CBPR, Communities for Healthy Living (CHL) is a family-centered intervention implemented within Head Start to prevent childhood obesity and promote family well-being. We are currently undertaking a randomized controlled trial to test the effectiveness of CHL in 23 Head Start centers in the greater Boston area. In this protocol paper, we outline an embedded process evaluation designed to monitor intervention adherence and adaptation, support ongoing quality improvement, and examine contextual factors that may moderate intervention implementation and/or effectiveness. Methods This mixed methods process evaluation was developed using the Pérez et al. framework for evaluating adaptive interventions and is reported following guidelines outlined by Grant et al. Trained research assistants will conduct structured observations of intervention sessions. Intervention facilitators and recipients, along with Head Start staff, will complete surveys and semi-structured interviews. De-identified data for all eligible children and families will be extracted from Head Start administrative records. Qualitative data will be analyzed thematically. Quantitative and qualitative data will be integrated using triangulation methods to assess intervention adherence, monitor adaptations, and identify moderators of intervention implementation and effectiveness. Discussion A diverse set of quantitative and qualitative data sources are employed to fully characterize CHL implementation. Simultaneously, CHL’s process evaluation will provide a case study on strategies to address the challenges of process evaluation for CBPR interventions. Results from this process evaluation will help to explain variation in intervention implementation and outcomes across Head Start programs, support CHL sustainability and future scale-up, and provide guidance for future complex interventions developed using CBPR. Trial registration ClinicalTrials.gov, NCT03334669 . Registered on October 10, 2017
INTRODUCTION: Pregnancy is a time of vast knowledge acquisition, however, in a busy clinic schedule, providers have limited time to provide anticipatory guidance. Video has been used to provide stereotyped education, however, information is lacking on the acceptability and effectiveness of video education for antepartum patients. This quality improvement project queried sources of education for antenatal patients, the potential role of video education, and the educational impact of a video currently used in a residency outpatient clinic. METHODS: A survey was designed to query patient usage and perceived efficacy of commonly utilized resources for information in pregnancy. Surveys were administered during patients' initial prenatal intake appointment. Patients also completed a knowledge quiz before and after watching a 10-minute video on breastfeeding. RESULTS: 74 patients participated in the survey. Patients reported the most commonly used and most helpful sources of information were family (43), general websites (37), and friends (36). 69% of respondents reported an interest in videos about pregnancy. Patients showed a statistically significant improvement in knowledge of breastfeeding after watching a 10-minute video (2.83, 3.57 p=0.0078). Patient scores on the knowledge quiz did not differ by video preference. CONCLUSION: Patients report their most common and helpful sources of information do not come from professionals. Patients are amenable to video as a source of counseling in pregnancy, and show improved knowledge following education through this modality. Future studies will help to clarify specific characteristics of effective antepartum video education tools, as well as potential impacts on antepartum care.
