Background Approximately one-third of children in England leave primary school overweight or obese. There is little evidence of effective obesity prevention programmes for children in this age group. Objective To determine the effectiveness and cost-effectiveness of a school-based healthy lifestyles programme in preventing obesity in children aged 9–10 years. Design A cluster randomised controlled trial with an economic and process evaluation. Setting Thirty-two primary schools in south-west England. Participants Children in Year 5 (aged 9–10 years) at recruitment and in Year 7 (aged 11–12 years) at 24 months’ post-baseline follow-up. Intervention The Healthy Lifestyles Programme (HeLP) ran during the spring and summer terms of Year 5 into the autumn term of Year 6 and included four phases: (1) building a receptive environment, (2) a drama-based healthy lifestyles week, (3) one-to-one goal setting and (4) reinforcement activities. Main outcome measures The primary outcome measure was body mass index (BMI) standard deviation score (SDS) at 24 months post baseline measures (12 months post intervention). The secondary outcomes comprised waist circumference SDS, percentage body fat SDS, proportion of children overweight and obese at 18 and 24 months, accelerometer-assessed physical activity and food intake at 18 months, and cost-effectiveness. Results We recruited 32 schools and 1324 children. We had a rate of 94% follow-up for the primary outcome. No difference in BMI SDS was found at 24 months [mean difference –0.02, 95% confidence interval (CI) –0.09 to 0.05] or at 18 months (mean difference –0.02, 95% CI –0.08 to 0.05) between children in the intervention schools and children in the control schools. No difference was found between the intervention and control groups in waist circumference SDS, percentage body fat SDS or physical activity levels. Self-reported dietary behaviours showed that, at 18 months, children in the intervention schools consumed fewer energy-dense snacks and had fewer negative food markers than children in the control schools. The intervention effect on negative food markers was fully mediated by ‘knowledge’ and three composite variables: ‘confidence and motivation’, ‘family approval/behaviours and child attitudes’ and ‘behaviours and strategies’. The intervention effect on energy-dense snacks was partially mediated by ‘knowledge’ and the same composite variables apart from ‘behaviours and strategies’. The cost of implementing the intervention was approximately £210 per child. The intervention was not cost-effective compared with control. The programme was delivered with high fidelity, and it engaged children, schools and families across the socioeconomic spectrum. Limitations The rate of response to the parent questionnaire in the process evaluation was low. Although the schools in the HeLP study included a range of levels of socioeconomic deprivation, class sizes and rural and urban settings, the number of children for whom English was an additional language was considerably lower than the national average. Conclusions HeLP is not effective or cost-effective in preventing overweight or obesity in children aged 9–10 years. Future work Our very high levels of follow-up and fidelity of intervention delivery lead us to conclude that it is unlikely that school-based programmes targeting a single age group can ever be sufficiently intense to affect weight status. New approaches are needed that affect the school, the family and the wider environment to prevent childhood obesity. Trial registration Current Controlled Trials ISRCTN15811706. Funding This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research ; Vol. 6, No. 1. See the NIHR Journals Library website for further project information.
Abstract Objective Accurate knowledge is central to effective self‐care of osteoarthritis (OA). This study aimed to assess the measurement properties of the Osteoarthritis Knowledge Scale (OAKS) with versions for the hip and knee. Methods Participants with hip OA ( n = 144), knee OA ( n = 327), and no OA ( n = 735) were recruited. Rasch analysis was conducted to assess psychometric properties using data from all participants with hip OA and 144 randomly selected participants with either knee OA or no OA. Test‐retest reliability and measurement error were estimated among those with hip ( n = 51) and knee ( n = 142) OA. Results Four items from the draft scales were deleted following Rasch analysis. The final 11‐item OAKS was unidimensional. Item functioning was not affected by gender, age, educational level, or scale version (hip or knee). Person separation index was 0.75. Test‐retest intraclass correlation coefficient was 0.81 (95% CI 0.74, 0.86; hip version 0.66 [0.47, 0.79]; knee version 0.85 (0.79, 0.90)). Smallest detectable change was 9 points (scale range 11–55; hip OA version 11 points; knee OA version 8 points). Conclusion The OAKS is a psychometrically adequate, unidimensional measure of important OA knowledge that can be used in populations with and without hip and knee OA. Caution is needed when using with populations with only hip OA as test‐retest reliability of the hip version did not surpass the acceptable range.
Background: The literature on trauma-informed care practices (TIC) indicates that this framework is beneficial for young people, carers, and staff. However, a significant gap in the literature and practice is the absence of psychometrically sound scales to measure carer adherence to TIC principles. Emerging evidence suggests that TIC practices shift carer attitudes and beliefs, which mediate positive outcomes for both carers and young people.Objective: To develop a theoretically comprehensive and psychometrically sound measure of carer TIC beliefs using Rasch methodology.Participants and Setting: Active carers (N = 719, M = 43 years, SD = 10.7 years) from online support groups in Australia, Canada, the United States of America, the United Kingdom, and the Republic of Ireland completed the questionnaire online.Methods: Based on previous research (e.g., limitations of the Trauma-Informed Belief Scale-Brief [TIBS-B]; Beehag, Dryer, et al., 2023a) and a scoping review of the TIC literature (Beehag, 2023), 61 candidate items were created that covered the three main characteristics of carer-related TIC theory (i.e., beliefs on TIC strategies to manage trauma symptoms, beliefs on the impact of adverse childhood experiences (ACE), and beliefs on the importance of self-care/reflection). The resulting data was subjected to Rasch analyses.Results: Following analyses and minor modifications, a 35-item version of the questionnaire was confirmed, which fitted the Rasch model and demonstrated unidimensionality, reasonable targeting, and sound internal consistency reliability (Person Separation Index = .81).Conclusions: The TIBS-C is a psychometrically sound measure of child welfare carer TIC beliefs. Future studies are needed to provide further evidence of its validity (e.g., predictive validity) and reliability (e.g., test-retest reliability).
Here, we report on a quasi-experimental study to explore the applicability and perceived benefits of the CRAFT program, which is based on mindfulness, yoga, positive psychology, and emotional intelligence, to improve higher education student musicians' health and well-being during the lockdown. A subset of student musicians at a Higher Conservatory of Music in Spain followed the CRAFT program during the academic year 2019/2020, 1 h per week as part of their curriculum. Students enrolled in CRAFT-based elective subjects formed the CRAFT program group (n = 40), while other students represented the control group (n = 53). The onset of the national lockdown elicited by the COVID-19 pandemic occurred halfway through the program, which was subsequently delivered in an online format. We administered an online survey to explore the effect that the exposure to the CRAFT program had in terms of how participants dealt with various health and well-being concerns arising from the COVID-19 lockdown. There was a significantly higher proportion of proactive participants in the CRAFT program group, 92%, than in the control group, 58%, in terms of implementing practices to improve their health and well-being during the lockdown. Additionally, significantly more participants acknowledged perceived benefits from their practices in the CRAFT program group, 78%, than in the control group, 52%. Among proactive participants, yoga/meditation was the most implemented in the CRAFT program group, followed by exercise, and other yoga/meditation practices, whereas in the control group, exercise and Alexander technique-based practices were the most applied. In the CRAFT program group, the highest rate of perceived benefits was from yoga/meditation CRAFT-based practices, 51%, followed by exercise, 32%, and other yoga/meditation practices, 27%, whereas in the control group, benefits were reported by 29% of exercising participants and 16% for those having practiced the Alexander technique. A similar pattern was observed when excluding participants with previous yoga/meditation experience. This study revealed how participants can independently apply learned skills from the CRAFT program in response to a naturally occurring life event of unprecedented global impact, suggesting that previous exposure to mindfulness and yoga is likely to have a beneficial effect on how young adults react towards exceptionally stressful conditions.
Men with prostate cancer experience many side effects and symptoms that may be improved by a physically active lifestyle. It was hypothesized that older men with prostate cancer who were physically active would report significantly higher levels of quality of life (QOL) as assessed by the WHOQOL-BREF and the WHOQOL-OLD. Of the 348 prostate cancer survivors who were invited to participate in the present postal survey, 137 men returned the questionnaires. Those who were physically active had significantly lower prostate specific antigen (PSA) scores and higher social participation than those insufficiently active. These findings offer some support for the benefits of physical activity (PA) within the prostate cancer population in managing the adverse side effects of their treatments on aspects of their QOL. Future research should more closely examine what types of PA best promote improvements in varying aspects of QOL and psychological well-being for prostate cancer survivors.
The present article gives an outline of the manner in which mindfulness is promoted in Western contexts. While some approaches focus on prevention of mental health issues by encouraging mindfulness before problems occur, most of the literature describes mindfulness exercises as a key component in psychological therapy for patients with existing mental health concerns. During the past few decades, mindfulness has been incorporated increasingly into the mainstream secular psychological literature and is thus no longer restricted to Buddhism, where this concept and its associated practices are generally thought to originate. As with Buddhist traditions, nonreligious methods of mindfulness practice are very diverse. The use of mindfulness in secular contexts adds novel and interesting challenges, as it usually occurs in conjunction with already established psychological methods of therapy. The main contribution of this article is intended to be in its provision of a brief sketch of the use of the concept of mindfulness in Western therapeutic applications. The emphasis is not on attempting to provide a complete and comprehensive historical account, but to outline the general nature of mindfulness research and practices in Western countries. Some exploratory links with Won-Buddhism will be highlighted as this form of Buddhism is particularly well aligned with psychological research.
Pregnancy-related anxiety has been linked to many maternal and child-related negative outcomes. However, there is an absence of free, well-validated screeners for this condition. The Pregnancy-related Anxiety Scale-Screener (PrAS-Screener) was evaluated using robust Rasch methodology. This study also aimed to develop a shorter version to meet the need of settings governed by professional guidelines stipulating the use of brief instruments. Data from 400 pregnant women (Mage = 27.82, SD = 5.38) were subjected to Rasch analyses and the resulting Rasch models confirmed in a second sample (N = 400, Mage = 26.29, SD = 4.95). After minor modifications, the original 15-item PrAS-Screener demonstrated good fit, unidimensionality, excellent targeting, invariance, and internal consistency. After removal of items with content overlap, an 11-item version was developed, with this version showing good fit, unidimensionality, reasonable targeting, and sound internal consistency. The PrAS-Screeners show promise as psychometrically sound clinical scales for screening pregnancy-related anxiety.
The development of executive function (EF) in children, particularly with respect to self-regulation skills, has been linked to long-term benefits in terms of social and health outcomes. One such skill is the ability to deal with frustrations when waiting for a delayed, preferred reward. Although robots have increasingly been utilized in educational situations that involve teaching psychosocial skills to children, including various aspects related to self-control, the utility of robots in increasing the likelihood of self-imposed delay of gratification remains to be explored. Using a single-case experimental design, the present study exposed 24 preschoolers to three experimental conditions where a choice was provided between an immediately available reward and a delayed but larger reward. The likelihood of waiting increased over sessions when children were simply asked to wait, but waiting times did not increase further during a condition where teachers offered activities as a distraction. However, when children were exposed to robots and given the opportunity to interact with them, waiting times for the majority of children increased with medium to large effect sizes. Given the positive implications of strong executive function, how it might be increased in children in which it is lacking, limited, or in the process of developing, is of considerable import. This study highlights the effectiveness of robots as a distractor during waiting times and outlines a potential new application of robots in educational contexts.
Psychology is a secular discipline, but because of its application to all domains of life, it inevitably makes contact with religious and spiritual practices. These practices have often been described in manners that avoid any direct engagement with the philosophical assumptions that underlie religious traditions. Recent systematic inclusions of mindfulness exercises in psychological practice, however, force the field into more direct discussions of religious philosophies, particularly those of Buddhism. While certain aspects of mindfulness have been successfully incorporated into psychological therapies, some Buddhist scholars have argued that the Western secular conceptualization of mindfulness is too restricted, as it does not acknowledge the roles of the other elements of Buddhist practice, particularly those pertaining to morality and wisdom. The present article reviews the arguments recently forwarded by Buddhist scholars that definitions and applications of mindfulness in Western mindfulness-based practices deviate from those of Buddhism. The article concludes that such discrepancies are not too dissimilar from differences in the conceptualization of mindfulness within Buddhism itself, and Western conceptualizations of mindfulness appear to be most closely related to those of later emerging Buddhist traditions.
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