Abstract
BackgroundThe majority of the older Singaporean women aged 50 years and above are physically inactive and have unhealthy dietary habits, placing them at ‘high risk’ of non-communicable diseases (NCDs). The adoption of regular physical activity (PA) and a healthy diet are essential lifestyle behaviours to reduce this risk. This randomised controlled trial (RCT) involves the development, implementation and evaluation of a PA and nutrition programme for community-dwelling Singaporean women who currently attend recreational centres (RCs are public facilities supporting social leisure activities) in their local area. The intervention will be developed after conducting formative evaluation with RC attendees and managers through focus group discussions and pilot testing of resources (i.e. surveys, accelerometers, and health booklets). Programme ambassadors (trained, certified fitness instructors and nutritionists) will deliver all sessions in English and Mandarin; implement classes to meet participants’ varying needs; and conduct sessions at different times at convenient venues. Social Cognitive Theory (SCT) has been selected as the theoretical framework to inform intervention strategies as it explores the interactions of human behaviour with the environment and has been found to be valuable when developing behavioural change interventions particularly in older adults (J Gerontol B Psychol Sci Soc Sci 67B(1):18–26, 2012; Obesity Reviews 15(12):983–95, 2014). Its major construct, self-efficacy, is invaluable in achieving successful behaviour change, such as increasing levels of PA or improving dietary intake (Trials. 2017; https://doi.org/10.1186/s13063-016-1771-9; Psychol Health Med 18(6):714–24, 2013).MethodsThe development and implementation of the PA and nutrition intervention strategies will be guided by SCT and Motivational interviewing (MI) and implemented by trained programme ambassadors at the RCs. Sixty RCs located in Singapore will be selected from five major geographical districts and randomly allocated to the intervention (n = 30) or control (n = 30) cluster. A sample of 600 (intervention n = 300; control n = 300) women aged 50 years and above will then be recruited from these 60 centres and only the intervention group will be enrolled into the PA and nutrition intervention. It is hypothesised that by the end of the intervention, the intervention group participants compared to the control group will show significantly greater improvements in the following outcome variables: PA and dietary behaviours, health-related quality of life, objective measures of PA, anthropometric, lipid and glucose profiles. Data will be collected at baseline and 6 months and analysed using mixed regression models.DiscussionIt is anticipated that recruitment, retention and compliance of participants will be challenging due to the target group being unfamiliar with such community-based research programmes.Trial registrationAustralian and New Zealand Clinical Trials Registry, ACTRN12617001022358. Registered on 14 July 2017. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372984&isReview=true
Highlights
The findings reported in the academic literature on the effectiveness of the physical activity (PA) and nutrition strategies in communitybased interventions typically originate from Canada, US, Europe and Australia
A proposed schedule for enrolment, intervention and assessment is shown in the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) Figure (Fig. 1) and recommended items to address for intervention trials are reflected in the Additional file 1: SPIRIT Checklist [21]
Calendar Participants will receive easy, healthy recipes found to enhance the adoption of healthy dietary behaviours among women of lower health literacy levels [69] in a ‘health calendar’ that contains health tips acting as reminders to stay active and eat healthily
Summary
Study design A 6-month, community-based PA and nutrition cluster RCT suited to the Singaporean context will be implemented and evaluated over two time points (baseline and 6 months); see Table 1. Demographic data including age, ethnicity, education, marital status, existing medical conditions, type of medications use and type of housing dwelling will be collected Process evaluation This will be undertaken throughout the intervention programme to determine reach (attendance); fidelity (quality of programme, programme delivery and resources), together with recruitment, dose delivered and received [53]. Structured feedback forms and focus group interviews will be undertaken with the participants to determine the effectiveness of programme and programme ambassadors; explore barriers, motivators; and satisfaction levels [55] Collection of these data will provide information on the effectiveness of strategies, applicability of resources, and other factors that impact upon the delivery of the intervention [56]. MI motivational interviewing, PA physical activity, RC recreational centre, SCT social cognitive theory
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