Behavior Change Training Research Articles

Impact of a Clinical Placement on Pre-Professional Health Students Perceived Knowledge, Skills, and Confidence in the Delivery of Behaviour Change and Physical Activity Support

Background: Clinical placements may provide an appropriate setting for health professional students to learn and apply skills for supporting clients to improve their physical activity. Methods: A mixed methods study was conducted with pre-professional health students completing clinical placement at one of two interprofessional community clinics. Surveys assessed student self-reported perceived skills, knowledge, and confidence for behaviour change and physical activity support pre- and post-placement (unmatched n=40). Interviews were conducted with students (n=18) and clinical educators (n=4). Change in student knowledge, skills, and confidence were assessed using non-parametric tests; qualitative data underwent inductive thematic analysis. Results: Post-placement, unmatched participants perceived knowledge and understanding (p = 0.017), skills (p = 0.001), and confidence (p = 0.004) in behaviour change significantly increased. Perceived confidence in providing physical activity behavior change support for low-risk (p = 0.022) and complex conditions (p = 0.009) significantly improved. Qualitative data emphasised the importance of clinical educators and direct clinical experiences in preparing students for future practice. Conclusion: Student-facilitated interprofessional clinical placements may be important for developing pre-professional knowledge, skills, and confidence in delivering behaviour change and physical activity support. Further exploration of clinical placement opportunities for strengthening pre-professional health students training in physical activity promotion and behaviour change is recommended.

S06-3: We Walk. Developing and pilot testing a dyadic intervention to promote outdoor walking in people after stroke: benefits, challenges and solutions

Abstract Purpose After stroke, physical activity (PA) levels are low, risking secondary stroke, cardiovascular disease, falls and poor mobility. Regular PA reduces these risks. Walking is a preferred PA option for stroke survivors, and social support influences uptake and maintenance of behaviours. We therefore developed WeWalk, a person-centred, dyadic peer-support behavioural intervention supported by walking buddies, to promote regular walking after stroke. This study evaluated participants’ experiences of WeWalk to refine it ready for effectiveness testing and implementation. Methods Intervention: WeWalk involved facilitated face-to-face and telephone sessions with a researcher with behaviour change training, supported by intervention handbooks and diaries. Dyads agreed walking goals and plans, monitored progress, and developed strategies for maintaining walking. Evaluation Data were collected through semi-structured interviews and facilitator fieldnotes during intervention delivery, and were analysed using thematic analysis, guided by a theoretical framework of acceptability. Results We recruited 21 dyads comprising community-dwelling PWS and their walking buddies. Eighteen dyads completed exit interviews, one dyad was lost to follow-up and two withdrew with ill-health. We identified three themes: acceptability evolves with experience, mutuality, and person-centredness with personally relevant tailoring. As dyads recognised how WeWalk components supported walking, perceptions of acceptability grew. Effort receded as goals and enjoyment of walking together were realised. The dyadic structure provided accountability, and participants’ confidence developed as they experienced physical and psychological benefits of walking. WeWalk required careful facilitation. It worked best when dyads exhibited relational connectivity and mutuality in setting and achieving goals however in a few dyads agreeing and enacting mutual goals was more challenging. Tailoring intervention components to individual circumstances and values supported dyads in achieving meaningful goals. Conclusions WeWalk is feasible and acceptable, illustrating the potential of dyadic interventions after stroke. However, its complexity requires considered implementation strategies. Data highlight the need for careful matching of dyads, facilitation of dyadic working by practitioners who can support development of dyadic relationships; and community structures linked to healthcare pathways that support implementation. We have worked with charities health services organisations to plan and develop these implementation strategies and report the challenges and potential solutions to delivering this complex intervention.

Research Bites

Mary M. Yoke, Ph.D., M.A., M.M., FACSM, EIM,is a full-time faculty member at the School for Health and Human Sciences at IUPUI (Department of Kinesiology). Before her position in Indiana, she was an adjunct professor at Adelphi University for 22 years, where she authored or coauthored numerous group exercise research studies. She is the author of four fitness textbooks and one consumer book on happiness; she has presented in 18 countries and throughout the United States on a wide variety of health/fitness topics and has obtained 24 certifications. Her research interests include behavior change, positive psychology, motivation, obesity, group fitness, and personal training efficacy. Disclosure:The author declares no conflict of interest and does not have any financial disclosures.

Implementation of behaviour change training in practice amongst pharmacy professionals in primary care settings: Analysis using the COM-B model

BackgroundThe Pharmacy Integration Fund (PhIF) was established in England in 2016, with funded learning programmes or ‘pathways’ designed to support the development of clinical pharmacy practice in a range of settings. Despite pharmacy staff being well positioned to provide more clinical work, limited research has investigated behaviour change training targeted at widespread practice transformation. Objective(s)To investigate implementation of PhIF learning in practice, using the COM-B model of behaviour change. MethodsAn online survey distributed in February and October 2020 included questions on motivations for learning, confidence in target behaviours and impact of PhIF training on behaviour. The October 2020 survey also included questions exploring the effect of the COVID-19 pandemic. Quantitative data were analysed in SPSS. v.27 (IBM). Inferential statistics were used to compare between the pathways (Primary care pathways [PCP], Post-registration pathway [PRP] and Accuracy Checking Pharmacy Technician [ACPT] pathway). Free text comments were categorised and themed. ResultsThree-hundred and eighty-three responses were received (49% PRP learners, 39% PCP learners and 12% ACPT learners). Learners generally had the capacity and opportunities to apply learning, and were strongly motivated to implement behaviours in practice, although learners based in community pharmacy (those on the PRP) were less likely to report receiving employer support. Enhanced knowledge/skills (capacity) were more commonly reported than change to patient-facing activities, leading clinical services and conducting medication reviews with patients with complex needs (clinical practice behaviours targeted by the pathways). The COVID-19 pandemic heightened barriers to implementing practice change. ConclusionsImplementation of a range of clinical practice behaviours following at scale training appears to have been largely successful. Despite this, the community pharmacy context, where funded service opportunities may be lacking, continues to present challenges to workforce transformation plans. More work is needed to understand how training can be implemented to promote practice change for pharmacy professionals in all settings.

Impact of a scalable training program on the quality of colonoscopy performance and risk of postcolonoscopy colorectal cancer

Endoscopist adenoma detection rates (ADRs) vary widely and are associated with patients' risk of postcolonoscopy colorectal cancers (PCCRCs). However, few scalable physician-directed interventions demonstrably both improve ADR and reduce PCCRC risk. Among patients undergoing colonoscopy, we evaluated the influence of a scalable online training on individual-level ADRs and PCCRC risk. The intervention was a 30-minute, interactive, online training, developed using behavior change theory, to address factors that potentially impede detection of adenomas. Analyses included interrupted time series analyses for pretraining versus posttraining individual-physician ADR changes (adjusted for temporal trends) and Cox regression for associations between ADR changes and patients' PCCRC risk. Across 21 endoscopy centers and all 86 eligible endoscopists, ADRs increased immediately by an absolute 3.13% (95% confidence interval [CI], 1.31-4.94) in the 3-month quarter after training compared with .58% per quarter (95% CI, .40-.77) and 0.33% per quarter (95% CI, .16-.49) in the 3-year pretraining and posttraining periods, respectively. Posttraining ADR increases were higher among endoscopists with pretraining ADRs below the median. Among 146,786 posttraining colonoscopies (all indications), each 1% absolute increase in screening ADR posttraining was associated with a 4% decrease in their patients' PCCRC risk (hazard ratio, .96; 95% CI, .93-.99). An ADR increase of≥10% versus<1% was associated with a 55% reduced risk of PCCRC (hazard ratio, .45; 95% CI, .24-.82). A scalable, online behavior change training intervention focused on modifiable factors was associated with significant and sustained improvements in ADR, particularly among endoscopists with lower ADRs. These ADR changes were associated with substantial reductions in their patients' risk of PCCRC.

Behavior Change Training for Health Professionals: Evaluation of a 2-Hour Workshop.

Rates of noncommunicable diseases continue to rise worldwide. Many of these diseases are a result of engaging in risk behaviors. Without lifestyle and behavioral intervention, noncommunicable diseases can worsen and develop into more debilitating diseases. Behavioral interventions are an effective strategy to reduce the burden of disease. Behavior change techniques can be described as the "active ingredients" in behavior change and address the components that need to be altered in order for the target behavior to change. Health professionals, such as pharmacists and nurses, can engage in opportunistic behavior change with their patients, to encourage positive health behaviors. We aimed to develop, implement, and evaluate a behavior change workshop targeted at health professionals in Australia, with the goal of increasing knowledge of behavior change techniques and psychological variables. A prospective study design was used to develop and evaluate a 2-hour behavior change workshop targeted at health professionals. The workshop was developed based on the Capability, Opportunity, Motivation, and Behavior Model and had five core objectives: (1) to detail the role of health professionals in delivering optimal care, (2) to demonstrate opportunities to change behavior, (3) to describe principles of behavior change, (4) to explain behavior change techniques, and (5) to determine the most appropriate behavior change techniques to use and when to use them. A total of 10 workshops were conducted. To evaluate the workshops and identify any potential long-term changes in behavior, we collected pre- and postworkshop data on knowledge and psychological constructs from the attendees. A final sample of 41 health professionals comprising general practitioners, nurses, and pharmacists completed the pre- and postworkshop surveys. Following the workshops, there were significant improvements in knowledge of behavior change techniques (t40=-5.27, P<.001), subjective norms (t40=-3.49, P=.001), descriptive norms (t40=-3.65, P<.001), perceived behavioral control (t40=-3.30, P=.002), and intention (t36=-3.32, P=.002); each had a large effect size. There was no significant difference in postworkshop attitude (t40=0.78, P=.44). The participants also found the workshops to be highly acceptable. A 2-hour, theoretically informed workshop designed to facilitate the use of behavior change techniques by health professionals was shown to be largely effective. The workshops resulted in increases in knowledge, descriptive and subjective norms, perceived behavioral control, and intention, but not in attitude. The intervention was also shown to be highly acceptable, with the large majority of participants deeming the intervention to be needed, useful, appropriate, and applicable, as well as interesting and worth their time. Future research should examine the lasting impacts of the workshop on health professionals' practices.

Facilitating Behavior Change Training (DOJ)

Federal Grants & ContractsVolume 46, Issue 14 p. 5-5 Grants alerts Facilitating Behavior Change Training (DOJ) First published: 13 June 2022 https://doi.org/10.1002/fgc.32437Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume46, Issue1416 June 2022Pages 5-5 RelatedInformation

Using Behavior Change Interventions in Cardiac and Pulmonary Rehabilitation: Perspectives from Healthcare Professionals in the United Kingdom.

This study explores healthcare professionals’ experiences of using behavior change interventions in clinical practice. Semi-structured qualitative interviews were conducted with 11 healthcare professionals working in a cardiac and pulmonary rehabilitation National Health Service Trust in the United Kingdom. Interviews were transcribed and analyzed using inductive thematic analysis. Four overarching themes representing healthcare practitioners’ perceptions of using behavior change interventions were identified: (1) reliance on experiential learning, (2) knowledge transition, (3) existing professional development programs, and (4) barriers and facilitators for continued professional development. The results are discussed in relation to the implications they may have for behavior change training in clinical healthcare practice. Healthcare professionals require bespoke and formalized training to optimize their delivery of behavior change interventions in cardiac and pulmonary rehabilitation. Doing so will enhance intervention fidelity and implementation that can potentially ameliorate patient rehabilitation outcomes.

Development and Implementation of Couple-Based Collaborative Management Model of Type 2 Diabetes Mellitus for Community-Dwelling Chinese Older Adults: A Pilot Randomized Trial.

Background: To mobilize family's positive involvement in improving and sustaining self-management activities of older adults with diabetes, we developed a couple-based collaborative management model (CCMM) for community-dwelling older Chinese.Methods: The model was developed stepwise through applying theoretical models, interviewing older couples and community healthcare workers, as well as incorporating expert reviews. A 3-month pilot study was conducted to test the model's feasibility and its treatment effects by linear regression on 18 pairs of older couples aged 60 years+, who were equally divided into a couple-based intervention arm and a patient-only control arm.Results: The developed CCMM covered four theory-driven intervention modules: dyadic assessment, dyadic education, dyadic behavior-change training, and dyadic monitoring. Each module was delivered by community healthcare workers and targeted at older couples as the management units. Based on interviews with older couples and healthcare workers, 4 weekly education and training group sessions and 2-month weekly behavior change booster calls were designed to address older adults' main management barriers. These modules and session contents were evaluated as essential and relevant by the expert panel. Furthermore, the CCMM showed good feasibility and acceptability in the pilot, with non-significant yet more positive changes in physiological outcomes of diabetic participants and couples' well-being and exercise levels of these in the intervention arm than their controlled counterparts.Conclusion: We systematically developed a couple-based collaborative management model of diabetes, which was well-received by healthcare practitioners and highly feasible among older Chinese couples living in the community. The model's treatment effects need to be verified in fully powered randomized controlled trials.Clinical Trial Registration: http://www.chictr.org.cn/showproj.aspx?proj=42964, identifier: ChiCTR1900027137.

A feasibility and acceptability study of an e-training intervention to facilitate health behaviour change conversations in dental care settings.

Introduction Health behaviours result in oral health problems. Behaviour change techniques, informed by behaviour science, are rarely utilised by dental care professionals (DCPs) within routine care.Aim To develop a theory-informed intervention to support DCPs' behaviour change conversations and evaluate its feasibility and acceptability.Intervention A behaviour change toolkit (Toothpicks) comprising 33 behaviour change techniques relevant to dentistry, delivered within an interactive online course.Design Development and mixed-methods evaluation of the intervention.Materials and methods Participants' motivation to discuss behaviour change with patients was measured before and after training using a validated questionnaire. Acceptability was assessed through semi-structured interviews.Results DCPs' (N = 32) motivation increased significantly post-training. Participants found the training acceptable and reported subsequently implementing techniques into their practice. Potential barriers preventing implementation to clinical practice include perceived lack of opportunities to effect change within the constraints of the clinical context.Conclusions Acceptable theory-informed training that is acceptable and accessible can be developed that increases DCPs' motivation to discuss behaviour change with patients. Further research is necessary to establish the longer-term impact of brief behaviour change training on DCPs' clinical practice and patient health behaviours.

“SET” for Success: Targeted Instruction in Learning Strategies and Behavior Change in Introductory Psychology

Background: Undergraduates may not use the most effective learning strategies, particularly those considered “desirable difficulties” such as spacing, elaboration, and testing (“SET”). Objective: This study examined knowledge-based, metacognitive, and behavioral outcomes from interventions designed to teach undergraduates about the “SET” strategies and about behavior change techniques to support adoption of these study behaviors. Method: Introductory psychology students ( n = 244) received a learning-strategies-only intervention (LS), a learning-strategies-plus-behavior-change (LS+BC) intervention, or no intervention. They completed three assessment surveys to measure outcomes across the semester. Results: Intervention participants showed enhanced knowledge of the “SET” strategies. LS participants rated testing as more helpful, reported higher use of elaboration and testing, and had marginally higher final course grades than the control group. Adding behavior-change training did not enhance the outcomes. Growth mindset was associated with greater intervention-related gains on several measures. Conclusion: Curriculum-embedded LS training was associated with positive shifts in “SET” strategy knowledge and with behavioral changes for two strategies. Teaching Implication: This study provides evidence of the benefits of LS training as integrated into the introductory psychology curriculum, and can help guide educators to support students in acquiring more effective study strategies.

Evaluating the effects of behavior change training on the knowledge, confidence and skills of sport and exercise science students

BackgroundBehavior change interventions have the potential to have a transformative effect on the health of populations. Allied health professionals have a key role to play in delivering these interventions. However, traditionally undergraduate allied health professional programs have not had a behavior change focus. The aim of this study was to assess the effectiveness of a training program on sport and exercise science students’ knowledge, confidence and skills in the provision of behavior change support.MethodA mixed method convergent design was used to address the research question. Fifteen sport and exercise science students took part in a training program consisting of seven 90-min weekly face to face group sessions. Student satisfaction with training methods was assessed. Pre-to-post training changes in students’ confidence and knowledge in the provision of behavior change support was evaluated. Delivery of behavior change support was assessed by an audio recorded role-play rated by an expert using the Health Care Climate Questionnaire, and an adapted version of the Communication Evaluation in Rehabilitation Tool. Students also completed a reflective assignment.ResultsStudents were satisfied with the training. There were increases in students’ confidence and knowledge of certain behavior change components post-training but not behavior change techniques. Students delivered behavior change support in a broadly needs supportive manner. The reflective assignment showed that students found particular behavior change strategies difficult to implement.ConclusionIt is feasible to train undergraduate students in particular components of behavior change support. Academic institutions should embed behavior change training into the allied health professional curriculum to ensure graduates are job ready with the knowledge, confidence and skills to support health related behavior change within the wider health system.

Relationship between emotional eating and coping with stress of nursing students.

This research aims to determine the relationship between the coping skills and emotional eating habits of young adults. The population consisted of 473 nursing students whom registered in the Faculty of Health Sciences at a state university in Turkey during 2018 and 2019 education terms. Data were collected through the Demographic Form, Turkish Emotional Eating Scale (TEES), and Coping Style Scale (CSS). "Eating in anxiety" (r = -.174; P = .000) and "eating in the negative mood" (r = -.123; P = .007) subscale scores of TEES showed a statistically significant, negative correlation with the "self-confident approach" subscale score of CSS. In light of the data, it is suggested to increase the frequency of psychological counseling offered for these students and setup behavior change training either an individual or group settings. Besides, the conjoint effort of health professionals and psychiatric nurses would be highly beneficial for the development of effective assessment tools to determine students at risk and engage in appropriate prevention strategies such as training programs that would have a direct impact on the students' habitual diet. Subsequent research is recommended incorporating additional variables such as body perception, ideal female image, expectations of perfection toward the body, and self-worth defined thru the body.

Identifying barriers, facilitators, and implementation strategies for a faith-based physical activity program

BackgroundCommunity engagement is critical to the acceleration of evidence-based interventions into community settings. Harnessing the knowledge and opinions of community leaders increases the likelihood of successful implementation, scale-up, and sustainment of evidence-based interventions. Faith in Action (Fe en Acción) is an evidence-based promotora-led physical activity program designed to increase moderate-to-vigorous physical activity among churchgoing Latina women.MethodsWe conducted in-depth interviews using a semi-structured interview guide based on the Consolidated Framework for Implementation Research (CFIR) at various Catholic and Protestant churches with large Latino membership in San Diego County, California to explore barriers and facilitators to implementation of Faith in Action and identify promising implementation strategies for program scale-up and dissemination. We interviewed 22 pastors and church staff and analyzed transcripts using an iterative-deductive team approach.ResultsPastors and church staff described barriers and facilitators to implementation within three domains of CFIR: characteristics of individuals (lack of self-efficacy for and knowledge of physical activity; influence on churchgoers’ behaviors), inner setting (church culture and norms, alignment with mission and values, competing priorities, lack of resources), and outer setting (need for buy-in from senior leadership). From the interviews, we identified four promising implementation strategies for the scale-up of faith-based health promotion programs: (1) health behavior change training for pastors and staff, (2) tailored messaging, (3) developing community collaborations, and (4) gaining denominational support.ConclusionsWhile churches can serve as valuable partners in health promotion, specific barriers and facilitators to implementation must be recognized and understood. Addressing these barriers through targeted implementation strategies at the adopter and organizational level can facilitate improved program implementation and lead the way for scale-up and dissemination.

Acceptability and Effects of Commercially Available Activity Trackers for Chronic Pain Management Among Older African American Adults.

Wearable activity trackers may facilitate walking for chronic pain management. We assessed the acceptability of a commercially available tracker and three alternative modes of reporting daily steps among older adults in a low-income, urban community. We examined whether using the tracker (Fitbit ZipTM) was associated with improvements in functioning and activity. Randomized controlled pilot and feasibility trial. Fifty-one African American adults in Detroit, Michigan, aged 60 to 85 years, with chronic musculoskeletal pain (28 in the intervention group, 23 controls). Participants completed telephone surveys at baseline and eight weeks. Intervention participants wore trackers for six weeks, alternately reporting daily step counts via text messages, automated telephone calls, and syncing (two weeks each). We used multimethods to assess satisfaction with trackers and reporting modalities. Adherence was indicated by the proportion of expected days on which valid step counts were reported. We assessed changes in pain interference, physical function, social participation, walking frequency, and walking duration. More than 90% of participants rated trackers as easy to use, but some had technical or dexterity-related difficulties. Text reporting yielded 79% reporting adherence vs 69% each for automated calls and syncing. Intervention participants did not show greater improvement in functioning or walking than controls. With appropriate support, wearable activity trackers and mHealth reporting for chronic pain self-care are feasible for use by vulnerable older adults. Future research should test whether the effects of trackers on pain-related outcomes can be enhanced by incorporating behavior change strategies and training in evidence-based cognitive-behavioral techniques.

Physicians' perspectives on medication adherence and health promotion among cancer survivors.

Cancer survivors face an increased risk of cardiovascular events compared with the general population. Adopting a healthy lifestyle may reduce these risks, and guidelines encourage health-promotion counseling for cancer survivors, but the extent of physician adherence is unclear. This mixed-method study surveyed 91 physicians, including 30 primary care physicians (PCPs), 30 oncologists, and 31 specialists (urologists, dermatologists, and gynecologists). Interviews also were conducted with 12 oncologists. Most PCPs (90%) reported recommending health promotion (eg, weight loss, smoking cessation) to at least some cancer survivors, whereas few oncologists (26.7%) and specialists (9.7%) said they ever did so (P<.001). Although most physicians believed that at least 50% of cancer survivors would be adherent to medication regimens to prevent cancer recurrence, they also believed that, if patients were trying to lose weight, they would not remain medication-adherent. In interviews, oncologists expressed fear that providing health-promotion advice would distress or overwhelm patients. Additional health-promotion barriers identified by thematic analysis included: identifying cancer as oncologists' focal concern, time pressure, insufficient behavior change training, and care coordination challenges. Facilitators included perceiving a patient benefit and having health-promotion resources integrated into the cancer care system. Physicians often do not have the time, expertise, or resources to address health promotion with cancer survivors. Research is needed to evaluate whether health-promotion efforts compromise medical regimen adherence, as physicians' responses suggest.

(374) Acceptability and Effects of Using Wearable Activity Trackers for Chronic Pain Management among Older African American Adults

Wearable activity trackers can help people with chronic musculoskeletal pain set and achieve goals for increasing daily walking as a pain self-management strategy. Yet older adults from vulnerable populations may face obstacles to using trackers that should be considered in intervention design. In a sample of 51 African American adults with chronic musculoskeletal pain ages 60-85 in an economically disadvantaged community, we evaluated the acceptability of the Fitbit ZipTM and three alternative modes of reporting daily steps. Our randomized design (28 in intervention group, 23 controls) also allowed us to assess whether using a Fitbit was associated with improvements in PROMIS pain interference and walking frequency, assessed during telephone surveys at baseline and eight weeks. Intervention participants wore a Fitbit for six weeks, and reported daily step counts via text messages, automated telephone calls, and syncing (two weeks each). Acceptability was measured by participant-identified facilitators, challenges, and satisfaction; and feasibility by the proportion of expected days in which step-counts were reported. More than 90% of participants reported that Fitbits were easy to use, but some experienced technical or dexterity-related difficulties with Fitbits and/or with reporting steps. Text reporting yielded 79% adherence, vs. 68% each for automated calls and automatic syncing. Participants’ preferences for reporting mode varied. Intervention participants did not show greater improvement in pain interference than controls. While 75% of intervention group participants reported that the Fitbit motivated them to walk more, pre-post change in walking frequency was not significantly different between intervention and control groups. With attention to specific needs and tailored support, wearable activity trackers and mHealth reporting for chronic pain self-care are feasible for use by vulnerable older adults. Future research should test how the effects of activity trackers on pain-related outcomes can be enhanced by incorporating behavior change strategies and training in evidence-based cognitive-behavioral techniques. Funding: This study was supported by a grant from the National Institutes of Health, P30 AG015281, and the Michigan Center for Urban African American Aging Research and by grants from the National Institute on Aging [K01 AG050706-01A1 to MRJ]; UM OAIC Pepper Center 2017 Pilot Grant (Janevic, PI).

An investigation of Australian midwifery curricula for obesity management and health behaviour change training.

Fifty percent of Australian women enter pregnancy overweight or obese. Unfortunately, few women receive weight management advice from health professionals during pregnancy. The aim of this study was to investigate current midwifery curricula from Australian universities to identify strengths and deficits in the teaching of preconception and antenatal weight management. Midwifery courses from 20 universities were identified. Of the 568 units taught at these universities, 252 course outlines were obtained. Data were coded using the qualitative analysis technique of Framework Analysis for the following main themes: 1) the effect of weight, diet and physical activity on health outcomes for women who are pregnant or planning a pregnancy; 2) weight management advice in any population; and 3) health behaviour change techniques in any context. Analysis revealed a variety of teaching methods and skills training that emphasised the importance of clinical judgement and autonomous clinical practice, in conjunction with critical enquiry and sourcing reputable evidence. There was little evidence, however, that weight management advice was taught explicitly to midwifery students in the curricula. A greater emphasis on skilling midwifery students to address weight gain during pregnancy, and behavioural techniques to achieve this, is required.

The role of physical activity in the context of pulmonary rehabilitation

Pulmonary rehabilitation is an important treatment for patients with chronic obstructive pulmonary disease (COPD). Although this intervention leads to large and clinically meaningful improvements in exercise capacity and quality of life, the effect of pulmonary rehabilitation on physical activity is controversial. Physical activity is lower in patients with COPD as compared to healthy age-matched controls and it is related to important health outcomes (e.g. increased risk of mortality and hospitalization). It is an important goal for rehabilitation programs to enhance physical activity to more normal levels in order to achieve the ultimate goal of rehabilitation ‘to improve adherence to health enhancing behaviors’. This review discusses the role of physical activity in the context of pulmonary rehabilitation and possible ways to embed interventions geared to behavior change (i.e. to enhance physical activity) and exercise training (i.e. to enhance physical fitness) into comprehensive rehabilitation programs for patients with COPD.

Targeting caregivers with context specific behavior change training increased uptake of recommended hygiene practices during food preparation and complementary feeding in Dedza district of Central Malawi

ABSTRACTThe effect of a targeted training intervention on uptake of recommended hygiene practices by caregivers of children 6–23 months was assessed. A sub-sample of 40 mothers from 303 households was used for a detailed study of hygiene practices during preparation of complementary foods after training. Mothers and caregivers were observed for 6 months and evaluated using a questionnaire. Data were analyzed using SPSS and Chi-square test was used to determine the differences in proportions of mothers and caregivers who adopted recommended practices. Results showed significant increase in the proportions of mothers and caregivers who followed recommended hygiene practices after training. There was significant decrease in prevalence of diarrhea among the children (45% to 8.6%). It can be concluded that targeted training on practical hands-on activities such as hand washing, cleaning of cooking and serving utensils, covering of food and water increase adoption of recommended hygiene and sanitation practices.