Exercise Goal Setting Research Articles

Examining the effectiveness of an online program to cultivate mindfulness and self-compassion skills (Mind-OP): Randomized controlled trial on Amazon's Mechanical Turk

ObjectivesThe demand for effective psychological treatments for depression, anxiety, and heightened stress is far outstripping their supply. Accordingly, internet delivered, self-help interventions offer hope to many people, as they can be easily accessed and at a fraction of the price of face-to-face options. Mindfulness and self-compassion are particularly exciting approaches, as evidence suggests interventions that cultivate these skills are effective in reducing depression, anxiety, and heightened stress. We examined the effectiveness of a newly developed program that combines mindfulness, self-compassion, and goal-setting exercises into a brief self-guided intervention (Mind-OP). The secondary aim of this study was to investigate the feasibility of conducting a randomized-controlled trial entirely on a popular crowdsourcing platform, Amazon's Mechanical Turk (MTurk). MethodsWe randomized 456 participants reporting heightened depression, anxiety, or stress to one of two conditions: the 4-week Mind-OP intervention (n = 227) or to an active control condition (n = 229) where participants watched nature videos superimposed onto relaxing meditation music for four consecutive weeks. We administered measures of anxiety, depression, perceived stress, dispositional and state mindfulness, self-compassion, and nonattachment. ResultsIntent-to-treat and per-protocol analyses revealed that, compared to participants in the control condition, participants in the Mind-OP intervention condition reported significantly less anxiety and stress at the end of the trial, as well as significantly greater mindfulness, self-compassion, and nonattachment. ConclusionsMind-OP appears effective in reducing anxiety symptoms and perceived stress among MTurk participants. We highlight issues (e.g., attrition) related to feasibility of conducting randomized trials on crowdsourcing platforms such as MTurk.

Effectiveness of a personalized health profile on specificity of self-management goals among people living with HIV in Canada: a protocol for a blinded pragmatic randomized controlled trial

Background: Goal setting is a crucial element in self-management of chronic diseases. Personalized outcome feedback is needed for goal setting, a requirement for behavior change. This study contributes to the understanding of the specificity of patient-formulated self-management goals by testing the effectiveness of a personalized health outcome profile. Objective: To estimate among people living with HIV, to what extent providing feedback on their health outcomes, compared to no feedback, will affect number and specificity of patient-formulated self-management goals. Methods: A personalized health outcome profile has been produced for individuals enrolled in a Canadian HIV Brain Health Now cohort study at cohort entry and at the last recorded visit. Participants will be randomized to receive or not “My Personal Brain Health Dashboard” prior to a goal setting exercise. Self-defined goals in free text will be collected through an online platform. Intervention and control groups will receive instructions on goal setting and tips to improve brain health. A total of 420 participants are needed to detect a rate ratio (number of specific words/numbers of person-goals, intervention:control) of 1.5. Text mining techniques will be used to quantify goal specificity based on word matches with a goal-setting lexicon. The expectation is that the intervention group will set more goals and have more words matching the developed lexical than the control group. The total number of words per person-goals will be calculated for each group and Poisson regression will be used to estimate the rate ratio and 95% confidence intervals and compare rate ratios between men and women using an interaction term. Conclusions: This study will contribute to growing evidence for the value of person-reported health outcomes in tailoring interventions, and will provide a thorough understanding of the quality of person-defined goals using text mining. Trial registration: Clinical Trials NCT04175795, registered on 25th November 2019.

Support Group to Reduce Diabetes Distress in Adolescents with Type 1 Diabetes

Background: Adolescents have the poorest glycemic control of all age groups with type 1 diabetes mellitus (T1DM). One-third of adolescents with T1D experience severe diabetes distress. Diabetes distress can negatively affect daily diabetes management, glycemic control, and quality of life. Screening for diabetes distress is important because it can be difficult to identify and may be present in patients with well-controlled diabetes. Purpose: We aim to assess a support group intervention to reduce diabetes distress and improve glycemic control in adolescents with T1DM. Description of topic: We will use a quasi-experimental single group design with pre- and post-intervention evaluation of glycated hemoglobin levels (HbA1c) and diabetes distress. Adolescents will participate in a month-long intervention comprising weekly professional-led support groups focusing on diabetes distress. Support group topics include recognizing diabetes distress, appropriate age-related diabetes management guidelines, problem-solving, coping, and communication skills. Interactive activities include discussion, question and answer, skills practice, modeling, problem-solving, and goal-setting exercises. We will measure distress using the Diabetes Distress Scale (DDS). The DDS consists of 17 questions with four subscales: emotional burden, regimen distress, interpersonal distress and physician distress. Participants rate their perceived level of distress (“not a problem” to “very serious problem”) for each item. Results are anticipated to be available in Spring 2020. Hypothesized results include reduced DDS without significant changes in HbA1c. Decreases in emotional burden and interpersonal distress are hypothesized to have the most significant change after participation in the support group. Clinical Implications: A T1DM support group provides exposure to health care professionals outside of the clinic setting and may be effective tool for managing T1DM. Recognizing and discussing diabetes distress may have positive effects on glycemic control as well as physical and psychological well-being. Support from peers may help normalize diabetes self-care behaviors, making it more likely for adolescents to participate in daily diabetes management.

Social Cognitive Theory and Physical Activity in Older Adults with Multiple Sclerosis.

The expanding population of older adults with multiple sclerosis (MS) likely experiences many of the same benefits of physical activity (PA) as younger and middle-aged adults with MS. However, participation in PA is exceedingly low in this segment of the MS population. This study examined variables from social cognitive theory (SCT) as correlates of PA in older adults with MS to inform the subsequent development of behavioral interventions. Older adults with MS (≥60 years of age, N = 180) completed an online survey including demographic and clinical characteristics, SCT variables (exercise self-efficacy, exercise goal setting, social support, and outcome expectations), and PA (total PA [TPA] and moderate-to-vigorous PA [MVPA]). Bivariate correlation analyses indicated that all SCT variables were significantly associated with TPA and MVPA (all P ≤ .001). Hierarchical linear regression analyses indicated that disability status was a significant correlate of TPA (β = -0.48, R2 = 0.23) and MVPA (β = -0.44, R2 = 0.19) in step 1; disability and self-efficacy were significant correlates of TPA (disability β = -0.20, self-efficacy β = 0.59, R2 = 0.50) and MVPA (disability β = -0.16, self-efficacy β = 0.60, R2 = 0.47) in step 2; and disability, self-efficacy, and exercise goal setting were significant correlates of TPA (disability β = -0.21, self-efficacy β = 0.50, exercise goal setting β = 0.14, R2 = 0.55) and MVPA (disability β = -0.17, self-efficacy β = 0.51, exercise goal setting β = 0.15, R2 = 0.51) in step 3. These results suggest that behavioral interventions focusing on self-efficacy and exercise goal setting as targets from SCT may be appropriate for increasing PA in older adults with MS.

Influence of Social Cognitive Factors on Physical Activity among Breast Cancer Survivors

Purpose: To measure the degree of physical activity among breast cancer survivors and to identify how it was influenced by social cognitive factors, as defined in Bandura’s social cognitive theory. Methods: A total of 128 breast cancer survivors were recruited for this descriptive study and answered the survey questionnaire. The collected data covered general characteristics, physical activity, and social cognitive factors, such as self-efficacy, outcome expectations, goal setting, and socio-structural factors (social support and negative impact of cancer). Data collection was conducted from July to October 2017. Results: The degree of physical activity among breast cancer survivors was moderate. The participants’ level of physical activity differed according to their Body Mass Index (BMI) and type of surgery. Physical activity was significantly correlated with exercise goal setting, exercise self-efficacy, outcome expectations, and family support. Exercise goal setting (β=.55, p＜.001), BMI (㎏/㎡) (β=-.21, p=.003), and exercise self-efficacy (β=.15, p=.040) were identified as factors influencing physical activity. Conclusion: Intervention programs to increase the degree of physical activity among breast cancer survivors will need to consider various aspects, including goal setting, BMI regulation, and self-efficacy improvement. Repeated studies on the social recognition of breast cancer survivors and extended studies on health promotion activities are recommended.

A Legacy of Leadership

A selective and prestigious paid student leadership position, orientation leaders help new students and their parents or guests make the transition to University of California, Merced through relationship-building activities, student life presentations, goal-setting exercises, and academic advising in 1-day orientation sessions throughout the summer. Readers of this article will gain insights into recruiting, hiring, and forming strong teams by effectively utilizing returning staff. Named legacy orientation leaders by the author of this article, the returning staff members’ new title is reflective of the elevated responsibility and opportunities they have within our program. The legacy orientation leader application and interview processes, recruitment efforts, and participation in individual and group interview processes are discussed. Through these involvements, legacy leaders become torchbearers of program traditions and values in recruiting and selecting new orientation leader staff.

Feasibility study of goal setting discussions between older adults and volunteers facilitated by an eHealth application: development of the Health TAPESTRY approach

BackgroundIn keeping with the changing needs of the Canadian population, primary care systems need to become more person-focused in providing quality care to older adults. As part of Health TAPESTRY, a complex intervention to strengthen primary care for older adults, a goal setting exercise was developed and tested in an initial feasibility study, intended to foster collaboration between patients and providers.MethodsParticipants—clinic clients—were recruited from the McMaster Family Health Team in Hamilton, Ontario. Five participants took part in the goal setting feasibility study phase I, which tested the functionality of a technology-enabled goal setting exercise between older adults and volunteers. Based on observations and feedback from volunteers, interprofessional team members, and older adults, the exercise was refined to include a guided survey and goals report. The goal setting survey is a list of probing questions designed based on SMART (specific, measurable, attainable, relevant, timely) goal setting strategies and goal attainment scaling (GAS). This was used in phase II, carried out with 16 participants, where the feasibility of goal setting and goal attainment with support from volunteers and interprofessional teams was tested. Volunteers carried out the goal setting survey via a tablet computer, a report of client goals was generated and sent to interprofessional teams, and client goals were discussed during clinic huddles. At 6 months of follow-up, clients self-evaluated their progress using GAS.Results and discussionThe goal setting exercise in phase I took an average of 24:45 (SD 11:42) minutes and yielded a diverse set of life and health goals. Goals identified by older adults were primarily focused on the maintenance of a certain level of activity or health state. Phase I work resulted in important changes to the goal setting process (e.g., asking about goal setting later in conversation, changing wording of questions) and development of a summary report of goals sent to the interprofessional team. In phase II, 44 goals were set by 16 participants during an average 7:23 (SD 4:26) minute discussion. Of these goals, 43.9% were characterized as health goals while 63.4% were characterized as life goals. Under the umbrella of Life goals, productivity featured most prominently at 22.9% of all goals. Goal attainment was not measured in phase I. In phase II, clients had an average weighted goal attainment score of 51.5. Considering client preferences for one goal over another, 68.8% of clients, on average, at least partially achieved the goals they had set.ConclusionGoal setting as part of the Health TAPESTRY approach was feasible and provided interprofessional teams with client narratives that helped improve care management for older adults. The overall intervention—including the refined goal setting component—is being scaled and evaluated in a pragmatic randomized controlled trial.

To what extent does therapy of chronic stroke patients address participation? A content analysis of ambulatory physical and occupational therapy based on the International Classification of Functioning, Disability, and Health framework

Purpose: The study aim was to analyze whether ambulatory therapy of chronic stroke patients contains elements that specifically address “Activity and participation”, and to what extent participation as a major goal in rehabilitation is realized in ambulatory care.Method: Qualitative and quantitative content analysis of standard therapy of 71 chronic stroke patients with upper limb impairment. 469 statements on therapy of 34 therapists were analyzed using data-driven and concept-driven coding based on the International Classification of Functioning, Disability and Health framework.Results: Almost half of therapy provided to stroke patients was related to “Upper extremity” (47.5%), as one out of seven identified main categories. Regarding International Classification of Functioning, Disability, and Health framework, 75.1% of therapeutic practices in ambulatory therapy covered “Body functions,” but only 13.2% addressed “Activities and participation”. Some statements contained specific therapeutic concepts (9.4%) or isolated notes (2.1%) and were not linkable to the International Classification of Functioning, Disability and Health framework.Conclusions: Ambulatory therapy of chronic stroke patients is related, in part, to participation. There is potential for an increase in participation by applying therapeutic approaches, which actively involve the patients in goal-setting and therapeutic exercises to specifically address activities and participation.Implications for rehabilitationTo realize participation as a major goal in the rehabilitation process ambulatory therapy of chronic stroke patients, one should focus on therapeutic approaches and exercises that specifically address activities and participation.Structured goal-setting, which actively involve patients, can be used to identify goals relevant to individual activities and participation.

Drinking goals and attainment in a naltrexone trial of young adult heavy drinkers.

Drinking goals set at treatment onset predict treatment outcome in patients with alcohol use disorders. Yet the cognitive constructs of goal setting and goal attainment are understudied in young adult drinkers. This study sought to examine how the interplay of goal setting and goal attainment during treatment impacts treatment outcome in a sample of young adult heavy drinkers. Participants were 128 young adult heavy drinkers (Mage = 21.5 years) who participated in a double-blind, placebo-controlled, 8-week efficacy trial of naltrexone plus brief counseling. Participants were not required to be interested in changing their drinking for inclusion. Drinking goals were assessed at baseline, midtreatment, and end of treatment. Outcomes were peak drinking, typical drinking, and drinking frequency. Results from PROCESS serial, multiple mediator models showed that midtreatment goal setting and goal attainment collectively predicted peak drinking (b = 0.87, 95% CI [0.40, 1.37]) and drinking frequency (b = 0.66, 95% CI [0.37, 1.06]). Only midtreatment goal setting mediated the relationship between baseline goal setting and typical drinking (b = 0.35, 95% CI [0.10, 0.85]). Participants who set more ambitious drinking goals at baseline were more likely to set subsequent, ambitious goals; more ambitious goals at midtreatment were associated with better treatment outcomes. Setting initial, ambitious goals led to further ambitious goals, which ultimately contributed to lower levels of drinking. Thus, cognitive processes during treatment may be an important target of intervention efforts. For example, the inclusion of goal-setting exercises during treatment could serve to improve intervention effects. (PsycINFO Database Record

Sources of Variability in Physical Activity Among Inactive People with Multiple Sclerosis.

Evidence supports that physical activity (PA) improves symptoms of multiple sclerosis (MS). Although application of principles from Social Cognitive Theory (SCT) may facilitate positive changes in PA behaviour among people with multiple sclerosis (pwMS), the constructs often explain limited variance in PA. This study investigated the extent to which MS symptoms, including fatigue, depression, and walking limitations combined with the SCT constructs, explained more variance in PA than SCT constructs alone among pwMS. Baseline data, including objectively assessed PA, exercise self-efficacy, goal setting, outcome expectations, 6-min walk test, fatigue and depression, from 65 participants of the Step It Up randomized controlled trial completed in Ireland (2016), were included. Multiple regression models quantified variance explained in PA and independent associations of (1) SCT constructs, (2) symptoms and (3) SCT constructs and symptoms. Model 1 included exercise self-efficacy, exercise goal setting and multidimensional outcomes expectations for exercise and explained ~14% of the variance in PA (R 2=0.144, p<0.05). Model 2 included walking limitations, fatigue and depression and explained 20% of the variance in PA (R 2=0.196, p<0.01). Model 3 combined models 1 and 2 and explained variance increased to ~29% (R 2=0.288; p<0.01). In Model 3, exercise self-efficacy (β=0.30, p<0.05), walking limitations (β=0.32, p<0.01), fatigue (β=-0.41, p<0.01) and depression (β=0.34, p<0.05) were significantly and independently associated with PA. Findings suggest that relevant MS symptoms improved by PA, including fatigue, depression and walking limitations, and SCT constructs together explained more variance in PA than SCT constructs alone, providing support for targeting both SCT constructs and these symptoms in the multifactorial promotion of PA among pwMS.

Social Cognitive Theory Correlates of Physical Activity in Inactive Adults with Multiple Sclerosis.

There is a growing body of evidence that physical activity (PA) improves symptoms of multiple sclerosis (MS). Despite the benefits of PA, people with MS are relatively inactive compared with their healthy counterparts. This study investigated associations between social cognitive theory (SCT) constructs and energy expenditure (EE) as an objective measure of PA in a sample of inactive people with MS. Participants (n = 65) completed several questionnaires and were assessed using standardized outcome measures as part of a cross-sectional analysis of baseline data from a randomized controlled trial (Step it Up). The bivariate correlation analysis indicated that of all SCT constructs, only exercise self-efficacy was significantly correlated with EE (r = 0.297, P = .022). Multiple linear regression analysis found that exercise self-efficacy independently explained 9% of the variance in EE (R2 = 0.088). A model including exercise self-efficacy, exercise goal setting, exercise planning, and exercise benefits explained 17% of the variance in EE (F4,54 = 2.741, P = .038, R2 = 0.169). In this model, only exercise self-efficacy was significantly associated with EE scores (Exercise Self-Efficacy Scale β = .320, P = .016). The constructs of SCT explained little of the variance of objectively measured PA in a sample of inactive people with MS who volunteered for an exercise trial. The only significant variable was exercise self-efficacy, which confirms the importance of enhancing it through PA interventions.

Physical Activity and Its Correlates in Youth with Multiple Sclerosis

To investigate physical activity levels in youth with multiple sclerosis and monophasic acquired demyelinating syndromes ([mono-ADS], ie, children without relapsing disease) compared with healthy controls and to determine factors that contribute to engagement in physical activity. We hypothesized that greater physical activity goal setting and physical activity self-efficacy would be associated with greater levels of vigorous physical activity in youth with multiple sclerosis. A total of 68 consecutive patients (27 multiple sclerosis, 41 mono-ADS) and 37 healthy controls completed fatigue, depression, Physical Activity Self-Efficacy Scale, perceived disability, Exercise Goal-Setting scale, and physical activity questionnaires, and wore an accelerometer for 7 days. All patients had no ambulatory limitations (Expanded Disability Status Scale, scores all <4). Youth with multiple sclerosis engaged in fewer minutes per day of vigorous (P = .009) and moderate and vigorous physical activity (P = .048) than did patients with mono-ADS and healthy controls. A lower proportion of the group with multiple sclerosis (63%) reported participating in any strenuous physical activity than the mono-ADS (85%) and healthy control (89%) groups (P = .020). When we adjusted for age and sex, the Physical Activity Self-Efficacy Scale and Exercise Goal-Setting scale were associated positively with vigorous physical activity in the group with multiple sclerosis. Fatigue and depression did not predict physical activity or accelerometry metrics. Youth with multiple sclerosis participate in less physical activity than their counterparts with mono-ADS and healthy controls. Physical activity self-efficacy and exercise goal setting serve as potentially modifiable correlates of physical activity, and are measures suited to future interventions aimed to increase physical activity in youth with multiple sclerosis.

Intimacy after prostate cancer: A brief couples' workshop is associated with improvements in relationship satisfaction.

Prostate cancer (PCa) treatments often leave men with erectile dysfunction (ED). Even when ED treatments are effective in restoring men's ability to have an erection sufficient for intercourse, couples continue to struggle sexually. Effective treatments to help couples recover sexually are needed. PCa patients and partners (N = 59 couples) attending a one-time couples' intimacy workshop, participated in an evaluation. The workshop, offered eight times over a 2-year period, emphasized a couples-based approach to treatment that enhances direct communication about sexuality and implementation of sexual recovery strategies that are consistent with the couple's values. Couples completed pre and post questionnaires (at baseline and 2months later) assessing the primary outcome of relationship adjustment (Revised Dyadic Adjustment Scale) and secondary outcome of sexual function (Sexual Function Questionnaire). T-tests were employed to examine pre-post changes in scores. A small qualitative sub-study was conducted on the use of a Commitment to Change goal-setting exercise, completed during the workshop. Results provide insight into the specific nature of improvements. Patients and partners showed improvements in relationship satisfaction. Improvements with small-to-medium effect sizes were observed for patients and partners sexual function; however, after adjusting for multiple comparisons, these changes were no longer statistically significant. The specific goals set by couples, and their achievement status, are presented. The workshop offers a comprehensive, one-session intervention to help couples implement a treatment plan to promote sexual recovery after PCa treatment. Given the observed improvements, progression to a randomized control trial is warranted. Copyright © 2016 John Wiley & Sons, Ltd.

Impact of Exercise and Education in Adults of Lubbock, Texas: Implications for Better Lifestyle.

The objective of our study was to evaluate the exercise and educational intervention in the city of Lubbock via GET FiT Lubbock (GFL) program. The GFL program was designed to increase exercise and educational opportunities, which positively impact health risk factors in Lubbock residents. The GFL program design included the recruitment of subjects to participate on a team that consisted of four individuals, each subject tracked their exercise minutes, and their educational session attendance. The tracking of exercise and educational sessions was done on the GFL website. Biometric testing was conducted pre- and post- intervention. The program was located within the Lubbock community in places that were close to their place of residence. The intervention included walking and educational sessions, including goal setting lectures, nutrition information, and exercise demonstrations. Study participants, included male and female adults who tracked their exercise time and educational sessions. Exercise minutes and educational session attendance were self-reported. Our data analysis revealed that significant difference was found between pre- and post- intervention measures, including weight, body mass index (BMI), high-density lipoprotein (HDL). Significant difference was found for weight, BMI, and HDL in females. Based on these findings, we conclude that the intervention showed positive effects on exercise and lifestyle.

Androgen deprivation therapy educational program: A Canadian true nth initiative.

243 Background: Androgen deprivation therapy (ADT) is commonly prescribed for advanced prostate cancer (PCa) patients, but ADT has many side effects that can impair patients’ quality of life. In various Canadian cities, we are running an educational program to help PCa patients and their partners deal with the side effects of ADT, and maintain a strong relationship with each other while on ADT. Methods: Patients, who are about to start or have been on ADT, and their partners are invited to attend an educational program. Each patient is given a copy of the book Androgen Deprivation Therapy: An essential guide for men with prostate cancer and their partners (Wassersug et al., 2014) and attends a 1.5 hour educational class, where they learn strategies for managing ADT side effects and how to effectively make healthier lifestyle changes using goal-setting exercises. At the end of the class, participants are given the option to attend a monthly follow-up session. To evaluate the effectiveness of the program, participants are asked to complete questionnaire package before attending the class and again 2-3 months later. Results: As of August 2015, 179 patients and 113 partners have attended the ADT Educational Program at Victoria, Vancouver, and Calgary. About 40% of patients returned for the follow-up session. 62 attendees participated in the research evaluation portion of the program. Uniquely designed for this study, the questionnaire package assesses ADT side effect frequency, bother associated with side effects, use of management strategies, and self-efficacy regarding side effect management. An assessment of physical activity and relationship adjustment, and feedback about the class are also included. Conclusions: Patients and partners appreciate being informed about ADT side effects managements and how to make healthier lifestyle changes while on ADT. It remains to be seen how effective the program is in limiting the bother from ADT side effects and helping couples maintain a strong dyadic relationship in the fact of the challenges brought on by ADT. Good enrollment in the in-person program in the 3 cities has propelled the development of the program in Halifax and Toronto starting in fall 2015, and an online version to be available in early 2016.

Social Cognitive Correlates of Physical Activity in Black Individuals With Multiple Sclerosis

ObjectiveTo examine variables from social cognitive theory as correlates of physical activity in black and white individuals with multiple sclerosis (MS). DesignCross-sectional. SettingNational survey. ParticipantsBlack (n=151) and white (n=185) individuals with MS were recruited through the North American Research Committee on Multiple Sclerosis Registry. InterventionNot applicable. Main Outcome MeasuresThe battery of questionnaires included information on demographic and clinical characteristics, physical activity, exercise self-efficacy, function, social support, exercise outcome expectations, and exercise goal setting and planning. ResultsBlack individuals with MS reported significantly lower levels of physical activity compared with white individuals with MS. Physical activity levels were significantly correlated with self-efficacy, outcome expectations, functional limitations as impediments, and goal setting in black participants with MS. The pattern and magnitude of correlations were comparable with those observed in white participants based on Fisher z tests. ConclusionsResearchers should consider applying behavioral interventions that target social cognitive theory variables for increasing physical activity levels among black individuals with MS.

Setting Goals in Different Roles: Applying Key Results From the Goal-Setting Literature

Decades of research have demonstrated that managers can effect substantial performance improvements by setting challenging and specific performance goals (Locke & Latham, 2002), providing goal-relevant feedback on a regular basis (Karakowsky & Mann, 2008), and, when appropriate, involving subordinates in goal setting (Stansfield & Longenecker, 2006). This article reviews core findings from the goal setting literature, and presents a collaborative exercise in which teams of students apply these findings to address management problems in five fictitious scenarios. Debriefing tips cite additional research evidence to allow for more nuanced classroom discussion of goal setting. A pretest indicated that prior to completing the goal-setting exercise, only a minority of students had a strong intuitive sense of how to set effective goals; a posttest following its completion demonstrated substantial improvement. Students rated the exercise as both challenging and effective in improving their knowledge of goal setting.

Brief Alcohol Interventions for Adolescents and Young Adults: A Systematic Review and Meta-Analysis

This study reports findings from a meta-analysis summarizing the effectiveness of brief alcohol interventions for adolescents (age 11–18) and young adults (age 19–30). We identified 185 eligible study samples using a comprehensive literature search and synthesized findings using random-effects meta-analyses with robust standard errors. Overall, brief alcohol interventions led to significant reductions in alcohol consumption and alcohol-related problems among adolescents (g¯ = 0.27 and g¯ = 0.19) and young adults (g¯ = 0.17 and g¯ = 0.11). These effects persisted for up to 1year after intervention and did not vary across participant demographics, intervention length, or intervention format. However, certain intervention modalities (e.g., motivational interviewing) and components (e.g., decisional balance, goal-setting exercises) were associated with larger effects. We conclude that brief alcohol interventions yield beneficial effects on alcohol-related outcomes for adolescents and young adults that are modest but potentially worthwhile given their brevity and low cost.

Exploring the experience of using a web-based cardiac rehabilitation programme in a primary care angina population: a qualitative study

Aim: To explore patient experiences of using a new web-based cardiac rehabilitation programme. Methods: A qualitative approach was chosen and semi-structured interviews were conducted with sixteen participants. Data were analysed using a foundational thematic analytic process. Results: Two overarching themes – ‘patient benefits and programme facilitators’ and ‘programme barriers’ – were identified. Participants reported increased physical activity, improved psychological wellbeing and greater patient empowerment when managing angina symptoms. Certain programme components (exercise goal setting, the online exercise diary, tailored comprehensive information and communicating with rehabilitation specialists) were discussed in terms of facilitating engagement. Participants valued the intervention particularly as they had not been offered a rehabilitation programme during their standard care and, in particular, the convenience of the web-based programme with no restrictions on time or location. Programme barriers included family/work commitments, bad weather, receiving the programme late in relation to their angina diagnosis, preconceptions about an internet-based programme being suitable for a younger age group, the difficulty of making lifestyle changes when in older age, and the need to be motivated when carrying out the programme independently. Conclusions: Primary care angina patients could benefit from an online version of rehabilitation. Patients’ views about useful programme components should be incorporated when developing web-based interventions.

Usability testing of Avoiding Diabetes Thru Action Plan Targeting (ADAPT) decision support for integrating care-based counseling of pre-diabetes in an electronic health record

PurposeUsability testing can be used to evaluate human–computer interaction (HCI) and communication in shared decision making (SDM) for patient–provider behavioral change and behavioral contracting. Traditional evaluations of usability using scripted or mock patient scenarios with think-aloud protocol analysis provide a way to identify HCI issues. In this paper we describe the application of these methods in the evaluation of the Avoiding Diabetes Thru Action Plan Targeting (ADAPT) tool, and test the usability of the tool to support the ADAPT framework for integrated care counseling of pre-diabetes. The think-aloud protocol analysis typically does not provide an assessment of how patient–provider interactions are effected in “live” clinical workflow or whether a tool is successful. Therefore, “Near-live” clinical simulations involving applied simulation methods were used to compliment the think-aloud results. This complementary usability technique was used to test the end-user HCI and tool performance by more closely mimicking the clinical workflow and capturing interaction sequences along with assessing the functionality of computer module prototypes on clinician workflow. We expected this method to further complement and provide different usability findings as compared to think-aloud analysis. Together, this mixed method evaluation provided comprehensive and realistic feedback for iterative refinement of the ADAPT system prior to implementation. MethodsThe study employed two phases of testing of a new interactive ADAPT tool that embedded an evidence-based shared goal setting component into primary care workflow for dealing with pre-diabetes counseling within a commercial physician office electronic health record (EHR). Phase I applied usability testing that involved “think-aloud” protocol analysis of eight primary care providers interacting with several scripted clinical scenarios. Phase II used “near-live” clinical simulations of five providers interacting with standardized trained patient actors enacting the clinical scenario of counseling for pre-diabetes, each of whom had a pedometer that recorded the number of steps taken over a week. In both phases, all sessions were audio-taped and motion screen-capture software was activated for onscreen recordings. Transcripts were coded using iterative qualitative content analysis methods. ResultsIn Phase I, the impact of the components and layout of ADAPT on user's Navigation, Understandability, and Workflow were associated with the largest volume of negative comments (i.e. approximately 80% of end-user commentary), while Usability and Content of ADAPT were representative of more positive than negative user commentary. The heuristic category of Usability had a positive-to-negative comment ratio of 2.1, reflecting positive perception of the usability of the tool, its functionality, and overall co-productive utilization of ADAPT. However, there were mixed perceptions about content (i.e., how the information was displayed, organized and described in the tool).In Phase II, the duration of patient encounters was approximately 10min with all of the Patient Instructions (prescriptions) and behavioral contracting being activated at the end of each visit. Upon activation, providers accepted the pathway prescribed by the tool 100% of the time and completed all the fields in the tool in the simulation cases. Only 14% of encounter time was spent using the functionality of the ADAPT tool in terms of keystrokes and entering relevant data. The rest of the time was spent on communication and dialog to populate the patient instructions. In all cases, the interaction sequence of reviewing and discussing exercise and diet of the patient was linked to the functionality of the ADAPT tool in terms of monitoring, response-efficacy, self-efficacy, and negotiation in the patient-provider dialog. There was a change from one-way dialog to two-way dialog and negotiation that ended in a behavioral contract. This change demonstrated the tool's sequence, which supported recording current exercise and diet followed by a diet and exercise goal setting procedure to reduce the risk of diabetes onset. ConclusionsThis study demonstrated that “think-aloud” protocol analysis with “near-live” clinical simulations provided a successful usability evaluation of a new primary care pre-diabetes shared goal setting tool. Each phase of the study provided complementary observations on problems with the new onscreen tool and was used to show the influence of the ADAPT framework on the usability, workflow integration, and communication between the patient and provider. The think-aloud tests with the provider showed the tool can be used according to the ADAPT framework (exercise-to-diet behavior change and tool utilization), while the clinical simulations revealed the ADAPT framework to realistically support patient-provider communication to obtain behavioral change contract. SDM interactions and mechanisms affecting protocol-based care can be more completely captured by combining “near-live” clinical simulations with traditional “think-aloud analysis” which augments clinician utilization. More analysis is required to verify if the rich communication actions found in Phase II compliment clinical workflows.