Program Attendance Research Articles

Using Longitudinal Social Network Analysis to Evaluate a Community-Wide Parenting Intervention

Harsh parenting attitudes and behaviors negatively impact children’s behavior and development, and are linked to heightened levels of violence in children. Parent training programs are effective preventive interventions, but only reach caregivers who attend them. In this study, programs were implemented alongside a community mobilization process, intended to use caregivers’ social networks to disseminate new parenting skills community wide. We used social network analysis to explore whether this intervention, first, increased positive parenting, second, changed social networks of female caregivers (selection), and, third, influenced parenting behavior via connections (socialization), while controlling for psychiatric morbidity, parenting stress, alcohol misuse, and child’s age. “Colored” Afrikaans-speaking female caregivers (N = 235; mean age 35.92 years) in a rural community in South Africa, with children between 1½ and 18 years old, were included in the study; two waves of data were collected (January–April 2016 and June–October 2017). We detected community-wide increases in positive parenting behavior (involvement, supervision, consistent discipline, and reduced corporal punishment). Attending at least one session of a parenting skills training program (n = 51; 21.7%) significantly predicted increases in network centrality (i.e., outdegree and indegree). Caregivers appeared to use similar parenting behavior to other caregivers they were connected to within the network, especially when those others attended a parenting skills training program. Overall, the results suggest that the information in the intervention was spread throughout the community through social interactions with program attendees and the community mobilization process. The results also illustrate the value of social network analysis for ascertaining the processes by which the intervention achieved its impact.

Results from a pre-post, uncontrolled pilot study of a mindfulness-based program for early elementary school teachers

BackgroundMindfulness-based programs are a novel and promising approach for supporting teachers’ occupational health and well-being. Although rationales for mindfulness programs for teachers have been offered, the empirical research base evaluating approaches for educating teachers in mindfulness is still developing. This study reports the findings of a pilot study of a mindfulness-based program. This study is unique in that it is one of the only studies of the Mindfulness-Based Emotional Balance (MBEB) program to focus on early elementary teachers, to be implemented by a new instructor, and to recruit teachers via extrinsic motivators.MethodsA pre-post, uncontrolled pilot study of a 27.5-h mindfulness-based program for teachers was conducted with 21 pre-kindergarten–third-grade teachers from the Pacific Northwest of the USA. Program acceptability was assessed based on attendance and teacher reports of program benefits. Effect sizes for within-person changes (from pre- to post-program) in teachers’ skills and mindsets, well-being, occupational health, and teaching practices were calculated. Teachers also suggested improvements to the program.ResultsWith regard to program attendance and acceptability, teachers attended 87% of sessions, with 58% of teachers reporting a personal benefit and 58% of teachers reporting a professional benefit of the program. Effect sizes for changes in teachers’ skills and mindsets ranged from small to large, |d| = 0.30 to 0.83, and ranged from small to medium for changes in teachers’ well-being |d| = 0.07 to 0.48, occupational health |d| = 0.14 to 0.39, and teaching practices |d| = 0.15 to 0.48. Teachers suggested shortening the program and linking it more closely to their work in the classroom.ConclusionsThis study suggests that the MBEB program may be beneficial to early elementary teachers, even when implemented by someone other than the program developer, and when provided with extrinsic motivation to participate (more closely mapping to a larger-scale trial of the program). Teachers’ suggestions regarding program length and structure are considered, along with useful avenues for future research on mindfulness-based programs for teachers.

Feasibility of a 26-Week Exercise Program to Improve Brain Health in Older Adults at Risk for Type 2 Diabetes: A Pilot Study

ObjectivesOlder adults at risk for type 2 diabetes (i.e. overweight individuals or those with prediabetes) experience accelerated cognitive and brain deficits. Aerobic training is known to improve these deficits, but the effects of resistance training are relatively unknown. Before conducting a large-scale, randomized, controlled trial to assess the effects of resistance training, we first conducted a pilot feasibility study to examine recruitment, attendance and retention rates in this population. MethodsProgram participants (aged 60 to 80 years, mean age 68.7±5.7 years, 50% females) at risk for type 2 diabetes (body mass index of ≥25 or fasting blood glucose of 6.1 to <7 mmol/L) underwent 26 weeks of thrice-weekly progressive resistance training (n=13) or balance-and-tone exercises (control group, n=11). Recruitment, attendance and retention rates were recorded, and study feedback from program participants and research assistants was collected via questionnaires. ResultsWe recruited 72 older adults (total number enrolled = 24) over 17 months. Program retention and attendance were 95.8% and 84.4%, respectively. Program participants and research assistants expressed a high level of study enjoyment, and suggestions on how to improve study procedures were provided. ConclusionsBased on our findings, a large-scale study in this at-risk group of older adults is feasible, and key strategies to improving future trials were identified.

An analysis of policy interventions regarding school lunch programs and their role in the healthy nutrition of children in Córdoba, Argentina

The aim of this article is to analyze school lunch programs and their role in the healthy nutrition of children in Córdoba, Argentina from 2013 to 2018. A descriptive, cross-sectional study was conducted that included a sample of 10 schools in 2013 and 10 different schools in 2018. A survey of school lunch programs and 24-hour nutrition reminders was carried out with 341 children. The nutritional value of school lunch programs decreased over the study period, particularly among schools in contexts of greater social vulnerability. Significant reductions in average calcium and energy intake were also observed. Indicators of chronic malnutrition, overweight, and excess calcium and vitamin A and C intakes worsened among children attending school lunch programs. Regarding the association between school lunch program attendance and low height for age/risk of low height for age, the odds ratio was not statistically significant. We argue for the necessity of promoting policies that seek urgent improvements in child nutritional indicators from a rights-based perspective.

Socioeconomic status, secondary prevention activities during the first year after a myocardial infarction and target attainments

Abstract Background Socioeconomic status (SES) is a strong predictor of recurrent events post-myocardial infarction (MI) with unclear underlying mechanisms. To what extent SES is associated with secondary prevention activities (SPAs) and attainment of quality-of-care treatment goals is unknown. Purpose We aimed to assess the association between SES and SPAs during the first year post-MI and attained treatment targets at the 1-year follow-up. Methods Nationwide Swedeheart registry-based cohort study on 30,191 18–76 year old 11–15 month survivors of a first MI (8,180 women) 2006–2013. Complementary individual-level clinical data and data on SES (age and gender stratified quintiles of disposable income, level of education, and marital status), were linked from other national registries. Associations between SES and the outcomes were estimated in multivariable logistic regression models with basic adjustment for potential registry-related confounding. Results The associations between all indicators of SES and attendance to patient education and physical training programs were strong, moderate for dietary program attendance but absent for participation in smoking cessation program (Table 1). Higher SES was also associated with repeated lipid profile measurements and the highest vs lowest income with intensified statin therapy. Correspondingly, higher SES was associated with having achieved target levels of LDL-C, blood pressure, and HbA1c as well as with persistence to and being on high intensity statin treatment (Figure 1). Further, higher SES was strongly associated with having quit smoking. No association with income was however observed regarding the weekly physical activity goal. Conclusions Higher SES was strongly associated with most SPAs including programs aiming at life style change and risk factor control as well as with attainment of corresponding secondary prevention targets. This may be explanatory for higher long-term risk of recurrent disease. Figure 1. Target Attainment Forest Plots Funding Acknowledgement Type of funding source: Other. Main funding source(s): Stockholm City Council and The Swedish Heart and Lung Association

HIV testing amid COVID-19: community efforts to reach men who have sex with men in three Kenyan counties.

In comparison to European and American countries, Kenya has been less impacted by the COVID-19 pandemic in terms of reported cases and mortalities. However, everyday life has been dramatically affected by highly restrictive government-imposed measures such as stay-at-home curfews, prohibitions on mobility across national and county boundaries, and strict policing, especially of the urban poor, which has culminated in violence. This open letter highlights the effects of these measures on how three community-based organizations (CBOs) deliver HIV programs and services to highly stigmatized communities of men who have sex with men living in the counties of Kisumu, Kiambu and Mombasa. In particular, emphasis is placed on how HIV testing programs, which are supported by systematic peer outreach, are being disrupted at a time when global policymakers call for expanded HIV testing and treatment targets among key populations. While COVID 19 measures have greatly undermined local efforts to deliver health services to members and strengthen existing HIV testing programs, each of the three CBOs has taken innovative steps to adapt to the restrictions and to the COVID-19 pandemic itself. Although HIV testing in clinical spaces among those who were once regular and occasional program attendees dropped off noticeably in the early months of the COVID-19 lockdown, the program eventually began to rebound as outreach approaches shifted to virtual platforms and strategies. Importantly and unexpectedly, HIV self-testing kits proved to fill a major gap in clinic-based HIV testing at a time of crisis.

The effects of financial incentives on diabetes prevention program attendance and weight loss among low-income patients: the We Can Prevent Diabetes cluster-randomized controlled trial

BackgroundPenetration and participation of real life implementation of lifestyle change programs to prevent type 2 diabetes has been challenging. This is particularly so among low income individuals in the United States. The purpose of this study is to examine the effectiveness of financial incentives on attendance and weight loss among Medicaid beneficiaries participating in the 12-month Diabetes Prevention Program (DPP).MethodsThis is a cluster-randomized controlled trial with two financial incentive study arms and an attention control study arm. Medicaid beneficiaries with prediabetes from 13 primary care clinics were randomly assigned to individually earned incentives (IND; 33 groups; n = 309), a hybrid of individual- and group-earned incentives (GRP; 30 groups; n = 259), and an attention control (AC; 30 groups; n = 279). Up to $520 in incentives could be earned for attaining attendance and weight loss goals over 12 months. Outcomes are percent weight loss from baseline, achieving 5% weight loss from baseline, and attending 75% of core and 75% of maintenance DPP sessions. Linear mixed models were used to examine weight change and attendance rates over the 16 weeks and 12 months.ResultsThe percent weight change at 16 weeks for the IND, GRP, and AC participants were similar, at − 2.6, − 3.1%, and − 3.4%, respectively. However, participants achieving 5% weight loss in the IND, GRP, and AC groups was 21.5, 24.0% (GRP vs AC, P < 0.05), and 15.2%. Attendance at 75% of the DPP core sessions was significantly higher among IND (60.8%, P < 0.001) and GRP (64.0%, P < 0.001) participants than among AC (38.6%) participants. Despite substantial attrition over time, attendance at 75% of the DPP maintenance sessions was also significantly higher among IND (23.0%, P < 0.001) and GRP (26.1%, P < 0.001) participants than among AC (11.0%) participants.ConclusionsFinancial incentives can improve the proportion of Medicaid beneficiaries attending the 12-month DPP and achieving at least 5% weight loss.Trial registrationClinicalTrials.govNCT02422420; retrospectively registered April 21, 2015.

Postdischarge Outcomes of Adolescents Attending a Long-term Addiction Treatment Program

Objectives: The purpose of this study was to: (1) describe the alcohol and other drug use patterns among adolescents discharged from a unique long-term semiresidential treatment program in Canada; (2) compare graduates and nongraduates on alcohol and other drug use, and 12-step program attendance; and (3) evaluate the relationship between psychosocial outcomes and continuous abstinence during the 2 years following discharge from the program (ie, obtaining education, becoming employed, maintaining a steady relationship with a significant other, and less involvement in deviant behaviors). Materials and Methods: Fifty individuals (41 treatment graduates and 9 treatment nongraduates) were interviewed by telephone after discharge. The time interval between discharge from treatment and study interview ranged from 2 to 9 years, with a median of 5 years. Additional data for 48 participants were obtained from administrative records at the treatment program. Results: Among the overall sample, 50.0% were abstinent for the first 2 years postdischarge, and maintaining abstinence for 2 years was more prevalent among program graduates than nongraduates (58.5% vs. 11.1%). Nearly all relapses involved alcohol or cannabis. With the exception of being in a serious relationship, continuous abstinence was unrelated to other psychosocial variables. Conclusions: This specialized, long-term residential program yielded high continuous abstinence rates for program graduates, but intensive support during and following treatment discharge for these young adults is warranted to improve educational attainment and employment prospects, and decrease deviant behaviors following discharge. Additional research is needed to more fully understand the long-term outcomes of adolescents attending community-based drug treatment programs.

The impact of afterschool program attendance on academic outcomes of middle school students.

This evaluation examined the effects of afterschool programs-supported by an afterschool system intermediary organization (ASIO)-on middle school students' academic performance and examined how those effects varied by student characteristics and program engagement. In this longitudinal, quasi-experimental matched comparison group evaluation, propensity score matching was used to create demographically balanced samples of ASIO-supported afterschool program participants and nonparticipants. Students enrolled in the afterschool programs did not differ from non-participants in growth over time on most academic outcomes. Students attending the afterschool programs showed less growth on certain state test scores compared to nonparticipants. Student demographic characteristics did not consistently influence participant outcomes. Among program participants only, students who were enrolled more than 1 year demonstrated a 7-percentile-point increase in state test scores per year of program engagement. There was no consistent evidence that ASIO-supported afterschool program participation was associated with improved student academic outcomes. However, study results support increased emphasis on afterschool program retention, given that longer duration of participation in the afterschool programs was associated with more growth on multiple academic outcomes.

Predictors of type 2 diabetes remission in the Diabetes Remission Clinical Trial (DiRECT).

To identify predictors of type 2 diabetes remission in the intervention arm of DiRECT (Diabetes Remission Clinical Trial). Participants were aged 20-65 years, with type 2 diabetes duration of <6 years and BMI 27-45 kg/m2 , and were not receiving insulin. Weight loss was initiated by total diet replacement (825-853 kcal/day, 3-5 months, shakes/soups), and weight loss maintenance support was provided for 2 years. Remissions (HbA1c <48 mmol/mol [<6.5%], without antidiabetes medications) in the intervention group (n = 149, mean age 53 years, BMI 35 kg/m2 ) were achieved by 68/149 participants (46%) at 12 months and by 53/149 participants (36%) at 24 months. Potential predictors were examined by logistic regression analyses, with adjustments for weight loss and effects independent of weight loss. Baseline predictors of remission at 12 and 24 months included being prescribed fewer antidiabetes medications, having lower triglyceride and gamma-glutamyl transferase levels, and reporting better quality of life with less anxiety/depression. Lower baseline HbA1c was a predictor at 12 months, and older age and male sex were predictors at 24 months. Being prescribed antidepressants predicted non-remission. Some, but not all effects were explained by weight loss. Weight loss was the strongest predictor of remission at 12 months (adjusted odds ratio per kg weight loss 1.24, 95% CI 1.14, 1.34; P < 0.0001) and 24 months (adjusted odds ratio 1.23, 95% CI 1.13, 1.35; P <0.0001). Weight loss in kilograms and percentage weight loss were equally good predictors. Early weight loss and higher programme attendance predicted more remissions. Baseline BMI, fasting insulin, fasting C-peptide and diabetes duration did not predict remission. Other than weight loss, most predictors were modest, and not sufficient to identify subgroups for which remission was not a worthwhile target.

Exploring the impact of pain management programme attendance on complex regional pain syndrome (CRPS) patients' decision making regarding immunosuppressant treatment to manage their chronic pain condition.

Objectives Complex regional pain syndrome (CRPS) is a rare chronic pain condition for which no curative treatment exists. Patients in tertiary centres are often required to make decisions about treatment options. This study was conducted to explore how prior attendance of a pain management program might alter patients' decision making processes. Methods This qualitative study uses focus groups to gather patient views on an immunosuppressant drug treatment (mycophenolate) for the management of CRPS. Participants were allocated to one of three focus groups based on their treatment journey; Group 1 (n=3) were involved in a recent mycophenolate drug trial; Group 2 (n=5) were neither involved in the trial nor attended a Pain Management Programme (PMP); Group 3 (n=6) were not involved in the trial but had attended a PMP. Outcomes were considered within the framework of Leventhal's Common Sense Model (CSM) in relation to the decision making process. Results Thematic analysis identified differing themes for each group. Group 1: (1) Medication as a positive form of treatment, (2) The trial/drug and (3) Pacing. Group 2: (1) Medication as form of treatment, (2) Other forms of support/treatment and (3) Side effects of mycophenolate. Group 3: (1) Varied view of medication, (2) Consideration of other forms of support and (3) Side effects. Conclusions Attendance on a PMP might provide patients with skills to better manage uncertainty when faced with various treatment options. Leventhal's model goes some way to explaining this. The specific importance of, and benefit from understanding pacing when commencing an effective drug treatment for chronic pain became apparent.

Mobile App Use for Insomnia Self-Management in Urban Community-Dwelling Older Korean Adults: Retrospective Intervention Study.

BackgroundAs an evidence-based psychotherapy for treating insomnia, cognitive behavioral therapy for insomnia (CBT-I), which helps people with sleep problems to change their unhelpful sleep-related beliefs and habits, has been well-established in older adults. Recently, the utilization of mobile CBT-I apps has been getting attention from mental health professionals and researchers; however, whether mobile CBT-I apps are usable among older users has yet to be determined.ObjectiveThe aims of this study were to explore the relationships between subjective sleep quality and subjective memory complaints and depressive symptoms; to explore the relationship between perceived difficulty in mobile app use and usability of the mobile phone–based self-help CBT-I app, named MIND MORE, in urban community-dwelling Korean older adults; to compare changes in subjective sleep quality from pre-intervention to post-intervention, during which they used the mobile app over a 1-week intervention period; and evaluate adherence to the app.MethodsDuring the 2-hour training program delivered on 1 day titled “Overcoming insomnia without medication: How to use the ‘MIND MORE’ mobile app for systematic self-management of insomnia” (pre-intervention), 41 attendants were asked to gain hands-on experience with the app facilitated by therapists and volunteer workers. They were then asked to complete questionnaires on sociodemographic characteristics, subjective evaluation of mental health status (ie, depression, memory loss and impairment, and sleep problems), and app usability. For the 1-week home-based self-help CBT-I using the app (post-intervention), 9 of the 41 program attendants, who had already signed up for the pre-intervention, were guided to complete the given questionnaires on subjective evaluation of sleep quality after the 1-week intervention, specifically 8 days after the training program ended.ResultsDue to missing data, 40 of 41 attendants were included in the data analysis. The main findings of this study were as follows. First, poor subjective sleep quality was associated with higher ratings of depressive symptoms (40/40; ρ=.60, P<.001) and memory complaints (40/40; ρ=.46, P=.003) at baseline. Second, significant improvements in subjective sleep quality from pre-intervention to post-intervention were observed in the older adults who used the MIND MORE app only for the 1-week intervention period (9/9; t8=3.74, P=.006). Third, apart from the program attendants who did not have a smartphone (2/40) or withdrew from their MIND MORE membership (3/40), those who attended the 1-day sleep education program adhered to the app from at least 2 weeks (13/35, 37%) to 8 weeks (2/35, 6%) without any further contact.ConclusionsThis study provides empirical evidence that the newly developed MIND MORE app not only is usable among older users but also could improve subjective sleep quality after a 1-week self-help intervention period.

Symptom experience as a predictor of cardiac rehabilitation education programme attendance after percutaneous coronary intervention: A prospective questionnaire survey.

Despite evidence that participation in cardiac rehabilitation programmes after percutaneous coronary intervention is associated with better clinical outcomes, many patients with coronary artery disease do not participate in such programmes. A traditional educational approach is recommended to provide patients with information regarding the benefits of cardiac rehabilitation in relation to their underlying coronary artery disease and modification of risk factors. The purpose of this study was to examine the role of patient factors (symptom experience and health belief) on cardiac rehabilitation education programme attendance among Korean patients subjected to percutaneous coronary intervention. A prospective survey was conducted enrolling 173 patients who underwent percutaneous coronary intervention. Information on symptom experience, health belief (perceived susceptibility/severity/benefits/ barriers) and sociodemographic and clinical characteristics was collected at baseline (after percutaneous coronary intervention). Three to four weeks later, information on disease-related knowledge and health behaviour was compared between cardiac rehabilitation education programme attendees and non-attendees. Eighty of 173 (46.2%) patients surveyed attended the cardiac rehabilitation education programme. Symptom experience before percutaneous coronary intervention was the most significant predictor of programme attendance (odds ratio=3.46; 95% confidence interval 1.45-8.27), followed by higher perceived socioeconomic status (odds ratio=2.90; 95% confidence interval 1.28-6.58), perceived susceptibility (odds ratio=1.22, 95% confidence interval 1.08-1.39), perceived benefits (odds ratio=1.09; 95% confidence interval 1.02-1.17) and perceived severity (odds ratio=1.04; 95% confidence interval 1.00-1.08). Better disease-related knowledge and health behaviour were significantly associated with cardiac rehabilitation education programme attendance. This study provides evidence that educational programmes to help improve patients' perceptions of their disease susceptibility and severity, especially health behaviour benefits in patients without symptom experience before percutaneous coronary intervention, are necessary.

Evaluation of the scale-up and implementation of mind, exercise, nutrition \u2026 do it! (MEND) in British Columbia: a hybrid trial type 3 evaluation

BackgroundThe Mind, Exercise, Nutrition … Do it! (MEND) childhood obesity intervention was implemented in British Columbia (B.C.), Canada from April 2013 to June 2017. The study objective was: a) to describe and explore program reach, attendance, satisfaction, acceptability, fidelity, and facilitators and challenges during scale-up and implementation of MEND in B.C. while b) monitoring program effectiveness in improving children’s body mass index (BMI) z-score, waist circumference, dietary and physical activity behaviours, and psychological well-being.MethodsThis prospective, pragmatic implementation evaluation (Hybrid Type 3 design) recruited families with children and adolescents aged 7–13 with a BMI ≥ 85th percentile for age and sex. The 10-week MEND B.C. program was delivered in 27 sites, throughout all five B.C. health regions (Northern, Interior, Island, Fraser, and Vancouver Coastal) over 4 years. Families attended two weekly in-person group sessions aimed to increase physical activity and promote healthy eating. BMI z-score and waist circumference were measured at baseline and follow-up. Dietary and physical activity behaviours and psychological well-being were measured using validated questionnaires. A mixed-method approach was used to collect and analyze the data.ResultsOne hundred thirty-six MEND B.C. programs were delivered over 4 years. The program reached 987 eligible participants. 755 (76.5%) children and adolescents completed the program. The average program attendance was 81.5%. Parents reported the program content was easy to understand, culturally suitable, respectful of family’s financial situation, and provided adequate information to build a healthy lifestyle. Children achieved significant positive changes across all four evaluation years in BMI z-score (d = − 0.13), nutrition behaviours (d = 0.64), physical activity levels (d = 0.30), hours of screen time per week (d = − 0.38) and emotional distress (d = − 0.21). Challenges to continued program implementation included: recruitment, resource requirement for implementation, and the need to tailor the program locally to be more flexible and culturally relevant.ConclusionsThe program reached a broad demographic of children and adolescents in B.C. Families were highly satisfied with the program delivery. MEND. B.C. at scale was effective across all four evaluation years in improving BMI z-score, lifestyle behaviours and psychological well-being among children. Future interventions need to explore strategies to enhance program delivery flexibility.

Overseas students in Thailand: A qualitative study of cross-cultural adjustment of French exchange students in a Thai university context

ABSTRACT In recent years, due to the rapid growth of English language programs in higher educational institutions, inexpensive living expenses, and affordable tuition fees in Thailand, the number of international students coming to the kingdom has risen year on year, with a parallel increase in the challenging experiences of acculturation of being an exchange student in an alien environment away from one’s domestic norms. This qualitative study aims to gain an in-depth understanding of French exchange students’ experiences of cross-cultural adjustment encountered during their residency and exchange program attendance in Thailand. The findings of this present study shed light on a better understanding of lived experiences of French exchange students in four major areas: (1) linguistic limitations and their possible solutions; (2) culture shock and associated acculturative stress; (3) cultural adjustment; and (4) proposed extra-curricular activities to foster French exchange students’ cross-cultural adaptation to the Thai collectivistic context. The implications of this study will be beneficial for educators working in academic international relations departments to better understand the challenges faced by international students and explore social support mechanisms to address problems arising during the students’ residency.

Factors to consider during the implementation of nutrition and physical activity trials for people with psychotic illness into an Australian community setting

BackgroundResearch in lifestyle interventions focusing on nutrition and physical activity in people living with psychotic illness, highlights anthropometric and metabolic benefits of these interventions. However, little is known about potential factors to consider during implementation into real-world contexts. Community-managed organisations (CMOs) that provide services for people with mental illness, offer an ideal implementation context for lifestyle interventions. Successful translation of lifestyle interventions into CMOs may be achieved though considering the factors associated with program access and delivery in these settings. This study primarily aimed to identify the factors that affect program access in a local CMO from the perspective of consumers and staff. The secondary aim was to describe the elements that impact on program delivery from the perspective of staff.MethodsThirteen semi-structured interviews were conducted with 6 consumers and 7 staff in a CMO in regional Australia. Topics explored in interviews were based on implementation concepts identified in the “Integrated Promoting Action on Research Implementation in Health Systems” (i-PARIHS) knowledge translation framework. Thematic data analysis was conducted using Nvivo software.ResultsEmergent themes on issues that influenced program access were (1) consumer financial status, domestic responsibilities, and health; (2) the design and delivery of programs; (3) structure and practices of the organisation; (4) attitude, skills and effort of staff involved in program delivery; and (5) social connections and stigma experienced by consumers during program access. Moreover, staff perceptions on elements that impacted program delivery highlighted themes on consumer attendance and interest in prospective programs, availability and restrictions to the use of funding, as well as the organisational structure and practices.ConclusionsThe factors affecting program access and delivery can generally be managed or planned for during the design of lifestyle interventions and subsequent translation into the CMO context. However, resolution of issues related to consumer financial status and health requires the collaboration of various government sectors for system-wide solutions.

Partners' attachment styles and overprotective support as predictors of patient outcomes in cardiac rehabilitation.

This study investigates whether the adult attachment styles of support partners in a cardiac rehabilitation context predict their use of overprotective support strategies, and whether such overprotection in turn predicts lower self-efficacy and poorer program attendance in cardiac rehabilitation patients. Participants were 69 partner-patient dyads, mostly older adults (mean age = 65 years) in long-term relationships (M = 35 years). During the first week of a 10-week cardiac rehabilitation program in a midsized rural hospital, participants completed self-report questionnaires that were used to assess partners' attachment styles and levels of overprotection, as well as patients' health-related self-efficacy. Attendance at each session of the program was then tracked by cardiac rehabilitation staff members. A moderated mediation model using bootstrapping showed that when partners were insecurely attached (high in both attachment avoidance and attachment anxiety), a mediational model held, such that more insecure partner attachment predicted more extensive use of overprotective support strategies, which in turn predicted lower patient self-efficacy for exercise and less-frequent program attendance. Implications for training support partners in more-effective support strategies are discussed. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

The relationship between transportation vulnerability, school attendance, and free transportation to an afterschool program for youth

Transportation vulnerability, defined as lack of access to transportation resulting in financial, social, or health consequences, reduces quality of life. While research has focused on the relationship between transportation vulnerability and the built environment among adults, youth have received less attention. This study examined the association between transportation vulnerability and school attendance in Miami-Dade County, Florida from 2010 to 2017 across schools that were/were not provided free transportation for students to attend a park-based physical activity afterschool program called Fit2Play (n = 289 public schools; 84% with Title I status; 41% located in high transportation vulnerable areas, 28% provided with free transportation to a program park). Adjusted longitudinal generalized linear mixed models showed a positive association between transportation vulnerability and school attendance with stronger magnitude in schools with versus without free school-to-program transportation (β = 1.16, 95% CI 0.69, 1.63). Sub-analyses showed a 3.23% (95% CI 2.45, 4.02) mean increase in school attendance for program sites with high program attendance located in high versus low transportation vulnerable areas. These findings suggest that transportation interventions have potential to improve school attendance and community-based recreation participation over time for youth exposed to high transportation vulnerability. Study results highlight the need to explore sustainable services that reduce transportation vulnerability for youth in high-need subgroups to improve school and community program participation.

HIV testing amid COVID-19: community efforts to reach men who have sex with men in three Kenyan counties.

In comparison to European and American countries, Kenya has been less impacted by the COVID-19 pandemic in terms of reported cases and mortalities. However, everyday life has been dramatically affected by highly restrictive government-imposed measures such as stay-at-home curfews, prohibitions on mobility across national and county boundaries, and strict policing, especially of the urban poor, which has culminated in violence. This open letter highlights the effects of these measures on how three community-based organizations (CBOs) deliver HIV programs and services to highly stigmatized communities of men who have sex with men living in the counties of Kisumu, Kiambu and Mombasa. In particular, emphasis is placed on how HIV testing programs, which are supported by systematic peer outreach, are being disrupted at a time when global policymakers call for expanded HIV testing and treatment targets among key populations. While government measures have greatly undermined local efforts to deliver health services to members and strengthen existing HIV testing programs, each of the three CBOs has taken innovative steps to adapt to the government restrictions and to the COVID-19 pandemic itself. Although HIV testing in clinical spaces among those who were once regular and occasional program attendees dropped off noticeably in the early months of the COVID-19 lockdown, the program eventually began to rebound as outreach approaches shifted to virtual platforms and strategies. Importantly and unexpectedly, HIV self-testing kits proved to fill a major gap in clinic-based HIV testing at a time of crisis.

Why Is Exercise Effective in Reducing Pain in People with Osteoarthritis?

The aim of this narrative review was to summarize the beneficial effects of exercise for those with symptomatic hip and knee osteoarthritis (OA) utilizing data along the pipeline from translational to clinical studies to implementation into clinical practice. Exercise is first line treatment for managing symptomatic hip and knee OA. Aerobic, strengthening and neuromuscular approaches are all effective in reducing pain and improving function. Exercise dose and supervision may be more important. Twelve or more supervised exercise sessions seem superior to fewer sessions. Education about the condition, the role of exercise in reducing pain and improving function, and strategies for increasing physical activity is also key as long-term adherence to ongoing home exercise after program attendance is needed to maintain effects. The proposed mechanisms by which exercise improves pain and function in people with OA include general systemic effects and those local to the joint. General mechanisms include neural and systemic inflammation effects. Local mechanisms include exercise effects on muscle and other joint-related structures as well as local joint inflammation. Exercise effects on pain are as large or larger than for medications such as paracetamol and NSAIDs. Similar magnitude in pain relief and improvement in function from clinical trials has been shown immediately after the program and at 1-year follow-up in evidence-based structured education and exercise programs implemented into clinical practice in several countries. These programs are cost-effective. Although clinicians around the world are slowly adopting exercise as OA treatment, system changes are required to facilitate implementation of evidence-based exercise programs into clinical practice. Enhanced availability of education and supervised exercise programs and reimbursement schemes with support from publicly funded health services that reduce access barriers for patients are needed to support more universal evidence-based management and reduce the burden of symptomatic OA.