Range Of Chronic Health Conditions Research Articles

Human-centered design approach to building a transition readiness mHealth intervention for early adolescents.

Mobile health (mHealth) interventions may be an efficacious strategy for promoting health behaviors among pediatric populations, but their success at the implementation stage has proven challenging. The purpose of this article is to provide a blueprint for using human-centered design (HCD) methods to maximize the potential for implementation, by sharing the example of a youth-, family-, and clinician-engaged process of creating an mHealth intervention aimed at promoting healthcare transition readiness. Following HCD methods in partnership with three advisory councils, we conducted semistructured interviews with 13- to 15-year-old patients and their caregivers in two phases. In Phase 1, participants described challenges during the transition journey, and generated ideas regarding the format, content, and other qualities of the mHealth tool. For Phase 2, early adolescents and caregivers provided iterative feedback on two sequential intervention prototypes. Data were analyzed using thematic analysis in Phase 1 and the rapid assessment process for Phase 2. We interviewed 11 youth and 8 caregivers. The sample included adolescents with a range of chronic health conditions. In Phase 1, participants supported the idea of developing an autonomy-building tool, delivering transition readiness education via social media style videos. In Phase 2, participants responded positively to the successive prototypes and provided suggestions to make information accessible, relatable, and engaging. The procedures shared in this article could inform other researchers' plans to apply HCD in collaboration with implementation partners to develop mHealth interventions. Our future directions include iteratively developing more videos to promote transition readiness and implementing the intervention in clinical care.

Wellbeing and distress in young people with chronic conditions: how do positive psychology variables relate to mental health outcomes?

ABSTRACT Objective The aim of this study was to determine the unique and shared contributions of various positive psychology constructs (gratitude, optimism, hope, self-compassion, self-efficacy, and emotion regulation) to wellbeing and distress outcomes in young people living with a diverse range of chronic health conditions. Methods and Measures 169 Australians (84.0% female, mean age = 21.2) who reported living with a chronic physical condition completed a cross-sectional survey assessing wellbeing, distress, and each positive psychology variable. Two multiple regressions were used to determine the unique and shared contributions of the positive psychology variables to wellbeing and distress outcomes. Results When considered alongside symptom severity, the variables explained 53.4% and 38.1% of variance in distress and wellbeing, respectively. Only optimism and self-efficacy accounted for unique and significant variance in the model predicting wellbeing, accounting for 6.1% and 4.6% of unique variance, respectively. For the distress model, optimism, self-compassion, and emotion regulation each accounted for significant variance. When considered alongside other variables, hope and gratitude did not contribute to either model. Conclusion Findings suggest that individual positive psychology variables differentially contribute to wellbeing and distress outcomes in young people with chronic conditions. Optimism appears to account for unique variance in both outcomes, suggesting it may be a parsimonious target to promote complete mental health in this population.

Exploring attitudes of people with chronic conditions towards telerehabilitation: A qualitative study

Abstract Background Patient attitudes towards telerehabilitation have been explored in condition-specific cohorts. However, less is known about how patients perceive generic group telerehabilitation programmes for a range of chronic conditions. The aim of this research is to explore the attitudes of people with a range of chronic health conditions towards group-based telerehabilitation, and the acceptability of generic telerehabilitation programmes. Methods We conducted a qualitative research study using semi-structured focus groups via videoconferencing software. A purposive sample of 18 people with chronic health complaints including cardiorespiratory, neurological and musculoskeletal conditions were recruited. The sample included both those who had (n = 11), and had not (n = 7), previously engaged in telerehabilitation programmes. An online questionnaire collected demographic information and data regarding previous telerehabilitation participation and preferences. Focus groups were conducted via videoconferencing, in accordance with the Consolidated Criteria for Reporting Qualitative Research Checklist, and analysed using thematic analysis following Braun and Clarke's methodology. Findings were triangulated with quantitative questionnaire data. Results Four focus groups were conducted including participants with chronic cardiorespiratory (n = 8), neurological (n = 6) and musculoskeletal (n = 4) conditions. Three themes were identified regarding telerehabilitation: 1. Benefits and Facilitators 2. Challenges and Barriers, and 3. Preferences Conclusion(s) Telerehabilitation is convenient for people with chronic conditions, however, concerns exist regarding technology and the limitations of this healthcare delivery method. The role of telerehabilitation is valued, and future programmes should acknowledge patient preferences including a hybrid model of care, exercise and educational content, social interaction, and synchronous components. Key messages • Patients value the role of telerehabilitation in the future as an adjunct to traditional in-person rehabilitation, not as a replacement. • The acceptability of a generic telerehabilitation programme for a group of people with a range of chronic conditions remains unclear, and may differ between groups.

S418 Disease Burden and Diagnosis Pathways Among Patients With EoE in the United States: Evidence From Real World Clinical Practice

Introduction: Eosinophilic esophagitis (EoE), which is a chronic immune-mediated inflammatory disorder of the esophagus, is one of several heterogeneous inflammatory conditions, known as eosinophil-associated diseases (EADs). Common EoE symptoms are dysphagia, food impaction, abdominal pain, and nausea. EoE is associated with significant burden and upper gastrointestinal morbidity that impair health-related quality of life (HRQoL). This real-world study characterizes the patient journey to diagnosis and treatment among US patients with EoE. Methods: Adelphi Real World Disease Specific Programmes (DSPs) are multinational, point-in-time surveys, completed by physicians for their patients, which provide data regarding the real-world clinical practice for a range of chronic health conditions. This study used the Adelphi EoE DSP, which collected information in 2020 from US patients with EoE. Eligible patients were ≥12 years with a physician-confirmed EoE diagnosis, an esophageal count of ≥15 eosinophils (EOS)/high-power field (HPF) at diagnosis, and were currently prescribed treatment for EoE. Results: Overall, 322 patients with EoE were included in the United States. Mean patient age was 35.6 years and mean body mass index was 25.4. Most patients (63%) were male, 74% were employed full/part time, 15% were students, 3% were on leave/unemployed, and 3% needed caregiver support due to EoE. Most frequent EoE symptoms prior to diagnosis are shown in the Figure. Mean age at EoE symptom onset was 33.7 years, mean time from symptom onset to first healthcare provider (HCP) consult was 15.2 months, and from first consult to EoE diagnosis was 6.7 months; mean age at diagnosis was 35.5 years. Most patients (88%) were diagnosed with either moderate (67%) or severe (21%) EoE; among those assessed using EREFS (n=76), 57%, 91%, 67%, 80%, and 41% scored above Grade 0 in edema, rings, exudate, furrows, and stricture, respectively. Among 52 patients with a recent esophageal count, 77% (n=40) still had a count of ≥15 EOS/HPF after a mean 28 months since diagnosis and on treatment, although only 28% (n=11) of those patients were considered moderate/severe EoE cases. Allergic rhinitis (27%), asthma (22%), and anxiety (17%) were the most common comorbidities. Conclusion: EoE presents severe symptoms and comorbidities that could substantially impact patients’ HRQoL. Furthermore, patients faced 22 months of wait from symptom onset to HCP consult and receipt of an accurate diagnosis.Figure 1.: Most frequent EoE symptoms prior to diagnosis

Measuring PROMIS® Well-Being in Early Childhood.

Expand the current Patient-Reported Outcome Measurement Information System (PROMIS®) well-being measures to early childhood (1-5 years) using best practices from PROMIS and developmental science. Qualitative methods included expert input, literature and measure review, and parent interviews to confirm measure frameworks, item understandability, and developmental appropriateness. Quantitative methods included two waves of field testing and item response theory (IRT)-based psychometric evaluation of reliability and validity, as well as IRT centering and item calibration. Correlational analyses with other PROMIS Early Childhood (EC) Parent Report measures and known-group differences analyses by health status were conducted to evaluate construct validity. All measures were normed to the general U.S. population. Qualitative results suggested three primary early childhood well-being domains: Positive Affect, Engagement, and Self-Regulation. Quantitative results revealed a unidimensional factor structure for Positive Affect and multidimensional factor structures for Engagement and Self-Regulation, both of which had two factors accounting for >10% of modeled variance reflecting unique unidimensional domains. This resulted in five final PROMIS EC well-being measures: Positive Affect, Engagement-Curiosity, Engagement-Persistence, Self-Regulation-Flexibility, and Self-Regulation-Frustration Tolerance. Correlations and known-groups differences analyses showed robust construct validity across a range of chronic health conditions. The new PROMIS EC Parent Report well-being measures offer clinicians and researchers a brief, efficient, and precise way to evaluate young children's well-being. All five measures include only positively valanced item content, which pushes the field to evaluate the presence of children's positive assets rather than the absence of problems.

Technology-supported Acceptance and Commitment Therapy for chronic health conditions: A systematic review and meta-analysis

Chronic health conditions (CHCs) are common and associated with functional limitations. Acceptance and commitment therapy (ACT) shows promise in improving functioning, quality of life, and distress across several CHCs. The purpose of this study was to conduct a systematic review of technology-supported ACT for CHCs and perform a meta-analysis on functioning and ACT process outcomes. Multiple databases were systematically searched for randomized controlled trials. A total of 20 unique studies with 2,430 randomized participants were included. CHCs addressed in these studies were chronic pain (k = 9), obesity/overweight (k = 4), cancer (k = 3), hearing loss (k = 1), HIV (k = 1), multiple sclerosis (k = 1), and tinnitus (k = 1). Internet and telephone were the most used technology platforms. All studies included therapist contact with considerable heterogeneity between studies. Random effects meta-analyses found medium effect sizes showing technology-supported ACT outperformed comparator groups on measures of function at post-treatment (Hedges' g = −0.49; p = 0.002) and follow-up (Hedges' g = −0.52; p = 0.02), as well as ACT process outcomes at post-treatment (Hedges' g = 0.48; p < 0.001) and follow-up (Hedges’ g = 0.44; p < 0.001). Technology-supported ACT shows promise for improving function and ACT process outcomes across a range of CHCs. Recommendations are provided to optimize technology-supported ACT for CHCs. PROSPERO registration number: CRD42020200230.

Key Considerations for Providing Self-Management Support to Adults with Intellectual and Developmental Disabilities

The aim of this review is to identify key considerations for health providers delivering self-management support to adults with intellectual and developmental disabilities (IDD) living with chronic health conditions. There is an emerging body of evidence to inform the delivery of self-management support for adults with IDD living with chronic health conditions. The most extensive research on this topic relates to diabetes self-management, with a small number of studies on general chronic disease self-management. Three over-arching themes were identified: (1) acknowledging autonomy, responsibility, and risk; (2) building the capacity of caregivers, and (3) attending to emotional needs and psychosocial factors. To facilitate wellness, it is critical that health providers are equipped with the knowledge and resources required to provide appropriately tailored self-management supports for people with IDD living with a range of chronic health conditions. This review extends our current understanding of this approach and identifies both unique considerations and tensions that exist for this population and their caregivers.

Measuring outcomes that matter most to people with multiple sclerosis: the role of patient-reported outcomes.

Purpose of reviewPatient-reported outcome (PRO) represents a unique opportunity to measure the impact of health research, and care on outcomes that matter most to people with multiple sclerosis (PwMS).Recent findingsHow to incorporate PROs in MS clinical trials and, practice remains a matter of debate. The variety of measures available for use in MS has some benefits, but the lack of a set of standard measures has significant disadvantages. To help meeting the challenge, different PROs standard sets have been developed (PROMIS) for use across a broad range of chronic health conditions, and SymptoMScreen, specifically for MS. However, many of them were not co-created with PwMS and lacking understanding about what matters to patients. The newly proposed MS care unit model together with emerging initiatives such as iConquerMS and PROMOPROMS, are shaping new meaningful PROs. However, the uptake of PROMs in all settings can be effective only by a commonly held strategic agenda shared by all relevant stakeholders.SummaryThe newly born PRO Initiative for MS (PROMS) aims to develop a strategic agenda shared by all relevant stakeholders to help meeting the challenge of developing PRO measures that correspond to the needs of all stakeholders.

Chronic ill health in a regional Victoria setting: A 13-year comparison.

High-quality data regarding the prevalence of chronic disease in rural areas are essential in understanding the challenges faced by rural populations and for informing strategies to address health care needs. This study compared the prevalence of a range of self-reported chronic conditions and utilisation of GP services and emergency department in a regional Victorian setting between two studies conducted in the same region in 2001-2003 and 2014. Repeat cross-sectional studies conducted over a decade apart. The projects were conducted in the Goulburn Valley in regional Victoria. The earlier study randomly selected households from local government lists. The later study randomly selected householders from the telephone directory. Participants were asked whether they had been diagnosed with a range of chronic health conditions and how often they had visited a general practitioner or emergency department in the past 12months. The age-standardised prevalence of depression was higher in the 2014 study than the 2001-2003 study in men (increased by 8.0% (95% CI 4.5, 11.5%)) and women (increased by 13.7% (95% CI 8.4, 19.0%)). Similarly, the prevalence of age-standardised diabetes and hypertension was higher in 2014 than 2001-2003 (men increased by 3.6% (95% CI 0.7, 6.5% (diabetes)) and 13.6% (95% CI 8.6, 18.6% (hypertension)), women increased by 3.1% (95% CI 0.3, 6.5% (diabetes)) and 8.4% (95% CI 2.3, 14.5% (hypertension))). The results of this study indicate that the prevalence of self-reported depression, diabetes and hypertension has increased in this regional Victorian area over the past 13years. The reasons for these observed increases and the subsequent impact on the health care needs of regional communities warrants further investigation.

Protocol for psychosocial screening of adolescents and young adults with chronic illness.

One in five adolescents and young adults (AYA) has a chronic health condition necessitating on-going engagement with healthcare systems. Despite increasing prevalence there remains limited understanding of the burden of illness they experience. Living with a chronic illness can challenge healthy adolescent development, with the unique health and developmental issues affecting AYA requiring different responses from the healthcare system. To examine and compare the burden of illness in this group across a large range of chronic health conditions. In a dedicated health service for AYA aged 15-25 years with chronic health conditions, (13-25 years for those with substance use issues) we detail a protocol where demographics, general health, disease-specific indicators and comprehensive psychosocial variables will be collected. The health conditions include chronic gastrointestinal disease, cystic fibrosis, chronic rheumatic disease, phenylketonuria, craniomaxillofacial deformities, renal transplant patients and problematic substance use. Results will be compared to AYA without chronic illness and AYA with diabetes. This protocol outlines a comprehensive screening study for AYA with a large range of chronic health conditions, inclusive of medical, mental health, impairment and quality of life variables. It will inform service planning and provide a foundation upon which allied health service requirements (e.g. psychology) can be based. Whilst currently cross-sectional we anticipate further utility in broadening outcomes to include non-physical illness-related constructs. The commonalities and differences between conditions will be examined to facilitate efficiencies of scale for systems and supports. Further iterations including quantifying access to allied health services will facilitate studying the impact of such interventions on treatment adherence and improving psychosocial functioning, quality of life and disease outcomes.

Sitting less at work: a qualitative study of barriers and enablers in organisations of different size and sector

BackgroundProlonged sitting is associated with a range of chronic health conditions and working in office-based jobs is an important contributor to total daily sitting time. Consequently, interventions to reduce workplace sitting have been developed and tested; however, no single intervention strategy consistently produces reductions in workplace sitting time. Exploring barriers and enablers to sitting less at work has been shown to support the development of more effective interventions. In order to address these barriers and enablers during the development and implementation of sit less at work interventions, it is important to understand how they may differ in different types of organisation, an area which has not yet been explored. The main aim of this study was to determine whether barriers and enablers to sitting less at work varied between organisations of different size and sector.MethodsA qualitative study design was used. Four organisations of different sizes and sectors participated: a small business, a charity, a local authority and a large corporation. A total of ten focus groups comprising 40 volunteer employees were conducted. Focus groups were audio-recorded and transcribed verbatim. Transcripts were then thematically analysed using pre-defined themes, but analysis also allowed for emergence of additional themes.ResultsBarriers and enablers which were consistently raised by participants across all four organisations primarily included: individual-level factors such as habits and routines, and personal motivations and preferences; and factors relating to the internal physical environment. Barriers and enablers that differed by organisation mainly related to: organisational-level factors such as organisational culture, organisation size, and ways of working; and factors relating to the broader social, economic and political context such as the idea of presenteeism, and the impact of wider economic and political issues.ConclusionsThis study found that although some themes were consistently raised by participants from organisations of different size and sector, participants from these organisations also experienced some different barriers and enablers to sitting less at work. For future research or practice, the study findings highlight that organisation-specific barriers and enablers need to be identified and addressed during the development and implementation of sit less at work interventions.

A scoping review on the relations between urban form and health: a focus on Canadian quantitative evidence.

Despite the accumulating Canadian evidence regarding the relations between urban form and health behaviours, less is known about the associations between urban form and health conditions. Our study aim was to undertake a scoping review to synthesize evidence from quantitative studies that have investigated the relationship between built environment and chronic health conditions, self-reported health and quality of life, and injuries in the Canadian adult population. From January to March 2017, we searched 13 databases to identify peer-reviewed quantitative studies from all years that estimated associations between the objectively-measured built environment and health conditions in Canadian adults. Studies under-taken within urban settings only were included. Relevant studies were catalogued and synthesized in relation to their reported study and sample design, and health outcome and built environment features. Fifty-five articles met the inclusion criteria, 52 of which were published after 2008. Most single province studies were undertaken in Ontario (n = 22), Quebec (n = 12), and Alberta (n = 7). Associations between the built environment features and 11 broad health outcomes emerged from the review, including injury (n = 19), weight status (n = 19), cardiovascular disease (n = 5), depression/anxiety (n = 5), diabetes (n = 5), mortality (n = 4), self-rated health (n = 2), chronic conditions (n = 2), metabolic condi-tions (n = 2), quality of life (n = 1), and cancer (n = 1). Consistent evidence for associations between aggregate built environment indicators (e.g., walkability) and diabetes and weight and between connectivity and route features (e.g., transportation route, trails, pathways, sidewalks, street pattern, intersections, route characteristics) and injury were found. Evidence for greenspace, parks and recreation features impacting multiple health outcomes was also found. Within the Canadian context, the built environment is associated with a range of chronic health conditions and injury in adults, but the evidence to date has limitations. More research on the built environment and health incorporating rigorous study designs are needed to provide stronger causal evidence to inform policy and practice.

A New Approach for Lifestyle Medicine Payment.

With more than 85% of health care costs attributable to chronic health conditions, an emphasis on treating the underlying causes of these conditions is imperative. Lifestyle medicine offers treatments that can reverse a wide range of chronic health conditions at minimal cost and without negative side effects. Although one might expect its use to be widespread among health care professionals, it is far from common in everyday practice. A significant contributing factor is the lack of financial incentives for health care providers who practice lifestyle medicine. Current practitioners generally do not receive remuneration consistent with the cost savings resulting from reversing chronic health conditions using lifestyle medicine. The Actuarial Patient Value model offers a new approach to encourage the practice of lifestyle medicine through the use of cash financial incentives based on actual patient health outcomes. This model aligns the incentives of the 3 primary stakeholders in the health care system by offering providers increased compensation, giving patients the opportunity to learn about and achieve optimal health, and reducing costs for health care payers.

Parity associated with telomere length among US reproductive age women.

Is telomere length related to parity among a nationally representative sample of US reproductive age women? History of live birth was associated with shorter telomere length. Shorter telomeres have been linked with a range of chronic health conditions and mortality and parity has been associated with health indicators. However, there is a lack of research on how parity relates to telomere length. This nationally representative, cross-sectional study included 1954 women from the National Health and Nutrition Examination Survey, 1999-2002, the only survey period which includes measurement of telomere length. Women aged 20-44 were included. Parity, defined as number of previous live births, was ascertained by questionnaire. Leukocyte telomere length was measured by polymerase chain reaction and reported as a ratio in relation to standard reference DNA (T/S ratio). The relationship between leukocyte T/S ratio and parity was examined using survey weighted linear regression. Models were adjusted for race/ethnicity, age, BMI, income-to-poverty ratio, education, early age at menarche and smoking status. Among reproductive age women in the US, the adjusted mean leukocyte T/S ratio was 4.2% (95% CI: 0.9, 7.3) shorter in parous compared with nulliparous women. Parity was associated with 116 fewer base pairs (95% CI: 26, 204) on average, using estimated coefficients from the adjusted linear regression models and mean covariate values. This study was cross-sectional and therefore was unable to establish temporality. The dataset lacked information on social factors, stress and fertility status, which may help explain these findings. Only two previous studies have examined this question and our findings should be interpreted with caution. These findings in a nationally representative sample of US reproductive age women suggest that history of live birth may be associated with accelerated cellular aging. The magnitude of the observed association was greater than that of the impact of smoking or obesity on telomere length, suggesting that parity may have an independent influence on cellular aging and warrant further study. The study was funded in part by the Undergraduate Research Scholars Program at George Mason University. The authors have no conflicts of interest. NA.

An Acceptance and Commitment Therapy (ACT) intervention for Chronic Fatigue Syndrome (CFS): A case series approach

ObjectiveAcceptance and Commitment Therapy (ACT) has been shown to improve the psychological well-being of individuals suffering from a range of chronic health conditions, and aims to increase psychological flexibility in order to foster greater engagement in personally meaningful behavior. We aimed to assess whether the approach (delivered via guided bibliotherapy) may have utility for individuals experiencing the debilitating effects of Chronic Fatigue Syndrome (CFS). MethodsWe used a mixed-methods multiple single-case design to explore the effects of a six week self-help ACT intervention for six participants diagnosed with CFS. ResultsSignificant increases in ratings of valued living were replicated and maintained in four participants, with qualitative data further highlighting the importance of the values component of the intervention. Acceptance scores improved in four participants but were not maintained at follow-up, whereas improvements in psychological flexibility were observed and maintained for three participants. All participants wearing an activity monitor evinced increased physical activity postintervention, which was maintained at follow up in half of the participants. ConclusionThe ACT self-help intervention appeared to benefit most participants on at least one assessed metric, particularly in terms of the promotion and pursuit of individual values, and increased physical activity. However, the results suggest these benefits may be difficult to maintain longer term without further input.

Chronic Illness and Developmental Vulnerability at School Entry.

This study examined the association between chronic illness and school readiness, by using linked administrative population data. The sample included children born in 2003-2004 who were residing in Western Australia in 2009 and had a complete Australian Early Development Census record (N = 22 890). Health and demographic information was also analyzed for 19 227 mothers and 19 030 fathers. The impact of child chronic illness on 5 developmental domains (social, emotional, language, cognitive, and physical) at school entry was analyzed. Analyses examined the association between child developmental outcomes and chronic illness generally, single or multiple chronic illness diagnosis, and diagnosis type. Logistic regression models estimated odds ratios for each outcome, adjusted for child, parent, and community sociodemographic variables. In the adjusted models, children with a chronic illness had an increased risk of being classified as developmentally vulnerable on all domains, compared with children without a chronic illness (20%-35% increase in risk). There was no increased risk for children with multiple chronic illness diagnoses over those with a single diagnosis (all Ps > .05). There was no evidence of a disease-specific effect driving this risk. Regardless of the number or type of conditions, chronic illness in young children is a risk factor for reduced school readiness. These effects were seen for health conditions not traditionally considered detrimental to school readiness, such as chronic otitis media. Thus, the implications of a broader range of chronic health conditions in early childhood on school readiness need to be considered.

You never transition alone! Exploring the experiences of youth with chronic health conditions, parents and healthcare providers on self-management.

BackgroundRecent evidence suggests that fostering strategies to enable youth with chronic health conditions to work towards gradual self‐management of their health is key in successful transition to adult healthcare. To date, there is limited research on self‐management promotion for youth. The purpose of this study is to explore self‐management from the perspectives of youth, parents and healthcare providers in transition to adult healthcare.MethodsPart of a larger longitudinal transition (TRACE‐2009–2013) study, interpretive phenomenology was used to explore the meaning of the lived experiences and perceptions of youth, parents, and healthcare providers about transition to adult healthcare. Purposeful sampling was utilized to select youth with a range of chronic health conditions from the TRACE cohort (spanning 20 diagnoses including developmental disabilities and chronic conditions), their parents and healthcare providers.ResultsThe emerging three themes were: increasing independence of youth; parents as safety nets and healthcare providers as enablers and collaborators. The findings indicate that the experiences of transitioning youth, parents and service providers are interconnected and interdependent.ConclusionsResults support a dynamic and developmentally appropriate approach when working with transitioning youth and parents in practice. As youth depend on parents and healthcare providers for support in taking charge of their own health, parents and healthcare providers must work together to enable youth for self‐management. At a policy level, adequate funding, institutional support and accreditation incentives are recommended to allow for designated time for healthcare providers to foster self‐management skills in transitioning youth and parents.

“Life just keeps throwing lemons”: the lived experience of food insecurity among Aboriginal people with disabilities in the West Kimberley

This paper reports findings of a qualitative study conducted in collaboration with Aboriginal people with disabilities and their carers residing in the rural and remote Kimberley region of Western Australia, specifically the impact of chronic food insecurity on their daily lives. Nutritious food is important to maintaining health, particularly for Aboriginal people with disabilities who are at the greatest risk of a range of chronic health conditions, illnesses and secondary disability. In the remote areas of the West Kimberley, the high cost of living, including food expenses and the generally low incomes of residents mean that food insecurity is common. A large portion of the population living in remote and rural areas of the Kimberley is Aboriginal, and chronic illness and disability are twice as likely among this group. Lack of access to nutritious food has a cyclical interaction with disability, resulting in secondary impairments and ill health, which leads to greater economic exclusion and further food insecurity. Participants in this research consistently reported that they coped with food insecurity by fishing and crabbing on their traditional lands, “in country”. This link between land sovereignty, food sovereignty and food security for Aboriginal Australians has echoes with global food sovereignty movements.

Engaging Older Adults With Physical-Activity Delivered In Professional Soccer Clubs

Older-adults (seniors), are at risk from a range of chronic health conditions. Consequently, they are considered a priority group in UK policy promoting healthy lifestyles through physical-activity (PA). PURPOSE: To investigate the initial pre-adoption profiles, participant benefits and key implementation characteristics of the ‘Extra Time’ (ET) Programme. METHODS: ET is a national programme of PA-led health improvement for local older-adults (aged 55+) delivered in/by 16 professional soccer clubs. Sessions involved weekly moderate-intensity PA sessions including indoor bowls, cricket, new age curling, walking and soccer. Self-reports assessed demographics, PA, fan-status and benefits of engagement. Interviews with participants identified key implementation characteristics of interventions. RESULTS: N=486 participants engaged ET, 95%, (n=462) were White British and 59.7%, (n=290) were female. Females (Mdn = 70-74 years) were significantly older compared to males (Mdn = 65-69 years), U = 21778, z = -4.445, p <.001, r = -0.20. Most participants (65.4%/n=318) had not participated in previous programmes held by soccer clubs. The majority (80.2%, n=390) reported locating ET in a professional soccer club made it ‘more appealing’ because of the sense of community it created. This predominated other factors, including being a fan (24.3%, n=118) and available facilities (16.9%, n=82). The benefits, reported by the participants, included ‘making friends/enjoyment’ (77.2%, n=375), ‘feeling healthier’ (55.2%, n=249) and ‘feeling happier with their life’ (35.6%, n=173). Further, feeling healthy (H [4] = 31.834, p <.001) and fitter (H [4] = 12.538, p < 0.05) as a result of ET was significantly affected by PA participation. Jonckheere’s test revealed a significant trend in the data; as the frequency of PA increased, participants felt healthier (J = 38317, z = 4.196, r = -0.19) and fitter (J = 35932, z = 2.564, r = -0.12). Interviews (n=18) identified key implementation characteristics including using soccer venues, PA options, social opportunities and the flexibility of the programmes. CONCLUSION: Results support the potential of the ET Programme for recruiting older-adults into PA-led health improvement interventions delivered in English professional soccer clubs.

Development and validation of a generic scale for use in transition programmes to measure self-management skills in adolescents with chronic health conditions: the TRANSITION-Q.

To develop a generic self-management skills scale for use with adolescents diagnosed with a chronic health condition who are aged 12 to 18 years. There is a lack of methodologically sound scales for healthcare teams to use to measure self-management skills in adolescents with chronic conditions transitioning to adult care. Adolescents aged 12 to 18 years with a broad range of chronic health conditions, including neurodevelopmental conditions, were recruited from May to August 2013 from nine outpatient clinics at McMaster Children's Hospital (Canada). Thirty-two participated in a cognitive interview, and 337 completed a questionnaire booklet. Interviews were used to develop the TRANSITION-Q. Rasch measurement theory (RMT) analysis was used to identify items that represent the best indicators of self-management skills. Traditional psychometric tests of measurement performance were also conducted. The response rate was 92% (32/32 cognitive; 337/371 field test). RMT analysis resulted in a 14-item scale with three response options. The overall fit of the observed data to that expected by the Rasch model was non-significant, providing support that this new scale measured a unidimensional construct. Other tests supported the scale as scientifically sound, e.g. Person Separation Index = 0.82; good item fit statistics; no differential item function by age or gender; low residual correlations between items; Cronbach's alpha = 0.85; test-retest reliability = 0.90; and tests of construct validity that showed, as hypothesized, fewer skills in younger participants and in participants who required assistance to complete the scale. Finally, participants who agreed they are ready to transfer to adult healthcare reported higher TRANSITION-Q scores than did participants who disagreed. The TRANSITION-Q is a short, clinically meaningful and psychometrically sound scale. This generic scale can be used in research and in paediatric and adolescent clinics to help evaluate readiness for transition.