Association between physical activity and neighborhood environment among middle-aged adults in Shanghai.

OBJECTIVE: To determine the perceived neighborhood environment (NE) variables that are associated with physical activity (PA) in urban areas in China. METHODS: Parents of students at two junior high schools in Shanghai, one downtown and the other in the suburbs, were recruited to participate in the study. They completed an International Physical Activity Questionnaire (IPAQ) and Neighborhood Environment Walkability Scale-Abbreviated (NEWS-A) survey. Participant physical activity was also objectively measured using accelerometers. RESULTS: Participants from downtown areas were more positively associated with transportation PA and leisure-time PA than respondents living in the suburbs. Residential density was found to be a significant positive predictor of recreational or leisure-based PA. Street connectivity was negatively associated with leisure time PA for respondents. Moderate-vigorous PA was found to be negatively associated with traffic safety. There were no significant associations between environmental factors and transportation PA. Women had higher levels of moderate-vigorous PA than men. CONCLUSIONS: The results of this study demonstrate that residential density, street connectivity, and traffic safety have a significant impact on Chinese middle-aged adults' PA, suggesting urban planning strategies for promoting positive public health outcomes.

Qualitative evaluation of Chronic Disease Self Management Program (CDSMP) in Shanghai.

OBJECTIVES: To explore the impact of Chronic Disease Self-Management Program (CDSMP) on participants' perception of their behavior, health status and quality of life and how the program achieve its benefits, and to collect suggestions for future improvement and dissemination. METHODS: Qualitative data were obtained from 57 participants attending all sessions of the CDSMP course using semi-structured interviews and analyzed using content analysis. RESULTS: The interviewees perceived that CDSMP improved their knowledge, self-management skills, positive health behavior, increased self-confidence, health status and quality of life. Behavior change and self-efficacy were the two main transmitters of the effectiveness of CDSMP in Shanghai. The identified deficiencies focused on language, size and style of helpbook and the lack of Chinese relaxing exercises. CONCLUSION: CDSMP was perceived to be effective to participants mainly through behavior change and self-efficacy development, though it had a few deficiencies to be modified. PRACTICE IMPLICATIONS: CDSMP in Shanghai needs further work and research on the content and delivery modification for future improvement and dissemination.

Implementation and quantitative evaluation of chronic disease self-management programme in Shanghai, China: randomized controlled trial.

OBJECTIVE: To evaluate the effectiveness of the Shanghai Chronic Disease Self-Management Program (CDSMP). METHODS: A randomized controlled trial with six-month follow-up compared patients who received treatment with those who did not receive treatment (waiting-list controls) in five urban communities in Shanghai, China. Participants in the treatment group received education from a lay-led CDSMP course and one copy of a help book immediately; those in the control group received the same education and book six months later. FINDINGS: In total, 954 volunteer patients with a medical record that confirmed a diagnosis of hypertension, heart disease, chronic lung disease, arthritis, stroke, or diabetes who lived in communities were assigned randomly to treatment (n = 526) and control (n = 428) groups. Overall, 430 (81.7%) and 349 (81.5%) patients in the treatment and control groups completed the six-month study. Patients who received treatment had significant improvements in weekly minutes of aerobic exercise, practice of cognitive symptom management, self-efficacy to manage own symptoms, and self-efficacy to manage own disease in general compared with controls. They also had significant improvements in eight indices of health status and, on average, fewer hospitalizations. CONCLUSION: When implemented in Shanghai, the CDSMP was acceptable culturally to Chinese patients. The programme improved participants' health behaviour, self-efficacy, and health status and reduced the number of hospitalizations six months after the course. The locally based delivery model was integrated into the routine of community government organizations and community health services. Chinese lay leaders taught the CDSMP courses as successfully as professionals.