The effects of message framing on self-management behavior among people with type 2 diabetes: A randomized controlled trial.

BACKGROUND: Message framing describes how information is communicated and demonstrated to influence its effect on future attitudes and behaviors. Message content can be structured as 'gain-framed', emphasizing the benefits of engagement as recommended, whereas 'loss-framed' describes the negative consequences of not engaging as recommended. However, the impact of message framing on behavior change in people with chronic diseases like diabetes is not well understood. OBJECTIVE: Analyze the impact of message framing in diabetes education on self-management in people with type 2 diabetes, and identify potential moderating effects of patient activation on message framing. DESIGN: A three-arm randomized controlled trial was performed. SETTING(S): Participants were recruited from inpatients in the endocrine and metabolic unit of a university-affiliated hospital in Changchun. PARTICIPANTS: A total of 84 adults with type 2 diabetes were equally randomized into gain-, loss-, or no-message framing groups and received a 12-week intervention. METHODS: Both the message framing groups received 30 video messages. One group of participants received the gain-framed messages emphasizing desirable outcomes from effective diabetes self-care. The other group of participants received the loss-framed messages emphasizing the undesirable consequences of ineffective diabetes self-care. The control group received 30 videos about diabetes self-care without message framing. Self-management behavior, self-efficacy, patient activation, diabetes knowledge, attitudes, and quality of life were measured at baseline and 12 weeks. RESULTS: Compared with the control group, participants who watched either gain or loss-framed messages had significant increases in self-management behavior and quality of life after the intervention. The scores of self-efficacy, patient activation, knowledge, and attitudes of the loss-framing group were considerably higher than the control group. Further analysis revealed an interaction between patient activation and message framing (P = 0.002), with gain and loss message framing interventions more effective in increasing self-management behaviors in people with type 2 diabetes who had a higher and lower activation level, respectively. CONCLUSIONS: Using message framing in diabetes education is a promising strategy to build and foster self-management behavior. It also suggests that appropriate message framing be chosen to enhance self-management behavior based on the level of patient activation. REGISTRATION NUMBER: ChiCTR2100045772.

Effectiveness of eHealth Interventions on Moderate-to-Vigorous Intensity Physical Activity Among Patients in Cardiac Rehabilitation: Systematic Review and Meta-analysis.

BACKGROUND: Cardiac rehabilitation is a class IA recommendation for patients with cardiovascular diseases. Physical activity is the core component and core competency of a cardiac rehabilitation program. However, many patients with cardiovascular diseases are failing to meet cardiac rehabilitation guidelines that recommend moderate-to-vigorous intensity physical activity. OBJECTIVE: The major objective of this study was to review the evidence of the effectiveness of eHealth interventions in increasing moderate-to-vigorous intensity physical activity among patients in cardiac rehabilitation. The secondary objective was to examine the effectiveness of eHealth interventions in improving cardiovascular-related outcomes, that is, cardiorespiratory fitness, waist circumference, and systolic blood pressure. METHODS: A comprehensive search strategy was developed, and a systematic search of 4 electronic databases (PubMed, Web of Science, Embase, and Cochrane Library) was conducted for papers published from the start of the creation of the database until November 27, 2022. Experimental studies reporting on eHealth interventions designed to increase moderate-to-vigorous intensity physical activity among patients in cardiac rehabilitation were included. Multiple unblinded reviewers determined the study eligibility and extracted data. Risk of bias was evaluated using the Cochrane Collaboration Tool for randomized controlled trials and the Cochrane Effective Practice and Organization of Care group methods for nonrandomized controlled trials. A random-effect model was used to provide the summary measures of effect (ie, standardized mean difference and 95% CI). All statistical analyses were performed using Stata 17. RESULTS: We screened 3636 studies, but only 29 studies were included in the final review, of which 18 were included in the meta-analysis. The meta-analysis demonstrated that eHealth interventions improved moderate-to-vigorous intensity physical activity (standardized mean difference=0.18, 95% CI 0.07-0.28; P=.001) and vigorous-intensity physical activity (standardized mean difference=0.2, 95% CI 0.00-0.39; P=.048) but did not improve moderate-intensity physical activity (standardized mean difference=0.19, 95% CI -0.12 to 0.51; P=.23). No changes were observed in the cardiovascular-related outcomes. Post hoc subgroup analyses identified that wearable-based, web-based, and communication-based eHealth intervention delivery methods were effective. CONCLUSIONS: eHealth interventions are effective at increasing minutes per week of moderate-to-vigorous intensity physical activity among patients in cardiac rehabilitation. There was no difference in the effectiveness of the major eHealth intervention delivery methods, thereby providing evidence that in the future, health care professionals and researchers can personalize convenient and affordable interventions tailored to patient characteristics and needs to eliminate the inconvenience of visiting center-based cardiac rehabilitation programs during the COVID-19 pandemic and to provide better support for home-based maintenance of cardiac rehabilitation. TRIAL REGISTRATION: PROSPERO International Prospective Register of Systematic Reviews CRD42021278029; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=278029.

Smartphone-based gamification intervention to increase physical activity participation among patients with coronary heart disease: A randomized controlled trial.

INTRODUCTION: Despite proven benefits, patients with coronary heart disease (CHD) typically fail to participate in sufficient physical activity (PA). Effective interventions should be implemented to help patients maintain a healthy lifestyle and modify their present behavior. Gamification is the use of game design features (such as points, leaderboards, and progress bars) to improve motivation and engagement. It shows the potential for encouraging patients to engage in PA. However, empirical evidence on the efficacy of such interventions among patients with CHD is still emerging. PURPOSE: The aim of the study is to explore whether a smartphone-based gamification intervention could increase PA participation and other physical and psychological outcomes in CHD patients. METHODS: Participants with CHD were randomly assigned to three groups (control group, individual group, and team group). The individual and team groups received gamified behavior intervention based on behavioral economics. The team group combined gamified intervention with social interaction. The intervention lasted for 12 weeks, and the follow-up was12 weeks. The primary outcomes included the change in daily steps and the proportion of patient days that step goals were achieved. The secondary outcomes included competence, autonomy, relatedness, and autonomous motivation. RESULTS: For the individual group, smartphone-based gamification intervention significantly increased PA among CHD patients over the 12-week period (step count difference 988; 95% CI 259-1717; p < 0.01) and had a good maintenance effect during the follow-up period (step count difference 819; 95% CI 24-1613; p < 0.01). There are also significant differences in competence, autonomous motivation, body mass index (BMI), and waist circumference in 12 weeks between the control group and individual group. For the team group, gamification intervention with collaboration didn't result in significant increases in PA. But patients in this group had a significant increase in competence, relatedness, and autonomous motivation. CONCLUSION: A smartphone-based gamification intervention was proven to be an effective way to increase motivation and PA engagement, with a substantial maintenance impact (Chinese Clinical Trial Registry Identifier: ChiCTR2100044879).

Effects of message framing on self-management behaviour among patients with type 2 diabetes: a randomised controlled trial protocol.

INTRODUCTION: Accumulating evidence has indicated successful diabetes health education can potentially help to improve blood sugar levels in people with diabetes. However, with a rapid rise in the number of people with diabetes cases and the increasing burden on healthcare, it is often difficult for healthcare providers to find suitable time to provide health education to meet their needs. Thus, more novel and effective ways are needed to conduct education. The message frame provides a new perspective for implementation of a more effective health education in the form of changing information presentation, and the same objective content is described in either positive or negative language or outcomes. Gain framing emphasises the positive consequences of adhering to useful recommendations, while loss framing highlights the negative consequences of the non-adherence. The purpose of our research is to potentially explore the effectiveness of diabetes education based on message framing on the self-management behaviour. METHODS AND ANALYSIS: A single-blind, three-arm randomised controlled trial involving 84 participants will be conducted. The participants will be assigned into three groups randomly in a 1:1:1 ratio and will receive 12-week intervention. Patients in group 1 will be provided gain framing education videos about the self-management skills for type 2 diabetes, patients in group 2 will be given education videos based on loss framing and patients in group 3 will receive education with no specific message framing. The primary outcome is self-management behaviour. The secondary outcomes will be self-efficacy, patient activation, diabetes-related knowledge and attitude, quality of life and blood glucose level. All outcomes will be measured at baseline and 12 weeks. ETHICS AND DISSEMINATION: This study was approved by the Ethics Committee of School of Nursing, Jilin University (No. 2020101501). The research results will be published in peer-reviewed publications and presented in international conferences. TRIAL REGISTRATION NUMBER: ChiCTR 2100045772; Pre-results.

Effects of Remotely Supervised Physical Activity on Health Profile in Frail Older Adults: A Randomized Controlled Trial Protocol.

Background: Frailty is considered a major public health challenge of the 21st century, characterized by the decline of multiform body functions. Physical activity may be the most effective intervention to delay frailty. This study aims to verify the effect of remotely supervised physical activity on health profile in community-dwelling frail older adults. Design: This is a multicenter, three-blind, two-arm, and cohort randomized controlled study. Methods: The intelligent exercise rehabilitation management system (IERMS) is an integrated digital platform that involves evaluation, guidance, monitoring, and feedback. A total of 120 participants aged ≥ 65 years and diagnosed as frailty on the FRAIL scale will be recruited and randomly divided into two groups. Group 1 will receive a 12-week IERMS-based intervention, and Group 2 will receive the usual care. Data will be collected at baseline, 12 and 24 weeks. The primary outcome is the physical function, and secondary outcomes include gait parameters, psychology, and cognition measurements. Analyses will be performed using DSS statistics, version 25. P < 0.05 will be considered statistically significant. Conclusion: We believe that intervention plays a positive role in delaying the frailty. If our program is effective, we will provide a viable means to promote healthy aging in primary healthcare. Trial registration number: ChiCTR2100052286; Pre-results.

The Effects of mHealth-Based Gamification Interventions on Participation in Physical Activity: Systematic Review.

BACKGROUND: It is well known that regular physical exercise has associated benefits; yet, participation remains suboptimal. Mobile health (mHealth) has become an indispensable medium to deliver behavior change interventions, and there is a growing interest in the gamification apps in mHealth to promote physical activity (PA) participation. Gamification could use game design elements (such as points, leaderboards, and progress bars), and it has the potential to increase motivation for PA and engagement. However, mHealth-based gamification interventions are still emerging, and little is known about the application status and efficacy of such interventions. OBJECTIVE: This systematic review aims to investigate gamification apps in mHealth for improving PA levels and simultaneously summarize the impact of gamification interventions on PA participation. METHODS: We searched PubMed, Scopus, Web of Science, Embase, CINAHL (EBSCO host), and IEEE Xplore from inception to December 20, 2020. Original empirical research exploring the effects of gamification interventions on PA participation was included. The papers described at least one outcome regarding exercise or PA participation, which could be subjective self-report or objective indicator measurement. Of note, we excluded studies about serious games or full-fledged games. RESULTS: Of 2944 studies identified from the database search, 50 (1.69%) were included, and the information was synthesized. The review revealed that gamification of PA had been applied to various population groups and broadly distributed among young people but less distributed among older adults and patients with a disease. Most of the studies (30/50, 60%) combined gamification with wearable devices to improve PA behavior change, and 50% (25/50) of the studies used theories or principles for designing gamified PA interventions. The most frequently used game elements were goal-setting, followed by progress bars, rewards, points, and feedback. This review demonstrated that gamification interventions could increase PA participation; however, the results were mixed, and modest changes were attained, which could be attributed to the heterogeneity across studies. CONCLUSIONS: Overall, this study provides an overview of the existing empirical research in PA gamification interventions and provides evidence for the efficacy of gamification in enhancing PA participation. High-quality empirical studies are needed in the future to assess the efficacy of a combination of gamification and wearable activity devices to promote PA, and further exploration is needed to investigate the optimal implementation of these features of game elements and theories to enhance PA participation.

Mobile health-based gamification intervention to increase physical activity participation among patients with coronary heart disease: study protocol of a randomised controlled trial.

INTRODUCTION: Despite proven benefits, physical activity participation remains low in patients with coronary heart disease (CHD). Scientific evidence suggests that mobile health (mHealth)-based gamification interventions could increase physical activity levels. However, several systematic reviews demonstrated that most gamification intervention designs do not appropriately leverage theories from health behaviour models, and empirical evidence on the efficacy of such interventions among patients with CHD is still emerging. This study embeds the principles of behavioural economics into a gamification intervention based on a smartphone app (WeChat applet) to explore whether a mHealth-based gamification intervention can improve participation in physical activity and other related physical and psychological outcomes in patients with CHD. METHODS: We propose a single-blinded three-arm randomised controlled trial with 108 patients with CHD, who will be randomly divided into three groups (Control group: WeChat applet+step goal setting; Individual group: WeChat applet+step goal setting+gamification; Team group: WeChat applet+step goal setting+gamification+collaboration). The interventions will last for 12 weeks and follow-up for 12 weeks. All patients will receive only WeChat applet-based step goal setting in the follow-up period. The primary outcome is physical activity participation, which includes a change in daily steps and self-reported physical activity from the baseline to 12 and 24 weeks, and the proportion of patient-days that step goals achieved in 12 and 24 weeks. The secondary outcomes include biomedical and lifestyle-related risk factors, intrinsic motivation, enjoyment, competence, autonomy and relatedness, social support and mental health and patients' satisfaction, perceptions and intervention experience. ETHICS AND DISSEMINATION: The Human Research Ethics Committee of the School of Nursing, Jilin University (HREC 2020122401) approved this. The results will be published in peer-reviewed journals and presented at conferences. TRIAL REGISTRATION NUMBER: ChiCTR2100044879; Pre-results.

Effect of Glomus intraradices on root morphology, biomass production and phosphorous use efficiency of Chinese fir seedlings under low phosphorus stress.

Introduction: Available phosphorus (P) scarcity in the highly weathered soils of the subtropical forests in southern China is a serious concern. To ensure whether inoculation of arbuscular mycorrhizal fungi (AMF) with Chinese fir (Cunninghamia lanceolata) under low P stress conditions could promote its growth and P utilization capacity, an indoor pot simulation experiment was carried out with the different P supply treatments and Chinese fir seedlings as the tested material. Methods: The experiment had two P supply treatments, no P supply (P0, 0 mmol·L-1 KH2PO4) and normal P supply (P1, 1.0 mmol·L-1 KH2PO4). The seedling in each P supply treatment was inoculated with Glomus intraradices (Gi), a widespread species of AMF in the natural environment, and with no AMF inoculation as a control treatment (CK). The Gi infection rate in the root system, root cortex tissue dissolution rate, root morphological indexes and biomass, whole plant P use efficiency, and root P use efficiency of Chinese fir were determined under different treatment conditions. Results and Discussion: The results showed that P0 treatment significantly increased the Gi infection rate (p< 0.05). After inoculating AMF with different P supply treatments, the root cortex tissue dissolution rate was considerably enhanced. In contrast, the Chinese fir's root length and surface area were reduced; however, the root volume did not change significantly. The average root diameter in the P0 treatment and inoculated with AMF was significantly more prominent than in the uninoculated treatment (p< 0.05). The root biomass and root-to-shoot ratio at different P supply treatments were significantly higher in the Gi infection treatment than in the CK group. Under different P supply treatments, root inoculation with Gi promoted root P use efficiency and whole plant P use efficiency. In conclusion, low P stress condition promoted the colonization of AMF in the root system, increased the dissolution of root cortex tissue, root volume, and the average diameter, and promoted root biomass accumulation and P use efficiency.