A qualitative investigation of demands, resources and self-regulation during Navy deployment.

Creating a sustainable workplace for Navy personnel is vital for their wellbeing and retention. This qualitative study explores the interplay between job and personal demands, resources, and stress self-regulation strategies affecting psychological strain among Navy personnel during deployment. We conducted semi-structured key informant interviews with 25 Navy personnel (68% male) to determine the demands and resources at sea that affect psychological strain. The findings identified that individual differences in coping strategies (e.g., recovery management), abilities (i.e. ability to make social connections), and their mind-set about deployment (e.g., sense of purpose) were perceived to play a role in the experience of strain. Additionally, the presence of supportive peers and leaders was identified as a key resource, whereas external stressors (e.g., family crisis) and social tension onboard, amplified by confined spaces, were commonly reported demands. Our findings also contribute to a growing body of research suggesting a nuanced interaction between individual coping strategies and job design. Formal organizational support was identified as enabling adaptive self-regulation strategies, while the capacity to form and maintain positive relationships helped foster a sense of belonging, countering isolation. Another key contribution was the individual differences in the appraisal of resources offered by the organization and the potential importance of resource appraisal in how effective resources were perceived to be for addressing shipboard demands. We provide recommendations relating to targets for personnel training, interventions, and leadership in terms of communication, supporting day-to-day and equal opportunity for recovery, resource access, maintaining morale, and shaping the evaluation of demands.

Road to referral success in COPD: Enhancing patient engagement through dedicated conversations about pulmonary rehabilitation programs.

RESEARCH QUESTION: From the perspectives of healthcare professionals (HCPs) and people with chronic obstructive pulmonary disease (COPD) known to tertiary care, what influences successful referrals to a pulmonary rehabilitation program (PRP)? METHODS: This cross-sectional qualitative study was informed by a critical realist perspective. We purposively sampled people with COPD and HCPs who deliver COPD care and used semi-structured interviews and focus groups to explore determinants of a successful referral to a PRP. Interviews were recorded, transcribed verbatim and analysed using reflexive thematic analysis. RESULTS: Data were available on 38 HCPs and 15 people with COPD. We generated three core themes pertaining to successful referrals. The first theme was that HCPs should be mindful of how professional responsibilities (such as their personal value and interest in a PRP, their degree of understanding of PRPs, and the organisational culture the PRPs are embedded within) shape decision-making during a therapeutic interaction. The second theme, there's more to me than my COPD, characterised psychological perceptions that shape a person's readiness to engage in a PRP. The third theme, communication is a two-way street that requires careful navigation, characterised the interpersonal dynamic between HCP and patient, and how dedicated conversations about PRPs can encourage successful referrals. CONCLUSION: Therapeutic interactions that include dedicated conversations about PRPs can foster successful referrals among people with COPD. During these interactions, HCPs should take the time to understand and carefully unpack psychological perceptions whilst imparting value, interest and enthusiasm for PRPs. Doing so can shape patient engagement toward referral success.

Interventions with a clear focus on achieving behaviour change are important for maintaining training-related gains in people with chronic obstructive pulmonary disease: a systematic review.

QUESTIONS: In people with chronic obstructive pulmonary disease (COPD) who complete an exercise training program (ETP) offered at a sufficient dose to result in training-related gains, to what extent are these gains maintained 12 months after program completion? Do variables such as the application of behaviour change techniques moderate the maintenance of these training-related gains? DESIGN: Systematic review, meta-analysis and meta-regression of randomised controlled trials. PARTICIPANTS: People with stable COPD. INTERVENTION: Trials were included if they applied ≥ 4 weeks of a whole-body ETP and reported outcome data immediately following program completion and 12 months after initial program completion. The control group received usual care that did not include a formal exercise training component. OUTCOME MEASURES: Exercise tolerance, health-related quality of life and dyspnoea during activities of daily living. DATA SOURCES: EMBASE, PEDro, PubMed and the Cochrane Library. RESULTS: Nineteen randomised trials with 2,103 participants were found, of which 12 had a sufficiently similar design to be meta-analysed. At 12 months after ETP completion, compared with the control group, the experimental group demonstrated better exercise tolerance (SMD 0.48, 95% CI 0.19 to 0.77) and quality of life (SMD 0.22, 95% CI 0.03 to 0.41) with no clear effect on dyspnoea. Meta-regression using data from all 19 trials demonstrated that the magnitude of between-group differences at the 12-month follow-up was moderated by: behaviour change being a core aim of the strategies implemented following completion of the ETP; the experimental group receiving more behaviour change techniques during the program; and the magnitude of between-group change achieved from the program. CONCLUSION: At 12 months after completion of an ETP of ≥ 4 weeks, small gains were maintained in exercise tolerance and health-related quality of life. Applying behaviour change techniques with a clear focus on participants integrating exercise into daily life beyond initial program completion is important to maintain training-related gains. REGISTRATION: CRD42020193833.

Psychosocial predictors of doping intentions and use in sport and exercise: a systematic review and meta-analysis.

OBJECTIVE: To conduct a meta-analytic review of psychosocial predictors of doping intention, doping use and inadvertent doping in sport and exercise settings. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Scopus, Medline, Embase, PsychINFO, CINAHL Plus, ProQuest Dissertations/Theses and Open Grey. ELIGIBILITY CRITERIA: Studies (of any design) that measured the outcome variables of doping intention, doping use and/or inadvertent doping and at least one psychosocial determinant of those three variables. RESULTS: We included studies from 25 experiments (N=13 586) and 186 observational samples (N=3 09 130). Experimental groups reported lower doping intentions (g=-0.21, 95% CI (-0.31 to -0.12)) and doping use (g=-0.08, 95% CI (-0.14 to -0.03), but not inadvertent doping (g=-0.70, 95% CI (-1.95 to 0.55)), relative to comparators. For observational studies, protective factors were inversely associated with doping intentions (z=-0.28, 95% CI -0.31 to -0.24), doping use (z=-0.09, 95% CI -0.13 to to -0.05) and inadvertent doping (z=-0.19, 95% CI -0.32 to -0.06). Risk factors were positively associated with doping intentions (z=0.29, 95% CI 0.26 to 0.32) and use (z=0.17, 95% CI 0.15 to 0.19), but not inadvertent doping (z=0.08, 95% CI -0.06 to 0.22). Risk factors for both doping intentions and use included prodoping norms and attitudes, supplement use, body dissatisfaction and ill-being. Protective factors for both doping intentions and use included self-efficacy and positive morality. CONCLUSION: This study identified several protective and risk factors for doping intention and use that may be viable intervention targets for antidoping programmes. Protective factors were negatively associated with inadvertent doping; however, the empirical volume is limited to draw firm conclusions.

Stepping back or stepping in: A qualitative investigation of self-distanced versus self-immersed stressor reflections with competitive swimmers.

High performance sport consists of stressor events which can disrupt an athletes' functioning and negatively influence performance. The way in which one reflects upon stressor events and develops insights regarding how they coped is essential to overcoming similar experiences in the future. We conducted a pilot randomised controlled trial with a qualitative analysis to explore the coping insights among 48 highly trained/national level swimmers in the lead up to major swimming competitions, who reflected on stressor events from self-distanced or self-immersed perspectives over a 3-week period. Using the self-reflection and coping insight framework as a guideline, we captured divers coping insights across both groups. Irrespective of the group to which they were assigned, athletes showed positive signs towards re-interpreting their stressor experience and embracing the stressor event, whereas consideration of individual values and adoption of a future-focus viewpoint were areas lacking. The emotionality described by athletes in their written reflections varied across both groups and influenced the development of coping insights. Our findings indicate a necessity to examine the emotionality associated with unique stressor events and consider integrating reflection strategies, while also enhancing the operational definitions within conceptual models of stress reflection protocols.

Quantifying uptake and completion of pulmonary rehabilitation programs in people with chronic obstructive pulmonary disease known to tertiary care.

BACKGROUND: People with symptomatic chronic obstructive pulmonary disease (COPD) benefit from pulmonary rehabilitation programs (PRPs), but program attrition is common. METHODS: For people with COPD who presented to tertiary care and appeared appropriate for a PRP, we prospectively mapped their PRP journey, explored factors influencing attendance to pre-program assessment and captured program attrition. RESULTS: Of the 391 participants, 31% (95% CI 27 to 36) were referred to a PRP (n = 123; age 68 ± 10years, 62 males [50%], FEV1 45 ± 19%predicted). Of those referred, 94 (76% [69 to 84]) attended a pre-program assessment. Ex-smokers and those who had a healthcare professional (HCP) explain they would be referred were more likely to attend a pre-program assessment (odds ratio [95%CI]; 2.6 [1.1 to 6.1]; and 4.7 [1.9 to 11.7], respectively). Of the 94 who attended, 63 (67% [58 to 77]) commenced; and of those who commenced, 35 (56% [43 to 68]) completed a PRP. All who completed (n = 35, 100%) were provided at least one strategy to maintain training-related gains. CONCLUSION: Attrition occurs throughout the PRP journey. Interactions with HCPs about PRPs positively influenced attendance. Understanding how HCPs can best contextualise PRPs to encourage referral acceptance and uptake is an important area for further work.

Autonomous motivation promotes goal attainment through the conscious investment of effort, but mental contrasting with implementation intentions makes goal striving easier.

People with autonomous motives (e.g., personal importance) may use automated strategies to effortlessly sustain goal-directed behavior and overcome obstacles. We investigated whether conscious effort, ease of goal striving, physiological effort, and the number of obstacles encountered mediate relations between motives and goal attainment for a competitive cycling goal. Additionally, half the participants (n = 57) were trained in Mental Contrasting with Implementation Intentions (MCII) - a technique that facilitates development of goal-directed behavior - with remaining participants (n = 54) treated as controls. Conscious investment of effort mediated relations between autonomous motives and goal attainment. Subjective ease of goal striving and physiological effort did not. This result indicates that successful goal striving is not perceived as effortless for autonomously motivated individuals working on competitive goals. Conversely, MCII predicted a reduction in obstacles, which in turn was associated with easier goal striving but not goal attainment. Although MCII did not support goal attainment in the current study, its ability to minimize the influence of obstacles may still be useful for other types of goals or for sustaining long-term goal pursuit.

Health behaviour profiles in young Australian adults in relation to physical and mental health: The Raine Study.

ISSUES ADDRESSED: We aimed to identify latent health behaviour profiles of young adults and examine their associations with physical and mental health outcomes. We also characterised the profiles by socio-demographic characteristics. METHODS: Data were collected between 2012 and 2014. Participants (N = 476) were young adults (M age [SD] = 22.1 [.57] years) from Generation 2 of the Raine Study longitudinal cohort. Health behaviours were measured via ActiGraph GT3X waist monitors (physical activity, sedentary behaviour) and questionnaires (diet quality, alcohol, smoking and sleep). Physical and mental health were measured using clinical health assessments, blood biomarkers, and questionnaires. Latent Profile Analysis using Mplus (8.2) was employed to identify profiles. RESULTS: Four latent profiles were identified: 'heavy drinkers with moderately unhealthy eating habits' (high takeaway foods; n = 135), 'unhealthy food abstainers' (low takeaway foods; n = 138), 'moderately sedentary alcohol abstainers' (n = 139) and 'physically active drinkers with unhealthy eating habits' (high takeaway foods and sugary drinks; n = 64). 'Physically active drinkers with unhealthy eating habits' had the poorest (physical and mental) health outcomes, yet the lowest insulin resistance. 'Unhealthy food abstainers' had the most favourable health outcomes (adiposity, health perceptions, blood pressure). Sex differed among the profiles. CONCLUSIONS: The profiles identified among young adults are different to profiles with general adult populations. A novel finding was that 'physically active drinkers with unhealthy eating habits' had low insulin resistance. The findings also suggest that future interventions may need to be sex specific. SO WHAT: Our findings suggest that health behaviour interventions for young adults should be targeted to distinct profile characteristics.

A Mixed-Methods Feasibility Study of a Gamified Therapy Prescription App for Children with Neurodisability.

AIM: Determine the feasibility of a gamified therapy (occupational therapy, physiotherapy, speech pathology) prescription app developed for children with neurodisability for delivering school and home therapy programs (the Zingo app). METHOD: A mixed-methods feasibility study was conducted with children (and their parents, therapists, and teachers) with neurodisability (n = 8, female= 5) who were prescribed a 4-week individualized therapy program by their usual treating therapist using Zingo. Primary outcome measures were program adherence, engagement, app quality, and user experience, collected with quantitative and qualitative methods. RESULTS: Mean adherence to the program was 58.0% (SD 27.2). Our combined Engagement Index (EI) score was 74.4% (SD 11.7). App quality measured using Mobile Application Rating Scale- User version was 4.6/5 (SD 0.7, n = 6) for parents, 4.6/5 (SD 0.5, n = 5) for teachers, and 4.4/5 (SD 0.6, n = 6) for therapists. Thematic analysis of semi-structured interviews yielded a primary theme of "app as motivator" for therapy. CONCLUSIONS: Adherence findings were affected by COVID-19 outbreak however remain comparable with other studies in this cohort. EI findings compared favorably with other studies. The findings are supportive of the feasibility of Zingo for delivering home and school therapy programs for children with neurodisability and was found to motivate therapy program completion.

Examining the roles of experiential avoidance and cognitive fusion on the effects from mindfulness to athlete burnout: A longitudinal study.

OBJECTIVES: Athlete burnout is a maladaptive outcome that is potentially detrimental for performance and wellbeing. Cross-sectional evidence suggests that mindfulness might be associated with athlete burnout via experiential avoidance and cognitive fusion. In the current study, we extend knowledge of these hypothesized mediational pathways using a longitudinal design. METHODS: Data was collected at three occasions with a three-month interval. A final sample of 280 elite Chinese athletes aged 15-32 years (Mage = 19.13; SD = 2.92; Female = 130) reported their mindfulness at Time 1, experiential avoidance and cognitive fusion at Time 2, and athlete burnout at Time 3. Structural equation modelling was adopted to examine the mediating roles of experiential avoidance and cognitive fusion on the effects from mindfulness to athlete burnout. RESULTS: We found statistically meaningful directs effects from mindfulness (Time 1) to experiential avoidance and cognitive fusion (Time 2), which in turn influenced athlete burnout (Time 3). However, the direct effect from mindfulness at Time 1 to athlete burnout at Time 3 was non-significant. The indirect effects of experiential avoidance and cognitive fusion on the effects from mindfulness to athlete burnout were significant, providing longitudinal evidence that these two variables contribute meaningfully to the mindfulness-burnout pathway. CONCLUSION: With initial evidence for the mediating effects of experiential avoidance and cognitive fusion, future studies could consider using experimental designs to examine the potential changing mechanisms of mindfulness on reducing athlete burnout.