The effects of a theory-informed intervention on physical activity behaviour, motivation and well-being of frontline aged care workers: A pilot study with 6-month follow-up.

ISSUE ADDRESSED: Due to the nature of their jobs, frontline aged care workers may be a population at risk of poor health and lifestyle habits. Support of their well-being through the workplace is likely to be complex. The objective of this study was to assess the effectiveness of a need-supportive program for changing physical activity and psychological well-being via the motivational processes of behavioural regulations and perceived need satisfaction. METHODS: Frontline aged care workers (n = 25) participated in a single cohort, pre-post pilot trial. The program included a Motivational Interviewing style appointment, education on goal setting and self-management, the use of affect, exertion and self-pacing for regulating physical activity intensity and practical support activities. Outcomes (7-day accelerometery, 6-min walk, K10 and AQoL-8D), and motivational processes (BREQ-3 and PNSE) were measured at baseline, 3 and 9 months, and analysed using linear mixed models for repeated measures. RESULTS: There were significant increases in perceived autonomy at 3 months (Δ .43 ± SE: .20; p = .03) and 6-min walk distance at 9 months (Δ 29.11 m ± SE: 13.75; p = .04), which appeared to be driven by the relative autonomy index (behavioural regulations in exercise questionnaire [BREQ-3]). Amotivation increased at 3 months (Δ .23 ± SE:.12; p = .05); which may have been due to low scores at baseline. No other changes were demonstrated at any timepoint. SO WHAT?: Participants demonstrated positive changes in motivational processes and physical function, however, due to the low levels of participation in the program, the program had a negligible impact at the organisational level. Future researchers and aged care organisations should aim to address factors impacting participation in well-being initiatives.

Understanding farmers' barriers to health and mental health-related help-seeking: The development, factor structure, and reliability of the Farmer Help-Seeking Scale.

PURPOSE: The aim of this research was to develop a contextually and culturally appropriate scale to assess farmers' barriers to health-related help-seeking. METHODS: An initial pool of items was developed from the academic literature and input from an expert panel of farmers, rural academics, and rural clinicians. A draft 32-item questionnaire was then developed and sent to farmers registered with FARMbase, which is an Australian national farmer database. FINDINGS: Two hundred and seventy-four farmers completed the draft questionnaire (93.7% male, 73.7% aged 56-75 years). An exploratory factor analysis identified 6 factors; "Health Issues are a Low Priority," "Concerns about Stigma," "Structural Health System Barriers," "Minimization and Normalization," "Communication Barriers," and "Continuity of Care.". Test-retest reliability was examined with a further 10 farmers (90% male, Mean age = 57, SD = 5.91), who completed the questionnaire twice (at 2- to 3-week intervals). Results indicated moderate-good test-retest reliability. CONCLUSIONS: The resulting 24-item Farmer Help-Seeking Scale provides a measure of help-seeking that is specifically designed to capture the unique context, culture, and attitudes that can interfere with farmers' help-seeking, and inform the development of strategies to increase health-service utilization in this at-risk group.

'It is a life changing experience': The experiences of living kidney donors who live in rural Australia.

INTRODUCTION: A growing body of research has examined the physical, psychological, social and financial impacts of living kidney donation. However, little is known about the unique experiences or additional burdens faced by living donors from regional or remote locations. OBJECTIVE: To explore the experiences of living kidney donors who live outside metropolitan centres and to determine how support services could be orientated to better meet their unique needs. DESIGN/SETTING/PARTICIPANTS: Seventeen living kidney donors participated in semistructured telephone interviews. Qualitative data were analysed using thematic analysis. FINDINGS: Eight themes were identified: (1) donor's emotional well-being is influenced by the recipient's outcome, (2) varied levels of access to medical support and other important services in rural areas, (3) travel takes a toll on time, finances and well-being, (4) varied level of financial impact, (5) medical, emotional and social challenges, (6) both lay and health professional support is valued, (7) varied levels of knowledge and experiences accessing information and (8) a worthwhile experience overall. CONCLUSION: Despite many challenges, and travel adding to the complexity, rural living kidney donors generally consider it to be a worthwhile experience. The provision of additional emotional, practical and educational support would be welcomed by this group.

Do food-related capabilities, opportunities and motivations of adolescents mediate the association between socioeconomic position in adolescence and diet quality in early adulthood?

BACKGROUND: Socio-economic position (SEP) in adolescence may influence diet quality over the life course. However, knowledge of whether individual and environmental determinants of diet quality mediate the longitudinal association between SEP and diet quality is limited. This study examined whether and to what extent food-related capabilities, opportunities and motivations of adolescents mediated the longitudinal association between SEP in adolescence and diet quality in early adulthood overall and by sex. METHODS: Longitudinal data (annual surveys) from 774 adolescents (16.9 years at baseline; 76% female) from ProjectADAPT (T1 (baseline), T2, T3) were used. SEP in adolescence (T1) was operationalized as highest level of parental education and area-level disadvantage (based on postcode). The Capabilities, Opportunities and Motivations for Behaviour (COM-B) model was used as a framework to inform the analysis. Determinants in adolescence (T2) included food-related activities and skills (Capability), home availability of fruit and vegetables (Opportunity) and self-efficacy (Motivation). Diet quality in early adulthood (T3) was calculated using a modified version of the Australian Dietary Guidelines Index based on brief dietary questions on intake of foods from eight food groups. Structural equation modelling was used to estimate the mediating effects of adolescents' COM-B in associations between adolescent SEP and diet quality in early adulthood overall and by sex. Standardized beta coefficients (ß) and robust 95% confidence intervals (CI) were generated, adjusted for confounders (T1 age, sex, diet quality, whether still at school, and living at home) and clustering by school. RESULTS: There was evidence of an indirect effect of area-level disadvantage on diet quality via Opportunity (ß: 0.021; 95% CI: 0.003 to 0.038), but limited evidence for parental education (ß: 0.018; 95% CI: -0.003 to 0.039). Opportunity mediated 60.9% of the association between area-level disadvantage and diet quality. There was no evidence of an indirect effect via Capability or Motivation for either area-level disadvantage or parental education, or in males and females separately. CONCLUSIONS: Using the COM-B model, the home availability of fruit and vegetables (Opportunity) of adolescents explained a large proportion of the association between area-level disadvantage in adolescence and diet quality in early adulthood. Interventions to address poor diet quality among adolescents with a lower SEP should prioritize environmental determinants of diet quality.

A Self-Help Online Intervention Is Associated with Reduced Distress and Improved Mental Wellbeing in Australian Farmers: The Evaluation and Key Mechanisms of www.ifarmwell.com.au.

OBJECTIVES: Farmers are faced with many stressors, along with numerous barriers to accessing traditional forms of mental health support. The ifarmwell online intervention was co-designed with farmers and is informed by Acceptance and Commitment Therapy to equip farmers with transferable coping strategies, particularly to help them cope with circumstances beyond their control. We aimed to evaluate the effect of ifarmwell on farmers' short- and long-term distress and mental wellbeing. METHODS: Australian farmers (21-73 years) who registered on www.ifarmwell.com.au completed measures at the commencement of module 1 (N = 228), the end of the intervention (N = 77) and 6-months post-intervention (N = 61). Primary outcomes included distress (Kessler Psychological Distress Scale) and mental wellbeing (Mental Health Continuum - Short Form). We also examined the relationship between distress, mental wellbeing, neuroticism (Quickscales-R) and ACT-based psychological mechanisms; psychological inflexibility (Acceptance and Action Questionnaire-II), cognitive fusion (Cognitive Fusion Questionnaire), believability of automatic thoughts (Automatic Thoughts Questionnaire-B), coping via acceptance (4 items from the situational COPE) and mindfulness (Five Facet Mindfulness Questionnaire-Short Form). Secondary outcomes of acceptability (Client Satisfaction Questionnaire-8) and usability (System Usability Scale) were also explored. RESULTS: Pre- to post-intervention, farmers' distress decreased and mental wellbeing increased. These effects were maintained at 6-month follow-up. Changes in these outcomes were greatest for participants who entered the intervention with high baseline distress (߈= -0.59, 95%CI =[-0.70, -0.47]) and low mental wellbeing (߈= -0.33, 95%CI = [-0.47, -0.19]). Decreases in distress and increases in mental wellbeing were associated with decreases in psychological inflexibility, cognitive fusion, and believability of thoughts, and increases in coping via acceptance and mindfulness. Levels of satisfaction (M = 26.92/32) and usability (M = 84.70/100) were high, and 94.6% of participants said they would recommend ifarmwell to a friend in need of similar advice and tools. CONCLUSIONS: ifarmwell is an effective and usable intervention that is likely to help farmers reduce their levels of distress and improve their mental wellbeing, by improving their psychological flexibility, ability to focus on the present and accept things beyond their control, as well as by reducing the extent to which they believe unhelpful thoughts.

"We're Lucky to Have Doctors at All"; A Qualitative Exploration of Australian Farmers' Barriers and Facilitators to Health-Related Help-Seeking.

This study aimed to explore barriers and facilitators that impact on farmers' help-seeking behaviours for health and mental health concerns. Fifteen semi-structured interviews were conducted with farmers (12 male; age 51.7 ± 12.6 years) from three rural regions in South Australia. Interviews explored demographic and farm-related characteristics, perceptions of individual (and where relevant family) health and mental health concerns and experiences, and perceived barriers of health support-seeking. Thematic analysis was used to identify key themes. Four key themes were identified relating to help-seeking; personal attitudes and beliefs, farm-related barriers, health system barriers and the provision of support from family and friends. Dominant personal attitudes included valuing independence, strength and privacy. Farm related barriers included the 'farm comes first' and the fact that 'farm work is never done'. Health system barriers included issues relating to availability of choice and access, professionals (lack of) understanding of farm life, and time and financial costs of accessing care. Provision of support from family and friends involved informal help and advice, including facilitating access to professional support. Multiple attitudinal, structural, and farm-related issues affect farmers' help-seeking. Professionals who understand farm work practices and routines are valued by farmers and this is likely to facilitate access to care. Workforce development programs and community programs that involve farmers' perspectives as consumers and co-designers, using evidence-based strategies, may assist in strengthening these relationships.

Combining Farmers' Preferences With Evidence-Based Strategies to Prevent and Lower Farmers' Distress: Co-design and Acceptability Testing of ifarmwell.

BACKGROUND: Farming is physically and psychologically hazardous. Farmers face many barriers to help seeking from traditional physical and mental health services; however, improved internet access now provides promising avenues for offering support. OBJECTIVE: This study aims to co-design with farmers the content and functionality of a website that helps them adopt transferable coping strategies and test its acceptability in the broader farming population. METHODS: Research evidence and expert opinions were synthesized to inform key design principles. A total of 18 farmers detailed what they would like from this type of website. Intervention logic and relevant evidence-based strategies were mapped. Website content was drafted and reviewed by 2 independent mental health professionals. A total of 9 farmers provided detailed qualitative feedback on the face validity of the draft content. Subsequently, 9 farmers provided feedback on the website prototype. Following amendments and internal prototype testing and optimization, prototype usability (ie, completion rate) was examined with 157 registered website users who were (105/157, 66.9%) female, aged 21-73 years; 95.5% (149/156) residing in inner regional to very remote Australia, and 68.2% (107/157) "sheep, cattle and/or grain farmers." Acceptability was examined with a subset of 114 users who rated at least module 1. Interviews with 108 farmers who did not complete all 5 modules helped determine why, and detailed interviews were conducted with 18 purposively sampled users. Updates were then made according to adaptive trial design methodology. RESULTS: This systematic co-design process resulted in a web-based resource based on acceptance and commitment therapy and designed to overcome barriers to engagement with traditional mental health and well-being strategies-ifarmwell. It was considered an accessible and confidential source of practical and relevant farmer-focused self-help strategies. These strategies were delivered via 5 interactive modules that include written, drawn, and audio- and video-based psychoeducation and exercises, as well as farming-related jokes, metaphors, examples, and imagery. Module 1 included distress screening and information on how to speak to general practitioners about mental health-related concerns (including a personalized conversation script). Modules were completed fortnightly. SMS text messages offered personalized support and reminders. Qualitative interviews and star ratings demonstrated high module acceptability (average 4.06/5 rating) and suggested that additional reminders, higher quality audio recordings, and shorter modules would be useful. Approximately 37.1% (52/140) of users who started module 1 completed all modules, with too busy or not got to it yet being the main reason for non-completion, and previous module acceptability not predicting subsequent module completion. CONCLUSIONS: Sequential integration of research evidence, expert knowledge, and farmers' preferences in the co-design process allowed for the development of a self-help intervention that focused on important intervention targets and was acceptable to this difficult-to-engage group. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12617000506392; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372526.

Sociodemographic Predictors of Attitudes to Support Seeking From a Medical Doctor or Other Health Provider Among Rural Australians.

BACKGROUND: Rural Australians experience higher prevalence of several chronic diseases than metropolitan Australians and are less likely to access supportive health services. This study explored associations of sociodemographic factors and barriers to support seeking for health in a sample of rural South Australians. METHODS: Participants (n = 610) from three rural regions participated in a computer-assisted telephone interview (CATI), based on the Barriers to Help Seeking Scale. Each participant reported on barriers in one of three health contexts: 'general' physical health, skin cancer, and mental health. Sociodemographic factors included gender, age, highest education, region of residence, and presence of chronic conditions. Chi-squared Automatic Interaction Detection (CHAID) determined independent associations of sociodemographic factors and barrier categories (high, medium and low importance). RESULTS: Privacy was a high-importance barrier in the mental health context, particularly among participants of age < 63 years. The tendency to minimise and normalise health issues was also a high-importance barrier in the mental health context. In the physical health context, those with a chronic condition were more likely to perceive normalisation as a barrier than those without a chronic condition. Need for control and self-reliance was a high-importance barrier in the mental health context and a low-importance barrier in the skin cancer context, particularly among participants < 63 years. Structural factors and distrust of providers were high-importance barriers among those who did not complete secondary education, regardless of context. CONCLUSION: This study highlights the importance of a nuanced approach to promoting help-seeking in rural Australians, with message content and delivery tailored to specific health conditions and demographic circumstances.

Efficacy of theory-informed workplace physical activity interventions: a systematic literature review with meta-analyses.

This review aimed to assess the efficacy of workplace physical activity interventions; compare the efficacy of those that were and were not informed by behaviour change theory, and outline the effectiveness of different intervention components. A search was undertaken in Medline, Embase, PsycINFO, Ovid Emcare (previously CINAHL) and SportDiscus. Randomised, non-randomised and cluster-controlled trials with objectively measured physical activity and/or measured or predicted maximal oxygen uptake (VO2max) as outcomes were included in the review (83 papers from 79 trials). Random-effects meta-analyses of mean differences were undertaken. Workplace physical activity programmes demonstrated positive overall intervention effects for daily step counts (814.01 steps/day; CI: 446.36, 1181.67; p < 0.01; i2 = 88%) and measured VO2max (2.53 ml kg-1 min-1; CI: 1.69, 3.36; p < 0.01; i2 = 0%) with no sub-group differences between theory- and non-theory informed interventions. Significant sub-group differences were present for predicted VO2max (p < 0.01), with a positive intervention effect for non-theory informed studies (2.11 ml.kg-1 min-1; CI: 1.20, 3.02; p < 0.01; i2 = 78%) but not theory-informed studies (-0.63 ml kg-1 min-1; CI: -1.55, 0.30; p = 0.18; i2 = 0%). Longer-term follow-ups ranged from 24 weeks to 13 years, with significant positive effects for measured VO2max (2.84 ml kg-1 min-1; CI: 1.41, 4.27; p < 0.01; i2 = 0%). Effective intervention components included the combination of self-monitoring with a goal, and exercise sessions onsite or nearby. The findings of this review were limited by the number and quality of theory-informed studies presenting some outcomes, and confounding issues in complex interventions. Future researchers should consider rigorous testing of outcomes of theory-informed workplace physical activity interventions and incorporate longer follow-ups.

Exploring the social conditions of physical activity participation amongst rural South Australian women: A qualitative study.

ISSUE ADDRESSED: Australian women are less likely to participate in recommended levels of weekly physical activity compared with men. Physical activity participation rates decrease with geographical remoteness. Research suggests that a lack of social support mechanisms within the home environment may act as a barrier for rural women to engage in physical activity, along with discomfort experienced within exercise environments. The purpose of this study was to explore the social conditions that facilitate or inhibit physical activity participation amongst women from two rural South Australian communities. METHODS: A qualitative descriptive approach underpinned by a phenomenological methodological orientation was applied. Participants were recruited using a purposive sampling strategy before semi-structured interviews (N = 16) were conducted and prepared for thematic analysis. RESULTS: Four inter-related themes were identified: support from others, time, expectations and available opportunities. Further contextual analysis revealed interwoven notions of physical activity spaces, time and social context within the themes. CONCLUSIONS: Multiple types of regulators interact to shape the motivational pattern of an individual. The themes identified align with self-determination, transactional and structuration theory, suggesting a need to consider human behaviour both pragmatically and conceptually. SO WHAT?: Results provide insight into social barriers and facilitators for physical activity participation and concomitantly provide the initial development of a framework for local strategic planning of health-promoting activities, and individual reflection to increase physical activity participation amongst rural women.

Barriers and enablers to implementing mental well-being programs through Australian rural football clubs-A qualitative descriptive study.

ISSUE ADDRESSED: Suicide rates in rural Australia are almost twice as high as those in urban areas. In rural communities, football clubs are often the 'hub' of the community and are being explored as an avenue to deliver mental health and well-being promotion. The aim of this study was to explore barriers and enablers for programs promoting mental health and well-being through rural Australian football clubs. METHOD: This qualitative descriptive study included 12 individuals of 10 rural clubs affiliated with the South Australian National Football League. Recruitment occurred via emails to club secretaries/presidents. Semi-structured telephone interviews explored mental health and well-being issues experienced in clubs, previous involvement with mental well-being programs and potential barriers/enablers for future programs. Interviews were transcribed verbatim and analysed thematically. RESULTS: Thematic analysis identified three themes encompassing barriers and enablers: (1) more than a football club, (2) attitudes towards mental health and (3) what is needed to implement a program. The third theme had subthemes of resources, importance of timing, mental health initiatives and components of a program. CONCLUSION: Key barriers included difficulty getting people involved due to individual attitudes towards mental health, and not having the finances/resources to implement a program. Major enablers included the important role the football club serves in the community, the inclusion of speakers with credibility and making the program engaging. SO WHAT?: This study identifies key factors which may impact on community engagement and program effectiveness for mental health and well-being programs delivered via rural football clubs.

Feasibility and Process Evaluation of a Need-Supportive Physical Activity Program in Aged Care Workers: The Activity for Well-Being Project.

The need to undertake pilot testing and evaluation of novel health promotion programs has become increasingly apparent for the purpose of understanding the true effects of complex interventions and for testing and refining behavioral theories that these interventions are informed by. A mixed-methods process evaluation and feasibility study was undertaken for a need-supportive physical activity program that was piloted in a single-group pre-post study. The piloted program was designed to support participant needs of autonomy, competence, and relatedness through evidence-based and theory-informed behavior change strategies including a motivational interviewing style appointment, education on self-management tools (i.e., pedometers, goal setting, action and coping planning, a customized website for goal setting and self-monitoring), and self-determined methods of regulating physical activity intensity [affect, rating of perceived exertion (RPE), and self-pacing]. The program aimed to positively impact physical activity behavior, psychological well-being, and associated motivational processes. Reach, adoption, fidelity, context, change and performance objectives, and feasibility of the program were evaluated using information from survey respondents from the target population (n = 118) and implementing staff (n = 6); questionnaires from pilot study participants (n = 21); and individual semi-structured interviews with a combination of pilot study participants, non-participants, and implementing staff (n = 19). Process evaluation of the Activity for Well-Being program found that the reach of the program was moderate but adoption was low. The use of self-management tools and self-determined methods of regulating physical activity intensity appeared to be feasible. The website had mixed responses and low engagement. The element of having a support person elicited a strong positive response in the program participant interviews. Involving local implementing staff more directly into the delivery of the intervention could have potentially improved reach, adoption, and feasibility of the program.

Test-retest reliability of a self-reported physical activity environment instrument for use in rural settings.

OBJECTIVE: Little is known about how the physical environment impacts physical activity behaviour among rural populations, who are typically less active and at higher risk of chronic disease than urban dwellers. The lack of individual-level instruments to assess the physical environment in rural areas limits advancement of this field. Among rural adults, this study aimed to evaluate (a) the test-retest reliability of a self-reported questionnaire of individual-level perceptions of the physical activity environment, and (b) the stability of a self-reported physical activity questionnaire. DESIGN: Cross-sectional questionnaire repeated twice, 2 weeks apart. The questionnaire included 94 items relating to the perceived physical environment (representing nine summary scores), demographic characteristics and physical activity. SETTING: Rural Australia. PARTICIPANTS: Rurally residing adults (≥18 years) across three Australian states. MAIN OUTCOME MEASURES: Test-retest reliability evaluated by weighted Kappa statistics (individual items) and intra-class correlations (summary scores). RESULTS: A total of 292 participants (20% men) completed both questionnaires, on average 22 days apart. Test-retest reliability of individual items ranged from weighted Kappa 0.37-0.85 (median: 0.59). Internal reliability for five summary scores was good to excellent (Cronbach's alpha: 0.81-0.97). Test-retest reliability was good to excellent for six summary scores (intra-class correlations: 0.67-0.77). CONCLUSIONS: The findings indicated good to excellent test-retest reliability for most items, particularly "fixed" constructs for this new questionnaire measuring the perceived physical environment in rural populations. This study represents an important step towards improving measurement of physical activity environments in rural populations, potentially leading to better tailored interventions to promote active and healthy living in rural areas.

Differences in the health, mental health and health-promoting behaviours of rural versus urban cancer survivors in Australia.

PURPOSE: People affected by cancer who live in rural Australia experience inferior survival compared to their urban counterparts. This study determines whether self-reported physical and mental health, as well as health-promoting behaviours, also differ between rural and urban Australian adults with a history of cancer. METHODS: Weighted, representative population data were collected via the South Australian Monitoring and Surveillance System between 1 January 2010 and 1 June 2015. Data for participants with a history of cancer (n = 4295) were analysed with adjustment for survey year, gender, age group, education, income, family structure, work status, country of birth and area-level relative socioeconomic disadvantage (SEIFA). RESULTS: Cancer risk factors and co-morbid physical and mental health issues were prevalent among cancer survivors regardless of residential location. In unadjusted analyses, rural survivors were more likely than urban survivors to be obese and be physically inactive. They were equally likely to experience other co-morbidities (diabetes, chronic obstructive pulmonary disease, cardiovascular disease, arthritis or osteoporosis). With adjustment for SEIFA, rural/urban differences in obesity and physical activity disappeared. Rural survivors were more likely to have trust in their communities, less likely to report high/very high distress, but equally likely to report a mental health condition, both with and without adjustment for SEIFA. CONCLUSIONS: There is a need for deeper understanding of the impact of relative socioeconomic disadvantage on health (particularly physical activity and obesity) in rural settings and the development of accessible and culturally appropriate interventions to address rural cancer survivors' specific needs and risk factors.

Predicting Engagement With Online Walking Promotion Among Metropolitan and Rural Cancer Survivors.

BACKGROUND: Physical activity has numerous associated benefits for cancer survivors. Compared with their urban counterparts, rural Australians experience a health disadvantage, including poorer survival rate after diagnosis of cancer. OBJECTIVE: The aims of this study were to test the effectiveness of an online 12-week walking intervention designed for cancer survivors and explore region-specific psychological predictors of behavior change. METHODS: This was a quasi-randomized controlled trial of an online resource designed according to Social Cognitive Theory and Self-determination Theory, based on individualized goal setting. Measures of habitual walking, motivation, and self-efficacy were taken at baseline, postintervention, and 3-month follow-up in an intervention group (n = 46) and active control group (n = 45). The control group was provided a pedometer but did not have access to the online program. RESULTS: An increase in steps/day at 12 weeks was observed in both groups, with a larger increase in the intervention group; these increases were not sustained at the 3-month follow-up. Psychological predictors of maintained change in steps per day (motivation, barrier self-efficacy, and relapse self-efficacy) did not differ between metropolitan and rural participants. Changes in steps per day among intervention participants were predicted by changes in relapse self-efficacy and barrier self-efficacy. CONCLUSIONS: The intervention was successful in increasing physical activity postintervention; however, changes were not maintained at follow-up. There were no region-specific predictors of engagement in the intervention. IMPLICATIONS FOR PRACTICE: Nurses are seamlessly positioned to promote health interventions like walking. Nurses should reframe physical activity with patients so that relapse is seen as common and possibly inevitable when adopting a regular physical activity habit.

Changes in Physical Activity Behaviour and Psychosocial Correlates Unique to the Transition from Primary to Secondary Schooling in Adolescent Females: A Longitudinal Cohort Study.

Few studies have investigated physical activity changes over the transition from primary to secondary school. This study assessed change in physical activity and the psychosocial correlates across 12 months in two cohorts of adolescent girls, who were either in primary school in year 1, moving to secondary school in year 2 (Transition cohort) or an older cohort (Secondary cohort) who remained in early secondary school. Female adolescents (n = 191; 38% response rate) in South Australia self-reported physical activity and psychosocial correlates of physical activity. Changes between baseline and 12-month follow-up were assessed using paired t-tests. Multiple regression modelling identified psychosocial predictors of physical activity change. Physical activity declined in the transition but not the secondary cohort. The decline was most pronounced during school break times. Independent predictors of physical activity change were: change in enjoyment in the transition cohort; and changes in enjoyment, perceived outcomes, and friend encouragement in the secondary cohort. Transitioning from primary to secondary school is a critical period during which physical activity typically declines, particularly among females. Effective physical activity promotion in this vulnerable group will depend on a deeper understanding of the sociocultural, curricular and environmental influences on physical activity that are unique to each school context.

Healthy for Life Pilot Study: A Multicomponent School and Home Based Physical Activity Intervention for Disadvantaged Children.

The study aimed to develop and evaluate a multicomponent school and home based physical activity (PA) intervention in children in grades 3-7 (aged 8-13 years) and determine the psychological variables that influence PA; 10 × 1 h school-based training sessions, a home-based activity program and 4 × 1 h lifestyle workshops for parents. PA was assessed at an intervention and nearby control school using accelerometers and self-report at 3-time points: baseline, post intervention and 10-week follow-up. Self-efficacy, self-management strategies, enjoyment, perceived barriers to PA, outcome-expectancy and social support were evaluated. The study showed 73% of the children with complete data sets at the intervention school (n = 27) did not increase device measured moderate to vigorous PA (MVPA) in the after-school period (3 p.m. to 6 p.m.) or over the whole day or during school break time immediately following the intervention or at follow-up, as compared to 70% of children with complete data sets at the control school (n = 35; p > 0.05 for all). Overall, 59% of boys attained more than double the recommended 120 min of MVPA each day compared to 42% of girls (p = 0.013). At the baseline, children's self-reported PA in the intervention school positively correlated with: outcome expectancy (R = 0.240, p = 0.015), enjoyment (R = 0.339, p < 0.001), self-efficacy (R = 0.399, p < 0.001), self-management (R = 0.617, p < 0.001), social support at home (R = 0.406, p < 0.001), and social support at school (R = 0.407, p < 0.001). Similar relationships were observed after the intervention and at follow-up. Focus groups with the children, parents and interviews with teachers identified areas for improvement of the intervention. In conclusion, while the multifaceted approach to improve PA was ineffective over the time span of the study, important predictors of PA in this sample of disadvantaged children were identified.

Physical Activity Trends in Separate Contexts Among South Australian Older Children (10-12 Y) and Early Adolescents (13-15 Y) From 1985 to 2013.

PURPOSE: To assess trends in South Australian children's physical activity between 1985 and 2003 and 2013 in the contexts of school active transport, organized sport, physical education, and school break times. METHOD: The 1985 Australian Health and Fitness Survey was administered in South Australian schools in 2004 (8 schools) and 2013 (9 schools) and was demographically matched to the 10 South Australian schools in the Australian Health and Fitness Survey. Ordinal logistic modeling was used to identify trends, stratified by older children (10-12 y) and early adolescent (13-15 y) subgroups. RESULTS: School active transport generally declined for males and older female children (19 and 20 percentage points per decade, respectively), whereas early adolescent females increased in walking to school (11 percentage points per decade). School sport participation declined for early adolescents, and club sport participation declined in early adolescent females (23 percentage points per decade). Moderate to vigorous physical activity participation during school break times (particularly lunchtime) generally declined (16-26 percentage points per decade). Observed changes in most contexts occurred between 2004 and 2013. CONCLUSION: There was evidence of context-specific declines in children's physical activity participation over this time span. Early adolescent females were the subgroup of most concern, experiencing declines in most contexts.