Breast cancer survivors' preferences for social support features in technology-supported physical activity interventions: findings from a mixed methods evaluation.

Incorporating peer and professional social support features into remotely delivered, technology-supported physical activity interventions may increase their effectiveness. However, very little is known about survivors' preferences for potential social features. This study explored breast cancer survivors' preferences for both traditional (e.g., coaching calls and peer support) and innovative (i.e., message boards and competitions) social support features within remotely delivered, technology-supported physical activity interventions. Survivors [N = 96; Mage = 55.8 (SD = 10.2)] self-reported demographic and disease characteristics and physical activity. A subset (n = 28) completed semistructured phone interviews. Transcribed interviews were evaluated using a thematic content analysis approach and consensus review. Following interviews, the full sample self-reported preferences for social features for remotely delivered physical activity interventions via online questionnaires. Questionnaire data were analyzed using descriptive statistics. Four themes emerged from interview data: (a) technology increases social connectedness; (b) interest in professional involvement/support; (c) connecting with similar survivors; and (d) apprehension regarding competitive social features. Quantitative data indicated that most survivors were interested in social features including a coach (77.1 per cent), team (66.7 per cent), and exercise buddy (57.3 per cent). Survivors endorsed sharing their activity data with their team (80.0 per cent) and buddy (76.6 per cent), but opinions were mixed regarding a progress board ranking their activity in relation to other participants' progress. Survivors were interested in using a message board to share strategies to increase activity (74.5 per cent) and motivational comments (73.4 per cent). Social features are of overall interest to breast cancer survivors, yet preferences for specific social support features varied. Engaging survivors in developing and implementing remotely delivered, technology-supported social features may enhance their effectiveness.

A qualitative exploration of social and environmental factors affecting diet and activity in knee replacement patients.

AIMS AND OBJECTIVES: To examine perceived social and environmental barriers and facilitators for healthy eating and activity before and after knee replacement. BACKGROUND: Many patients undergoing knee replacement surgery are overweight or obese. While obesity treatment guidelines encourage diet and activity modifications, gaps exist in understanding social and environmental determinants of these behaviours for knee replacement patients. Identifying these determinants is critical for treatment, as they are likely amplified due to patients' mobility limitations, the nature of surgery and reliance on others during recovery. DESIGN: This qualitative study used semi-structured interviews. METHODS: Twenty patients (M = 64.7 ± 9.8 years, 45% female, 90% Caucasian, body mass index 30.8 ± 5.5 kg/m2 ) who were scheduled for or had recently undergone knee replacement were interviewed. Participants were asked to identify social and environmental factors that made it easier or harder to engage in healthy eating or physical activity. Deidentified transcripts were analysed via constant comparative analysis to identify barriers and facilitators to healthy eating and activity. This paper was written in accordance with COnsolidated criteria for REporting Qualitative research standards. RESULTS: Identified social and environmental healthy eating barriers included availability of unhealthy food and attending social gatherings; facilitators included availability of healthy food, keeping unhealthy options "out of sight," and social support. Weather was the primary activity barrier, while facilitators included access to physical activity opportunities and social support. CONCLUSIONS: Results provide salient factors for consideration by clinicians and behavioural programmes targeting diet, activity, and weight management, and patient variables to consider when tailoring interventions. RELEVANCE TO CLINICAL PRACTICE: Practitioners treating knee replacement patients would be aided by an understanding of patients' perceived social and environmental factors that impede or facilitate surgical progress. Particularly for those directly interacting with patients, like nurses, physiotherapists, or other professionals, support from health professionals appears to be a strong facilitator of adherence to diet and increased activity.

Preferences and motivation for weight loss among knee replacement patients: implications for a patient-centered weight loss intervention.

BACKGROUND: Most knee replacement patients are overweight/obese, yet are commonly excluded from evidence-based weight loss programs due to mobility limitations and barriers faced around the time of surgery. The purpose of this study was to identify knee replacement patient preferences for weight loss programs and qualitatively understand previous motives for weight loss attempts as well as strategies used to facilitate behavior changes. METHODS: Patients who were either scheduled to have knee replacement or had one recently completed within the last 3 months were recruited to participate. Patients completed a brief weight loss program preference questionnaire assessing preferred components of a weight loss program (i.e. self-monitoring, educational topics, program duration). Qualitative interviews were completed to identify motives for and strategies used during past weight loss attempts. All interviews were transcribed, de-identified, and analyzed using constant comparative analysis. RESULTS: Twenty patients (11 pre-operative and 9 post-operative) between 47 and 79 years completed the study (55% male, 90% White, and 85% with a BMI ≥25 kg/m2). Patients reported a preference for a weight loss program that starts before surgery, is at least 6 months in duration, and focuses both on diet and exercise. The majority of patients preferred to have a telephone-based program and wanted to track diet and physical activity on a smartphone application. The most common motive for weight loss mentioned by patients related to physical appearance (including how clothing fit), followed by wanting to lose weight to improve knee symptoms or to prevent or delay knee replacement. Strategies that patients identified as helpful during weight loss attempts included joining a formal weight loss program, watching portion sizes, and self-monitoring their dietary intake, physical activity, or weight. CONCLUSIONS: This study provides a preliminary examination into the motives for weight loss, strategies utilized during past weight loss attempts, and preferences for future weight loss programs as described by knee replacement patients. These results will help guide the development and adaptation of future patient-centered weight loss programs as well as help clinicians recommend targeted weight programs based on the specific preferences of the knee replacement population.

Physical activity: a synopsis and comment on "community-wide interventions for increasing physical activity".

In this synopsis, we summarize and comment on Baker and colleagues' Cochrane review of studies on the population-level impact of community-wide physical activity (PA) interventions. Insufficient PA remains a major public health problem. Community-wide interventions offer an opportunity to extend reach by increasing the proportion of the population experiencing the intervention. A previous Cochrane review of community-wide PA interventions concluded that evidence for effectiveness was mixed. Hence, Baker and colleagues incorporated new data about community-based PA interventions. This Cochrane review concluded there is an overall lack of evidence that community-wide interventions improve PA outcomes at the population level. Recommendations are that future research should use high quality research design, more explicitly test ways to increase reach, and utilize objective measurements of PA to increase validity. We suggest that future research should first optimize the intervention by systematically evaluating treatment components and selecting a maximally efficient and effective treatment package.

Acceptability of smartphone technology to interrupt sedentary time in adults with diabetes.

Breaking up sitting time with light- or moderate-intensity physical activity may help to alleviate some negative health effects of sedentary behavior, but few studies have examined ways to effectively intervene. This feasibility study examined the acceptability of a new technology (NEAT!) developed to interrupt prolonged bouts (≥20 min) of sedentary time among adults with type 2 diabetes. Eight of nine participants completed a 1-month intervention and agreed that NEAT! made them more conscious of sitting time. Most participants (87.5 %) expressed a desire to use NEAT! in the future. Sedentary time decreased by 8.1 ± 4.5 %, and light physical activity increased by 7.9 ± 5.5 % over the 1-month period. The results suggest that NEAT! is an acceptable technology to intervene on sedentary time among adults with type 2 diabetes. Future studies are needed to examine the use of the technology among larger samples and determine its effects on glucose and insulin levels.

Optimization of remotely delivered intensive lifestyle treatment for obesity using the Multiphase Optimization Strategy: Opt-IN study protocol.

BACKGROUND: Obesity-attributable medical expenditures remain high, and interventions that are both effective and cost-effective have not been adequately developed. The Opt-IN study is a theory-guided trial using the Multiphase Optimization Strategy (MOST) to develop an optimized, scalable version of a technology-supported weight loss intervention. OBJECTIVE: Opt-IN aims to identify which of 5 treatment components or component levels contribute most meaningfully and cost-efficiently to the improvement of weight loss over a 6 month period. STUDY DESIGN: Five hundred and sixty obese adults (BMI 30-40 kg/m(2)) between 18 and 60 years old will be randomized to one of 16 conditions in a fractional factorial design involving five intervention components: treatment intensity (12 vs. 24 coaching calls), reports sent to primary care physician (No vs. Yes), text messaging (No vs. Yes), meal replacement recommendations (No vs. Yes), and training of a participant's self-selected support buddy (No vs. Yes). During the 6-month intervention, participants will monitor weight, diet, and physical activity on the Opt-IN smartphone application downloaded to their personal phone. Weight will be assessed at baseline, 3, and 6 months. SIGNIFICANCE: The Opt-IN trial is the first study to use the MOST framework to develop a weight loss treatment that will be optimized to yield the best weight loss outcome attainable for $500 or less.

e-Health intervention development: a synopsis and comment on "What Design Features are Used in Effective e-Health Interventions? A Review Using Techniques From Critical Interpretive Synthesis".

In this synopsis and commentary on the Morrison and colleagues article published in Telemedicine and e-Health (18:2, 137-144, 2012), we provide a brief review of effective design features of e-Health interventions as well as a discussion on future directions. The Internet is being used more frequently to deliver health behavior interventions; however, it is unclear which design features contribute to intervention outcomes. Morrison and colleagues conducted a review using critical interpretive synthesis techniques to identify design features that mediate the effects of e-Health intervention outcomes. A total of four design features were identified (social context and support, contacts with intervention, tailoring, and self-management) that may mediate the effect of the intervention on outcomes. This review provides a preliminary conceptual framework to guide future evaluations of the effects of e-Health design features on intervention outcomes. Future research should target optimizing e-Health interventions to determine which design features should be included as well as how they contribute to outcomes.