Piloting the addition of contingency management to best practice counselling as an adjunct treatment for rural and remote disordered gamblers: study protocol.

INTRODUCTION: Problematic gambling is a significant Canadian public health concern that causes harm to the gambler, their families, and society. However, a significant minority of gambling treatment seekers drop out prior to the issue being resolved; those with higher impulsivity scores have the highest drop-out rates. Consequently, retention is a major concern for treatment providers. The aim of this study is to investigate the efficacy of internet-delivered cognitive behavioural therapy (CBT) and internet-delivered CBT and contingency management (CM+) as treatments for gambling disorder in rural Albertan populations. Contingency management (CM) is a successful treatment approach for substance dependence that uses small incentives to reinforce abstinence. This approach may be suitable for the treatment of gambling disorder. Furthermore, internet-delivered CM may hold particular promise in rural contexts, as these communities typically struggle to access traditional clinic-based counselling opportunities. METHODS AND ANALYSIS: 54 adults with gambling disorder will be randomised into one of two conditions: CM and CBT (CM+) or CBT alone (CBT). Gambling will be assessed at intake, every treatment session, post-treatment, and follow-up. The primary outcome measures are treatment attendance, gambling abstinence, gambling, gambling symptomatology, and gambling urge. In addition, qualitative interviews assessing study experiences will be conducted with the supervising counsellor, graduate student counsellors, study affiliates, and a subset of treatment seekers. This is the first study to use CM as a treatment for gambling disorder in rural and remote populations. ETHICS AND DISSEMINATION: This study was approved by the University of Lethbridge's Human Subject Research Committee (#2016-080). The investigators plan to publish the results from this study in academic peer-reviewed journals. Summary information will be provided to the funder. TRIAL REGISTRATION NUMBER: NCT02953899; Pre-results.

Sources of moral distress for nursing staff providing care to residents with dementia.

The World Health Organization estimates the number of people living with dementia at approximately 35.6 million; they project a doubling of this number by 2030 and tripling by 2050. Although the majority of people living with a dementia live in the community, residential facility care by nursing care providers is a significant component of the dementia journey in most countries. Research has also shown that caring for persons with dementia can be emotionally, physically, and ethically challenging, and that turnover in nursing staff in residential care settings tends to be high. Moral distress has been explored in a variety of settings where nurses provide acute or intensive care. The concept, however, has not previously been explored in residential facility care settings, particularly as related to the care of persons with dementia. In this paper, we explore moral distress in these settings, using Nathaniel's definition of moral distress: the pain or anguish affecting the mind, body, or relationships in response to a situation in which the person is aware of a moral problem, acknowledges moral responsibility, makes a moral judgment about the correct action and yet, as a result of real or perceived constraints, cannot do what is thought to be right. We report findings from a qualitative study of moral distress in a single health region in a Canadian province. Our aim in this paper is to share findings that elucidate the sources of moral distress experienced by nursing care providers in the residential care of people living with dementia.

Physical Activity Perceptions and Influences among Older Adults in Rural Nova Scotia.

This study identified factors that influenced physical activity (PA) participation among older adults from rural settings in Nova Scotia Canada and explored how the rural context may influence PA participation and promotion. Data were collected via individual semistructured interviews with 20 older adults (Mage = 77.5 years) from rural areas of Cape Breton and subjected to thematic analysis procedures (Braun & Clarke, 2006). Four themes representing factors that influence the prioritization of PA were identified: (1) historical context of activity, work, and productivity; (2) already busy with day-to-day activities; (3) being/staying on the go; and (4) cautionary approach. These findings suggest that PA promotion should be contextually salient, and highlight the need for a shared understanding between rural older adults and PA promoters regarding what constitutes being "physically active". Effective promotion of PA among rural older adults may require a shift away from contemporary methods of PA promotion.

A Qualitative Exploration of Exercise Among Pulmonary Rehabilitation Participants: Insight From Multiple Sources of Social Influence.

BACKGROUND: Exercise training within the pulmonary rehabilitation (PR) context is considered the most effective strategy to reduce COPD symptoms. However, participation in PR and continued exercise training following program completion are low. Previous research examined factors related to attendance and adherence, but the knowledge base to date has been limited to quantitative findings that focus solely on participants diagnosed with COPD. In addition to quantitative research, exploring multiple perspectives (eg, PR participants, significant others, staff, and stakeholders) using qualitative research methods opens a window of additional understanding. The goal of this study was to obtain multiple perspectives on PR to gain insight into factors that affect exercise participation among individuals diagnosed with COPD. METHODS: A total of 26 participants were interviewed via telephone, including 8 individuals diagnosed with COPD (4 men and 4 women, mean age of 67 [range of 58-77] y), 4 family members, 11 PR staff, and 3 community stakeholders. RESULTS: Analysis revealed 3 themes: task self-efficacy for exercise, provision of support and encouragement, and perceptions of gender differences. Despite initial concerns, individuals diagnosed with COPD reported becoming more confident during PR and emphasized the importance of being supported by staff. PR staff perceived that men tended to approach exercise in a more eager and aggressive manner compared with women, who were more cautious and hesitant. CONCLUSIONS: In addition to enhancing task self-efficacy, findings suggest that exercise participation and adherence within the PR environment may be improved by adopting a gender-tailored approach.

A qualitative examination of the impact of microgrants to promote physical activity among adolescents.

BACKGROUND: Microgrants are a mechanism for providing funding to community organizations or groups to support health initiatives. Little research to date has examined the use of microgrants in promoting physical activity (PA), and no studies have explored how microgrants may support PA promotion among adolescents. The purpose of this study was to explore the role of microgrants in enhancing PA opportunities for Canadian adolescents. METHODS: Employing a case study approach, nine community organizations from across Canada were selected as cases providing sports and physical activities with the support of microgrant funding. Researchers visited each organization and conducted semi-structured interviews with 40 program participants (12-25 years of age, M = 16.3, SD = 2.6) and 17 adult organizers/instructors (23-57 years of age, M = 37.4, SD = 10.0). Interview transcripts were inductively and deductively coded to identify concepts and create a hierarchy of themes. RESULTS: Analysis produced themes regarding participants' perceptions of the Funding, Running Programs and Events, the Impact of Program (for the Organization, Teen Participants, and the Community). Opportunities for PA programming would not have been possible without the microgrant funding. Microgrant funding was valuable in promoting PA for adolescents, and they afforded opportunities for adolescents to engage in new and/or nontraditional activities. In addition to promoting PA, the microgrants had benefits for participants and the community organizations including improved organizational capacity. CONCLUSIONS: Microgrants appear to be an effective mechanism for enhancing community capacity to provide PA opportunities for Canadian adolescents by helping to reduce financial barriers and empowering adolescents to take an active role in identifying and hosting new and creative PA events within their communities.

Strength of messaging in changing attitudes in a workplace wellness program.

The potential benefits of workplace wellness programs are limited by low participation rates of employees, which could be due in part to ineffective persuasion by program providers. This study uses the Elaboration Likelihood Model, as a guiding theory in mixed methods research, to investigate feedback messages about physical activity delivered in a workplace wellness program. This study uses questionnaire and interview data from 32 employees to determine if personally relevant health messages are associated with either positive or negative responses to the messages and subsequent attitude change. General feedback is more appreciated by those who are less fit but are not effective in changing attitudes toward physical activity. Individually targeted messages result in a significant positive attitude change for participants responding positively to the messages. This suggests that individualized health promotion messages provide a stronger argument for individuals, thus increasing the likelihood of attitude change.

A qualitative examination of perceptions of physical activity guidelines and preferences for format.

A descriptive exploratory study was conducted to gain an understanding of public perceptions of physical activity guidelines and to discover what formats appeal to participants. Canada's Physical Activity Guide (CPAG) was used as an example of such guidelines. Data were collected from 22 participants in five focus groups (composed of female undergraduate students, female office workers, male office workers, participants in a Type II diabetes rehabilitation program, and participants in a cardiovascular rehabilitation program). Cross-case qualitative analyses were conducted. Six themes emerged under the general categories of familiarity and preferences for PA promotional materials. In terms of familiarity, participants lacked awareness of CPAG and criticized its format. In terms of preferences, participants encouraged the use of stylistically similar messaging to those used by commercial advertisers, wanted personal stories, Internet-based media, and the use of celebrities' success stories. There was little awareness of CPAG and the current format was unappealing.

A mixed methods evaluation of televised health promotion advertisements targeted at older adults.

The purpose of this research was to evaluate television advertisements targeted at 55-70-year olds that promoted physical activity and fruit and vegetable consumption. Awareness of the campaign, perceived credibility of the source, intentions to visit a promoted website, and intentions to perform the healthy behaviors were evaluated using mixed methods research. Results from a population level survey (n=1600) showed low unprompted and prompted awareness of the campaign and no differences in intentions or behaviors among those who were aware of the campaign. Unprompted recall resulted in a very wide range of responses including the citation of many commercial advertisers. Qualitative themes that emerged from the focus groups included neutral, positive, and negative comments about the advertisements, source credibility, website considerations specific to seniors, and suggestions about appropriate advertising for older adults. This research showed that the increased attention paid to the advertisements was due in a large part to negative reactions to the character used in the advertisements. Another important finding was the government was not considered to be a credible source of health information. Finally, health promoters should be cautious about websites as the primary source of information, particularly for older adults.

A case study of physical activity among older adults in rural Newfoundland, Canada.

The purpose of this study was to assess rural older adults' perceptions of leisure-time physical activity and examine these perceptions from a historical perspective. Semistructured interviews were conducted with 10 inhabitants (mean age 82 years) of Fogo Island, Newfoundland and Labrador, Canada. Interviews were transcribed verbatim and subjected to inductive analysis. Member-checking interviews were conducted with 5 participants. Findings indicated that beginning in childhood, participants were socialized into a subculture of work activity. As a result of these historical and social forces, leisure-time physical activity did not form part of the participants' lives after retirement. Strategies for successful aging involved keeping busy, but this "busyness" did not include leisure-time physical activity. Results demonstrated the importance of developing a broader understanding of how past and present-day contexts can influence participation in leisure-time physical activity.

Who plays bingo in later life? The sedentary lifestyles of 'little old ladies'.

UNLABELLED: Bingo is a popular past time with less than 20% of seniors, but the prevailing stereotype of bingo players describes elderly women with nothing better to do, smoking heavily while gambling away their limited income day after day. Little research has actually explored the lifestyles of seniors who frequent the bingo halls or identified social factors explaining who plays and why. PURPOSE: The purpose of this study was to clarify the social context and lifestyle characteristics of seniors who regularly invest money on bingo. DESIGN AND METHODS: A 30-min telephone survey was conducted randomly with quotas for gender and urban/rural location with 400 Albertans aged 65+. Next, a strategic sample of 44 bingo players was added to the population sample to strengthen the dependent variable for regression analyses. Multiple regression analyses were used to define key characteristics of bingo players among 10 social or contextual factors and 5 lifestyle variables. RESULTS: Being female, more elderly, living in rental accommodation, receiving federal income supplements and reporting more health problems were significant predictors of more money typically spent on bingo (18% variance explained), and these findings lend support to the "little old lady" stereotype. However, sedentary living, rather than smoking, was the only significant and predictive lifestyle pattern, suggesting that the lifestyle vices projected about bingo players are not entirely accurate. CONCLUSIONS: Elderly women of marginal means do dominate the game of bingo in terms of money spent, but their gaming lifestyle apparently has less to do with habits of smoking, eating poorly, drinking alcohol, or having excessive leisure time, and more to do with sedentary recreation that is socially delimited by their gender, age, income and health.