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Development of a Game-Based Intervention to Promote HPV Vaccination Among Adolescents: A Qualitative Analysis

Description

Purpose: This qualitative research aimed to create a developmentally and gender-appropriate game-based intervention to promote Human Papillomavirus (HPV) vaccination in adolescents. <br/>Background: Ranking as the most common sexually transmitted infection, about 80 million Americans are currently infected by HPV, and

Purpose: This qualitative research aimed to create a developmentally and gender-appropriate game-based intervention to promote Human Papillomavirus (HPV) vaccination in adolescents. <br/>Background: Ranking as the most common sexually transmitted infection, about 80 million Americans are currently infected by HPV, and it continues to increase with an estimated 14 million new cases yearly. Certain types of HPV have been significantly associated with cervical, vaginal, and vulvar cancers in women; penile cancers in men; and oropharyngeal and anal cancers in both men and women. Despite HPV vaccination being one of the most effective methods in preventing HPV-associated cancers, vaccination rates remain suboptimal in adolescents. Game-based intervention, a novel medium that is popular with adolescents, has been shown to be effective in promoting health behaviors. <br/>Methods: Sample/Sampling. We used purposeful sampling to recruit eight adolescent-parent dyads (N = 16) which represented both sexes (4 boys, 4 girls) and different racial/ethnic groups (White, Black, Latino, Asian American) in the United States. The inclusion criteria for the dyads were: (1) a child aged 11-14 years and his/her parent, and (2) ability to speak, read, write, and understand English. Procedure. After eligible families consented to their participation, semi-structured interviews (each 60-90 minutes long) were conducted with each adolescent-parent dyad in a quiet and private room. Each dyad received $50 to acknowledge their time and effort. Measure. The interview questions consisted of two parts: (a) those related to game design, functioning, and feasibility of implementation; (b) those related to theoretical constructs of the Health Belief Model (HBM) and the Theory of Planned Behavior (TPB). Data analysis. The interviews were audio-recorded with permission and manually transcribed into textual data. Two researchers confirmed the verbatim transcription. We use pre-developed codes to identify each participant’s responses and organize data and develop themes based on the HBM and TPB constructs. After the analysis was completed, three researchers in the team reviewed the results and discussed the discrepancies until a consensus is reached.<br/>Results: The findings suggested that the most common motivating factors for adolescents’ HPV vaccination were its effectiveness, benefits, convenience, affordable cost, reminders via text, and recommendation by a health care provider. Regarding the content included in the HPV game, participants suggested including information about who and when should receive the vaccine, what is HPV and the vaccination, what are the consequences if infected, the side effects of the vaccine, and where to receive the vaccine. The preferred game design elements were: 15 minutes long, stories about fighting or action, option to choose characters/avatars, motivating factors (i.e., rewards such as allowing users to advance levels and receive coins when correctly answering questions), use of a portable electronic device (e.g., tablet) to deliver the education. Participants were open to multiplayer function which assists in a facilitated conversation about HPV and the HPV vaccine. Overall, the participants concluded enthusiasm for an interactive yet engaging game-based intervention to learn about the HPV vaccine with the goal to increase HPV vaccination in adolescents. <br/>Implications: Tailored educational games have the potential to decrease the stigma of HPV and HPV vaccination, increasing communication between the adolescent, parent, and healthcare provider, as well as increase the overall HPV vaccination rate.

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2021-05

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TEXT2COPE program for parents of overweight or obese preschool-aged children

Description

Children are five times more likely to be overweight at the age of 12 years if they are overweight during the preschool period, and 60% of overweight preschoolers are overweight at the age of 12 years (Matusik & Malecka-Tendera, 2011).

Children are five times more likely to be overweight at the age of 12 years if they are overweight during the preschool period, and 60% of overweight preschoolers are overweight at the age of 12 years (Matusik & Malecka-Tendera, 2011). Primary care interventions are urgently needed to improve healthy lifestyle behaviors in families. Parental influence plays an important factor in the development of healthy behaviors in children. Cognitive behavioral interventions have demonstrated preliminary success in promoting healthy lifestyle behaviors in both adults and children. Mobile technology used to supplement interventions aimed at behavior change offers an outlet to bridge gaps in health disparities and generate innovative evidence. Therefore, the purpose of this research was to establish the feasibility, acceptability, and preliminary effects of a cognitive-behavioral intervention (TEXT2COPE) synergized with mobile technology on the healthy lifestyle behaviors of parents of overweight and obese preschoolers. Primary aims of the proposed pilot study were to (a) examine the feasibility and acceptability of the TEXT2COPE program among parents of overweight or obese preschoolers with mobile phones; (b) evaluate the preliminary effects of the TEXT2COPE program on healthy lifestyle behaviors in families with overweight or obese preschoolers; and (c) evaluate the relationship among the study variables (i.e., cognitive beliefs, perceived difficulty, and healthy lifestyle behaviors). Findings indicate that this program is feasible and acceptable in this population. The intervention improved healthy lifestyle beliefs and behaviors in parents. Further supported are the interconnected relationships between parental beliefs, thoughts, and behaviors.

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2014

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Knowledge in action: effectively teaching healthy behavior knowledge in physical education classes

Description

An intervention study was conducted with elementary physical education teachers and their use of a newly developed series of fitness segments called Knowledge in Action (KIA). This study was designed to enable teachers to teach healthy behavior knowledge (HBK) in

An intervention study was conducted with elementary physical education teachers and their use of a newly developed series of fitness segments called Knowledge in Action (KIA). This study was designed to enable teachers to teach healthy behavior knowledge (HBK) in their classes without sacrificing physical activity levels. This study has two phases. First, the intervention was conducted to determine the effectiveness of the KIA fitness segment intervention. Second, teachers' perceptions of both teaching HBK and the KIA fitness segments were investigated. Ten teacher participants were randomly assigned to the intervention or control group. Intervention teachers participated in professional development, provided with all teaching materials, and YouTube videos that modeled the teaching of the KIA fitness segments. Teacher fidelity was measured through observations. Student physical activity patterns were measured in randomly selected teachers' classes (both intervention and control) to determine potential physical activity pattern differences between groups. Teachers were interviewed from one to three times across the project in order to determine perceptions of teaching HBK and the KIA fitness segments. Researchers used constant comparison method to uncover possible common themes. Student knowledge was assessed pre/post using PE Metrics Standard 3 cognitive test to determine HBK changes. Data analysis included General liner models (GLM) at the student level (gender) and Hierarchical linear models (HLM) at the school level (treatment, school). There was a moderate mean teacher fidelity score (77.9%) found among the intervention teachers. HLM results showed students in the intervention group had a 3.4(20%) greater improvement in HBK scores when compared with their control counterparts (p<0.001). Student activity levels were found to be similar in both groups with 871.33 and 822.22 steps in the intervention and control groups, respectively. Although all of the teachers thought it was important to teach HBK they were not spending time on it during classes at pretest. Three common themes were discovered: (a) Effective Teacher Training of the Segments, (b), Teachers Learned a Novel Strategy, and (c) Teachers Recommended Modifications. In summary, the KIA fitness segments received favorable views and gave teachers a way to teach HBK without reducing physical activity time.

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2013

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Message sources, targeted messages, and physical activity: a social cognitive theory view

Description

This study utilized targeted messages and expert and referent sources in an effort to promote physical activity behavior in college students. College students aged 18-25, excluding collegiate athletes, were randomized into three conditions using their current physical activity level. Two

This study utilized targeted messages and expert and referent sources in an effort to promote physical activity behavior in college students. College students aged 18-25, excluding collegiate athletes, were randomized into three conditions using their current physical activity level. Two of the conditions received targeted messages highlighting three primary components of social cognitive theory - self-efficacy, outcome expectations, and goals - while the third condition received no messages. In addition, the experimental conditions received the messages from either an expert (i.e., a personal trainer) or a referent (i.e., a close friend). In this way, this experiment analyzed whether receiving social cognitive theory messages increased physical activity indicators compared to the control condition, as well as if the message source caused differences in the physical activity indicators. Moreover, participants completed Time 1 and Time 2 measures to determine if receiving messages or not caused changes over a one week time period. Seven physical activity indicators were assessed: self-efficacy, positive outcome expectations, negative outcome expectations, attitudes, response-efficacy, intentions, and physical activity behavior. Results revealed that both the personal trainer and close friend conditions had significantly higher scores than the control condition for intentions at Time 1 and Time 2, as well as physical activity behavior at Time 2. Moreover, the personal trainer condition had significantly higher positive outcome expectations compared to both the friend and control conditions. No other significant differences were found across conditions for Time 1 attitudes, response-efficacy, negative outcome expectations, self-efficacy, and Time 2 attitudes, and self-efficacy. Overall, targeted messages were effective in increasing physical activity intentions and behavior regardless of the message source.

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2012

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Evaluation of Taylor Place Fit's motivational signage and mural painting to determine the influence on stair use

Description

Encouraging stair use may increase physical activity among college students. The overall goals of this study were to quantitatively and qualitatively evaluate a stair use initiative, which included a mural painting contest in a residential hall. The number of

Encouraging stair use may increase physical activity among college students. The overall goals of this study were to quantitatively and qualitatively evaluate a stair use initiative, which included a mural painting contest in a residential hall. The number of individuals exiting the stairs were counted and interview data were obtained regarding the visibility of the signs and murals and whether the signs or murals influenced stair use. Focus groups and interviews were conducted with the community assistants (CAs) and staff members involved with the project to obtain qualitative data on their perceptions and opinions of the mural painting event. It was hypothesized that the average number of individuals per half hour who used the stairs would significantly increase from baseline to post-test. To examine changes over time in individuals exiting the stairs, a quasi-experimental design was used with one baseline measurement and multiple posttests (n=5). Stair use was determined by counting individuals exiting the stairwells. Time differences in exiting stair use were examined with repeated measures analysis of variance (ANOVA). Descriptive statistics and t-tests were used to analyze interview data. Qualitative data were analyzed using a thematic analysis approach. There was a significant time effect on stair use (F=7.512, p =0.000) and a significant interaction between staircase and time (F=7.518, p=0.000). There was no significant interaction of gender over time (F=.037, p=0.997). A repeated measures ANOVA was conducted on each staircase individually and showed that significant time differences were only found in the Southwest staircase. Based on exit interviews (n=28), most students saw the directional signs (61%) and murals (89.3%). However, neither the signs (71.4%) nor the murals (82.1%) were perceived as influential on stair use. Data from the focus groups and interviews revealed that the mural painting contest did not occur as intended, because the contest piece did not take place. In conclusion, solely having residents of a residential hall paint murals in stairwells was insufficient for increasing stair use. A mural painting contest may be a viable approach if properly planned and implemented.

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2011

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Environmental and Behavioral Influences of Physical Activity In Middle School Students

Description

Background: Limited physical activity (PA) is a key factor contributing to obesity and independently protects from diseases in youth and later in life. Students spend most of their time in schools sedentary and have limited opportunities to engage in PA.

Background: Limited physical activity (PA) is a key factor contributing to obesity and independently protects from diseases in youth and later in life. Students spend most of their time in schools sedentary and have limited opportunities to engage in PA. By making changes to the school environment and developing a school culture that actively supports and reinforces PA behavior, Comprehensive School Physical Activity Programs are designed to make PA engagement throughout each school day the accepted social norm. The purpose of this study was to determine the effects of environmental and behavioral modifications to school-level PA participation for girls and boys.

Methods: This study used a hybrid reversal design by alternating baseline phases with two intervention phases that provided increased access and opportunity to PA, and behavioral prompting and reinforcing plus access and opportunity, for all students to engage in PA during lunch. Physical activity and contextual data were collected using a previously validated instrument (System for Observing Play and Leisure Activity in Youth; SOPLAY). Behavioral data were collected using a novel instrument (System for Observing Behavioral Ecology for Youth in Schools; SOBEYS) developed to measure prompting and reinforcement contingencies of PA participation consistent with the Behavioral Ecological Model.

Data Analysis: The number of students engaged in moderate-to-vigorous PA (MVPA) and the proportion of students in MVPA were analyzed using visual analysis of graphic data and general linear statistical models, with environmental and behavioral variables as predictors.

Results: Increases in the number of girls and boys in MVPA were seen visually and statistically during the environmental and the environmental plus behavioral intervention phases compared to baseline. No differences were seen visually or statistically between intervention phases. Intervention effects were larger for boys than girls. The SOBEYS instrument was able to produce valid and reliable data regarding prompting and reinforcement of PA. However, environmental factors appear to have a greater influence on PA than behavioral factors.

Conclusion: Modifying the school environment to increase access and opportunity for PA during lunch can lead to positive changes in MVPA during the school day, with special consideration needed to engage more girls.

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Date Created
2014

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Yoga for HEART (Health Empowerment and Realizing Transformation) intervention to enhance motivation for physical activity in older adults

Description

Cardiovascular disease (CVD) is the leading cause of mortality in the U.S. While physical activity can reduce CVD risk, most adults do not engage in adequate physical activity to maintain or improve health. Older adults are less likely

Cardiovascular disease (CVD) is the leading cause of mortality in the U.S. While physical activity can reduce CVD risk, most adults do not engage in adequate physical activity to maintain or improve health. Older adults are less likely to participate in physical activity and experience a greater burden of CVD compared to younger adults. Despite knowledge of motivators and barriers to physical activity, the challenge to reduce cardiovascular risk in the older adult population remains unmet. Older adults face unique and complex barriers to physical activity, including limited social contextual resources and behavioral change processes. Interventions to enhance wellness motivation have demonstrated potential in promoting health behavior change among older adults.

The purpose of this study was to examine the feasibility of the Yoga for HEART (Health Empowerment and Realizing Transformation) Intervention to increase motivation for physical activity and improve cardiovascular health in older adults. A pilot randomized controlled trial design was used. The Intervention group received Yoga for HEART, a 12-week program to foster motivation for health behavior change. The Control group received a 12-week group yoga program that did not contain theory-based components. The intervention was based on Wellness Motivation Theory, conceptualizing health behavior change as dynamic process of intention formation and goal-directed behavior leading to the development of new and positive health patterns. Critical inputs (i.e., empowering education, motivational support, social network support) were designed to promote social contextual resources and behavioral change processes to increase motivation for physical activity and improve cardiovascular health.

Specific Aims were to: (a) examine intervention acceptability, demand, and fidelity, and (b) evaluate intervention efficacy in promoting physical activity and improving cardiovascular health through increased social contextual resources and behavioral change processes. Participants in the Intervention group realized a significant reduction in body mass index (BMI) from baseline to 12 weeks when compared to participants in the Control group. Intervention group participants demonstrated improvement in theoretical mechanisms (i.e., self-knowledge, motivation appraisal, self-regulation, environmental resources) and intended outcomes (i.e., body composition) when compared to Control group participants. Findings from this study support the feasibility of the Yoga for HEART Intervention in older adults.

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2018

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Does It Work for Me? Supporting Self-Experimentation of Simple Health Behavior Interventions

Description

Many individual-level behavioral interventions improve health and well-being. However, most interventions exhibit considerable heterogeneity in response. Put differently, what might be effective on average might not be effective for specific individuals. From an individual’s perspective, many healthy behaviors exist that

Many individual-level behavioral interventions improve health and well-being. However, most interventions exhibit considerable heterogeneity in response. Put differently, what might be effective on average might not be effective for specific individuals. From an individual’s perspective, many healthy behaviors exist that seem to have a positive impact. However, few existing tools support people in identifying interventions that work for them, personally.

One approach to support such personalization is via self-experimentation using single-case designs. ‘Hack Your Health’ is a tool that guides individuals through an 18-day self-experiment to test if an intervention they choose (e.g., meditation, gratitude journaling) improves their own psychological well-being (e.g., stress, happiness), whether it fits in their routine, and whether they enjoy it.

The purpose of this work was to conduct a formative evaluation of Hack Your Health to examine user burden, adherence, and to evaluate its usefulness in supporting decision-making about a health intervention. A mixed-methods approach was used, and two versions of the tool were tested via two waves of participants (Wave 1, N=20; Wave 2, N=8). Participants completed their self-experiments and provided feedback via follow-up surveys (n=26) and interviews (n=20).

Findings indicated that the tool had high usability and low burden overall. Average survey completion rate was 91%, and compliance to protocol was 72%. Overall, participants found the experience useful to test if their chosen intervention helped them. However, there were discrepancies between participants’ intuition about intervention effect and results from analyses. Participants often relied on intuition/lived experience over results for decision-making. This suggested that the usefulness of Hack Your Health in its current form might be through the structure, accountability, and means for self-reflection it provided rather than the specific experimental design/results. Additionally, situations where performing interventions within a rigorous/restrictive experimental set-up may not be appropriate (e.g., when goal is to assess intervention enjoyment) were uncovered. Plausible design implications include: longer experimental and phase durations, accounting for non-compliance, missingness, and proximal/acute effects, and exploring strategies to complement quantitative data with participants’ lived experiences with interventions to effectively support decision-making. Future work should explore ways to balance scientific rigor with participants’ needs for such decision-making.

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Date Created
2019

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Investigating the Link between Active Transportation Use and Cardiometabolic Health

Description

This dissertation was guided by the Ecological Model of Physical Activity and Ecological Model of Obesity and sought to determine the relationship between active transportation (AT), physical activity, and cardiometabolic health among adults and ethnic minority women. Chapter 2

This dissertation was guided by the Ecological Model of Physical Activity and Ecological Model of Obesity and sought to determine the relationship between active transportation (AT), physical activity, and cardiometabolic health among adults and ethnic minority women. Chapter 2 presents an investigation into the relationship between walking for AT and cardiometabolic health among adults through systematic review. Chapter 3 presents an exploration of the cross-sectional relationships of AT and moderate-to-vigorous physical activity (MVPA) with cardiometabolic health among African American (AA) and Hispanic/Latina (HL) women from Texas. Chapter 4 presents an investigation into the cross-sectional relationship of AT on cardiometabolic health and physical activity among primarily HL women.

In Chapter 2, walking for AT was found to be related to smaller waist circumference, lower blood pressure, and lower prevalence of abdominal obesity and hypertension, and that differences may exist based on sex. Walking for AT was not clearly defined, and criteria used to determine the presence of cardiometabolic outcomes were inconsistent. No significant relationships between AT and cardiometabolic health were found in Chapter 3 or 4; however, AT users had slightly better cardiometabolic health. AT users had significantly higher levels of self-reported total physical activity compared to those who did not use AT in Chapter 3. Furthermore, a significant relationship was found between MVPA and diastolic blood pressure. Associations differed by ethnicity, with MVPA being inversely related to body fat in both AA and HL women, but to body mass index only in AA women. AT users were found to be seven times more likely to meet 2018 national MVPA recommendations than non-AT users in Chapter 4. Across all studies, measures of AT were subjective and of low quality, potentially limiting the ability to detect significant findings.

High quality randomized controlled studies should be conducted using clearly defined, objective measures of AT, and analyzed based on sex and race/ethnicity. Clinicians should recommend AT use to promote meeting MVPA recommendations where appropriate, potentially resulting in improved cardiometabolic health. Policymakers should advocate for changes to the built environment to encourage AT use and MVPA to improve public health.

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2019

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Barriers & motivators to physical activity in older Mexican American men

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The purpose of this phenomenological study was to explore the cultural, social, environmental, and gender factors that may influence physical activity (PA) in older Mexican American (MA) men living in Tucson, Arizona. The Mexican origin population is the fastest growing

The purpose of this phenomenological study was to explore the cultural, social, environmental, and gender factors that may influence physical activity (PA) in older Mexican American (MA) men living in Tucson, Arizona. The Mexican origin population is the fastest growing Hispanic subgroup in our nation, increasing from 20.6 million in the year 2000 to 31.8 million in 2010. Arizona has the sixth largest Hispanic population in the United States and the Mexican origin population accounts for 91% of Arizona's Hispanics. Despite the fast growing Mexican population, there are a limited number of studies that examine MAs and PA. There are even fewer interventions created to foster PA among older (≥65 years old) MA men. Fourteen individual interviews were conducted with older MA men living in Tucson, Arizona. Data was collected, organized, and analyzed according to the methodologies of Clark Moustakas and the Social Ecology Model for Health Promotion framework. Six themes emerged which reflected the older MA male's perception of health, masculinity, and physical activity: a) Retirement promotes self-care behaviors, b) Women, health care providers, and the Internet are important in promoting health, c) Aging changes physical activity, d) I take care of myself, e) Physical activity is a personal choice and lifestyle, and f) I learn and make adjustments as needed. Themes were used to create textural and structural descriptions of their experiences. Descriptions were formed into the essence of the phenomenon. The results of this study increase our understanding of health, masculinity, and physical activity in older MA men. This research will inform the development of an evidence-based PA intervention to promote cardiovascular (CV) health in older MA men that may be implemented in a variety of community-based settings.

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2015