A Scoping Review of Positive Lifestyle and Wellness Interventions to Inform the Development of a Comprehensive Health Promotion Program: "HealthPro"

Risk Factors of Chronic Kidney Disease Progression: Between Old and New Concepts

Chronic kidney disease (CKD) is a condition characterized by the gradual loss of kidney function over time and it is a worldwide health issue. The estimated frequency of CKD is 10% of the world's population, but it varies greatly on a global scale. In absolute terms, the staggering number of subjects affected by various degrees of CKD is 850,000,000, and 85% of them are in low- to middle-income countries. The most important risk factors for chronic kidney disease are age, arterial hypertension, diabetes, obesity, proteinuria, dyslipidemia, and environmental risk factors such as dietary salt intake and a more recently investigated agent: pollution. In this narrative review, we will focus by choice just on some risk factors such as age, which is the most important non-modifiable risk factor, and among modifiable risk factors, we will focus on hypertension, salt intake, obesity, and sympathetic overactivity.

Mindfulness-based stress reduction for men on active surveillance for prostate cancer and their spouses: Design and methodology of a randomized controlled trial

BACKGROUND

Although active surveillance (AS) is an increasingly adopted treatment paradigm for management of very low risk prostate cancer, many men and their partners face a variety of AS-related psychosocial stressors. Stressors may include anxiety and fear of progression, which may negatively affect short- and long-term psychosocial adjustment and influence early withdrawal from AS in order to seek definitive therapies such as surgery or radiation. Here we describe the protocol for an NCI-funded trial, which seeks to examine the efficacy of mindfulness training compared with a time/attention-matched health promotion control condition in a geographically generalizable sample of men on AS and their spouses.

METHODS

Using a randomized, controlled, partially double-blinded study design, this study involves the delivery of 8 weeks of standardized mindfulness training (MBSR; mindfulness-based stress reduction) and patient reported outcomes over a 12-month period (proposed enrollment of 80 men on AS and spouses), compared with a health promotion control (proposed enrollment of 80 men on AS and spouses) that has been matched for time and attention. Baseline (T1) measures (e.g., anxiety, fear of progression, quality of life) are administered just prior to randomization to the two study arms, followed by repeated assessments at 2 months (T2), 6 months (T3) and 12 months (T4).

CONCLUSION

This study has the potential to offer men and their partners on AS with important educational and self-regulatory skills to better cope and adjust with known stressors related to being placed on this protocol.

Empowering Women in the Face of Body Ideals: A Scoping Review of Health Promotion Programs

Achieving women's health equity and empowerment is a global priority. In a Western context, women are often disempowered by the value society places on body size, shape or weight, which can create a barrier to health. Health promotion programs can exacerbate women's preoccupations with their bodies by focusing outcomes toward achieving an "ideal" body size. Women's health promotion activities should be empowering if the desired outcomes are to improve their health and well-being long-term. This review sought to identify key elements from health promotion programs that aimed to empower women. A search was conducted in PubMed, MEDLINE, Web of Science, Scopus, CINAHL complete, and Academic Search Premiere databases. The search yielded 27 articles that collectively reported on 10 different programs. Through thematic synthesis, each article was analyzed for (1) key program features employed to empower women and (2) how such programs evaluated women's health. Seven themes resulted, of which five describe key empowering features (active participation, social support, sustainable change, holistic health perspective, strength-based approach) and two evaluation characteristics (assessment across multiple health domains and a mixed-method design). The findings from this review can assist health promoters to design and improve initiatives that aim to empower women.

Speaking Their Language: Does Environmental Signage Align to Personal Dimensions of Environmentally Responsible Behavior in Undergraduate Residence Halls?

Everyday environmental behaviors within the residential sphere contribute significantly to global carbon emissions. Understanding the factors underlying these behaviors is key to changing behavior. This paper examines undergraduate behavior in on-campus housing as a case study with the following aims: (1) to identify the personal dimensions that underlie undergraduates’ environmentally responsible behaviors (ERBs) and (2) to determine if environmental signage in on-campus housing aligns with these existing personal dimensions. This study involved an online survey of ERBs, values, motivations, and knowledge of students in six residence halls. A content analysis of environmental signage examined how values and motivations were used to frame environmental messages. Comparisons were made to determine how the communications aligned to occupants’ values and motivations. Undergraduate ERBs are supported by subjects’ Biospheric values, Environmental Concern, and motivation to engage with Technology. Female subjects performed significantly more ERBs than male students. Male students placed a significantly higher value on Egoism, which was significantly associated with poorer environmental behaviors. Signage with behavioral appeals is a relatively cost-effective and prevalent intervention strategy. However, signage should be tailored to appeal to a range of values and motivations of the target audience, including students’ desires to interact with technology and the personal benefits of environmental responsibility.

Next Level Health: a holistic health and wellbeing program to empower New Zealand women

Improving equity in women's health requires gender-specific and empowering approaches. However, health programs often disempower women by adopting a 'one-size-fits-all' approach that emphasizes diet, exercise and weight loss over other important aspects like sleep and mental wellbeing. This article reports on the design of Next Level Health (NLH), a program that aims to empower women through developing a wide range of health behaviors to support their holistic wellbeing. NLH is grounded by ethics, theory and evidence to support women to make achievable, sustainable changes that are relevant to their everyday lives. Women utilized the NLH framework to develop an integrative health routine across six domains: physical activity, sleep, nutrition, eating behavior, self-care and stress management. The framework guided them to set small, incremental goals that were adaptive to their needs and built from their existing circumstances. Participants reflected on their progress with a facilitator during monthly meetings, accessed a social media support page and received monthly text messages. Health programs remain an essential approach to improving women's health alongside community- and policy-level strategies. The development of NLH exemplifies how evidence may partner with modern health promotion values to inform relevant and ethical program design for women.

Retrospective evaluation of a pilot eHealth/mHealth telewellness program for people with disabilities: Mindfulness, Exercise, and Nutrition To Optimize Resilience (MENTOR)

BACKGROUND

People with disabilities have few options to participate in wellness programs that are tailored to their health, functional level, specific interests/needs, and available in the comfort of their home. To address this need, we evaluated a mobile health wellness program for people with physical disabilities.

METHODS

Retrospective pilot evaluation of MENTOR (Mindfulness, Exercise, and Nutrition To Optimize Resilience), an 8-week, 40-hour online telewellness program adapted from the peer reviewed literature on wellness. The three core wellness domains-mindfulness, exercise, and nutrition-were delivered via Zoom to groups of participants with a disability. Each group met weekly with an assigned health coach who responded to Q&A about the program and presented new material on several additional wellness domains that could impact their health (e.g., relationships, contribution to society/community, spending outdoor time in nature). Pre/post measures included the Godin Leisure-Time Exercise Questionnaire (GLTEQ) and the UAB/Lakeshore Wellness Assessment (LWA). Participants were also interviewed and provided feedback after the program, which was thematically analyzed.

RESULTS

A total of 154 people from 15 states enrolled in the MENTOR program and 135 completed it (87.7% completers). Data were analyzed from a subset of participants (n=53) who were asked to complete a pre/post assessment and had complete data. Participants who were physically inactive at baseline improved their GLTEQ total activity (P=0.002; effect size =0.56) and moderate-to-vigorous activity scores (P=0.005; effect size =0.53). LWA results demonstrated that participants increased their exercise behavior (P=0.006; effect sizes =0.39) and contribution to society/community (P=0.013; effect size =0.37). Participants with low overall wellness (mental, physical & emotional health) at baseline had statistically significant improvements in exercise, nutrition, sleep, core values, self-care, hobbies, contribution to society/community, relationships, and overall wellness (all P<0.05 with effect sizes ranging from 0.43 to 1.07). Resultant qualitative themes were: (I) lifestyle transformation occurred through new positive experiences, physical and mental health benefits, and adoption of healthy behaviors; and (II) engagement through accessible online bonding through enjoyable and professional experiences.

CONCLUSIONS

A pilot telewellness program for people with disabilities is feasible and potentially effective in improving several domains of wellness. There is a need for precision-based mobile health (mHealth) programs that are tailored for people with disabilities and that can be accessed from various portable devices including their phone and/or tablet.

Adolescent well-being: A concept analysis

Although there is a vast literature on the concept of well-being, there appears to be no consensus regarding its meaning. A clear conceptualization of adolescent well-being is necessary as the foundation for interventions and research addressing this phenomenon. Adolescence is a transitional period characterized by rapid growth, gaining independence, and learning social skills as well as behaviours that lay the foundations for future well-being. Therefore, the purpose of this paper was to analyse the concept of adolescent well-being and identify its attributes, antecedents, and empirical referents based on the literature. The Walker and Avant (2019) method was used. Ninety-four articles were included in the final review. The defining attributes of adolescent well-being were identified as autonomy, connectedness, optimism and competency. The antecedents were grouped under internal and external factors. Internal factors included the behavioural, physical, psychological, and spiritual domains. External factors included the environmental, economic, education, leisure, social, and safety as well as security domains. For the adolescent to reach well-being, all these domains must be present, albeit, the social domain was highly stressed. The consequences of adolescent well-being included eudaimonia, having high resilience as well as low risk-taking behaviours and delinquency. Empirical referents were discussed in terms of ways of measuring the defining attributes. Stemming from the eudaimonic perspective, to promote adolescent well-being, care providers need to integrate in education, practice, and research the importance of establishing positive relations and connectedness, to enhance adolescent autonomy and optimism and assist them to grow into competent and self-fulfilled beings.

Preventing type 2 diabetes among South Asian Americans through community-based lifestyle interventions: A systematic review

Ethnic South Asian Americans (SAAs) have the highest relative risk of type 2 diabetes mellitus (T2DM) in the United States (US). Culturally tailored lifestyle interventions have the potential to promote South Asian diabetes prevention; however, the extent of their use and evaluation in US settings remains limited. This systematic review characterizes and evaluates outcomes of community-based lifestyle interventions targeted towards T2DM indicators among South Asians living in the US. A PRISMA-informed search of Pubmed, Embase, Cochrane, Web of Science, and clinical trial registry databases using key words pertaining to South Asians migrants and diabetes indicators (glucose and insulin outcomes) was conducted of community-based lifestyle interventions published up until October, 31 2019. Of the eight studies included in the final synthesis, four interventions focused on cultural and linguistic adaptations of past chronic disease prevention curricula using group-based modalities to deliver the intervention. Hemoglobin A1c (A1c) was the most common outcome indicator measured across the interventions. Three of the five studies observed improvements in indicators post-intervention. Based on these findings, this review recommends 1) greater exploration of community-based lifestyle interventions with high quality diabetes indicators (such as fasting blood glucose) in ethnic SAA communities, 2) expanding beyond traditional modalities of group-based lifestyle interventions and exploring the use of technology and interventions integrated with passive, active, and individualized components, and 3) development of research on diabetes prevention among second generation SAAs.

Identifying and Addressing Individuals Resistant to Behavioral Lifestyle Treatment

The prevention and treatment of lifestyle disease involves overlapping factors. Those at the highest risk for the development of lifestyle disease are also at the highest risk for poor treatment outcomes. Although behavioral treatment of lifestyle disease has demonstrated efficacy on average, considerable individual variation exists in treatment response. In clinical settings, individuals unresponsive to treatment are typically provided escalated care. Community-based care is designed to reach high-risk populations unlikely to seek medical care. However, in community settings escalated treatment options are not usually available for individuals unresponsive to treatment. Addressing this gap is imperative to improve health outcomes of high-risk populations and to identify individuals who may be resistant to behavioral lifestyle treatment.