The validity and reliability of the Malay version of the social support for exercise and physical environment for physical activity scales

The mediating role of behavioral systems in linking physical activity and anxiety symptoms in college students

Data show that the detection rate of anxiety symptoms among college students has risen from 16.6 to 34.8% over the past 10 years, and that college students are gradually becoming a high prevalence group for anxiety symptoms.This study aims to investigate the relationship between physical activity, behavioral inhibition and activation, and anxiety symptoms in college students. Specifically, it seeks to identify the mediating role of individual subcomponents of behavioral inhibition and activation in the association between physical activity and anxiety symptoms. A total of 5125 college students were recruited to participate in the study. Participants completed the Physical Activity Rating Scale-3, the Behavioral Inhibition/Activation System Scale, and the Generalized Anxiety Disorder-7 (GAD-7) scale. ANOVA, linear regression analysis and structural equation modelling were used to analyse the data and subcomponents of each variable (physical activity, anxiety symptoms, BIS/BAS) were analysed. Anxious college students demonstrated significantly lower scores in reward responsiveness, drive, and fun seeking, while exhibiting higher scores in behavioral inhibition. Additionally, these students engaged in physical activity at lower intensities, for shorter times, with reduced frequency, and overall less total exercise (all p < 0.001). Furthermore, a significant negative correlation was observed between levels of physical activity and anxiety (r= - 0.145, p < 0.001), while a weak correlation was identified between physical activity levels and the behavioral inhibition system (r= - 0.020, p = 0.156). Conversely, physical activity levels were significantly positively correlated with the behavioral activation subcomponents of reward responsiveness (r = 0.062, p < 0.001), drive (r = 0.122, p < 0.001), and fun seeking (r = 0.067, p < 0.001). Physical activity, behavioral inhibition, and behavioral activation were significant predictors of anxiety symptoms among university students. Among male students, exercise intensity (Beta= - 0.088, p = 0.001) and reward responsiveness (Beta= - 0.255, p < 0.001) showed the strongest correlations with anxiety levels, while among female students, exercise time (Beta = - 0.084, p < 0.001) and behavioral inhibition (Beta = 0.291, p < 0.001) were the most highly correlated. Physical activity levels had a direct effect of 84.37% on reducing anxiety symptoms (Beta= - 0.286, p < 0.001), with 15.63% of the effect mediated by the behavioral inhibition and activation system (Beta= - 0.053, p < 0.001). The mediating effects of the behavioral inhibition and activation system were stronger in females (29.92%, Beta= - 0.076, p = 0.001) compared to males (15.76%, Beta= - 0.061, p < 0.001). Factor loadings indicated that exercise time (male: 1.81, female: 2.71) and drive (male: 1.01, female: 1.04) were more effective in alleviating anxiety symptoms, particularly in the dimensions of uncontrollable worrying (1.07), worry too much (1.03), trouble relaxing (1.00), and nervousness (1.00). Physical activity exerts a direct influence on anxiety, with its anxiolytic effects partially mediated by the behavioral inhibition and activation system. This mediating effect is most pronounced in the female college student population.

Psychometric properties of the social determinants of health questionnaire (SDH-Q): development and validation

BACKGROUND

The influence of social determinants of health (SDH) on sustainable development goals (SDG) has gained attention in recent years. However, there is a scarcity in the availability of valid and reliable instruments to assess the multiple aspects of SDH. Hence, this study was conducted to develop a brief self-reported measure for assessing SDH.

METHOD

A cross-sectional survey was conducted among university undergraduate students in Nigeria. The study consisted of 300 participants in the EFA (males 55.7%, females 44.3%) and 430 participants in the CFA (males 54.0%, females 46.0%). Participants were selected using a convenience sampling approach to assess their perceptions regarding SDH. Content Validity Index (CVI), Face Validity Index (FVI), Exploratory Factor Analysis (EFA), Confirmatory Factor Analysis (CFA), Composite Reliability (CR), Average Variance Extracted (AVE), Cronbach's alpha, and Intraclass Correlation Coefficient (ICC) were computed to determine the psychometric properties of the newly developed SDH scale.

RESULTS

In the EFA, two factors were extracted (structural determinants of SDH and intermediary determinants of SDH), with all 20 items retained. The total variance explained by the EFA model was 61.8%, and the factor correlation was 0.178. The Cronbach's alpha values of the two factors were 0.917 and 0.939. In the CFA, the initial model did not fit the data well based on fit indices. After several re-specification of the model, the final re-specified measurement model demonstrated adequate fit factor structure of the SDH scale with two factors and 20 items (CFI = 0.943, TLI = 0.930, SRMR = 0.056, RMSEA = 0.053, RMSEA p-value = 0.220). The CR was 0.797 for structural determinants of SDH and 0.794 for intermediary determinants of SDH. The ICC was 0.938 for structural determinants of SDH and 0.941 for intermediary determinants of SDH.

CONCLUSION

The findings indicate that the SDH scale has adequate psychometric properties and can be used to assess the perceived level of SDH. We recommended that this tool be tested in other populations with diverse age groups and other demographic characteristics.

Psychometric properties of the newly developed self-report environmental determinants of health questionnaire (EDH-Q): development and validation

BACKGROUND

The environmental determinants of health (EDH) have a significant impact on people's physical, mental, and social wellbeing. Everyone needs access to environmental resources of all types, including food, materials, and energy, to survive. Currently, no valid and reliable instrument exists for evaluating individuals' perceived levels of EDH. Hence, the purpose of this study was to develop and validate the environmental determinants of health questionnaire (EDH-Q) among undergraduate students in Nigeria.

METHOD

We conducted a cross-sectional survey among undergraduate students in Nigeria to assess the psychometric properties of the newly developed Environmental Determinants of Health Questionnaire (EDH-Q). Respondents were selected using a convenience sampling approach to evaluate their perceptions of environmental determinants of health. The Content Validity Index (CVI) and Face Validity Index (FVI) were calculated to ascertain the scale's content validity and response process validity, respectively. Additionally, exploratory factor analysis (EFA), confirmatory factor analysis (CFA), composite reliability (CR), average variance extracted (AVE), Cronbach's alpha, and intraclass correlation coefficient (ICC) were computed to assess the scale's construct validity.

RESULTS

The study involved 300 respondents in the EFA (males 55.7%, females 44.3%) and 430 respondents in the CFA (males 54.0%, females 46.0%). In the EFA, two constructs were identified (the natural environment and the built environment). The EFA model was able to explain 63.57% of the total cumulative variance, and the factor correlation was 0.671. The whole scale Cronbach's alpha value was 0.947, while the two constructs' Cronbach's alpha values were 0.918 (natural environment) and 0.935 (built environment). In the CFA, six pairs of error covariances were included between items within the same construct to improve the fit indices of the initial proposed measurement model. The final re-specified measurement model showed that the EDH-Q, which has two constructs and 18 items, has adequate construct validity (CFI = 0.948, TLI = 0.938, SRMR = 0.046, RMSEA = 0.052, and RMSEA p-value = 0.344). The CRs were 0.845 (natural environment) and 0.854 (built environment). The ICCs were 0.976 (natural environment) and 0.970 (built environment).

CONCLUSION

The results show that the newly created EDH-Q has sufficient construct validity and may be utilized to assess participants' perceptions of their level of EDH. Researchers should examine this instrument in populations with different age ranges and other demographic characteristics, as the present study only applied it to undergraduate students who may share similar characteristics.

Structural relationship of the social-ecological factors and psychological factors on physical activity

The present study examines the mediating effect of psychological factors in the structural relationships between social and physical environmental factors and the amount of physical activity among undergraduate students at Universiti Sains Malaysia. The sample consisted of 422 students with a mean age of 20.2 years (SD = 1.27). The majority of the students were female (69.7%) and Malay (81.3%). Standardized scales were used to measure the total amount of physical activity and all the study variables. The final SEM had a good fit to the data: CFI = 0.968, TLI = 0.948, SRMR = 0.036, RMSEA (90%CI) = 0.046 (0.025, 0.065), RMSEA p-value = 0.609 with 11 paths relationships. Family support had a significant effect on perceived benefits and perceived barriers. The effect of friend support on physical activity was significantly mediated by perceived benefits, self-efficacy, and psychological needs satisfaction. The effect of the availability of exercise facilities on physical activity was significantly mediated by perceived benefits and psychological needs satisfaction. Furthermore, psychological needs satisfaction mediated the effect of perceived benefits, perceived barriers, and self-efficacy on physical activity. The study findings illustrated that the application of the social-ecological model and psychological factors is important in order to understand and promote positive physical activity behaviour.

Psychometrics validation of the Chinese version of social support for exercise scale among adolescents in China

Physical activity (PA) is widely recognized as crucial for human health, yet the low level of PA in adolescents continues to raise major concerns. This study aims to validate the Chinese version of the Social Support Scale for Exercise (SE) and establish its reliability among Chinese adolescents. A cross-sectional study was conducted on two primary and two secondary schools in central China. Students were recruited using a random cluster sampling method, and written informed consent was provided after they were briefed on the purpose of the study. The standard forward-backward translation was applied to translate the English version of the SE into Chinese. The Social Support Scale used in this study consists of two factors: family support and friend support. Data were analyzed using Mplus 8 for the CFA, composite reliability (CR), average variance extracted (AVE), and intra-class correlation coefficients (ICC) were calculated. A total of 1422 students (boys = 838, girls = 604) with a mean age of 11 years (SD = 1.6) participated in the study. The measurement model of the translated social support scale fit the data well: CFI = .935; TLI = .929; SRMR = .038; RMSEA = .053, with a 90% confidence interval of (.051, .056; RMSEA p < .001). The composite reliability values of .935 for family support and .948 for friend support were acceptable. The intra-class correlation coefficients (ICC) based on test-retest were .928 for family support, and .904 for friend support. Hence, the Chinese version of the SE was valid and reliable, its implementation will provide researchers with a valuable tool to comprehensively assess Chinese adolescents' exercise-related social support and help develop targeted and effective interventions to improve their physical activity levels.

Web-Based Intervention to Act for Weight Loss in Adults With Type 2 Diabetes With Obesity (Chance2Act): Protocol for a Nonrandomized Controlled Trial

BACKGROUND

In adults with type 2 diabetes (T2D), weight loss can improve hemoglobin A1c, blood pressure, and triglycerides, and reduce the frequency of medications needed. Unfortunately, a large proportion of these individuals are not ready to initiate weight efforts, making existing obesity management strategies less effective. Many digital health interventions aim at weight loss, but there is still limited evidence on their effectiveness in changing weight loss behavior, especially in adults with T2D.

OBJECTIVE

This study aims to develop and validate "Chance2Act," a new web-based intervention, designed specifically to facilitate behavioral change in adults with T2D with obesity who are not ready to act toward weight loss. Then, the effectiveness of the newly developed intervention will be determined from a nonrandomized controlled trial.

METHODS

A web-based intervention will be developed based on the Transtheoretical Model targeting adults with T2D with obesity who are not ready to change for weight loss. Phase 1 will involve the development and validation of the web-based health intervention module. In phase 2, a nonrandomized controlled trial will be conducted in 2 government health clinics selected by the investigator. This is an unblinded study with a parallel assignment (ie, intervention vs control [usual care] with an allocation ratio of 1:1). A total of 124 study participants will be recruited, of which 62 participants will receive the Chance2Act intervention in addition to the usual care. The primary outcome is the changes in an individual's readiness from a stage of not being ready to change (precontemplation, contemplation, or preparation stage) to being ready for weight loss (action stage). The secondary outcomes include changes in self-efficacy, decisional balance, family support for weight loss, BMI, waist circumference, and body fat composition.

RESULTS

The phase 1 study will reveal the intervention's validity through the Content Validity Index and Face Validity Index, considering it valid if both indices exceed 0.83. The effectiveness of the intervention will be determined in phase 2, where the differences within and between groups will be analyzed in terms of the improvement of stages of change and all secondary outcomes as defined in the methodology. Data analysis for phase 2 will commence in 2024, with the anticipated publication of results in March 2024.

CONCLUSIONS

If proven effective, the result of the study may give valuable insights into the effective behavioral modification strategies for a web-based intervention targeting adults with T2D with obesity but not yet ready to change for weight loss. This intervention may be replicated or adopted in different settings, focusing on behavioral modification support that patients need. This study offers a deeper understanding of the application of behavior change techniques for a more holistic approach to obesity care in T2D.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05736536; https://clinicaltrials.gov/study/NCT05736536.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/48313.

Canonical correlation analysis of depression and anxiety symptoms among college students and their relationship with physical activity

To explore the association between depression and anxiety symptoms among college students and the relationship between the two and physical activity. A cross-sectional study design was used to survey 1790 enrolled university students using the Depression Self-Rating Scale, Anxiety Self-Rating Scale and Physical Activity Rating Scale. 37.75% of male students and 39.73% of female students detected depressive symptoms, 17.65% of male students and 17.86% of female students detected anxiety symptoms, 11.89% of male students and 11.75% of female students detected both depressive and anxiety symptoms. Canonical correlation between depression and anxiety symptoms of college students were significant. The depression and anxiety score of college students in the high level group was significantly lower than that in the low and medium level groups, and no significant difference was found between the low and medium level groups. Affective disorder and anxious mood of male students correlated most closely with intensity, while somatic disorder, psychomotor disorder and depressive psychological disorder correlated most closely with duration. Affective disorder of female students correlated most closely with frequency, depressive psychological disorder and anxious mood correlated most closely with intensity, while premonition of misfortune and frequent urination correlated most closely with duration. Depression and anxiety symptoms of college students were closely related and co-occurrence was common. Students with high level of physical activity had milder symptoms. Different exercise interventions are recommended for different symptoms.

The relationship between physical activity and trait anxiety in college students: The mediating role of executive function

Objectives

Aimed to analyze the mediating effect of executive function between physical activity level and trait anxiety in college students.

Methods

The International Physical Activity Questionnaire, State-Trait Anxiety Inventory, Stroop task, 1-back task, and More-odd shifting task were used to analyze 248 college students.

Results

Trait anxiety were significantly correlated with shifting function (r = 0.182, P = 0.004) and inhibition function (r = 0.163, P = 0.010) and not with working memory (r = 0.056, P = 0.385). Vigorous physical activity (VPA) was most highly correlated with inhibition function (Beta = −0.144, P = 0.024) and working memory (Beta = −0.208, P = 0.001), and light physical activity (LPA) was most highly correlated with shifting function (Beta = −0.211, P = 0.001). Physical activity had a 72.31% association with trait anxiety (B = −0.195), with 11.79% mediated by inhibition function (B = −0.023) and 15.90% by shifting function (B = −0.031).

Conclusion

College students' physical activity promotes both inhibition and shifting functions, which in turn affect trait anxiety. VPA had a direct effect, while the effect of moderate physical activity (MPA) and LPA was completely mediated exclusively through executive functions, and the mediating effect of shifting function was the highest. It is recommended that college workers should motivate students with high trait anxiety to engage in more VPA and pay attention to changes in their inhibition and shifting functions.

Psychometric Properties of the Chinese-Language Attitude toward Physical Activity Scale: A Confirmatory Study on Chinese Children

Background: This study examined the psychometric properties of the Chinese version of the Attitude toward Physical Activity Scale (APAS) using a cross-sectional design. Methods: The sample consisted of 692 primary students in China (boy 52.6%, girl 47.4%). The mean age of the participants was 9.4 years (SD = 0.92). Psychometric properties of the 57-item APAS was examined using confirmatory factor analysis (CFA). Results: The hypothesized seven factors model was supported by CFA (CFI = 0.912, TLI = 0.901, SRMR = 0.041, RMSEA = 0.029) after 22 items were removed and the inclusion of seven residual covariance for items loaded on the same factor. Cronbach’s alphas of the scales ranged between 0.50 and 0.76. The composite reliability (CR) was between 0.50 and 0.75. All inter-factor correlation coefficient was less than 0.85. Conclusions: Findings provided empirical evidence that the Chinese version of the APAS has adequate psychometric properties for assessing attitudes of primary school children in China toward physical activity.