Exercise Prescription Practices Among Mental Health Professionals on College Campuses: Testing the Information-Motivation-Behavioral Skills Model

BACKGROUND

The co-occurrence of physical inactivity and poor mental health in the college student population can lead to chronic health issues that have negative short-term effects (e.g., academic success). Poor mental health is associated with long-term conditions (e.g., obesity, serious mental illness) that are linked to premature mortality. The purpose of this study was to examine the information-motivation-behavioral (IMB) skills model and evaluate its ability to explain the variance in the use of exercise prescription in mental health treatment.

METHOD

Mental health professionals (MHPs) (n = 255) were recruited from college counseling centers in the USA. Structural equation modeling was used to examine the relationship between the predictor variables of information (exercise knowledge and benefits of exercise), motivation (personal beliefs, perceived barriers, and organizational support), and behavioral skills (self-efficacy), and the outcome variable of exercise prescription (i.e., brief counseling and referral for exercise).

RESULTS

The predictors accounted for 23% of the variance in exercise prescription (p = .001). Organizational support had a significant direct effect on exercise prescription (β = 0.27, p = .05). Personal beliefs (β = 0.96, p = .05) and organizational support (β = 0.31, p = .04) had significant direct effects on self-efficacy for prescribing exercise. MHP personal exercise behavior was associated with exercise prescription.

CONCLUSION

MHPs may be willing to support physical activity promotion and exercise prescription, but organizational structures are critical to enhance and sustain the delivery of this adjunctive therapy. The personal exercise history of MHPs may be an important consideration for behavior change interventions. The development and validation of scales are important considerations for future intervention study design.

A Systematic Review of Patient- and Family-Level Inhaled Corticosteroid Adherence Interventions in Black/African Americans

BACKGROUND

Inhaled corticosteroid (ICS) adherence rates are suboptimal among adult black/African Americans. Comprehensive studies characterizing the effectiveness and the methodological approaches to the development of interventions to improve ICS adherence in adult black/African Americans have not been performed.

OBJECTIVES

Conduct a systematic review of patient/family-level interventions to improve ICS adherence in adult black/African Americans.

METHODS

We searched MEDLINE, EMBASE, Web of Science, and CINAHL from inception to August 2017 for English-language US studies enrolling at least 30% black/African Americans comparing patient/family-level ICS adherence interventions with any comparator. Two investigators independently selected, extracted data from, and rated risk of bias. We collected information on intervention characteristics and outcomes, and assessed whether studies were informed by behavior theory, stakeholder engagement, or both.

RESULTS

Among 1661 abstracts identified, we reviewed 230 full-text articles and identified 4 randomized controlled trials (RCTs) and 1 quasi-experimental (pre-post design) study meeting criteria. Study participants (N range, 17-333) varied in mean age (22-47 years), proportion black/African Americans studied (71%-93%), and sex (69%-82% females). RCTs evaluated problem-solving classes, self-efficacy training, technology-based motivational interviewing program, and the use of patient advocates. The RCT testing self-efficacy training was the only intervention informed by both behavior theory and stakeholder engagement. All 4 RCTs compared interventions with active control and rated as medium risk of bias. No RCTs found a statistically significant improvement in adherence.

CONCLUSIONS

Few studies assessing asthma adherence interventions focused on adult black/African-American populations. No RCTs demonstrated improved ICS adherence in participants. Future studies that are informed by behavior change theory and stakeholder engagement are needed.