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The International Journal of Behavioral... Mar 2022Physical activity and sport have numerous health benefits and participation is thought to be lower in disadvantaged children and adolescents. However, evidence for the... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Physical activity and sport have numerous health benefits and participation is thought to be lower in disadvantaged children and adolescents. However, evidence for the disparity in physical activity is inconsistent, has not been reviewed recently, and for sport has never been synthesised. Our aim was to systematically review, and combine via meta-analyses, evidence of the socioeconomic disparities in physical activity and sport participation in children and adolescents in high income countries.
METHODS
We conducted searches of five electronic databases using physical activity, sport, and socioeconomic disparity related terms. Two independent reviewers assessed 21,342 articles for peer-reviewed original research, published in English that assessed socioeconomic disparities in physical activity and sport participation in children and adolescents. We combined evidence from eligible studies using a structural equation modelling approach to multilevel meta-analysis.
RESULTS
From the 104 eligible studies, we meta-analysed 163 effect sizes. Overall, children and adolescents living in higher socioeconomic status households were more likely to participate in sport (OR: 1.87, 95% CIs 1.38, 2.36) and participated for a longer duration (d = 0.24, 95% CIs 0.12, 0.35). The socioeconomic disparity in the duration of sport participation was greater in children (d = 0.28, 95% CIs 0.15, 0.41) compared with adolescents (d = 0.13, 95% CIs - 0.03, 0.30). Overall, children and adolescents living in higher socioeconomic status households were more likely to meet physical activity guidelines (OR: 1.21, 95% CIs 1.09, 1.33) and participated for a longer duration (d = 0.08, 95% CIs 0.02, 0.14). The socioeconomic disparity in the duration of total physical activity between low and high socioeconomic status households was greater in children (d = 0.13, 95% CIs 0.04, 0.21) compared with adolescents (d = 0.05, 95% CIs - 0.05, 0.15). There was no significant disparity in leisure time physical activity (d = 0.13, 95% CIs - 0.06, 0.32).
CONCLUSIONS
There was evidence of socioeconomic disparities in sport participation and total physical activity participation among children and adolescents. Socioeconomic differences were greater in sport compared to total physical activity and greater in children compared with adolescents. These findings highlight the need importance of targeting sport programs according to socio-economic gradients, to reduce inequities in access and opportunity to organised sport.
Topics: Adolescent; Child; Developed Countries; Exercise; Humans; Income; Social Class; Sports
PubMed: 35303869
DOI: 10.1186/s12966-022-01263-7 -
Worldviews on Evidence-based Nursing Jun 2017The past 20 years have seen distinct shifts in the way the participation of children and adolescents in research is viewed. This has been emphasized by the growing... (Review)
Review
BACKGROUND
The past 20 years have seen distinct shifts in the way the participation of children and adolescents in research is viewed. This has been emphasized by the growing pediatric research enterprise. Additional information on children's and adolescents' experiences during research participation is needed to better inform researchers on the ethical conduct of research with this vulnerable population.
AIMS
The objective of this analysis was to examine ethical issues in research with children and adolescents from their perspective as participants, including: assent, parental consent, risk perception, impact of research participation, and incentives.
METHODS
This systematic review was conducted per the Long, Godfrey, Randall, Brettle, and Grant framework by means of an iterative searching process. Using the key words "research ethics" and "child or pediatric or adolescent," PubMed, CINAHL, and EBSCOhost databases were searched to identify articles. Limitations placed on the searches were: English language, year of publication between 2003 and 2014, humans, abstract available, and age birth-18 years.
FINDINGS
Twenty-three empiric studies were identified and formed the sample. Included studies represented a diverse range of areas of research, methods, settings, sample demographics, authors, and journals.
LINKING EVIDENCE TO ACTION
Even young children demonstrated the ability to understand essential elements of research, although there is variability in children's level of understanding. Trust was a significant contributing factor to children's and adolescents' participation in research, and also shaped their assessments of risk. Research participation was mainly beneficial for children and adolescents. Incentives were mainly viewed positively, although concerns of possible undue influence were expressed.
Topics: Adolescent; Child; Ethics, Research; Humans; Perception; Research Subjects; Trust
PubMed: 28207982
DOI: 10.1111/wvn.12209 -
Journal of Medical Internet Research Oct 2016With advances in technology, the adoption of wearable devices has become a viable adjunct in poststroke rehabilitation. Regaining ambulation is a top priority for an... (Review)
Review
BACKGROUND
With advances in technology, the adoption of wearable devices has become a viable adjunct in poststroke rehabilitation. Regaining ambulation is a top priority for an increasing number of stroke survivors. However, despite an increase in research exploring these devices for lower limb rehabilitation, little is known of the effectiveness.
OBJECTIVE
This review aims to assess the effectiveness of lower limb wearable technology for improving activity and participation in adult stroke survivors.
METHODS
Randomized controlled trials (RCTs) of lower limb wearable technology for poststroke rehabilitation were included. Primary outcome measures were validated measures of activity and participation as defined by the International Classification of Functioning, Disability and Health. Databases searched were MEDLINE, Web of Science (Core collection), CINAHL, and the Cochrane Library. The Cochrane Risk of Bias Tool was used to assess the methodological quality of the RCTs.
RESULTS
In the review, we included 11 RCTs with collectively 550 participants at baseline and 474 participants at final follow-up including control groups and participants post stroke. Participants' stroke type and severity varied. Only one study found significant between-group differences for systems functioning and activity. Across the included RCTs, the lowest number of participants was 12 and the highest was 151 with a mean of 49 participants. The lowest number of participants to drop out of an RCT was zero in two of the studies and 19 in one study. Significant between-group differences were found across three of the 11 included trials. Out of the activity and participation measures alone, P values ranged from P=.87 to P ≤.001.
CONCLUSIONS
This review has highlighted a number of reasons for insignificant findings in this area including low sample sizes, appropriateness of the RCT methodology for complex interventions, a lack of appropriate analysis of outcome data, and participant stroke severity.
Topics: Adult; Humans; Lower Extremity; Stroke; Stroke Rehabilitation; Survivors; Walking
PubMed: 27717920
DOI: 10.2196/jmir.5891 -
BMJ Open Sport & Exercise Medicine 2020Desires and expectations of patients in regard to resume participation in sport activities after knee arthroplasty strongly increased in recent years. Therefore, this...
OBJECTIVE
Desires and expectations of patients in regard to resume participation in sport activities after knee arthroplasty strongly increased in recent years. Therefore, this review systematically reviewed the available scientific literature on the effect of knee arthroplasty on sports participation and activity levels.
DESIGN
Systematic review and meta-analysis.
DATA SOURCES
PubMed, Embase, SPORTDiscus and reference lists were searched in February 2019.
STUDIES ELIGIBILITY CRITERIA
Inclusion of knee osteoarthritis patients who underwent total knee arthroplasty (TKA) and/or unicondylar knee arthroplasty. Studies had to include at least one preoperative and one postoperative measure (≥1 year post surgery) of an outcome variable of interest (ie, activity level: University of California, Los Angeles and/or Lower Extremity Activity Scale; sport participation: type of sport activity survey).
RESULTS
Nineteen studies were included, consisting data from 4074 patients. Knee arthroplasty has in general a positive effect on activity level and sport participation. Most patients who have stopped participating in sport activities in the year prior to surgery, however, do not seem to reinitiate their sport activities after surgery, in particular after a TKA. In contrast, patients who continue to participate in sport activities until surgery appear to become even more active in low-impact and medium-impact sports than before the onset of restricting symptoms.
CONCLUSIONS
Knee arthroplasty is an effective treatment in resuming sports participation and physical activity levels. However, to achieve the full benefits from knee arthroplasty, strategies and guidelines aimed to keep patients capable and motivated to participate in (low-impact or medium-impact) sport activities until close before surgery are warranted.
PubMed: 32597907
DOI: 10.1136/bmjsem-2019-000729 -
SAGE Open Nursing 2022An advancing healthcare system in which patients are often required to self-manage care needs across countless settings and clinicians is increasing focus on... (Review)
Review
INTRODUCTION
An advancing healthcare system in which patients are often required to self-manage care needs across countless settings and clinicians is increasing focus on participation in care. Mismanagement of care during already risky care-transitions further increases adverse care outcomes. Understanding factors of patient participation in transitional care in an adult population can help guide ways to reduce this burden.
METHODS
A systematic review of the literature guided by the PRISMA method was conducted to identify factors of patient participation in transitional care. Quantitative studies in which patient participation was measured as an outcome variable and related statistics reported, and data were collected from an adult sample, were included. Two authors independently reviewed, critiqued, and synthesized the articles, and later categorized study variables according to identified trends.
RESULTS
Twelve studies across international and multidisciplinary backgrounds were identified. Across studies, efforts were largely based on understanding or improving patient self-management of care during transitions. The majority of studies were experimental and care interventions grounded in patient and healthcare team partnerships, delivered beyond the hospital setting. An array of measures was used to quantify patient participation. Factors of patient participation in transitional care included higher perceived levels of self-efficacy, confidence, and skills to participate in care.
CONCLUSION
The results of this study suggest patient participation in transitional care is largely based on perceptions of self-efficacy, confidence, and skill. Patient-centric transitional care interventions targeting these factors and delivered beyond the hospital setting may improve care outcomes. Implications and direction for further studies includes conceptual clarity, the study of a broader-reaching patient population demographic, and use of multidisciplinary interventions. Outcome variables should remain focused on patient perception of care involvement and participation and expanded to include variables such as functional abilities and social determinants of health.
PubMed: 35111928
DOI: 10.1177/23779608221074658 -
PloS One 2015Community participation is a major principle of people centered health systems, with considerable research highlighting its intrinsic value and strategic importance.... (Review)
Review
Community Participation in Health Systems Research: A Systematic Review Assessing the State of Research, the Nature of Interventions Involved and the Features of Engagement with Communities.
BACKGROUND
Community participation is a major principle of people centered health systems, with considerable research highlighting its intrinsic value and strategic importance. Existing reviews largely focus on the effectiveness of community participation with less attention to how community participation is supported in health systems intervention research.
OBJECTIVE
To explore the extent, nature and quality of community participation in health systems intervention research in low- and middle-income countries.
METHODOLOGY
We searched for peer-reviewed, English language literature published between January 2000 and May 2012 through four electronic databases. Search terms combined the concepts of community, capability/participation, health systems research and low- and middle-income countries. The initial search yielded 3,092 articles, of which 260 articles with more than nominal community participation were identified and included. We further excluded 104 articles due to lower levels of community participation across the research cycle and poor description of the process of community participation. Out of the remaining 160 articles with rich community participation, we further examined 64 articles focused on service delivery and governance within health systems research.
RESULTS
Most articles were led by authors in high income countries and many did not consistently list critical aspects of study quality. Articles were most likely to describe community participation in health promotion interventions (78%, 202/260), even though they were less participatory than other health systems areas. Community involvement in governance and supply chain management was less common (12%, 30/260 and 9%, 24/260 respectively), but more participatory. Articles cut across all health conditions and varied by scale and duration, with those that were implemented at national scale or over more than five years being mainstreamed by government. Most articles detailed improvements in service availability, accessibility and acceptability, with fewer efforts focused on quality, and few designs able to measure impact on health outcomes. With regards to participation, most articles supported community's in implementing interventions (95%, n = 247/260), in contrast to involving communities in identifying and defining problems (18%, n = 46/260). Many articles did not discuss who in communities participated, with just over a half of the articles disaggregating any information by sex. Articles were largely under theorized, and only five mentioned power or control. Majority of the articles (57/64) described community participation processes as being collaborative with fewer describing either community mobilization or community empowerment. Intrinsic individual motivations, community-level trust, strong external linkages, and supportive institutional processes facilitated community participation, while lack of training, interest and information, along with weak financial sustainability were challenges. Supportive contextual factors included decentralization reforms and engagement with social movements.
CONCLUSION
Despite positive examples, community participation in health systems interventions was variable, with few being truly community directed. Future research should more thoroughly engage with community participation theory, recognize the power relations inherent in community participation, and be more realistic as to how much communities can participate and cognizant of who decides that.
Topics: Community Health Planning; Community Participation; Female; Government Programs; Health Knowledge, Attitudes, Practice; Health Services Accessibility; Humans; Male; Peer Group
PubMed: 26496124
DOI: 10.1371/journal.pone.0141091 -
The Cochrane Database of Systematic... Nov 2021Decision coaching is non-directive support delivered by a healthcare provider to help patients prepare to actively participate in making a health decision. 'Healthcare... (Review)
Review
BACKGROUND
Decision coaching is non-directive support delivered by a healthcare provider to help patients prepare to actively participate in making a health decision. 'Healthcare providers' are considered to be all people who are engaged in actions whose primary intent is to protect and improve health (e.g. nurses, doctors, pharmacists, social workers, health support workers such as peer health workers). Little is known about the effectiveness of decision coaching.
OBJECTIVES
To determine the effects of decision coaching (I) for people facing healthcare decisions for themselves or a family member (P) compared to (C) usual care or evidence-based intervention only, on outcomes (O) related to preparation for decision making, decisional needs and potential adverse effects.
SEARCH METHODS
We searched the Cochrane Library (Wiley), Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid), Embase (Ovid), PsycINFO (Ovid), CINAHL (Ebsco), Nursing and Allied Health Source (ProQuest), and Web of Science from database inception to June 2021.
SELECTION CRITERIA
We included randomised controlled trials (RCTs) where the intervention was provided to adults or children preparing to make a treatment or screening healthcare decision for themselves or a family member. Decision coaching was defined as: a) delivered individually by a healthcare provider who is trained or using a protocol; and b) providing non-directive support and preparing an adult or child to participate in a healthcare decision. Comparisons included usual care or an alternate intervention. There were no language restrictions.
DATA COLLECTION AND ANALYSIS
Two authors independently screened citations, assessed risk of bias, and extracted data on characteristics of the intervention(s) and outcomes. Any disagreements were resolved by discussion to reach consensus. We used the standardised mean difference (SMD) with 95% confidence intervals (CI) as the measures of treatment effect and, where possible, synthesised results using a random-effects model. If more than one study measured the same outcome using different tools, we used a random-effects model to calculate the standardised mean difference (SMD) and 95% CI. We presented outcomes in summary of findings tables and applied GRADE methods to rate the certainty of the evidence.
MAIN RESULTS
Out of 12,984 citations screened, we included 28 studies of decision coaching interventions alone or in combination with evidence-based information, involving 5509 adult participants (aged 18 to 85 years; 64% female, 52% white, 33% African-American/Black; 68% post-secondary education). The studies evaluated decision coaching used for a range of healthcare decisions (e.g. treatment decisions for cancer, menopause, mental illness, advancing kidney disease; screening decisions for cancer, genetic testing). Four of the 28 studies included three comparator arms. For decision coaching compared with usual care (n = 4 studies), we are uncertain if decision coaching compared with usual care improves any outcomes (i.e. preparation for decision making, decision self-confidence, knowledge, decision regret, anxiety) as the certainty of the evidence was very low. For decision coaching compared with evidence-based information only (n = 4 studies), there is low certainty-evidence that participants exposed to decision coaching may have little or no change in knowledge (SMD -0.23, 95% CI: -0.50 to 0.04; 3 studies, 406 participants). There is low certainty-evidence that participants exposed to decision coaching may have little or no change in anxiety, compared with evidence-based information. We are uncertain if decision coaching compared with evidence-based information improves other outcomes (i.e. decision self-confidence, feeling uninformed) as the certainty of the evidence was very low. For decision coaching plus evidence-based information compared with usual care (n = 17 studies), there is low certainty-evidence that participants may have improved knowledge (SMD 9.3, 95% CI: 6.6 to 12.1; 5 studies, 1073 participants). We are uncertain if decision coaching plus evidence-based information compared with usual care improves other outcomes (i.e. preparation for decision making, decision self-confidence, feeling uninformed, unclear values, feeling unsupported, decision regret, anxiety) as the certainty of the evidence was very low. For decision coaching plus evidence-based information compared with evidence-based information only (n = 7 studies), we are uncertain if decision coaching plus evidence-based information compared with evidence-based information only improves any outcomes (i.e. feeling uninformed, unclear values, feeling unsupported, knowledge, anxiety) as the certainty of the evidence was very low.
AUTHORS' CONCLUSIONS
Decision coaching may improve participants' knowledge when used with evidence-based information. Our findings do not indicate any significant adverse effects (e.g. decision regret, anxiety) with the use of decision coaching. It is not possible to establish strong conclusions for other outcomes. It is unclear if decision coaching always needs to be paired with evidence-informed information. Further research is needed to establish the effectiveness of decision coaching for a broader range of outcomes.
Topics: Adult; Anxiety; Child; Family; Female; Health Personnel; Humans; Male; Mentoring; Patient Participation
PubMed: 34749427
DOI: 10.1002/14651858.CD013385.pub2 -
Rural and Remote Health Mar 2023Poor mental health is an under-recognised burden in rural locations. This is evident in suicide rates that are 40% higher in rural communities than in urban ones,...
INTRODUCTION
Poor mental health is an under-recognised burden in rural locations. This is evident in suicide rates that are 40% higher in rural communities than in urban ones, despite a similar prevalence of mental disorders. The level of readiness and engagement of rural communities to adapt or even acknowledge poor mental health can impact effective interventions. For interventions to be culturally appropriate, community engagement should include individuals, their support networks and relevant stakeholders. Community participation guides people living in rural communities to be aware of and take responsibility for community mental health. Community engagement and participation foster empowerment. This review examines how community engagement, participation and empowerment were used in the development and implementation of interventions aimed at improving mental health of adults residing in rural communities.
METHODS
Databases CINAHL, EmCare, Google Scholar, Medline, PsychInfo, PubMed and Scopus were systematically searched from database inception to July 2021. Eligible studies included adults living in a rural cohort where community engagement was used to develop and implement a mental health intervention.
RESULTS
From 1841 records identified, six met the inclusion criteria. Methods were both qualitative and quantitative, including participatory-based research, exploratory descriptive research, community-built approach, community-based initiative and participatory appraisal. Studies were located in rural communities of the USA, UK and Guatemala. Sample size ranges was 6-449 participants. Participants were recruited using prior relationships, project steering committee, local research assistants and local health professionals. All six studies underwent various strategies of community engagement and participation. Only two articles progressed to community empowerment where locals influenced one another independently. The underlying purpose of each study was to improve community mental health. The duration of the interventions ranged from 5 months to 3 years. Studies on the early stages of community engagement discovered a need to address community mental health. Studies where interventions were implemented resulted in improved community mental health.
CONCLUSION
This systematic review found similarities in community engagement when developing and implementing interventions for community mental health. Community engagement should involve adults residing in rural communities when developing interventions - if possible, both with a diverse gender representation and a background in health. Community participation can include upskilling adults living in rural communities and providing appropriate training materials to do so. Community empowerment was achieved when the initial contact with rural communities was through local authorities and there was support from community management. Future use of the strategies of engagement, participation and empowerment could determine if they can be replicated across rural communities for mental health.
Topics: Humans; Adult; Mental Health; Rural Population; Mental Disorders; Community Participation; Health Personnel
PubMed: 36966523
DOI: 10.22605/RRH7438 -
Diabetes Care Sep 2022Physical activity (PA) is a cornerstone of type 2 diabetes mellitus (T2DM) treatment. Sex differences in PA behavior or barriers/facilitators to PA among individuals... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Physical activity (PA) is a cornerstone of type 2 diabetes mellitus (T2DM) treatment. Sex differences in PA behavior or barriers/facilitators to PA among individuals with T2DM are unclear.
PURPOSE
To summarize the evidence related to sex differences in participation in PA and barriers/facilitators to PA among individuals with T2DM across the life span.
DATA SOURCES
Systematic searches (CRD42021254246) were conducted with Ovid MEDLINE, Embase, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Allied and Complementary Medicine Database (AMED), APA PsychInfo, and SPORTDiscus.
STUDY SELECTION
We included studies with assessment of PA, sedentary behaviors (SB), or barriers/facilitators to PA among individuals with T2DM by sex or gender.
DATA EXTRACTION
Participant characteristics, meeting PA guidelines, participation in PA and SB, and barriers/facilitators to PA were extracted by two independent reviewers.
DATA SYNTHESIS
A total of 53 articles (65,344 participants) were included in the systematic review and 21 articles in the meta-analysis. Sex differences were not observed in meeting of PA guidelines among adolescents (odds ratio 0.70 [95% CI 0.31, 1.59]), but males were more likely than females to meet PA guidelines among adults (1.65 [1.36, 2.01]) and older adults (1.63 [1.27, 2.09]). Males performed more moderate-to-vigorous PA (MVPA) than females across all age-groups. Common barriers to PA were lack of time (men) and lack of social support and motivation (women).
LIMITATIONS
Limitations include heterogeneity of measures used to assess PA and lack of stratification of data by sex.
CONCLUSIONS
Sex differences in meeting PA guidelines were not observed among adolescents but were apparent among adults and older adults with T2DM. Females consistently engaged in less MVPA than males across the life span.
Topics: Adolescent; Aged; Diabetes Mellitus, Type 2; Exercise; Female; Humans; Longevity; Male; Sedentary Behavior; Sex Characteristics
PubMed: 36044665
DOI: 10.2337/dc22-0576 -
PloS One 2023Women from Black, Asian and mixed ethnicity backgrounds in the UK experience higher rates of maternal and neonatal mortality and morbidity, and report poorer experiences...
BACKGROUND
Women from Black, Asian and mixed ethnicity backgrounds in the UK experience higher rates of maternal and neonatal mortality and morbidity, and report poorer experiences of maternity care. Research is required to understand how to reduce these disparities, however, it is acknowledged these groups of women are under-represented in clinical research.
AIM
To investigate factors which influence participation in maternity research for women from an ethnic minority background.
METHODS
A systematic review was conducted to examine influencing factors for research participation. MEDLINE/CINHAL/PsycInfo/EMBASE databases were systematically searched in March 2021 and updated in March 2022. Papers were eligible if they explored maternal research participation and identified a woman's ethnicity in the results. No restrictions were placed on methodology. A convergent integrated approach was used to synthesise findings.
FINDINGS
A total of 14 papers met the inclusion criteria. Results were divided into eight overarching themes. A personalised approach to recruitment and incorporating culturally sensitive communication and considerations enhanced research participation. Distrust around sharing data, a perception of risk to research participation, and research lacking in personal relevance adversely affected the decision to participate. Large variation existed in the quality of the studies reviewed.
CONCLUSIONS
Consideration of a woman's culture and background in the design and the delivery of a maternity research study may facilitate participation, particularly when sampling from a specific population. Further research, informed by women from ethnic minority backgrounds is warranted to develop women-centred recommendations for conducting inclusive maternity research. Prospero registration: www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42021261686.
Topics: Infant, Newborn; Humans; Female; Pregnancy; Ethnicity; Minority Groups; Ethnic and Racial Minorities; Maternal Health Services; Obstetrics; Qualitative Research
PubMed: 36827386
DOI: 10.1371/journal.pone.0282088