gamified sleep intervention for veterans: an overview

A good night’s sleep is well known to be imperative for maintaining one’s overall wellness. Yet, about half of Canadian adults struggle with falling asleep or maintaining sleep. The impacts of insufficient sleep are wide-ranging, from physiological correlates such as diabetes to mental correlates such as depression. Effective treatments for sleep-related issues exist: for example, online interventions for insomnia have been found to be effective. As a medicine and a health psychology student at, respectively, Sherbrooke University and McGill University, we worked on the MissionVAV health promotion program during the COVID-19 pandemic, providing free gamified interventions for Canadian Veterans and their families. Over the course of several online interventions related to physical health, we observed that a large proportion of our participants were dissatisfied with their sleep. Consequently, we have developed an 8-week online sleep intervention to address this primordial element of primary prevention. The intervention aims to better our participants’ sleep through providing weekly readings on the following topics: age-related changes in sleep, proper sleep hygiene, varied relaxation techniques as well as the relationship between sleep and chronic pain, menopause, shift work, rumination, exercise and light. To promote healthy sleep hygiene habits, daily self-assessment questions are provided and are incentivized through points and storytelling. Furthermore, health coaches trained in sleep medicine follow participants throughout their journey to provide support and reinforcement. Ultimately, the intervention aims to shed light on the importance of sleep within preventative medicine, tackling it systematically in an engaging, gamified fashion.

Online health promotion program and individualized health coaching for veteran wellbeing

The pandemic has highlighted the need for accessible and effective health promotion as Canadians are isolated from their communities during social distancing measures. A web-based health promotion program in which participants also received individualized email-based health coaching from medical students has been available during the pandemic to empower veterans and their family members to engage in healthy lifestyle change. Health coaches’ email interactions with participants used techniques of motivational interviewing, including an empathetic style, statements of affirmation, and reflections. Open-ended questions were useful in gaining insight into the participant’s current lifestyle, including habits, challenges, and coping strategies. As services have transitioned online and individuals have become more isolated, the connection formed between online health coaches and individuals participating in the health promotion program became crucial in countering the mental and physical health repercussions of the pandemic. In a preliminary analysis, we show that web-based health promotion with health coaching, for Canadian Veterans and their families, leads to significant weight loss, increased activity and improvement in wellbeing metrics such as sleep and stress. The medical students acting as health coaches were able to gain a deeper understanding of the challenges involved in behaviour change, something that is seldom covered in detail in the medical school curricula. Medical students were also able to practice their motivational counseling skills surrounding lifestyle changes. Given the lack of available evidence for web-based health promotion that targets veterans and their families, these preliminary results appear promising, with longer-term follow-up planned for the next two years.

Pilot Evaluation of the Impact of Lottery-Based Incentives on Engagement Levels of Male Low SES Vocational Students With an mHealth App

In general, individuals with lower socioeconomic status (SES) are less physically active and adhere to poorer diets than higher SES individuals. To promote healthier lifestyles in lower SES populations, we hosted a digital health promotion program among male vocational students at a school in The Netherlands. In a pilot study, we evaluated whether this target audience could be engaged with an mHealth app using lottery-based incentives that trigger feelings of anticipated regret. Especially, we studied the social and interpersonal aspects of regret lotteries in a within-subject experimental design. In this design, subjects either participated in a social variant (i.e., with students competing against their peers for a chance at a regret lottery), or an individual variant (i.e., with subjects solely individually engaged in a lottery). Additionally, we studied the impact of different payout schedules in a between-subject experimental design. In this design, participants were assigned to either a short-term, low-value payout schedule, or a long-term, high-value payout schedule. From a population of 72 male students, only half voluntarily participated in our 10-week program. From interviews, we learned that the main reason for neglecting the program was not related to the lottery-based incentives, nor to the prizes that were awarded. Instead, non-enrolled subjects did not join the program, because their peers were not joining. Paradoxically, it was suggested that students withheld their active participation until a larger portion of the sample was actively participating. From the subjects that enrolled in the program (N = 36, males, between 15 and 25 years of age), we found that a large proportion stopped interacting with the program over time (e.g., after roughly 4 weeks). Our results also indicated that students performed significantly more health-related activities when assigned to the social regret lottery, as opposed to the individual variant. This result was supported by interview responses from active participants: They mainly participated to compete against their peers, and not so much for the prizes. Hence, from this study, we obtained initial evidence on the impact of social and competitive aspects in lottery-based incentives to stimulate engagement levels in lower SES students with an mHealth app.

Pathways to Employee Outcomes in a Workplace Health Promotion Program

Purpose This study examined the relationship between employee outcomes and employer implementation of evidence-based interventions (EBIs) for chronic disease prevention. Design Cross-sectional samples collected at 3 time points in a cluster-randomized, controlled trial of a workplace health promotion program to promote 12 EBIs. Setting King County, WA. Sample Employees of 63 small, low-wage workplaces. Measures Employer EBI implementation; 3 types of employee outcomes: perceived implementation of EBIs; perceived employer support for health; and health-related behaviors, perceived stress, depression risk, and presenteeism. Analysis Intent-to-treat and correlation analyses using generalized estimating equations. We tested bivariate associations along potential paths from EBI implementation, through perceived EBI implementation and perceived support for health, to several employee health-related outcomes. Results The intent-to-treat analysis found similar employee health-related behaviors in intervention and control workplaces at 15 and 24 months. Workplaces implemented varying combinations of EBIs, however, and bivariate associations were significant for 4 of the 6 indicators of physical activity and healthy eating, as well as perceived stress, depression risk, and presenteeism. We did not find significant positive associations for cancer screening and tobacco cessation. Conclusion Our findings support broader dissemination of EBIs for physical activity and healthy eating, as well as more focus on improving employer support for employee health. They also suggest we need better interventions for cancer screening and tobacco cessation.

ANALYSIS OF THE PREVALENCE OF ALCOHOL CONSUMPTION IN HYPERTENSION PATIENTS AT THE GLENO INPATIENT PUBLIC HEALTH CENTER ERMERA MUNICIPALITY, TIMOR-LESTE

Background; Arterial hypertension is a chronic disease where the blood pressure in the arteries is persistently above the normal value (systolic pressure > 140 mmHg or diastolic pressure is > 90 mmHg). The worldwide number of hypertension deaths reaches 9.4 million deaths. Hypertension data recorded at Gleno Inpatient Health Centre (IHC) in 2019 reaches 810 patients. Objective; This study aimed to analysis on alcohol consumption with prevalence of hypertension. Methods; This quantitative research used correlation approach, the samples were the patients who make an appointment and intern in Gleno IHC, the sampling technique was non-probability, the purposive sampling technique based of the inclusion criteria and the instrument was a questionnaire. Results; Sample size on study were 46 respondents. Based on the results of correlation statistical analysis Spearman Rank indicates the p-value was 0.001, which is lower than 0.05. This test showed a significant relationship between the consumption of alcohol with the occurrence of hypertension in Gleno IHC. Never the less, the result of the correlation test (r) was 0.473. Which means having the most high impact of alcohol consumption with an opportunity of 0.473 times. Which result in the most severe hypertension disease in Gleno IHC. Conclusion; This research indicated that the relationship is positive and significant between the alcohol consumption and the prevalence of hypertension in Gleno Inpatient Health Centre, municipality of Ermera. This result can be used as a good input to improve the health promotion program and better service for hypertension patients at this health centre.

Efficacy of an Enhanced Implementation Strategy to Increase Parent Engagement with a Health Promotion Program in Childcare

Previous efforts to involve parents in implementation of childcare-based health promotion interventions have yielded limited success, suggesting a need for different implementation strategies. This study evaluated the efficacy of an enhanced implementation strategy to increase parent engagement with Healthy Me, Healthy We. This quasi-experimental study included childcare centers from the second of two waves of a cluster-randomized trial. The standard approach (giving parents intervention materials, prompting participation at home, inviting participation with classroom events) was delivered in 2016–2017 (29 centers, 116 providers, and 199 parents). The enhanced approach (standard plus seeking feedback, identifying and addressing barriers to parent participation) was delivered in 2017–2018 (13 centers, 57 providers, and 114 parents). Parent engagement was evaluated at two levels. For the center-level, structured interview questions with providers throughout the intervention were systematically scored. For the parent-level, parents completed surveys following the intervention. Differences in parent engagement were evaluated using linear regression (center-level) and mixed effects (parent-level) models. Statistical significance was set at p < 0.025 for two primary outcomes. There was no difference in parent engagement between approaches at the center-level, β = −1.45 (95% confidence interval, −4.76 to 1.87), p = 0.38l. However, the enhanced approach had higher parent-level scores, β = 3.60, (95% confidence interval, 1.49 to 5.75), p < 0.001. In the enhanced approach group, providers consistently reported greater satisfaction with the intervention than parents (p < 0.001), yet their fidelity of implementing the enhanced approach was low (less than 20%). Results show promise that parent engagement with childcare-based health promotion innovations can positively respond to appropriately designed and executed implementation strategies, but strategies need to be feasible and acceptable for all stakeholders.

What Are the Characteristics of the Parish Nursing Research Literature and How Can it Inform Parish Nurse Practice and Research in Canada? A Scoping Review

Background Parish nursing is a specialized branch of professional nursing that promotes health and healing by integrating body, mind and spirit as a practice model. Parish nurses contribute to the Canadian nursing workforce by promoting individual and community health and acting as system navigators. Research related to parish nursing practice has not been systematically collated and evaluated. Purpose This review seeks to explore, critically appraise and synthesize the parish nurse (PN) research literature for its breadth and gaps, and to provide recommendations for PN practice and research. Methods A scoping review was conducted using Levac and colleagues’ procedures and Arksey and O’Malley's enhanced framework. The CINAHL, ProQuest and PubMed databases were comprehensively searched for original research published between 2008 and 2020. The final sample includes 43 articles. The Mixed Methods Appraisal Tool was used to critically assess literature quality. Results There is a significant gap in PN research from Canada and non-U.S. countries. Methodological quality is varied with weak overall reporting. The literature is categorized under three thematic areas: (1) practice roles of the PN, (2) role implementation, and (3) program evaluation research. Research that evaluates health promotion program interventions is prominent. Conclusions More rigorous research methods and the use of reporting checklists are needed to support evidence-informed parish nursing practice. Building relationships among parish nurses, nursing researchers and universities could advance parish nursing research and improve evidence-based parish nursing practice. Research into the cost effectiveness, healthcare outcomes, and the economic value of PN practice is needed.

A brief, daily, online mental health and wellbeing intervention for university staff during the COVID-19 pandemic: Program description and outcomes using a mixed methods design (Preprint)

BACKGROUND The unprecedented changes and isolation measures to contain the coronavirus disease (COVID-19) have had multiple psychological and social impacts, with implications for professional and personal functioning. Evidence-informed interventions that can be rapidly implemented under pandemic conditions to support mental health during such times were urgently needed. OBJECTIVE This study aimed to determine the acceptability and preliminary outcomes of a daily online mental health promotion program for tertiary education staff during the COVID-19 pandemic. METHODS The ‘VU Elevenses’ program was delivered as an uncontrolled intervention at Victoria University (VU) in the western metropolitan region of Melbourne, Australia. In April 2020, an email invitation was sent to all academic and professional staff inviting them to: 1) participate in the program; and 2) opt-in to the research component. The ‘VU Elevenses’ program provided 10-15-minute micro-interventions comprising lifestyle and wellbeing strategies to promote mental health, via an online meeting platform, at 11am each weekday. A mixed-method approach was used to evaluate the program, combining structured questionnaires with semi-structured interviews to investigate the experiences of staff who participated in the program. RESULTS Between 16-90 participants provided weekly program feedback. A total of 106 university staff opted into the longitudinal research component and 10 staff participated in the interviews. Participants reported high levels of satisfaction with sessions and perceived benefits for mental health. Approximately one quarter of participants reported moderate to severe symptoms of depression, anxiety, and stress at baseline, with significant reductions in these symptoms in the first seven weeks of the program, corresponding with easing in mandatory isolation (‘lockdown’) restrictions. However, symptoms of depression, anxiety and stress all increased when lockdown measures were reintroduced, but not to the same levels as the initial lockdown period. Overall changes in depression and anxiety from baseline to the end of the program were explained by changes in COVID related distress, whereas changes in self-compassion explained changes in stress. CONCLUSIONS We show that it is feasible and acceptable to develop and deliver a program of brief interventions in a timely manner, using a simple and accessible online platform. Although participation in the program was initially associated with reduced symptoms of depression, anxiety and stress, participants’ mental health worsened with the reintroduction of a ‘lockdown’ period. However, as symptoms of depression, anxiety and stress did not return to levels observed at the start of the VU Elevenses program, participation in the uncontrolled intervention may have offered a protective benefit against the impact of the second significant lockdown period. CLINICALTRIAL N/A