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Objective: Due to global urbanization, technological advancements, and increasing convenience in daily activities, reduced energy expenditure in all aspects of life has become a major public health concern. A positive physical activity (PPA) intervention was developed to promote physical activity and fitness among Hong Kong families. PPA utilizes positive affective attitudes to circumvent barriers to health behavior change by helping families associate feelings of enjoyment with physical activity. Zero-Time Exercise (ZTEx) was introduced and promoted as a foot-in-the-door approach., Method: Using a community-based collaborative approach, the research team worked with social service organizations, a government department, and schools to implement a cluster randomized controlled crossover trial at a citywide scale. A total of 1,983 eligible participants from 1,467 families were recruited from all 18 districts in Hong Kong. Data were collected using structured questionnaires and physical fitness assessments at preintervention and 1-month and 3-month follow-up., Results: PPA was effective in increasing ZTEx and ZTEx with family members at 1-month and 3-month follow-up and in improving balance and endurance at 3-month follow-up. Semistructured focus groups provided further support for the intervention effectiveness and added in-depth insights into the participants' motivational, interpersonal, and affective experiences., Conclusion: The results not only shed light on the intervention's effectiveness for physical activity and fitness but also demonstrated that the community-based collaborative approach was successful in engaging relevant stakeholders in an active and fruitful partnership with effective capacity building for program development. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

A brief intervention using Zero-time Exercise (ZTEx), a foot-in-the-door approach, was developed to reduce sedentary behaviour and increase physical activity. ZTEx refers to the integration of simple strength- and stamina-enhancing physical activity into daily life, which can be done anytime, anywhere and by anyone. This paper presents the development, feasibility, and preliminary evidence for the effectiveness of this intervention under the Hong Kong Jockey Club FAMILY Project. Needs assessments were conducted with social workers from the Christian Family Services Center(CFSC) and the Social Welfare Department (SWD). This single group prospective ZTEx intervention trial, guided by the Health Action Process Approach, included a 3-hr core session at baseline and a 1-hr booster session at 1-month follow-up. Fifty-six participants (social and service-related workers) from CFSC (n = 28) and SWD (n = 28) received the intervention and completed the self-administered questionnaires at baseline. Forty-nine and 43 participants completed the 1-month and 3-month self-administered questionnaires, respectively. Fifteen participants attended the focus group interviews to share their feedback on ZTEx intervention after implementing their community-based ZTEx activities. Intention-to-treat analysis was conducted with missing data replaced by baseline values. Participants reported significant decreases in sitting time by 27 (2, 52) minutes (mean [95% confidence interval]) and 36 (0.2, 71) minutes on a weekday, increases in physical activity while seated by 0.7 (0.2, 1.4) days and 1.1 (0.6, 1.7) days in a week, and improvements in perceived knowledge, outcome expectancies and plan on doing ZTEx at the 1-month and 3-month follow-up, respectively. Balance and muscle strength significantly improved at the 1-month follow-up. The effect ranged from small to large (Cohen's d: 0.27-1.05, all p < 0.05). The qualitative feedbacks support the quantitative findings. Our findings show early evidence that ZTEx effectively reduced sedentary behaviour and enhanced physical activity and fitness. Further trials on this simple and low-cost intervention as the first step to promote higher intensity exercise are warranted., (© 2019 John Wiley & Sons Ltd.)

To ease the shortage of professionals, lay volunteers were trained to become health promoters and role models for a large community program to enhance physical activity, well-being, and neighborhood cohesion in socioeconomically disadvantaged groups in Hong Kong. This study aimed to examine the effects on health promoters (trainees) and the feasibility and acceptability of capability-building train-the-trainer workshops (TTTs) using Zero-time Exercise (ZTEx) to implement a community program for about 1,000 participants. A four-session (totally 8 hours) TTT introduced an evidence-based ZTEx intervention to enhance physical activity and well-being, and build capacity for community program implementation. Twenty-eight trainees actively participated in the TTT. Twenty-five and 21 trainees completed the 1- and 3-month questionnaires, respectively. Eleven trainees attended the 1-year focus group interview. Repeated measures analysis of variance and Friedman test were used to compare the parametric and nonparametric data, respectively. Qualitative data were analyzed using thematic content analysis. The trainees reduced their sedentary behavior and improved their interpersonal communication skills, knowledge, and attitude toward ZTEx, grip strength, balance, and perceived well-being. The community participants reported improvements in neighborhood cohesion and grip strength. The 1-year qualitative results supported the 3-month quantitative findings. This brief and innovative TTT affirmed the feasibility of using ZTEx and the role modeling approach for lay health promoters to reduce sedentary behavior and enhance physical activity, fitness, and well-being. They then contributed to the successful implementation of community programs that benefited many. This study provides a new model for building capacity for health promotion in the community.

Health information and communication technologies (ICTs) are increasingly used but little is known about routine exposure to health information from ICTs and its associations with health behaviors. A territory-wide population-based dual landline and mobile telephone survey was conducted in 2016 in Hong Kong, where smartphone ownership and Internet access are among the most prevalent, easiest and fastest in the world. Health information exposure from traditional sources (television/radio/newspaper/magazine), Internet websites, social media sites and instant messaging (IM); and information on smoking, alcohol consumption and physical activity were recorded. Prevalence was weighted by age, sex and education level of the general population. Multinomial logistic regression was used to assess the association of health information exposure with smoking and alcohol consumption, whilst multivariable linear regression was used to assess the association with frequency of moderate and vigorous physical activity (days/week). Of 3063 respondents, most (71.6%) were often or sometimes exposed to health information from traditional sources, followed by Internet websites (40.9%), social media sites (40.7%), and IM (27.0%). Respondents with lower education and household income were less frequently exposed to health information from Internet websites, social media sites and IM (all P < 0.001). Health information exposure from IM was associated with being never smokers, and more frequent moderate and vigorous physical activity (all P for trend <0.05). Health information exposure from IM was least frequent but associated with healthier behaviors. Further public health education campaigns can consider using IM to deliver information, particularly to disadvantaged groups., (Copyright © 2018 Elsevier Inc. All rights reserved.)

This paper presents the development and evaluation of the train-the-trainer (TTT) workshop for lay resident leaders to be lay health promoters. The TTT workshop aimed to prepare the trainees to implement and/or assist in conducting a series of community-based family well-being activities for the residents in a public low rent housing estate, entitled "Learning Families Project", under the FAMILY project. The four-hour TTT workshop was conducted for 32 trainees (72% women, 43% aged ≥ 60, 41% ≤ elementary school education). The workshop aimed to promote trainees' knowledge, self-efficacy, attitude and practice of incorporating the positive psychology themes into their community activities and engaging the residents to join these activities and learn with their family members. Post-training support was provided. The effectiveness of the TTT was examined by self-administered questionnaires about trainees' reactions to training content, changes in learning and practice at three time points (baseline, and immediately and one year after training), and the difference in residents' survey results before and after participating in the community activities delivered by the trainees. The trainees' learning about the general concepts of family well-being, learning family, leadership skills and planning skills increased significantly with medium to large effect sizes (Cohen's d: 0.5-1.4) immediately after the training. The effects of perceived knowledge and attitude towards practice were sustained to one year (Cohen's d: 0.4-0.6). The application of planning skills to implement community activities was higher at one year (Cohen's d: 0.4), compared with baseline. At one year, the residents' survey results showed significant increases in the practice of positive communication behaviours and better neighbour cohesions after joining the family well-being activities of LFP. Qualitative feedback supported the quantitative results. Our TTT workshop could serve as a practical example of development and evaluation of training programs for lay personnel to be lay health promoters., Trial Registration: ClinicalTrials.gov NCT02844244.

Families are often faced with long working hours and stressful urban lifestyles which adversely affect family well-being. The Happy Family Kitchen Movement project, which emphasized the interaction and integration of physical health and psychosocial health, was conducted to promote well-being and health in Hong Kong families. Social workers and teachers from 54 social service units and schools in collaboration with the research team designed and implemented a brief community-based family "holistic health" intervention for 1983 individuals from 1467 families. In a 3-arm cluster randomized controlled trial, participants were allocated into positive physical activity (PPA), positive healthy diet (PHD), or control group. The positive psychology framework, which encompassed joy, gratitude, and savoring, was used to help families build positive attitudes with stronger motivation to engage in health promotion behaviors. Data were collected at pre-intervention, immediately post-intervention, and at 1-month and 3-month follow-up. Results showed that compared to the control, PPA was effective in improving subjective happiness at immediately post-intervention and PHD was effective in promoting family harmony at 1-month and subjective happiness at 3-month, with small effect size. Both PPA and PHD showed some evidence of effectiveness on mental quality of life at 3-month. Participants' evaluation of the program provided evidence for the perceived usefulness of PPA and PHD. Qualitative data provided additional support for program effectiveness with in-depth insights into the participants' experiences. These two innovative brief interventions could be a viable, attractive and low cost approach for promoting family "holistic health" in community settings. [ABSTRACT FROM AUTHOR]

Evidence-based practice and capacity-building approaches are essential for large-scale health promotion interventions. However, there are few models in the literature to guide and evaluate training of social service workers in community settings. This paper presents the development and evaluation of the “train-the-trainer” workshop (TTT) for the first large scale, community-based, family intervention projects, entitled “Happy Family Kitchen Project” (HFK) under the FAMILY project, a Hong Kong Jockey Club Initiative for a Harmonious Society. The workshop aimed to enhance social workers’ competence and performance in applying positive psychology constructs in their family interventions under HFK to improve family well-being of the community they served. The two-day TTT was developed and implemented by a multidisciplinary team in partnership with community agencies to 50 social workers (64% women). It focused on the enhancement of knowledge, attitude, and practice of five specific positive psychology themes, which were the basis for the subsequent development of the 23 family interventions for 1419 participants. Acceptability and applicability were enhanced by completing a needs assessment prior to the training. The TTT was evaluated by trainees’ reactions to the training content and design, changes in learners (trainees) and benefits to the service organizations. Focus group interviews to evaluate the workshop at three months after the training, and questionnaire survey at pre-training, immediately after, six months, one year and two years after training were conducted. There were statistically significant increases with large to moderate effect size in perceived knowledge, self-efficacy and practice after training, which sustained to 2-year follow-up. Furthermore, there were statistically significant improvements in family communication and well-being of the participants in the HFK interventions they implemented after training. This paper offers a practical example of development, implementation and model-based evaluation of training programs, which may be helpful to others seeking to develop such programs in diverse communities. [ABSTRACT FROM AUTHOR]