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Highlights from the article: Message From the Co-Guest Editors: Scholarship of Teaching and Learning in Public Health Education in Australasia The Council of Academic Public Health Institutions Australasia (CAPHIA) is the umbrella organization representing public health in universities throughout Australia, New Zealand, and surrounding island nations (referred to as Australasia [see [1]]). In addition to orienting a global audience to public health higher education in Australasia, [7] highlight the need for renewed efforts in evaluating undergraduate public health education across the region and raise the important issue of accreditation standards.

Introduction: Primary care physicians are well placed to offer physical activity counseling, but insufficient time is a barrier. Referral to an exercise specialist is an alternative. In Australia, exercise specialists are publicly funded to provide face-to-face counseling to patients who have an existing chronic illness. This trial aimed to (1) determine the efficacy of primary care physicians' referral of insufficiently active patients for counseling to increase physical activity, compared with usual care, and (2) compare the efficacy of face-to-face counseling with counseling predominantly via telephone.Study Design: Three-arm pragmatic RCT.Setting/participants: Two hundred three insufficiently active (<7,000 steps/day) primary care practice patients (mean age 57 years; 70% female) recruited in New South Wales, Australia, in 2011-2014.Intervention: (1) Five face-to-face counseling sessions by an exercise specialist, (2) one face-to-face counseling session followed by four telephone calls by an exercise specialist, or (3) a generic mailed physical activity brochure (usual care). The counseling sessions operationalized social cognitive theory via a behavior change counseling framework.Main Outcome Measures: Change in average daily step counts between baseline and 12 months. Data were analyzed in 2016.Results: Forty (20%) participants formally withdrew; completion rates at 3 and 6 months were 64% and 58%, respectively. Intervention attendance was high (75% received five sessions). The estimated mean difference between usual care and the combined intervention groups at 12 months was 1,002 steps/day (95% CI=244, 1,759, p=0.01). When comparing face-to-face with predominantly telephone counseling, the telephone group had a non-significant higher mean daily step count (by 619 steps) at 12 months.Conclusions: Provision of expert physical activity counseling to insufficiently active primary care patients resulted in a significant increase in physical activity (approximately 70 minutes of walking per week) at 12 months. Face-to-face only and counseling conducted predominantly via telephone were both effective. This trial provides evidence to expand public funding for expert physical activity counseling and for delivery via telephone in addition to face-to-face consultations.Trial Registration: This trial is registered at www.anzctr.org.au/ ACTRN12611000884909. [ABSTRACT FROM AUTHOR]

Background: Participation in physical activity can improve the health outcomes of breast cancer survivors. To impact public health, broad-reaching sustainable interventions that promote physical activity are needed. Purpose: To evaluate the efficacy of two distance-based interventions for promoting physical activity among breast cancer survivors compared with a standard recommendation control. Methods: Breast cancer survivors who had finished 'active' cancer treatment were eligible to participate. Participants (n = 330) were randomly assigned to receive one of the following maildelivered interventions: three computer-tailored newsletters, a previously developed breast cancerspecific physical activity booklet or a pamphlet detailing the public health recommendations for physical activity (control). Primary outcomes were self-reported moderate to vigorous aerobic activity and participant's self-reported resistance training activity at 4 months post-baseline. Secondary outcomes were pedometer step counts, whether or not participants were meeting the physical activity guidelines, time spent in sedentary behaviour, fatigue and health-related quality of life. Results: Participants randomised into the tailored-print intervention group were three times more likely to commence resistance training and meet the resistance-training guidelines immediately after the intervention than participants allocated to the control group. There were no other significant intervention effects. Conclusion: Computer-tailored newsletters may be an effective strategy for enhancing resistancebased physical activity among breast cancer survivors. The null findings relating to other outcomes may be due to ceiling effects (in the case of aerobic activity, fatigue and health-related quality of life) or the sensitivity of the measure used (in the case of sitting time). These issues require further exploration. [ABSTRACT FROM AUTHOR]

Objective Several physical activity interventions have been effective in improving the health outcomes of breast cancer survivors. However, few interventions have provided detailed descriptions regarding how such interventions work. To develop evidence-based practice in this field, detailed descriptions of intervention development and delivery is needed. This paper aims to (1) describe the theory-and evidence-based development of the Move More for Life program, a physical activity program for breast cancer survivors; and (2) serve as an exemplar for theory-based applied research. Method The program-planning model outlined by Kreuter and colleagues was used to develop the computer-tailored intervention. Results The tailoring guide developed by Kreuter and colleagues served as a useful program planning tool in terms of integrating theory and evidence-based best practice into intervention strategies. Overall, participants rated the intervention positively, with the majority reporting that the tailored materials caught their attention, were personally relevant to them, and were useful for helping them to change their behaviour. However, there was considerable room for improvement. Conclusion The Move More for Life program is an example of a theory-based, low-cost and potentially sustainable strategy to physical activity promotion and may stand as an exemplar for Social Cognitive Theory-based applied research. By providing a detailed description of the development of the Move More for Life program, a critical evaluation of the working mechanisms of the intervention is possible, and will guide researchers in the replication or adaption and re-application of the specified techniques. This has potential implications for researchers examining physical activity promotion among cancer survivors and for researchers exploring distance-based physical activity promotion techniques among other populations. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Describe the socio-demographic/medical correlates of the use of biologically based complementary and alternative medicines (BBCAM) amongst a heterogeneous sample of recent cancer survivors. Method: Cross-sectional analysis was undertaken on the baseline data of a population-based longitudinal study conducted in New South Wales and Victoria, Australia (2006–2008) of cancer survivors 6months post diagnosis. Participants (n =1323) completed a self-report survey assessing socio-demographic/medical characteristics and use of BBCAM (dietary supplements or vitamins, herbal treatments, and special diets). Results: Twenty-seven percent of respondents (n =349) reported using at least one BBCAM to help manage their cancer and related symptoms. Nutritional supplements and vitamins were the most commonly reported BBCAM (23%). Correlates of BBCAM use included cancer type (bowel [OR=3.3; CI:1.8–5.9], breast [OR=2.4; CI:1.4–4.1], head and neck [OR=3.8; CI: 2.0–7.2], haematological [OR=2.0; CI: 1.1–3.7], prostate [OR=1.8; CI: 1.0–3.9] versus melanoma), education level (university degree [OR=1.6; CI:1.1–2.3] versus secondary school) and treatment types (chemotherapy [OR=2.0; CI:1.4–2.7] versus not, bone marrow/stem cell transplant/immunotherapy [OR=2.3; CI:1.2–4.4] versus not). Conclusion: Providers should openly discuss the use of complementary and alternative therapies with all cancer patients, and given potential safety concerns, be proactive in exploring BBCAM use among the subgroups of survivors identified in this study. [ABSTRACT FROM AUTHOR]

Background: Due to early detection and advances in treatment, the number of women surviving breast cancer is increasing. Whilst there are many positive aspects of improved survival, breast cancer survival is associated with many long-term health and psychosocial sequelae. Engaging in regular physical activity post-diagnosis can reduce this burden. Despite this evidence, the majority of breast cancer survivors do not engage in regular physical activity. The challenge is to provide breast cancer survivors with appealing and effective physical activity support in a sustainable and cost-effective way. This article describes the protocol for the Move More for Life Study, which aims to assess the relative efficacy of two promising theory-based, print interventions designed to promote regular physical activity amongst breast cancer survivors. Method and design: Breast cancer survivors were recruited from across Australia. Participants will be randomised into one of three groups: (1) A tailored-print intervention group, (2) a targeted-print intervention group, or (3) a standard recommendation control group. Participants in the tailored-print intervention group will receive 3 tailored newsletters in the mail over a three month period. Participants in the targeted-print group will receive a previously developed physical activity guidebook designed specifically for breast cancer survivors immediately after baseline. Participants in the standard recommendation control will receive a brochure detailing the physical activity guidelines for Australian adults. All participants will be assessed at baseline, and at 4 and 10 months post-baseline. Intervention efficacy for changing the primary outcomes (mins/wk aerobic physical activity; sessions/exercises per week resistance physical activity) and secondary outcomes (steps per day, health-related quality life, compliance with physical activity guidelines, fatigue) will be assessed. Mediation and moderation analyses will also be conducted. Discussion: Given the growing number of cancer survivors, distance-based behaviour change programs addressing physical activity have the potential to make a significant public health impact. Trial registration: Australian New Zealand Clinical Trials Registry (ANZCTR) identifier: ACTRN12611001061921 [ABSTRACT FROM AUTHOR]

Background: The Exercise and Nutrition Routine Improving Cancer Health (ENRICH) study is investigating a novel lifestyle intervention aimed at improving the health behaviors of adult cancer survivors and their carers. The main purpose of the study is to determine the efficacy of lifestyle education and skill development delivered via groupbased sessions on the physical activity and dietary behaviors of participants. This article describes the intervention development, study design, and participant recruitment. Methods/Design: ENRICH is a randomized controlled trial, conducted in Australia, with two arms: an intervention group participating in six, two-hour face-to-face sessions held over eight weeks, and a wait-list control group. Intervention sessions are co-facilitated by an exercise physiologist and dietician. Content includes healthy eating education, and a home-based walking (utilizing a pedometer) and resistance training program (utilizing elastic tubing resistance devices). The program was developed with reference to social cognitive theory and chronic disease self-management models. The study population consists of cancer survivors (post active-treatment) and their carers recruited through community-based advertising and referral from health professionals. The primary outcome is seven-days of sealed pedometry. Secondary outcomes include: self-reported physical activity levels, dietary intake, sedentary behavior, waist circumference, body mass index, quality of life, and perceived social support. The outcomes will be measured at baseline (one week prior to attending the program), eight-weeks (at completion of intervention sessions), and 20-weeks. The intervention group will also be invited to complete 12-month follow-up data collection. Process evaluation data will be obtained from participants by questionnaire and attendance records. Discussion: No trials are yet available that have evaluated the efficacy of group-based lifestyle education and skill development amongst mixed groups of cancer survivors and their carers. The results will have implications for the planning and provision of health and support services during the cancer survivorship phase. [ABSTRACT FROM AUTHOR]

Changes in the higher education sector over the past decade have led to increasing demands on academics and resulted in increasing workloads, longer work hours and increased workplace stress. Declining government commitment to university funding has placed increasing pressure on academics to attract research funding and to publish. In addition, an individual academic's publication record is a core criterion for decisions regarding promotion and tenure at most universities. However, incentives to support and enable that writing to take place have been limited. A range of different interventions have been described in the literature to enhance research output and encourage academics to publish. However, many are expensive in terms of the financial and personal costs involved, when compared with the increased publication outputs. In this article the authors reflect on how their small university department facilitated on-site writing retreats that increased publication output, with minimal disruption and limited costs. They provide a reflective account of two such retreats conducted over a twelve-month period and make recommendations for other departments wishing to adopt a similar approach. [ABSTRACT FROM AUTHOR]

There is a growing awareness that undertaking qualitative research is an embodied experience and that researchers may be emotionally affected by the work that they do. Despite the interest in the emotional nature of qualitative research, there is very little empirical evidence about the researchers' experiences of undertaking qualitative research. A grounded theory analysis of one-on-one interviews with thirty public health researchers working on a qualitative project provided both theoretical and empirical evidence that qualitative researchers undertake emotion work throughout their research projects. The findings provide examples of researchers doing emotion work in their research projects; highlight some of the consequences of emotion work and offer some suggestions for researcher self-care. [ABSTRACT FROM AUTHOR]

Background: Hysterectomy is a common procedure in Australia; approximately 1 in 5 Australian women undergoing a hysterectomy by the age of 50 for indications such as fibroids, disorders of menstruation (including excessive or irregular menstrual bleeding), and endometriosis. However, little is known about the characteristics of women who have had the procedure or the predictors of hysterectomy as a treatment for menstrual problems. This study of 687 middle-aged Australian women suffering from menstrual symptoms aimed to identify the common health and demographic characteristics that were likely to lead to hysterectomy for the treatment of these problems. Methods: A cross-sectional and a prospective cohort study were undertaken as a substudy of the Australian Longitudinal Study on Women''s Health (Women''s Health Australia). Women from the mid-aged cohort of the Women''s Health Australia study who identified having menstrual problems (n = 715) in the 1996 and 1998 surveys or who had undergone a hysterectomy (n = 218) during that time were recruited. A self-administered instrument was mailed to the 933 women in 2000. Data were analyzed using backward logistic regression to identify the characteristics that increased the likelihood of women undergoing hysterectomy for the treatment of menstrual problems. Results: Factors that increased the likelihood of hysterectomy as a treatment for menstrual problems were varied. They included the number of menstrual symptoms experienced (odds ratio [OR], 1.63; p < .005) or conditions diagnosed (such as fibroids or excessive menstrual bleeding; OR, 2.5; p < .0005), a perception that information was available about menstrual problems (OR, 1.16; p < .001), being influenced in the decision making process to elect a treatment option (OR, 1.25; p < .025), and dissatisfaction with the other treatments tried before hysterectomy (OR, 0.63; p < .0005). Conclusions: Hysterectomy seem to be the treatment of choice for women experiencing a number of menstrual problems and less than satisfactory outcomes with other treatment options. Importantly, women appear to be making decisions based on the perception of sufficient information available about their menstrual problems, regardless of whether or not this was actually the case. Women are being influenced in their decision-making process to undergo a hysterectomy by health professionals, such as general practitioners and gynecologists. [Copyright &y& Elsevier]

Traditionally, risk assessments in research have been limited to examining the risks to the research participants. Although doing so is appropriate and important, there is growing recognition that undertaking research can pose risks to researchers as well. A grounded theory study involving a range of researchers who had undertaken qualitative health research on a sensitive topic was completed. Analysis of the in-depth, face-to-face unstructured individual interviews with 30 Australian public health researchers provided evidence that researchers do confront a number of physical and emotional risks when undertaking research. Training, preparation, and supervision must be taken into account so that the risk to researchers can be minimized. Researchers need to consider occupational health and safety issues in designing research projects that deal with physical and emotional risks. Recommendations for professional supervision, policy development, and minimum training standards for researchers are provided. [ABSTRACT FROM AUTHOR]

Qualitative health researchers immerse themselves in the settings that they are studying. This immersion involves personal interaction with their participants, with the result that the boundaries between the researcher and the group of people under study can easily become blurred. Although health researchers have been undertaking qualitative research for many years, recognition of boundary issues inherent in this type of research have received little attention. To investigate such issues, the authors conducted interviews with 30 qualitative health researchers. A grounded theory analysis of the interview transcripts revealed that researchers can identify a number of boundaries in their research, including the boundaries between researcher and friend, researcher and counselor or therapist, and professional boundaries. The authors discuss the findings and offer recommendations for qualitative health researchers involved in researching sensitive topics, including the need for researchers to consider the impacts that undertaking research might have on them. [ABSTRACT FROM AUTHOR]

The international emergence of undergraduate education in public health has transformed the public health education landscape. While this shift is clearest and most widely evaluated in the United States, efforts in other parts of the world—such as Australasia—have not kept pace. This article aims to redress the evidence gap by identifying and discussing the different approaches through which Australian and New Zealand universities deliver public health education at the undergraduate level. A content analysis was conducted of online handbook information published by 47 universities across Australia and New Zealand, to gauge the various ways in which these universities implement undergraduate public health education. Each offering identified was assigned to one of four predetermined categories. Of the 47 universities, 45 were found to offer some form of undergraduate coursework in public health. Offerings took primarily the form of single subjects. Less commonly implemented were specializations (n = 20), stand-alone undergraduate degrees (n = 11), and double degree combinations (n = 6). This breadth of activity highlights the need for renewed efforts in evaluating undergraduate public health education across the region. Further research is recommended into three areas: (1) emerging best practices in curriculum development and implementation, (2) explorations of public health accreditation in the region, and (3) the outcomes achieved by students and graduates of undergraduate public health degrees across Australia and New Zealand. These efforts will ultimately strengthen the operationalization and contribution of this education in helping shape the future public health workforce in Australasia. [ABSTRACT FROM AUTHOR]

Highlights from the article: Scaffolding on the work of [1], [4], and others, [5] contend that the scholarship of teaching and learning must adhere to key characteristics of scholarship more generally. The best health promotion pedagogy accounts for the needs of specific students, and specific cohorts of students, and is therefore varied. Many classes already have students from a variety of national, ethnic, class, and religious backgrounds, so many health promotion pedagogy scholars are already accustomed to cross-cultural communication. Examination of student heterogeneity is important in pedagogical scholarship because it recognizes that student perspectives will not be uniform.

Background: Cancer diagnosis may be a cue for health behavior change. Previous research that assessed the impact of a cancer diagnosis on multiple health behavior (MHB) change is limited by small sample size, cross‐sectional study design, and a focus on individual rather than multiple behaviors. This study investigated the impact of a cancer diagnosis on compliance with MHB recommendations. Methods: Data from Australian Longitudinal Study on Women's Health (ALSWH) were utilized. Compliance with MHB was assessed by cancer survivorship period; 0‐3 years pre‐diagnosis, 0‐3 years postdiagnosis, 4‐12 years postdiagnosis, and compared to controls. A MHB score based on the WCRF/AICR guidelines was calculated for six behaviors (physical activity, smoking, alcohol, BMI, fruit, and vegetable intake); scores ranged from 0 to 6, with a higher score indicating higher compliance. Generalized estimating equation (GEE) was used for statistical analysis. Results: Participants comprised 7585 women from the 2001 ALSWH survey, of whom 2285 developed cancer during 15 years of follow‐up. Compared to controls, the mean MHB score was slightly lower (Mean Difference (MD) = −0.015, P >.05) in survivors pre‐diagnosis, after adjusting for confounders; however, the compliance score increased during postdiagnosis, with the mean difference score being significantly higher in recent survivors (0‐3 years post diagnosis; MD = 0.055, P <.01). Likewise, within cancer survivors, the mean compliance score significantly increased 0‐3 years postdiagnosis (MD = 0.07, P <.05) compared to pre‐diagnosis, but this significant improvement was not maintained over the longer term (MD = 0.037, P >.05). Conclusion: In this sample, survivors had higher MHB score than controls. A cancer diagnosis may provide a teachable moment for health behavior change in the period immediately following diagnosis, but this effect was not sustained during longer‐term survivorship. [ABSTRACT FROM AUTHOR]

Purpose: To explore whether there was a difference in objectively measured physical activity and study participation between people who received their preferred study group allocation (matched) and those who did not receive their preferred study group (mismatched).Design: Secondary data from the NewCOACH randomized controlled trial.Setting: Insufficiently active patients in the primary care settings in Sydney and Newcastle, Australia.Participants: One hundred seventy-two adults aged 20 to 81 years.Intervention: Participants indicated their intervention preference at baseline for (1) five face-to-face visits with an exercise specialist, (2) one face-to-face visit and 4 telephone follow-ups with an exercise specialist, (3) written material, or (4) slight-to-no preference. Participants were then allocated to an intervention group and categorized as either "matched" or "mismatched" based on their indications. Participants who reported a slight-to-no preference was categorized as "matched."Measures: Daily step count as measured by pedometers and study participation.Analysis: Mean differences between groups in daily step count at 3 and 12 months (multiple linear regression models) and study participation at baseline, 3 months, and 12 months (χ2 tests).Results: Preference for an intervention group prior to randomization did not significantly (all P's > .05 using 95% confidence interval) impact step counts (differences of <600 steps/day between groups) or study participation.Conclusion: Future research should continue to address whether the strength of preferences influence study outcome and participation and whether the study preferences change over time. [ABSTRACT FROM AUTHOR]

Health promotion teaching and learning is informed by the competencies of our profession, and importantly, it involves continually improving our practice so that, in turn, we improve the learning experiences of our students. The student voice is pivotal to this teaching and learning opportunity, and while we might seek student feedback after we have finished teaching a course, it is less common to obtain feedback in a regular and routine manner throughout the delivery of the course. This is a lost opportunity for students, teachers, and for health promotion practice. One mechanism to redress this gap is the use of "time-critical-feedback," which involves a teacher undertaking the collection, analysis, and use of information about the learning experiences of students after each in-class or online session. Crucially, as a form of student-to-teacher feedback, time-critical-feedback can enable us to understand the impact of our teaching through the eyes of our learners, resolve concerns more quickly, enhance the joy of teaching, increase student engagement, and strengthen student voice. After all, our learners are the eyes, ears, and hearts of our impact. [ABSTRACT FROM AUTHOR]

Increasingly recognized as an educational domain in its own right, Ma-ori health is a central focus of medical and health sciences curricula in Aotearoa/New Zealand. As part of the Bachelor of Health Sciences offered at the University of Canterbury, Ma-ori health content is taught in a compulsory introductory course "Ma-ori Health Issues & Opportunities" (HLTH 106), positioned at the interface of Ma-ori health and public health. The course follows a trajectory through Ma-ori history, the Treaty of Waitangi, colonization, and the emergence of inequities, ending with structural and Ma-ori-led approaches for redress. Much of the content challenges prevailing public discourses relating to Aotearoa/New Zealand's settlement and status as an egalitarian society, the basis of many students' preconceptions. A social determinants of health frame has supported the navigation of this "tricky" terrain, and the construction of evidence-based counternarratives. Iterative curriculum development demonstrated the value of taking account not only of learner needs but also the characteristics of public health that may hinder learning. [ABSTRACT FROM AUTHOR]

Opportunities for evaluating experiential learning activities in tertiary public health education are growing. It has previously been shown that utilizing the "This is Public Health" (TIPH) sticker campaign as an experiential photo essay task led to increased understanding of public health. Emerging mobile technologies such as geocaching, which provide an opportunity to increase the experiential component of the TIPH photo essay task, have not been evaluated. This study aimed to determine whether adding geocaching to the TIPH photo essay task increased the efficacy of learning about public health, when compared with the TIPH photo essay task alone. A two-arm nonrandomized trial was conducted with 785 allied health and preprofessional teaching students studying first-year public health courses. Students were allocated to either the TIPH photo essay task (n = 210) or the TIPH photo task plus geocaching (n = 92) according to the course they were enrolled into. The primary outcome was the quality of the definition of public health provided by students, which was assessed using the Definition of Public Health Rating Scale. Data were analyzed using a linear mixed model. Of 302 (39%) students who consented to participate, 212 (70%) provided baseline and follow-up data. After adjusting for baseline demographic differences, the geocaching group had improved knowledge of public health at follow-up according to the Definition of Public Health Rating Scale (increasing 0.29 units more than the traditional group; p =.03). As this increase in knowledge score is unlikely to be of practical significance, the additional burden of implementing geocaching may not be justified. [ABSTRACT FROM AUTHOR]

To ensure student engagement and optimal preparation of the future workforce, academic educators frequently and repeatedly update curricula and pedagogic approaches. Evaluation of these updates often focuses on how well the chosen educational technique achieves its goal. For updates that add a new learning goal, it is important that evaluation considers the value of the goal in a crowded curriculum. Peer-to-peer feedback and coaching provides a low-investment and timely method of evaluation and can be facilitated by conferences focused on pedagogy. This coaching article uses a case study of an assignment for postgraduate students incorporating student-produced videos developed independently at three Australian universities. The authors learned of one another's work in preparation for delivering presentations at a conference focused on teaching public health and decided to collaborate on a single workshop. In the process, they reinforced and expanded their understanding of the benefits and important considerations for a video assignment and engaged in two-way coaching with conference delegates from across Australasia. Benefits include teaching students skills that will become increasingly important in their future careers, the potential for enhanced student engagement due to novelty, and resistance to plagiarism. Important considerations include explaining the aim and parameters of the assessment as well as minimizing student anxiety. Preparation for the workshop led to refinements in some of the assessments. This article is simultaneously an affirmation of the value of peer-to-peer coaching opportunities that can arise at pedagogy conferences and an argument for the value of video assignments in public health education. [ABSTRACT FROM AUTHOR]

Studies regarding the effectiveness of online learning compared with that of face to face (F2F) learning are conflicting. Some studies show students studying online have better outcomes, some show they have worse outcomes, and others show there is no difference. This retrospective cohort study compares competence in epidemiological concepts at the end of a graduate unit between Masters of Public Health students who studied F2F and those who studied online. In this unit, F2F students attended a 1-hour lecture (which was recorded) and a 2-hour tutorial each week. Online students listened to the recorded lecture and covered the same tutorial material through a facilitated asynchronous discussion board or a weekly synchronous 2-hour webinar. Students completed the same optional in-semester assignment and end of semester open-book exam. The results from 442 students (55% F2F) who completed the unit between 2015 and 2018 inclusive were included. The analysis compared final unit marks, controlling for prior academic performance. Results indicate that competence was reasonable in both formats of the unit but higher in F2F students, who after adjustment for prior degree academic performance achieved an average of 4.6 (95% confidence interval [2.2, 7.1]) more marks than online students. The better performance for F2F students was particularly true for students with poorer prior academic performance. These results suggest that F2F mode was more effective than online mode, particularly for students with a lower prior academic performance. Course instructors could usefully focus on enhancing student–instructor interaction and targeting students with lower academic ability when delivering online units of study. [ABSTRACT FROM AUTHOR]

Abstract Introduction Type 2 diabetes mellitus (T2DM) is a global public health concern. Aerobic physical activity (PA) and resistance training (RT) play significant roles in the prevention and management of T2DM. The aim of this pilot trial is to determine the preliminary efficacy and confirm feasibility of referral to exercise physiologists, psychologists, and provision of a technology-based behavior change support package to promote aerobic PA and RT in school teachers 'at risk' of or diagnosed with T2DM. Research design and methods The SMART (S upport, M otivation and P hysical A ctivity R esearch for T eachers') Health pilot study will be evaluated using a three-arm randomized controlled trial. The intervention will be guided by Social Cognitive Theory, Health Action Process Approach Model and Cognitive Behavioral Therapy strategies. The participants will be randomly allocated to one of three study groups: Group 1: wait-list control group; Group 2: 5 face-to-face visits with a psychologist and exercise specialist over 3 months; and Group 3: same as Group 2 plus technology-based behavior change support package for an additional 6 months. Assessments will be conducted at baseline, 3-, 9- (primary time-point) and 18-months post-baseline. The primary outcome will be PA measured with pedometers. Discussion SMART Health is an innovative, multi-component intervention, that integrates referral to exercise specialists, psychologists and provision of a technology-based behavior support package to promote PA and RT in adults diagnosed with T2DM or 'at risk' of T2DM. The findings will be used to guide future PA interventions and to develop effective community-based diabetes prevention and treatment programs. Trial Registration Australian New Zealand Clinical Trials Registry No: ACTRN12616001309471 [ABSTRACT FROM AUTHOR]

Background: General practitioners (GPs) cite time as a barrier to physical activity counseling. An alternative for time-poor GPs in Australia is the referral of insufficiently active patients to exercise physiologists (EPs). As data on the predictors of adherence to physical activity counseling interventions are limited, this study aimed to identify the sociodemographic, medical, health, and psychological characteristics of insufficiently active primary care patients who adhered to a physical activity counseling intervention delivered by EPs. Methods: This secondary analysis of data from the NewCOACH randomized trial used logistic regression to identify predictors of adherence, defined as patient participation in at least four of the five physical activity counseling sessions. EPs provided information about the number of sessions, while other potential predictors were obtained from the self-administered baseline questionnaire and medical summary sheets provided by the GPs. Results: Of the 132 patients referred to an EP, 102 (77%) were adherent: 91 (69%) and eleven (8.3%) participated in all, or all but one, of the sessions, respectively. Of the remainder, seven (5.3%) patients participated in three sessions, seven (5.3%) participated in two sessions, five (3.8%) participated in one session, and eleven (8.3%) did not participate in any session. The odds of being adherent were 5.84 (95% CI 1.46–23.4, P≤0.05) times higher among retired participants than in those who were not in paid employment. The odds of being adherent 1) increased as the positive outcome expectation score increased (OR 1.89, 95% CI 1.12–3.18, P≤0.05) and 2) decreased as the duration (days) between referral and the initial counseling session increased (OR 0.95, 95% CI 0.92–0.98, P<0.01). Conclusion: More than three quarters of the patients participated in all, or all but one, of the sessions. Being retired, positive outcome expectations, and having a shorter wait between referral and the initial appointment predicted adherence. [ABSTRACT FROM AUTHOR]

The Institute for Urban Indigenous Health (IUIH) aimed to improve access to cataract surgery in urban South East Queensland (SEQ) for Indigenous Australians, without compromising clinical visual outcomes. The Penchansky and Levesque concept of access as the 'fit' between the patient's needs and the ability of the system to meet those needs was used to inform the redesign of the mainstream cataract surgical pathway. The IUIH staff and community stakeholders mapped the traditional external cataract surgical pathway and then innovatively redesigned it to reduce the number of patients being removed by the system at key transition points. The integration of eye health within the primary health care (PHC) clinic has improved the continuity and coordination of care along the surgical pathway, and ensured the sustainability of collaborative partnerships with key external organisations. Audit data demonstrated a significant increase in utilisation of cataract surgical services after the process redesign. Previous studies have found that PHC models involving integration, coordination and continuity of care enhance patient health outcomes; however, the IUIH surgical model extends this to tertiary care. There is scope to apply this model to other surgical pathways and communities who experience access inequity. [ABSTRACT FROM AUTHOR]

Objectives: In this paper, we report maintenance of behavior change in a nutrition and physical activity intervention for cancer survivors at 12-months follow-up. Methods: The ENRICH (Exercise and Nutrition Routine Improving Cancer Health) program was an 8-week face-to-face program for cancer survivors and caregivers, focused on healthy eating, healthy weight, resistance training, and a walking program. Randomized controlled trial participants completed a survey and 7-days of pedometry at baseline, 8-weeks, and 20-weeks. Intervention participants completed 12-month measures. Maintenance was assessed by examining change between 20-weeks and 12-months for cancer survivors. Results: Sixty cancer survivors in the intervention group completed baseline data collection, and 29 (48%) completed 12-month assessments. Initial improvements in step counts, weight, and body mass index were maintained from 20-weeks to 12-months. Vegetable consumption declined significantly (difference -30g/day; p = .04). Moderate-to-vigorous physical activity increased significantly (difference 55 minutes/week; p = .05). Conclusions: Physical activity and weight improvements were maintained over 12-months indicating the potential for a multiple health behavior intervention to help cancer survivors sustain improvements to lifestyle behaviors. Additional support is warranted to assist cancer survivors to make and maintain dietary changes. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to identify demographic, clinical, psychosocial, and environmental correlates of objectively assessed physical activity among breast cancer survivors.Methods: Baseline data were utilized from 574 female breast cancer survivors who participated in three different intervention studies: Resistance and Endurance exercise After ChemoTherapy (REACT), Exercise and Nutrition Routine Improving Cancer Health (ENRICH), and Move More for Life (MM4L). Participants were eligible if they were aged ≥18 years and had completed primary cancer treatment. Physical activity was objectively assessed by accelerometers or pedometers. Participants completed self-reported questionnaires on demographic, psychosocial, and environmental factors. Information regarding clinical factors was obtained from medical records or patient self-report. Multivariable linear regression analyses were applied on the pooled dataset to identify factors that were significantly correlated with physical activity. In addition, the explained variance of the model was calculated.Results: The multivariable regression model revealed that older age, (β = -0.01, 95 %CI = -0.02; -0.003), higher body mass index (β = -0.05, 95 %CI = -0.06; -0.03), lower self-efficacy (β = 0.2, 95 %CI = 0.08; 0.2), and less social support (β = 0.1, 95 %CI = 0.05; 0.2) were significantly correlated with lower physical activity. This model explained 15 % of the variance in physical activity.Conclusion: Age, body mass index, self-efficacy, and social support were significantly correlated with objectively assessed physical activity in breast cancer survivors. It may therefore be recommended that physical activity intervention studies in these women target those who are older, and have a higher body mass index, and should operationalize behavior change strategies designed to enhance self-efficacy and social support.Trial Registration: The REACT study is registered at the Netherlands Trial Register [NTR2153]. The ENRICH study is registered at Australian New Zealand Clinical Trials Register [ANZCTRN12609001086257]. And the MM4L study is registered at Australian New Zealand Clinical Trials Register [ACTRN12611001061921]. [ABSTRACT FROM AUTHOR]

We test the hypothesis that the odds of self-reported receipt of lifestyle advice from a health care provider will be lower among outpatient cardiac rehabilitation (OCR) nonattendees and nonreferred patients compared to OCR attendees. Logistic regression was used to analyse cross-sectional data provided by 65% (4971/7678) of patients aged 20 to 84 years discharged from public hospitals with a diagnosis indicating eligibility for OCR between 2002 and 2007. Among respondents, 71% (3518) and 55% (2724) recalled advice regarding physical activity and diet, respectively, while 88% (592/674) of smokers recalled quit advice. OCR attendance was low: 36% (1764) of respondents reported attending OCR, 11% (552) did not attend following referral, and 45% (2217) did not recall being invited. The odds of recalling advice regarding physical activity and diet were significantly lower among OCR nonattendees compared to attendees (OR 0.34, 95% CI 0.21, 0.56 and OR 0.33, 95% CI 0.25, 0.44, resp.) and among nonreferred respondents compared to OCR attendees (OR 0.10, 95% CI 0.07, 0.15 and OR 0.17, 95% CI 0.14, 0.22, resp.). Patients hospitalised for coronary heart disease should be referred to OCR or a suitable alternative to improve recall of lifestyle advice that will reduce the risk of further coronary events. [ABSTRACT FROM AUTHOR]