Browsing by Author "Jiang, Yannan"
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- ItemA Co-Designed, Culturally-Tailored mHealth Tool to Support Healthy Lifestyles in Māori and Pasifika Communities in New Zealand: Protocol for a Cluster Randomized Controlled Trial.(0000-00-00) Verbiest, Marjolein; Borrell, Suaree; Dalhousie, Sally; Tupa'i-Firestone, Ridvan; Funaki, Tevita; Goodwin, Deborah; Grey, Jacqueline; Henry, Akarere; Hughes, Emily; Humphrey, Gayle; Jiang, Yannan; Jull, Andrew; Pekepo, Crystal; Schumacher, Jodie; Te Morenga, Lisa; Tunks, Megan; Vano, Mereaumate; Whittaker, Robyn; Ni Mhurchu, ClionaBACKGROUND New Zealand urgently requires scalable effective behavior change programs to support healthy lifestyles that are tailored to the needs and lived contexts of M ori and Pasifika communities OBJECTIVE The primary objective of this study is to determine the effects of a co designed culturally tailored lifestyle support mHealth tool the OL OR mobile phone app and website on key risk factors and behaviors associated with an increased risk of noncommunicable disease diet physical activity smoking and alcohol consumption compared with a control condition METHODS A 12 week community based two arm cluster randomized controlled trial will be conducted across New Zealand from January to December 2018 Participants target N 1280 64 clusters 32 M ori 32 Pasifika 32 clusters per arm 20 participants per cluster will be individuals aged 18 years who identify with either M ori or Pasifika ethnicity live in New Zealand are interested in improving their health and wellbeing or making lifestyle changes and have regular access to a mobile phone tablet laptop or computer and to the internet Clusters will be identified by community coordinators and randomly assigned 1 1 ratio to either the full OL OR tool or a control version of the app data collection only plus a weekly notification stratified by geographic location Auckland or Waikato for Pasifika clusters and by region rural urban or provincial for M ori clusters All participants will provide self reported data at baseline and at 4 and 12 weeks postrandomization The primary outcome is adherence to healthy lifestyle behaviors measured using a self reported composite health behavior score at 12 weeks that assesses smoking behavior fruit and vegetable intake alcohol intake and physical activity Secondary outcomes include self reported body weight holistic health and wellbeing status medication use and recorded engagement with the OL OR tool RESULTS Trial recruitment opened in January 2018 and will close in July 2018 Trial findings are expected to be available early in 2019 CONCLUSIONS Currently there are no scalable evidence based tools to support M ori or Pasifika individuals who want to improve their eating habits lose weight or be more active This wait list controlled cluster randomized trial will assess the effectiveness of a co designed culturally tailored mHealth tool in supporting healthy lifestyles TRIAL REGISTRATION Australia New Zealand Clinical Trials Register ACTRN12617001484336 http www ANZCTR org au ACTRN12617001484336 aspx Archived by WebCite at http www webcitation org 71DX9BsJb REGISTERED REPORT IDENTIFIER RR1 10 2196 10789
- ItemDevelopment of an Evidence-Based mHealth Weight Management Program Using a Formative Research Process.(2014-08-07) Waterlander, Wilma; Whittaker, Robyn; McRobbie, Hayden; Dorey, Enid; Ball, Kylie; Maddison, Ralph; Myers Smith, Katie; Crawford, David; Jiang, Yannan; Gu, Yulong; Michie, Jo; Ni Mhurchu, ClionaBACKGROUND There is a critical need for weight management programs that are effective cost efficient accessible and acceptable to adults from diverse ethnic and socioeconomic backgrounds mHealth delivered via mobile phone and Internet weight management programs have potential to address this need To maximize the success and cost effectiveness of such an mHealth approach it is vital to develop program content based on effective behavior change techniques proven weight management programs and closely aligned with participants needs OBJECTIVE This study aims to develop an evidence based mHealth weight management program Horizon using formative research and a structured content development process METHODS The Horizon mHealth weight management program involved the modification of the group based UK Weight Action Program WAP for delivery via short message service SMS and the Internet We used an iterative development process with mixed methods entailing two phases 1 expert input on evidence of effective programs and behavior change theory and 2 target population input via focus group n 20 participants one on one phone interviews n 5 and a quantitative online survey n 120 RESULTS Expert review determined that core components of a successful program should include 1 self monitoring of behavior 2 prompting intention formation 3 promoting specific goal setting 4 providing feedback on performance and 5 promoting review of behavioral goals Subsequent target group input confirmed that participants liked the concept of an mHealth weight management program and expressed preferences for the program to be personalized with immediate prompt and informative text messages practical and localized physical activity and dietary information culturally appropriate language and messages offer social support group activities or blogs and weight tracking functions Most target users expressed a preference for at least one text message per day We present the prototype mHealth weight management program Horizon that aligns with those inputs CONCLUSIONS The Horizon prototype described in this paper could be used as a basis for other mHealth weight management programs The next priority will be to further develop the program and conduct a full randomized controlled trial of effectiveness
- ItemEffects and costs of real-time cardiac telerehabilitation: randomised controlled non-inferiority trial.(0000-00-00) Maddison, Ralph; Rawstorn, Jonathan Charles; Stewart, Ralph A H; Benatar, Jocelyne; Whittaker, Robyn; Rolleston, Anna; Jiang, Yannan; Gao, Lan; Moodie, Marj; Warren, Ian; Meads, Andrew; Gant, NicholasOBJECTIVE Compare the effects and costs of remotely monitored exercise based cardiac telerehabilitation REMOTE CR with centre based programmes CBexCR in adults with coronary heart disease CHD METHODS Participants were randomised to receive 12 weeks of telerehabilitation or centre based rehabilitation REMOTE CR provided individualised exercise prescription real time exercise monitoring coaching and theory based behavioural strategies via a bespoke telerehabilitation platform CBexCR provided individualised exercise prescription and coaching via established rehabilitation clinics Outcomes assessed at baseline 12 and or 24 weeks included maximal oxygen uptake V O2max primary modifiable cardiovascular risk factors exercise adherence motivation health related quality of life and programme delivery hospital service utilisation and medication costs The primary hypothesis was a non inferior between group difference in V O2max at 12 weeks inferiority margin 1 25 mL kg min inferiority margins were not set for secondary outcomes RESULTS 162 participants mean 61 12 7 years 86 men were randomised V O2 max was comparable in both groups at 12 weeks and REMOTE CR was non inferior to CBexCR REMOTE CR CBexCR adjusted mean difference AMD 0 51 95 CI 0 97 to 1 98 mL kg min p 0 48 REMOTE CR participants were less sedentary at 24 weeks AMD 61 5 95 CI 117 8 to 5 3 min day p 0 03 while CBexCR participants had smaller waist AMD 1 71 95 CI 0 09 to 3 34 cm p 0 04 and hip circumferences AMD 1 16 95 CI 0 06 to 2 27 cm p 0 04 at 12 weeks No other between group differences were detected Per capita programme delivery NZD1130 GBP573 vs NZD3466 GBP1758 and medication costs NZD331 GBP168 vs NZD605 GBP307 p 0 02 were lower for REMOTE CR Hospital service utilisation costs were not statistically significantly different NZD3459 GBP1754 vs NZD5464 GBP2771 p 0 20 CONCLUSION REMOTE CR is an effective cost efficient alternative delivery model that could as a complement to existing services improve overall utilisation rates by increasing reach and satisfying unique participant preferences
- ItemEvaluation of MyTeen - a SMS-based mobile intervention for parents of adolescents: a randomised controlled trial protocol.(0000-00-00) Chu, Joanna Ting Wai; Whittaker, Robyn; Jiang, Yannan; Wadham, Angela; Stasiak, Karolina; Shepherd, Matthew; Bullen, ChrisBACKGROUND Parents play an important role in the lives of adolescents and efforts aimed at strengthening parenting skills and increasing knowledge on adolescent development hold much promise to prevent and mitigate adolescent mental health problems Innovative interventions that make use of technology based platforms might be an effective and efficient way to deliver such support to parents This protocol presents the design of a randomised controlled trial to investigate the effectiveness of a SMS based mobile intervention MyTeen for parents of adolescents on promoting parental competence and mental health literacy METHODS A parallel two arm randomised controlled trial will be conducted in New Zealand aiming to recruit 214 parents or primary caregivers of adolescents aged 10 15 years via community outreach and social media Eligible participants will be allocated 1 1 into the control or the intervention group stratified by ethnicity The intervention group will receive a tailored programme of text messages aimed at improving their parental competence and mental health literacy over 4 weeks The control group care as usual will receive no intervention from the research team but can access alternative services if they wish and will be offered the intervention programme upon completion of a 3 month post randomisation follow up assessment Data will be obtained at baseline post intervention 1 month and 3 month follow up The primary outcome is parental competence assessed by the Parental Sense of Competence Scale at 1 month follow up Secondary outcomes include mental health literacy knowledge of help seeking parental distress parent adolescent communication and programme satisfaction DISCUSSION To our knowledge this is the first randomised controlled trial on the effectiveness of delivering a parenting support intervention for parents of adolescents solely via a SMS based mobile intervention If effective it could have great potential to reach and support parents of adolescents TRIAL REGISTRATION Australian New Zealand Clinical Trial Registry ACTRN12618000117213 Registered on 29 01 2018
- ItemThe HEART Mobile Phone Trial: The Partial Mediating Effects of Self-Efficacy on Physical Activity among Cardiac Patients.(2014-06-06) Maddison, Ralph; Pfaeffli, Leila; Stewart, Ralph; Kerr, Andrew; Jiang, Yannan; Rawstorn, Jonathan; Carter, Karen; Whittaker, RobynBACKGROUND The ubiquitous use of mobile phones provides an ideal opportunity to deliver interventions to increase physical activity levels Understanding potential mediators of such interventions is needed to increase their effectiveness A recent randomized controlled trial of a mobile phone and Internet mHealth intervention was conducted in New Zealand to determine the effectiveness on exercise capacity and physical activity levels in addition to current cardiac rehabilitation CR services for people n 171 with ischemic heart disease Significant intervention effect was observed for self reported leisure time physical activity and walking but not peak oxygen uptake at 24 weeks There was also significant improvement in self efficacy OBJECTIVE To evaluate the mediating effect of self efficacy on physical activity levels in an mHealth delivered exercise CR program METHODS Treatment evaluations were performed on the principle of intention to treat Adjusted regression analyses were conducted to evaluate the main treatment effect on leisure time physical activity and walking at 24 weeks with and without change in self efficacy as the mediator of interest RESULTS Change in self efficacy at 24 weeks significantly mediated the treatment effect on leisure time physical activity by 13 but only partially mediated the effect on walking by 4 at 24 weeks CONCLUSION An mHealth intervention involving text messaging and Internet support had a positive treatment effect on leisure time physical activity and walking at 24 weeks and this effect was likely mediated through changes in self efficacy Future trials should examine other potential mediators related to this type of intervention
- ItemHEART: heart exercise and remote technologies: a randomized controlled trial study protocol.(2011-06-20) Maddison, Ralph; Whittaker, Robyn; Stewart, Ralph; Kerr, Andrew; Jiang, Yannan; Kira, Geoffrey; Carter, Karen H; Pfaeffli, LeilaBACKGROUND Cardiovascular disease CVD is the leading cause of death worldwide Cardiac rehabilitation CR is aimed at improving health behaviors to slow or reverse the progression of CVD disease Exercise is a central element of CR Technologies such as mobile phones and the Internet mHealth offer potential to overcome many of the psychological physical and geographical barriers that have been associated with lack of participation in exercise based CR We aim to trial the effectiveness of a mobile phone delivered exercise based CR program to increase exercise capacity and functional outcomes compared with usual CR care in adults with CVD This paper outlines the rationale and methods of the trial METHODS A single blinded parallel two arm randomized controlled trial is being conducted A total of 170 people will be randomized at 1 1 ratio either to receive a mHealth CR program or usual care Participants are identified by CR nurses from two metropolitan hospitals in Auckland New Zealand through outpatient clinics and existing databases Consenting participants are contacted to attend a baseline assessment The intervention consists of a theory based personalized automated package of text and video message components via participants mobile phones and the Internet to increase exercise behavior delivered over six months The control group will continue with usual CR Data collection occurs at baseline and 24 weeks post intervention The primary outcome is change in maximal oxygen uptake from baseline to 24 weeks Secondary outcomes include post intervention measures on self reported physical activity IPAQ cardiovascular risk factors systolic blood pressure weight and waist to hip ratio health related quality of life SF 36 and cost effectiveness DISCUSSION This manuscript presents the protocol for a randomized controlled trial of a mHealth exercise based CR program Results of this trial will provide much needed information about physical and psychological well being and cost effectiveness of an automated telecommunication intervention If effective this intervention has enormous potential to improve the delivery of CR and could easily be scaled up to be delivered nationally and internationally in a very short time enhancing the translational aspect of this research It also has potential to extend to comprehensive CR nutrition advice smoking cessation medication adherence TRIAL REGISTRATION ACTRN12611000117910
- ItemImproving coronary heart disease self-management using mobile technologies (Text4Heart): a randomised controlled trial protocol.(2014-03-11) Dale, Leila Pfaeffli; Whittaker, Robyn; Jiang, Yannan; Stewart, Ralph; Rolleston, Anna; Maddison, RalphCardiac rehabilitation CR is a secondary prevention program that offers education and support to assist patients with coronary heart disease CHD make lifestyle changes Despite the benefits of CR attendance at centre based sessions remains low Mobile technology mHealth has potential to reach more patients by delivering CR directly to mobile phones thus providing an alternative to centre based CR The aim of this trial is to evaluate if a mHealth comprehensive CR program can improve adherence to healthy lifestyle behaviours for example physically active fruit and vegetable intake not smoking low alcohol consumption over and above usual CR services in New Zealand adults diagnosed with CHD
- ItemMeasuring physical activity in a cardiac rehabilitation population using a smartphone-based questionnaire.(2013-03-25) Pfaeffli, Leila; Maddison, Ralph; Jiang, Yannan; Dalleck, Lance; Löf, MarieBACKGROUND Questionnaires are commonly used to assess physical activity in large population based studies because of their low cost and convenience Many self report physical activity questionnaires have been shown to be valid and reliable measures but they are subject to measurement errors and misreporting often due to lengthy recall periods Mobile phones offer a novel approach to measure self reported physical activity on a daily basis and offer real time data collection with the potential to enhance recall OBJECTIVE The aims of this study were to determine the convergent validity of a mobile phone physical activity MobilePAL questionnaire against accelerometry in people with cardiovascular disease CVD and to compare how the MobilePAL questionnaire performed compared with the commonly used self recall International Physical Activity Questionnaire IPAQ METHODS Thirty adults aged 49 to 85 years with CVD were recruited from a local exercise based cardiac rehabilitation clinic in Auckland New Zealand All participants completed a demographics questionnaire and underwent a 6 minute walk test at the first visit Subsequently participants were temporarily provided a smartphone with the MobilePAL questionnaire preloaded that asked 2 questions daily and an accelerometer which was to be worn for 7 days After 1 week a follow up visit was completed during which the smartphone and accelerometer were returned and participants completed the IPAQ RESULTS Average daily physical activity level measured using the MobilePAL questionnaire showed moderate correlation r 45 P 01 with daily activity counts per minute Acc CPM and estimated metabolic equivalents MET r 45 P 01 measured using the accelerometer Both MobilePAL beta 42 P 008 and age beta 48 P 002 were significantly associated with Acc CPM adjusted R 2 40 When IPAQ derived energy expenditure measured in MET minutes per week IPAQ met was considered in the predicted model both IPAQ met beta 51 P 001 and age beta 36 P 016 made unique contributions adjusted R 2 47 F2 27 13 58 PUnder 001 There was also a significant association between the MobilePAL and IPAQ measures r 49 beta 51 P 007 CONCLUSIONS A mobile phone delivered questionnaire is a relatively reliable and valid measure of physical activity in a CVD cohort Reliability and validity measures in the present study are comparable to existing self report measures Given their ubiquitous use mobile phones may be an effective method for physical activity surveillance data collection
- ItemA mHealth cardiac rehabilitation exercise intervention: findings from content development studies.(2012-09-17) Pfaeffli, Leila; Maddison, Ralph; Whittaker, Robyn; Stewart, Ralph; Kerr, Andrew; Jiang, Yannan; Kira, Geoff; Carter, Karen; Dalleck, LanceBACKGROUND Involving stakeholders and consumers throughout the content and study design ensures interventions are engaging and relevant for end users The aim of this paper is to present the content development process for a mHealth mobile phone and internet based cardiac rehabilitation CR exercise intervention METHODS An innovative mHealth intervention was developed with patient input using the following steps conceptualization formative research pre testing and pilot testing Conceptualization including theoretical and technical aspects was undertaken by experts For the formative component focus groups and interviews with cardiac patients were conducted to discuss their perceptions of a mHealth CR program A general inductive thematic approach identified common themes A preliminary library of text and video messages were then developed Participants were recruited from CR education sessions to pre test and provide feedback on the content using an online survey Common responses were extracted and compiled An iterative process was used to refine content prior to pilot testing and conduct of a randomized controlled trial RESULTS 38 CR patients and 3 CR nurses participated in the formative research and 20 CR patients participated in the content pre testing Participants perceived the mHealth program as an effective approach to inform and motivate patients to exercise For the qualitative study 100 n 41 of participants thought it to be a good idea and 11 of participants felt it might not be useful for them but would be for others Of the 20 participants who completed the online survey 17 out of 20 85 stated they would sign up to a program where they could receive information by video messages on a website and 12 out of 20 60 showed interest in a texting program Some older CR patients viewed technology as a potential barrier as they were unfamiliar with text messaging or did not have mobile phones Steps to instruct participants to receive texts and view the website were written into the study protocol Suggestions to improve videos and wording of texts were fed back to the content development team and refined CONCLUSIONS Most participants thought a mHealth exercise program was an effective way to deliver exercise based CR The results were used to develop an innovative multimedia exercise intervention A randomized controlled trial is currently underway TRIAL REGISTRATION ACTRN12611000117910
- ItemA mobile phone intervention increases physical activity in people with cardiovascular disease: Results from the HEART randomized controlled trial.(2015-05-07) Maddison, Ralph; Pfaeffli, Leila; Whittaker, Robyn; Stewart, Ralph; Kerr, Andrew; Jiang, Yannan; Kira, Geoffrey; Leung, William; Dalleck, Lance; Carter, Karen; Rawstorn, JonathanAIM To determine the effectiveness and cost effectiveness of a mobile phone intervention to improve exercise capacity and physical activity behaviour in people with ischaemic heart disease IHD METHODS AND RESULTS In this single blind parallel two arm randomized controlled trial adults n 171 with IHD were randomized to receive a mobile phone delivered intervention HEART n 85 plus usual care or usual care alone n 86 Adult participants aged 18 years or more with a diagnosis of IHD were clinically stable as outpatients able to perform exercise able to understand and write English and had access to the Internet The HEART Heart Exercise And Remote Technologies intervention involved a personalized automated package of text messages and a secure website with video messages aimed at increasing exercise behaviour delivered over 24 weeks All participants were able to access usual community based cardiac rehabilitation which involves encouragement of physical activity and an offer to join a local cardiac support club All outcomes were assessed at baseline and 24 weeks and included peak oxygen uptake PVO2 primary outcome self reported physical activity health related quality of life self efficacy and motivation secondary outcomes Results showed no differences in PVO2 between the two groups difference 0 21 ml kg 1 min 1 95 CI 1 1 0 7 p 0 65 at 24 weeks However significant treatment effects were observed for selected secondary outcomes including leisure time physical activity difference 110 2 min week 95 CI 0 8 221 3 p 0 05 and walking difference 151 4 min week 95 CI 27 6 275 2 p 0 02 There were also significant improvements in self efficacy to be active difference 6 2 95 CI 0 2 12 2 p 0 04 and the general health domain of the SF36 difference 2 1 95 CI 0 1 4 1 p 0 03 at 24 weeks The HEART programme was considered likely to be cost effective for leisure time activity and walking CONCLUSIONS A mobile phone intervention was not effective at increasing exercise capacity over and above usual care The intervention was effective and probably cost effective for increasing physical activity and may have the potential to augment existing cardiac rehabilitation services
- ItemPresleep activities and time of sleep onset in children.(2013-02-04) Foley, Louise S; Maddison, Ralph; Jiang, Yannan; Marsh, Samantha; Olds, Timothy; Ridley, KateOBJECTIVE Presleep activities have been implicated in the declining sleep duration of young people A use of time approach may be used to describe the presleep period The study aims were to describe the activities undertaken 90 minutes before sleep onset and to examine the association between activities and time of sleep onset in New Zealand young people METHODS Participants N 2017 5 18 years self reported their time use as part of a national survey All activities reported in the 90 minutes before sleep were extracted The top 20 activities were grouped into 3 behavioral sets screen sedentary time nonscreen sedentary time and self care An adjusted regression model was used to estimate presleep time spent in each behavioral set for 4 distinct categories of sleep onset very early early late or very late and the differences between sleep onset categories were tested RESULTS In the entire sample television watching was the most commonly reported activity and screen sedentary time accounted for 30 minutes of the 90 minute presleep period Participants with a later sleep onset had significantly greater engagement in screen time than those with an earlier sleep onset Conversely those with an earlier sleep onset spent significantly greater time in nonscreen sedentary activities and self care CONCLUSIONS Screen sedentary time dominated the presleep period in this sample and was associated with a later sleep onset The development of interventions to reduce screen based behaviors in the presleep period may promote earlier sleep onset and ultimately improved sleep duration in young people