Home page

The homepage is visible to the public at www.womenswellness.com.au and provides general information about the program and a Register Interest field, illustrated in Figure 4.2.

Figure 4.2. Website Home Page 4.4.2 Administration portal

The administration portal allows the Site Administrator to access all facets of the website and perform a number of functions, including:

 Monitoring and managing the ‘Register Interest’ database;

 Managing all Users of the site;

 Enrolment of participants into Cohorts (groups);

 Enrolment of health professionals and Site Administrators;

 Cohort management;

 Content management of individual pages on the website;

 Content management of news;

 Monitoring the Discussion Board;

 Managing Frequently Asked Questions page;

 Managing/uploading podcasts;

 Consultation management, and;

 Report management.

Password protected access to the Administration portal was limited to as few people as possible to maintain the security and integrity of the website, participant information and program content.

4.4.3 Participant/User portal

Prior to commencing the Program, the website Administrator creates a User Account for each participant. A start date is set for a calendar Monday, and on that date a password is generated electronically from the website and emailed to the participant.

When participants (users) click on the Participant Portal tab, they are able to login to the website using their secure username and password.

Dashboard tab

Following log-in users will see their dashboard and a number of tabs including:

Journal; Review; My Wellness Record; Resources; Social and My Account. As participants work through the program, a timeline with weeks of the program represented by flower symbols is visible (Figure 4.3).

Figure 4.3. Screenshot of ‘Dashboard’

Journal tab

The bulk of the program content is accessed through the Journal Tab, where users work through readings and activities. In the Preparation section, users are welcomed to the program and invited to enter and save personal goals for the first four weeks including: physical goals (weight, BMI and waist circumference);

exercise and fitness goals (walking, running, flexibility, strength, endurance);

habitual goals (smoking and alcohol drinking) and food and nutrition goals (water, fruit and vegetables and phytoestrogens). See Figure 4.4.

Figure 4.4. Screenshot of ‘Goal Setting’ page

Following this preparation section, participants work through the program day by day for the first three weeks. From Week 4 the content is delivered in weekly blocks until the completion of the program at the end of Week 12. An example illustration of a journal page is provided in Figure 4.5.

Figure 4.5. Screenshot of ‘Journal’

An important part of the Journal Tab is the Exercise Schedule, where every Sunday participants are asked to plan their Exercise Schedule for the next seven

days. Participants can type information into the table and then save the Schedule (Figure 4.6).

Figure 4.6. Screenshot of ‘Exercise Schedule’

Review tab

At the end of each week on Sunday, participants are asked to complete a weekly Review. The website prompts users to do this by sending an automatic reminder email and text message. Clicking on the Review Tab provides access to a table where drop down menus allow information to be entered and then saved.

Information to enter includes: calcium, water, fruit, vegetables, phytoestrogens, aerobic exercise, strength exercise, pelvic floor exercise, waist circumference, weight, alcohol and cigarette consumption. See Figure 4.7 below.

Figure 4.7. Screenshot of Weekly ‘Review’ table My Wellness Records tab

In the Wellness Records tab participants can view a number of charts that give a graphical representation of data they have previously entered in the Weekly Review chart. The charts provide feedback about diet, exercise and other health behaviours. Screenshots of the Exercise Reports are illustrated in Figure 4.8 and Figure 4.9 below.

Figure 4.8. Screenshot 1 of ‘Exercise Reports’

Figure 4.9. Screenshot 2 of ‘Exercise Reports’

Resources tab

In the Resources tab there is additional information to assist participants to undertake the program, including the Program e-book described at Section 4.3 above, podcasts and a Frequently Asked Questions page.

Podcasts

Under the resources tab there are short video podcasts including; a system tour;

introduction to the program; exercise; maintaining a healthy diet; stress, sleep and sexuality and chronic disease prevention. The text of the Exercise podcast is included in Appendix F. See Figure 4.10 below that illustrates the podcast page of the website.

Figure 4.10. Screenshot of ‘Resources – Podcasts’ page Frequently asked questions

The ‘FAQ’ tab in the Resources section, provides information to assist participants in navigating around the website and to answer common questions asked about health, diet, exercise and the program in general. For example, information is provided about returning to exercise after being unwell.

Social tab

The Social tab gives access to ‘News’ and a private ‘Discussion board’.

News

News about the program or evidence based information about topical women’s health issues is posted in this area by the system administrator. This may include a summary of recent published research. For example, information about a study reporting the benefits of walking to lower the risk of breast cancer is provided, with references and links to the original publication. Figure 4.11 illustrates the News page.

Figure 4.11. Screenshot of ‘News’ page Discussion board

The Discussion Board (See Figure 4.12) allows participants who are in the same ‘Cohort’ and commencing the program on the same date, to communicate with other participants about different topics. Participants can start a discussion topic or

‘thread’ which can be followed by other participants who can add comments. The discussion board is not open to the public and is monitored by the system administrator for inappropriate language or discussion.

Figure 4.12. Screenshot of ‘Discussion Board’

Consultation tab

For participants allocated to receive health professional consultations, the Consultation tab allows access to the appointment management system to manage their personal consultations with the Registered Nurse. Appointment requests can be accepted or re-scheduled.

Just prior to a scheduled Consultation time, a portal on the website allows the participant to communicate with the Registered Nurse ‘face to face’ via Skype. This function will be explained more in the following section.

Alerts and Reminders

A range of alerts and reminders are generated by the website and sent to Users (both Participants and Health Professionals) via the Website, email or text message.

These alerts are designed to prompt User’s about:

 Logon details and commencement date;

 Goal setting activities;

 Weekly review and exercise planning activities;

 Accept Consultation appointment requests or re-schedule appointment, and;

 Consultation reminders.

4.4.4 Health Professional Portal

The Health Professional portal can be accessed through the Home Page using unique password for each Registered Nurse granted access by the Site Administrator.

When first accessing the HP portal the User is prompted to review the Training Manual and undertake an online quiz with questions relating to each of the 8 modules. Once the quiz is complete access to the HP ‘Dashboard’ is granted (See Figure 4.13).

Figure 4.13. Health Professional portal ‘Dashboard’

Dashboard tab

On the Dashboard tab HP can view participants allocated to their Cohort and to manage their consultations. A calendar is visible which allows HP to allocate available times for consultations and then to generate appointment times that are sent to participants. Participants can accept or re-schedule appointment times.

From the Dashboard tab HP’s can also access the Participant portal of those allocated to their Cohort (group). This allows them to view the Journal, Goal setting, Activities, and Wellness Records of an individual participant.

Consultation tab

When a participant confirms an appointment, an hour before the appointment time the HP can then open the Skype consultation portal to allow two-way communication with the participant.

During the online consultation the HP is also able to view the participant’s Goals, Wellness records and to make Consultation notes in a notes window. Figure 4.14 illustrates the layout of the Consultation page.

Figure 4.14. Illustration of Consultation portal

4.5 HEALTH PROFESSIONAL CONSULTATIONS

An important aspect of the intervention was consultations with a Registered Nurse in Week 1, Week 4, Week 8 and Week 12 of the program. The consultations

were delivered to Group B in a face to face format at the QUT Health Clinic and online via the consultation portal on the website to Group C.

Advanced practice Registered Nurses were chosen to deliver the intervention because they possess a range of skills that equip them to effectively deliver a health promotion program for the primary prevention of disease. These include:

 Advanced communication skills;

 Health assessment skills;

 Knowledge and understanding of chronic disease risk factors;

 Experience delivering health education and risk factor counselling to

individuals and groups;

 Advanced clinical problem solving skills;

 Understanding of the health system and links with other health

providers;

 Knowledge and experience in referral of participants to other health

professionals if required, and;

 Understanding of best practice in research processes.

The two Registered nurses delivering consultations in this project were highly experienced specialist clinicians, one with expertise in women’s health and the other expertise in cardiac rehabilitation.

To help maintain quality control and consistency in delivery of the consultations, a nine module Women’s Wellness Program Training Manual (Anderson, D., McGuire, & Porter-Steele, 2013) was developed for health professionals to complete prior to delivery of consultations. It was piloted with one

of the Registered Nurses who delivered the program in this trial. Modules included in the manual are:

1. Communicating online;

2. Menopause and sexuality;

3. Complementary therapies;

4. Stress, relaxation and sleep;

5. Exercise;

6. Pelvic floor exercises;

7. Nutrition;

8. Chronic diseases and screening programs, and;

9. Health professional instructional guide for the website.

4.5.1 Format of health consultations

During consultations health education and information provided about topics on different stages the program. An outline of information included in each of the consultations is provided in Table 4.1 below.

Table 4.2

Health Consultations Delivered by Registered Nurses

Consultation Time Topics covered

1. Week 1 60 minutes Introduction to the program

Participant expectations

Personal goal setting using Personal Goals record

2. Week 4 30 - 60 minutes Step 2 Consolidating healthy

lifestyle and learning more about health

Review and discuss issues Reinforce health information Review and discuss goals

3. Week 8 30- 60 minutes Step 3 Maintaining healthy

lifestyle and health promotion for illness prevention

Review and discuss issues Reinforce health information Review and discuss goals

4. Week 12 30 – 60 minutes Step 4 Becoming independent

Review and discuss issues Discuss ways to remain motivated after the program Discuss goals for future health

During consultations there was an emphasis on working with participants to set realistic and achievable goals for behaviour change. While there was consistency in information provided and structure for the consultations, the information was also tailored for the individual needs of participants depending on the goals they identified or topics that arose in the conversation. For example, if a participant identified that they did not enjoy walking for exercise, then other exercise options were discussed.

4.6 STRATEGIES TO PROMOTE EXERCISE BEHAVIOUR CHANGE Exercise is an essential component of the Women’s Wellness Program. A number of strategies are used to promote the benefits of exercise and reduce barriers to positive behaviour change.

4.6.1 Promoting the benefits of exercise

Throughout the program, evidence based information is provided and the benefits of regular exercise are discussed. For example in Week 1 Day 3, a range of exercise benefits are presented in an illustration shown in Figure 4.15 below.

Figure 4.15. Illustration from the Book – ‘Benefits of Exercise’

The benefits of exercise are continually reinforced, and presented in the context of improving health and wellness as women transition to menopause. A lot of evidence based information about menopause is provided with recommendation that

regular exercise may assist in reducing menopausal symptoms such as hot flushes and sleep disturbance.

In Step 3, the importance of exercise is further explained and reinforced in the context of healthy ageing and prevention of chronic diseases including heart disease, diabetes and cancer.

4.6.2 Structure

The program provides a structured approach to guide participants to increase physical activity and exercise. It recognises that women will be at different levels of fitness and recommends starting slowly and gradually building up the intensity and duration of exercise over the 12 weeks. Detailed information and guidelines are provided about aerobic exercise, stretching and flexibility and strength training exercise.

Aerobic exercise

In Week 1/Day 3 the benefits of exercise to health are outlined and the 2012 Physical Activity Guidelines for Adults are described (Australian Government Department of Health and Ageing, 2012). These recommend that for optimal health adults should aim to do 30 to 60 minutes of moderate to vigorous exercise on most days of the week; and at a minimum a total of 150 minutes per week. If a participant is not currently exercising it is suggested they commence regular walking, and gradually build up the intensity and duration of aerobic exercise over the 12 week program. The Borg rating of perceived exertion scale (Borg, 1998) is provided and explained to encourage participants to understand and recognise moderate intensity level of exertion during exercise (See Appendix G).

Stretching and flexibility

On Week 2/Day 2 of the program stretching is introduced. Participants are encouraged to stretch after exercise and a series of stretches is illustrated with photographs including: hamstring stretch; quadriceps stretch; gluteal stretch;

shoulder and chest stretch (See Appendix H: Stretching exercise).

Strength training exercise

On Week 2/Day 3 strength training exercise is explained and recommended for a minimum of at least two sessions per week. A series of strength exercises without equipment (Program 1) is described in detail with photographic illustrations included to guide participants. The exercises recommended are: squats, lunges, modified push-ups, seated tricep dips, abdominal and pelvic floor exercises and lower back strengthening (See Appendix I: Strength training Program 1).

In Week 5, participants are encouraged to use 2 kilogram hand weights while undertaking a series of exercises (Program 2) including: squats, lunges, modified push-ups, shoulder press, bicep curl, overhead triceps extension. Again the exercises are explained and illustrated with photographs to guide participants. In Week 5 it is also suggested that strength exercises can be undertaken in a fitness centre (Program 3) where a fitness instructor can guide in the use of exercise equipment (See Appendix J: Strength training Program 2 and 3).

Pelvic floor exercises

On Week 2, Day 1 pelvic floor exercises are discussed, with a recommendation that women practice them twice a day. Instructions are provided to inform participants’ how to do the exercises correctly.

4.6.3 Goal setting, exercise planning and weekly review

Goal setting and weekly planning and recording of exercise is also encouraged throughout the 12 week program. In Week 1, Week 4, Week 8 participants are encouraged to set realistic and achievable goals for aerobic exercise, stretching and strength training for the following four weeks.

On Day 7 of Week 1 and each week thereafter, participants are asked to plan their exercise for the coming week and to record it on an ‘Exercise Schedule’. On the same day they are also encouraged to review and record the exercise and other health behaviours they have undertaken during the past week in a ‘Weekly Review’ table.

See Figures 4.6 and 4.7 from the website, with similar tables also presented in the program book.

4.6.4 Integration of exercise with other health behaviours

Throughout the program, exercise behaviour change is integrated with other health behaviours and health information including healthy eating principles, stress management, sleep, and healthy lifestyle behaviours. A ‘WELLNESS’ acronym is used throughout the 12 weeks to remind participants of the key health messages (See Figure 4.16 below).

Figure 4.16. ‘WELLNESS’ Acronym

4.6.5 Self-reflection

At regular intervals throughout the program, participants are encouraged to reflect on how well they are meeting the exercise and other goals they have set and to acknowledge positive behaviour change they have made. For example, Week 6 is titled ‘Reflection and transformation week’ with participants being invited to review all the lifestyle changes they have made, reward themselves for positive change and to reflect and write down what they would like to improve.

4.6.6 Acknowledging barriers and challenges to behaviour change

In addition to self-reflection, Week 11 is titled ‘Motivation and change’, where it is acknowledged that maintaining healthy lifestyle habits like regular exercise is challenging. Some suggestions are provided to assist in maintaining motivation including: establishing a routine, self-belief, goal setting, reflecting on the positive benefits and how change often happens in stages that are gradual and incremental.

4.6.7 Health consultations

In addition to the strategies outlined above, participants in Group B (face-to-face with health professional support) and Group C (online with health professional support) also receive health consultations from a Registered Nurse, where additional support is provided with goal setting to promote increased exercise and healthy lifestyle behaviours (See Section 4.5).

4.7 SUMMARY

In summary, the intervention is a complex multi-modal 12 week intervention targeting a range of health behaviours most importantly exercise and healthy eating.

In this study, participants undertook the program either independently online, face to face with health professional support or online with health professional support. A

program book complements the website. In the following chapter results of Phase 1 of the study are presented.

Chapter 5: Results Phase 1

5.1 INTRODUCTION

This chapter presents results of Phase 1 of the study, where cross sectional data were collected from 225 participants prior to commencement of the intervention. The aim of Phase 1 of the study was to examine the factors that predict perceived barriers to exercise in midlife women. Firstly, in Section 5.2 socio-demographic characteristics, health risk factors, health characteristics, perceived benefits and barriers to exercise and social-cognitive factors are described. Next, in Section 5.3 the results of bivariate analysis where the relationship between perceived barriers to exercise and a range of variables, is presented. Finally, in Section 5.4 hierarchical regression modelling is used to investigate the predictors of perceived barriers to exercise.

5.2 PART A: UNIVARIATE ANALYSIS

5.2.1 Description of socio-demographic characteristics Age

The age of women ranged between 40 to 65 years old. The mean age was 50.9 years (SD = 5.9). Most of the women were married (72.9%) or in a de facto relationship (9.3%). The remaining participants were separated, divorced, widowed or single (10.2%). The majority of participants were born in Australia (79.1%) with most born outside of Australia being born in English speaking countries including the United Kingdom, New Zealand, Canada, South Africa and Ireland. Only three participants identified as being Aboriginal or Torres Strait Islander (1.3%). The majority of participants (91.1%) spoke English in the home with twenty participants (8.9%) speaking a language other than English at home. Approximately two thirds

(68.9%) of participants had a university or college degree with 20.9% having a trade, technical certificate or diploma. Most of the remaining participants (6.5%) reported completing senior school. The majority of women were employed either full-time (52.9%) or part-time (29.3%). Over half of participants (60%) had a gross annual household income above AUS$100,000 with a further quarter (24%) having household income between AU$60,000 to AU$100,000. Most participants were residents of Queensland (52.9%) or New South Wales (25.8%), with the remaining participants living in Western Australia, South Australia, Victoria and the Northern Territory. Table 5.1 presents the socio-demographic variables of women participating in Phase 1 of the study.

Table 5.1

Socio-demographic Characteristics of Participants Phase 1(N = 225)

Variables N % or M (SD) Aboriginal, Torres Strait or South Sea Islander

Yes

Highest education level obtained Completed junior school Junior senior school

Trade, technical certificate, diploma University or college degree

5.2.2 Description of health risk factors BMI

Based on self-reported height and weight, BMI was calculated for each participant. The mean BMI was 28.77 (SD = 5.69). Continuous BMI was transformed into categories with 27.1% of all participants being normal weight, and the majority being overweight (38.2%) or obese (34.7%).

Table 5.2 illustrates the comparison of BMI between Australian women in different age categories and study participants. While the lowest age category for

Table 5.2 illustrates the comparison of BMI between Australian women in different age categories and study participants. While the lowest age category for

In document Benefits and barriers to exercise in midlife women undertaking a web-based multi-modal lifestyle intervention for the primary prevention of chronic disease (Page 144-200)