OBJECTIVEBehavioral interventions targeting “free-living” physical activity (PA) and exercise that produce long-term glycemic control in adults with type 2 diabetes are warranted. However, little is known about how clinical teams should support adults with type 2 diabetes to achieve and sustain a physically active lifestyle.RESEARCH DESIGN AND METHODSWe conducted a systematic review of randomized controlled trials (RCTs) (published up to January 2012) to establish the effect of behavioral interventions (compared with usual care) on free-living PA/exercise, HbA1c, and BMI in adults with type 2 diabetes. Study characteristics, methodological quality, practical strategies for increasing PA/exercise (taxonomy of behavior change techniques), and treatment fidelity strategies were captured using a data extraction form.RESULTSSeventeen RCTs fulfilled the review criteria. Behavioural interventions showed statistically significant increases in objective (standardized mean difference [SMD] 0.45, 95% CI 0.21–0.68) and self-reported PA/exercise (SMD 0.79, 95% CI 0.59–0.98) including clinically significant improvements in HbA1c (weighted mean difference [WMD] –0.32%, 95% CI –0.44% to –0.21%) and BMI (WMD –1.05 kg/m2, 95% CI –1.31 to –0.80). Few studies provided details of treatment fidelity strategies to monitor/improve provider training. Intervention features (e.g., specific behavior change techniques, interventions underpinned by behavior change theories/models, and use of ≥10 behaviour change techniques) moderated effectiveness of behavioral interventions.CONCLUSIONSBehavioral interventions increased free-living PA/exercise and produced clinically significant improvements in long-term glucose control. Future studies should consider use of theory and multiple behavior change techniques associated with clinically significant improvements in HbA1c, including structured training for care providers on the delivery of behavioural interventions.

This study examines the construct validity of an original self-report instrument for the assessment of mental toughness: the Sports Mental Toughness Questionnaire (SMTQ). Two independent studies supported a three-factor (Confidence, Constancy, and Control) 14-item model for the SMTQ. With a sample of 633 athletes (427 males, 206 females; M age = 21.5 years; SD = 5.48), drawn from 25 sport classifications, and competing at international, national, county and provincial, or club and regional standards, the first study utilized item development and exploratory factor analytic techniques to establish the psychometric properties of the SMTQ. Study 2 employed confirmatory factor analytic techniques with an independent sample of 509 sports performers (351 males, 158 females; M age = 20.2 years; SD = 3.35), competing at the aforementioned standards, and representative of 26 sports. Confirmatory analysis using structural equation modeling confirmed the overall structure. A single factor underlying mental toughness (G mt ) was identified with higher-order exploratory factor analysis using the Schmid-Leiman procedure. Collectively, satisfying absolute and incremental fit-index benchmarks, the inventory was shown to possess satisfactory psychometric properties, with adequate reliability, divergent validity, and discriminative power. The results revealed promising features of the SMTQ, lending preliminary support to the instrument's factorial validity and reliability. Further construct validation of the SMTQ is recommended, including its use as an index for evaluating the effect of intervention programs.

Introduction: Caring for a person with Parkinson's disease (PwP) can have a variety

Background-Consumer involvement in clinical guidelines has long been advocated although there are few empirical accounts of attempts to do so. It is therefore not surprising that there is a lack of clarity about how and when to involve consumers and what to expect from them within the process of guideline development. Methods-The North of England evidence based guideline development programme has used four diVerent methods of consumer involvement. Results-When individual patients were included in a guideline development group they contributed infrequently and had problems with the use of technical language. Although they contributed most in discussions of patient education, their contributions were not subsequently acted on. In a "one oV" meeting with a group of patients there were again reported problems with medical terminology and the group were most interested in sections on patient education and self management. However, their understanding of the use of scientific evidence in order to contribute to a more cost eVective health care remained unclear. In a workshop it was possible to explain the technical elements of guideline development to patients who could then engage with such a process and make relevant suggestions as a consequence. However, this was relatively resource intensive. A patient advocate within a guideline development group felt confidence to speak, was used to having discussions with health professionals, and was familiar with the medical terminology. Conclusions-Consumers should be involved in all stages of guideline development. While this is possible, it is not straightforward. There is no one right way to accomplish this and there is a clear need for further work on how best to achieve it.

Summary: The evaluation and monitoring of interventions that are designed to alleviate psychosocial stress rely largely on subjective assessments of coping as primary outcome measures. The pros and cons of different response formats used to measure coping variables are unexplored; yet arguably, response format is a very important methodological issue for the clinical application and evaluation of psychosocial interventions. This study compared the levels of functional coping and transactional coping patterns assessed with multi-item 7-point Likert Scales (LS) and 65mm Visual Analogue Scales (VAS), within the framework of the Functional Dimensions of Coping (FDC) Scale developed by Ferguson and Cox, 1997. LS yielded significantly higher levels of functional coping for all four subscales, and captured a wider range of transactional coping patterns for the approach, emotion, and avoidance coping functions, than VAS. The authors recommend the use of LS for baseline assessments of transactionally defined coping function within the FDC framework.

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Aims To explore which behaviour change techniques and other intervention features are associated with increased levels of physical activity and improved HbA 1c in adults with Type 2 diabetes.Methods Moderator analyses were performed on a dataset of 21 behaviour change techniques and six intervention features identified in a systematic review of behavioural interventions (N = 1975 patients with Type 2 diabetes) to establish their associations with changes in physical activity and HbA 1c .Results Four behaviour change techniques (prompt focus on past success, barrier identification/problem-solving, use of follow-up prompts and provide information on where and when to perform physical activity) had statistically significant associations with increased levels of physical activity. Prompt review of behavioural goals and provide information on where and when to perform physical activity behaviour had statistically significant associations with improved HbA 1c . Pedometer use was associated with decreased levels of physical activity.Conclusions These data suggest that clinical care teams can optimise their consultations by incorporating specific behaviour change techniques that are associated with increased levels of physical activity and improved long-term glycaemic control.

This study assesses the construct validity of a measure of mental toughness, Loehr's Psychological Performance Inventory. Performers (N = 408, 303 men, 105 women, M age = 24.0 yr., SD = 6.7) drawn from eight sports (artistic rollerskating, basketball, canoeing, golf, rugby league, rugby union, soccer, swimming), and competing at either international, national, county and provincial, or club and regional standards. They completed the 42-item Psychological Performance Inventory during training camps. Principal components analysis provided minimal support for the factor structure. Instead, the exploratory analysis yielded a 4-factor 14-item model (PPI-A). A single factor underlying mental toughness (G(MT)) was identified with higher-order exploratory factor analysis using the Schmid-Leiman procedure. Psychometric analysis of the model, using confirmatory analysis techniques, fitted the data well. Collectively satisfying absolute and incremental fit index benchmarks, the inventory possesses satisfactory psychometric properties, with adequate reliability and convergent and discriminant validity. The results lend preliminary support to the factorial validity and reliability of the model; however, further investigation of its stability is required before recommending practitioners use changes in scores as an index for evaluating effects of training in psychological skills.