Browsing by Author "Lambert, Estelle"

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    Accuracy of reporting food energy intake: Influence of ethnicity and body weight status in South African women
    (2010) Mchiza, Z J; Goedecke, Julia; Lambert, Estelle
    The current study sought to identify characteristics that may be associated with the misreporting of food energy intake (EI) in urban South African women. A total of 198 women (61 black, 76 of mixed ancestry, 61 white) completed a quantified food frequency questionnaire, from which daily energy and macronutrient intake were calculated. Body composition (body mass index [BMI], percentage of body fat), body image (Feel-Ideal Difference index and Body Shape questions) and socio-economic status (SES) (household density and asset index) were also measured. Food EI in relation to estimated basal metabolic rate ratio that was less than 1.05 represented under-reporting, whereas a ratio greater than 2.28 represented over-reporting. Results suggested that 26% of the participants under-reported, 64% adequately reported and 10% over-reported. Participants who under-reported had a higher BMI (p < 0.01) and higher percentage of body fat (p < 0.05) than those who adequately and over-reported. The majority of under-reporters were black (38%) versus 21% under-reporters of mixed ancestry and 20% white under-reporters (p < 0.01). Eighty-three per cent of black under-reporters were obese. On the other hand, a majority (63%) of overweight women of mixed ancestry and a majority (50%) of white normal-weight women under-reported their food EI. Under-reporters reported a lower intake of dietary fat (p < 0.01) and a higher intake of dietary protein (p < 0.01) than adequate or over-reporters. Food EI reporting was not influenced by SES or body image. In conclusion, results suggest that food EI reporting is influenced by body size, and may be ethnic-specific in South African women.
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    Advancing the global physical activity agenda: recommendations for future research by the 2020 WHO physical activity and sedentary behavior guidelines development group
    (2020-11-26) DiPietro, Loretta; Al-Ansari, Salih S; Biddle, Stuart J H; Borodulin, Katja; Bull, Fiona C; Buman, Matthew P; Cardon, Greet; Carty, Catherine; Chaput, Jean-Philippe; Chastin, Sebastien; Chou, Roger; Dempsey, Paddy C; Ekelund, Ulf; Firth, Joseph; Friedenreich, Christine M; Garcia, Leandro; Gichu, Muthoni; Jago, Russell; Katzmarzyk, Peter T; Lambert, Estelle; Leitzmann, Michael; Milton, Karen; Ortega, Francisco B; Ranasinghe, Chathuranga; Stamatakis, Emmanuel; Tiedemann, Anne; Troiano, Richard P; van der Ploeg, Hidde P; Willumsen, Juana F
    Abstract Background In July, 2019, the World Health Organization (WHO) commenced work to update the 2010 Global Recommendations on Physical Activity for Health and established a Guideline Development Group (GDG) comprising expert public health scientists and practitioners to inform the drafting of the 2020 Guidelines on Physical Activity and Sedentary Behavior. The overall task of the GDG was to review the scientific evidence and provide expert advice to the WHO on the amount of physical activity and sedentary behavior associated with optimal health in children and adolescents, adults, older adults (> 64 years), and also specifically in pregnant and postpartum women and people living with chronic conditions or disabilities. Methods The GDG reviewed the available evidence specific to each sub-population using systematic protocols and in doing so, identified a number of gaps in the existing literature. These proposed research gaps were discussed and verified by expert consensus among the entire GDG. Results Evidence gaps across population sub-groups included a lack of information on: 1) the precise shape of the dose-response curve between physical activity and/or sedentary behavior and several of the health outcomes studied; 2) the health benefits of light-intensity physical activity and of breaking up sedentary time with light-intensity activity; 3) differences in the health effects of different types and domains of physical activity (leisure-time; occupational; transportation; household; education) and of sedentary behavior (occupational; screen time; television viewing); and 4) the joint association between physical activity and sedentary time with health outcomes across the life course. In addition, we acknowledge the need to conduct more population-based studies in low- and middle-income countries and in people living with disabilities and/or chronic disease, and to identify how various sociodemographic factors (age, sex, race/ethnicity, socioeconomic status) modify the health effects of physical activity, in order to address global health disparities. Conclusions Although the 2020 WHO Guidelines for Physical Activity and Sedentary Behavior were informed by the most up-to-date research on the health effects of physical activity and sedentary time, there is still substantial work to be done in advancing the global physical activity agenda.
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    Chronic disease risk factors, healthy days and medical claims in South African employees presenting for health risk screening
    (BioMed Central Ltd, 2008) Kolbe-Alexander, Tracy L; Buckmaster, Chris; Nossel, Craig; Dreyer, Liezel; Bull, Fiona; Noakes, Timothy D; Lambert, Estelle
    BACKGROUND: Non-communicable diseases (NCD) accounts for more than a third (37%) of all deaths in South Africa. However, this burden of disease can be reduced by addressing risk factors. The aim of this study was to determine the health and risk profile of South African employees presenting for health risk assessments and to measure their readiness to change and improve lifestyle behaviour. METHODS: Employees (n = 1954) from 18 companies were invited to take part in a wellness day, which included a health-risk assessment. Self-reported health behaviour and health status was recorded. Clinical measures included cholesterol finger-prick test, blood pressure and Body Mass Index (BMI). Health-related age was calculated using an algorithm incorporating the relative risk for all case mortality associated with smoking, physical activity, fruit and vegetable intake, BMI and cholesterol. Medical claims data were obtained from the health insurer. RESULTS: The mean percentage of participation was 26% (n = 1954) and ranged from 4% in transport to 81% in the consulting sector. Health-related age (38.5 +/- 12.9 years) was significantly higher than chronological age (34.9 +/- 10.3 yrs) (p < 0.001). Both chronological and risk-related age were significantly different between the sectors (P < 0.001), with the manufacturing sector being the oldest and finance having the youngest employees. Health-related age was significantly associated with number of days adversely affected by mental and physical health, days away from work and total annual medical costs (p < 0.001). Employees had higher rates of overweight, smoking among men, and physical inactivity (total sample) when compared the general SA population. Increased health-related expenditure was associated with increased number of risk factors, absenteeism and reduced physical activity. CONCLUSION: SA employees' health and lifestyle habits are placing them at increased risk for NCD's, suggesting that they may develop NCD's earlier than expected. Inter-sectoral differences for health-related age might provide insight into those companies which have the greatest need for interventions, and may also assist in predicting future medical expenditure. This study underscores the importance of determining the health and risk status of employees which could assist in identifying the appropriate interventions to reduce the risk of NCD's among employees.
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    Clustering of risk factors for non-communicable disease and healthcare expenditure in employees with private health insurance presenting for health risk appraisal: a cross-sectional study
    (BioMed Central Ltd, 2013) Kolbe-Alexander, Tracy; Conradie, Jaco; Lambert, Estelle
    BACKGROUND: The global increase in the prevalence of NCD's is accompanied by an increase in risk factors for these diseases such as insufficient physical activity and poor nutritional habits. The main aims of this research study were to determine the extent to which insufficient physical activity (PA) clustered with other risk factors for non-communicable disease (NCD) in employed persons undergoing health risk assessment, and whether these risk factors were associated with higher healthcare costs. METHODS: Employees from 68 companies voluntarily participated in worksite wellness days, that included an assessment of self-reported health behaviors and clinical measures, such as: blood pressure (BP), Body Mass Index (BMI), as well as total cholesterol concentrations from capillary blood samples. A risk-related age, 'Vitality Risk Age' was calculated for each participant using an algorithm that incorporated multiplicative pooled relative risks for all cause mortality associated with smoking, PA, fruit and vegetable intake, BMI, BP and cholesterol concentration. Healthcare cost data were obtained for employees (n = 2 789). RESULTS: Participants were 36+/-10years old and the most prevalent risk factors were insufficient PA (67%) and BMI[greater than or equal to]25 (62%). Employees who were insufficiently active also had a greater number of other NCD risk factors, compared to those meeting PA recommendations (chi2 = 43.55; p < 0.0001). Moreover, employees meeting PA guidelines had significantly fewer visits to their family doctor (GP) (2.5 versus 3.11; p < 0.001) than those who were insufficiently PA, which was associated with an average cost saving of ZAR100 per year (p < 0.01). Furthermore, for every additional year that the 'Vitality Risk Age' was greater than chronological age, there was a 3% increased likelihood of at least one additional visit to the doctor (OR = 1.03; 95% CI = 1.01 - 1.05). CONCLUSION: Physical inactivity was associated with clustering of risk factors for NCD in SA employees. Employees with lower BMI, better self-reported health status and readiness to change were more likely to meet the PA guidelines. These employees might therefore benefit from physical activity intervention programs that could result in improved risk profile and reduced healthcare expenditure.
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    Development of a four-item physical activity index from information about subsistence living in rural African women: a descriptive, cross-sectional investigation
    (BioMed Central Ltd, 2009) Cook, Ian; Alberts, Marianne; Lambert, Estelle
    BACKGROUND:We investigated the criterion validity of a physical activity index (PAI) derived from socio-demographic variables obtained from convenience samples of rural African women. METHODS: We used a sample (N = 206) from a larger dataset which surveyed adult rural Africans during 1997, and data collected during 2003/4 from 138 adult rural African women. A three-point PAI (low-, medium- and high-subsistence) was constructed from four socio-demographic questions related to electricity, cooking methods, water collection and availability of motorized transport. Criterion measures included measures of adiposity, blood biochemistry, resting blood pressure (RBP), physical fitness (VO2max) and single-plane accelerometry (ACC). RESULTS: Age, educational level and health status were not related to PAI level (p > 0.1). There was a significant negative, linear trend between the PAI level and adiposity level (p < 0.04), and fasting blood glucose concentration (p < 0.0001), while VO2max was positively related to PAI level (p = 0.0190). The PAI level was positively and linearly related to ACC output, namely counts.day-1 (p = 0.0044), steps.day-1 (p = 0.0265), min.day-1 of moderate-to-vigorous activity (p = 0.0040), and the percentage of subjects adhering to physical activity public health guidelines (p = 0.0157). Other criterion measures did not reach significance, but were in the expected direction (sedentary behaviour: p > 0.08, RBP: p > 0.07). CONCLUSION: The PAI derived from a socio-demographic questionnaire is a valid instrument for broadly categorizing levels of physical activity for this specific population of rural African women. As the epidemiological transition progresses, validity will need to be re-established.
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    Fasting substrate oxidation in relation to habitual dietary fat intake and insulin resistance in non-diabetic women: a case for metabolic flexibility?
    (BioMed Central Ltd, 2013) Carstens, Madelaine; Goedecke, Julia; Dugas, Lara; Evans, Juliet; Kroff, Jacolene; Levitt, Naomi; Lambert, Estelle
    BACKGROUND: Metabolic flexibility described as "the capacity of the body to match fuel oxidation to fuel availability" has been implicated in insulin resistance. We examined fasting substrate oxidation in relation to dietary macronutrient intake, and markers of insulin resistance in otherwise healthy women, with and without a family history of diabetes mellitus (FH DM). METHODS: We measured body composition (dual x-ray absorptiometry), visceral and subcutaneous adipose tissue area (VAT, SAT, using Computerised Tomography), fasting [glucose], [insulin], [free fatty acids], [blood lipids], insulin resistance (HOMA-IR), resting energy expenditure (REE), respiratory exchange ratio(RER) and self-reported physical activity in a convenience sample of 180 women (18-45 yrs). A food frequency questionnaire was used to assess energy intake (EI) and calculate the RER: Food Quotient (FQ) ratio. Only those with EI:REE (1.05 -2.28) were included (N=140). Insulin resistance was defined HOMA-IR (>1.95). RESULTS: The Insulin Resistant (IR) group had higher energy, carbohydrate and protein intakes (p<0.05) and lower PA levels than Insulin Sensitive (IS) group (P<0.001), but there were no differences in RER or RER:FQ between groups. However, nearly 50% of the variance in HOMA-IR was explained by age, body fat %, VAT, RER:FQ and FH DM (adjusted R2=0.50, p<0.0001). Insulin-resistant women, and those with FH DM had a higher RER:FQ than their counterparts (p<0.01), independent of body fat % or distribution. CONCLUSION: In these apparently healthy, weight-stable women, insulin resistance and FH DM were associated with lower fat oxidation in relation to dietary fat intake, suggesting lower metabolic flexibility.
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    "HealthKick": Formative assessment of the health environment in low-resource primary schools in the Western Cape Province of South Africa
    (BioMed Central Ltd, 2012) de Villiers, Anniza; Steyn, Nelia; Draper, Catherine; Fourie, Jean; Barkhuizen, Gerhard; Lombard, Carl; Dalais, Lucinda; Abrahams, Zulfa; Lambert, Estelle
    BACKGROUND: This study evaluated the primary school environment in terms of being conducive to good nutrition practices, sufficient physical activity and prevention of nicotine use, with the view of planning a school-based health intervention. METHODS: A sample of 100 urban and rural disadvantaged schools was randomly selected from two education districts of the Western Cape Education Department, South Africa. A situation analysis, which comprised an interview with the school principal and completion of an observation schedule of the school environment, was done at all schools. RESULTS: Schools, on average, had 560 learners and 16 educators. Principals perceived the top health priorities for learners to be an unhealthy diet (50%) and to far lesser degree, lack of physical activity (24%) and underweight (16%). They cited lack of physical activity (33%) and non-communicable diseases (NCDs; 24%) as the main health priorities for educators, while substance abuse (66%) and tobacco use (31%) were prioritised for parents. Main barriers to health promotion programmes included lack of financial resources and too little time in the time table. The most common items sold at the school tuck shops were crisps (100%), and then sweets (96%), while vendors mainly sold sweets (92%), crisps (89%), and ice lollies (38%). Very few schools (8%) had policies governing the type of food items sold at school. Twenty-six of the 100 schools that were visited had vegetable gardens. All schools reported having physical activity and physical education in their time tables, however, not all of them offered this activity outside the class room. Extramural sport offered at schools mainly included athletics, netball, and rugby, with cricket and soccer being offered less frequently. CONCLUSION: The formative findings of this study contribute to the knowledge of key environmental and policy determinants that may play a role in the health behaviour of learners, their parents and their educators. Evidently, these show that school environments are not always conducive to healthy lifestyles. To address the identified determinants relating to learners it is necessary to intervene on the various levels of influence, i.e. parents, educators, and the support systems for the school environment including the curriculum, food available at school, resources for physical activity as well as appropriate policies in this regard.
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    HealthKick: a nutrition and physical activity intervention for primary schools in low-income settings
    (BioMed Central Ltd, 2010) Draper, Catherine; de Villiers, Anniza; Lambert, Estelle; Fourie, Jean; Hill, Jillian; Dalais, Lucinda; Abrahams, Zulfa; Steyn, Nelia
    BACKGROUND: The burden of non-communicable diseases, including type 2 diabetes, is growing in South Africa. This country has a complex mix of over- and under-nutrition, especially in low-income communities, and concerning levels of physical inactivity in children and youth. This paper describes HealthKick, a school-based nutrition and physical activity intervention in primary schools in these settings aimed at reducing diabetes risk factors.METHODS/DESIGN:This study includes schools within historically disadvantaged, low-income communities from an urban area close to the city of Cape Town and from two rural areas outside of Cape Town, South Africa. The three Educational Districts involved are Metropole North, Cape Winelands and the Overberg. The study has three phases: intervention mapping and formative assessment, intervention development, and outcome and process evaluation. Sixteen schools were purposively selected to participate in the study and randomly allocated as intervention (eight schools) and control (eight schools).The primary aims of HealthKick are to promote healthful eating habits and increase regular participation in health-enhancing physical activity in children, parents and teachers, to prevent overweight, and reduce risk of chronic diseases (particularly type 2 diabetes); as well as to promote the development of an environment within the school and community that facilitates the adoption of healthy lifestyles.The components of HealthKick are: action planning, toolkit (resource guide, a resource box and physical activity resource bin), and an Educators' Manual, which includes a curriculum component.DISCUSSION:This study continues to highlight the key role that educators play in implementing a school-based intervention, but that developing capacity within school staff and stakeholders is not a simple or easy task. In spite of the challenges experienced thus far, valuable findings are being produced from this study, especially from Phase 1. Materials developed could be disseminated to other schools in low-income settings both within and outside of South Africa. Owing to the novelty of the HealthKick intervention in low-income South African primary schools, the findings of the evaluation phase have the potential to impact on policy and practice within these settings.
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    Intra-familial and ethnic effects on attitudinal and perceptual body image: a cohort of South African mother-daughter dyads
    (BioMed Central Ltd, 2011) Mchiza, Zandile; Goedecke, Julia; Lambert, Estelle
    BACKGROUND: International studies suggest ethnic differences in obesity prevalence may be due, in part, to differences in body image and body size dissatisfaction between groups. Further, there is evidence to suggest that there is a familial resemblance in body image between mothers and their younger (preadolescent) daughters. This research was therefore conducted to specifically identify the extent to which family status (presented as mother-daughter resemblance) and ethnicity impact on body image attitudes and perceptions of South African mothers and their pre-adolescent daughters. METHODS: Mother-daughter dyads (n = 201, 31% black, 37% mixed ancestry and 32% white) answered questions regarding their body image perception (the way they saw their body size status), their body image ideals, and body image attitudes (body size dissatisfaction in particular, presented as the Feel-Ideal Difference [FID] index score). Mothers' and daughters' body image results were compared within dyads and across ethnic groups using repeated measures of ANOVA. RESULTS: Overall, body image resemblances exist between South African mothers and their pre-adolescent daughters. Mothers and daughters chose similarly weighted silhouettes to represent their body size ideals (p = 0.308), regardless of their ethnicity or body mass index (BMI). The FID index scores were similar between mothers and their daughters only after the confounding effects of maternal BMI were removed (p = 0.685). The silhouettes chosen to represent thinness were also similar between mothers and their daughters (p = 0.960) regardless of ethnicity and maternal BMI. On the other hand, the silhouettes chosen to represent fatness were similar (p = 0.342) between mothers and their daughters, only after the confounding effects of maternal BMI were removed. Lastly, mothers and their daughters chose similarly weighted silhouettes as engendering feelings of beauty, respect and happiness (p = 0.813; p = 0.615 and p = 0.693, respectively). In this instance, black mother-daughter dyads chose significantly heavier silhouettes than the other ethnic groups. This implies that black mothers and daughters associate beauty, respect and happiness with a bigger body size. CONCLUSION: Resemblances exist between pre-adolescent girls and their mothers on issues related to ideal and attitudinal body image. In this regard, South African researchers should consider the effects ethnicity and family status on body image of women when developing targeted interventions to prevent or manage obesity.
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    "Perceived neighborhood walkability" and physical activity in four urban settings in South Africa
    (2019) Isiagi, Moses; Lambert, Estelle; Okop, Kufre Joseph
    Introduction. In Africa, studies on the associations between the perceived neighbourhood walkability and physical activity, particularly, by socio-economic status (SES) remain scarce. This study explores these associations by validating the Neighbourhood Environmental Walkability Scale (NEWS-Africa) in an urban setting of South Africa to gain a better understanding of the construct of neighbourhood “walkability”. Methods. A convient sample of residents from four suburbs in urban metropole (n=52, 18-65yr, 81% women) in the Western Cape Province, South Africa (viz. Langa, Khayelitsha, Pinelands and Table View) were recruited through invitations following community gatherings and church services. Measures were obtained on perceived neighbourhood walkability, self-reported and measured physical activity and socio-economic status. Langa and Khayelitsha represented two primarily low-SES townships, whereas Pinelands and Table View represented suburbs of a higher-SES. Participants completed the 76-item (13 subscales) NEWS-Africa survey by structured interviews and reported weekly minutes of walking for transport and recreation using items from the International Physical Activity Questionnaire. Objective data on physical activity was collected using accelerometers, and ground-truthing was used to assess the neighbourhood environment using global information systems (GIS) in a 1000m buffer around each geocoded household. The research was carried out in three parts: 1) Evaluating the reliability and construct validity of the NEWS-Africa instrument between the two-SES groups. 2) Examining some of the walkability constructs and subscales of the NEWS-Africa instrument using GIS and ground-truthing, and the extent to which the SES of communities influenced these associations. 3) Examining the differences in self-reported physical activity (domains), measured physical activity (MVPA) when groups are divided according to SES, GIS walkability (1000m buffers) and if the data support the notion of utilitarian walking in low SES groups, irrespective of the built environment attributes. Results. For the combined-SES groups, the test-retest reliability indicated a good reliability with 10 out of the 13 scales of the NEWS-Africa being significantly and positively correlated. The Spearman’s correlations ranged from (rs = -0.43, p=0.00 to rs = 0.79, p=0.00). For construct validity of the NEWS -Africa instrument against self-reported physical activity, only three scales were related to walking for transport: Neighbourhood surroundings scale (rs= -0.34, p=0.01), Safety from Traffic scale (rs =0.34, p< 0.05) and people in the low-SES and combined SES perceived public bus/ train stops to be nearer than they actually were (rs =-0.50, P< 0.05). Of the 13 scales of the NEWS-Africa questionnaire, 6 were significantly correlated to GIS-measured walkability index parameters. The Roads and walking paths scale was positively associated with GIS-measured walkability (rs = 0.3), and the Stranger danger scale was negatively associated with GIS-measured walkability (rs = -0.4). When we considered GIS-measured Land use mix, 3 of the NEWS- Africa scales were correlated (For the entire sample, the scales including Places for walking, cycling and playing overall scale (rs = 0.3), and Neighbourhood surroundings scale (rs = 0.3), were positively associated respectively). Conversely, Stranger danger scale was inversely correlated (rs = -0.6). Intersection density measured with GIS was significantly and positively associated with the Roads and walking paths scale for all groups combined (rs = 0.3). For GIS-measured walkability, self-report physical and measured physical activity, there were no associations in any of the domains for self-reported physical activity within the 1000m buffer for all groups. However, for the objectively measured physical activity in the 1000m buffer, vigorous physical activity (rs = -0.39) was inversely associated with intersection density in the low-SES and moderate (rs = -0.29) and total MVPA (rs = -0.31) were inversely associated with Intersection density in the high SES. Conclusions: The overall results of the current study across all chapters generally show a mismatch between the perceived and objectively-assessed built environment, particularly in low-income communities. Furthermore, in low-SES communities, we failed to show the expected relationships between attributes of the built environment and physical activity, suggesting that physical activity in these communities is more utilitarian in nature, and as such, may not be as influenced by aspect of the built environment. In summary, the data suggest that the environment (including crime rates, poor access to physical activity facilities and public transportation predominantly made by buses) has less of an association with physical activity in LMICs and more disadvantaged communities, where physical activity is used for utilitarian, rather than recreational purposes. This study stemmed from the need to broaden research on the relationship between the built environment and physical activity, considering walkability constructs. These findings also suggest that the definition of the construct of walkability be re-examined, in relation to low SES settings.
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    Protocol for the modeling the epidemiologic transition study: a longitudinal observational study of energy balance and change in body weight, diabetes and cardiovascular disease risk
    (BioMed Central Ltd, 2011) Luke, Amy; Bovet, Pascal; Forrester , Terrence; Lambert, Estelle; Plange-Rhule, Jacob; Schoeller, Dale; Dugas, Lara; Durazo-Arvizu, Ramon; Shoham, David; Cooper, Richard; Brage, Soren; Ekelund, Ulf; Steyn, Nelia
    BACKGROUND: The prevalence of obesity has increased in societies of all socio-cultural backgrounds. To date, guidelines set forward to prevent obesity have universally emphasized optimal levels of physical activity. However there are few empirical data to support the assertion that low levels of energy expenditure in activity is a causal factor in the current obesity epidemic are very limited. METHODS/DESIGN: The Modeling the Epidemiologic Transition Study (METS) is a cohort study designed to assess the association between physical activity levels and relative weight, weight gain and diabetes and cardiovascular disease risk in five population-based samples at different stages of economic development. Twenty-five hundred young adults, ages 25-45, were enrolled in the study; 500 from sites in Ghana, South Africa, Seychelles, Jamaica and the United States. At baseline, physical activity levels were assessed using accelerometry and a questionnaire in all participants and by doubly labeled water in a subsample of 75 per site. We assessed dietary intake using two separate 24-hour recalls, body composition using bioelectrical impedance analysis, and health history, social and economic indicators by questionnaire. Blood pressure was measured and blood samples collected for measurement of lipids, glucose, insulin and adipokines. Full examination including physical activity using accelerometry, anthropometric data and fasting glucose will take place at 12 and 24 months. The distribution of the main variables and the associations between physical activity, independent of energy intake, glucose metabolism and anthropometric measures will be assessed using cross-section and longitudinal analysis within and between sites. DISCUSSION: METS will provide insight on the relative contribution of physical activity and diet to excess weight, age-related weight gain and incident glucose impairment in five populations' samples of young adults at different stages of economic development. These data should be useful for the development of empirically-based public health policy aimed at the prevention of obesity and associated chronic diseases.
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    The relationship between the built environment and habitual levels of physical activity in South African older adults: a pilot study
    (BioMed Central Ltd, 2015) Kolbe-Alexander, Tracy; Pacheco, Kyla; Tomaz, Simone; Karpul, David; Lambert, Estelle
    BACKGROUND: Previous research has shown that the built environment plays a role in habitual levels of physical activity (PA), however much of this research has been conducted in adults and higher income countries. The aim of this pilot study was to examine the strength of association between the built environment and PA in South African older adults. METHODS: Participants were recruited (n=44, mean age 65+/-8.5years) from two suburbs, representing either a high socioeconomic (HSA) or low socioeconomic area (LSA). Self-reported PA, and subjective assessments of neighborhood walkability (Neighborhood Environment Walkability Scale, NEWS) was measured. Participants wore Actigraph GT3x accelerometers to objectively quantify PA. RESULTS: HSA participants reported significantly more leisure-time and less transport PA. Objectively measured and self-reported MVPA was significantly higher in HSA participants. NEWS 'Land-use Mix' was negatively associated with leisure-time MVPA, (r2=0.20; p<0.02). In addition, neighborhood aesthetics was positively associated with leisure-time physical activity (r2=0.33; p=0.02). 'Safety from traffic' was inversely associated with travel-related PA (r2=0.14, p=0.01). None of the other NEWS scores were associated with PA for the total group. CONCLUSION: Leisure-time and transport-related PA was influenced by socio-economic status. Attributes of the perceived built environment associated with leisure-time and total MVPA in older South Africa adults were different in low- and high- income settings.
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    Steps that count! : The development of a pedometer-based health promotion intervention in an employed, health insured South African population
    (BioMed Central Ltd, 2012) Pillay, Julian; Kolbe-Alexander, Tracy; Proper, Karin; van Mechelen, Willem; Lambert, Estelle
    BACKGROUND: Physical activity (PA) has been identified as a central component in the promotion of health. PA programs can provide a low cost intervention opportunity, encouraging PA behavioral change while worksites have been shown to be an appropriate setting for implementing such health promotion programs. Along with these trends, there has been an emergence of the use of pedometers as a self-monitoring and motivational aid for PA.This study determines the effectiveness of a worksite health promotion program comprising of a 10-week, pedometer-based intervention ("Steps that Count!"), and individualized email-based feedback to effect PA behavioral change. METHODS: The study is a randomized controlled trial in a worksite setting, using pedometers and individualized email-based feedback to increase steps per day (steps/d). Participant selection will be based on attendance at a corporate wellness event and information obtained, following the completion of a Health Risk Appraisal (HRA), in keeping with inclusion criteria for the study. All participants will, at week 1 (pre-intervention), be provided with a blinded pedometer to assess baseline levels of PA. Participants will be provided with feedback on pedometer data and identify strategies to improve daily PA towards current PA recommendations. Participants will thereafter be randomly assigned to the intervention group (INT) or control group (CTL). The INT will subsequently wear an un-blinded pedometer for 10 consecutive weeks.Individualized feedback messages based on average steps per day, derived from pedometer data (INT) and general supportive/motivational messages (INT+CTL), will be provided via bi-weekly e-mails; blinded pedometer-wear will be conducted at week 12 (post-intervention: INT+CTL).DISCUSSION:The purpose of this paper is to outline the rationale behind, and the development of, an intervention aimed at improving ambulatory PA through pedometer use, combined with regular, individualized, email-based feedback. Pedometer-measured PA and individualized feedback may be a practical and easily applied intervention.TRIAL REGISTRATION:Number: DOH-27-0112-3951
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    Targeting uptake of exercise-promoting structured patient education intervention: foundational research and process description of a discrete choice experiment to understand perceived intervention utility and design preferences for men with prostate cancer
    (2024) Ezenwankwo, Elochukwu Fortune; Albertus, Yumna; Lambert, Estelle; Lambert, Victoria Estelle
    Beyond effectiveness, critical aspects of the design process for complex healthcare interventions, including the organisation of the various independent components and features of the interventions or how they are presented to the users, can influence their overall uptake and long-term sustainability. The discrete choice experiment offers a pragmatic consumer-oriented approach to exploring and understanding individual preferences and perceived utility when planning complex interventions, ensuring that even without real-life observational data, only intervention attributes most valued by the intended users are prioritised in the design phase. This thesis presents foundational research and process description of a discrete choice experiment designed to understand perceived intervention utility and design preferences among men with prostate cancer for an exercise-promoting structured patient education intervention. The overarching goal is to clarify critical issues about effective components and delivery procedures for developing/implementing patient education intervention to increase daily/weekly exercise among prostate cancer survivors. This project began with foundational research to examine and identify key attributes (or variables) and attribute levels (i.e., different functionalities of the attributes) for the discrete choice experiment using two key research approaches, (a) systematic literature reviews and (b) qualitative research. At the end of the foundational research, issues and challenges raised by men along with the opportunities and mechanisms identified in the literature and the qualitative interviews was resolved into four conditions central to the success (or failure) of promoting and increasing exercise engagement among survivors of prostate cancer in Cape Town, South Africa, using structured patient education interventions. These conditions, 1) program/service [Levels: Counselling/Education; b) Unsupervised exercise PLUS counselling; c) Supervised exercise program PLUS education/counselling], 2) delivery structure [Levels: a) Alone; b) Group-based; c) Individual and group-based], 3) setting [Levels: a) Community centre (or Local Gym); b) Home; c) Hospital (in-/outpatient rehab setting)], and 4) service personnel [levels: a) Physiotherapists (other cancer exercise specialists); b) Technology-assisted (mHealth); c) Former PCa patient now cancer exercise couch], comprised attributes of the discrete choice experiment. This research aimed for five attributes and three attribute levels for the experiment. A fifth attribute, service operation [levels: a) 12 weeks; 1x/wk; 2hr/session; operates Weekends only; b) 8 weeks; 2x/wk; 2hr/session; operates Mon-Thurs; c) 12 weeks; 2x/wk; 1hr/session; operates Mon-Thurs], was further introduced, bringing the total number of attributes to five. Qualitative research played a crucial role in establishing the attribute levels. An unlabelled fractional-factorial design with 27 choice tasks was developed using Ngene software (v.1.3). The 27 choice tasks were further blocked into 3 separate surveys of 9 choice sets each. An ‘opt-out' was included in the experiment to allow respondents to reject the two alternatives in a given choice scenario where such alternatives have not reflected their preferred choice. The Multinomial Logit Regression was chosen to determine the main effect of the five attributes (the independent variables) on the choice alternatives (the dependent variables) upon when the discrete choice experiment is implemented. Overall, nine choice tasks were deemed sufficient per survey to fit a regression model while minimising time and cognitive burden on the participants. Targeting the uptake of exercise-promoting structured patient education intervention can be particularly challenging among men with prostate cancer, especially in care contexts like Cape Town, South Africa, such intervention does not yet form part of patients' core management suite. This thesis recognises the place of discrete choice experiments in designing and implementing effective complex interventions like structured patient education interventions. It is thus hoped that this thesis and, ultimately, the implementation of the discrete choice experiment amount to well-invested efforts in the quest for effective strategies to increase daily/weekly exercise among prostate cancer survivors and mainstream exercise oncology in standard cancer care practice in Cape Town, South Africa.
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    The evaluation of social media to increase engagement rate, reach and health education: the case for WoW!
    (2023) Lekota, Feroza; Lambert, Estelle
    Introduction: In 2021, South Africans had a 51.9 percent chance of dying from an NCD. The Western Cape on Wellness (WoW!) program advocates for wellness, through partnership, innovation and policy, including health in communities, worksites and schools. Increasing knowledge and awareness regarding health behaviors and NCD risk factors is an important pathway in preventing and mitigating the problem at hand through a combination of structural and social policy change. Social media provides an unprecedented opportunity and innovative way to provide a solution to the problem. The internet has increasingly become a popular source of health information by connecting individuals with health content, experts, and support. Aim & Objective: To use a social media campaign with expert knowledge to change healthy lifestyle actions and increase health knowledge and engagement in a para-social western cape on wellness social media group. Methods: A mixed methods quantitative and qualitative analysis was undertaken to assess key messages, which were publicly available on the WoW! Facebook group. 60 lifestyle messages were posted on the WoW! Facebook group 5 times a week from Monday through to Friday. Each message was disseminated by a moderator and followed a theme for the day. Three icons were used to measure levels of participant engagement likes, shares, comments. Associated comments were extracted and coded using a codebook based on items from the supportive accountability model and peer social support analysis. The identified search material was reviewed allowing removal of any personally identifying or geographical material in order that that the comments were rendered anonymous. One –way ANOVA was performed to determine whether level of likes, shares and comments differed between posts. One-way ANOVA was performed to determine whether level of engagement differed between post types, with Tukey–Kramer test used to determine post hoc differences. An independent samples t-test was conducted to determine whether total engagement differed between moderator initiated posts and Facebook user-initiated posts. Results: The most common form of engagement was "likes," and engagement was higher for moderator initiated rather than participant-initiated posts. Overall traffic to the page increased over the 3 month period from 1083 WoW! Facebook users to 1300. Likes were the most common and easiest form of engagement (M=7.6, SD 9.8) with comments being the lowest (m=0.81, SD 2.3). The most engaged with and resonative messages were the #transformationthursday posts. Empirically physical activity behaviour and change in eating patterns did increase over time. The 7 main themes that were identified constituted 53.3% (112/210) of all comments in the pre and during campaign analyses. The most prevalent theme was social cohesion and connectedness at 29% (33/112). The least common theme was developing professional communication and organisational support at 4.5% (5/112). Overall, there were more comments before the campaign (n=63), than during (n=49). In terms of Geographical proximity most of the comments and posts came from participants in the Metro (58.3%) and rural districts Paarl (48.3%) and George (40%). A proximal or virtual tie to a place adds connection and thus value to the information. Conclusion: The favourable results of the WoW! Facebook campaign shows promise for future social media-driven health campaigns to educate and prevent lifestyle related chronic conditions. Social media content for knowledge sharing should be created through a well-intentioned process with the support of moderators to facilitate the conversation and drive engagement.
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    Working on wellness (WOW): A worksite health promotion intervention programme
    (BioMed Central Ltd, 2012) Kolbe-Alexander, Tracy; Proper, Karin; Lambert, Estelle; van Wier, Marieke; Pillay, Julian; Nossel, Craig; Adonis, Leegale; Van Mechelen, Willem
    BACKGROUND: Insufficient PA has been shown to cluster with other CVD risk factors including insufficient fruit and vegetable intake, overweight, increased serum cholesterol concentrations and elevated blood pressure. This paper describes the development of Working on Wellness (WOW), a worksite intervention program incorporating motivational interviewing by wellness specialists, targeting employees at risk. In addition, we describe the evaluation the effectiveness of the intervention among employees at increased risk for cardiovascular disease. METHODS: The intervention mapping (IM) protocol was used in the planning and design of WOW. Focus group discussions and interviews with employees and managers identified the importance of addressing risk factors for CVD at the worksite. Based on the employees' preference for individual counselling, and previous evidence of the effectiveness of this approach in the worksite setting, we decided to use motivational interviewing as part of the intervention strategy. Thus, as a cluster-randomised, controlled control trial, employees at increased risk for CVD (N=928) will be assigned to a control or an intervention group, based on company random allocation. The sessions will include motivational interviewing techniques, comprised of two face-to-face and four telephonic sessions, with the primary aim to increase habitual levels of PA. Measures will take place at baseline, 6 and 12months. Secondary outcomes include changes in nutritional habits, serum cholesterol and glucose concentrations, blood pressure and BMI. In addition, healthcare expenditure and absenteeism will be measured for the economic evaluation. Analysis of variance will be performed to determine whether there were significant changes in physical activity habits in the intervention and control groups at 6 and 12months.DISCUSSION:The formative work on which this intervention is based suggests that the strategy of targeting employees at increased risk for CVD is preferred. Importantly, this study extends the work of a previous, similar study, Health Under Construction, in a different setting. Finally, this study will allow an economic evaluation of the intervention that will be an important outcome for health care funders, who ultimately will be responsible for implementation of such an intervention.TRIAL REGISTRATION:United States Clinical Trails Register NCT 01494207