Rozprawy doktorskie na temat „Multicomponent intervention”

Thesis (Ph. D.)--Ohio State University, 2003.
Title from first page of PDF file. Document formatted into pages; contains xii, 136 p.; also includes graphics. Includes abstract and vita. Advisor: Antoinette Miranda, College of Education. Includes bibliographical references (p. 117-125).

Appropriate nutrition is linked to the prevention of several major diseases, yet over 50% of Americans do not eat diets sufficient in the necessary proportions of protein, vitamins, and minerals. Increased interest in health prevention has led to the development of a variety of programs designed to change dietary habits. Most have been only marginally successful. One explanation for their failure is the lack of consideration given to the characteristics of the targeted population in the development of the programs. In this study, a five week multicomponent intervention was designed using marketing and psychological principles to increase the selection of dinner entrees low in fat, calories, and sugar and to improve participants‘ knowledge of and attitude toward appropriate nutrition. Subjects were 8600 students who ate in the dining halls of a large southeastern university. The study investigated the additive effectiveness of three intervention components in three dining halls. One dining hall received availability; the second, availability plus point of choice information; the third, availability‘ plus point of choice information plus an incentive program. The results were derived from three separate sources: cafeteria data, survey data, and individual data. Cafeteria results were not significant. Inspection of daily selection data revealed wide fluctuation in selection across entrees, indicating dramatic changes in student preferences. Inspection of weekly selection means revealed that the incentive program combined with increased availability and point of choice information was initially effective in increasing the selection of the Perfect Balance entree. Prompting was the most effective intervention, yielding an average increase of 31.5% in selection of the Perfect Balance entree. Survey data indicated a minor increase in knowledge in. the information condition. Across all conditions there was a decrease in self-efficacy. Forty-four individuals were involved in a tracking project designed to assess whether the aggregate impact of the interventions reflected consistent change within specific individuals or intermittent change across all individuals. Analyses indicated a significant increase in selection behavior across time ( p <.05). The condition by phase interaction approached significance ( p =.07). The greatest change occurred in the incentive condition with a 16% increase, compared to a .3% increase in the information condition, and a 2.5% increase in the availability condition. The social marketing analysis of the study reveals several important barriers to change: resistance from staff and administration, poor quality entrees, student distrust of the dining hall administration, and limited availability of certain entrees.
Ph. D.

Youth psychological well-being has become increasingly acknowledged as not merely the absence of psychological distress, but the presence of positive indicators of optimal functioning. Students with complete mental health (i.e., low psychopathology and high well-being) demonstrate the best academic, social, and physical health outcomes. As such, there remains a need to address children’s well-being through a holistic approach emphasizing the prevention of mental health problems and promotion of flourishing. Positive psychology interventions (PPIs) have emerged as a promising method of enhancing students’ complete mental health. Previous investigations support the utility of multitarget PPIs with middle school students and single-target PPIs (e.g., character strengths, hope) with younger elementary students, though the extent to which comprehensive multitarget, multicomponent PPIs enhance classes of elementary students’ outcomes relative to a control has not been examined. This study compared levels of subjective well-being, mental health problems, classroom social support, and classroom engagement between students in 6 classrooms randomly assigned to participate in a 10-week intervention targeting a variety of positive psychological constructs (i.e., positive relationships, gratitude, kindness, character strengths, hope) with parent and teacher components, and students in 7 classrooms randomly assigned to a delayed intervention control group. Follow-up analyses examined levels of outcomes of the immediate intervention group relative to the control group at post-intervention, as well as levels of outcomes in the intervention group three months after program completion. At post-intervention, classes of students participating in the immediate intervention group did not have significantly improved student-reported life satisfaction, positive affect or negative affect, classmate or teacher support, emotional or behavioral engagement, nor teacher-reported relationship satisfaction, instrumental help, and emotional or behavioral engagement relative to the control classes. However, several trends were found: (a) students in the immediate intervention group had lower negative affect relative to the delayed intervention control among students with greater baseline negative affect levels, (b) students in the immediate intervention group had lower teacher-reported levels of instrumental help relative to the control among students with greater baseline instrumental help levels, and (c) students in the immediate intervention group reported lower levels of behavioral engagement relative to the delayed intervention control. Because of the lack of improvement in immediate intervention group outcomes relative to the control group at post-intervention, continuation of those anticipated improvements from post-intervention to 3-month follow-up could not be detected. However, there was a significant increase in teacher-reported internalizing symptoms from post-intervention to follow-up among the immediate intervention group (without comparison to a control). Overall, findings from this study do not provide empirical support for the efficacy of a multitarget, multicomponent PPI when delivered universally to classes of elementary students. Nevertheless, high levels of treatment acceptability and feasibility from students and teachers as well as limitations to the study design support the need for educational scholars and practitioners to continue exploring the impact of multitarget PPIs delivered to students in multiple formats and various age levels in order to promote complete mental health across tiers of support and thus optimize success for all students.

This study examined the contribution of adult directed lessons to student social engagement as part of a multicomponent procedure of adult directed lessons and child specific prompting with peer support delivered to four elementary-aged students with Autism Spectrum Disorder. Prior to intervention, each participant exhibited deficits in social engagement compared to same-age peers. The study was conducted in two phases. In Phase One, assessment, interviews, rating scales, and observations were conducted to determine the social skills deficits of each student. During Phase Two, intervention, a individualized intervention plan was implemented using adult directed lessons and child specific prompting with peer support. Using a combined ABC and reversal (A-B-BC-B-BC), a functional relation between the full intervention and immediate increase in social engagement was demonstrated. When the intervention procedures returned to adult directed individualized social skills lessons only, a rapid decrease in social engagement occurred. Reinstatement of the full intervention procedure resulted in high levels of social engagement. Generalization across peers was evident and maintenance data indicated high levels of social engagement for three out of the four participants. Implications, limitations, and directions for future research are presented.

ADHD is a common disorder in youth, with core deficits that impair important areas of functioning, most notably academic achievement. Existing school-based interventions may not be as effective in improving long-term academic outcomes for adolescents with comorbid ADHD and internalizing disorders. The purpose of this study was to explore the association between ADHD and internalizing symptoms in adolescents and the impact of anxiety and depression symptom severity on their academic outcomes after engaging in a multicomponent school-based intervention (BEST Project). The BEST Project was implemented in several high schools, with 126 participants included in this study. All participants met DSM-5 criteria for ADHD, were 14-18 years old, and attended public high schools.

A multiple multivariate regression analysis was conducted to investigate if internalizing symptom severity predicts pre-treatment academic performance. Female students were found to have more academic problems. To examine whether pre-treatment internalizing symptom severity predicts post-treatment academic performance and moderates the relationship between the effects of the BEST project and academic performance, a second multiple multivariate regression analysis was conducted. Graphed interactions and Johnson-Neyman results suggest that once student’s internalizing symptom scores are above the median, treatment effects on homework problems are stronger for those with anxiety symptoms and weaker for youth with depression symptoms. These findings suggest anxiety may serve as a protective factor in the context of a structured intervention. Limitations and future directions for research and practice are discussed.

Current UK public health policy and research identifies potential health risks of physical inactivity and high levels of sitting. This is a particularly pertinent issue for office workers, who spend, on average, over two-thirds of the work day sitting. This thesis reports on the design and evaluation of a multicomponent sit-stand desk intervention, delivered within two not-for-profit office-based organisations in London, England. A mixed method study design was employed. A pilot randomised controlled trial examined the efficacy of the intervention on reducing sitting and increasing standing and physical activity, using wearable monitors to measure outcome variables at baseline, and at four additional timepoints up to 12-months following the onset of the intervention. A process evaluation, including in-depth qualitative interviews and participant observation, investigated the processes that influenced the feasibility, acceptability and efficacy of the intervention. Mixed-model ANOVA indicated that the intervention reduced workplace sitting, on average, by 38 minutes, however there was no significant influence on workplace physical activity, or any of the outcome variables across the whole day. The process evaluation revealed that discourses surrounding employee health and organisational effectiveness, and employees' health-focused occupational identities increased the acceptability of sit-stand desk provision, whereas monetary concerns, a centralised organisational structure and incompatibility of the sit-stand desks with the workplace environment negatively influenced implementation feasibility. The sit-stand desk design, expectations and outcomes related to health and productivity, and the organisational culture and interpersonal relationships positively and negatively influenced sit-stand desk experience to differing degrees between participants. Mixed method analyses of outcome and process data illustrated the potential for integrating findings to enhance understanding of 'what works' within behavioural intervention research. Sit-stand desks are not a one-size-fits-all solution to reducing sitting and increasing physical activity, however, they should be available to office-based employees as part of a wider workplace health strategy.

Objectiu: Dissenyar, implementar i avaluar una intervenció multifacètica en el lloc de treball per prevenir i gestionar el dolor musculoesquelètic (DME). Mètodes: Es va dissenyar, implementar i avaluar (efectivitat, procés i cost-efectivitat) un assaig controlat aleatoritzat per clústers d'un any. La intervenció va incloure ergonomia participativa, promoció de la salut i gestió de casos. Resultats: Als 12 mesos, el grup d’intervenció va mostrar una disminució estadísticament significativa del risc de dolor d’espatlles, cervical i dorsal en comparació amb el control. No es va trobar cap efecte estadísticament significatiu per a DME en altres parts del cos, incapacitat temporal ni capacitat funcional. L’ergonomia participativa va mostrar un alt nivell d’implementació, la promoció de la salut va diferir segons l’activitat i la gestió de casos va mostrar un baix nivell d’implementació. Per reduir 1-punt-percentual extra el dolor d’espatlles, cervical i dorsal es necessitaven 3,63€ (perspectiva social) i 1,69 € (perspectiva del sistema sanitari). Conclusions: Aquesta intervenció va ser efectiva i cost-efectiva per reduir el dolor d’espatlles, cervical i dorsal, i es va implementar majoritàriament com es pretenia.
Objective: To design, implement and evaluate a multifaceted intervention in the workplace to prevent and manage musculoskeletal pain (MSP). Methods: A two-armed multifaceted cluster randomized controlled trial of one year duration was designed, implemented, and evaluated (effectiveness, process and cost-effectiveness). The intervention included participatory ergonomics, health promotion, and case management. Results: At 12 months, the intervention group showed a statistically significant decrease of the risk in neck, shoulders and upper-back pain compared to the control. No statistically significant effect was found for MSP in other locations, sickness absence nor work functioning. Participatory ergonomics showed a high implementation level, health promotion differed according to the activity and case management showed a low implementation level. To achieve 1-extra-percentual point reduction of MSP in neck, shoulders and upper-back were needed €3.63 (societal perspective) and €1.69 (health system perspective). Conclusions: This intervention was effective and cost-effective to reduce neck, shoulder and upper-back pain and predominantly implemented as intended.

L’exposition aux pesticides augmente le risque de certaines pathologies à long-terme chez les agriculteurs. La prévention repose actuellement sur l’application de « bonnes pratiques agricoles », mal définies et éloignées des pratiques habituelles des agriculteurs. Notre objectif était de contribuer à la prévention en France, en adoptant une double approche systémique et individuelle, visant à améliorer la prise en compte des expositions réelles des agriculteurs et proposer des solutions adaptées.Le premier volet de la thèse a étudié le caractère conservateur des modèles de prédiction des expositions professionnelles en comparant les expositions mesurées dans des divers contextes de travail habituel avec celles calculées par les modèles. Les modèles réglementaires sous-estiment les expositions des opérateurs agricoles, notamment en arboriculture, espaces verts et grandes cultures, en surestimant l’efficacité des équipements de protection individuelle et en négligeant certains déterminants d’exposition. Pour les travailleurs en réentrée/récolte, l’exposition après plusieurs jours est également sous-estimée.Dans le second volet, après un diagnostic des pratiques de prévention des agriculteurs, une intervention multicomposante basée notamment sur des théories psychosociales et destinées à influencer les comportements, alternative à la formation Certiphyto classique, a été développée. Les agriculteurs n’adoptent pas toujours les pratiques de prévention malgré leur connaissance des risques, en raison de barrières, normes sociales et auto-efficacité perçues. Une intervention a été conçue, incluant des démonstrations pratiques, un formateur pair et des processus d’engagement et de changement de normes sociales. Son efficacité sera évaluée par des critères objectifs (expositions urinaires) et auto-rapportés (comportements, perceptions psychosociales).Cette thèse propose d’intégrer davantage les expositions réelles des agriculteurs dans la prévention, tant dans les processus réglementaires que dans la formation pour encourager l’adoption de pratiques de protection. Nous devons poursuivre nos efforts pour atteindre d’autres travailleurs fortement exposés mais peu formés et adopter une approche pluridisciplinaire et globale pour réduire les risques des pesticides
Pesticide exposure increases the risk of some long-term disease among farmers. Prevention currently relies on the application of “good agricultural practices”, which are poorly defined and far from farmers’ usual practices. Our aim was to contribute to prevention in France, by adopting a dual systemic and individual approach, aimed at improving consideration of farmers’ actual exposures and proposing appropriate solutions.The first part of this thesis studied the conservative approach of occupational exposure prediction models, by comparing exposures measured in various usual working contexts with those calculated by the models. Regulatory models underestimate the exposure of agricultural operators, particularly in fruit growing, green spaces and field crops, by overestimating the effectiveness of personal protective equipment and neglecting some exposure determinants. For re-entry/harvest workers, exposure after several days is also underestimated.In the second part, following a diagnosis of farmers’ preventive practices, a multi-component intervention was developed, based in particular on psychosocial theories and designed to influence behavior, as an alternative to standard Certiphyto training. Farmers do not always adopt preventive practices despite their knowledge of the risks, due to perceived barriers, social norms and self-efficacy. An intervention has been designed, including practical demonstrations, a peer trainer and processes of commitment and social norm change. Its effectiveness will be assessed by objective (urinary exposures) and self-reported (behaviours, psychosocial perceptions) criteria.This thesis proposes to integrate farmers’ actual exposures more closely into prevention, both in regulatoryprocesses and in training to encourage the adoption of protective practices. We need to continue our efforts to reach other highly exposed but poorly trained workers, and adopt a multidisciplinary and comprehensive approach to reducing pesticide risks

Masters Research - Master of Clinical Psychology (MClinPsych)
Objectives: The objective of this study was to test the feasibility and acceptability of the adaptedStrategies for Relatives (START) program within the Australian health care context, for the alleviation of carer distress and burden. Further, we aimed to determine the feasibility and acceptability of the telehealth modality. Method: Twenty-two family carers were randomly assigned to the START eight-week manualised coping program or cognitive behaviour therapy (CBT). Carers completed purpose developed pre- and post-intervention questionnaires to determine the acceptability of the program. Standardised measures of mood and perceived carer burden were also administered to explore treatment effects. Results: Of the 22 carers recruited, six who completed the START program and four who completed the CBT program provided follow-up data. START carers reported higher overall satisfaction and acceptance of the intervention compared to carers in the CBT group. Furthermore, the telehealth modality was shown to be a practical and acceptable method of intervention delivery. Conclusions: These pilot findings indicate preliminary evidence for the acceptability and feasibility of the START intervention for supporting carers in their caring roles. Further investigation is needed to determine intervention efficacy for the treatment of mental health related symptomology.

Thesis (Ph. D.)--University of Wisconsin--Madison, 1996.
Typescript. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 72-82).

碩士
國立中正大學
運動競技系運動與休閒教育研究所
105
Background: The global dementia population is growing rapidly, 2015 the International Society for the Dementia (ADI) estimates that one person suffers from dementia every 3 seconds, and Mild Cognitive Impairment (MCI) is considered to be the critical period to preventing and improving morbidity. However, the drug can not be completely successful in the prevention or treatment of dementia, the study has been found through the exercise which can effectively improve and promote brain cognitive function. Purpose: To explore the Effect of Physical and Cognitive Exercises Intervention on Functional Fitness and Cognitive Function in Elderly with Mild Cognitive Impairment. Methods: More than 65 years old the elderlyin the study.Subjects were divied into experimental group (n=15, age: 78.2±6.48yrs) and control group (n=5, age: 77.4±8.05yrs）by their personal preference.The Mini-mental state examination and the functional fitness testing for older adults (30-second chair stand, 30-second arm curl, chair sit-and-reach, back scratch, 8-foot up-and-go, 2-minute step) were performed before and after the course intervention. The experimental group was instructed to by the physical and cognitive exercises intervention for 1days per week, 90 minutes per session for eight weeks. Pre-and Post-tests were implemented before and after the intervention in both group. Data processing and analysis: SPSS 22.0 version of the statistical suite of software, descriptive statistics, One-Way ANOVA and one-way ANCOVA was used to evaluate the difference between groups after training for each parameter analysis of the test, the significant level as α = .05. Results: The experimental group has significant improvement on the physical and cognitive exercises intervention after the course exercise after eight weeks, upper body muscle strength and Aerobic endurance. Cognitive function and so on are positive progress, but not significant difference. Conclusion: The multidimensional course can improve the fitness of the elderly with mild cognitive dysfunction and improve the performance of some cognitive function. Therefore, the integration of physical and cognitive exercises on mild cognitive impairment of the Elderly is very effective and can achieve the concept of preventive medicine.

This experimental study was conducted to examine the effectiveness of multicomponent reading intervention and a no treatment comparison condition on the reading comprehension of adolescent students with adequate word reading and low reading comprehension. The sample consisted of 44 students in 9th grade who were randomly assigned to an intervention treatment offered as an elective course (N=25) or a no treatment comparison (N=19). Reading intervention teachers, trained by experienced research staff provided instruction for 90-min sessions two to three times per week during for approximately 80 sessions. Treatment effects for each outcome measure were estimated using analysis of covariance (ANCOVA). Results indicate no statistically significant differences between conditions. Effects, which were calculated with partial eta squared (η2), ranged from -.26 to .23 with two of the three measures favoring the treatment condition. Three separate repeated measure of analysis of variance (RM-ANCOVAs) were conducted using the Kaufmann Brief Intelligence Test (KBIT) as a covariate for the following measures: (1) Woodcock Johnson Passage Comprehension subtest (WJIII-PC); (2) Test of Sentence Reading Efficiency (TOSRE); (3) Gates MacGinitie Reading test (GM-RT). An additional ANCOVA was conducted for the GM-RT using the pretest scores from the GM-RT as a covariate. Results indicate that the treatment condition was not favorable to a no treatment comparison for students with adequate word reading and low comprehension. More research into ways to make reading comprehension instruction more effective for Adolescent students with low reading comprehension is warranted.
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Research Doctorate - Doctor of Philosophy (PhD)
Background and Aims: Physical inactivity has been described as a primary cause of most chronic conditions, as important as both tobacco and obesity as a major modifiable risk factor for chronic diseases. The economic burden of physical inactivity globally is INT $53.8 billion. Despite this, as few as 20% of adolescents globally meet current physical activity recommendations, with socio-economically disadvantaged adolescents less likely to be physically active. Given evidence suggests physical activity levels throughout adolescence track into adulthood, effective interventions targeting socio-economically disadvantaged adolescents are warranted. Comprehensive school-based physical activity interventions have the potential to impact on physical activity levels, yet few such interventions have targeted socio-economically disadvantaged adolescents. As a result, development of cost-effective school-based physical activity interventions targeting socio-economically disadvantaged adolescents is a public health priority. Methods: The primary aim of this thesis was to evaluate a 24-month, school-based physical activity intervention in a trial targeting a cohort of Grade 7 students attending schools located in socio-economically disadvantaged communities (Physical Activity 4 Everyone (PA4E1)). The PA4E1 intervention was evaluated using a cluster randomised controlled trial (RCT) involving 1100 adolescents (Grade 7, mean age 12.0 years at baseline) from five intervention and five control schools located in the Hunter, Central Coast and Mid North Coast regions of New South Wales, Australia. The two year multicomponent intervention was guided by socio-ecological theory and the Health Promoting Schools Framework, incorporating seven physical activity strategies and six implementation support strategies. The three physical activity strategies implemented across the curriculum were teaching strategies to increase physical activity in physical education lessons, student physical activity plans and enhanced school sport programs; the two school environment strategies were recess/lunchtime activities and school physical activity policy; and two broader school environment strategies were linking schools with community physical activity providers and linking with parents. Six additional strategies supported school implementation of the physical activity intervention strategies including an in-school physical activity consultant, leadership and executive support, teacher training, resources, prompts and intervention implementation performance feedback. The primary outcome was mean duration of moderate-to-vigorous physical activity (MVPA) minutes per day assessed using Actigraph (GT3X) accelerometers at baseline, and 12- and 24-months post randomisation. Additional physical activity outcome measures included: mean minutes per day of vigorous and moderate activity, counts per minute, % wear time spent in MVPA, vigorous and moderate activity, in-school and out-of-school physical activity. Secondary outcome measures were weight, body mass index (BMI), and BMI Z-score. In addition, a cost effectiveness evaluation was undertaken whereby intervention costs and incremental cost effectiveness ratios were calculated for both physical activity and adiposity. Physical activity and weight status data were analysed using repeated measures linear mixed models with models developed for the baseline to 12-month period, as well as baseline to 24-month period. Results: Parental consent was provided for 1233 of the 1468 Grade 7 students from participating schools. At baseline, 1150 students wore an accelerometer (mean age 12.0 years, 54% female), with 965 providing at least three days of valid wear data (83% of accelerometer wearers, 78% of those with consent). At 24-month follow-up, 985 students wore an accelerometer (mean age 14.0 years, 57% female), with 441 of these (45%) providing valid wear data. At both 12- and 24-month follow-up there was a significant group-by-time effect in favour of the intervention group for MVPA. At 12-month mid-intervention follow-up, students in the intervention group participated in 3.85 minutes (95% CI= 0.79, 6.91) more MVPA per day than students in the control group. At 24-month follow up students in the intervention group participated in 7.02 minutes (95% CI= 2.68, 11.36) more MVPA per day (p = ≤0.01) than students in the control group. The mean duration of daily MVPA increased by 4.39 minutes for intervention group students and decreased by 2.63 minutes for control group students. The intervention group students participated in 2.53 minutes more vigorous physical activity (p=0.03, 95% CI= 0.27- 4.79) and 4.5 minutes more moderate physical activity (p≤0.01, 95% CI= 1.98, 7.03) than the control group students at 24-months post randomisation. At 12-month mid intervention, there was a significant group-by-time effect for weight (mean difference=-0.90kg) and BMI (-0.28kg/m2) in favour of the intervention group. At 24-months, there were statistically significant group-by-time effects for weight (mean difference= -0.78 kg, 95% CI= -1.40; -0.16, p=0.03) and BMI (mean difference= -0.28, 95% CI= -0.50,-0.06, p=0.01) in favour of the intervention group. The intervention cost was AUD $329,952 over 24-months. The incremental cost effectiveness ratio per additional minute of MVPA per day was AUD$56 ($35 - $147) and AUD$563 ($282 - $3,942) per 10% reduction in BMI z-score. Conclusion: The PA4E1 trial showed the intervention was effective in not only reducing the decline in physical activity among adolescents attending schools located in socio-economically disadvantaged areas, but in increasing physical activity in comparison to a decrease in the control group. In addition, the intervention had a significant positive effect on adiposity and BMI. The findings suggest that implementation of the intervention by socio-economically disadvantaged secondary schools has the potential to reverse the decline in physical activity in this population group at a relatively small marginal cost. Further understanding of the mechanisms for implementation of the program at scale is required to contribute towards achieving health gains at a population level. The results of the trial suggest an opportunity for the dissemination of the evidenced based program to a larger number of schools. Measuring the sustainability of the intervention, inclusive of effect on both student level outcomes and school practice implementation level outcomes is suggested.

Research Doctorate - Doctor of Philosophy (PhD)
Growing concerns over the alarming number of people at risk of, or diagnosed with type 2 diabetes (T2D) has led to a proliferation of lifestyle behavioural interventions to prevent or delay the onset of this chronic disease. The benefits of regular aerobic and resistance training activities are well-established, and physical inactivity has been identified as a significant risk factor for the onset and progression of T2D. However, the initiation and maintenance of regular physical activity is challenging for this population and novel strategies are warranted to improve daily activity. The rapid development of smartphone technology provides a platform which can foster physical activity behaviour change. Additionally, effective cost-free alternatives for physical activity behaviour change could reduce barriers related with the financial burden of using sports facilities. The outdoor environment offers an ideal setting to promote aerobic and resistance training activities. Whilst community-based physical activity interventions have been somewhat effective in targeting changes at the individual level, few interventions have incorporated the use of physical environments in conjuction with social support. Moreover, very few interventions have focused on promoting resistance training using features of the outdoor built environment. As such, there is a need to implement novel, multi-component interventions to promote physical activity amongst individuals at risk of or diagnosed with T2D. This thesis developed and evaluated the efficacy of the eCoFit intervention and highlights the potential of a novel, multi-component intervention for T2D treatment and prevention. The information presented within this thesis has important implications for research and practise regarding the promotion of outdoor physical activity among T2D population. The effective and scalable intervantions are urgently required to combat the rising prevalence of T2D.