A qualitative examination of contextual influences on negative alcohol consequence evaluations among young adult drinkers

Alcohol misuse and associated negative consequences experienced by college students persists as a public health concern. Quantitative studies demonstrate variability in subjective evaluations of consequences, and how positively or negatively consequences are evaluated is associated with drinking behavior. Lacking is a qualitative exploration of how drinkers evaluate consequences and what influences those evaluations. We conducted a series of single-gender focus groups (13 groups; 3-7 per group; n = 62, 48% female) with college student drinkers. Questions focused on: (a) types of negative and positive consequences experienced (b) personal perceptions of negative consequences and (c) factors influencing those perceptions. Verbatim transcripts were content analyzed using applied thematic analysis with NVivo software. Several negative consequences not included in current assessment tools emerged. Reactions to these "negative" consequences of alcohol misuse were not labeled as uniformly negative by participants. Contextual influences on reactions to consequences included: social factors (e.g., normative perceptions, social context, discussions with friends), level of intoxication, concurrent positive consequences, time, and alcohol as an excuse. Future research should focus on consequence measure development and examine interactions between contextual and individual influences on subjective consequence evaluations. (PsycINFO Database Record

Women's reproductive decision making and abortion experiences in Cape Town, South Africa: A qualitative study

Unintended pregnancy is a significant public health issue in South Africa. Despite free services including contraception, women face structural and institutional barriers to accessing care. This qualitative study comprised interviews with 16 women aged 18 to 40 years and receiving post-abortion services at a public clinic in Cape Town. Data analysis revealed three main themes: personal journeys in seeking abortion, contraceptive experiences, and contrasting feelings of empowerment (in reproductive decision making) and disempowerment (in the health care system). Women perceived themselves as solely responsible for their reproductive health, but found it difficult to obtain adequate information or services.

Development and Validation of the Outcome Expectations for Yoga Scale

OBJECTIVE

Our objective was to develop an instrument that can measure outcome expectations of yoga and to evaluate the instrument for internal consistency and initial construct validity.

METHODS

A 20-item scale was developed to assess physical, mental, and spiritual health benefits related to yoga practice among adults. The scale was tested in a baseline survey with adults participating in a clinical trial. Principal component analysis was used to investigate the internal structure of the measure. Outcome expectations for yoga were examined for demographic differences.

RESULTS

The sample (N = 185) was 54% women, 89% white and had a mean age of 46 years. The final 20-item scale had high item loadings that ranged from .57 to .88 with a Cronbach's alpha value of .96. Significant differences were found in outcome expectation score by sex.

CONCLUSION

This newly developed scale can be used to assess outcome expectations for yoga and tailor interventions to promote adherence to yoga practice.

Telephone-Delivered Mindfulness Training for People Living with HIV: A Qualitative 360° Inquiry

For people living with HIV and AIDS (PLWHA), life stress often undermines quality of life and interferes with medical care. Mindfulness training (MT) may help PLWHA to manage stress. Because standard MT protocols can be burdensome, we explored telephone delivery as a potentially more feasible approach. We used an innovative 360° qualitative inquiry to seek input regarding telephone-delivery of MT for PLWHA in advance of a planned intervention trial. We also sought input on a time- and attention-matched control. Twenty five HIV patients, providers and advocates, were recruited to five focus groups. Participants understood the construct of mindfulness and recognized its potential benefits for stress management and improving medication adherence. Patients preferred the term "mindfulness" to meditation. Telephone-delivery appealed to all patients but several challenges were raised. Topics for the control intervention included nutrition, sleep, and aging. The 360° approach allowed three groups (patients, providers, advocates) to influence intervention development.

Who Enrolls in a Quit Smoking Program with Yoga Therapy?

OBJECTIVES

Yoga may improve stress, affect, and weight control, all of which are commonly cited barriers to quitting smoking. However, the importance of these concerns may vary by sex, race, ethnicity, and age. We examined smoking-relevant characteristics of individuals enrolling in an 8-week randomized controlled trial testing yoga as a complementary treatment to standard smoking cessation.

METHODS

Of 958 callers, 227 were eligible and enrolled.

RESULTS

The sample was 55% female, 86% non-Hispanic white, with a mean age of 46 years (SD = 12). Males smoked more cigarettes/ day than females and had lower motivation to quit smoking. Females were more likely to smoke for weight control, social and mood-related reasons, and had higher expectations for the efficacy of yoga. Age was negatively associated with the presence of other smokers in the household, and smoking in response to negative moods, and was positively associated with smoking rate, and confidence in quitting.

CONCLUSIONS

This study demonstrated that both males and females were interested in a program offering yoga as a complementary therapy for smoking cessation. However, there were both sex and age-related differences with respect to smoking-related variables that may suggest a need to adapt the intervention for sub-populations.

Mediators of a physical activity intervention among women with a family history of breast cancer

The current study examined mediators of an efficacious physical activity intervention. Women with a mean age of 42.6 (range 23-61) years and a family history of breast cancer were randomized to either an Internet-based physical activity intervention (n = 28) or an active control condition (n = 27) for three months. Data were collected between November 2010 and August 2011. Hypothesized mediators were examined using a product of coefficients model with bootstrapped standard errors. Significant mediation was observed for both self-efficacy and behavioral processes. Specifically, the regression coefficients of the indirect effects ("ab path": unstandardized effect of the intervention on physical activity that occurred through the mediator) were ab = 38.58 (95% confidence interval [CI]: 8.66-92.76) for self-efficacy, and ab = 42.02 (95% CI: 6.76-104.84) for behavioral processes. Other factors examined in this study, including cognitive processes, decisional balance, and perceived risk of breast cancer, were not statistically significant mediators. Findings suggest that self-efficacy and behavioral processes may be key constructs to use in targeting future physical activity interventions among women with a family history of breast cancer.

Vaginal film for prevention of HIV: using visual and tactile evaluations among potential users to inform product design

Topical prevention of HIV and other STIs is a global health priority. To provide options for users, developers have worked to design safe, effective and acceptable vaginal dissolving film formulations. We aimed to characterize user experiences of vaginal film size, texture and color, and their role in product-elicited sensory perceptions (i.e. perceptibility), acceptability and willingness to use. In the context of a user-centered product evaluation study, we elicited users' 'first impressions' of various vaginal film formulation designs via visual and tactile prototype inspection during a qualitative user evaluation interview. Twenty-four women evaluated prototypes. Participants considered size and texture to be important for easy insertion. Color was more important following dissolution than prior to insertion. When asked to combine and balance all properties to arrive at an ideal film, previously stated priorities for individual characteristics sometimes shifted, with the salience of some individual characteristics lessening when multiple characteristics were weighted in combination. While first impressions alone may not drive product uptake, users' willingness to initially try a product is likely impacted by such impressions. Developers should consider potential users' experiences and preferences in vaginal film design. This user-focused approach is useful for characterizing user sensory perceptions and experiences relevant to early design of prevention technologies.

The varieties of contemplative experience: A mixed-methods study of meditation-related challenges in Western Buddhists

Buddhist-derived meditation practices are currently being employed as a popular form of health promotion. While meditation programs draw inspiration from Buddhist textual sources for the benefits of meditation, these sources also acknowledge a wide range of other effects beyond health-related outcomes. The Varieties of Contemplative Experience study investigates meditation-related experiences that are typically underreported, particularly experiences that are described as challenging, difficult, distressing, functionally impairing, and/or requiring additional support. A mixed-methods approach featured qualitative interviews with Western Buddhist meditation practitioners and experts in Theravāda, Zen, and Tibetan traditions. Interview questions probed meditation experiences and influencing factors, including interpretations and management strategies. A follow-up survey provided quantitative assessments of causality, impairment and other demographic and practice-related variables. The content-driven thematic analysis of interviews yielded a taxonomy of 59 meditation-related experiences across 7 domains: cognitive, perceptual, affective, somatic, conative, sense of self, and social. Even in cases where the phenomenology was similar across participants, interpretations of and responses to the experiences differed considerably. The associated valence ranged from very positive to very negative, and the associated level of distress and functional impairment ranged from minimal and transient to severe and enduring. In order to determine what factors may influence the valence, impact, and response to any given experience, the study also identified 26 categories of influencing factors across 4 domains: practitioner-level factors, practice-level factors, relationships, and health behaviors. By identifying a broader range of experiences associated with meditation, along with the factors that contribute to the presence and management of experiences reported as challenging, difficult, distressing or functionally impairing, this study aims to increase our understanding of the effects of contemplative practices and to provide resources for mediators, clinicians, meditation researchers, and meditation teachers.

Breast cancer relatives' physical activity intervention needs and preferences: qualitative results

Background

While many risk factors for breast cancer, such as family history, are not modifiable, some, however, can be modified. The study used formative qualitative research to learn about the physical activity intervention preferences and needs of first-degree female relatives (FDFRs) of breast cancer patients; that information was then used to develop a targeted physical activity intervention.

Methods

Twenty FDFRs first completed a 12-week physical activity intervention and then attended two sequential focus groups (7 groups total). In the first set of focus groups participants provided feedback on the intervention. In the follow-up focus groups, proposed changes based on collected responses from the first groups were presented and participants provided feedback to further refine the intervention.

Results

Overall, we found strong interest for an intervention using breast cancer-related health concerns to promote positive behavior change. A theme underlying all of the feedback was the desire for a personalized intervention that was directly relevant to their lives. Participants wanted this personalization achieved through individually tailored content and incorporation of stories from other FDFRs. In order to successfully use concerns about breast cancer to motivate behavior change, participants also wanted a discussion about their individual risk factors for breast cancer including, but not limited to, lack of physical activity.

Conclusions

This study demonstrates women’s interest in receiving personalized information and highlights specific ways to individualize an intervention that increases motivation and engagement. Using a sequential qualitative approach was effective for formative intervention development.

Trial registration number

NCT03115658 (Retrospectively registered 4/13/17).

Digital Pills to Measure Opioid Ingestion Patterns in Emergency Department Patients With Acute Fracture Pain: A Pilot Study

BACKGROUND

Nonadherence to prescribed regimens for opioid analgesic agents contributes to increasing opioid abuse and overdose death. Opioids are frequently prescribed on an as-needed basis, placing the responsibility to determine opioid dose and frequency with the patient. There is wide variability in physician prescribing patterns because of the lack of data describing how patients actually use as-needed opioid analgesics. Digital pill systems have a radiofrequency emitter that directly measures medication ingestion events, and they provide an opportunity to discover the dose, timing, and duration of opioid therapy.

OBJECTIVE

The purpose of this study was to determine the feasibility of a novel digital pill system to measure as-needed opioid ingestion patterns in patients discharged from the emergency department (ED) after an acute bony fracture.

METHODS

We used a digital pill with individuals who presented to a teaching hospital ED with an acute extremity fracture. The digital pill consisted of a digital radiofrequency emitter within a standard gelatin capsule that encapsulated an oxycodone tablet. When ingested, the gastric chloride ion gradient activated the digital pill, transmitting a radiofrequency signal that was received by a hip-worn receiver, which then transmitted the ingestion data to a cloud-based server. After a brief, hands-on training session in the ED, study participants were discharged home and used the digital pill system to ingest oxycodone prescribed as needed for pain for one week. We conducted pill counts to verify digital pill data and open-ended interviews with participants at their follow-up appointment with orthopedics or at one week after enrollment in the study to determine the knowledge, attitudes, beliefs, and practices regarding digital pills. We analyzed open-ended interviews using applied thematic analysis.

RESULTS

We recruited 10 study participants and recorded 96 ingestion events (87.3%, 96/110 accuracy). Study participants reported being able to operate all aspects of the digital pill system after their training. Two participants stopped using the digital pill, reporting they were in too much pain to focus on the novel technology. The digital pill system detected multiple simultaneous ingestion events by the digital pill system. Participants ingested a mean 8 (SD 5) digital pills during the study period and four participants continued on opioids at the end of the study period. After interacting with the digital pill system in the real world, participants found the system highly acceptable (80%, 8/10) and reported a willingness to continue to use a digital pill to improve medication adherence monitoring (90%, 9/10).

CONCLUSIONS

The digital pill is a feasible method to measure real-time opioid ingestion patterns in individuals with acute pain and to develop real-time interventions if opioid abuse is detected. Deploying digital pills is possible through the ED with a short instructional course. Patients who used the digital pill accepted the technology.

Phone-delivered mindfulness training to promote medication adherence and reduce sexual risk behavior among persons living with HIV: Design and methods

INTRODUCTION

Two-thirds of people living with HIV (PLWH) show sub-optimal adherence to antiretroviral therapy (ART) and one-third engages in risky sex. Both non-adherence and risky sex have been associated with emotional distress and impulsivity. To allay distress and lessen impulsivity, mindfulness training (MT) can be helpful. In this trial, we will investigate the utility of phone-delivered MT for PWLH. The primary outcomes comprise feasibility and acceptability of phone-delivery; secondary outcomes are estimates of efficacy of MT on adherence to ART and safer sexual practices as well as on their hypothesized antecedents.

METHODS/DESIGN

Fifty participants will be enrolled in this parallel-group randomized clinical trial (RCT). Outpatients recruited from an HIV treatment clinic will be randomized (1:1 ratio) to either MT or to an attention-control intervention; both interventions will be administered during 8 weekly phone calls. ART adherence (self-reported measure and unannounced phone pill counts), sexual behavior (self-reports and biomarkers), mindfulness, depression, stress, and impulsivity will be measured at baseline, post-intervention, and 3months post-intervention.

CONCLUSIONS

MT has great potential to help PLWH to manage stress, depressive symptoms, and impulsivity. Positive changes in these antecedents are expected to improve safer sex practices and ART adherence. If results from this exploratory trial support our hypotheses, we will conduct a large RCT to test (a) the efficacy of MT on ART adherence and safer sex practices and (b) the hypothesis that improved ART adherence and safer sex will reduce viral load, and decrease the incidence of sexually transmitted infections, respectively.

The Mobile Phone Affinity Scale: Enhancement and Refinement

Background

Existing instruments that assess individuals’ relationships with mobile phones tend to focus on negative constructs such as addiction or dependence, and appear to assume that high mobile phone use reflects pathology. Mobile phones can be beneficial for health behavior change, disease management, work productivity, and social connections, so there is a need for an instrument that provides a more balanced assessment of the various aspects of individuals’ relationships with mobile phones.

Objective

The purpose of this research was to develop, revise, and validate the Mobile Phone Affinity Scale, a multi-scale instrument designed to assess key factors associated with mobile phone use.

Methods

Participants (N=1058, mean age 33) were recruited from Amazon Mechanical Turk between March and April of 2016 to complete a survey that assessed participants’ mobile phone attitudes and use, anxious and depressive symptoms, and resilience.

Results

Confirmatory factor analysis supported a 6-factor model. The final measure consisted of 24 items, with 4 items on each of 6 factors: Connectedness, Productivity, Empowerment, Anxious Attachment, Addiction, and Continuous Use. The subscales demonstrated strong internal consistency (Cronbach alpha range=0.76-0.88, mean 0.83), and high item factor loadings (range=0.57-0.87, mean 0.75). Tests for validity further demonstrated support for the individual subscales.

Conclusions

Mobile phone affinity may have an important impact in the development and effectiveness of mobile health interventions, and continued research is needed to assess its predictive ability in health behavior change interventions delivered via mobile phones.

Utilizing an Ingestible Biosensor to Assess Real-Time Medication Adherence

Medication adherence monitoring has relied largely on indirect measures of pill ingestion including patient self-report, pharmacy refills, electronically triggered pill bottles, and pill counts. Our objective is to describe an ingestible biosensor system comprising a radio-frequency identification (RFID)-tagged gelatin capsule. Once the capsule dissolves in the stomach, the RFID tag activates to transmit a unique signal to a relay device which transmits a time-stamped message to a cloud-based server that functions as a direct measure of medication adherence. We describe a constellation of mobile technologies that provide real-time direct measures of medication adherence. Optimizing connectivity, relay design, and interactivity with users are important in obtaining maximal acceptability. Potential concerns including gut retention of metallic components of the ingestible biosensor and drug dissolution within a gelatin capsule should be considered. An ingestible biosensor incorporated into a medication management system has the potential to improve medication compliance with real-time monitoring of ingestion and prompt early behavioral intervention. Integration of ingestible biosensors for multiple disease states may provide toxicologists with salient data early in the care of poisoned patients in the future. Further research on device design and interventions to improve adherence is needed and will shape the evolving world of medication adherence.

Internet-based physical activity intervention for women with a family history of breast cancer

OBJECTIVE

Physical inactivity is a modifiable risk factor for breast cancer. Physical activity interventions that can be delivered through the Internet have the potential to increase participant reach. The efficacy of an Internet-based physical activity intervention was tested in a sample of women at an elevated risk for breast cancer.

METHOD

A total of 55 women with at least 1 first-degree relative with breast cancer (but no personal history of breast cancer) were randomized to a 3-month theoretically grounded Internet-based physical activity intervention or an active control arm. Minutes of moderate to vigorous physical activity, psychosocial mediators of physical activity adoption and maintenance, as well as worry and perceived risk of developing breast cancer were assessed at baseline, 3-month, and 5-month follow up.

RESULTS

Participants were on average 46.2 (SD = 11.4) years old with a body mass index of 27.3 (SD = 4.8) kg/m2. The intervention arm significantly increased minutes of moderate to vigorous physical activity compared to the active control arm at 3 months (213 vs. 129 min/week) and 5 months (208 vs. 119 min/week; both ps < .001). Regression models indicated that participants in the intervention had significantly higher self-efficacy for physical activity at 3 months (p < .01) and borderline significantly higher self-efficacy at 5 months (p = .05). Baseline breast cancer worry and perceived risk were not associated with physical activity.

CONCLUSION

Findings from this study suggest that an Internet-based physical activity intervention may substantially increase physical activity in women with a family history of breast cancer.

Text Messaging-Based Interventions for Smoking Cessation: A Systematic Review and Meta-Analysis

BACKGROUND

Tobacco use is one of the leading preventable global health problems producing nearly 6 million smoking-related deaths per year. Interventions delivered via text messaging (short message service, SMS) may increase access to educational and support services that promote smoking cessation across diverse populations.

OBJECTIVE

The purpose of this meta-analysis is to (1) evaluate the efficacy of text messaging interventions on smoking outcomes, (2) determine the robustness of the evidence, and (3) identify moderators of intervention efficacy.

METHODS

Electronic bibliographic databases were searched for records with relevant key terms. Studies were included if they used a randomized controlled trial (RCT) to examine a text messaging intervention focusing on smoking cessation. Raters coded sample and design characteristics, and intervention content. Summary effect sizes, using random-effects models, were calculated and potential moderators were examined.

RESULTS

The meta-analysis included 20 manuscripts with 22 interventions (N=15,593; 8128 (54%) women; mean age=29) from 10 countries. Smokers who received a text messaging intervention were more likely to abstain from smoking relative to controls across a number of measures of smoking abstinence including 7-day point prevalence (odds ratio (OR)=1.38, 95% confidence interval (CI)=1.22, 1.55, k=16) and continuous abstinence (OR=1.63, 95% CI=1.19, 2.24, k=7). Text messaging interventions were also more successful in reducing cigarette consumption relative to controls (d+=0.14, 95% CI=0.05, 0.23, k=9). The effect size estimates were biased when participants who were lost to follow-up were excluded from the analyses. Cumulative meta-analysis using the 18 studies (k=19) measuring abstinence revealed that the benefits of using text message interventions were established only after only five RCTs (k=5) involving 8383 smokers (OR=1.39, 95% CI=1.15, 1.67, P<.001). The inclusion of the subsequent 13 RCTs (k=14) with 6870 smokers did not change the established efficacy of text message interventions for smoking abstinence (OR=1.37, 95% CI=1.25, 1.51, P<.001). Smoking abstinence rates were stronger when text messaging interventions (1) were conducted in Asia, North America, or Europe, (2) sampled fewer women, and (3) recruited participants via the Internet.

CONCLUSIONS

The evidence for the efficacy of text messaging interventions to reduce smoking behavior is well-established. Using text messaging to support quitting behavior, and ultimately long-term smoking abstinence, should be a public health priority.

Measuring self-efficacy to use vaginal microbicides: the Microbicide Use Self-Efficacy instrument

Objectives To evaluate the psychometric properties of the Microbicide Use Self-Efficacy (MUSE) instrument and to examine correlates of self-efficacy to use vaginal microbicides among a sample of racially and ethnically diverse women living in the north-eastern United States.

METHODS

Exploratory and confirmatory factor analytic methods were used to explore and determine the dimensionality and psychometric properties of the MUSE instrument. Construct validity was assessed by examining the relationships of the MUSE instrument to key sexual behaviour, partner communication, relationship and psychosocial variables.

RESULTS

Two dimensions of self-efficacy to use microbicides were psychometrically validated and identified as 'Adherence and Access' and 'Situational Challenges.' The two four-item subscales measuring Adherence and Access and Situational Challenges had reliability coefficients of 0.78 and 0.85, respectively. Correlates of the two measures were tested at a Bonferroni-adjusted α level of P=0.001, and 19 of 43 variables analysed were found to significantly relate to Adherence and Access, whereas 16 of 43 variables were significantly related to Situational Challenges. Of the 35 significant relationships, 32 were in the domains of partner communication, partner relationships, and behavioural and psychosocial variables.

CONCLUSIONS

The MUSE instrument demonstrated strong internal validity, reliability and initial construct validity. The MUSE instrument can be a useful tool in capturing the multidimensional nature of self-efficacy to use microbicides among diverse populations of women.

Perceptibility and the "Choice Experience": User Sensory Perceptions and Experiences Inform Vaginal Prevention Product Design

The development of pericoital (on demand) vaginal HIV prevention technologies remains a global health priority. Clinical trials to date have been challenged by nonadherence, leading to an inability to demonstrate product efficacy. The work here provides new methodology and results to begin to address this limitation. We created validated scales that allow users to characterize sensory perceptions and experiences when using vaginal gel formulations. In this study, we sought to understand the user sensory perceptions and experiences (USPEs) that characterize the preferred product experience for each participant. Two hundred four women evaluated four semisolid vaginal formulations using the USPE scales at four randomly ordered formulation evaluation visits. Women were asked to select their preferred formulation experience for HIV prevention among the four formulations evaluated. The scale scores on the Sex-associated USPE scales (e.g., Initial Penetration and Leakage) for each participant's selected formulation were used in a latent class model analysis. Four classes of preferred formulation experiences were identified. Sociodemographic and sexual history variables did not predict class membership; however, four specific scales were significantly related to class: Initial Penetration, Perceived Wetness, Messiness, and Leakage. The range of preferred user experiences represented by the scale scores creates a potential target range for product development, such that products that elicit scale scores that fall within the preferred range may be more acceptable, or tolerable, to the population under study. It is recommended that similar analyses should be conducted with other semisolid vaginal formulations, and in other cultures, to determine product property and development targets.

Psychometric Properties and Validity of a Multi-dimensional Risk Perception Scale Developed in the Context of a Microbicide Acceptability Study

Currently available risk perception scales tend to focus on risk behaviors and overall risk (vs partner-specific risk). While these types of assessments may be useful in clinical contexts, they may be inadequate for understanding the relationship between sexual risk and motivations to engage in safer sex or one's willingness to use prevention products during a specific sexual encounter. We present the psychometric evaluation and validation of a scale that includes both general and specific dimensions of sexual risk perception. A one-time, audio computer-assisted self-interview was administered to 531 women aged 18-55 years. Items assessing sexual risk perceptions, both in general and in regards to a specific partner, were examined in the context of a larger study of willingness to use HIV/STD prevention products and preferences for specific product characteristics. Exploratory and confirmatory factor analyses yielded two subscales: general perceived risk and partner-specific perceived risk. Validity analyses demonstrated that the two subscales were related to many sociodemographic and relationship factors. We suggest that this risk perception scale may be useful in research settings where the outcomes of interest are related to motivations to use HIV and STD prevention products and/or product acceptability. Further, we provide specific guidance on how this risk perception scale might be utilized to understand such motivations with one or more specific partners.

Ingestible Biosensors for Real-Time Medical Adherence Monitoring: MyTMed

Medication nonadherence complicates the management and treatment of chronic disease. Nonadherence to medications is associated with significant mortality, accelerated disease progression, and increased health care costs. My/Treatment/Medication (MyTMed) is a novel adherence monitoring system that obtains direct measures of medication adherence/nonadherence. MyTMed consists of 1) a "digital pill" with a radiofrequency emitter that activates on contact with gastric pH; 2) a relay Hub that captures the radiofrequency signal and transmits it to 3) a cloud based server that connects patient and physicians via a bidirectional interface. In our increasingly mobile world, MyTMed is able to provide medication ingestion data and deliver interventions in real time that support adherence. We describe the patient-centered design of MyTMed as well as the behavioral theory supporting the interface architecture.

PULSE-SMART: Pulse-Based Arrhythmia Discrimination Using a Novel Smartphone Application

BACKGROUND

Atrial fibrillation (AF) is a common and dangerous rhythm abnormality. Smartphones are increasingly used for mobile health applications by older patients at risk for AF and may be useful for AF screening.

OBJECTIVES

To test whether an enhanced smartphone app for AF detection can discriminate between sinus rhythm (SR), AF, premature atrial contractions (PACs), and premature ventricular contractions (PVCs).

METHODS

We analyzed two hundred and nineteen 2-minute pulse recordings from 121 participants with AF (n = 98), PACs (n = 15), or PVCs (n = 15) using an iPhone 4S. We obtained pulsatile time series recordings in 91 participants after successful cardioversion to sinus rhythm from preexisting AF. The PULSE-SMART app conducted pulse analysis using 3 methods (Root Mean Square of Successive RR Differences; Shannon Entropy; Poincare plot). We examined the sensitivity, specificity, and predictive accuracy of the app for AF, PAC, and PVC discrimination from sinus rhythm using the 12-lead EKG or 3-lead telemetry as the gold standard. We also administered a brief usability questionnaire to a subgroup (n = 65) of app users.

RESULTS

The smartphone-based app demonstrated excellent sensitivity (0.970), specificity (0.935), and accuracy (0.951) for real-time identification of an irregular pulse during AF. The app also showed good accuracy for PAC (0.955) and PVC discrimination (0.960). The vast majority of surveyed app users (83%) reported that it was "useful" and "not complex" to use.

CONCLUSION

A smartphone app can accurately discriminate pulse recordings during AF from sinus rhythm, PACs, and PVCs.

Feasibility of an HIV/STI Risk-Reduction Program for Incarcerated Women Who Have Experienced Interpersonal Violence

HIV and other sexually transmitted infections (STIs) and interpersonal violence (IV; e.g., childhood abuse, partner violence, and rape) victimization are significant and interconnected public health problems facing incarcerated women. We adapted a best-evidence HIV-prevention intervention for women (the Women's CoOp) to address sexual safety among incarcerated women with histories of interpersonal violence victimization. The standard Women's CoOp teaches safe sex, substance use harm reduction, and violence prevention information and skills needed to empower women to make more intentional decisions about their safety. We also incorporated strategies to increase affect management, social support, and access to community resources. This resulted in the first trauma-focused HIV-prevention intervention for women that directly addresses the sequelae of IV (such as affect dysregulation in sexual situations) within the context of HIV harm reduction. This manuscript describes the rationale, feasibility, acceptability, and pre-post outcomes of this intervention among 14 women nearing release from prison in two state prison systems. Assessments took place at baseline, prior to release, and at 2-, 5-, and 8 months after release. The intervention overall and each of its components were feasible and acceptable. Participants' number of unprotected sexual occasions, post-traumatic stress disorder symptoms, and depressive symptoms decreased significantly from baseline to post-release. Effectiveness in obtaining resources increased significantly from baseline to post-release. Because pre-post measurements of outcomes are confounded with incarceration and subsequent release in this preliminary study, a randomized controlled trial is needed to establish the efficacy of this tailored intervention.

Provider Experiences with Prison Care and Aftercare for Women with Co-occurring Mental Health and Substance Use Disorders: Treatment, Resource, and Systems Integration Challenges

Incarcerated women with co-occurring mental health and substance use disorders (COD) face complex psychosocial challenges at community reentry. This study used qualitative methods to evaluate the perspectives of 14 prison and aftercare providers about service delivery challenges and treatment needs of reentering women with COD. Providers viewed the needs of women prisoners with COD as distinct from those of women with substance use alone and from men with COD. Providers described optimal aftercare for women with COD as including contact with the same provider before and after release, access to services within 24-72 hours after release, assistance with managing multiple social service agencies, assistance with relationship issues, and long-term follow-up. Providers also described larger service system and societal issues, including systems integration and ways in which a lack of prison and community aftercare resources impacted quality of care and reentry outcomes. Practice and policy implications are provided.

Meaning-making matters in product design: users' sensory perceptions and experience evaluations of long-acting vaginal gels and intravaginal rings

OBJECTIVE

Users' sensory perceptions and experiences of intravaginal products can inform acceptability and adherence. Focusing on the meanings women derive from formulation/device characteristics facilitates developers' design iterations toward optimizing user experience. We investigated how users of long-acting gels and intravaginal rings (IVRs) impute meaning to characteristics that may affect future product use.

STUDY DESIGN

Focus groups were conducted with contraceptive IVR and vaginal lubricant users. Current perceptibility science and historical theory on the cultural acceptability of fertility regulating methods informed the analysis.

RESULTS

A total of 21 IVR users and 29 lubricant users attended focus groups in which they manipulated products in their hands and discussed reactions to product characteristics. Participants used prior product experiences and sensory perceptions of prototype manipulations to inform meanings about product properties and performance for pregnancy, disease prevention, comfort, and perceived efficacy. The meanings derived from product characteristics depended on why the product would be used; a characteristic deemed problematic in one risk context may be considered preferable in another.

CONCLUSIONS

Intravaginal product users create narratives that ascribe influence or causality to product characteristics. These meanings, whether correct or incorrect biologically, will shape vaginal product acceptability, use, and effectiveness.

IMPLICATIONS

Long-acting and sustained-release drug delivery systems will be part of the multipurpose prevention continuum. Developers must consider how sensory experiences and culturally salient assumptions shape the meanings users make of product design characteristics. Those meanings will ultimately impact use and effectiveness.

Mothers' attitudes and beliefs about infant feeding highlight barriers to exclusive breastfeeding in American Samoa

BACKGROUND

In American Samoa, initiation of breastfeeding is almost universal but exclusive breastfeeding, a promising target for obesity prevention, is short in duration.

AIMS

(1) To examine American Samoan mothers' feeding experiences and attitudes and beliefs about infant feeding and (2) to identify potential barriers to exclusive breastfeeding.

METHODS

Eighteen semi-structured interviews were conducted with American Samoan mothers at 16-32 days postpartum. Interviews focused on mother's knowledge and beliefs about infant feeding, how their infants were fed, why the mother had chosen this mode of infant feeding, and how decisions about feeding were made within her social surroundings. A thematic qualitative analysis was conducted to identify salient themes in the data.

FINDINGS

Intention to exclusively breastfeed did not predict practice; most women supplemented with formula despite intending to exclusively breastfeed. The benefits of breastfeeding were well-recognized, but the importance of exclusivity was missed. Formula-use was not preferred but considered an innocuous "back-up option" where breastfeeding was not possible or not sufficient for infant satiety. Identified barriers to exclusive breastfeeding included: the convenience of formula; perceptions among mothers that they were not producing enough breast milk; and pain while breastfeeding. The important support role of family for infant feeding could be utilized in intervention design.

CONCLUSION

This study identified barriers to exclusive breastfeeding that can be immediately addressed by providers of breastfeeding support services. Further research is needed to address the common perception of insufficient milk in this setting.