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Poggio R, Melendi SE, Beratarrechea A, Gibbons L, Mills KT, Chen CS, Nejamis A, Gulayin P, Santero M, Chen J, Rubinstein A, He J, Irazola V. Cluster Randomized Trial for Hypertension Control: Effect on Lifestyles and Body Weight. Am J Prev Med 2019; 57:438-446. [PMID: 31473065 PMCID: PMC6755040 DOI: 10.1016/j.amepre.2019.05.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 05/02/2019] [Accepted: 05/03/2019] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Lifestyle modification, such as healthy diet habits, regular physical activity, and maintaining a normal body weight, must be prescribed to all hypertensive individuals. This study aims to test whether a multicomponent intervention is effective in improving lifestyle and body weight among low-income families. STUDY DESIGN Cluster randomized trial conducted between June 2013 and October 2016. SETTING/PARTICIPANTS A total of 1,954 uninsured adult patients were recruited in the study within 18 public primary healthcare centers of Argentina. INTERVENTION Components targeting the healthcare system, providers, and family groups were delivered by community health workers; tailored text messages were sent for 18 months. MAIN OUTCOME MEASURES Changes in the proportion of behavioral risk factors and body weight from baseline to end of follow-up. Data were analyzed in 2017. RESULTS Low fruit and vegetable consumption (fewer than 5 servings per day) decreased from 96.4% at baseline to 92.6% at 18 months in the intervention group, whereas in the control group it increased from 97.0% to 99.9% (p=0.0110). The proportion of low physical activity (<600 MET-minutes/week) decreased from 54.3% at baseline to 46.2% at 18 months in the intervention group and kept constant around 52% (p=0.0232) in the control group. The intervention had no effect on alcohol intake (p=0.7807), smoking (p=0.7607), addition of salt while cooking or at the table (p=0.7273), or body weight (p=0.4000). CONCLUSIONS The multicomponent intervention was effective for increasing fruit and vegetable intake and physical activity with no effect on alcohol consumption, smoking, addition of salt, or body weight among low-income families in Argentina. TRIAL REGISTRATION This study is registered at www.clinicaltrials.gov NCT01834131.
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Affiliation(s)
- Rosana Poggio
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina.
| | - Santiago E Melendi
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | | | - Luz Gibbons
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Katherine T Mills
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana; Tulane University Translational Science Institute, New Orleans, Louisiana
| | - Chung-Shiuan Chen
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana; Tulane University Translational Science Institute, New Orleans, Louisiana
| | - Analía Nejamis
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Pablo Gulayin
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Marilina Santero
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Jing Chen
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana; Tulane University Translational Science Institute, New Orleans, Louisiana; Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana
| | | | - Jiang He
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana; Tulane University Translational Science Institute, New Orleans, Louisiana; Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana
| | - Vilma Irazola
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
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Mallett KA, Turrisi R, Billingsley E, Trager B, Ackerman S, Reavy R, Robinson JK. Evaluation of a Brief Dermatologist-Delivered Intervention vs Usual Care on Sun Protection Behavior. JAMA Dermatol 2019; 154:1010-1016. [PMID: 30090918 DOI: 10.1001/jamadermatol.2018.2331] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Despite receiving dermatologic care, many patients with or without a history of skin cancer either do not use sun protection or fail to use it in an effective manner. Objective To examine the association of a brief dermatologist-delivered intervention vs usual care with patient satisfaction and sun protection behavior. Design, Setting, and Participants A longitudinal controlled cohort study among adults receiving dermatology care was conducted from April 25 to November 6, 2017, at 2 dermatologic clinic sites within a Northeastern health care system to compare outcomes associated with the intervention with that of usual care on 1- and 3-month patient outcomes. The sample consisted primarily of non-Hispanic white patients aged 21 to 65 years. Participants were assigned to the intervention group (n = 77) or the control group (n = 82) based on the site location of their dermatologists. Interventions The intervention (<3 minutes) was delivered by dermatologists during a skin examination or the suturing phase of skin cancer surgery. The intervention consisted of 6 components targeting sun risk and protective behaviors. Main Outcomes and Measures First, patient's satisfaction with the dermatologist's communication was assessed. Second, the association of the intervention with changing sun protection behavior of the patient was examined. Results Patients in the intervention group (46 women and 31 men; mean [SD] age, 52.4 [9.6] years) rated dermatologist-patient communication more positive compared with patients in the control group (59 women and 23 men; mean [SD] age, 51.4 [11.3 years]). Eighteen percent (14 of 77) of patients in the intervention group reported 1 or more sunburns 1 month after the intervention compared with 35% (29 of 82) of patients in the control group (P = .01). No differences in report of sunburns were seen at the 3-month follow-up. Patients in the intervention group reported increased use of sunscreen across 3 months (face: intervention, increased 12% and controls, decreased 4%; P = .001; body: intervention, increased 12% and controls, decreased 1%; P = .02; reapplication: intervention, increased 15% and controls, remained stable; P = .002). Conclusions and Relevance The intervention was delivered by dermatologists after minimal standardized training and resulted in a higher level of satisfaction with dermatologist-patient communication and improved sun protection behavior among patients across several months.
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Affiliation(s)
- Kimberly A Mallett
- Prevention Research Center, The Pennsylvania State University, University Park
| | - Rob Turrisi
- Department of Biobehavioral Health, The Pennsylvania State University, University Park
| | - Elizabeth Billingsley
- Department of Dermatology, Milton S. Hershey Medical Center, The Pennsylvania State University, University Park
| | - Bradley Trager
- Department of Biobehavioral Health, The Pennsylvania State University, University Park
| | - Sarah Ackerman
- Prevention Research Center, The Pennsylvania State University, University Park
| | - Racheal Reavy
- Prevention Research Center, The Pennsylvania State University, University Park
| | - June K Robinson
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,Editor, , Chicago, Illinois
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Field C, Oviedo Ramirez S, Juarez P, Castro Y. Process for developing a culturally informed brief motivational intervention. Addict Behav 2019; 95:129-137. [PMID: 30909079 DOI: 10.1016/j.addbeh.2019.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 01/28/2019] [Accepted: 03/01/2019] [Indexed: 01/18/2023]
Abstract
The present study culturally enhances a standard brief intervention for alcohol use. Through an iterative process engaging key stakeholders; including patients, and expert consultants, this research sought to enhance current evidence based interventions. Five culturally informed enhancements consistent with Motivational Interviewing were introduced into standard brief interventions. These culturally informed enhancements can be refined to address the cultural risk and protective factors of other priority populations. The distinctions and advantages of this approach over prior cultural adapted interventions is discussed. Importantly, the present study outlines a process for refining the culturally informed brief intervention to other target populations.
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Affiliation(s)
- Craig Field
- Department of Psychology, University of Texas at El Paso, USA.
| | | | - Patricia Juarez
- Department of Psychology, University of Texas at El Paso, USA
| | - Yessenia Castro
- Steve Hicks School of Social Work, The University of Texas at Austin, USA
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Shen X, Shen X. The Role of Occupational Therapy in Secondary Prevention of Diabetes. Int J Endocrinol 2019; 2019:3424727. [PMID: 31428147 PMCID: PMC6681589 DOI: 10.1155/2019/3424727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 06/28/2019] [Indexed: 01/23/2023] Open
Abstract
Diabetes mellitus is becoming a global health concern due to its prevalence and projected growth. Despite a growing number of interventions for secondary prevention of diabetes, there is a persistent poor glycemic control and poor adherence to the prescribed diabetes management regimen. In light of the tremendous costs of diabetes to both individuals and the society, it is pressing to find effective ways to improve diabetes self-management (DSM) and treatment adherence. Occupational therapists can bring values to the diabetes care team by evaluating multiple levels of influence on DSM, addressing personal and environmental barriers to well-being and DSM, and supporting patients to develop of a highly complex competences and skills to satisfactorily self-manage diabetes. This article summarizes two evidence-based, well-structured occupational therapy (OT) programs that use activity-based treatments and psychosocial strategies, respectively, to improve DSM abilities and to enhance quality of life. As the needs of adolescents with diabetes are quite different from other diabetic populations, this article also provides a summary of pediatric OT interventions that aim to facilitate autonomy and development of DSM ability among adolescents with diabetes. Evidence indicates that OT interventions can improve the quality of life and treatment adherence in patients with diabetes and hence should be continued and built on to address the increasing needs of diabetic populations.
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Affiliation(s)
- Xizi Shen
- Schools of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Xingping Shen
- Department of Endocrinology, Zhongshan Hospital Xiamen University, Xiamen, Fujian, China
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Shafii T, Benson SK, Morrison DM. Brief Motivational Interviewing Delivered by Clinician or Computer to Reduce Sexual Risk Behaviors in Adolescents: Acceptability Study. J Med Internet Res 2019; 21:e13220. [PMID: 31293242 PMCID: PMC6652122 DOI: 10.2196/13220] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 04/05/2019] [Accepted: 04/23/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Clinicians are expected to screen their adolescent patients for an increasing number of health behaviors and intervene when they uncover risky behaviors, yet, the clinic time allotted to screen, intervene, and provide resources is insufficient. Brief motivational interviewing (MI) offers succinct behavior change counseling; however, for implementation, clinicians need training, skill, and time. Computerized screening and counseling adjuvants may help clinicians increase their scope of behavioral screening, especially with sensitive topics such as sexual health, and provide risk-reduction interventions without consuming provider time during visits. OBJECTIVE The objectives of this study were to (1) understand the extent to which health care providers use brief MI for sexual health discussions with adolescent patients and (2) assess the acceptability of incorporating a brief MI-based intervention to reduce sexual risk behaviors into their clinical practice delivered by either themselves or a computer. METHODS At a national medical conference, surveys were administered to clinicians who provide sexual health care to adolescents. They were asked about their current use of MI for sexual risk behavior discussions and their willingness to implement computerized sexual health screening and computerized sexual risk behavior interventions into their clinical practice. RESULTS The large majority (87.6%, 170/194) of clinicians already used MI with their patients with less than half (72/148, 48.6%) reporting they had been formally trained in MI. Despite all (195/195, 100.0%) clinicians feeling very or completely comfortable discussing sexual risk behaviors with their patients, the large majority (160/195, 82.1%) reported it would be useful, very useful, or extremely useful for a computerized program to do it all: screen their patients, generate risk profiles, and provide the risk-reduction counseling rather than doing it themselves. CONCLUSIONS In this study, most clinicians used some form of brief MI or client-centered counseling when discussing sexual risk behaviors with adolescents and are very comfortable doing so. However, the large majority would prefer to implement computerized sexual health screening, risk assessment, and sexual risk behavior interventions into their clinical care of adolescents.
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Affiliation(s)
- Taraneh Shafii
- Division of Adolescent Medicine, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, United States
| | - Samantha K Benson
- Harborview Medical Center, University of Washington School of Medicine, Seattle, WA, United States
| | - Diane M Morrison
- School of Social Work, University of Washington, Seattle, WA, United States
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Oeffinger KC, Ford JS, Moskowitz CS, Chou JF, Henderson TO, Hudson MM, Diller L, McDonald A, Ford J, Mubdi NZ, Rinehart D, Vukadinovich C, Gibson TM, Anderson N, Elkin EB, Garrett K, Rebull M, Leisenring W, Robison LL, Armstrong GT. Promoting Breast Cancer Surveillance: The EMPOWER Study, a Randomized Clinical Trial in the Childhood Cancer Survivor Study. J Clin Oncol 2019; 37:2131-2140. [PMID: 31260642 PMCID: PMC6698920 DOI: 10.1200/jco.19.00547] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The aim of the current study was to increase the uptake of screening mammography among high-risk women who were treated for a childhood cancer with chest radiotherapy. PATIENTS AND METHODS Two hundred four female survivors in the Childhood Cancer Survivor Study who were treated with chest radiotherapy with 20 Gy or greater, age 25 to 50 years, and without breast imaging in the past 24 months were randomly assigned 2:1 to receive a mailed informational packet followed by a tailored telephone-delivered brief motivational interview (intervention) versus an attention control. Primary outcome was the difference in the proportion of participants who completed a screening mammogram by 12 months as evaluated in an intent-to-treat analysis. Stratum-adjusted relative risk (RR) and 95% CI were estimated using the Cochran-Mantel-Haenszel method. Secondary outcomes included the completion of screening breast magnetic resonance imaging (MRI) and barriers to screening and moderating factors. RESULTS Women in the intervention group were significantly more likely than those in the control group to report a mammogram (45 [33.1%] of 136 v 12 [17.6%] of 68; RR, 1.9; 95% CI, 1.1 to 3.3). The intervention was more successful among women age 25 to 39 years (RR, 2.2; 95% CI, 1.1 to 4.7) than among those age 40 to 50 years (RR, 1.4; 95% CI, 0.6 to 3.2). The proportion of women who reported a breast MRI at 12 months was similar between the two groups: 16.2% (intervention) compared with 13.2% (control; RR, 1.2; 95% CI, 0.6 to 2.5). Primary barriers to completing a screening mammogram and/or breast MRI included lack of physician recommendation, deferred action by survivor, cost, and absence of symptoms. CONCLUSION Use of mailed materials followed by telephone-delivered counseling increased mammography screening rates in survivors at high risk for breast cancer; however, this approach did not increase the rate of breast MRI. Cost of imaging and physician recommendation were important barriers that should be addressed in future studies.
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Affiliation(s)
| | - Jennifer S Ford
- 2Hunter College, City University of New York, New York, NY.,3The Graduate Center of the City University of New York, New York, NY
| | | | - Joanne F Chou
- 4Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | - Lisa Diller
- 7Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | | | - James Ford
- 6St Jude Children's Research Hospital, Memphis, TN
| | - Nidha Z Mubdi
- 4Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | | | | | - Elena B Elkin
- 4Memorial Sloan Kettering Cancer Center, New York, NY
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Park J, Gross DP, Rayani F, Norris CM, Roberts MR, James C, Guptill C, Esmail S. Model of Human Occupation as a framework for implementation of Motivational Interviewing in occupational rehabilitation. Work 2019; 62:629-641. [PMID: 31104046 DOI: 10.3233/wor-192895] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND A conceptual framework is needed to understand injured workers' decision-making and inform evidence-based interventions to address behavior change regarding return-to-work (RTW). The Model of Human Occupation (MOHO) can help with understanding how an injured worker's characteristics can generate behavior change while Motivational Interviewing (MI) can help facilitate behavior change. OBJECTIVE This theoretical paper provides an overview of how MOHO and MI can be applied and integrated in occupational rehabilitation. The objectives of this paper are to: (1) evaluate MOHO as a framework for supporting occupational therapists (OTs) in occupational rehabilitation; (2) describe MI as a suitable approach for OTs in occupational rehabilitation; and (3) compare and integrate MOHO and MI. METHOD Several important works and reviews were used to integrate MOHO and MI with occupational rehabilitation. IMPLICATIONS FOR PRACTICE The identification of a model and approach to support OT practice in occupational rehabilitation can assist OTs to determine the most appropriate interventions and contribute to standards of best practice. CONCLUSIONS Integrating MOHO and MI provides a comprehensive framework for understanding impairment and RTW change processes with the potential to reduce work disability and improve RTW outcomes.
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Affiliation(s)
- Joanne Park
- Department of Occupational Therapy, University of Alberta, Edmonton, Canada.,Workers' Compensation Board of Alberta Millard Health, Edmonton, Canada
| | - Douglas P Gross
- Department of Physical Therapy, University of Alberta, Edmonton, Canada
| | - Fahreen Rayani
- Workers' Compensation Board of Alberta Millard Health, Edmonton, Canada
| | - Colleen M Norris
- Faculty of Nursing and Faculty of Medicine, University of Alberta, Edmonton, Canada
| | | | - Carole James
- School of Health Sciences, University of Newcastle, Newcastle, Australia
| | - Christine Guptill
- Department of Occupational Therapy, University of Alberta, Edmonton, Canada
| | - Shaniff Esmail
- Department of Occupational Therapy, University of Alberta, Edmonton, Canada
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58
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Arasu A, Moran LJ, Robinson T, Boyle J, Lim S. Barriers and Facilitators to Weight and Lifestyle Management in Women with Polycystic Ovary Syndrome: General Practitioners' Perspectives. Nutrients 2019; 11:nu11051024. [PMID: 31067757 PMCID: PMC6566405 DOI: 10.3390/nu11051024] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 04/18/2019] [Accepted: 04/29/2019] [Indexed: 12/30/2022] Open
Abstract
Background: Weight and lifestyle management is advocated as the first-line treatment for polycystic ovary syndrome (PCOS) by evidence-based guidelines. Current literature describes both systems- and individual-related challenges that general practitioners (GPs) face when attempting to implement guideline recommendations for lifestyle management into clinical practice for the general population. The GPs’ perspective in relation to weight and lifestyle advice for PCOS has not been captured. Methods: Fifteen GPs were recruited to take part in semi-structured interviews. NVIVO software was used for qualitative analysis. Results: We report that GPs unanimously acknowledge the importance of weight and lifestyle management in PCOS. Practice was influenced by both systems-related and individual-related facilitators and barriers. Individual-related barriers include perceived lack of patient motivation for weight loss, time pressures, lack of financial reimbursement, and weight management being professionally unrewarding. System-related barriers include costs of accessing allied health professionals and unavailability of allied health professionals in certain locations. Individual-related facilitators include motivated patient subgroups such as those trying to get pregnant and specific communication techniques such as motivational interviewing. System-related facilitators include the GP’s role in chronic disease management. Conclusions: This study contributes to the understanding of barriers and facilitators that could be addressed to optimize weight and lifestyle management in women with PCOS in primary care.
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Affiliation(s)
- Alexis Arasu
- Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC 3168, Australia.
| | - Lisa J Moran
- Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC 3168, Australia.
| | - Tracy Robinson
- Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC 3168, Australia.
| | - Jacqueline Boyle
- Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC 3168, Australia.
| | - Siew Lim
- Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC 3168, Australia.
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Mimiaga MJ, Hughto JMW, Reisner SL. A Randomized Pilot Study of a Group-Delivered HIV Risk Reduction Intervention for At-Risk Urban Men Who Have Sex with Men Who Regularly Attend Private Sex Events. ARCHIVES OF SEXUAL BEHAVIOR 2019; 48:1059-1071. [PMID: 30805830 DOI: 10.1007/s10508-018-1326-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Revised: 08/24/2018] [Accepted: 10/04/2018] [Indexed: 06/09/2023]
Abstract
Across HIV prevention studies, as many as 25% of men who have sex with men (MSM) report meeting male partners at private sex events and attendance is associated with increased number of sexual partners, condomless anal sex (CAS), and HIV infection. Despite the need for effective HIV prevention interventions, no risk reduction interventions have been tested to reduce HIV sexual risk of MSM that regularly engage in sexual risk at private sex events. This randomized pilot study assessed the feasibility and acceptability of an HIV risk reduction intervention to reduce CAS among urban MSM (N = 14) reporting risk at a private sex event in the prior 12 months. The intervention arm received four group sessions (2 h/session) focusing on HIV risk reduction education and skills building. Both the intervention (n = 8) and control (n = 6) conditions received HIV testing and pre- and posttest risk reduction counseling and completed a sexual risk and psychosocial assessment visit at baseline and 3 months post-intervention. In addition, intervention participants completed a brief exit interview post-intervention. Mean age was 37 years, and 57% were racial/ethnic minorities. At follow-up, the intervention group reported greater reductions in sexual risk behavior in the past 3 months including number of CAS episodes, number of partners at private sex events, and CAS episodes at private sex events. The intervention group also reported reduced sexual compulsivity, increases in HIV disclosure, and reduced drug use at private sex events over study follow-up. Exit interviews revealed that participants found the intervention to be highly acceptable. Findings demonstrate feasibility of procedures, participant acceptability, and initial promise of a group-delivered HIV risk reduction intervention for MSM who attend and engage in CAS at private sex events. Further testing of this intervention in a larger pilot randomized controlled trial is warranted.
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Affiliation(s)
- Matthew J Mimiaga
- Center for Health Equity Research, Brown University, Providence, RI, USA.
- Departments of Behavioral and Social Health Sciences and Epidemiology, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02903, USA.
- Department of Psychiatry and Human Behavior, Brown University Alpert Medical School, Providence, RI, USA.
| | - Jaclyn M W Hughto
- Center for Health Equity Research, Brown University, Providence, RI, USA
- Departments of Behavioral and Social Health Sciences and Epidemiology, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02903, USA
- Department of Psychiatry and Human Behavior, Brown University Alpert Medical School, Providence, RI, USA
| | - Sari L Reisner
- Department of Pediatrics, Harvard Medical School/Boston Children's Hospital, Boston, MA, USA
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
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Chima CC, Salemi JL, Sidani MA, Zoorob RJ. Coaching and Education for Diabetes Distress (CEDD): Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2019; 8:e12166. [PMID: 30938687 PMCID: PMC6465980 DOI: 10.2196/12166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 01/26/2019] [Accepted: 02/10/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Diabetes distress (DD), a type of psychological distress specific to people with diabetes, is strongly associated with difficulties in performing self-care and inability to meet glycemic targets. Despite increased recognition of the need to manage DD, interventions that are both feasible and effective for reducing DD in routine care settings are not yet known. A pilot study showed that health coaching (HC) has some efficacy in addressing DD, but no adequately powered study has implemented a pragmatic research design capable of assessing the real-world effectiveness of HC in reducing DD. OBJECTIVE The aim of this study is to describe the rationale and design of an ongoing clinical trial, Coaching and Education for Diabetes Distress trial, that seeks to assess whether HC effectively reduces DD among primary care patients with diabetes and whether HC is more effective than an educational program targeting DD. METHODS The 2-arm randomized controlled trial is taking place at an academic family medicine practice in Houston, Texas. Both arms will receive usual care, which includes education about DD. In addition, the intervention arm will receive 8 HC sessions over a 5-month period. The primary outcome measure is reduction in DD over a 6-month period. Additional outcome measures include changes in hemoglobin A1c and self-care practices (medication-taking, dietary, and physical activity behaviors). RESULTS As of March 2019, screening and recruitment are ongoing, and the results are expected by July 2020. CONCLUSIONS HC is feasible in primary care and has been successfully applied to improving chronic disease self-management and outcomes. This study will provide evidence as to whether it has significant value in addressing important unmet psychological and behavioral needs of patients with diabetes. TRIAL REGISTRATION ClinicalTrials.gov NCT03617146; https://clinicaltrials.gov/ct2/show/NCT03617146 (Archived by WebCite at http://www.webcitation.org/76Va37dbO). INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/12166.
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Affiliation(s)
- Charles C Chima
- Department of Population Health Science, John D Bower School of Population Health, University of Mississippi Medical Center, Jackson, MS, United States.,Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Jason L Salemi
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Mohamad A Sidani
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Roger J Zoorob
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, United States
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Kruse G, Park ER, Shahid NN, Abroms L, Haberer JE, Rigotti NA. Combining Real-Time Ratings With Qualitative Interviews to Develop a Smoking Cessation Text Messaging Program for Primary Care Patients. JMIR Mhealth Uhealth 2019; 7:e11498. [PMID: 30912755 PMCID: PMC6454345 DOI: 10.2196/11498] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 11/15/2018] [Accepted: 11/22/2018] [Indexed: 01/03/2023] Open
Abstract
Background Text messaging (short message service, SMS) interventions show promise as a way to help cigarette smokers quit. Few studies have examined the effectiveness of text messaging (SMS) programs targeting smokers associated with primary care or hospital settings. Objective This study aimed to develop a text messaging (SMS) program targeting primary care smokers. Methods Adult smokers in primary care were recruited from February 2017 to April 2017. We sent patients 10 to 11 draft text messages (SMS) over 2 days and asked them to rate each message in real time. Patients were interviewed daily by telephone to discuss ratings, message preferences, and previous experiences with nicotine replacement therapy (NRT). Content analysis of interviews was directed by a step-wise text messaging (SMS) intervention development process and the Information-Motivation-Behavioral Skills model of medication adherence. Results We sent 149 text messages (SMS) to 15 patients. They replied with ratings for 93% (139/149) of the messages: 134 (96%, 134/139) were rated as clear or useful and 5 (4%, 5/139) as unclear or not useful. Patients’ preferences included the addition of graphics, electronic cigarette (e-cigarette) content, and use of first names. Regarding NRT, patients identified informational gaps around safety and effectiveness, preferred positively framed motivational messages, and needed behavioral skills to dose and dispose of NRT. Conclusions Patients recommended text message (SMS) personalization, inclusion of e-cigarette information and graphics, and identified barriers to NRT use. Combining real-time ratings with telephone interviews is a feasible method for incorporating primary care patients’ preferences into a behavioral text messaging (SMS) program.
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Affiliation(s)
- Gina Kruse
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, United States.,Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Elyse R Park
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States.,Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Naysha N Shahid
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Lorien Abroms
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, United States
| | - Jessica E Haberer
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States.,Center for Global Health, Massachusetts General Hospital, Boston, MA, United States
| | - Nancy A Rigotti
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, United States.,Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
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Amico KR, Dunlap A, Dallas R, Lindsey J, Heckman B, Flynn P, Lee S, Horvath K, West Goolsby R, Hudgens M, Filipowicz T, Polier M, Hill E, Mueller Johnson M, Miller J, Neilan A, Ciaranello A, Gaur A. Triggered Escalating Real-Time Adherence Intervention to Promote Rapid HIV Viral Suppression Among Youth Living With HIV Failing Antiretroviral Therapy: Protocol for a Triggered Escalating Real-Time Adherence Intervention. JMIR Res Protoc 2019; 8:e11416. [PMID: 30882360 PMCID: PMC6441855 DOI: 10.2196/11416] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 11/05/2018] [Accepted: 01/23/2019] [Indexed: 01/19/2023] Open
Abstract
Background Youth living with HIV (YLWH) are confronted with many self-care challenges that can be experienced as overwhelming in the context of normal developmental processes that characterize adolescence and young adulthood. A sizable minority of YLWH have unsuppressed viral loads in the United States attributable to antiretroviral therapy (ART) nonadherence. Interventions to promote sustained viral suppression in YLWH are needed. Objective The aim of this study is to evaluate the efficacy of the Triggered Escalating Real-Time Adherence (TERA) intervention in comparison with standard of care (SOC) in YLWH (aged 13-24 years) failing ART on (1) primary outcome measures—HIV viral suppression (VLS), defined as both <200 copies/ml and <50 copies/ml at 12 weeks, and (2) secondary outcome measures—VLS rates and rates of ART adherence at 24, 36, and 48 weeks as well as patterns of adherence over time as measured by an electronic dose monitoring (EDM) device. Methods The TERA study is a phase 2, multisite clinical trial conducted with 120 YLWH failing ART (randomized 1:1 to TERA or SOC) at participating clinical sites within the Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN). Participants are followed for a total of 48 weeks. For TERA arm participants, the first 12 weeks involve delivery of the intervention. For all participants, clinical outcomes are collected throughout follow-up, and adherence is assessed using EDM over the full 48 weeks. During the 12-week intervention period, TERA arm participants receive 3 remote coaching sessions delivered in clinic via videoconferencing timed to coincide with baseline and follow-up clinical visits, text message reminders when the EDM has not been opened at dose time (which escalate to 2-way theory-informed short message service coaching interactions in response to real-time nonadherence), and review of dosing graphs produced by EDM at follow-up visits. Results Launch dates for enrollment varied by site. Enrollment began in April 2018 and is expected to be completed by August 2019, with results presented by the second quarter of 2021. Conclusions Effective, generalizable, and scalable approaches to rapidly assist YLWH failing to achieve and sustain VLS may have a substantial impact on individual health and efforts to curb transmission. Coaching for a brief but intensive period from remote coaches and using communication channels common to youth may offer multiple unique advantages in promoting self-care. Trial Registration ClinicalTrials.gov NCT03292432; https://clinicaltrials.gov/ct2/show/NCT03292432 (Archived by WebCite at http://www.webcitation.org/768J8ijjp). International Registered Report Identifier (IRRID) DERR1-10.2196/11416
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Affiliation(s)
- K Rivet Amico
- School of Public Health, Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI, United States
| | - Amanda Dunlap
- School of Public Health, Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI, United States
| | - Ronald Dallas
- St. Jude Children's Research Hospital, Department of Infectious Diseases, Memphis, TN, United States
| | - Jane Lindsey
- Chan School of Public Health, Department of Biostatistics, Harvard University, Boston, MA, United States
| | - Barbara Heckman
- Frontier Science and Technology Research Foundation, Amherst, NY, United States
| | - Patricia Flynn
- St. Jude Children's Research Hospital, Department of Infectious Diseases, Memphis, TN, United States
| | - Sonia Lee
- National Institutes of Health, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, United States
| | - Keith Horvath
- School of Public Health, Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, United States
| | - Rachel West Goolsby
- Gillings School of Public Health, Department of Biostatistics, Collaborative Studies Coordinating Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Michael Hudgens
- Gillings School of Public Health, Department of Biostatistics, Collaborative Studies Coordinating Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Teresa Filipowicz
- Gillings School of Public Health, Department of Biostatistics, Collaborative Studies Coordinating Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Melissa Polier
- Gillings School of Public Health, Department of Biostatistics, Collaborative Studies Coordinating Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Emily Hill
- School of Public Health, Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI, United States
| | - Megan Mueller Johnson
- School of Public Health, Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI, United States
| | - Jessica Miller
- School of Public Health, Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI, United States
| | - Anne Neilan
- Massachusetts General Hospital, Division of Infectious Diseases, Boston, MA, United States
| | - Andrea Ciaranello
- Massachusetts General Hospital, Division of Infectious Diseases, Boston, MA, United States
| | - Aditya Gaur
- St. Jude Children's Research Hospital, Department of Infectious Diseases, Memphis, TN, United States
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63
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Caccavale LJ, Corona R, LaRose JG, Mazzeo SE, Sova AR, Bean MK. Exploring the role of motivational interviewing in adolescent patient-provider communication about type 1 diabetes. Pediatr Diabetes 2019; 20:217-225. [PMID: 30575237 PMCID: PMC7196323 DOI: 10.1111/pedi.12810] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 12/04/2018] [Accepted: 12/10/2018] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Adolescents with type 1 diabetes (T1D) frequently experience deterioration in glycemic control. Providers have unique opportunities to address diabetes self-management, yet little is known about the most effective way to communicate with adolescents. This investigation used a motivational interviewing (MI) framework to characterize naturally-occurring adolescent patient-provider communication in medical encounters and examined relations between adolescent patient-provider communication and (a) T1D self-management and (b) glycemic control (hemoglobin A1c [HbA1c]). METHODS Medical encounters between pediatric endocrine providers and 55 adolescents with T1D (49% female; M age = 14.8 years; M baseline HbA1c = 8.6%) were audio recorded and coded using standardized rating instruments. Patients and parents completed measures assessing T1D care behaviors and self-efficacy. Assessments were completed at routine endocrinology visits (baseline) and 1 and 3-month post-baseline; HbA1c was obtained from medical records at baseline and 3-month. RESULTS Hierarchical multiple regressions showed that greater provider use of MI non-adherent behaviors (eg, confronting, persuading) was associated with (a) poorer 3-month HbA1c, P < 0.001; (b) worse 1-month adolescent diabetes adherence P < 0.001, and (c) lower diabetes self-efficacy at 1-month (P < 0.001) follow-up. Lower patient self-efficacy for diabetes self-management mediated the relation between provider use of MI non-adherent language and lower diabetes adherence (P = 0.020). CONCLUSION Providers' use of persuasion and confrontation regarding risks of non-adherence was associated with poorer glycemic control and adherence. Communication training for providers that targets reductions in MI-inconsistent language may have the potential to improve diabetes self-care in this vulnerable population.
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Affiliation(s)
- Laura J Caccavale
- Department of Pediatrics, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia
| | - Rosalie Corona
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia
| | - Jessica G LaRose
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Suzanne E Mazzeo
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia
| | - Alexandra R Sova
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Melanie K Bean
- Department of Pediatrics, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia
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Wilbur J, Braun LT, Buchholz SW, Miller AM, Fogg L, Halloway S, Schoeny ME. Randomized Controlled Trial of Lifestyle Walking for African American Women: Blood Pressure Outcomes. Am J Lifestyle Med 2018; 13:508-515. [PMID: 31523217 DOI: 10.1177/1559827618801761] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The aim of this study was to test the effects of a lifestyle physical activity intervention (group meetings alone vs supplemented by personal or automated calls) on changes in systolic/diastolic blood pressures from baseline to 24 and 48 weeks among African American women. This was a randomized controlled trial with intervention conditions randomly assigned across 6 community health care sites. Participants were 288 sedentary African American women without major signs/symptoms of cardiovascular disease. Each intervention had 6 group meetings over 48 weeks, with 1 of 3 options between meetings: (1) no calls, (2) personal motivational calls, or (3) automated motivational calls. Blood pressures were taken at baseline, 24 weeks, and 48 weeks. Separate analyses were conducted using blood pressure classifications from the 2003 and 2017 high blood pressure guidelines. Average blood pressures decreased approximately 3 mm Hg for systolic and 2 mm Hg for diastolic from baseline to 48 weeks, with no differences between conditions. For both 2003 and 2017 blood pressure classifications, the risk ratio (odds of moving to a lower classification) was 1.44 for each assessment (P < .001). This lifestyle walking intervention appears beneficial in lowering blood pressure across blood pressure classifications in midlife African American women.
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Affiliation(s)
| | - Lynne T Braun
- College of Nursing, Rush University, Chicago, Illinois
| | | | | | - Louis Fogg
- College of Nursing, Rush University, Chicago, Illinois
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Spencer MS, Kieffer EC, Sinco B, Piatt G, Palmisano G, Hawkins J, Lebron A, Espitia N, Tang T, Funnell M, Heisler M. Outcomes at 18 Months From a Community Health Worker and Peer Leader Diabetes Self-Management Program for Latino Adults. Diabetes Care 2018; 41:1414-1422. [PMID: 29703724 PMCID: PMC6014532 DOI: 10.2337/dc17-0978] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 04/07/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE This study evaluated the effectiveness of a community health worker (CHW) diabetes self-management education (DSME) program, followed by two different approaches to maintain improvements in HbA1c and other clinical and patient-centered outcomes over 18 months. RESEARCH DESIGN AND METHODS The study randomized 222 Latino adults with type 2 diabetes and poor glycemic control from a federally qualified health center to 1) a CHW-led, 6-month DSME program or 2) enhanced usual care (EUC). After the 6-month program, participants randomized to the CHW-led DSME were further randomized to 1) 12 months of CHW-delivered monthly telephone outreach (CHW-only) or 2) 12 months of weekly group sessions delivered by peer leaders (PLs) with telephone outreach to those unable to attend (CHW+PL). The primary outcome was HbA1c. Secondary outcomes were blood pressure, lipid levels, diabetes distress, depressive symptoms, understanding of diabetes self-management, and diabetes social support. Assessments were conducted at baseline and at 6, 12, and 18 months. RESULTS Participants in the CHW intervention at the 6-month follow-up had greater decreases in HbA1c (-0.45% [95% CI -0.87, -0.03]; P < 0.05) and in diabetes distress (-0.3 points [95% CI -0.6, -0.03]; P < 0.05) compared with EUC. CHW+PL participants maintained HbA1c improvements at 12 and 18 months, and CHW-only participants maintained improvements in diabetes distress at 12 and 18 months. CHW+PL participants also had significantly fewer depressive symptoms at 18 months compared with EUC (-2.2 points [95% CI -4.1, -0.3]; P < 0.05). Participants in CHW-led DSME had significant improvements in diabetes social support and in understanding of diabetes self-management at 6 months relative to EUC, but these intervention effects were not sustained at 18 months. CONCLUSIONS This study demonstrates the effectiveness of a 6-month CHW intervention on key diabetes outcomes and of a volunteer PL program in sustaining key achieved gains. These are scalable models for health care centers in low-resource settings for achieving and maintaining improvements in key diabetes outcomes.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Tricia Tang
- University of British Columbia, Vancouver, British Columbia, Canada
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66
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Holman D, Lynch R, Reeves A. How do health behaviour interventions take account of social context? A literature trend and co-citation analysis. Health (London) 2018; 22:389-410. [PMID: 28504005 PMCID: PMC6377061 DOI: 10.1177/1363459317695630] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In recent years, health behaviour interventions have received a great deal of attention in both research and policy as a means of encouraging people to lead healthier lives. The emphasis of such interventions has varied over time, in terms of level of intervention (e.g. individual vs community) and drawing on different disciplinary perspectives. Recently, a number of critiques have focused on how health behaviour interventions sometimes sideline issues of social context, framing health as a matter of individual choice and, by implication, a personal responsibility. Part of this criticism is that health behaviour interventions often do not draw on alternative social science understandings of the structured and contextual aspects of behaviour and health. Yet to our knowledge, no study has attempted to empirically assess the extent to which, and in what ways, the health behaviour intervention field has paid attention to social context. In this article, we undertake this task using bibliometric techniques in order to map out the health behaviour intervention field. We find that the number of health behaviour interventions has grown rapidly in recent years, especially since around 2006, and that references to social science disciplines and concepts that foreground issues of social context are rare and, relatively speaking, constitute less of the field post 2006. More quantifiable concepts are used most, and those more close to the complexities of social context are mentioned least. The document co-citation analysis suggests that pre 2006, documents referring to social context were relatively diffuse in the network of key citations, but post 2006 this influence had largely diminished. The journal co-citation analysis shows less disciplinary overlap post 2006. At present, health behaviour interventions are continuing to focus on individualised approaches drawn from behavioural psychology and behavioural economics. Our findings lend empirical support to a number of recent papers that suggest more interdisciplinary collaboration is needed to advance the field.
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Affiliation(s)
| | | | - Aaron Reeves
- London School of Economics and Political
Science, UK
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67
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Derges J, Kidger J, Fox F, Campbell R, Kaner E, Taylor G, McMahon C, Reeves L, Hickman M. 'DrinkThink' alcohol screening and brief intervention for young people: a qualitative evaluation of training and implementation. J Public Health (Oxf) 2018; 40:381-388. [PMID: 28977388 PMCID: PMC6053838 DOI: 10.1093/pubmed/fdx090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 06/18/2017] [Accepted: 07/04/2017] [Indexed: 11/22/2022] Open
Abstract
Background Alcohol Screening and Brief Intervention (ASBI) helps reduce risky drinking in adults, but less is known about its effectiveness with young people. This article explores implementation of DrinkThink, an ASBI co-produced with young people, by health, youth and social care professionals trained in its delivery. Methods A qualitative evaluation was conducted using focus groups with 33 staff trained to deliver DrinkThink, and eight interviews with trained participants and service managers. These were recorded, transcribed and a thematic analysis undertaken. Results DrinkThink was not delivered fully by health, youth or social care agencies. The reasons for this varied by setting but included: the training staff received, a working culture that was ill-suited to the intervention, staff attitudes towards alcohol which prioritized other health problems presented by young people, over alcohol use. Conclusions Implementation was limited because staff had not been involved in the design and planning of DrinkThink. Staffs' perceptions of alcohol problems in young people and the diverse cultures in which they work were subsequently not accounted for in the design. Co-producing youth focused ASBIs with the professionals expected to deliver them, and the young people whom they target, may ensure greater success in integrating them into working practice.
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Affiliation(s)
- J Derges
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - J Kidger
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - F Fox
- University Hospital Bristol, NHS Foundation Trust, Bristol, UK
| | - R Campbell
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - E Kaner
- Institute of Health & Society, University of Newcastle, Newcastle upon Tyne, UK
| | - G Taylor
- Department for Health, University of Bath, Bath, UK
| | - C McMahon
- B&NES Council Public Health, Bath, UK
| | | | - M Hickman
- School of Social and Community Medicine, University of Bristol, Bristol, UK
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Abstract
PURPOSE OF REVIEW Implementing Motivational Interviewing (MI) in primary care settings has been problematic due in part to persistent gaps in knowledge. Examples include poor understanding of how to effectively train persons to conduct MI, or of which aspects of MI-related communication are associated with better outcomes for patients. This review describes how recent research findings addressing the knowledge gaps support a growing role for MI in primary care. RECENT FINDINGS Two trials of MI training combined classroom time with ongoing coaching and feedback, resulting in enhanced MI ability relative to a control arm where PCPs received minimal or no MI training. A third MI training trial excluded coaching and feedback, failing to increase use of MI. Adding to a growing list of behavioral health-related problems for which MI training has shown some effectiveness, a trial of training PCPs to use MI with depressed patients was associated with significantly improved depressive symptoms. Moreover, aspects of the PCPs' MI-related language and patients' arguments for positive behavior changes, "change talk," appeared to explain the positive effects of MI training on depression outcome. MI-training approaches have improved such that PCPs and possibly other clinic staff may want to consider MI training as a way to more effectively support their patients as they address behavioral health-related problems (e.g., tobacco use). MI training should focus on eliciting "change talk" from patients. Researchers and funding agencies might collaborate to continue closing knowledge gaps in the MI literature.
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Thiabpho C, Changbumrung S, Soonthornworasiri N, Yoddumnern-Attig B, Thaboot P, Nissayan P, Kwanbunjan K. Intensive lifestyle modification program on weight loss and metabolic syndrome risk reduction among obese women in rural areas of Thailand. JOURNAL OF HEALTH RESEARCH 2018. [DOI: 10.1108/jhr-05-2018-022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Purpose
The purpose of this paper is to examine the effect of the intensive lifestyle modification program on weight and metabolic syndrome risk reduction in rural obese women who have no underlying non-communicable diseases in Thailand.
Design/methodology/approach
A randomized controlled trial was conducted. In total, 60 healthy obese women aged 30-50 years were recruited and randomly assigned to either the intervention (n=30) or control (n=30) group after health screening. Tailored nutritional counseling, health education and exercise training were included in the lifestyle modification program. Behavioral modification techniques were also incorporated. The intervention was conducted weekly for the first eight weeks, then biweekly until week 16.
Findings
The student’s t-test was used to compare mean difference between groups. The total weight loss in the intervention group (n=29) was significantly higher, 7.6±2.9 kg, compared with the control group (n=30) who lost 0.7±1.4 kg (p<0.001). The intervention group lost weight 10.2 percent from baseline which was significantly higher than that in the control group (p<0.001). Systolic and diastolic blood pressures, fasting blood sugar, and waist circumference were significantly improved. Triglyceride levels slightly improved while high density lipoprotein cholesterol was slightly lowered. The intervention group showed a statistical reduction in abnormal components of metabolic syndrome compared with the control group, with the relative risk=0.24, 95% confidence interval=0.072-0.791, and p=0.018.
Originality/value
Compatibility of the program activities conducted by a health professional who had achieved healthy weight loss and accepted as a role model was a key to achieving effective weight loss and metabolic syndrome risk reduction in obese women in rural areas. The program should be integrated into the conventional practice of health care centers.
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Brandford A, Adegboyega A, Combs B, Hatcher J. Training Community Health Workers in Motivational Interviewing to Promote Cancer Screening. Health Promot Pract 2018; 20:239-250. [PMID: 29577772 DOI: 10.1177/1524839918761384] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Health disparities researchers attempting to engage and effectively deliver interventions to underserved populations often encounter a number of challenges ranging from geographical considerations to more complex issues of medical mistrust. While there are a number of strategies researchers may employ to address these challenges, one of the most successful of these has been the use of community health workers (CHWs). Despite the documented success of CHWs, little information exists on the use of theory-driven intervention strategies with these community partners. Researchers who have partnered with CHWs tend to provide brief descriptions of training strategies and provide little discussion of the challenges and barriers to training a lay population in the delivery of technical interventions, including ensuring fidelity to the intervention protocol. The purpose of this article is to describe the feasibility of training CHWs to deliver a motivational interviewing intervention to promote cancer screening in underserved populations. With this article we present an innovative way to use motivational interviewing delivered by CHWs. Specifically, we will detail the development of the training protocol, the implementation of that training in a variety of research settings, and the development and implementation of fidelity protocols. We will use examples from two research studies where CHWs were successfully trained to use MI to promote cancer screening in underserved communities to highlight the challenges and barriers faced in developing and implementing the training and strategies used to overcome these challenges during the refinement of the intervention.
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71
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Wilbur J, Miller AM, Fogg L, McDevitt J, Castro CM, Schoeny ME, Buchholz SW, Braun LT, Ingram DM, Volgman AS, Dancy BL. Randomized Clinical Trial of the Women's Lifestyle Physical Activity Program for African-American Women: 24- and 48-Week Outcomes. Am J Health Promot 2018; 30:335-45. [PMID: 27404642 DOI: 10.1177/0890117116646342] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To compare the effects of a physical activity (PA) intervention of group meetings versus group meetings supplemented by personal calls or automated calls on the adoption and maintenance of PA and on weight stability among African-American women. DESIGN Randomized clinical trial with three conditions randomly assigned across six sites. SETTING Health settings in predominately African-American communities. SUBJECTS There were 288 women, aged 40 to 65, without major signs/symptoms of pulmonary/cardiovascular disease. INTERVENTION Six group meetings delivered over 48 weeks with either 11 personal motivational calls, 11 automated motivational messages, or no calls between meetings. MEASURES Measures included PA (questionnaires, accelerometer, aerobic fitness), weight, and body composition at baseline, 24 weeks, and 48 weeks. ANALYSIS Analysis of variance and mixed models. RESULTS Retention was 90% at 48 weeks. Adherence to PA increased significantly (p < .001) for questionnaire (d = .56, 128 min/wk), accelerometer (d = .37, 830 steps/d), and aerobic fitness (d = .41, 7 steps/2 min) at 24 weeks and was maintained at 48 weeks (p < .001), with no differences across conditions. Weight and body composition showed no significant changes over the course of the study. CONCLUSION Group meetings are a powerful intervention for increasing PA and preventing weight gain and may not need to be supplemented with telephone calls, which add costs and complexity.
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Affiliation(s)
- JoEllen Wilbur
- Women, Children, and Family Nursing, College of Nursing, Rush University, Chicago, IL, USA
| | - Arlene Michaels Miller
- Community, Systems, and Mental Health Nursing, College of Nursing, Rush University, Chicago, IL, USA
| | - Louis Fogg
- Community, Systems, and Mental Health Nursing, College of Nursing, Rush University, Chicago, IL, USA
| | - Judith McDevitt
- Women, Children, and Family Nursing, College of Nursing, Rush University, Chicago, IL, USA
| | - Cynthia M Castro
- Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA, USA
| | - Michael E Schoeny
- Community, Systems, and Mental Health Nursing, College of Nursing, Rush University, Chicago, IL, USA
| | - Susan W Buchholz
- Adult Health/Gerontological Nursing, College of Nursing, Rush University, Chicago, IL, USA
| | - Lynne T Braun
- Adult Health/Gerontological Nursing, College of Nursing, Rush University, Chicago, IL, USA
| | - Diana M Ingram
- Community, Systems, and Mental Health Nursing, College of Nursing, Rush University, Chicago, IL, USA
| | | | - Barbara L Dancy
- College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
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73
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Kruse GR, Kelley JHK, Chase K, Rigotti NA. Feasibility of a proactive text messaging intervention for smokers in community health centers. JMIR Form Res 2017; 2:v2i1e11. [PMID: 30506038 PMCID: PMC6261471 DOI: 10.2196/formative.9608] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Few smokers receive evidence-based cessation services during primary care visits. Objective We aimed to assess the feasibility of a proactive text messaging program for primary care patients who smoke. Methods We used electronic health records to identify smokers who had a mobile phone number listed from two community health centers in Massachusetts. Between March 2014 and June 2015, patients were screened by their primary care physician and then sent a proactive text message inviting them to enroll by texting back. Patients who opted in were asked about their readiness to quit. The text message program included messages from the QuitNowTXT library and novel content for smokers who were not ready to quit. Results Among 949 eligible smokers, 88 (9.3%) enrolled after receiving a single proactive text message. Compared with those who did not enroll, enrollees were more often female (54/88, 61% vs 413/861, 48.0%, P=.02), but otherwise did not differ in age, race, insurance status, or comorbidities. In all, 28% (19/67) of enrollees reported they were not ready to quit in the next 30 days, 61% (41/67) were ready to quit, and 11% (7/67) already quit. The median time in the program was 9 days (interquartile range 2-32 days). Of current smokers, 25% (15/60) sent one or more keyword requests to the server. These did not differ by readiness to quit. Conclusions A proactively delivered text messaging program targeting primary care patients who smoke was feasible and engaged both smokers ready to quit and those not ready to quit. This method shows promise as part of a population health model for addressing tobacco use outside of the primary care office.
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Affiliation(s)
- Gina R Kruse
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital.,Tobacco Research and Treatment Center, Massachusetts General Hospital.,Harvard Medical School.,Partners Center for Connected Health, Massachusetts General Hospital
| | - Jennifer H K Kelley
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital.,Tobacco Research and Treatment Center, Massachusetts General Hospital.,Harvard Medical School.,Partners Center for Connected Health, Massachusetts General Hospital
| | - Karen Chase
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital.,Tobacco Research and Treatment Center, Massachusetts General Hospital.,Harvard Medical School.,Partners Center for Connected Health, Massachusetts General Hospital
| | - Nancy A Rigotti
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital.,Tobacco Research and Treatment Center, Massachusetts General Hospital.,Harvard Medical School.,Partners Center for Connected Health, Massachusetts General Hospital
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74
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Yedidia MJ. Competencies for engaging high-needs patients in primary care. HEALTHCARE-THE JOURNAL OF DELIVERY SCIENCE AND INNOVATION 2017; 6:122-127. [PMID: 29217389 DOI: 10.1016/j.hjdsi.2017.06.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 06/21/2017] [Accepted: 06/25/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Patients who heavily utilize hospitals and emergency departments frequently have complex needs requiring services spanning medical, behavioral, and social service sectors. This study identifies essential competencies for caring for high-needs patients and highlights their importance to primary care delivery. METHODS Transcripts of in-depth interviews with 30 clinical and administrative staff at 23 complex care programs across the United States were analyzed using standard qualitative techniques. Selected programs had several years of experience in serving patients with multiple chronic conditions, serious mental illness, substance use disorders, severe poverty, and homelessness. These programs exemplified diverse models (assertive community treatment, housing first, behavioral health, high utilizer), and all of them shared the common element of integrating primary care into their services. RESULTS Competencies, including those known and taught in other fields, have distinctive application to informing delivery of high quality primary care to populations with complex needs, including: motivational interviewing for establishing patients' priorities and helping them improve their health on their own terms; trauma-informed care for modifying primary care procedures to mitigate the ill-effects of prior trauma prevalent in this population; and harm reduction for altering medical regimens to accommodate constraints on what patients are able or willing to do. Other capabilities, cultivated by these programs, include empathizing with patients, promoted by exposure to simulations of patient experiences (e.g., hearing voices); as well as withholding judgment and counteracting patient passivity to foster open discussion of treatment plans. CONCLUSIONS Absence of deliberate attention to equipping providers with specific competencies for caring for high-needs patients may contribute to lack of patient engagement and sub-optimal outcomes, ultimately undermining the success of programs serving these populations.
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Affiliation(s)
- Michael J Yedidia
- Center for State Health Policy, Rutgers University, 112 Paterson Street, 5th Floor, New Brunswick, NJ 08901, United States.
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75
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Feasibility, effectiveness and cost-effectiveness of a telephone-based weight loss program delivered via a hospital outpatient setting. Transl Behav Med 2017; 6:386-95. [PMID: 27528527 DOI: 10.1007/s13142-015-0337-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Engaging patients in a group-based weight loss program is a challenge for the acute-care hospital outpatient setting. To evaluate the feasibility, effectiveness and cost-effectiveness of a telephone-based weight loss service and an existing face-to-face, group-based service a non-randomised, two-arm feasibility trial was used. Patients who declined a two-month existing outpatient group-based program were offered a six-month research-based telephone program. Outcomes were assessed at baseline, two months (both groups) and six months (telephone program only) using paired t tests and linear regression models. Cost per healthy life year gained was calculated for both programs. The telephone program achieved significant weight loss (-4.1 ± 5.0 %; p = 0.001) for completers (n = 35; 57 % of enrolees) at six months. Compared to the group-based program (n = 33 completers; 66 %), the telephone program was associated with greater weight loss (mean difference [95%CI] -2.0 % [-3.4, -0.6]; p = 0.007) at two months. The cost per healthy life year gained was $33,000 and $85,000, for the telephone and group program, respectively. Telephone-delivered weight management services may be effective and cost-effective within an acute-care hospital setting, likely more so than usual (group-based) care.
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76
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Beyond face-to-face individual counseling: A systematic review on alternative modes of motivational interviewing in substance abuse treatment and prevention. Addict Behav 2017; 73:216-235. [PMID: 28554033 DOI: 10.1016/j.addbeh.2017.05.023] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 05/17/2017] [Accepted: 05/19/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVES This systematic review aimed to synthesize the evidence on the effectiveness of motivational interviewing (MI), delivered in modes other than face-to-face individual counseling, in preventing and treating substance abuse related behaviors. METHODS Four databases (PubMed/MEDLINE, PsycINFO, ISI Web of Science and Cochrane Library) were searched for randomised clinical trials (RCTs) that evaluated the effectiveness of alternative modes of MI (other than face-to-face individual counseling) in preventing and treating substance abuse. Eligible studies were rated on methodological quality and their findings were qualitatively synthesized. RESULTS A total of 25 articles (on 22 RCTs) were eligible for this review. Beyond face-to-face counseling, telephone was the most frequently used medium for delivering MI (11 studies), followed by Internet communication (4 studies) and short message service (SMS) (2 studies). Mail was incorporated as a supplement in one of the studies for telephone MI. In contrast to one-to-one individual counseling, group MI was adopted in 5 studies. The effectiveness of telephone MI in treating substance abuse was supported by all of the published RCTs we located. Internet-based MI was effective in preventing and treating alcoholism, but its outcome appeared to be inconsistent for smoking cessation and poor for abstinence from illicit drugs. SMS-based MI appeared to be useful for controlling tobacco and drinking. Group MI was attempted for quitting alcohol and drugs, with mixed findings on its outcomes. CONCLUSIONS Collectively, the studies reviewed indicate that telephone MI is a promising mode of intervention in treating and preventing substance abuse. The effectiveness of other alternative modes (SMS-based MI, Internet-based MI and group MI) remains inconclusive given the controversial findings and a limited number of studies. By synthesizing the currently available evidence, this systematic review suggested that telephone MI might be considered as an alternative to face-to-face MI for treating and preventing substance abuse. Further research is needed to investigate the effectiveness of SMS-based MI, Internet MI, group MI and other alternative modes. Studies with methodological rigor and incorporating MI fidelity measures have great potential to advance the understanding in this field.
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77
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Arora NS, Davis JK, Kirby C, McGuire AL, Green RC, Blumenthal-Barby JS, Ubel PA. Communication challenges for nongeneticist physicians relaying clinical genomic results. Per Med 2017; 14:423-431. [PMID: 29181085 DOI: 10.2217/pme-2017-0008] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 05/16/2017] [Indexed: 02/07/2023]
Abstract
Aim Identify the behavioral challenges to the use of genome sequencing (GS) in a clinical setting. Materials & methods We observed how general internists and nongenetic specialists delivered GS results to patients enrolled in the MedSeq Project. Using transcripts of such disclosure interactions, we made qualitative observations of communication behaviors that could limit the usefulness of GS results until reaching the point of thematic saturation. Results Findings included confusion regarding genomic terminology, difficulty with the volume or complexity of information and difficulties communicating complex risk information to patients. We observed a broad dismissal of clinical value of GS by some physicians and sometimes ineffective communication regarding health behavior change. Conclusion Overcoming these behavioral challenges is necessary to make full use of clinical GS results.
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Affiliation(s)
- Nonie S Arora
- University of Michigan Medical School, Ann Arbor, MI 48109, USA.,University of Michigan Medical School, Ann Arbor, MI 48109, USA
| | - J Kelly Davis
- Duke-Margolis Health Policy Center, Durham, NC 27708, USA.,Fuqua School of Business, Duke University, Durham, NC 27708, USA.,Duke-Margolis Health Policy Center, Durham, NC 27708, USA.,Fuqua School of Business, Duke University, Durham, NC 27708, USA
| | - Christine Kirby
- Duke-Margolis Health Policy Center, Durham, NC 27708, USA.,Fuqua School of Business, Duke University, Durham, NC 27708, USA.,Duke-Margolis Health Policy Center, Durham, NC 27708, USA.,Fuqua School of Business, Duke University, Durham, NC 27708, USA
| | - Amy L McGuire
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX 77030, USA.,Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX 77030, USA
| | - Robert C Green
- Division of Genetics, Department of Medicine, Brigham & Women's Hospital, Boston, MA 02115, USA.,Harvard Medical School, Boston, MA 02115, USA.,Partners Healthcare Personalized Medicine, Boston, MA 02139, USA.,Division of Genetics, Department of Medicine, Brigham & Women's Hospital, Boston, MA 02115, USA.,Harvard Medical School, Boston, MA 02115, USA.,Partners Healthcare Personalized Medicine, Boston, MA 02139, USA
| | - J S Blumenthal-Barby
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX 77030, USA.,Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX 77030, USA
| | - Peter A Ubel
- Duke-Margolis Health Policy Center, Durham, NC 27708, USA.,Fuqua School of Business, Duke University, Durham, NC 27708, USA.,Sanford School of Public Policy, Duke University, Durham, NC 27708, USA.,Duke University School of Medicine, Durham, NC 27710, USA.,Duke-Margolis Health Policy Center, Durham, NC 27708, USA.,Fuqua School of Business, Duke University, Durham, NC 27708, USA.,Sanford School of Public Policy, Duke University, Durham, NC 27708, USA.,Duke University School of Medicine, Durham, NC 27710, USA
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78
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Rhodes LA, Williams DM, Marciniak MW, Weber DJ. Community pharmacists as vaccine providers. INTERNATIONAL JOURNAL OF HEALTH GOVERNANCE 2017. [DOI: 10.1108/ijhg-05-2017-0020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this paper is to describe the history of pharmacist involvement as vaccine providers in the USA and discuss examples of growing interests in other parts of the world.
Design/methodology/approach
Literature searches were performed in PubMed as well as pharmacy-related journals.
Findings
Pharmacists have been involved with the storage and management of vaccines for more than a century. Based on the unmet needs in meeting national goals for vaccination rates among adults in the USA, efforts led to training and recognizing pharmacists as vaccine providers which is now within the scope of practice for a pharmacist in all US states and territories. Pharmacists complete a comprehensive training program in vaccine sciences, regulatory considerations, as well as demonstration of skills in administering vaccines. Over 300,000 pharmacists have been trained in vaccine delivery and this represents the majority of the pharmacist workforce in the USA. There are examples of the beneficial impact of pharmacist involvement as vaccine providers in community pharmacy settings.
Research limitations/implications
This review is based on a thorough review of the literature but was not conducted in a systematic fashion.
Originality/value
This review provides a historical perspective and evidence of the benefit of pharmacists as vaccine providers.
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Halbach P, Keller AO. Evaluating Motivational Interviewing in the Physician Assistant Curriculum. J Physician Assist Educ 2017; 28:132-137. [PMID: 28762991 PMCID: PMC5561004 DOI: 10.1097/jpa.0000000000000133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE Motivational interviewing (MI) is an evidence-based technique that enables clinicians to help patients modify health behaviors. Although MI is an essential tool for physician assistants (PAs), the extent to which it is addressed in PA curricula in the United States is unknown. This study is a comprehensive description of MI education in PA programs in the United States. METHODS Data are from the 2014 Physician Assistant Education Association Annual Program Survey. Descriptive statistics were conducted on de-identified data from all 186 PA programs in the United States. RESULTS Of the 186 PA programs surveyed, 72.58% (n = 135) reported at least one course providing MI training. Availability of courses providing training in skills essential to the MI process varied. Having a course with verbal communication training was most frequently endorsed, and having a course with training in developing discrepancy was least frequently endorsed. The most popular teaching modality was lecture (84.95%, n = 158), whereas only 41.40% (n = 77) and 58.60% (n = 109) reported role play with evaluation and standardized patient exercises with evaluation, respectively. CONCLUSIONS More than 70% of programs included at least one course in their curriculum that provided training in MI, suggesting that PA programs recognize the importance of MI. Instruction in change talk was not provided in nearly half of the programs. Role-play and standardized patient exercises with evaluation were underused methods despite their proven efficacy in MI education. As the first comprehensive benchmark of MI education for PAs, this study shows that although most programs address MI, opportunities exist to improve MI training in PA programs in the United States.
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Affiliation(s)
- Patrick Halbach
- Patrick Halbach, MS, MPAS, PA-C, is a physician assistant in the Department of Orthopaedic Surgery at the University of Minnesota in Minneapolis. Abiola O. Keller, PhD, MPH, PA-C, is a clinical assistant professor and director of clinical research in the Department of Physician Assistant Studies at Marquette University, College of Health Sciences in Milwaukee, Wisconsin
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80
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Davidson LF, Doyle M, Silver EJ. Discussing Future Goals and Legal Aspects of Health Care: Essential Steps in Transitioning Youth to Adult-Oriented Care. Clin Pediatr (Phila) 2017; 56:902-908. [PMID: 28466656 DOI: 10.1177/0009922817706142] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Discussing realistic future goals with the adolescent alone and with family, and reviewing legal aspects of health care transition (HCT), are essential steps in the transition from pediatric to adult-oriented care. Secondary analysis of datasets from 2 studies related to HCT assessed differences in provider practice for youth with and without special health care needs (SHCNs). Across both datasets, between 57% and 68.6% of providers reported some discussion of future goals with adolescent or with family. However, only 28.6% to 31% of providers reported discussing future goals with youth with SHCNs alone. It was rare for providers to report discussing legal aspects of HCT with any youth. Findings identify a gap in discussing future goals and legal aspects of HCT, as part of routine care for adolescents. Additional research to understand barriers and improve likelihood of these steps within HCT is needed.
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Affiliation(s)
- Lynn F Davidson
- 1 Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Maya Doyle
- 1 Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA.,2 Quinnipiac University, Hamden, CT, USA
| | - Ellen J Silver
- 1 Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA
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81
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Arkkukangas M, Sundler AJ, Söderlund A, Eriksson S, Johansson AC. Older persons' experiences of a home-based exercise program with behavioral change support. Physiother Theory Pract 2017; 33:905-913. [PMID: 28812402 DOI: 10.1080/09593985.2017.1359869] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND It is a challenge to promote exercise among older persons. Knowledge is needed regarding the maintenance of exercise aiming at preventing falls and promoting health and well-being in older persons. PURPOSE This descriptive study used a qualitative inductive approach to describe older persons' experiences of a fall-preventive, home-based exercise program with support for behavioral change. METHODS Semi-structured interviews were conducted with 12 elderly persons aged 75 years or older, and a qualitative content analysis was performed. RESULTS Four categories emerged: facilitators of performing exercise in everyday life, the importance of support, perceived gains from exercise, and the existential aspects of exercise. CONCLUSION With support from physiotherapists (PTs), home-based exercise can be adapted to individual circumstances in a meaningful way. Including exercises in everyday life and daily routines could support the experience of being stronger, result in better physical functioning, and give hope for an extended active life in old age.
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Affiliation(s)
- Marina Arkkukangas
- a School of Health, Care and Social Welfare, Mälardalen University , Västerås , Sweden
| | - Annelie J Sundler
- b Faculty of Caring Science, Work Life and Social Welfare , University of Borås , Sweden
| | - Anne Söderlund
- c School of Health, Care and Social Welfare , Mälardalen University , Västerås , SE , Sweden
| | - Staffan Eriksson
- d Centre for Clinical Research Sörmland , Uppsala University , Eskilstuna , Sweden.,e Department of Community Medicine and Rehabilitation, Physiotherapy , Umeå University , Umeå , Sweden.,f Department of Neuroscience, Physiotherapy , Uppsala University , Uppsala , Sweden
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82
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Thepwongsa I, Muthukumar R, Kessomboon P. Motivational interviewing by general practitioners for Type 2 diabetes patients: a systematic review. Fam Pract 2017; 34:376-383. [PMID: 28486622 DOI: 10.1093/fampra/cmx045] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Motivational interviewing (MI) is an effective tool to help clinicians with facilitating behavioural changes in many diseases and conditions. However, different forms of MI are required in different health care settings and for different clinicians. Although general practitioners (GPs) play a major role in Type 2 diabetes management, the effects of MI delivered by GPs intended to change the behaviours of their Type 2 diabetes patients and GP outcomes, defined as GP knowledge, satisfaction and practice behaviours, have not been systematically reviewed. METHODS An electronic search was conducted through Cochrane Library, Scopus, ProQuest, Wiley Online Library, Ovid MEDLINE, PubMed, CINAHL, MEDLINE Complete and Google Scholar from the earliest date of each database to 2017. Reference lists from each article obtained were reviewed. Measured changes in GP satisfaction, knowledge, and practice behaviours, and patient outcomes were recorded. RESULTS Eight out of 1882 studies met the criteria for inclusion. Six studies examined the effects of MI on Type 2 diabetes patient outcomes, only one of which examined its effects on GP outcomes. Two-thirds of the studies (4/6) found a significant improvement in at least one of the following patient outcomes: total cholesterol, low-density lipoproteins, fasting blood glucose, HbA1c, body mass index, blood pressure, waist circumference and physical activity. The effects of MI on GP outcomes yielded mixed results. CONCLUSIONS Few studies have examined evidence for the effectiveness of MI delivered by GPs to Type 2 diabetes patients. Evidence to support the effectiveness of MI on GP and patient outcomes is weak. Further quality studies are needed to examine the effects of MI on GP and patient outcomes.
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Affiliation(s)
- Isaraporn Thepwongsa
- Department of Community Medicine, Faculty of Medicine, Khon Kaen University, Thailand
| | | | - Pattapong Kessomboon
- Department of Community Medicine, Faculty of Medicine, Khon Kaen University, Thailand
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83
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van Grieken A, Vlasblom E, Wang L, Beltman M, Boere-Boonekamp MM, L'Hoir MP, Raat H. Personalized Web-Based Advice in Combination With Well-Child Visits to Prevent Overweight in Young Children: Cluster Randomized Controlled Trial. J Med Internet Res 2017; 19:e268. [PMID: 28751299 PMCID: PMC5553002 DOI: 10.2196/jmir.7115] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 05/01/2017] [Accepted: 05/02/2017] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Overweight is a major health issue, and parent-targeted interventions to promote healthy development in children are needed. OBJECTIVE The study aimed to evaluate E-health4Uth Healthy Toddler, an intervention that educates parents of children aged 18 to 24 months regarding health-related behaviors, as compared with usual care. The effect of this intervention on the following primary outcomes was evaluated when the children were 36 months of age: health-related behaviors (breakfast daily, activity and outside play, sweetened beverage consumption, television (TV) viewing and computer time), body mass index (BMI), and the prevalence of overweight and obesity. METHODS The BeeBOFT (acronym for breastfeeding, breakfast daily, outside playing, few sweet drinks, less TV viewing) study is a cluster randomized controlled trial involving 51 Youth Health Care (YHC) teams. In total, 1094 parents participated in the control group, and 1008 parents participated in the E-health4Uth Healthy Toddler intervention group. The intervention consisted of Web-based personalized advice given to parents who completed an eHealth module and discussion of the advice during a regular well-child visit. In this study the eHealth module was offered to parents before two regular well-child visits at 18 and 24 months of age. During the well-child visits, the parents' personalized advice was combined with face-to-face counseling provided by the YHC professional. Parents in the control group received usual care, consisting of the regular well-child visits during which general information on child health-related behavior was provided to parents. Parents completed questionnaires regarding family characteristics and health-related behaviors when the child was 1 month (inclusion), 6 months, 14 months, and 36 months (follow-up) of age. The child's height and weight were measured by trained health care professionals from birth through 36 months of age at fixed time points. Multilevel linear and logistic regression models were used to evaluate the primary outcomes at 36 months of age. RESULTS At 36 months, we observed no differences between health-related behaviors of children, BMI or the percentage of children having overweight or obesity in the control and intervention group (P>.05). An analysis of the intervention effect revealed that boys benefited from eating breakfast daily, non-Dutch children spent more time being active or playing outdoors, children of low-educated parents and of overweight and obese mothers spent less time watching TV or using the computer, and children of normal weight mothers drank less sweetened beverages (P<.05) compared with the control group. CONCLUSIONS The E-health4Uth Healthy Toddler intervention resulted in small improvements in health-related behaviors among subgroups but had no significant effects with respect to the children's BMI. We conclude that the E-health4Uth Healthy Toddler intervention may be useful for pediatric health care professionals in terms of providing parents with personalized information regarding their child's health-related behaviors. TRIAL REGISTRATION Netherlands Trial Register: NTR1831; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=1831 (Archived by WebCite at http://www.webcitation.org/6mm5YFOB0).
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Affiliation(s)
- Amy van Grieken
- Department of Public Health, Erasmus University Medical Center, Rotterdam, Netherlands
| | | | - Lu Wang
- Department of Public Health, Erasmus University Medical Center, Rotterdam, Netherlands
| | | | - Magda M Boere-Boonekamp
- IGS Institute for Innovation and Governance Studies, Department Health Technology and Services Research, University of Twente, Enschede, Netherlands
| | - Monique P L'Hoir
- Department of Agrotechnology and Food Sciences, Subdivision Human Nutrition, Wageningen University & Research, Wageningen, Netherlands
| | - Hein Raat
- Department of Public Health, Erasmus University Medical Center, Rotterdam, Netherlands
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Herrera PA, Moncada L, Defey D. Understanding Non-Adherence From the Inside: Hypertensive Patients' Motivations for Adhering and Not Adhering. QUALITATIVE HEALTH RESEARCH 2017; 27:1023-1034. [PMID: 27282381 DOI: 10.1177/1049732316652529] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Patients' low adherence to medical treatment in chronic illnesses is one of the biggest public health problems. Numerous studies attend to the diverse factors associated with patient adherence. However, little research has been done to explore patients' reasons for non-compliance from their own point of view. In this article, we aim to understand patient non-adherence using dialogical self-theory and qualitative research methods. We interviewed 51 hypertensive patients to explore their anti- and pro-adherence motivations. Results show that most patients adhere and non-adhere to different aspects of treatment programs (medication, exercise, diet) according to the way they construct meaning to those activities. Also, our findings support the notion that patients' non-adherent behavior aims to preserve important values such as self-esteem, autonomy, affiliation, well-being, freedom, and health (or that more adherence is not worth the extra effort). We discuss the therapeutic relevance of empathically understanding patients' worldview and implicit beliefs.
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Affiliation(s)
| | | | - Denise Defey
- 2 University of the Republic, Montevideo, Uruguay
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Voran D. Using Technology to Enhance Patient-Physician Interactions. PM R 2017; 9:S26-S33. [PMID: 28527500 DOI: 10.1016/j.pmrj.2017.01.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 12/12/2016] [Accepted: 01/05/2017] [Indexed: 10/19/2022]
Abstract
The computer is an integral part of a clinical office examination room. How a physician simultaneously uses the computer and interacts with patients will either enhance or deter patient engagement in areas of health maintenance and rehabilitation. With the growing emphasis on patient-centered care and management of chronic health conditions, patient engagement plays an ever-increasing role in U.S. health care. This paper reviews and discusses the 4 broad factors that influence the traditional physician-patient examination room interaction: physician computer/technology skills and dexterity, verbal and nonverbal communication, design and spatial arrangement, and hardware considerations. If used effectively, in-room technology will both enhance patient care and engender a greater degree of patient trust in their provider.
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Affiliation(s)
- David Voran
- Truman Medical Center, Community and Family Medicine, 7900 Lee's Summit Road, Kansas City, MO 64139-1246(∗).
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Miller ST, Akohoue SA. Two-year follow-up study of a group-based diabetes medical nutrition therapy and motivational interviewing intervention among African American women. PATIENT-RELATED OUTCOME MEASURES 2017; 8:57-61. [PMID: 28450793 PMCID: PMC5399984 DOI: 10.2147/prom.s125884] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To assess the 2-year efficacy of a combined medical nutrition therapy and motivational interviewing (MI) pilot study intervention and factors that influenced long-term dietary self-care. RESEARCH DESIGN AND METHODS Pilot study participants, African American women with type 2 diabetes, completed a 2-year follow-up study visit, including clinical assessments and completion of a dietary self-care questionnaire and a semi-structured interview. Wilcoxon signed-rank tests were used to evaluate differences between baseline and 2-year follow-up clinical and dietary self-care outcomes. Hierarchical coding was used to analyze semi-structured interviews and categorize facilitator and barrier themes into subthemes. Subthemes were quantified based on the number of subtheme-related comments. RESULTS Among the 12 participants (mean age 57.1±5.7 years), improvements were observed for HbA1c (baseline: 10.25%; interquartile range [IQR]: 8.10, 11.72 and follow-up: 8.8%; IQR: 7.48,10.22), systolic blood pressure (baseline: 142 mm Hg; IQR: 134.25, 157.25 and follow-up: 127 mm Hg; IQR: 113.5, 143.25), frequency of eating high-fat foods (baseline: 3.5 days; IQR: 2.75, 4.25 and follow-up: 3 days; IQR: 2.5, 4.5), and of spacing carbohydrates throughout the day (baseline: 3 days; IQR: 3.0, 4.0 and follow-up: 4 days; IQR: 1.5, 4.5). There was a statistically significant decrease (p=0.04) in the frequency of fruit and vegetable intake (baseline: 4 days; IQR: 3.75, 7.0 and follow-up: 3.5 days; IQR: 2.75, 4.0). Dietary self-care barriers and facilitators included internal (eg, motivation) and external factors (eg, social support). Motivation (70 comments) and lack of motivation (67 comments) were the most pervasive facilitator and barrier subthemes, respectively. CONCLUSION Overall, diabetes-related clinical and dietary self-care outcomes were improved following a combined medical nutritional therapy/MI intervention, and motivation played an important role in dietary self-care engagement. Future research is needed to assess the added benefit of MI in improving clinical and dietary self-care outcomes and to identify best strategies to support post-intervention dietary self-care engagement.
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Affiliation(s)
| | - Sylvie A Akohoue
- Department of Family and Community Medicine, Meharry Medical College, Nashville, TN, USA
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Gray E, Shields C, Fowles JR. Building Competency and Capacity for Promotion of Effective Physical Activity in Diabetes Care in Canada. Can J Diabetes 2017; 41:491-498. [PMID: 28392023 DOI: 10.1016/j.jcjd.2016.11.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 11/14/2016] [Accepted: 11/15/2016] [Indexed: 12/16/2022]
Abstract
OBJECTIVES The purpose of the present study was to examine the impact of the Canadian Diabetes Association's (CDA) resource titled Building Competency in Diabetes Education: Physical Activity and Exercise and associated workshops, on diabetes care providers' (DCPs) confidence and practices regarding physical-activity promotion 8 to 12 months after attending a workshop. METHODS In this action research study, 2 separate cross-sectional samples of DCPs were recruited. DCPs at baseline (N=462) completed a questionnaire assessing their current physical-activity promotion practices, intended changes in practice and intended implementation of the toolkit. At follow up, DCPs (n=132) completed an online questionnaire assessing their physical-activity counselling practices, confidence in their physical-activity counselling, use of the specific CDA resources as well as changes to practice and ongoing challenges. RESULTS At baseline, 58% of DCPs incorporated physical-activity content in the majority of their sessions; however, 66% of DCPs discussed physical activity in >50% of their sessions following the launch of the training initiative. Following the training, DCPs reported increased confidence across all 6 aspects of physical-activity counselling that were examined. Improvements were most frequently found in providing advice regarding the benefits of activity (86%) and providing instruction regarding resistance training (86%). DCPs most often changed their practices by discussing physical activity more frequently and confidently (27%); however, lack of time was frequently reported (37%) as an ongoing challenge to providing physical-activity counselling. CONCLUSIONS This evaluation highlights the impact of this national initiative and suggests that the resource is effective in improving physical-activity promotion in diabetes care.
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Affiliation(s)
- Emily Gray
- Acadia University, Wolfville, Nova Scotia, Canada
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88
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Aharonovich E, Sarvet A, Stohl M, DesJarlais D, Tross S, Hurst T, Urbina A, Hasin D. Reducing non-injection drug use in HIV primary care: A randomized trial of brief motivational interviewing, with and without HealthCall, a technology-based enhancement. J Subst Abuse Treat 2016; 74:71-79. [PMID: 28132704 DOI: 10.1016/j.jsat.2016.12.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 12/14/2016] [Accepted: 12/28/2016] [Indexed: 01/18/2023]
Abstract
AIMS In HIV-infected individuals, non-injection drug use (NIDU) compromises many health outcomes. In HIV primary care, the efficacy of brief motivational interviewing (MI) to reduce NIDU is unknown, and drug users may need greater intervention. We designed an enhancement to MI, HealthCall (HC), for daily patient self-monitoring calls to an interactive voice response (IVR) phone system, and provided participants with periodic personalized feedback. To reduce NIDU among HIV primary care patients, we compared the efficacy of MI+HealthCall to MI-only and an educational control condition. DESIGN Participants age >18 with >4days of NIDU during the prior 30days were recruited from large urban HIV primary care clinics. Of the 240 participants, 83 were randomly assigned to control, 77 to MI-only, and 80 to MI+HC. Counselors provided educational control, MI-only or MI+HC at baseline. At 30 and 60days (end-of-treatment), counselors briefly discussed drug use, moods and health behaviors, using HealthCall-generated graphs with MI+HC patients. Primary outcomes (last 30days) were number of days used primary drug (NumDU), and total quantity of primary drug used (dollar amount spent; QuantU), derived from the Time-Line Follow-Back. FINDINGS Across all groups, at end-of-treatment, frequency and quantity of NIDU decreased, with significantly greater reductions in the MI-Only group. A twelve-month post-treatment follow-up indicated sustained benefits of MI+HC and MI-only relative to control. CONCLUSIONS Brief interventions can be successfully used to reduce non-injection drug use in HIV primary care. IVR-based technology may not be sufficiently engaging to be effective. Future studies should investigate mobile technology to deliver a more engaging version of HealthCall to diverse substance abusing populations.
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Affiliation(s)
- Efrat Aharonovich
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA.
| | - Aaron Sarvet
- New York State Psychiatric Institute, New York, NY, USA
| | - Malki Stohl
- New York State Psychiatric Institute, New York, NY, USA
| | - Don DesJarlais
- Icahn School of Medicine, at Mount Sinai New York, New York, USA
| | - Susan Tross
- New York State Psychiatric Institute, New York, NY, USA; HIV Center for Clinical and Behavioral Studies/Division of Gender, Sexuality and Health, Department of Psychiatry, Columbia University Medical Center, New York, NY, USA
| | - Teresa Hurst
- Institute for Advanced Medicine, Mount Sinai Health System, New York, NY, USA
| | - Antonio Urbina
- Institute for Advanced Medicine, Mount Sinai Health System, New York, NY, USA
| | - Deborah Hasin
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
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Kaphingst KA, Lobb R, Fay ME, Hunt MK, Suarez EG, Fletcher RH, Emmons KM. Impact of Intervention Dose on Cancer-Related Health Behaviors among Working-Class, Multiethnic, Community Health Center Patients. Am J Health Promot 2016; 21:262-6. [PMID: 17375492 DOI: 10.4278/0890-1171-21.4.262] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose. To examine the relationship between intervention dose and health behavior change in Healthy Directions–Health Centers, an intervention designed to reduce cancer risk factors. Design. Analysis of intervention condition participant data from a randomized controlled trial. Setting. Community health centers in Massachusetts. Subjects. Patients residing in low-income, working-class, multiethnic neighborhoods. Intervention. Components were clinician endorsement, in-person counseling session and four telephone counseling sessions with a trained health advisor, and social-contextual tailored materials. Measures. Intervention dose was number of six possible intervention components completed by each participant. Changes in fruit and vegetable consumption, red meat consumption, physical activity, and multivitamin intake between baseline (n = 1088) and 8-month follow-up (n = 967; 89% of baseline sample) were determined. Analysis. Bivariate and multivariate associations between intervention dose and change in health behaviors were examined. Results. In multivariate analysis, the association between intervention dose and increase in multivitamin intake approached significance (p < .07). Seventy percent of participants completed all intervention activities. In bivariate analysis, completion of four telephone counseling calls was associated with decrease in red meat consumption (p < .05). Conclusion. These findings indicate that future studies should examine the number, content, and length of contacts needed for behavior change. The results also suggest that health centers are a channel for reaching diverse populations, as shown by the high level of intervention implementation.
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Affiliation(s)
- Kimberly A Kaphingst
- National Human Genome Research Institute, Social and Behavioral Research Branch, 2 Center Drive, MSC 0249, Building 2, Room 4E30, Bethesda, MD 20892, USA.
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90
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Reeves M, Winkler E, Mccarthy N, Lawler S, Terranova C, Hayes S, Janda M, Demark-Wahnefried W, Eakin E. The Living Well after Breast Cancer™ Pilot Trial: a weight loss intervention for women following treatment for breast cancer. Asia Pac J Clin Oncol 2016; 13:125-136. [PMID: 27863058 DOI: 10.1111/ajco.12629] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2016] [Indexed: 01/05/2023]
Abstract
AIM Obesity is associated with poor prognosis and risk of treatment side-effects in breast cancer survivors. This pilot study assessed the feasibility, acceptability, safety and efficacy of a telephone-delivered weight loss intervention, among women (BMI 25-40 kg/m2 ) following treatment for stage I-III breast cancer, on weight loss (primary outcome), quality of life and treatment-related side-effects (vs usual care). METHODS Ninety women (mean ± SD age: 55.3 ± 8.7years; BMI: 31.0 ± 4.3 kg/m2 ; 15.9 ± 2.9 months postdiagnosis), recruited from a state-based cancer registry, were randomized to a weight loss (diet and physical activity) intervention (n = 45) or usual care (n = 45). Data collected at baseline and 6 months included weight, body composition, quality of life, fatigue and body image. Acceptability and satisfaction were assessed in intervention participants. RESULTS Oncologists provided consent to contact 82.6% of patients, with 84.1% of those women contacted and eligible consenting to participate. Compared with usual care, mean weight loss was significantly greater in the intervention arm (-3.1 kg [95% CI, -5.4 to -0.7]; -3.7% baseline weight [95% CI, -6.6 to -0.9]), as were reductions in fat mass (-2.1 kg [95% CI, -4.2 to -0.1]) and waist circumference (-4.0 cm [95% CI, -6.6 to -1.3]). No other statistically significant intervention effects were observed. Participants were highly satisfied with the intervention overall and it is timing in relation to diagnosis/treatment. One reported adverse event (musculoskeletal injury) was attributable to the intervention. CONCLUSIONS This weight loss intervention was feasible, acceptable, safe and effective for women 1-2 years after a breast cancer diagnosis. The effect of weight loss on quality of life and treatment-related side-effects should be examined further in fully-powered studies.
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Affiliation(s)
- Marina Reeves
- The University of Queensland, School of Public Health, Cancer Prevention Research Centre, Brisbane, Queensland, Australia
| | - Elisabeth Winkler
- The University of Queensland, School of Public Health, Cancer Prevention Research Centre, Brisbane, Queensland, Australia
| | - Nicole Mccarthy
- Icon Cancer Care, Wesley, Queensland, Australia.,School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Sheleigh Lawler
- The University of Queensland, School of Public Health, Cancer Prevention Research Centre, Brisbane, Queensland, Australia
| | - Caroline Terranova
- The University of Queensland, School of Public Health, Cancer Prevention Research Centre, Brisbane, Queensland, Australia
| | - Sandi Hayes
- School of Public Health and Social Work, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Monika Janda
- School of Public Health and Social Work, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | | | - Elizabeth Eakin
- The University of Queensland, School of Public Health, Cancer Prevention Research Centre, Brisbane, Queensland, Australia
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91
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Schoeny ME, Fogg L, Buchholz SW, Miller A, Wilbur J. Barriers to physical activity as moderators of intervention effects. Prev Med Rep 2016; 5:57-64. [PMID: 27896045 PMCID: PMC5124353 DOI: 10.1016/j.pmedr.2016.11.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 11/06/2016] [Indexed: 11/30/2022] Open
Abstract
The impact of interventions to increase physical activity (PA) may vary as a function of participants' barriers to PA. The aim of this paper is to determine whether individual barriers (demographic, physical health, psychological health, neighborhood factors, perceived barriers to PA, social support for PA) moderate treatment effects on increases in PA. Three treatment conditions tested the relative efficacy of a group-based PA intervention alone or supplemented by either personal or automated phone calls made between group meetings. From 2010 to 2012, 284 African American women (ages 40-65) living in the Chicago, IL, area were randomized to one of the three treatment conditions. Data collection occurred at baseline as well as 24 and 48 weeks after baseline. Moderation of intervention effects by barriers to PA were tested across four outcome measures (self-reported moderate-vigorous PA, self-reported walking, accelerometer steps, and aerobic fitness) using multilevel mixed-effects analyses. Significant condition by barrier interaction effects for the accelerometer steps outcome were found for material hardships, general health, depressive symptoms, neighborhood crime rate, and perceived barriers to PA. For aerobic fitness, intervention effects were moderated by material hardships and perceived pain. Increases in the outcome variables were greater for the conditions in which group sessions were supplemented with personal and/or automated calls. Among participants with greater barriers to PA, supplementing the intervention group meetings with between-session personal and/or automated phone calls may be an effective way to strengthen intervention effects. These results may inform the use of treatment supplements in the context of adaptive interventions.
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Affiliation(s)
- Michael E Schoeny
- Rush University, College of Nursing, 600 S. Paulina St., Chicago, IL 60612, USA
| | - Louis Fogg
- Rush University, College of Nursing, 600 S. Paulina St., Chicago, IL 60612, USA
| | - Susan W Buchholz
- Rush University, College of Nursing, 600 S. Paulina St., Chicago, IL 60612, USA
| | - Arlene Miller
- Rush University, College of Nursing, 600 S. Paulina St., Chicago, IL 60612, USA
| | - JoEllen Wilbur
- Rush University, College of Nursing, 600 S. Paulina St., Chicago, IL 60612, USA
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92
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Oh H, Lee C. Culture and motivational interviewing. PATIENT EDUCATION AND COUNSELING 2016; 99:1914-1919. [PMID: 27401829 PMCID: PMC6698383 DOI: 10.1016/j.pec.2016.06.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Revised: 06/13/2016] [Accepted: 06/16/2016] [Indexed: 05/12/2023]
Affiliation(s)
- Hans Oh
- University of California Berkeley, Berkeley, USA; Prevention Research Center, Pacific Institute for Research and Evaluation, 180 Grand Avenue Suite 1200, Oakland, CA 94612, USA.
| | - Christina Lee
- Department of Applied Psychology, Bouvé College of Health Sciences, Northeastern University 360 Huntington Avenue 432, International Village Boston, MA 02115, USA
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Reeves MM, Terranova CO, Erickson JM, Job JR, Brookes DSK, McCarthy N, Hickman IJ, Lawler SP, Fjeldsoe BS, Healy GN, Winkler EAH, Janda M, Veerman JL, Ware RS, Prins JB, Vos T, Demark-Wahnefried W, Eakin EG. Living well after breast cancer randomized controlled trial protocol: evaluating a telephone-delivered weight loss intervention versus usual care in women following treatment for breast cancer. BMC Cancer 2016; 16:830. [PMID: 27793125 PMCID: PMC5086071 DOI: 10.1186/s12885-016-2858-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 10/19/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Obesity, physical inactivity and poor diet quality have been associated with increased risk of breast cancer-specific and all-cause mortality as well as treatment-related side-effects in breast cancer survivors. Weight loss intervention trials in breast cancer survivors have shown that weight loss is safe and achievable; however, few studies have examined the benefits of such interventions on a broad range of outcomes and few have examined factors important to translation (e.g. feasible delivery method for scaling up, assessment of sustained changes, cost-effectiveness). The Living Well after Breast Cancer randomized controlled trial aims to evaluate a 12-month telephone-delivered weight loss intervention (versus usual care) on weight change and a range of secondary outcomes including cost-effectiveness. METHODS/DESIGN Women (18-75 years; body mass index 25-45 kg/m2) diagnosed with stage I-III breast cancer in the previous 2 years are recruited from public and private hospitals and through the state-based cancer registry (target n = 156). Following baseline assessment, participants are randomized 1:1 to either a 12-month telephone-delivered weight loss intervention (targeting diet and physical activity) or usual care. Data are collected at baseline, 6-months (mid-intervention), 12-months (end-of-intervention) and 18-months (maintenance). The primary outcome is change in weight at 12-months. Secondary outcomes are changes in body composition, bone mineral density, cardio-metabolic and cancer-related biomarkers, metabolic health and chronic disease risk, physical function, patient-reported outcomes (quality of life, fatigue, menopausal symptoms, body image, fear of cancer recurrence) and behaviors (dietary intake, physical activity, sitting time). Data collected at 18-months will be used to assess whether outcomes achieved at end-of-intervention are sustained six months after intervention completion. Cost-effectiveness will be assessed, as will mediators and moderators of intervention effects. DISCUSSION This trial will provide evidence needed to inform the wide-scale provision of weight loss, physical activity and dietary interventions as part of routine survivorship care for breast cancer survivors. TRIAL REGISTRATION Australian and New Zealand Clinical Trial Registry (ANZCTR) - ACTRN12612000997853 (Registered 18 September 2012).
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Affiliation(s)
- Marina M. Reeves
- School of Public Health, The University of Queensland, Brisbane, Australia
| | | | - Jane M. Erickson
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - Jennifer R. Job
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - Denise S. K. Brookes
- School of Public Health, The University of Queensland, Brisbane, Australia
- School of Medicine, Children’s Nutrition Research Centre, The University of Queensland, Brisbane, Australia
| | - Nicole McCarthy
- Icon Cancer Care, Wesley Medical Centre, Brisbane, Australia
| | - Ingrid J. Hickman
- Department of Nutrition & Dietetics, Princess Alexandra Hospital, Brisbane, Australia
- Mater Research Institute, University of Queensland, Brisbane, Australia
| | - Sheleigh P. Lawler
- School of Public Health, The University of Queensland, Brisbane, Australia
| | | | - Genevieve N. Healy
- School of Public Health, The University of Queensland, Brisbane, Australia
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
- School of Physiotherapy, Curtin University, Perth, Australia
| | | | - Monika Janda
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - J. Lennert Veerman
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - Robert S. Ware
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - Johannes B. Prins
- Mater Research Institute, University of Queensland, Brisbane, Australia
| | - Theo Vos
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA
| | | | - Elizabeth G. Eakin
- School of Public Health, The University of Queensland, Brisbane, Australia
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94
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Motivational Interviewing in Dermatology. ACTAS DERMO-SIFILIOGRAFICAS 2016. [DOI: 10.1016/j.adengl.2016.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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95
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Lusilla-Palacios P, Masferrer E. La entrevista motivacional en dermatología. ACTAS DERMO-SIFILIOGRAFICAS 2016; 107:627-30. [DOI: 10.1016/j.ad.2016.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 03/06/2016] [Indexed: 10/21/2022] Open
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96
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Wagner CC, McMahon BT. Motivational Interviewing and Rehabilitation Counseling Practice. REHABILITATION COUNSELING BULLETIN 2016. [DOI: 10.1177/00343552040470030401] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This article explores commonalities between rehabilitation counseling and the counseling approach known as motivational interviewing. Motivational interviewing is an empirically supported, client-centered, directive counseling approach designed to promote client motivation and reduce motivational conflicts and barriers to change. The underpinnings of motivational interviewing are related to several principles that drive rehabilitation counseling practice. Motivational interviewing focuses on issues that have been emphasized in the rehabilitation literature: clients' sense of the importance of potential changes, their confidence that change can be successful, and their readiness to make changes. Current and potential uses of motivational interviewing in rehabilitation counseling practice are outlined, and additional research directions are recommended.
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97
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Ingraham N, Magrini D, Brooks J, Harbatkin D, Radix A, Haynes SG. Two Tailored Provider Curricula Promoting Healthy Weight in Lesbian and Bisexual Women. Womens Health Issues 2016; 26 Suppl 1:S36-42. [PMID: 27397914 DOI: 10.1016/j.whi.2016.04.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 03/10/2016] [Accepted: 04/01/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE Provider curricula to reduce potential weight bias or stigma in treating lesbian and bisexual (LB) women who are overweight or obese were pilot-tested in two unique settings. Trainings used LB cultural competency and motivational interviewing techniques to improve provider-patient interactions. METHODS Two training formats were used: Clinic Format and Academic Format. Clinic Format training was pilot tested at Lyon-Martin Health Services, a Program of HealthRight360, a community health center serving women, lesbians, and transgender people in San Francisco and in two community settings. Academic Format training was pilot tested by the Mautner Project of Whitman-Walker Health with physicians, medical residents, and students at Georgetown, George Washington, Howard, and Vanderbilt Universities. Both programs measured provider knowledge and attitude change. RESULTS Both programs saw significant percentage point gains in knowledge about LB women's avoidance of health care based on body size. Participants in the Academic Format program saw the greatest gain in knowledge about understanding health care avoidance (30 percentage point increase), whereas Clinic Format program participants gained most in understanding how to appropriately discuss weight loss with patients (23 percentage point increase). CONCLUSIONS Both programs increased provider knowledge about the barriers to health care facing LB women who are overweight and obese, reducing the potential for future negative interactions. However, the two programs differed in how they conceptualized the relationship between weight and health, likely contributing to differences in knowledge gain among participants at each site. Future studies should test differences between the two formats across site type or staff baseline knowledge differences.
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Affiliation(s)
- Natalie Ingraham
- Lyon-Martin Health Services, a Program of HealthRight360, San Francisco, California.
| | - D Magrini
- Mautner Project of Whitman-Walker, Whitman-Walker Health, Washington, DC
| | - Jacquetta Brooks
- Mautner Project of Whitman-Walker, Whitman-Walker Health, Washington, DC
| | - Dawn Harbatkin
- Lyon-Martin Health Services, a Program of HealthRight360, San Francisco, California
| | - Asa Radix
- Callen-Lorde Community Health Center, New York, New York
| | - Suzanne G Haynes
- Office on Women's Health, U.S. Department of Health & Human Services, Washington, DC
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Advances in Motivational Interviewing for Pediatric Obesity: Results of the Brief Motivational Interviewing to Reduce Body Mass Index Trial and Future Directions. Pediatr Clin North Am 2016; 63:539-62. [PMID: 27261549 PMCID: PMC6754172 DOI: 10.1016/j.pcl.2016.02.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Rates of childhood obesity in the United States remain at historic highs. The pediatric primary care office represents an important yet underused setting to intervene with families. One factor contributing to underuse of the primary care setting is lack of effective available interventions. One evidence-based method to help engage and motivate patients is motivational interviewing, a client-centered and goal-oriented style of counseling used extensively to increase autonomous motivation and modify health behaviors. This article summarizes the methods and results from a large trial implemented in primary care pediatric office and concludes with recommendations for improving the intervention and increasing its dissemination.
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Murphy KM, Mash R, Malan Z. The case for behavioural change counselling for the prevention of NCDs and improvement of self-management of chronic conditions. S Afr Fam Pract (2004) 2016. [DOI: 10.1080/20786190.2016.1187885] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Soundy A, Roskell C, Adams R, Elder T, Dawes H. Understanding Health Care Professional-Patient Interactions in Multiple Sclerosis: A Systematic Review and Thematic Synthesis. ACTA ACUST UNITED AC 2016. [DOI: 10.4236/ojtr.2016.44018] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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