Internet-Delivered Health Interventions That Work: Systematic Review of Meta-Analyses and Evaluation of Website Availability

Formative Usability of the Kidneytime Online Live Donor Kidney Transplant Education Tool Among Transplant Candidates

BACKGROUND

Web-based education may be a powerful tool to support transplant candidates' learning and communication about live donor kidney transplantation. Few educational interventions are web-based and have education sharing for living donor transplant as a primary goal.

METHODS

Through user-centered design and iterative usability testing, we developed a web platform, called KidneyTIME, to support an educational intervention for adult transplant candidates. KidneyTIME delivers animated videos to improve candidate knowledge, motivation, and self-efficacy to pursue living donor transplantation and to promote outreach through video sharing. The animated-video educational content was previously produced by the researchers. We conducted a formative usability evaluation of the KidneyTIME web platform to enable users to find, view, and share the previously produced videos. A total of 30 kidney transplant candidates were involved in 4 rounds of testing at one transplant center, with amendments made after each round.

RESULTS

Transplant candidates were predominantly White non-Hispanic; 47% had incomes <$30 000 and >43% had vision or motor impairment. Readability, navigation, and failure to find videos were the main usability issues identified. Substantial improvements were found in the usability of most functions after implementing certain features, such as enlarging text and buttons, enhancing contrast, and simplifying presentation. Participants reported that the intervention was user friendly and easy to navigate.

CONCLUSION

Considering feedback from a wide spectrum of users has improved the usability of KidneyTIME. A salient concern for End stage kidney disease populations is ensuring online accessibility despite vision and motor impairments.

Study protocol for iSIPsmarter: A randomized-controlled trial to evaluate the efficacy, reach, and engagement of a technology-based behavioral intervention to reduce sugary beverages among rural Appalachian adults

Sugar-sweetened beverage (SSB) consumption is disproportionately high among rural Appalachian adults, with intakes double the national average and nearly four times the recommended amount. This trial targets this major dietary risk factor and addresses notable gaps in the rural digital health intervention literature. iSIPsmarter is a technology-based behavior and health literacy intervention aimed at improving SSB behaviors. It is comprised of six Internet-delivered, interactive Cores delivered weekly, an integrated short message service (SMS) strategy to engage users in tracking and reporting SSB behaviors, and a cellular-enabled scale for in-home weighing. iSIPsmarter is adapted from an evidence-based intervention and is grounded by the Theory of Planned Behavior and health literacy, numeracy, and media literacy concepts. The RCT is guided by the RE-AIM framework and targets 244 rural Appalachian adults. The goal is to examine the efficacy of iSIPsmarter to reduce SSB in a two-group design [iSIPsmarter vs. static Participant Education website] with four assessment points. Changes in secondary outcomes (e.g., diet quality, weight, quality of life) and maintenance of outcomes will also be evaluated. Additional secondary aims are to examine reach and representativeness, patterns of user engagement, and cost. Two tertiary aims are exploratory mediation analyses and a systems-level, participatory evaluation to understand context for future organizational-level adoption of iSIPsmarter. The long-term goal is to sustain an effective, scalable, and high reach behavioral intervention to reduce SSB-related health inequities and related chronic conditions (i.e., obesity, diabetes, some obesity-related cancers, heart disease, hypertension, dental decay) in rural Appalachia and beyond. ClinicalTrial registry: NCT05030753.

Technology-based nutrition interventions using the Mediterranean diet: a systematic review

CONTEXT

Over the past 2 decades, overweight and obesity rates have increased exponentially, along with related comorbidities including type 2 diabetes, hypertension, cardiovascular disease, and some cancers. The Mediterranean Diet (MDiet) has been suggested as a potential way to mitigate the health burdens related to overweight and obesity.

OBJECTIVE

For this review, the literature on MDiet-focused digital interventions was examined to determine efficacy, best practices, and potential limitations.

DATA SOURCES

The search was conducted across 15 databases for relevant publications published through April 2020 in English, French, Spanish, Arabic, or Italian.

DATA EXTRACTION

Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed using a combination of keywords and phrases and evaluated independently for relevance, merit, and inclusion and exclusion criteria.

DATA ANALYSIS

The systematic literature review resulted in 15 articles that met the search criteria. Ten interventions were delivered online, and 5 were delivered via smartphone using an app. The majority of online MDiet-focused interventions were effective, particularly when modeled after evidence-based and best-practice online nutrition education interventions. Such interventions also are effective for promoting positive health behaviors and health outcomes, such as increased physical activity, increased levels of high-density lipoprotein cholesterol, and a lower total high-density lipoprotein cholesterol ratio.

CONCLUSION

Technology-based interventions to educate and promote adherence to the MDiet are successful in helping individuals achieve the stated outcomes. More research is needed to determine the efficacy of MDiet interventions delivered via smartphone apps.

The Mediation Effect of Phobic Anxiety on the Treatment Outcome of Activity and Participation across Age: Comparison between Online and Face-to-Face Rehabilitation Aftercare of an RCT

The efficacy of internet and mobile-based interventions (IMIs) has been demonstrated with different mental health disorders, but little is known about the mediating effect of phobic anxiety on activity and participation and the differential effect of age. The current study tested a moderated mediation model with short-term change in phobic anxiety mediating between treatment (IMI vs. face-to-face, F2F) and long-term change in activity and participation, and age of patients moderating this mediation. Participants (N = 142) were recruited from psychosomatic rehabilitation clinics and randomized into the IMI psychosomatic aftercare or F2F psychosomatic aftercare. Moderated mediation analyses were conducted using R software. Results showed that the long-term treatment effects of activity and participation (βc = -0.18, p = 0.034; βc' = -0.13, p = 0.145) were improved through the successful decrease of phobic anxiety (βa = -0.18, p = 0.047; βb = 0.37, p = 0.010). Older patients benefited equally from both IMI and F2F interventions regarding short-term treatment change in phobic anxiety, while younger participants benefited more from IMI (βAge*Treatment = 0.20, p = 0.004). IMIs targeting mental disorders can improve activity and participation along with phobic anxiety, especially in younger individuals. The needs of older patients should be considered with the development and improvement of IMIs.

New Australian guidelines for the treatment of alcohol problems: an overview of recommendations

OF RECOMMENDATIONS AND LEVELS OF EVIDENCE

Chapter 2: Screening and assessment for unhealthy alcohol use Screening Screening for unhealthy alcohol use and appropriate interventions should be implemented in general practice (Level A), hospitals (Level B), emergency departments and community health and welfare settings (Level C). Quantity-frequency measures can detect consumption that exceeds levels in the current Australian guidelines (Level B). The Alcohol Use Disorders Identification Test (AUDIT) is the most effective screening tool and is recommended for use in primary care and hospital settings. For screening in the general community, the AUDIT-C is a suitable alternative (Level A). Indirect biological markers should be used as an adjunct to screening (Level A), and direct measures of alcohol in breath and/or blood can be useful markers of recent use (Level B). Assessment Assessment should include evaluation of alcohol use and its effects, physical examination, clinical investigations and collateral history taking (Level C). Assessment for alcohol-related physical problems, mental health problems and social support should be undertaken routinely (GPP). Where there are concerns regarding the safety of the patient or others, specialist consultation is recommended (Level C). Assessment should lead to a clear, mutually acceptable treatment plan which specifies interventions to meet the patient's needs (Level D). Sustained abstinence is the optimal outcome for most patients with alcohol dependence (Level C). Chapter 3: Caring for and managing patients with alcohol problems: interventions, treatments, relapse prevention, aftercare, and long term follow-up Brief interventions Brief motivational interviewing interventions are more effective than no treatment for people who consume alcohol at risky levels (Level A). Their effectiveness compared with standard care or alternative psychosocial interventions varies by treatment setting. They are most effective in primary care settings (Level A). Psychosocial interventions Cognitive behaviour therapy should be a first-line psychosocial intervention for alcohol dependence. Its clinical benefit is enhanced when it is combined with pharmacotherapy for alcohol dependence or an additional psychosocial intervention (eg, motivational interviewing) (Level A). Motivational interviewing is effective in the short term and in patients with less severe alcohol dependence (Level A). Residential rehabilitation may be of benefit to patients who have moderate-to-severe alcohol dependence and require a structured residential treatment setting (Level D). Alcohol withdrawal management Most cases of withdrawal can be managed in an ambulatory setting with appropriate support (Level B). Tapering diazepam regimens (Level A) with daily staged supply from a pharmacy or clinic are recommended (GPP). Pharmacotherapies for alcohol dependence Acamprosate is recommended to help maintain abstinence from alcohol (Level A). Naltrexone is recommended for prevention of relapse to heavy drinking (Level A). Disulfiram is only recommended in close supervision settings where patients are motivated for abstinence (Level A). Some evidence for off-label therapies baclofen and topiramate exists, but their side effect profiles are complex and neither should be a first-line medication (Level B). Peer support programs Peer-led support programs such as Alcoholics Anonymous and SMART Recovery are effective at maintaining abstinence or reductions in drinking (Level A). Relapse prevention, aftercare and long-term follow-up Return to problematic drinking is common and aftercare should focus on addressing factors that contribute to relapse (GPP). A harm-minimisation approach should be considered for patients who are unable to reduce their drinking (GPP). Chapter 4: Providing appropriate treatment and care to people with alcohol problems: a summary for key specific populations Gender-specific issues Screen women and men for domestic abuse (Level C). Consider child protection assessments for caregivers with alcohol use disorder (GPP). Explore contraceptive options with women of reproductive age who regularly consume alcohol (Level B). Pregnant and breastfeeding women Advise pregnant and breastfeeding women that there is no safe level of alcohol consumption (Level B). Pregnant women who are alcohol dependent should be admitted to hospital for treatment in an appropriate maternity unit that has an addiction specialist (GPP). Young people Perform a comprehensive HEEADSSS assessment for young people with alcohol problems (Level B). Treatment should focus on tangible benefits of reducing drinking through psychotherapy and engagement of family and peer networks (Level B). Aboriginal and Torres Strait Islander peoples Collaborate with Aboriginal or Torres Strait Islander health workers, organisations and communities, and seek guidance on patient engagement approaches (GPP). Use validated screening tools and consider integrated mainstream and Aboriginal or Torres Strait Islander-specific approaches to care (Level B). Culturally and linguistically diverse groups Use an appropriate method, such as the "teach-back" technique, to assess the need for language and health literacy support (Level C). Engage with culture-specific agencies as this can improve treatment access and success (Level C). Sexually diverse and gender diverse populations Be mindful that sexually diverse and gender diverse populations experience lower levels of satisfaction, connection and treatment completion (Level C). Seek to incorporate LGBTQ-specific treatment and agencies (Level C). Older people All new patients aged over 50 years should be screened for harmful alcohol use (Level D). Consider alcohol as a possible cause for older patients presenting with unexplained physical or psychological symptoms (Level D). Consider shorter acting benzodiazepines for withdrawal management (Level D). Cognitive impairment Cognitive impairment may impair engagement with treatment (Level A). Perform cognitive screening for patients who have alcohol problems and refer them for neuropsychological assessment if significant impairment is suspected (Level A).

SUMMARY OF KEY RECOMMENDATIONS AND LEVELS OF EVIDENCE

Chapter 5: Understanding and managing comorbidities for people with alcohol problems: polydrug use and dependence, co-occurring mental disorders, and physical comorbidities Polydrug use and dependence Active alcohol use disorder, including dependence, significantly increases the risk of overdose associated with the administration of opioid drugs. Specialist advice is recommended before treatment of people dependent on both alcohol and opioid drugs (GPP). Older patients requiring management of alcohol withdrawal should have their use of pharmaceutical medications reviewed, given the prevalence of polypharmacy in this age group (GPP). Smoking cessation can be undertaken in patients with alcohol dependence and/or polydrug use problems; some evidence suggests varenicline may help support reduction of both tobacco and alcohol consumption (Level C). Co-occurring mental disorders More intensive interventions are needed for people with comorbid conditions, as this population tends to have more severe problems and carries a worse prognosis than those with single pathology (GPP). The Kessler Psychological Distress Scale (K10 or K6) is recommended for screening for comorbid mental disorders in people presenting for alcohol use disorders (Level A). People with alcohol use disorder and comorbid mental disorders should be offered treatment for both disorders; care should be taken to coordinate intervention (Level C). Physical comorbidities Patients should be advised that alcohol use has no beneficial health effects. There is no clear risk-free threshold for alcohol intake. The safe dose for alcohol intake is dependent on many factors such as underlying liver disease, comorbidities, age and sex (Level A). In patients with alcohol use disorder, early recognition of the risk for liver cirrhosis is critical. Patients with cirrhosis should abstain from alcohol and should be offered referral to a hepatologist for liver disease management and to an addiction physician for management of alcohol use disorder (Level A). Alcohol abstinence reduces the risk of cancer and improves outcomes after a diagnosis of cancer (Level A).

Barriers and facilitators to the availability of efficacious self-directed digital health tools for adults living with cancer and their caregivers: A systematic literature review and author survey study

OBJECTIVE

This study aimed to examine barriers and facilitators to the dissemination of efficacious self-directed digital health tools for adults affected by cancer, and quantify funding used to develop and evaluate these digital health tools.

METHODS

We conducted: (1) a systematic literature review to identify efficacious self-directed digital health tools for adults affected by cancer, published between 2009 and 2019 and (2) an author survey to identify barriers and facilitators to dissemination of those tools, grant funding and the user centredness of their design (UCD) process.

RESULTS

Of 1314 screened articles, 29 articles describing 26 tools met the inclusion criteria. From 26 surveys sent, 12 were completed, 6 of which described disseminated tools. Whilst researchers' motivation and infrastructure support facilitate tool dissemination, limited funds, lack of infrastructure and limited research timelines are the most common barriers. A median of AUD$250,000 was spent on tools not disseminated to end-users.

CONCLUSION

Although incorporating UCD processes in the development of digital health tools is important, it is imperative to integrate implementation processes into the planning stages of tool development to ensure dissemination.

PRACTICE IMPLICATIONS

Researchers, academic institutions, funding agencies and government and non-government organisations all have roles to play to support long-term implementation.

Development, Feasibility, Acceptability, and Utility of an Expressive Speech-Enabled Digital Health Agent to Deliver Online, Brief Motivational Interviewing for Alcohol Misuse: Descriptive Study

Background

Digital health agents — embodied conversational agents designed specifically for health interventions — provide a promising alternative or supplement to behavioral health services by reducing barriers to access to care.

Objective

Our goals were to (1) develop an expressive, speech-enabled digital health agent operating in a 3-dimensional virtual environment to deliver a brief behavioral health intervention over the internet to reduce alcohol use and to (2) understand its acceptability, feasibility, and utility with its end users.

Methods

We developed an expressive, speech-enabled digital health agent with facial expressions and body gestures operating in a 3-dimensional virtual office and able to deliver a brief behavioral health intervention over the internet to reduce alcohol use. We then asked 51 alcohol users to report on the digital health agent acceptability, feasibility, and utility.

Results

The developed digital health agent uses speech recognition and a model of empathetic verbal and nonverbal behaviors to engage the user, and its performance enabled it to successfully deliver a brief behavioral health intervention over the internet to reduce alcohol use. Descriptive statistics indicated that participants had overwhelmingly positive experiences with the digital health agent, including engagement with the technology, acceptance, perceived utility, and intent to use the technology. Illustrative qualitative quotes provided further insight about the potential reach and impact of digital health agents in behavioral health care.

Conclusions

Web-delivered interventions delivered by expressive, speech-enabled digital health agents may provide an exciting complement or alternative to traditional one-on-one treatment. They may be especially helpful for hard-to-reach communities with behavioral workforce shortages.

Motivation of UK graduate students in education: self-compassion moderates pathway from extrinsic motivation to intrinsic motivation

Academic motivation is recognised as a key factor for academic success and wellbeing. Highly motivated students actively engage with academic activities and maintain good wellbeing. Despite the importance of motivation in education, its relationship with engagement and wellbeing remains to be evaluated. Accordingly, this study explored the relationships between motivation, engagement, self-criticism and self-compassion among UK education postgraduate students. Of 120 postgraduate students approached, 109 completed three self-report scales regarding those constructs. Correlation, regression and moderation analyses were performed. Intrinsic and extrinsic motivation were positively associated with engagement, whereas amotivation was negatively associated with it. Engagement positively predicted intrinsic motivation. Self-criticism and self-compassion moderated the pathway from extrinsic motivation to intrinsic motivation: higher self-criticism weakened the pathway, while higher self-compassion strengthened it. Findings suggest the importance of engagement in relation to cultivating intrinsic motivation of education students. Moreover, enhancing self-compassion and reducing self-criticism can help transfer extrinsic to intrinsic motivation.

Effects of a web-based alcohol drinking prevention program linking school-to-home in elementary students

OBJECTIVES

We investigated the effects of a web-based alcohol drinking prevention program among early elementary school students in South Korea using the theory of planned behavior. This study utilized a combined family and school intervention approach.

DESIGN

This was a quasi-experimental study with a non-equivalent control group.

SAMPLE

A total of 251 third graders (experimental group: 170, control group: 81) from four public schools were included.

MEASUREMENTS

A web-based alcohol drinking prevention program was implemented in five weekly sessions. Students' attitudes, subjective norms, perceived behavioral control (PBC), and intentions toward alcohol drinking prevention behavior were evaluated through pre- and post-tests.

RESULTS

The average age of the participants was 9 years in both the experimental (82 male and 88 female students) and control (44 male and 37 female students) groups. A significant improvement in attitudes, PBC, and intentions toward alcohol drinking prevention behaviors was found in the experimental group.

CONCLUSIONS

A web-based alcohol drinking prevention program combining family and school interventions for lower elementary school students was effective at increasing intentions toward alcohol drinking prevention behavior. Alcohol drinking prevention programs should target lower elementary school students to effectively postpone the onset of alcohol drinking.

Psychosomatic Rehabilitation Patients and the General Population During COVID-19: Online Cross-sectional and Longitudinal Study of Digital Trainings and Rehabilitation Effects

BACKGROUND

The COVID-19 pandemic has largely affected people's mental health and psychological well-being. Specifically, individuals with a pre-existing mental health disorder seem more impaired by lockdown measures posing as major stress factors. Medical rehabilitation treatment can help people cope with these stressors. The internet and digital apps provide a platform to contribute to regular treatment and to conduct research on this topic.

OBJECTIVE

Making use of internet-based assessments, this study investigated individuals from the general population and patients from medical, psychosomatic rehabilitation clinics. Levels of depression, anxiety, loneliness, and perceived stress during the COVID-19 pandemic, common COVID-19-related worries, and the intention to use digital apps were compared. Furthermore, we investigated whether participating in internet-delivered digital trainings prior to and during patients' rehabilitation stay, as well as the perceived usefulness of digital trainings, were associated with improved mental health after rehabilitation.

METHODS

A large-scale, online, cross-sectional study was conducted among a study sample taken from the general population (N=1812) in Germany from May 2020 to April 2021. Further, a longitudinal study was conducted making use of the internet among a second study sample of psychosomatic rehabilitation patients at two measurement time points-before (N=1719) and after (n=738) rehabilitation-between July 2020 and April 2021. Validated questionnaires and adapted items were used to assess mental health and COVID-19-related worries. Digital trainings were evaluated. Propensity score matching, multivariate analyses of covariance, an exploratory factor analysis, and hierarchical regression analyses were performed.

RESULTS

Patients from the psychosomatic rehabilitation clinics reported increased symptoms with regard to depression, anxiety, loneliness, and stress (F_4,2028=183.74, P<.001, η²_p=0.27) compared to the general population. Patients perceived greater satisfaction in communication with health care professionals (F_1,837=31.67, P<.001, η²_p=0.04), had lower financial worries (F_1,837=38.96, P<.001, η²_p=0.04), but had higher household-related worries (F_1,837=5.34, P=.02, η²_p=0.01) compared to the general population. Symptoms of depression, anxiety, loneliness, and perceived stress were lower postrehabilitation (F_1,712=23.21, P<.001, η²_p=0.04) than prior to rehabilitation. Psychosomatic patients reported a higher intention to use common apps and digital trainings (F_3,2021=51.41, P<.001, η²_p=0.07) than the general population. With regard to digital trainings offered prior to and during the rehabilitation stay, the perceived usefulness of digital trainings on rehabilitation goals was associated with decreased symptoms of depression (β=-.14, P<.001), anxiety (β=-.12, P<.001), loneliness (β=-.18, P<.001), and stress postrehabilitation (β=-.19, P<.001). Participation in digital group therapy for depression was associated with an overall change in depression (F_1,725=4.82, P=.03, η²_p=0.01) and anxiety (F_1,725=6.22, P=.01, η²_p=0.01) from pre- to postrehabilitation.

CONCLUSIONS

This study validated the increased mental health constraints of psychosomatic rehabilitation patients in comparison to the general population and the effects of rehabilitation treatment. Digital rehabilitation components are promising tools that could prepare patients for their rehabilitation stay, could integrate well with face-to-face therapy during rehabilitation treatment, and could support aftercare.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04453475; https://clinicaltrials.gov/ct2/show/NCT04453475 and ClinicalTrials.gov NCT03855735; https://clinicaltrials.gov/ct2/show/NCT03855735.

Linking digital health divide to HPV awareness, HPV knowledge, and cervical cancer screening among women in the United States: A trend analysis from 2008 to 2017

The author aims to explore the trend of HPV awareness, HPV knowledge, and cervical cancer screening among American female adults, and the influence of digital health divide throughout the past decade. Data from the 2008, 2013, and 2017 iterations of the nationally representative survey of Health Information National Trends Survey (HINTS) were employed for this research. The author found that cervical cancer screening continuously increased in the past decade. Women's HPV awareness and knowledge remain low. Internet access, Internet health information seeking, and eHealth activities were significant determinants of HPV awareness and knowledge over the three iterations.

User feedback and usability testing of an online training and support program for dementia carers

BACKGROUND

eHealth interventions have been explored to provide convenient support and training to informal dementia carers. Design and usability issues may however hinder user acceptance of Web-based interventions. iSupport is an online program developed by World Health Organization (WHO) to support informal dementia carers.

PURPOSE

This study gathers user-feedback and evaluates the usability of the European-Portuguese version of iSupport.

METHODS

A mixed-methods study was conducted. Two focus groups discussions (n = 15) and 15 usability test sessions were conducted with carers and health/social support professionals to collect data on user satisfaction and requirements on the program's contents and Web interface. The usability testing protocol comprised pre/post-test surveys, a structured interview and observation of task performance in the Web platform. Content analysis of text data was performed by two independent coders.

RESULTS

Success rates were superior to 80% for most tasks. An average score of 89.5 on the System Usability Scale demonstrated an excellent perception of the program's usability. The program was perceived as trustworthy, and participants were globally satisfied with its aesthetics and easiness of use. Feedback and personalization were valued functional requirements, while no consensus was found for mood self-assessment or professional/peer interaction features. Lessons were considered culturally fit, thematically pertinent, and comprehensive. Suggestions for improvement were wide-ranging from program's layout to accessibility, usability, functional requirements, content format and lessons' themes.

CONCLUSIONS

This study derives user requirements for an evidence-based program for dementia carers. Both the study findings and usability assessment methodology can be imported to the development of similar programs worldwide.

Engagement with online psychosocial interventions for psychosis: A review and synthesis of relevant factors

BACKGROUND

Little is known about factors associated with engagement with online interventions for psychosis. This review aimed to synthesise existing data from relevant literature to develop a working model of potential variables that may impact on engagement with online interventions for psychosis.

METHODS

Online databases were searched for studies relevant to predictors of engagement with online interventions for psychosis; predictors of Internet use amongst individuals with psychosis; and predictors of engagement with traditional psychosocial treatments for psychosis. Data were synthesised into a conceptual model highlighting factors relevant to engagement with online interventions for psychosis.

RESULTS

Sixty-one studies were identified. Factors relevant to engagement related directly to the impact of psychosis, response to psychosis, integration of technology into daily lives and intervention aspects.

CONCLUSION

While several candidate predictors were identified, there is minimal research specifically investigated predictors of engagement with online interventions for psychosis. Further investigation examining both individual- and intervention-related factors is required to inform effective design and dissemination of online interventions for psychosis.

Internet-based intervention compared to brief intervention for smoking cessation in Brazil: a pilot study (Preprint)

Background

Smoking is still the leading cause of preventable death. Governments and health care providers should make available more accessible resources to help tobacco users stop.

Objective

This study describes a pilot longitudinal study that evaluated the efficacy of an internet-based intervention compared to the brief intervention for smoking cessation among Brazilians.

Methods

Eligible participants were recruited and randomly allocated to one of the two interventions. Measures were drawn by comparing cessation rates, motivation scores, and sought treatment between groups, assessed 1 and 3 months after the intervention. Inferential analysis was performed to compare the participants’ characteristics, and the intention to treat was calculated.

Results

A total of 49 smokers were enrolled in this study (n=25, 51% in the brief intervention group; n=24, 49% in the internet-based intervention group). Mean age was 44.5 (SD 13.3) years; most were male (n=29, 59.2%), had elementary school (n=22, 44.9%), smoked 14.5 cigarettes per day on average (SD 8.6), and had a mean score of 4.65 for nicotine dependence and 5.7 for motivation to quit. Moreover, 35 (71%) participants answered follow-up 1, and 19 (39%) answered follow-up 2. The results showed similar rates of cessation and reduction for both intervention groups.

Conclusions

The internet-based intervention was slightly more effective for smoking cessation, while the brief intervention was more effective in reducing the number of cigarettes smoked per day. This difference was small and had no statistical significance even after adjusting for intention-to-treat analysis. These results should be interpreted with caution, especially due to the small sample size.

Assessing the feasibility of an m-Health intervention for changing diet quality and mood in individuals with depression: the My Food & Mood program

Recent randomized controlled trials have shown that improving diet quality reduces symptoms in those with depression. The provision of digital health interventions that can support dietary change in those with depression has important benefits with respect to reach, accessibility convenience and cost. The My Food & Mood study used single arm cohort design to test the feasibility of such an intervention. Participants with current depressive symptoms were recruited and enrolled online to use the My Food & Mood m-Health (smartphone delivered) program for 8 weeks. Participants completed depression (PHQ-8) and dietary questionnaires (MEDAS) at baseline, week 4 and week 8. Metrics of use and intensity of use engagement measures were calculated from system logs and data entries. There was a significant change in both MEDAS score (t = 8.147, df = 44, p < 0.001) and PHQ-8 score (t = -7.199, df = 44, p < 0.001) throughout the study. There was a moderate positive association between change in MEDAS score and activities completed, goals and weeks engaged, and a strong inverse association between change in MEDAS score and change in PHQ-8 score. An m-Health program targeting dietary intervention in those with depression was feasible. Dietary change was associated with higher engagement and reduced depressive symptoms.

Prior depression predicts greater stress during Covid-19 mandatory lockdown among college students in France

BACKGROUND

The Covid-19 pandemic and its related public health measures such as mandatory lockdowns have been shown to have an impact on mental health. A key question is the role of pre-existing psychiatric disorders in how such measures are experienced.

METHODS

During the first country-wide lockdown imposed in France, a Covid-19 module was added to the French portion of the ongoing World Mental Health International college student survey. The present study focuses on respondents who completed the survey during that time frame (n = 291).

RESULTS

Students with prior depression endorsed greater increases in anxiety (72.2% vs 50.9%) and stress (72.2% vs 49.4%), as well as greater decreases in concentration (87.0% vs 72.9%) during lockdown as compared to those without depression history. In multivariate analyses, prior depression was associated with overall stress (AOR = 5.50), financial stress (AOR = 1.95), family stress (AOR = 2.47), work related stress (AOR = 5.15), and stress related to loved ones (AOR = 2.21). Prior depression was also associated with greater probability experiencing increased anxiety (AOR = 2.61) and stress (AOR = 2.55) during lockdown.

CONCLUSIONS

The findings indicate that the best predictor of experiencing stress and anxiety during the first Covid-19 lockdown was a history of depression prior to the pandemic outbreak. Implementing public health measures such as mandatory national lockdowns should be accompanied by strategies for reaching out to those who are vulnerable due to a history of mental illness.

Promoting parkrun to patients using the general practice website: a qualitative exploration of 'parkrun practice' websites

Background

The parkrun practice initiative is a widely accessible and low-cost approach in primary care, which promotes patient and staff health and wellbeing through increased physical activity and volunteering opportunities. The parkrun practice Toolkit offers guidance to practices on how to promote parkrun. One recommendation is to include a parkrun page on the practice website, or a link to the parkrun website. How practices are presenting this information is unknown.

Aim

To explore how parkrun practices are using their websites to promote parkrun, including the content and format of information presented and variety of promotion methods used, in order to provide recommendations for inclusion in the Toolkit.

Design & setting

Qualitative content analysis of a sample of parkrun practice websites.

Method

The websites of 114 practices that reported using their websites for parkrun promotion were systematically searched and the content analysed.

Results

Five main types of content were identified, namely: what parkrun or parkrun practice is; activities and events; addressing patients’ concerns; benefits of parkrun; and practical information. While there were similarities in the information provided, there were variations in presentation. Websites ranged from being extensive and highly informative, to minimal amounts of text or solely images.

Conclusion

Findings highlight the variability that currently exists across parkrun practice websites. Including a link on the homepage would assist patients to find information on parkrun and clarify the information that can be found. Suggestions are made on the type of information and how it could be presented to be further developed for inclusion in the Toolkit.

Effectiveness of digital psychotherapeutic intervention among perinatal women: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

The perinatal period is a challenging time of substantial emotional, physiological, social, and relational changes. Depression, anxiety, and stress symptoms are common, and co-exist in the perinatal period. Digital technology continues to grow at an unprecedented pace with wide application, including psychotherapeutic intervention. A growing number of meta-analyses supported the application of digital psychotherapeutic intervention across different populations, but relatively few meta- and meta-regression analyses have concentrated on perinatal women.

AIM

To evaluate the effectiveness of digital psychotherapeutic intervention on improving psychological outcomes among perinatal women and identify its essential features.

METHODS

Randomized controlled trials (RCTs) were obtained from eight databases, including Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, Embase, Scopus, PsycINFO, PubMed, Web of Science, and ProQuest Dissertation and Theses from inception up until November 24, 2020. Comprehensive Meta-analysis 3.0 software was used to conduct meta- and meta-regression analyses. The Cochrane risk-of-bias tool and the Grading of the Recommendation, Assessment, Development, and Evaluation system were adopted to assess the individual and overall qualities of the evidence, respectively.

RESULTS

A total of 25 RCTs that included 3239 women were identified. Meta-analyses revealed that intervention significantly improved depression (Hedges's g = 0.49), anxiety (g = 0.25), and stress (g = 0.47) symptoms compared to the control. Subgroup analyses demonstrated that a website platform with ≥ eight therapist-guided sessions using the theoretical principle of cognitive behavioral therapy was more effective than other treatments in improving depression symptoms in postnatal women. Meta-regression analyses observed that the age of perinatal women and the type of psychotherapy also had statistically significant effects on depression symptoms. Egger's regression asymmetry tests suggested that no publication biases occurred, but the overall quality of the evidence was very low.

CONCLUSION

This review suggests that digital psychotherapeutic intervention may be a potential solution to reduce psychological problems in perinatal women. Further high-quality RCTs with large sample sizes are needed.

Feasibility and Preliminary Efficacy of a Community-Based Addiction Rehabilitation Electronic System in Substance Use Disorder: Pilot Randomized Controlled Trial

BACKGROUND

Drug use disorder has high potential for relapse and imposes an enormous burden on public health in China. Since the promulgation of the Anti-drug law in 2008, community-based rehabilitation has become the primary approach to treat drug addiction. However, multiple problems occurred in the implementation process, leading to a low detoxification rate in the community. Mobile health (mHealth) serves as a promising tool to improve the effectiveness and efficiency of community-based rehabilitation. Community-based addiction rehabilitation electronic system (CAREs) is an interactive system for drug users and their assigned social workers.

OBJECTIVE

The study aimed to examine the feasibility and preliminary efficacy of CAREs in community-based rehabilitation from the perspective of drug users and social workers in Shanghai, China.

METHODS

In this pilot randomized controlled trial, 40 participants were recruited from the community in Shanghai from January to May 2019. Participants randomized to the intervention group (n=20) received CAREs + community-based rehabilitation, while participants in the control group (n=20) received community-based rehabilitation only for 6 months. CAREs provided education, assessment, and SOS (support) functions for drug users. The assigned social workers provided service and monitored drug use behavior as usual except that the social workers in the intervention group could access the webpage end to obtain drug users' information and fit their routine workflow into CAREs. The primary outcome was the feasibility of CAREs, reflected in the overall proportion and frequency of CAREs features used in both app and webpage end. The secondary outcomes were the effectiveness of CAREs, including the percentage of drug-positive samples, longest period of abstinence, contact times with social workers, and the change of Addiction Severity Index (ASI) from baseline to the 6-month follow-up.

RESULTS

The number of participants logged in to the app ranged from 7 to 20 per week, and CAREs had relatively high levels of continued patient use. Drug users preferred assessment and education features in the app end while their social workers showed high levels of use in urine results record and viewing assessment results on the webpage end. After the 6-month intervention, 3.3% (17/520) of samples in the intervention group and 7.5% (39/520) in the control group were drug-positive (F=4.358, P=.04). No significant differences were noted between the control and intervention groups in terms of longest duration of abstinence, number of contact times and ASI composite scores.

CONCLUSIONS

The study preliminarily demonstrated that with relatively good feasibility and acceptability, CAREs may improve the effectiveness and efficiency of the community-based rehabilitation, which provided instruction for further improvement of the system.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03451344; https://clinicaltrials.gov/ct2/show/NCT03451344.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.3389/fpsyt.2018.00556.

Acceptability of online exercise-based interventions after breast cancer surgery: systematic review and narrative synthesis

PURPOSE

eHealth and mHealth approaches are increasingly used to support cancer survivors. This review aimed to examine adherence, acceptability and satisfaction with Internet-based self-management programmes for post-surgical cancer rehabilitation and to identify common components of such interventions.

METHODS

Nine electronic databases were searched from inception up to February 15, 2020, for relevant quantitative and qualitative studies evaluating Internet-based cancer rehabilitation interventions. Studies were required to include an exercise or physical activity-based self-management intervention and a measure of adherence, acceptability or user satisfaction with the programme. Two independent reviewers performed all data extraction and quality assessment procedures. Data were synthesized using a narrative approach.

RESULTS

Six hundred ninety-six potential papers were identified and screened. Eleven met the inclusion criteria. Interventions had wide variations in levels of adherence, but the majority were reported as being acceptable to the users. Increased acceptability and user satisfaction were associated with interventions which were seen as time and cost-efficient, requiring acquisition of minimal or no new skills, which used coherent language, or which provided tailored information. The majority contained behaviour change components such as goal setting.

CONCLUSIONS

Despite high levels of heterogeneity between studies, Internet-based approaches may be an acceptable method for the delivery of self-management interventions in post-surgical cancer rehabilitation.

IMPLICATIONS FOR CANCER SURVIVORS

There is a need for further studies exploring factors associated with increased user engagement and usage of digital interventions in cancer rehabilitation settings. These findings should be used to help develop interventions prior to testing their effectiveness in adequately powered randomized controlled trials.

Getting the right message: a content analysis and application of the health literacy INDEX tool to online HIV resources in Australia

Health literacy is considered by some as a determinant of health. Research suggests that different levels of health literacy may be associated with human immunodeficiency virus (HIV) knowledge and behaviour, including willingness to test. This study assessed the health literacy demands of existing Australia HIV prevention resources available online using a health literacy assessment and content analysis. Two reviewers assessed 66 resources using the Health Literacy INDEX. Sixty-one (92%) scored below 50%, with an average score of 35.5%. A coding frame was developed to conduct a content analysis of the resources excluding videos, multiple webpages and booklets (n = 52). We coded for six categories of knowledge: HIV knowledge (100% of resources), transmission (96%), acquired immune deficiency syndrome (AIDS) knowledge (88%), testing (87%), consequence of infection (85%) and prevention (77%). We found that resources required a reading grade above grade 8, and very few resources considered audience appropriateness. There were missed opportunities to encourage HIV prevention or testing. Some resources used incorrect language to refer towards people living with HIV, and transmission and prevention messages were often inconsistent. Guidelines for developing HIV prevention resources are warranted to improve health literacy, accessibility and appropriateness of resources and ensure consistent messages and framing of HIV risk.

BLEND-A: blending internet treatment into conventional face-to-face treatment for alcohol use disorder - a study protocol

BACKGROUND

A major challenge to psychological treatment for alcohol use disorder (AUD) is patient non-compliance. A promising new treatment approach that is hypothesized to increase patient compliance is blended treatment, consisting of face-to-face contact with a therapist combined with modules delivered over the internet within the same protocol. While this treatment concept has been developed and proven effective for a variety of mental disorders, it has not yet been examined for AUD.

AIMS

The study described in this protocol aims to examine and evaluate patient compliance with blended AUD treatment as well as the clinical and cost effectiveness of such treatment compared to face-to-face treatment only.

METHODS

The study design is a pragmatic, stepped-wedge cluster randomized controlled trial. The included outpatient institutions (planned number of patients: n = 1800) will be randomized in clusters to implement either blended AUD treatment or face-to-face treatment only, i.e. treatment as usual (TAU). Both treatment approaches consist of motivational interviewing and cognitive behavioral therapy. Data on sociodemographics, treatment (e.g. intensity, duration), type of treatment conclusion (compliance vs. dropout), alcohol consumption, addiction severity, consequences of drinking, and quality of life, will be collected at treatment entry, at treatment conclusion, and 6 months after treatment conclusion. The primary outcome is compliance at treatment conclusion, and the secondary outcomes include alcohol consumption and quality of life at six-months follow-up. Data will be analyzed with an Intention-to-treat approach by means of generalized linear mixed models with a random effect for cluster and fixed effect for each step. Also, analyses evaluating cost-effectiveness will be conducted.

DISCUSSION

Blended treatment may increase treatment compliance and thus improve treatment outcomes due to increased flexibility of the treatment course. Since this study is conducted within an implementation framework it can easily be scaled up, and when successful, blended treatment has the potential to become an alternative offer in many outpatient clinics nationwide and internationally.

TRIAL REGISTRATION

Clinicaltrials.gov .: NCT04535258 , retrospectively registered 01.09.20.

Cannabis use and cannabis use disorder

Cannabis use disorder (CUD) is an underappreciated risk of using cannabis that affects ~10% of the 193 million cannabis users worldwide. The individual and public health burdens are less than those of other forms of drug use, but CUD accounts for a substantial proportion of persons seeking treatment for drug use disorders owing to the high global prevalence of cannabis use. Cognitive behavioural therapy, motivational enhancement therapy and contingency management can substantially reduce cannabis use and cannabis-related problems, but enduring abstinence is not a common outcome. No pharmacotherapies have been approved for cannabis use or CUD, although a number of drug classes (such as cannabinoid agonists) have shown promise and require more rigorous evaluation. Treatment of cannabis use and CUD is often complicated by comorbid mental health and other substance use disorders. The legalization of non-medical cannabis use in some high-income countries may increase the prevalence of CUD by making more potent cannabis products more readily available at a lower price. States that legalize medical and non-medical cannabis use should inform users about the risks of CUD and provide information on how to obtain assistance if they develop cannabis-related mental and/or physical health problems.

To What Extent is Internet Activity Predictive of Psychological Well-Being?

Background

Healthy internet activity (eg, making use of eHealth and online therapy) is positively associated with well-being. However, unhealthy internet activity (too much online time, problematic internet use/PIU, internet dependency/ID, etc.) is associated with reduced well-being, loneliness, and other related negative aspects. While most of the evidence is correlational, some research also shows that internet activity can be predictive for well-being.

Objective

The aim of this article is to elaborate on the question as to what extent internet activity is predictive of psychological well-being by means of (a) a scoping review and (b) theoretical understanding which model the interrelation of internet activity and psychological well-being.

Methodology

We searched different electronic databases such as Web of Science by using the search terms "Internet" OR "App" OR "digital" OR "online" OR "mobile application" AND "Use" OR "Activity" OR "Behavior" OR "Engagement" AND "Well-being" OR "Loneliness" for (a, the scoping review) or CCAM for (b, the theoretical understanding).

Results

The scoping review (a) summarizes recent findings: the extent to which internet activity is predictive for well-being depends on the internet activity itself: internet activity facilitating self-management is beneficial for well-being but too much internet activity, PIU and ID are detrimental to well-being. To understand (b) why, when and how internet activity is predictive for well-being, theoretical understanding and a model are required. While theories on either well-being or internet activity exist, not many theories take both aspects into account while also considering other behaviors. One such theory is the Compensatory Carry-Over Action Model (CCAM) which describes mechanisms on how internet use is related to other lifestyle behaviors and well-being, and that individuals are driven by the goal to adopt and maintain well-being - also called higher-level goals - in the CCAM. There are few studies testing the CCAM or selected aspects of it which include internet activity and well-being. Results demonstrate the potentials of such a multifactorial, sophisticated approach: it can help to improve health promotion in times of demographic change and in situations of lacking personnel resources in health care systems.

Conclusion and Recommendation

Suggestions for future research are to employ theoretical approaches like the CCAM and testing intervention effects, as well as supporting individuals in different settings. The main aim should be to perform healthy internet activities to support well-being, and to prevent unhealthy internet activity. Behavior management and learning should accordingly aim at preventing problematic internet use and internet dependency.

General Audience Engagement With Antismoking Public Health Messages Across Multiple Social Media Sites: Comparative Analysis

BACKGROUND

Public health organizations have begun to use social media to increase awareness of health harm and positively improve health behavior. Little is known about effective strategies to disseminate health education messages digitally and ultimately achieve optimal audience engagement.

OBJECTIVE

This study aims to assess the difference in audience engagement with identical antismoking health messages on three social media sites (Twitter, Facebook, and Instagram) and with a referring link to a tobacco prevention website cited in these messages. We hypothesized that health messages might not receive the same user engagement on these media, although these messages were identical and distributed at the same time.

METHODS

We measured the effect of health promotion messages on the risk of smoking among users of three social media sites (Twitter, Facebook, and Instagram) and disseminated 1275 health messages between April 19 and July 12, 2017 (85 days). The identical messages were distributed at the same time and as organic (unpaid) and advertised (paid) messages, each including a link to an educational website with more information about the topic. Outcome measures included message engagement (ie, the click-through rate [CTR] of the social media messages) and educational website engagement (ie, the CTR on the educational website [wCTR]). To analyze the data and model relationships, we used mixed effects negative binomial regression, z-statistic, and the Hosmer-Lemeshow goodness-of-fit test.

RESULTS

Comparisons between social media sites showed that CTRs for identical antitobacco health messages differed significantly across social media (P<.001 for all). Instagram showed the statistically significant highest overall mean message engagement (CTR=0.0037; 95% CI 0.0032-0.0042), followed by Facebook (CTR=0.0026; 95% CI 0.0022-0.0030) and Twitter (CTR=0.0015; 95% CI 0.0013-0.0017). Facebook showed the highest as well as the lowest CTR for any individual message. However, the message CTR is not indicative of user engagement with the educational website content. Pairwise comparisons of the social media sites differed with respect to the wCTR (P<.001 for all). Messages on Twitter showed the lowest CTR, but they resulted in the highest level of website engagement (wCTR=0.6308; 95% CI 0.5640-0.6975), followed by Facebook (wCTR=0.2213; 95% CI 0.1932-0.2495) and Instagram (wCTR=0.0334; 95% CI 0.0230-0.0438). We found a statistically significant higher CTR for organic (unpaid) messages (CTR=0.0074; 95% CI 0.0047-0.0100) compared with paid advertisements (CTR=0.0022; 95% CI 0.0017-0.0027; P<.001 and P<.001, respectively).

CONCLUSIONS

Our study provides evidence-based insights to guide the design of health promotion efforts on social media. Future studies should examine the platform-specific impact of psycholinguistic message variations on user engagement, include newer sites such as Snapchat and TikTok, and study the correlation between web-based behavior and real-world health behavior change. The need is urgent in light of increased health-related marketing and misinformation on social media.

Identifying Self-Management Support Needs for Pregnant Women With Opioid Misuse in Online Health Communities: Mixed Methods Analysis of Web Posts

Background

The current opioid crisis in the United States impacts broad population groups, including pregnant women. Opioid use during pregnancy can affect the health and wellness of both mothers and their infants. Understanding women’s efforts to self-manage opioid use or misuse in pregnancy is needed to identify intervention points for improving maternal outcomes.

Objective

This study aims to identify the characteristics of women in an online health community (OHC) with opioid use or misuse during pregnancy and the self-management support needs of these mothers.

Methods

A total of 200 web posts by pregnant women with opioid use participating in an OHC were double coded. Concepts and their thematic connections were identified through an inductive process until theoretical saturation was reached. Statistical tests were performed to identify patterns.

Results

The majority of pregnant women (150/200, 75.0%) in the OHC exhibited signs of misuse, and 62.5% (125/200) of the participants were either contemplating or pursuing dosage reduction. Self-managed withdrawal was more common (P<.001) than professional treatment among the population. A total of 5 themes of self-management support needs were identified as women sought information about the potential adverse effects of gestational opioid use, protocols for self-managed withdrawal, pain management safety during pregnancy, hospital policies and legal procedures related to child protection, and strategies for navigating offline support systems. In addition, 58.5% (117/200) of the pregnant women expressed negative emotions, of whom only 10.2% (12/117) sought to address their emotional needs with the help of the OHC.

Conclusions

OHCs provide vital self-management support for pregnant women with opioid use or misuse. Women pursuing self-managed dosage reduction are prone to misinformation and repeated relapses, which can result in extreme measures to avoid testing positive for drug use at labor. The study findings provide evidence for public policy considerations, including universal screening of substance use for pregnant women, emphasis on treatment rather than legal punishment, and further expansion of the Drug Addiction Treatment Act waiver training program. The improvement of web-based platforms that can organize geo-relevant information, dispense clinically validated withdrawal schedules, and offer structured peer support is envisioned for harm reduction among pregnant women who opt for self-management of opioid misuse.

Do sociodemographic variables moderate effects of an internet intervention for mild to moderate depressive symptoms? An exploratory analysis of a randomised controlled trial (EVIDENT) including 1013 participants

OBJECTIVE

To explore the moderating effects of sociodemographic variables on treatment benefits received from participating in an internet intervention for depression.

DESIGN

Randomised, assessor-blind, controlled trial.

SETTING

Online intervention, with participant recruitment using multiple settings, including inpatient and outpatient medical and psychological clinics, depression online forums, health insurance companies and the media (eg, newspaper, radio).

PARTICIPANTS

The EVIDENT trial included 1013 participants with mild to moderate depressive symptoms.

INTERVENTIONS

The intervention group subjects (n=509) received an online intervention (Deprexis) in addition to care as usual (CAU), while 504 participants received CAU alone.

METHODS

To explore subgroup differences, moderating effects were investigated using linear regression models based on intention-to-treat analyses. Moderating effects included sex, age, educational attainment, employment status, relationship status and lifetime frequency of episodes.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary endpoint was change in self-rated depression severity measured by the Patient Health Questionnaire-9 (PHQ-9), comparing baseline versus 12-week post-test assessment. Secondary outcome measures were the Hamilton Rating Scale for Depression and the Quick Inventory of Depressive Symptoms each at 12 weeks and at 6 and 12 months, and PHQ-9 at 6 and 12 months, respectively. In this article, we focus on the primary outcome measure only.

RESULTS

Between-group differences were observed in post-test scores, indicating the effectiveness of Deprexis. While the effects of the intervention could be demonstrated across all subgroups, some showed larger between-group differences than others. However, after exploring the moderating effects based on linear regression models, none of the selected variables was found to be moderating treatment outcomes.

CONCLUSIONS

Our findings suggest that Deprexis is equally beneficial to a wide range of people; that is, participant characteristics were not associated with treatment benefits. Therefore, participant recruitment into web-based psychotherapeutic interventions should be broad, while special attention may be paid to those currently under-represented in these interventions.

TRIAL REGISTRATION NUMBER

NCT01636752.

Improving Uptake of a National Web-Based Psychoeducational Workshop for Informal Caregivers of Veterans: Mixed Methods Implementation Evaluation

BACKGROUND

Although web-based psychoeducational programs may be an efficient, accessible, and scalable option for improving participant well-being, they seldom are sustained beyond trial publication. Implementation evaluations may help optimize program uptake, but few are performed. When the US Department of Veterans Affairs (VA) launched the web-based psychoeducational workshop Building Better Caregivers (BBC) for informal caregivers of veterans nationwide in 2013, the workshop did not enroll as many caregivers as anticipated.

OBJECTIVE

This study aims to identify the strengths and weaknesses of initial implementation, strategies likely to improve workshop uptake, whether the VA adopted these strategies, and whether workshop enrollment changed.

METHODS

We used mixed methods and the Promoting Action on Research Implementation in Health Services (PARIHS) implementation evaluation framework. In stage 1, we conducted semistructured interviews with caregivers, local staff, and regional and national VA leaders and surveys with caregivers and staff. We collected and analyzed survey and interview data concurrently and integrated the results to identify implementation strengths and weaknesses, and strategies likely to improve workshop uptake. In stage 2, we reinterviewed national leaders to determine whether the VA adopted recommended strategies and used national data to determine whether workshop enrollment changed over time.

RESULTS

A total of 54 caregivers (n=32, 59%), staff (n=13, 24%), and regional (n=5, 9%) and national (n=4, 7%) leaders were interviewed. We received survey responses from 72% (23/32) of caregivers and 77% (10/13) of local staff. In stage 1, survey and interview results were consistent across multiple PARIHS constructs. Although participants from low-enrollment centers reported fewer implementation strengths and more weaknesses, qualitative themes were consistent across high- and low-enrollment centers, and across caregiver, staff, and leadership respondent groups. Identified strengths included belief in a positive workshop impact and the use of some successful outreach approaches. Implementation weaknesses included missed opportunities to improve outreach and to better support local staff. From these, we identified and recommended new and enhanced implementation strategies-increased investment in outreach and marketing capabilities; tailoring outreach strategies to multiple stakeholder groups; use of campaigns that are personal, repeated, and detailed, and have diverse delivery options; recurrent training and mentoring for new staff; and comprehensive data management and reporting capabilities. In stage 2, we determined that the VA had adopted several of these strategies in 2016. In the 3 years before and after adoption, cumulative BBC enrollment increased from 2139 (2013-2015) to 4030 (2016-2018) caregivers.

CONCLUSIONS

This study expands the limited implementation science literature on best practices to use when implementing web-based psychoeducational programs. We found that robust outreach and marketing strategies and support for local staff were critical to the implementation success of the BBC workshop. Other health systems may want to deploy these strategies when implementing their web-based programs.

Analysis of the Emails From the Dutch Web-Based Intervention "Alcohol de Baas": Assessment of Early Indications of Drop-Out in an Online Alcohol Abuse Intervention

Nowadays, traditional forms of psychotherapy are increasingly complemented by online interactions between client and counselor. In (some) web-based psychotherapeutic interventions, meetings are exclusively online through asynchronous messages. As the active ingredients of therapy are included in the exchange of several emails, this verbal exchange contains a wealth of information about the psychotherapeutic change process. Unfortunately, drop-out-related issues are exacerbated online. We employed several machine learning models to find (early) signs of drop-out in the email data from the "Alcohol de Baas" intervention by Tactus. Our analyses indicate that the email texts contain information about drop-out, but as drop-out is a multidimensional construct, it remains a complex task to accurately predict who will drop out. Nevertheless, by taking this approach, we present insight into the possibilities of working with email data and present some preliminary findings (which stress the importance of a good working alliance between client and counselor, distinguish between formal and informal language, and highlight the importance of Tactus' internet forum).

Supporting Children With Speech Sound Disorders During COVID-19 Restrictions: Technological Solutions

Purpose

“Children are the hidden victims of the COVID-19 pandemic” (United Nations Children's Fund, 2020). Timely and effective speech intervention is important to reduce the impact on children's school achievement, ability to make friends, mental health, future life opportunities, and government resources. Prior to the coronavirus disease (COVID-19) pandemic, many Australian children did not receive sufficient speech-language pathology (SLP) services due to long waiting lists in the public health system. COVID-19 restrictions exacerbated this issue, as even children who were at the top of lengthy SLP waiting lists often received limited services, particularly in rural areas. To facilitate children receiving speech intervention remotely during the COVID-19 pandemic, evidence from randomized controlled trials regarding three technological solutions are examined: (a) Phoneme Factory Sound Sorter (Sound Start Study), (b) Waiting for Speech Pathology website, and (c) Apraxia World.

Conclusions

For the first two technological solutions, there were similar gains in speech production between the intervention and control groups, whereas, for the third solution, the average magnitude of treatment effect was comparable to face-to-face SLP therapy. Automated therapy management systems may be able to accelerate speech development and support communication resilience to counteract the effects of the COVID-19 restrictions on children with speech sound disorders. Technology-based strategies may also provide a potential solution to the chronic shortage of SLP services in rural areas into the future.

Using telehealth to assess depression and suicide ideation and provide mental health interventions to groups of chronically ill adolescents and young adults

Telehealth distance health care is a significant resource for young, chronically ill patient populations given their numerous medical complexities and their concomitant depression and/or suicide ideation experiences. This manuscript shares the telehealth methods used to prepare for a larger study of interventions for increasing adolescents' and young adults' chronic care resiliency and skills for preventing depression. The young patients in this study were prescribed lifelong home parenteral nutrition infusions, treatment for those with short gut bowel diseases. The training methods for our mental health nurse and psychologist to conduct depression and suicide ideation assessments from a distance are presented. The study implementation methods of group facilitated interventions and discussion are reviewed. The group discussions were conducted via audiovisual telehealth devices over encrypted firewall-protected connections with patients in their own homes and professionals in an office. The results of assessments of the 40 participants, 25% (n = 10) with depressive symptoms or suicide ideation, are described. Following participants' assessments, their subsequent depression measures were all in the normal range, without any suicide ideation, across the year of the study. Patient evaluation ratings were high in the areas of being able to connect with other young patients in similar situations, using the audiovisual equipment, and learning new useful information from the interventions. The methods developed for the study ensured that the safety and well-being of participants were supported through telehealth.

Availability of Spanish-Language Medical Apps in Google Play and the App Store: Retrospective Descriptive Analysis Using Google Tools

BACKGROUND

The number of medical and health apps in the App Store and Google Play repositories has been increasing in the recent years, and most of these apps are in English. However, little is known about the domain of Spanish health apps and their evolution.

OBJECTIVE

The aim of this study was to perform a retrospective descriptive analysis of medical apps for patients in the Spanish language by using Google search tools over a 5-year period and to compare the results by using a reproducible methodology to obtain a better knowledge of the medical apps available in the Spanish Language.

METHODS

Over a 5-year period, medical apps were catalogued using a Google-based methodology. Keywords of the first 14 categories of the International Classification of Diseases, Tenth Revision, were selected, and in December of each year, searches of the URLs of Google Play and the App Store were conducted using Google Advanced Search. The first 10 results were taken, and apps meeting the inclusion criteria were selected and rated with the iSYScore method.

RESULTS

Out of a sample of 1358 apps, 136 met the inclusion criteria. The 3 main categories of the medical apps were in the fields of endocrinology (diabetes), respiratory (chronic obstructive pulmonary disease, asthma, and allergies), and neurology (multiple sclerosis, Parkinson disease, and Alzheimer disease). Few apps were maintained over the 5 years. Only 10 of the 136 apps were maintained for 3 years or more. There was a large number of original apps in other languages that were translated into Spanish (56/136, 41.2%). In the last year of the study, the main reason (73/280, 26.1%) for discarding an app was the date of the last update.

CONCLUSIONS

The market of Spanish apps is poor; only few apps have appeared repeatedly over 5 years. Differences were found with the international market in terms of apps related to mental health, heart and circulatory system, and cancer, and coincidences were found in the relevance of apps for diabetes control.

Status of Institutional Review Board Meetings Conducted Through Web Conference Systems in Japanese National University Hospitals During the COVID-19 Pandemic: Questionnaire Study

Background

With the global proliferation of the novel COVID-19 disease, conventionally conducting institutional review board (IRB) meetings has become a difficult task. Amid concerns about the suspension of drug development due to delays within IRBs, it has been suggested that IRB meetings should be temporarily conducted via the internet.

Objective

This study aimed to elucidate the current status of IRB meetings conducted through web conference systems.

Methods

A survey on conducting IRB meetings through web conference systems was administered to Japanese national university hospitals. Respondents were in charge of operating IRB offices at different universities. This study was not a randomized controlled trial.

Results

The survey was performed at 42 facilities between the end of May and early June, 2020, immediately after the state of emergency was lifted in Japan. The survey yielded a response rate of 74% (31/42). Additionally, while 68% (21/31) of facilities introduced web conference systems for IRB meetings, 13% (4/31) of the surveyed facilities postponed IRB meetings. Therefore, we conducted a further survey of 21 facilities that implemented web conference systems for IRB meetings. According to 71% (15/21) of the respondents, there was no financial burden for implementing these systems, as they were free of charge. In 90% (19/21) of the facilities, IRB meetings through web conference systems were already being conducted with personal electronic devices. Furthermore, in 48% (10/21) of facilities, a web conference system was used in conjunction with face-to-face meetings.

Conclusions

Due to the COVID-19 pandemic, the number of reviews in clinical trial core hospitals has decreased. This suggests that the development of pharmaceuticals has stagnated because of COVID-19. According to 71% (15/21) of the respondents who conducted IRB meetings through web conference systems, the cost of introducing such meetings was US $0, showing a negligible financial burden. Moreover, it was shown that online deliberations could be carried out in the same manner as face-to-face meetings, as 86% (18/21) of facilities stated that the number of comments made by board members did not change. To improve the quality of IRB meetings conducted through web conference systems, it is necessary to further examine camera use and the content displayed on members’ screens during meetings. Further examination of all members who use web conference systems is required. Our measures for addressing the requests and problems identified in our study could potentially be considered protocols for future IRB meetings, when the COVID-19 pandemic has passed and face-to-face meetings are possible again. This study also highlights the importance of developing web conference systems for IRB meetings to respond to future unforeseen pandemics.

Evaluation of Factors Associated with Anxiety and Depression in Chinese Visiting Scholars in the United States During the COVID-19 Pandemic Assessed by Online Questionnaires

Background

This study aimed to use online questionnaires to evaluate the factors associated with anxiety and depression in Chinese visiting scholars in the United States during the COVID-19 pandemic.

Material/Methods

Using a cross-sectional design, 311 Chinese scholars visiting 41 states in the United States were interviewed on 20 and 21 April 2020 through WeChat using the Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder-7 (GAD-7) questionnaire.

Results

Of these 311 visiting scholars, 69 (22.2%) reported no symptoms of anxiety or depression, whereas 63 (20.3%) reported severe anxiety and 67 (21.5%) reported severe depression. Risk of anxiety was 93% higher in visiting scholars with than without accompanying parents in the US (odds ratio [OR], 1.93; 95% confidence interval [CI], 1.01–3.68) and was 1.72-fold (95% CI, 1.04–2.84) higher in those experiencing stress about family members with COVID-19. Stresses about personal security and return to China on schedule were associated with 1.73-fold (95% CI, 1.03–2.92) and 3.00-fold (95% CI, 1.51–5.95) higher risks of anxiety, respectively. Risks of depression were 1.86-fold (95% CI, 1.14–3.05), 1.84-fold (95% CI, 1.10–3.07), and 3.45-fold (95% CI, 1.72–6.92) higher in visiting Chinese scholars who were than were not experiencing stresses about financial support, personal security and return to China on schedule, respectively.

Conclusions

Chinese scholars visiting the United States during the COVID-19 pandemic experienced severe psychological distress. Surveys that include larger numbers of visiting scholars are warranted.

Increasing dietary fibre intake in healthy adults using personalised dietary advice compared with general advice: a single-blind randomised controlled trial

Objective:

A high-fibre diet is associated with a lower risk for diseases. However, few adults meet the dietary fibre recommendation. Therefore, the effects and acceptance of an algorithm-generated personalised dietary advice (PDA) compared with general advice (GA) on fibre intake were investigated.

Design:

A 6-week, single-blind randomised controlled trial with a 3-month follow-up.

Setting:

PDA was based on habitual intake and provided fibre-rich alternatives using a website; GA contained brochures. Dietary intake was assessed at baseline, week 1, week 6 and 3-month follow-up. Both groups evaluated their advice at week 6. All participants had access to PDA from week 7 until 3-month follow-up.

Participants:

Two groups of healthy adults: PDA (n 34) and GA (n 47). For 3-month follow-up analysis, participants were re-divided into visitors (n 52) and non-visitors (n 26) of the PDA.

Results:

At week 6, energy intake remained stable in both groups, but fibre intake per 1000 kcal increased non-significantly in both groups (PDA = Δ0·5 ± 2·8; GA = Δ0·8 ± 3·1, P = 0·128). Importantly, a significantly higher percentage of PDA participants adhered to the recommendation compared with week 1 (PDA = 21 % increase; GA = 4 % increase, P ≤ 0·001). PDA participants evaluated the advice significantly better compared with GA participants. At 3-month follow-up, fibre intake increased compared with baseline (visitors = Δ2·2 ± 2·6, P < 0·001; non-visitors = Δ1·5 ± 1·9, P = 0·001), but was insignificantly different between groups. Visitors had a decrease and non-visitors had an increase in energy intake (visitors =Δ − 132 ± 525; non-visitors = Δ109 ± 507, P = 0·055).

Conclusions:

The algorithm-generated PDA was well accepted and stimulated adherence to the recommendations more than GA, indicating to be a suitable and cost-efficient method for improving dietary fibre intake in healthy adults.

Clinician's Guide to Evaluating and Developing eHealth Interventions for Mental Health

Objective

This review aimed to examine key information regarding technology‐delivered interventions for patients with mental health and/or substance use disorders and to provide support for efforts by psychiatrists and other mental health professionals in recommending applications or helping to develop new technology‐delivered interventions.

Methods

The authors reviewed existing information about the appraisal, development, and evaluation of technology‐delivered interventions (eHealth interventions).

Results

High‐level guidance is available for clinicians who want to evaluate eHealth applications for their patients. Clinicians should be familiar with existing models of eHealth intervention development and with traditional as well as unique elements in the evaluation of efficacy for these approaches. However, existing intervention development models have not been empirically validated, and only one includes empirical optimization as an inherent part of its process.

Conclusions

Because of the proliferation of eHealth interventions, mental health professionals should bring to this area the same level of content knowledge, understanding of development and evaluation processes, and rigorous skepticism as they do for pharmacotherapy and therapist‐delivered behavioral interventions.

eHealth interventions are rapidly transforming mental health treatment.

Clinicians should apply the same rigor to evaluating eHealth interventions that they apply to pharmacological treatments or other behavioral therapies.

High‐level guidance and recommendations regarding ideal eHealth intervention development are available to aid in such evaluation, but empirical evidence in support of these guidelines is lacking.

Justice-involved women's preferences for an internet-based Sexual Health Empowerment curriculum

PURPOSE

The purpose of this paper is to gain insight into justice-involved women's preferences for an internet-based Sexual Health Empowerment (SHE) curriculum.

DESIGN/METHODOLOGY/APPROACH

The authors analyzed data from four focus groups conducted with 52 women in a minimum-security county jail in a Midwestern US city.

FINDINGS

Women reported daily access to the internet while in the community and use of the internet for searching about health concerns. Four themes emerged in the discussion about preferences for an internet-based SHE curriculum, that it cover healthy sexual expression, how to access resources, video as an educational modality and a non-judgmental approach.

PRACTICAL IMPLICATIONS

Justice-involved women are potentially reachable through internet-based health education. Their preferences for content and modality can be used to inform internet-based sexual health programming designed specifically for this population. Using this modality could offer easily disseminated, low-cost and consistent messaging about sexual health for a vulnerable group of women.

ORIGINALITY/VALUE

Though internet-based health education programming has been widely utilized in the general population, less attention has been paid to if and how these programs could be utilized with a vulnerable group of women who move between the justice system and communities. This exploratory study begins to fill that gap.

An online supported self-management toolkit for relatives of people with psychosis or bipolar experiences: the IMPART multiple case study

Background

Digital health interventions have the potential to improve the delivery of psychoeducation to people with mental health problems and their relatives. Despite substantial investment in the development of digital health interventions, successful implementation into routine clinical practice is rare.

Objectives

Use the implementation of the Relatives’ Education And Coping Toolkit (REACT) for psychosis/bipolar disorder to identify critical factors affecting uptake and use, and develop an implementation plan to support the delivery of REACT.

Design

This was an implementation study using a mixed-methods, theory-driven, multiple case study approach. A study-specific implementation theory for REACT based on normalisation process theory was developed and tested, and iterations of an implementation plan to address the key factors affecting implementation were developed.

Setting

Early-intervention teams in six NHS mental health trusts in England (three in the north and three in the south).

Participants

In total, 281 staff accounts and 159 relatives’ accounts were created, 129 staff and 23 relatives took part in qualitative interviews about their experiences, and 132 relatives provided demographic data, 56 provided baseline data, 21 provided data at 12 weeks’ follow-up and 20 provided data at 24 weeks’ follow-up.

Interventions

REACT is an online supported self-management toolkit, offering 12 evidence-based psychoeducation modules and support via a forum, and a confidential direct messaging service for relatives of people with psychosis or bipolar disorder. The implementation intervention was developed with staff and iteratively adapted to address identified barriers. Adaptations included modifications to the toolkit and how it was delivered by teams.

Main outcome measures

The main outcome was factors affecting implementation of REACT, assessed primarily through in-depth interviews with staff and relatives. We also assessed quantitative measures of delivery (staff accounts and relatives’ invitations), use of REACT (relatives’ logins and time spent on the website) and the impact of REACT [relatives’ distress (General Health Questionnaire-28), and carer well-being and support (Carer Well-being and Support Scale questionnaire)].

Results

Staff and relatives were generally positive about the content of REACT, seeing it as a valuable resource that could help services improve support and meet clinical targets, but only within a comprehensive service that included face-to-face support, and with some additional content. Barriers to implementation included high staff caseloads and difficulties with prioritising supporting relatives; technical difficulties of using REACT; poor interoperability with trust information technology systems and care pathways; lack of access to mobile technology and information technology training; restricted forum populations leading to low levels of use; staff fears of managing risk, online trolling, or replacement by technology; and uncertainty around REACT’s long-term availability. There was no evidence that REACT would reduce staff time supporting relatives (which was already very low), and might increase it by facilitating communication. In all, 281 staff accounts were created, but only 57 staff sent relatives invitations. In total, 355 relatives’ invitations were sent to 310 unique relatives, leading to the creation of 159 relatives’ accounts. The mean number of logins for relatives was 3.78 (standard deviation 4.43), but with wide variation from 0 to 31 (median 2, interquartile range 1–8). The mean total time spent on the website was 40.6 minutes (standard deviation 54.54 minutes), with a range of 0–298 minutes (median 20.1 minutes, interquartile range 4.9–57.5 minutes). There was a pattern of declining mean scores for distress, social dysfunction, depression, anxiety and insomnia, and increases in relatives’ well-being and eHealth literacy, but no changes were statistically significant.

Conclusions

Digital health interventions, such as REACT, should be iteratively developed, evaluated, adapted and implemented, with staff and service user input, as part of a long-term strategy to develop integrated technology-enabled services. Implementation strategies must instil a sense of ownership for staff and ensure that they have adequate training, risk protocols and resources to deliver the technology. Cost-effectiveness and impact on workload and inequalities in accessing health care need further testing, along with the generalisability of our findings to other digital health interventions.

Limitations

REACT was offered by the same team running the IMPlementation of A Relatives’ Toolkit (IMPART) study, and was perceived by staff and relatives as a time-limited research study rather than ongoing clinical service, which affected engagement. Access to observational data was limited.

Trial registration

Current Controlled Trials ISRCTN16267685.

Funding

This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 37. See the NIHR Journals Library website for further project information.

Usability, acceptability, and feasibility of the Implementation of Infant Pain Practice Change (ImPaC) Resource

The Implementation of Infant Pain Practice (ImPaC) Resource is an eHealth tool designed to support infant pain practice change and ultimately enhance pain outcomes. The aim of this study was to determine users' perspectives on usability, acceptability, and feasibility of the ImPaC Resource. A descriptive prospective mixed‐methods quality improvement study was conducted at a pediatric hospital in Canada. Individual “think aloud” interviews were conducted in a nonclinical environment (Phase A); “near live” testing was conducted while users interacted with the Resource in clinical setting (Phase B); individual “think‐aloud” interviews were conducted in a nonclinical environment (Phase C). Outcomes included usability (System Usability Scale—SUS), acceptability (Acceptability E‐Scale—AES), and feasibility. Interview transcripts were coded per a priori themes using deductive content analysis to create a structured categorization matrix. In Phase A, 10 clinicians interacted with the Resource in individual sessions. Median SUS score was 73.75 (range 52.5‐92.5). In Phase B, four clinicians implemented the Resource in the neonatal intensive care unit (NICU) over 4 months. Median SUS score was 85 (82.5‐92.5), and median AES score was 24 (21‐24). In Phase C, an enhanced prototype was produced, and the same users from Phase B navigated the Resource in individual sessions. Median SUS score was 88.75 (85‐95), and median AES score was 27.5 (25‐29). Users considered the Resource as feasible for implementation, easy to navigate, engaging, intuitive, comprehensive, and evidence‐based. Users highlighted the potential transferability of the Resource to other contexts and settings. The enhanced version of the ImPaC Resource was usable, acceptable, feasible, and met users' expectations and requirements. Results lead the way for evaluation of the Resource in a nationwide cluster randomized trial including 18 NICUs. This knowledge‐rich platform is expected to enhance infant pain practices and outcomes in diverse clinical settings.

e-INEBRIA Special Interest Group Roadmap for Best Practices for Research on Brief Digital Interventions for Problematic Alcohol and Illicit Drug Use

There is great potential for scaling up the delivery of brief interventions for alcohol and illicit drug use, given the increasing coverage of mobile devices and technologies for digital interventions, including apps for smartphones and tablets. However, while the number of digital interventions is increasing rapidly, the involvement of brief-intervention researchers and the development of good practices has just begun. In 2018, the Special Interest Group on digital interventions of the International Network on Brief Interventions for Alcohol & Other Drugs (e-INEBRIA SIG) initiated a conversation regarding possible avenues of future research, which subsequently became a roadmap for digital interventions. This roadmap consists of points considered relevant for future research, ongoing technological developments, and their implementation across a continuum of prevention and care. Moreover, it outlines starting points for the diversification of brief digital interventions, as well as next steps for quality improvement and implementation in public health and clinical practice. The roadmap of the e-INEBRIA SIG on digital interventions is a starting point that indicates relevant next steps and provides orientation for researchers and interested practitioners with regard to the ambiguous literature and the complexity of current digital interventions.

Randomised Controlled Trial Evaluating Active versus Passive Waiting for Speech-Language Pathology

INTRODUCTION

High demand for speech-language pathology means children sometimes wait over 12 months for services, missing out on timely support. Waiting can be a time of stress, concern, and powerlessness for caregivers. Provision of information via a website may support families and encourage active waiting.

OBJECTIVE

The aim of this study was to compare children's speech, intelligibility, language, and literacy outcomes, and caregivers' satisfaction and empowerment in active versus passive waiting conditions.

METHODS

Ninety-seven preschool-aged children referred to a community health speech-language pathology service in Australia were screened for eligibility. Eligible children (n =42) with speech/language difficulties were randomly allocated to: (a) active waiting (provision of a purpose-built website; n = 20), or (b) passive waiting (control group; n = 22). Pre- and post-assessments (after 6 months on a waiting list) were completed with children and caregivers by a speech-language pathologist blinded to group allocations.

RESULTS

Intention to treat (n =36) and per-protocol analyses (n =30) were conducted to measure group differences in child and caregiver outcomes at post-assessment using one-way ANCOVA, controlling for baseline scores. There were no statistically significant differences between groups for children's speech, intelligibility, language, and literacy, or caregivers' empowerment and satisfaction. Children in both groups made minimal gains over 6 months.

CONCLUSIONS

Provision of an active waiting website did not lead to statistically significant change in child or caregiver outcomes, and children in both groups made little progress over a 6-month period. Early speech-language pathology intervention delivered with appropriate dosage is needed to optimise children's outcomes. Until timely and effective speech-language pathology intervention can be provided for all who need it, provision of early assessments may be beneficial. There remains a need for effective ways to support children and families on waiting lists.

Ethische Aspekte internet- und mobilgestützter Interventionen (IMIs) bei Suchtstörungen

Ziel der Studie Internet- und mobilgestützte Interventionen (IMIs) werden häufig bei Suchtstörungen eingesetzt. Für die Wirksamkeit von IMIs liegt eine umfangreiche Evidenz vor. Hinsichtlich der spezifischen ethischen Aspekte, die sich aus dem Einsatz von IMIs bei Suchtstörungen ergeben, fehlt es bislang an Forschung. Mit unserem Beitrag leisten wir die erste eingehende ethische Analyse von IMIs in der Suchttherapie. Dabei orientieren wir uns an normativen Aspekten, die spezifisch für die Behandlung von Suchtstörungen sind. Dazu gehören die besondere Stigmatisierung von Suchtkranken, die Zuschreibung von Schuld und Eigenverantwortung, die mangelnde Akzeptanz des Krankheitskonzepts Sucht sowie die daraus resultierende Ablehnung und Abwertung von Betroffenen.

Methode Als methodisches Instrument verwenden wir den 3 ACES-Ansatz von Thornicroft und Tansella. Dieses Instrument erlaubt eine umfassende ethische Analyse des Einsatzes von IMIs im konkreten Einzelfall sowie der Implementierung von IMIs im Versorgungssystem.

Ergebnisse Unsere Analyse zeigt, dass IMIs in der Suchttherapie das Potential haben, ein Empowerment von PatientInnen zu leisten, die Stigmatisierung zu umgehen und einen niedrigschwelligen Zugang zu Versorgungsleistungen zu ermöglichen. Kritisch zu sehen sind Aspekte der Passung von Anwendungen auf die Bedürfnisse einzelner Patientengruppen und individueller PatientInnen, der therapeutischen Verantwortung, des Datenschutzes, der Datensicherheit und Privatheit sowie der Vernetzung unterschiedlicher Anbieter von Versorgungsleistungen.

Schlussfolgerung Eine weitere Implementierung von IMIs in der Suchttherapie ist nur dann wünschenswert, wenn verbindliche Qualitätsstandards geschaffen und die patientenzentrierte Anwendung unter Berücksichtigung individueller Patientencharakteristika sichergestellt wird.

Therapeutic utilization of meditation resources by people with multiple sclerosis: insights from an online patient discussion forum

We aimed to describe website traffic and qualitatively analyze an e-health community discussion forum. Participants in this study were people affected by multiple sclerosis visiting the Overcoming Multiple Sclerosis (OMS) website. This mixed methods study combined descriptive analysis of website traffic over 7 years and 1 month, and qualitative analysis of 1 week of posts in the meditation topic, coded into theme groups using qualitative thematic analysis. There were 166 meditation topics posted with 21,530 initial views of primary post and 785 sub-post responses. Meditation posts and sub-posts received 368,713 replies. Number of views increased from 4,684 in 2011 to over 80,000 in 2017, a considerably greater rate of increase than overall traffic. Qualitative analysis of posts on the meditation forum identified themes of barriers and enablers to utilization of meditation resources. Enablement themes dominated, observed across six of the seven theme groups with various forms of positive social and emotional support to learn and practice meditation. One theme, negative emotion, was identified as a barrier. The OMS peer-to-peer patient online discussion forum serves important functions in encouraging, educating and enabling its growing online community. Our analysis may help improve and innovate online support for lifestyle management in many chronic diseases.

Efficacy of Three Low-Intensity, Internet-Based Psychological Interventions for the Treatment of Depression in Primary Care: Randomized Controlled Trial

Background

Primary care is a major access point for the initial treatment of depression, but the management of these patients is far from optimal. The lack of time in primary care is one of the major difficulties for the delivery of evidence-based psychotherapy. During the last decade, research has focused on the development of brief psychotherapy and cost-effective internet-based interventions mostly based on cognitive behavioral therapy (CBT). Very little research has focused on alternative methods of treatment for depression using CBT. Thus, there is a need for research into other therapeutic approaches.

Objective

This study aimed to assess the effectiveness of 3 low-intensity, internet-based psychological interventions (healthy lifestyle psychoeducational program [HLP], focused program on positive affect promotion [PAPP], and brief intervention based on mindfulness [MP]) compared with a control condition (improved treatment as usual [iTAU]).

Methods

A multicenter, 4-arm, parallel randomized controlled trial was conducted between March 2015 and March 2016, with a follow-up of 12 months. In total, 221 adults with mild or moderate major depression were recruited in primary care settings from 3 Spanish regions. Patients were randomly distributed to iTAU (n=57), HLP (n=54), PAPP (n=56), and MP (n=54). All patients received iTAU from their general practitioners. The main outcome was the Spanish version of the Patient Health Questionnaire-9 (PHQ-9) from pretreatment (time 1) to posttreatment (time 2) and up to 6 (time 3) and 12 (time 4) months’ follow-up. Secondary outcomes included the visual analog scale of the EuroQol, the Short-Form Health Survey (SF-12), the Positive and Negative Affect Schedule (PANAS), and the Pemberton Happiness Index (PHI). We conducted regression models to estimate outcome differences along study stages.

Results

A moderate decrease was detected in PHQ-9 scores from HLP (β=–3.05; P=.01) and MP (β=–3.00; P=.01) compared with iTAU at posttreatment. There were significant differences between all intervention groups and iTAU in physical SF-12 scores at 6 months after treatment. Regarding well-being, MP and PAPP reported better PHI results than iTAU at 6 months post treatment. PAPP intervention significantly decreased PANAS negative affect scores compared with iTAU 12 months after treatment.

Conclusions

The low-intensity, internet-based psychological interventions (HLP and MP) for the treatment of depression in primary care are more effective than iTAU at posttreatment. Moreover, all low-intensity psychological interventions are also effective in improving medium- and long-term quality of life. PAPP is effective for improving health-related quality of life, negative affect, and well-being in patients with depression. Nevertheless, it is important to examine possible reasons that could be implicated for PAPP not being effective in reducing depressive symptomatology; in addition, more research is still needed to assess the cost-effectiveness analysis of these interventions.

Trial Registration

ISRCTN Registry ISRCTN82388279; http://www.isrctn.com/ISRCTN82388279

International Registered Report Identifier (IRRID)

RR2-10.1186/s12888-015-0475-0

Evaluating the co-use of opioids and cannabis for pain among current users using hypothetical purchase tasks

BACKGROUND

Cannabinoids may potentiate opioid analgesia and therefore could be used to reduce reliance on opioids for analgesia.

AIMS

The current study evaluated whether the concurrent availability of cannabis influences opioid consumption using a behavioral economic demand framework.

METHODS

An online survey assessed cannabis and opioid use frequency and dependence measures, pain severity, and demand for both cannabis and opioids alone and when concurrently available using hypothetical purchase tasks. Adults reporting current use of opioids for pain management and past 30-day cannabis exposure (N=155) completed two hypothetical purchase tasks in which only grams of cannabis or units of participants' index opioids were available for purchase, and two hypothetical tasks in which both were concurrently available and the price of one drug increased whereas the other was kept constant. Paired-sample t-tests compared the demand of each drug alone with when it was available concurrently with an alternative.

RESULTS

Demand intensity was significantly reduced and demand elasticity was significantly increased for both cannabis and opioids when the alternate commodity was available, although the reductions in cannabis consumption were more pronounced than they were for opioid consumption in the presence of the alternate commodity.

CONCLUSIONS

These data provide behavioral economic evidence that cannabis access may modestly reduce demand for opioids in persons who have pain. Additional clinical studies that evaluate the analgesic effects of cannabis and cannabis-opioid effects on pain are warranted.

Testing the efficacy of a minimal-guidance online self-help intervention for alcohol misuse in Estonia: study protocol of a randomized controlled trial

Background

Despite an initial steep decrease in alcohol misuse among Estonians through structural intervention means and the scaling up of alcohol counselling in the mid-2000’s, most of the country’s alcohol misuse indicators remain clearly higher than European averages. Consequently, an online self-help program was launched as part of an initial behavioral intervention initiative to foster progress in alcohol prevention on a population level.

Methods

A two-arm randomized controlled trial (RCT) has been designed to compare the efficacy of a culturally-adapted minimal-guidance online self-help program, the 8-week “Selge” online program against a control condition that consists of a self-administered test of alcohol use and advice regarding usual treatment in Estonia. A target sample of 600 individuals will be recruited and randomly assigned to either condition. The program will contain 10 modules based on principles of cognitive behavioural therapy (CBT) and motivational interviewing (MI). Participants in the control group will have access to the full treatment after they complete their final follow-up assessment. The primary outcome will be change in the Alcohol Use Disorders Identification Test (AUDIT) score between the 6-month follow-up and baseline assessments. Secondary outcomes will include the number of standard drinks consumed and alcohol-free days, drinking motives and motivation for change, as well as changes in mental health. Assessments will be completed at baseline, at the end of treatment, and at 6 months follow-up. Data analysis will follow the intention-to-treat principle and employ (generalised) linear mixed models.

Discussion

The “Selge” program is the first and only internet program for the intervention of alcohol misuse in Estonia. If proven effective, it will foster progress in the intervention of alcohol misuse in the Estonian population and be implemented as a standard program amidst the continuum of intervention and care.

Trial registration

Current Controlled Trials ISRCTN48753339 registered 04/06/2019 retrospectively.

Prevention and adherence in Rheumatic and Musculoskeletal disease

Rheumatic and Musculoskeletal Diseases (RMDs) are chronic conditions that affect a substantial number of people. RMDs are significantly related to co-morbidity. Therefore, focusing on prevention in RMDs is of importance to promote and maintain health. Prevention includes primary-, secondary-, tertiary-, and clinical prevention. Primary prevention aims to prevent the onset of disease before the disease process begins, secondary prevention includes detecting and reducing disease and risk factors at the earliest possible point, and tertiary prevention aims to limit the influence of a recognized or verified disease and to address or reduce further development or worsening of the disease, including physical and psychosocial disability. Clinical prevention attempts to integrate prevention into the disease management to limit disease progression and prevent complications and relapse. This chapter will focus on the evidence for prevention and highlight how innovations and trends can contribute by using digital technologies as an example.

E-Sexual Health: A Position Statement of the European Society for Sexual Medicine

BACKGROUND

Opportunities and pitfalls of e-health have been described and assessed in various health domains, but in the field of sexual health, the respective literature is limited.

AIM

The aim of this document is to present the European Society of Sexual Medicine's (ESSM) current position statement on e-sexual health.

METHODS

This statement article is an expert opinion-based proposal that was developed under the auspices of the ESSM with input from the e-sexual health subcommittee of the ESSM Scientific Committee.

OUTCOMES

ESSM statements were provided on four domains: health information for patients, e-learning for professionals, health interventions, and health research.

RESULTS

e-Sexual health is the use of information and communication technologies for sexual health including sexual health care, surveillance, education, knowledge, and research. Quality indicators have to be applied on Web pages that provide sexual health information, e-learning can increase educational opportunities for professionals, online treatment interventions can be effective but needs to be available to the public, and online health research can provide access to difficult to reach populations.

CLINICAL IMPLICATIONS

The ESSM acknowledges the necessity for the use of information and communication technologies to meet the sexual health needs of citizens and patients and also the professional needs of sexual healthcare providers, in an evidence-based manner.

STRENGTHS & LIMITATIONS

ESSM statements on this topic were provided based on expert opinion and summarize the ESSM position in this field.

CONCLUSION

The ESSM believes that e-sexual health can provide opportunities for the improvement of the sexual health of the population. Kirana PS, Gudeloglu A, Sansone A, et al. E-Sexual Health: A Position Statement of the European Society for Sexual Medicine. J Sex Med 2020;17;1246-1253.

Local Government Website Accessibility—Evidence from Poland

The paper investigates the accessibility of local government websites. It focuses in particular on disability, e-administration, and web accessibility standards for the visually impaired. The research involved 182 websites of local government bodies of the Małopolskie Voivodeship (Poland). It employed selected automated testing applications. The occurrence of selected accessibility tools on the websites was verified with a cognitive walkthrough. A questionnaire survey was conducted as well. Results of the automatic measurements were standardized using the unitarization method. The effort yielded an aggregate final score for each website in the form of the AAR (Aggregate Accessibility Rating). It was used to build a ranking list of the websites and order them by the accessibility criterion. The websites achieved 57.23% of the available AAR points in total. This indicates there is a great opportunity for improvement in the accessibility of the investigated websites (in the employed research design). Moreover, municipalities were found to be heavily committed to the questionnaire survey, which is indicative of the importance and relevance of the problem of accessibility and quality of public websites.

An Innovative Electronic Health Toolkit (Our Whole Lives for Chronic Pain) to Reduce Chronic Pain in Patients With Health Disparities: Open Clinical Trial

Background

Chronic pain affects millions of Americans. Our Whole Lives, an electronic health (eHealth) toolkit for Chronic Pain (Our Whole Lives for Chronic Pain [OWLCP]), is a mind-body chronic pain management platform that teaches self-management strategies to reduce pain impact and pain medication use.

Objective

The primary goal of this study was to evaluate the feasibility of OWLCP in reducing pain impact and pain-related outcomes.

Methods

We conducted a pre-post clinical study (2 cohorts) to assess the feasibility of OWLCP usage among low-income patients with chronic pain. Outcome data, collected at baseline and 9 weeks, included Patient-Reported Outcomes Measurement Information System (PROMIS-29), pain self-efficacy, and pain medication use. In the statistical analysis, we used descriptive statistics, logistic regression, linear regression, and qualitative methods.

Results

Among the enrolled 43 participants, the average age was 50 years, (39/43) 91% were female, (16/43) 37% were black, and (7/43) 16% were Hispanic. From baseline to follow-up, the PROMIS measures showed a reduction in depression (P=.02), pain interference (P=.003), and average pain impact score (P=.007). Pain self-efficacy increased ((P<.001), whereas opioid use had a 13% reduction (P=.03).

Conclusions

The eHealth chronic pain management platform, OWLCP, is a potential tool to reduce the impact of chronic pain for low-income racially diverse populations.