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Tarro L, Llauradó E, Ulldemolins G, Hermoso P, Solà R. Effectiveness of Workplace Interventions for Improving Absenteeism, Productivity, and Work Ability of Employees: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E1901. [PMID: 32183392 PMCID: PMC7142489 DOI: 10.3390/ijerph17061901] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 02/26/2020] [Accepted: 03/10/2020] [Indexed: 12/20/2022]
Abstract
To determine the effectiveness of workplace interventions and the most effective methodological design for the improvement of employee productivity, work ability, and absenteeism. A meta-analysis of randomized controlled trials (RCTs) of workplace interventions was conducted (PROSPERO, CRD42018094083). The PubMed, Scopus, PsycINFO, and Cochrane databases were searched. RCTs from 2000 to 2017 and with employees (18-65 years) were selected. Then, intervention characteristics and work-related outcomes data were extracted. A total of 47 RCTs were included in the systematic review, and 19 RCTs (11 absenteeism, 7 productivity, and 5 work ability) were included in the meta-analysis. The meta-analysis showed that the effectiveness of workplace interventions for absenteeism was -1.56 (95% CI, -2.67 to -0.44) and -2.65 (95% CI, -4.49 to -0.81) considering only moderate quality RCTs. In contrast, only a few studies of workplace interventions for productivity and work ability were included, which was insufficient for determining the effectiveness and best design for improving these work outcomes. The workplace is an interesting environment to reduce absenteeism, and individualized and counseling interventions with <10 sessions/total were the most effective workplace intervention methodological design for reducing the absenteeism of employees. Future high-quality RCTs that also consider health risks should be implemented to strengthen the results.
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Affiliation(s)
- Lucia Tarro
- Universitat Rovira i Virgili, Facultat de Medicina i Ciències de la Salut, Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), Health Education and Promotion, 43201 Reus, Spain;
- Technological Unit of Nutrition and Health, EURECAT-Technology Centre of Catalonia, 43204 Reus, Spain
| | - Elisabet Llauradó
- Universitat Rovira i Virgili, Facultat de Medicina i Ciències de la Salut, Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), Health Education and Promotion, 43201 Reus, Spain;
| | - Gemma Ulldemolins
- Activa Mutua, Mutua Colaboradora con la Seguridad Social, Tarragona, 43204 Catalonia, Spain; (G.U.); (P.H.)
| | - Pedro Hermoso
- Activa Mutua, Mutua Colaboradora con la Seguridad Social, Tarragona, 43204 Catalonia, Spain; (G.U.); (P.H.)
| | - Rosa Solà
- Universitat Rovira i Virgili, Facultat de Medicina i Ciències de la Salut, Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), Health Education and Promotion, 43201 Reus, Spain;
- Technological Unit of Nutrition and Health, EURECAT-Technology Centre of Catalonia, 43204 Reus, Spain
- Hospital Universitari Sant Joan de Reus, Internal medicine department IISPV, Reus, 43204 Catalonia, Spain
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102
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Erbes CR, Kuhn E, Polusny MA, Ruzek JI, Spoont M, Meis LA, Gifford E, Weingardt KR, Campbell EH, Oleson H, Taylor BC. A Pilot Trial of Online Training for Family Well-Being and Veteran Treatment Initiation for PTSD. Mil Med 2020; 185:401-408. [PMID: 31621884 DOI: 10.1093/milmed/usz326] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 07/27/2019] [Accepted: 08/13/2019] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Family members are important supports for veterans with Posttrauamtic Stress Disroder (PTSD), but they often struggle with their own distress and challenges. The Veterans Affairs-Community Reinforcement and Family Training (VA-CRAFT) website was designed to teach family members of veterans with PTSD effective ways to interact with their veterans to encourage initiation of mental health services as well as to care for themselves and improve their relationships. This article presents a pilot investigation of VA-CRAFT. MATERIALS AND METHOD Spouse/partners of veterans who had screened positive for PTSD but were not in mental health treatment were randomized to either use the VA-CRAFT website (n = 22) or to a waitlist control condition (n = 19) for 3 months. Veteran mental health service initiation was assessed posttreatment. Spouse/partner distress, caregiver burden, quality of life, and relationship quality were assessed pre and posttreatment. The study was approved by the Minneapolis VA Health Care System Institutional Review Board (IRB). RESULTS Differences between groups on veteran treatment initiation were small (Phi = 0.17) and not statistically significant. VA-CRAFT participants reported large and statistically significantly greater decreases in overall caregiver burden (η2 = 0.10) and objective caregiver burden (η2 = 0.14) than control participants. Effects were larger for those with greater initial distress. Effects sizes for other partner outcomes were negligible (η2 = 0.01) to medium (η2 = 0.09) and not statistically significant. Postintervention interviews suggested that only 33% of the VA-CRAFT participants talked with their veterans about starting treatment for PTSD during the trial. CONCLUSION Results from this pilot trial suggest that VA-CRAFT holds initial promise in reducing caregiver burden and as such it could be a useful resource for family members of veterans with PTSD. However, VA-CRAFT does not enhance veteran treatment initiation. It may benefit from enhancements to increase effectiveness and caregiver engagement.
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Affiliation(s)
- Christopher R Erbes
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, One Veterans Drive, Minneapolis, MN 55417
- University of Minnesota Medical School, 420 Delaware St., Minneapolis, MN 55455
| | - Eric Kuhn
- Veterans Affairs Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA 94025
- Stanford University School of Medicine, 291 Campus Drive, Stanford, CA 94305
- National Center for PTSD, 795 Willow Road Menlo Park, CA 94025
| | - Melissa A Polusny
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, One Veterans Drive, Minneapolis, MN 55417
- University of Minnesota Medical School, 420 Delaware St., Minneapolis, MN 55455
| | - Josef I Ruzek
- Veterans Affairs Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA 94025
- Stanford University School of Medicine, 291 Campus Drive, Stanford, CA 94305
- National Center for PTSD, 795 Willow Road Menlo Park, CA 94025
| | - Michele Spoont
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, One Veterans Drive, Minneapolis, MN 55417
- University of Minnesota Medical School, 420 Delaware St., Minneapolis, MN 55455
- National Center for PTSD, 795 Willow Road Menlo Park, CA 94025
| | - Laura A Meis
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, One Veterans Drive, Minneapolis, MN 55417
- University of Minnesota Medical School, 420 Delaware St., Minneapolis, MN 55455
| | - Elizabeth Gifford
- Veterans Affairs Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA 94025
| | | | - Emily Hagel Campbell
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, One Veterans Drive, Minneapolis, MN 55417
| | - Heather Oleson
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, One Veterans Drive, Minneapolis, MN 55417
| | - Brent C Taylor
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, One Veterans Drive, Minneapolis, MN 55417
- University of Minnesota Medical School, 420 Delaware St., Minneapolis, MN 55455
- University of Minnesota School of Public Health, 420 Delaware St., Minneapolis, MN 55455
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103
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Sakaguti NM, Fernandes MM, Mazzilli LEN, Plana JAC, Bouchardet FCH, Nogueira de Oliveira R. Development of a computer-aided design software for the quantitative evaluation of aesthetic damage. PLoS One 2019; 14:e0226322. [PMID: 31851712 PMCID: PMC6919621 DOI: 10.1371/journal.pone.0226322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 11/24/2019] [Indexed: 11/18/2022] Open
Abstract
Concerns associated with the assessment of aesthetic damage or injury raise critical difficulties, such as the scarcity of methodology and standardization that may result in fundamental precepts to establish impartial forms of compensation and aiming the total reparation of bodily injury. The complexity of the aesthetic damage evaluation is associated with the confluence of legal and technical perspectives and expert subjectivity while conducting examination and writing a report. Experts face additional difficulties associated with the objectivity while assessing aesthetic damage, independently on its location or expert skills, due to complex details observed in these lesions. Another situation in the clinical area, doctors (mainly plastic surgeons) and dentists could show the improvement or not, of the aesthetic condition to the patients. In health related areas, the use of information technology has contributed to increase the number of appropriate diagnoses, besides promoting quality, efficiency and satisfaction to health care providers. In order to make this assessment more objective, a technological tool was developed to aid experts in the evaluation of aesthetic damage and report elaboration. The objective was to develop computer-aided design software for aesthetic damage quantification/evaluation that is accessible via internet to be applied as a complementary report on body aesthetic damage. The software uses as a parameter the AIPE method, translated transculturally from Spanish to Portuguese and English. The present study allowed the construction of open access auxiliary software for the evaluation of corporal aesthetic damage. Its use is facilitated by intuitive and interactive filling, and the text may be customized by the user. It transforms the report into PDF and saves all evaluations already done in its own file. Information is encrypted for added security and confidentiality. The software is available on website at https://www.aestheticdamage.com.
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Affiliation(s)
- Nelson Massanobu Sakaguti
- Forensic Dentistry, Department of Social Dentistry, University of Sao Paulo, Sao Paulo, Brazil
- * E-mail:
| | - Mário Marques Fernandes
- Forensic Dentistry, Department of Social Dentistry, University of Sao Paulo, Sao Paulo, Brazil
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104
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Haderlein TP. Efficacy of technology-based eating disorder treatment: A meta-analysis. CURRENT PSYCHOLOGY 2019. [DOI: 10.1007/s12144-019-00448-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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105
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Lattie EG, Kashima K, Duffecy JL. An open trial of internet-based cognitive behavioral therapy for first year medical students. Internet Interv 2019; 18:100279. [PMID: 31534911 PMCID: PMC6743024 DOI: 10.1016/j.invent.2019.100279] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 08/21/2019] [Accepted: 09/02/2019] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE Medical students experience high rates of depression, and often face barriers to receiving traditional mental health services. Internet-based cognitive behavioral therapy (iCBT) programs offer a more accessible method of receiving care. Here, we conducted an open trial of an iCBT program for medical students and characterize program usage, program users, and self-reported psychosocial symptoms and coping skills. METHODS All incoming first year medical students at a large state-run university were invited to use an iCBT program which focused on mood management and mood symptom prevention. Participants received access to the 16-week program and completed measures of perceived stress, quality of life, and the development of cognitive and behavioral coping skills at baseline and end of program. RESULTS Of the 194 students in the class, 53 (27.32%) signed up to use the program. While the program attracted a representative portion of underrepresented minority students, program engagement among males was particularly low. Repeated use of the program was low. Self-reported symptoms of depression and anxiety were low at baseline, and continued to be low at end of program. Slight increases were observed from baseline to end of program in the self-reported use of cognitive coping skills. CONCLUSIONS Digital mental health tools appear to be of interest to first year medical students, but need to be better designed to support continued program use and to attract specific subgroups of students who may face additional barriers to seeking mental health services.
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Affiliation(s)
- Emily G. Lattie
- Center for Behavioral Intervention Technologies, Department of Medical Social Sciences, Northwestern University, Chicago, IL, United States
| | - Kathleen Kashima
- College of Medicine, University of Illinois, Chicago, IL, United States
| | - Jennifer L. Duffecy
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States
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106
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Khan K, Hall CL, Davies EB, Hollis C, Glazebrook C. The Effectiveness of Web-Based Interventions Delivered to Children and Young People With Neurodevelopmental Disorders: Systematic Review and Meta-Analysis. J Med Internet Res 2019; 21:e13478. [PMID: 31682573 PMCID: PMC6858614 DOI: 10.2196/13478] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 06/12/2019] [Accepted: 07/28/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The prevalence of certain neurodevelopmental disorders, specifically autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD), has been increasing over the last four decades. Nonpharmacological interventions are available that can improve outcomes and reduce associated symptoms such as anxiety, but these are often difficult to access. Children and young people are using the internet and digital technology at higher rates than any other demographic, but although Web-based interventions have the potential to improve health outcomes in those with long-term conditions, no previous reviews have investigated the effectiveness of Web-based interventions delivered to children and young people with neurodevelopmental disorders. OBJECTIVE This study aimed to review the effectiveness of randomized controlled trials (RCTs) of Web-based interventions delivered to children and young people with neurodevelopmental disorders. METHODS Six databases and one trial register were searched in August and September 2018. RCTs were included if they were published in a peer-reviewed journal. Interventions were included if they (1) aimed to improve the diagnostic symptomology of the targeted neurodevelopmental disorder or associated psychological symptoms as measured by a valid and reliable outcome measure; (2) were delivered on the Web; (3) targeted a youth population (aged ≤18 years or reported a mean age of ≤18 years) with a diagnosis or suspected diagnosis of a neurodevelopmental disorder. Methodological quality was rated using the Joanna Briggs Institute Critical Appraisal Checklist for RCTs. RESULTS Of 5140 studies retrieved, 10 fulfilled the inclusion criteria. Half of the interventions were delivered to children and young people with ASDs with the other five targeting ADHD, tic disorder, dyscalculia, and specific learning disorder. In total, 6 of the 10 trials found that a Web-based intervention was effective in improving condition-specific outcomes or reducing comorbid psychological symptoms in children and young people. The 4 trials that failed to find an effect were all delivered by apps. The meta-analysis was conducted on five of the trials and did not show a significant effect, with a high level of heterogeneity detected (n=182 [33.4%, 182/545], 5 RCTs; pooled standardized mean difference=-0.39; 95% CI -0.98 to 0.20; Z=-1.29; P=.19 [I2=72%; P=.006]). CONCLUSIONS Web-based interventions can be effective in reducing symptoms in children and young people with neurodevelopmental disorders; however, caution should be taken when interpreting these findings owing to methodological limitations, the minimal number of papers retrieved, and small samples of included studies. Overall, the number of studies was small and mainly limited to ASD, thus restricting the generalizability of the findings. TRIAL REGISTRATION PROSPERO International Prospective Register of Systematic Reviews: CRD42018108824; http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42018108824.
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Affiliation(s)
- Kareem Khan
- Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Charlotte L Hall
- Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - E Bethan Davies
- Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom.,NIHR MindTech Medtech Co-operative, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Chris Hollis
- Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom.,NIHR MindTech Medtech Co-operative, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom.,NIHR Nottingham Biomedical Research Centre, Nottingham, United Kingdom
| | - Cris Glazebrook
- Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom.,NIHR MindTech Medtech Co-operative, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
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107
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Rich-Edwards JW, Stuart JJ, Skurnik G, Roche AT, Tsigas E, Fitzmaurice GM, Wilkins-Haug LE, Levkoff SE, Seely EW. Randomized Trial to Reduce Cardiovascular Risk in Women with Recent Preeclampsia. J Womens Health (Larchmt) 2019; 28:1493-1504. [DOI: 10.1089/jwh.2018.7523] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Affiliation(s)
- Janet W. Rich-Edwards
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Jennifer J. Stuart
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Geraldine Skurnik
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Andrea T. Roche
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Garrett M. Fitzmaurice
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Laboratory for Psychiatric Biostatistics, McLean Hospital, Belmont, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Louise E. Wilkins-Haug
- Department of Obstetrics, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sue E. Levkoff
- College of Social Work, University of South Carolina, Columbia, South Carolina
| | - Ellen W. Seely
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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108
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Joseph-Shehu EM, Ncama BP, Mooi N, Mashamba-Thompson TP. The use of information and communication technologies to promote healthy lifestyle behaviour: a systematic scoping review. BMJ Open 2019; 9:e029872. [PMID: 31662364 PMCID: PMC6830587 DOI: 10.1136/bmjopen-2019-029872] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Health-promoting lifestyle behaviours are part of the activities of daily living that influence individual happiness, values and well-being. They play a crucial role in prevention and control of non-communicable diseases (NCDs) among all age groups. Current statistics on mortality, disability and morbidity associated with NCDs are alarming globally. The use of information and communication technology (ICT) for a health-promoting lifestyle behaviour programme enhances health behaviours that are important in the prevention and control of both communicable and non-communicable diseases. Our study aimed to map evidence on the use of ICT in comprehensive health-promoting lifestyle behaviour among healthy adults. METHODS Eleven electronic databases were searched for the study. We included studies published in English between January 2007 and December 2018 reporting on healthy adults, ICT and any subscales of the health-promoting lifestyle profile (HPLP). Studies focusing on diseases or disease management and studies that combine monitoring tools in the form of hardware (accelerometer or pedometer) with ICT or computer games were excluded. Data were summarised numerically and thematically. RESULTS All the studies reviewed were conducted in developed countries. Most of the studies reported on physical activity, and findings of one study covered all the subscales of HPLP. The use of ICT for health-promoting lifestyle behaviours was reported to be effective in ensuring health behaviours that can improve physical and mental health. CONCLUSION Our findings showed that there is a dearth of knowledge on comprehensive health-promoting lifestyle behaviour that can be beneficial for the control and prevention of NCDs. There is a need to carry out primary studies on the use of ICT and comprehensive health-promoting lifestyle, especially among adults in low-income and middle-income countries where there are alarming statistics for mortality and disability associated with NCDs. PROSPERO REGISTRATION NUMBER CRD42016042568.
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Affiliation(s)
- Elizabeth Musili Joseph-Shehu
- Nursing, University of KwaZulu-Natal College of Health Sciences, Durban, KwaZulu-Natal, South Africa
- Nursing Science, National Open University of Nigeria, Jabi, Abuja, Nigeria
| | - Busisiwe Purity Ncama
- Nursing, University of KwaZulu-Natal College of Health Sciences, Durban, KwaZulu-Natal, South Africa
| | - Nomaxabiso Mooi
- Nursing, University of KwaZulu-Natal College of Health Sciences, Durban, KwaZulu-Natal, South Africa
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109
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Zwerenz R, Baumgarten C, Becker J, Tibubos A, Siepmann M, Knickenberg RJ, Beutel ME. Improving the Course of Depressive Symptoms After Inpatient Psychotherapy Using Adjunct Web-Based Self-Help: Follow-Up Results of a Randomized Controlled Trial. J Med Internet Res 2019; 21:e13655. [PMID: 31651403 PMCID: PMC6838691 DOI: 10.2196/13655] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 06/20/2019] [Accepted: 07/07/2019] [Indexed: 01/13/2023] Open
Abstract
Background We recently showed in a randomized controlled trial that Web-based self-help as an adjunct improved the effectiveness of multimodal inpatient psychotherapy for depression. Objective The aims of this study were (1) to determine whether a Web-based self-help adjunctive to multimodal inpatient psychotherapeutic treatment could also improve the course of depressive symptoms and (2) to identify predictors of residual depressive symptoms at follow-up. Methods Overall, 229 patients were randomized either to the Web-based self-help intervention group (Deprexis) or an active control group (Web-based information about depression and depressive symptoms) in addition to multimodal inpatient psychotherapy. Participants in both groups were able to access their respective Web-based programs for 12 weeks, which meant that they typically had access after discharge from the inpatient unit (mean hospitalization duration: 40 days, T1). Follow-up was performed 6 months after study intake (T3). Results At follow-up, participants of the Web-based self-help group had considerably lower symptom load regarding depressive symptoms (d=0.58) and anxiety (d=0.46) as well as a better quality of life (d=0.43) and self-esteem (d=0.31) than participants of the control group. Nearly 3 times as many participants of the intervention group compared with the control group achieved remission in accordance with less deterioration. The number needed to treat based on the Beck Depression Inventory-II (BDI-II) improved over time (T1: 7.84, T2: 7.09, and T3: 5.12). Significant outcome predictors were BDI at discharge and treatment group. Conclusions Web-based self-help as an add-on to multimodal inpatient psychotherapy improved the short-term course of depressive symptoms beyond termination. Residual symptoms at discharge from inpatient treatment and utilization of the Web-based self-help were the major predictors of depressive symptoms at follow-up. Challenges and barriers (eg, costs, therapists’ concerns, or technical barriers) of adding Web-based interventions to inpatient treatment have to be addressed. Trial Registration ClinicalTrials.gov NCT02196896; https://clinicaltrials.gov/ct2/show/NCT02196896.
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Affiliation(s)
- Rüdiger Zwerenz
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, Johannes Gutenberg-University, Mainz, Germany
| | - Carlotta Baumgarten
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, Johannes Gutenberg-University, Mainz, Germany
| | - Jan Becker
- Institute for Teachers' Health, University Medical Center, Johannes Gutenberg-University, Mainz, Germany
| | - Ana Tibubos
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, Johannes Gutenberg-University, Mainz, Germany
| | - Martin Siepmann
- Clinic for Psychosomatic Medicine, Rhön-Klinikum AG, Bad Neustadt/ Saale, Germany.,Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Rudolf J Knickenberg
- Clinic for Psychosomatic Medicine, Rhön-Klinikum AG, Bad Neustadt/ Saale, Germany
| | - Manfred E Beutel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, Johannes Gutenberg-University, Mainz, Germany
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Jonas B, Leuschner F, Eiling A, Schoelen C, Soellner R, Tossmann P. Web-Based Intervention and Email-Counseling for Problem Gamblers: Results of a Randomized Controlled Trial. J Gambl Stud 2019; 36:1341-1358. [PMID: 31560101 PMCID: PMC7674348 DOI: 10.1007/s10899-019-09883-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Web-based interventions have the potential to reduce the treatment gap for problem gambling. In the past years, several web-based help options were made available to the public. However, only few studies were conducted to test their effects. This study investigated the efficacy of two interventions for problem gamblers provided online by the German Federal Center for Health Education (BZgA). The first intervention is the guided program “Check Out” (CO), the second is email counselling (EC). A web-based randomized controlled trial with follow-up surveys after 3, 6 and 12 months was conducted. Participants were allocated to CO, to EC or to a waitlist (WL). Outcomes were the degree of problem gambling according to the Problem Gambling Severity Index, the number of days gambled in past 30 days, the highest stake during the past 30 days and the subjective well-being (WHO-5). 167 individuals were included in the trial. In comparison to the WL at the 3 months follow-up, participants of CO showed significant improvements with moderate to strong effect sizes in all outcomes. Strongest effects were found in the problem gambling severity (d = 0.91; p = 0.023), followed by the well-being (d = 0.70; p = 0.011), the gambling days (d = 0.59; p = 0.001) and the highest stake (d = 0.55; p = 0.012). Improvements were sustained until last follow-up. Compared to the WL, users of EC had beneficiary results in the problem gambling severity (d = 0.74; p = 0.022). No significant effect differences were found between CO and EC. However, according to process evaluation, users of CO reported a significantly stronger working alliance than users of EC (d = 0.70; p = 0.019) and used the intervention considerably longer (d = 0.84; p = 0.004). CO helps treatment-seeking individuals to sustainably reduce their gambling behavior and to increase their general well-being. Compared to EC, CO seems a better support option, since its effects include a wider range of outcomes. Possible reasons are the more engaging program structure and elements of CO, as well as the closer interaction between client and counselor.
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Affiliation(s)
- Benjamin Jonas
- Delphi - Gesellschaft für Forschung, Beratung und Projektentwicklung mbH, Kaiserdamm 8, 14057, Berlin, Germany.
| | - Fabian Leuschner
- Delphi - Gesellschaft für Forschung, Beratung und Projektentwicklung mbH, Kaiserdamm 8, 14057, Berlin, Germany
| | - Anna Eiling
- Delphi - Gesellschaft für Forschung, Beratung und Projektentwicklung mbH, Kaiserdamm 8, 14057, Berlin, Germany
| | | | | | - Peter Tossmann
- Delphi - Gesellschaft für Forschung, Beratung und Projektentwicklung mbH, Kaiserdamm 8, 14057, Berlin, Germany
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111
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Taylor R, Shrewsbury VA, Vincze L, Campbell L, Callister R, Park F, Schumacher T, Collins C, Hutchesson M. Be Healthe for Your Heart: Protocol for a Pilot Randomized Controlled Trial Evaluating a Web-Based Behavioral Intervention to Improve the Cardiovascular Health of Women With a History of Preeclampsia. Front Cardiovasc Med 2019; 6:144. [PMID: 31616675 PMCID: PMC6775183 DOI: 10.3389/fcvm.2019.00144] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 09/05/2019] [Indexed: 01/07/2023] Open
Abstract
Background: Women with a history of preeclampsia are at greater risk of cardiovascular disease (CVD) related morbidity. Despite this knowledge, there is a lack of interventions available for women with a history of preeclampsia for the prevention of CVD. The aim of this pilot randomized controlled trial (RCT) is to determine the acceptability and preliminary efficacy of a web-based behavioral intervention targeted to women with a history of preeclampsia (Be Healthe for your Heart). Method: Australian women aged 18-45 years, with a recent history (≤4 years post diagnosis) of preeclampsia will be recruited for a 3-months, 2-arm parallel group pilot RCT. Participants will be randomized into 2 study arms: (1) Be Healthe for your Heart or; (2) Control, with assessments conducted at baseline, and after 3-months. Be Healthe for your Heart is an intervention delivered online via the program website, with weekly emails to support changes in modifiable CVD risk factors (excess body weight, physical inactivity, poor diet, and stress), using behavior change techniques (e.g., self-monitoring, goal setting). Intervention acceptability (satisfaction, usability, appropriateness, and usage) and impact on absolute full CVD 30-years risk score, CVD risk markers, and modifiable risk factors will be assessed. Discussion: No studies to date have evaluated acceptability and preliminary efficacy of a web-based intervention for the prevention of CVD in this high-risk population with preeclampsia. This pilot trial will inform development of a fully powered RCT if acceptability and preliminary efficacy are demonstrated.
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Affiliation(s)
- Rachael Taylor
- School of Health Sciences, Priority Research Centre for Physical Activity and Nutrition, Faculty of Health and Medicine, The University of Newcastle, Newcastle, NSW, Australia
| | - Vanessa A. Shrewsbury
- School of Health Sciences, Priority Research Centre for Physical Activity and Nutrition, Faculty of Health and Medicine, The University of Newcastle, Newcastle, NSW, Australia
| | - Lisa Vincze
- School of Allied Health Sciences, Griffith University, Gold Coast, QLD, Australia
| | - Linda Campbell
- School of Psychology, Faculty of Science, The University of Newcastle, Newcastle, NSW, Australia
| | - Robin Callister
- School of Biomedical Sciences and Pharmacy, Priority Research Centre for Physical Activity and Nutrition, Faculty of Health and Medicine, The University of Newcastle, Newcastle, NSW, Australia
| | - Felicity Park
- Department of Maternal Fetal Medicine, John Hunter Hospital, Newcastle, NSW, Australia
| | - Tracy Schumacher
- Department of Rural Health, Faculty of Health and Medicine, University of Newcastle, Tamworth, NSW, Australia
| | - Clare Collins
- School of Health Sciences, Priority Research Centre for Physical Activity and Nutrition, Faculty of Health and Medicine, The University of Newcastle, Newcastle, NSW, Australia
| | - Melinda Hutchesson
- School of Health Sciences, Priority Research Centre for Physical Activity and Nutrition, Faculty of Health and Medicine, The University of Newcastle, Newcastle, NSW, Australia
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Tait RJ, Paz Castro R, Kirkman JJL, Moore JC, Schaub MP. A Digital Intervention Addressing Alcohol Use Problems (the "Daybreak" Program): Quasi-Experimental Randomized Controlled Trial. J Med Internet Res 2019; 21:e14967. [PMID: 31486406 PMCID: PMC6753690 DOI: 10.2196/14967] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 07/10/2019] [Accepted: 07/12/2019] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Alcohol use is prevalent in many societies and has major adverse impacts on health, but the availability of effective interventions limits treatment options for those who want assistance in changing their patterns of alcohol use. OBJECTIVE This study evaluated the new Daybreak program, which is accessible via mobile app and desktop and was developed by Hello Sunday Morning to support high-risk drinking individuals looking to change their relationship with alcohol. In particular, we compared the effect of adding online coaching via real-time chat messages (intervention group) to an otherwise self-guided program (control group). METHODS We designed the intervention as a randomized control trial, but as some people (n=48; 11.9%) in the control group were able to use the online coaching, the main analysis comprised all participants. We collected online surveys at one-month and three-months follow-up. The primary outcome was change in alcohol risk (measured with the alcohol use disorders identification test-consumption [AUDIT-C] score), but other outcomes included the number of standard drinks per week, alcohol-related days out of role, psychological distress (Kessler-10), and quality of life (EUROHIS-QOL). Markers of engagement with the program included posts to the site and comments on the posts of others. The primary analysis used Weighted Generalized Estimating Equations. RESULTS We recruited 398 people to the intervention group (50.2%) and 395 people to the control group (49.8%). Most were female (71%) and the mean age was 40.1 years. Most participants were classified as probably dependent (550, 69%) on the AUDIT-10, with 243 (31%) classified with hazardous or harmful consumption. We followed up with 334 (42.1%) participants at one month and 293 (36.9%) at three months. By three months there were significant improvements in AUDIT-C scores (down from mean 9.1 [SD 1.9] to 5.8 [SD 3.1]), alcohol consumed per week (down from mean 37.1 [SD 28.3] to mean 17.5 [SD 18.9]), days out of role (down from mean 1.6 [SD 3.6] to 0.5 [SD 1.6]), quality of life (up from 3.2 [SD 0.7] to 3.6 [SD 0.7]) and reduced distress (down from 24.8 [SD 7.0] to 19.0 [SD 6.6]). Accessing online coaching was not associated with improved outcomes, but engagement with the program (eg, posts and comments on the posts of others) were significantly associated with improvements (eg, in AUDIT-C, alcohol use and EUROHIS-QOL). Reduced alcohol use was found for both probably dependent (estimated marginal mean of 40.8 to 20.1 drinks) and hazardous or harmful alcohol users (estimated marginal mean of 22.9 to 11.9 drinks). CONCLUSIONS Clinically significant reductions in alcohol use were found, as well as reduced alcohol risk (AUDIT-C) and days out of role. Importantly, improved alcohol-related outcomes were found for both hazardous or harmful and probably dependent drinkers. Since October 2016, Daybreak has reached more than 50,000 participants. Therefore, there is the potential for the program to have an impact on alcohol-related problems at a population health level, importantly including an effect on probably dependent drinkers. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry: ACTRN12618000010291; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373110. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/9982.
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Affiliation(s)
- Robert J Tait
- National Drug Research Institute, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Raquel Paz Castro
- Swiss Research Institute for Public Health and Addiction, University of Zurich, Zurich, Switzerland
| | | | | | - Michael P Schaub
- Swiss Research Institute for Public Health and Addiction, University of Zurich, Zurich, Switzerland
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Beintner I, Vollert B, Zarski AC, Bolinski F, Musiat P, Görlich D, Ebert DD, Jacobi C. Adherence Reporting in Randomized Controlled Trials Examining Manualized Multisession Online Interventions: Systematic Review of Practices and Proposal for Reporting Standards. J Med Internet Res 2019; 21:e14181. [PMID: 31414664 PMCID: PMC6713038 DOI: 10.2196/14181] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 06/07/2019] [Accepted: 06/27/2019] [Indexed: 02/02/2023] Open
Abstract
Background Adherence reflects the extent to which individuals experience or engage with the content of online interventions and poses a major challenge. Neglecting to examine and report adherence and its relation to outcomes can compromise the interpretation of research findings. Objective The aim of this systematic review is to analyze how adherence is accounted for in publications and to propose standards for measuring and reporting adherence to online interventions. Methods We performed a systematic review of randomized controlled trials on online interventions for the prevention and treatment of common mental disorders (depression, anxiety disorders, substance related disorders, and eating disorders) published between January 2006 and May 2018 and indexed in Medline and Web of Science. We included primary publications on manualized online treatments (more than 1 session and successive access to content) and examined how adherence was reported in these publications. Results We identified 216 publications that met our inclusion criteria. Adherence was addressed in 85% of full-text manuscripts, but only in 31% of abstracts. A median of three usage metrics were reported; the most frequently reported usage metric (61%) was intervention completion. Manuscripts published in specialized electronic health journals more frequently included information on the relation of adherence and outcomes. Conclusions We found substantial variety in the reporting of adherence and the usage metrics used to operationalize adherence. This limits the comparability of results and impedes the integration of findings from different studies. Based on our findings, we propose reporting standards for future publications on online interventions.
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Affiliation(s)
- Ina Beintner
- Faculty of Psychology, School of Science, Technische Universität Dresden, Dresden, Germany
| | - Bianka Vollert
- Faculty of Psychology, School of Science, Technische Universität Dresden, Dresden, Germany
| | - Anna-Carlotta Zarski
- Institute of Psychology, Faculty of Humanities, Social Sciences, and Theology, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Felix Bolinski
- Department of Clinical, Neuro- and Developmental Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Peter Musiat
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Dennis Görlich
- Institute of Biostatistics and Clinical Research, Faculty of Medicine, Westfälische Wilhelms-Universität Münster, Münster, Germany
| | - David Daniel Ebert
- Institute of Psychology, Faculty of Humanities, Social Sciences, and Theology, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Corinna Jacobi
- Faculty of Psychology, School of Science, Technische Universität Dresden, Dresden, Germany
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Davis AC, Wright CJC, Temple-Smith MJ, Hellard ME, Lim MSC. A Health Education Website Developed to Meet Young People's Information Needs About Web-Based Pornography and Sharing of Sexually Explicit Imagery (SCOPE): Usability Study. JMIR Form Res 2019; 3:e12824. [PMID: 31411140 PMCID: PMC6711035 DOI: 10.2196/12824] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 05/24/2019] [Accepted: 06/18/2019] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Although we know that many young people watch online pornography and engage in sexting, there is limited literature examining their needs in relation to information on these highly sensitive and complex issues. Online resources exist; however, we can find no evidence of any of them having been formally tested for usability within the target population. OBJECTIVE This study aimed to test the usability of a resource about online pornography and sexting among young people. METHODS Semistructured interviews were conducted with 17 participants aged 15 to 29 years. RESULTS We found that the SCOPE resource was perceived as trustworthy and credible because of its evidence-based content, nonjudgmental tone, and balanced perspectives. Multimedia and video content enhanced the layout and usability of the resource; however, content relevance could be improved by targeting age and developmental stages. Participants identified resource sections such as Real Stories from young people as relevant and engaging. However, they raised issues with the translation of formative research findings relating to these stories into their final presentation. CONCLUSIONS Our findings suggest that young people prefer online resources about complex issues, such as online pornography and sexting, if they are balanced in content and tone. Most importantly, in the context of responding to complex and sensitive issues such as these, co-design methods can ensure that young people are central to the development of resources and avoid gaps in translating research into practice. In the context of limited literature focusing on the usability of online resources about these topics, this paper provides important insights for public health practitioners working in this emerging space.
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Affiliation(s)
- Angela C Davis
- Burnet Institute, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | | | - Meredith J Temple-Smith
- Department of General Practice, Melbourne Medical School, The University of Melbourne, Melbourne, Australia
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Pilgrim K, Bohnet-Joschko S. Selling health and happiness how influencers communicate on Instagram about dieting and exercise: mixed methods research. BMC Public Health 2019; 19:1054. [PMID: 31387563 PMCID: PMC6683418 DOI: 10.1186/s12889-019-7387-8] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 07/26/2019] [Indexed: 11/25/2022] Open
Abstract
Background Eating disorders among adolescents are an ongoing public health concern. Sustainable health promotion programmes require a thorough understanding of the social context in which minors engage. Initial studies show that young people make extensive use of social networks in order to exchange experiences and gather information. During this process their (buying) behaviour is significantly affected by so-called influencers. Methods The exploratory research studies non-campaign driven health communication on dieting and exercise by influencers in social networks with a focus on content, techniques and visible impact. In a mixed methods approach, we initially analysed 1000 posts from influencers on Instagram quantitatively. Subsequently we conducted an in-depth content analysis of 9 extreme and 27 typical communication threads. Results Influencers gain the trust and friendship of their followers by designing body-shape focused visual content and targeted communication techniques. They identify and define diet and exercise as factors to be controlled for body perfection. By consuming dietary supplements and wearing tight-fitting branded sportswear, influencers promise a simplified way of optimizing one’s appearance as the key to happiness. Direct and surreptitious advertising of industry-specific products constitutes the communicative focus. At the same time, minors identify with the roles and ideals demonstrated by influencers and their needs are satisfied on several different levels. This creates a relationship of dependency between influencers and their followers. Conclusions The dynamics in the field of health communication by influencers on social networks will become increasingly important in the coming years. This is largely due to the targeted demand on the part of (mainly) underage users and the high attractiveness of influencer marketing on the part of companies. Influencers suggest a dependence on happiness, well-being, health and beauty. Only those who create a body shaped through control and discipline are healthy and beautiful - and can be happy. The indirectly communicated conclusions, which can be considered as extremely critical, illustrate the need for action in order to protect and positively accompany young people in their psychological and physical development. The shift of authority figures within Generation Z, as well as identified communication techniques, can be considered and may be harnessed by targeted, group-oriented campaign designs. Electronic supplementary material The online version of this article (10.1186/s12889-019-7387-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Katharina Pilgrim
- Chair of Management and Innovation in Health Care, Witten/Herdecke University, Witten, Germany.
| | - Sabine Bohnet-Joschko
- Chair of Management and Innovation in Health Care, Witten/Herdecke University, Witten, Germany
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Stein DJ, Costa DLC, Lochner C, Miguel EC, Reddy YCJ, Shavitt RG, van den Heuvel OA, Simpson HB. Obsessive-compulsive disorder. Nat Rev Dis Primers 2019; 5:52. [PMID: 31371720 PMCID: PMC7370844 DOI: 10.1038/s41572-019-0102-3] [Citation(s) in RCA: 311] [Impact Index Per Article: 62.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/27/2019] [Indexed: 12/15/2022]
Abstract
Obsessive-compulsive disorder (OCD) is a highly prevalent and chronic condition that is associated with substantial global disability. OCD is the key example of the 'obsessive-compulsive and related disorders', a group of conditions which are now classified together in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, and the International Classification of Diseases, 11th Revision, and which are often underdiagnosed and undertreated. In addition, OCD is an important example of a neuropsychiatric disorder in which rigorous research on phenomenology, psychobiology, pharmacotherapy and psychotherapy has contributed to better recognition, assessment and outcomes. Although OCD is a relatively homogenous disorder with similar symptom dimensions globally, individualized assessment of symptoms, the degree of insight, and the extent of comorbidity is needed. Several neurobiological mechanisms underlying OCD have been identified, including specific brain circuits that underpin OCD. In addition, laboratory models have demonstrated how cellular and molecular dysfunction underpins repetitive stereotyped behaviours, and the genetic architecture of OCD is increasingly understood. Effective treatments for OCD include serotonin reuptake inhibitors and cognitive-behavioural therapy, and neurosurgery for those with intractable symptoms. Integration of global mental health and translational neuroscience approaches could further advance knowledge on OCD and improve clinical outcomes.
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Affiliation(s)
- Dan J Stein
- Department of Psychiatry, University of Cape Town and SA MRC Unit on Risk & Resilience in Mental Disorders, Cape Town, South Africa.
| | - Daniel L C Costa
- OCD Research Program, Instituto de Psiquiatria, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Christine Lochner
- Department of Psychiatry, Stellenbosch University and SA MRC Unit on Risk & Resilience in Mental Disorders, Stellenbosch, South Africa
| | - Euripedes C Miguel
- OCD Research Program, Instituto de Psiquiatria, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Y C Janardhan Reddy
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Roseli G Shavitt
- OCD Research Program, Instituto de Psiquiatria, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Odile A van den Heuvel
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam, Netherlands
- Department of Anatomy & Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam, Netherlands
| | - H Blair Simpson
- Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York, NY, USA
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Jonas B, Tensil MD, Leuschner F, Strüber E, Tossmann P. Predictors of treatment response in a web-based intervention for cannabis users. Internet Interv 2019; 18:100261. [PMID: 31890614 PMCID: PMC6926274 DOI: 10.1016/j.invent.2019.100261] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 07/08/2019] [Accepted: 07/23/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Trials demonstrate the effectiveness of web-based interventions for cannabis-related disorders. For further development of these interventions, it is of vital interest to identify user characteristics which predict treatment response. METHODS Data from a randomized factorial trial on a web-based intervention for cannabis-users (n = 534) was reanalyzed. As potential predictors for later treatment response, 31 variables from the following categories were tested: socio-demographics, substance use and cognitive processing. The association of predictors and treatment outcome was analyzed using unbiased recursive partitioning and represented as classification tree. Predictive performance of the tree was assessed by comparing its cross-validated results to models derived with all-subsets logistic regression and random forest. RESULTS Goal commitment (p < .001), the extent of self-reflection (p < .001), the preferred effect of cannabis (p = .005) and initial cannabis use (p = .015) significantly differentiate between successful and non-successful participants in all three analysis methods. The predictive accuracy of all three models is comparable and modest. CONCLUSIONS Participants who commit to quit using cannabis, who at least have moderate levels of self-reflection and who prefer mild intoxicating effects were most likely to respond to treatment. To predict treatment response on an individual level, the classification tree should only be used as one of several sources of information.Trial registration: http://www.isrctn.com/ISRCTN99818059.
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Affiliation(s)
- Benjamin Jonas
- Delphi - Gesellschaft, Berlin, Germany,Corresponding author at: Delphi-Gesellschaft für Forschung, Beratung und Projektentwicklung mbH, Kaiserdamm 8, 14057 Berlin, Germany.
| | | | | | - Evelin Strüber
- Federal Centre for Health Education (BZgA), Cologne, Germany
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Pancer M, Manganaro M, Pace I, Marion P, Gagnon DH, Laramée MT, Messier F, Amari F, Ahmed S. A Web-Based Physical Activity Portal for Individuals Living With a Spinal Cord Injury: Qualitative Study. JMIR Form Res 2019; 3:e12507. [PMID: 31350835 PMCID: PMC6688442 DOI: 10.2196/12507] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 05/24/2019] [Accepted: 05/25/2019] [Indexed: 01/04/2023] Open
Abstract
Background The population with a spinal cord injury (SCI) largely remains inactive following discharge from rehabilitation despite evidence on the benefits of physical activity. These individuals need to develop skills to self-manage their condition in order to prevent secondary comorbidities and rehospitalization. A Web-based physical activity portal can address this need. Few Web-based interventions incorporate theoretical frameworks, behavior change techniques, and modes of delivery into their design. Objective This study aimed to identify the preferred features of a Web-based self-management physical activity portal through stakeholder engagement with individuals with a spinal cord injury and health care professionals (HCPs). Methods An interpretative phenomenology methodology and participatory design, along with an integrated knowledge translation approach, were used to conduct this study. Convenience sampling was used to recruit individuals with an SCI living in the community, who were either interested or already engaging in physical activity, and HCPs working with individuals with an SCI, from three city-based rehabilitation sites. Individual 1-hour sessions involving navigation of an existing website and a semistructured interview were conducted with all participants. Individuals with an SCI completed a demographics questionnaire prior to the individual sessions, while demographic information of the HCPs was collected during their interviews. Additionally, all participants were asked a question on their intention to use or recommend a portal. An in-depth thematic analysis was used to derive themes from participants’ responses. Results Thirteen individuals with an SCI and nine HCPs participated in the study. Five core themes emerged: (1) knowledge: guidance and barrier management; (2) possibility of achievement: the risks and benefits of physical activity and modelling; (3) self-regulation strategies: action planning, goal setting, tracking, rewards, and reminders; (4) interactivity: peers and professionals; and (5) format: appearance, language, and ease of use. The mean (median) ratings of the likelihood of promoting and using a Web-based portal tailored to individuals’ needs were 9.00 (8.78) and 7.75 (7.88) for HCPs and individuals with an SCI, respectively. Conclusions This study highlights features of an online self-management platform that can provide individuals with an SCI the motivation and volition to engage in physical activity. These findings will inform the design of a Web-based self-management physical activity portal to increase physical activity adherence and behavior change.
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Affiliation(s)
- Max Pancer
- School of Physical & Occupational Therapy, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Melissa Manganaro
- School of Physical & Occupational Therapy, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Isabella Pace
- School of Physical & Occupational Therapy, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Patrick Marion
- School of Physical & Occupational Therapy, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Dany H Gagnon
- Center for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, QC, Canada.,École de Réadaptation, Université de Montréal, Montreal, QC, Canada.,Centre Intégré Universitaire de Santé et de Services Sociaux de l'Est-de-l'Île-de-Montréal - Institut Universitaire sur la Réadaptation en Déficience Physique de Montréal, Montreal, QC, Canada
| | - Marie-Thérèse Laramée
- Center for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, QC, Canada.,Centre Intégré Universitaire de Santé et de Services Sociaux de l'Est-de-l'Île-de-Montréal - Institut Universitaire sur la Réadaptation en Déficience Physique de Montréal, Montreal, QC, Canada
| | - Frédéric Messier
- Center for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, QC, Canada.,Centre Intégré Universitaire de Santé et de Services Sociaux de l'Est-de-l'Île-de-Montréal - Institut Universitaire sur la Réadaptation en Déficience Physique de Montréal, Montreal, QC, Canada
| | - Fatima Amari
- School of Physical & Occupational Therapy, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Sara Ahmed
- School of Physical & Occupational Therapy, Faculty of Medicine, McGill University, Montreal, QC, Canada.,Center for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, QC, Canada.,Centre Intégré Universitaire de Santé et de Services Sociaux de l'Est-de-l'Île-de-Montréal - Institut Universitaire sur la Réadaptation en Déficience Physique de Montréal, Montreal, QC, Canada.,Centres Intégrés Universitaires de Santé et de Services Sociaux du Centre-Ouest-de-l'Île-de-Montréal, Montreal, QC, Canada.,McGill University Health Center, Montreal, QC, Canada
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Firet L, Teunissen TAM, van der Vaart H, Assendelft WJJ, Notten KJB, Kool RB, Lagro-Janssen ALM. An Electronic Health Intervention for Dutch Women With Stress Urinary Incontinence: Protocol for a Mixed Methods Study. JMIR Res Protoc 2019; 8:e13164. [PMID: 31298222 PMCID: PMC6657453 DOI: 10.2196/13164] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 04/20/2019] [Accepted: 04/26/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Stress urinary incontinence (SUI) is a common problem with a great potential influence on quality of life. Although SUI can be treated effectively with pelvic floor muscle training (PFMT), only a minority of women with this complaint seek help. An internet-based electronic health (eHealth) intervention could make care more accessible. The Swedish eHealth intervention Tät-treatment of Stress Urinary Incontinence offers PFMT and has shown to be effective in reducing symptoms in women with SUI. This intervention might be helpful for Dutch women too, but its adoption needs to be studied as the Netherlands differs from Sweden in terms of geographical characteristics and health care organization. OBJECTIVE The objective of this protocol is to investigate the barriers and facilitators to the adoption of an eHealth intervention for Dutch women with SUI and the effects of this intervention. METHODS We are conducting an explanatory sequential mixed methods study among 800 Dutch women with SUI who participate in the translated version of Tät-treatment of Stress Urinary Incontinence. This eHealth intervention takes 3 months. A pre-post study is conducted using surveys, which are sent at baseline (T0), 3 weeks after baseline (T1), posttreatment (T2), and 3 months posttreatment (T3). After the intervention, semistructured interviews will be held with 15 to 20 participants. The primary outcomes are barriers and facilitators to using the Tät-treatment of Stress Urinary Incontinence. This will also be analyzed among groups that differ in age and severity of incontinence. A thematic content analysis of the qualitative data will be performed. The secondary outcomes are: (1) effect on symptoms of urinary incontinence, (2) effect on quality of life, and (3) factors that are potentially associated with success. Effects will be analyzed by a mixed model analysis. Logistic regression analysis will be used to study what patient-related factors are associated with success. RESULTS Enrollment started in July 2018 and will be finished by December 2019. Data analysis will start in March 2020. CONCLUSIONS An eHealth intervention for Dutch women with SUI is promising because it can make treatment more accessible. The strength of this study is that it explores the possibilities for an internet-based-only treatment for women with SUI by using both quantitative and qualitative research methodologies. The study elaborates on existing results by using a previously tested and effective eHealth program. Insight into the barriers and facilitators to using this program can enhance the implementation of the intervention in the Dutch health care system. TRIAL REGISTRATION Netherlands Trial Registry (NTR) NTR6956; https://www.trialregister.nl/trial/6570. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/13164.
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Affiliation(s)
- Lotte Firet
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Theodora Alberta Maria Teunissen
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Huub van der Vaart
- Department of Gynecology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Willem Jan Jozef Assendelft
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | | | - Rudolf Bertijn Kool
- IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
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Torous J, Cerrato P, Halamka J. Targeting depressive symptoms with technology. Mhealth 2019; 5:19. [PMID: 31463305 PMCID: PMC6691087 DOI: 10.21037/mhealth.2019.06.04] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 06/24/2019] [Indexed: 12/17/2022] Open
Abstract
Interest in digital mental health, driven largely by the need to increase access to mental health services, presents new opportunities as well as challenges. This article provides a selective overview of several new approaches, including chatbots and apps, with a focus on exploring their unique characteristics. To understand the broader issues around digital mental health apps, we discuss recent reviews in this space in the context of how they can inform care today, and how these apps fail to address several important gaps. Framing apps as either tools to augment versus deliver care, we explore ongoing struggles in this space that will determine how apps are used, regulated, and reimbursed for. Realizing that many mental health apps today exist in this still undefined space and often possess no evidence, we conclude with an overview of the American Psychiatric Association (APA)'s app evaluation framework with the goal of offering a more informed approach to these digital tools.
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Affiliation(s)
- John Torous
- Department of Psychiatry and Division of Clinical Informatics, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - John Halamka
- Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA
- Chairman of the New England Healthcare Exchange Network, Boston, MA, USA
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Andersson G, Carlbring P, Titov N, Lindefors N. Internet Interventions for Adults with Anxiety and Mood Disorders: A Narrative Umbrella Review of Recent Meta-Analyses. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2019; 64:465-470. [PMID: 31096757 PMCID: PMC6610559 DOI: 10.1177/0706743719839381] [Citation(s) in RCA: 162] [Impact Index Per Article: 32.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Internet-delivered cognitive behaviour therapy (ICBT) has existed for 20 years and there are now several controlled trials for a range of problems. In this paper, we focused on recent meta-analytic reviews of the literature and found moderate to large effects reported for panic disorder, social anxiety disorder, generalized anxiety disorder, posttraumatic stress disorder, and major depression. In total, we reviewed 9 recent meta-analytic reviews out of a total of 618 meta-analytic reviews identified using our search terms. In these selected reviews, 166 studies were included, including overlap in reviews on similar conditions. We also covered a recent review on transdiagnostic treatments and 2 reviews on face-to-face v. internet treatment. The growing number of meta-analytic reviews of studies now suggests that ICBT works and can be as effective as face-to-face therapy.
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Affiliation(s)
- Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linköping University,
Linköpin, Sweden
- Department of Clinical Neuroscience, Psychiatry Section, Karolinska
Institutet, Solna, Sweden
- Gerhard Andersson, PhD, Department of Behavioural
Sciences and Learning, Linköping University, Linköping SE-58183, Sweden.
| | - Per Carlbring
- Department of Clinical Psychology, Stockholm University, Stockholm,
Sweden
- Department of Psychology, University of Southern Denmark, Odense,
Denmark
| | - Nickolai Titov
- MindSpot Clinic, Macquarie University, Sydney, Australia
- eCentreClinic, Department of Psychology, Macquarie University, Sydney,
Australia
| | - Nils Lindefors
- Department of Clinical Neuroscience, Psychiatry Section, Karolinska
Institutet, Solna, Sweden
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Abstract
Introduction: While for adults in Pennsylvania, obesity rates tripled from less than 10% in 1990 to 30% in 2015, the combined rates of overweight, obese, and severely obese children and adolescents in Pennsylvania are projected to approach 37.11% by the end of 2018. Method: Pediatric obesity rates in rural areas tend to be even higher than those in urban areas. Pediatric obesity needs to be addressed, since it is strongly correlated with several chronic diseases. Given the scarcity of resources to manage this trend, innovative population-based approaches are needed. Web-based telehealth, telemedicine, mobile health (mHealth), and telephone conferences have been proposed as solutions to treat and prevent childhood obesity in rural areas; the most suitable solution is through a family-based telemedicine intervention. The purpose of this study is to explore the feasibility of such a telehealth application especially for rural Pennsylvania. Results: Telehealth use in healthcare organizations in Pennsylvania is scarce; however, 92% of Pennsylvania's school districts meet the minimum internet connectivity standards. Discussions: This article, while acknowledging barriers to the adoption of the internet-based telemedicine resources, discusses solutions for increasing their availability and dissemination in rural Pennsylvania. Current internet connectivity standards in Pennsylvania schools reflect ability to participate in telehealth programs in terms of technological background, but schools are not engaged in such programs. An appraisal of the real-life challenges to implement this modality is critical and will pave the way for advocacy and implementation of useful telehealth services in low-resource areas.
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Affiliation(s)
- Hengameh Hosseini
- a Department of Health Administration and Human Resources , University of Scranton , Scranton , PA , USA
| | - Ayse Yilmaz
- b Department of Health Administration , Pennsylvania State University , Harrisburg , PA , USA
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Sanders I, Short CE, Bogomolova S, Stanford T, Plotnikoff R, Vandelanotte C, Olds T, Edney S, Ryan J, Curtis RG, Maher C. Characteristics of Adopters of an Online Social Networking Physical Activity Mobile Phone App: Cluster Analysis. JMIR Mhealth Uhealth 2019; 7:e12484. [PMID: 31162130 PMCID: PMC6746062 DOI: 10.2196/12484] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 04/07/2019] [Accepted: 04/11/2019] [Indexed: 01/20/2023] Open
Abstract
Background To date, many online health behavior programs developed by researchers have not been translated at scale. To inform translational efforts, health researchers must work with marketing experts to design cost-effective marketing campaigns. It is important to understand the characteristics of end users of a given health promotion program and identify key market segments. Objective This study aimed to describe the characteristics of the adopters of Active Team, a gamified online social networking physical activity app, and identify potential market segments to inform future research translation efforts. Methods Participants (N=545) were Australian adults aged 18 to 65 years who responded to general advertisements to join a randomized controlled trial (RCT) evaluating the Active Team app. At baseline they provided demographic (age, sex, education, marital status, body mass index, location of residence, and country of birth), behavioral (sleep, assessed by the Pittsburgh Quality Sleep Index) and physical activity (assessed by the Active Australia Survey), psychographic information (health and well-being, assessed by the PERMA [Positive Emotion, Engagement, Relationships, Meaning, Achievement] Profile; depression, anxiety and stress, assessed by the Depression, Anxiety, and Stress Scale [DASS-21]; and quality of life, assessed by the 12-Item Short Form Health Survey [SF-12]). Descriptive analyses and a k-medoids cluster analysis were performed using the software R 3.3.0 (The R Foundation) to identify key characteristics of the sample. Results Cluster analyses revealed four clusters: (1) younger inactive women with poor well-being (218/545), characterized by a higher score on the DASS-21, low mental component summary score on the SF-12, and relatively young age; (2) older, active women (153/545), characterized by a lower score on DASS-21, a higher overall score on the SF-12, and relatively older age; (3) young, active but stressed men (58/545) with a higher score on DASS-21 and higher activity levels; and (4) older, low active and obese men (30/545), characterized by a high body mass index and lower activity levels. Conclusions Understanding the characteristics of population segments attracted to a health promotion program will guide the development of cost-effective research translation campaigns. Trial Registration Australian New Zealand Clinical Trial Registry ACTRN12617000113358; https://www.anzctr.org .au/Trial/Registration/TrialReview.aspx?id=371463 International Registered Report Identifier (IRRID) RR2-10.1186/s12889-017-4882-7
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Affiliation(s)
- Ilea Sanders
- Alliance for Research in Exercise, Nutrition and Activity, School of Health Sciences, University of South Australia, Adelaide, Australia
| | - Camille E Short
- Freemasons Foundation Centre for Men's Health, Faculty of Health Sciences, The University of Adelaide, Adelaide, Australia
| | - Svetlana Bogomolova
- Ehrenberg-Bass Institute, School of Marketing, University of South Australia, Adelaide, Australia
| | - Tyman Stanford
- School of Mathematical Sciences, The University of Adelaide, Adelaide, Australia
| | - Ronald Plotnikoff
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Newcastle, Australia
| | - Corneel Vandelanotte
- Physical Activity Research Group, Central Queensland University, Adelaide, Australia
| | - Tim Olds
- Alliance for Research in Exercise, Nutrition and Activity, School of Health Sciences, University of South Australia, Adelaide, Australia
| | - Sarah Edney
- Alliance for Research in Exercise, Nutrition and Activity, School of Health Sciences, University of South Australia, Adelaide, Australia
| | - Jillian Ryan
- Alliance for Research in Exercise, Nutrition and Activity, School of Health Sciences, University of South Australia, Adelaide, Australia
| | - Rachel G Curtis
- Alliance for Research in Exercise, Nutrition and Activity, School of Health Sciences, University of South Australia, Adelaide, Australia
| | - Carol Maher
- Alliance for Research in Exercise, Nutrition and Activity, School of Health Sciences, University of South Australia, Adelaide, Australia
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Young C, Campolonghi S, Ponsonby S, Dawson SL, O'Neil A, Kay-Lambkin F, McNaughton SA, Berk M, Jacka FN. Supporting Engagement, Adherence, and Behavior Change in Online Dietary Interventions. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2019; 51:719-739. [PMID: 31036500 DOI: 10.1016/j.jneb.2019.03.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 03/06/2019] [Accepted: 03/10/2019] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Poor diet is a leading cause of death and disease globally. This epidemic requires effective and accessible interventions to stop the increasing number of diet-related deaths and the health and economic impacts of diet-related disease. Online interventions provide flexibility and accessibility. With the ubiquitous use of smartphones, they can be intertwined with daily activities such as shopping and eating. The aim of this review is to determine what features and behavior change techniques employed in online dietary interventions for adult populations promoting dietary behavior change. METHODS The researchers conducted a systematic search of Cumulative Index of Nursing and Allied Health, Cochrane Library, Global Health, MEDLINE, PsychINFO, and psychological and behavioral sciences electronic bibliography databases, and specialist electronic health (e-health) journals from database inception to January, 2018. Studies were included if they were randomized controlled trials of online dietary interventions with active comparator conditions in adult populations, and with reported dietary change measures. A quality score was applied to each study calculated by a developed scoring system. The review analyzed intervention dietary change measures, attrition (nonuse and dropout), engagement (metrics and intensity of use), adherence (defined as compliance to the treatment protocol), behavior change techniques employed to achieve dietary change, and techniques employed in successful (those who achieved significant results in the targeted dietary behavior) vs unsuccessful interventions as reported by the studies. RESULTS A total of 21 studies composed of a total of 7,455 adults and reporting on 19 different e-health interventions were included from 1,237 records. These studies targeted dietary change as measured by reduced energy intake (5) or changes in specific dietary components (15) and overall diet quality (4). Dietary change was a behavior target in general healthy populations (12) and for managing diseases such as obesity and cardiovascular disease (7), or for improving quality of life for those with chronic conditions (1). Improvements in dietary behavior were seen in 14 of the 19 interventions reported. DISCUSSION The results suggest that online interventions can be successful in achieving dietary behavior change across a range of defined populations. However, disparate reporting of engagement and limited reporting of nonuse attrition rates limited the analysis of which behavior change techniques were most effective in achieving this change. IMPLICATIONS FOR RESEARCH AND PRACTICE The results of this review support the potential of online and smartphone dietary interventions as a method to achieve change in diet in defined populations. However, further work needs to be done in examining how users engage with interventions, and thus which behavior change techniques are most effective.
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Affiliation(s)
- Claire Young
- Food and Mood Centre, IMPACT Strategic Research Centre, School of Medicine, Deakin University, Barwon Health, Geelong, Australia.
| | - Sara Campolonghi
- Food and Mood Centre, IMPACT Strategic Research Centre, School of Medicine, Deakin University, Barwon Health, Geelong, Australia
| | - Stephanie Ponsonby
- Food and Mood Centre, IMPACT Strategic Research Centre, School of Medicine, Deakin University, Barwon Health, Geelong, Australia
| | - Samantha L Dawson
- Food and Mood Centre, IMPACT Strategic Research Centre, School of Medicine, Deakin University, Barwon Health, Geelong, Australia; Early Life Epigenetics Group, Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Adrienne O'Neil
- Centre for Mental Health, Melbourne School of Population and Global Health, Melbourne, Australia
| | - Frances Kay-Lambkin
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia
| | - Sarah A McNaughton
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Victoria, Australia
| | - Michael Berk
- Food and Mood Centre, IMPACT Strategic Research Centre, School of Medicine, Deakin University, Barwon Health, Geelong, Australia
| | - Felice N Jacka
- Food and Mood Centre, IMPACT Strategic Research Centre, School of Medicine, Deakin University, Barwon Health, Geelong, Australia; Centre for Adolescent Health, Murdoch Children's Research Institute, Victoria, Australia; Black Dog Institute, New South Wales, Australia
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125
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Moreno MA, D'Angelo J. Social Media Intervention Design: Applying an Affordances Framework. J Med Internet Res 2019; 21:e11014. [PMID: 30912754 PMCID: PMC6454336 DOI: 10.2196/11014] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 12/15/2018] [Accepted: 12/28/2018] [Indexed: 11/24/2022] Open
Abstract
Social media interventions are a growing area of internet research, particularly for adolescent health. Researchers developing social media intervention approaches face the task of selecting a social media platform for their intervention. In this paper, we present the theoretical framework of affordances to help guide social media platform selection for intervention research. Affordances are a concept often used in fields associated with design and by those systematically studying the impact of a design of an object. Thus, the affordances approach is often used by those considering the impact of information technology and the design of social media platforms. Affordances are often described as properties of artifacts that can be recognized by users and contribute to their function or items that present an action possibility. We describe common affordances that can be applied to intervention design as well as current evidence and an intervention case example for each affordance. A scientific approach for the selection of the appropriate social media platform for a given intervention is an important research priority to advance the field of internet research.
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Affiliation(s)
- Megan A Moreno
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin, Madison, WI, United States
| | - Jonathan D'Angelo
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin, Madison, WI, United States
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126
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Mueller J, Davies A, Jay C, Harper S, Blackhall F, Summers Y, Harle A, Todd C. Developing and testing a web-based intervention to encourage early help-seeking in people with symptoms associated with lung cancer. Br J Health Psychol 2019; 24:31-65. [PMID: 29999214 PMCID: PMC6492236 DOI: 10.1111/bjhp.12325] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 06/05/2018] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To detail the development method used to produce an online, tailored, theory-based, user-centred intervention to encourage help-seeking for potential lung cancer symptoms. DESIGN Intervention development was structured around the person-based approach. The feasibility study involved a randomized controlled trial design. METHODS Intervention development drew on qualitative inquiries, the Theory of Planned Behaviour (TPB), and identifying concrete mechanisms of change to implement in the intervention (Behaviour Change Techniques). The final intervention involved two key features: (1) tailoring and (2) 'TPB components' to target beliefs about help-seeking. In an online feasibility study, we recruited people reporting potential lung cancer symptoms using mailing lists, social media, websites, and Google AdWords. Participants were randomized to the intervention, a tailored comparison group (CG) without TPB-components, an untailored CG with TPB components, or a CG with neither. Following treatment, participants clicked a button to indicate whether they wished to make an appointment and completed a TPB questionnaire. RESULTS A total of 130 participants reporting relevant symptoms were recruited (24% of website visitors). Participants in the intervention group reported higher intention to seek help than those who received tailored information without TPB components (p = .03). User comments indicate more support is needed for people who sought help for symptoms, but felt dismissed. CONCLUSIONS The potential for differential dropout in online randomized trials requires careful consideration. Future help-seeking interventions should provide support for those who have previously felt dismissed by health professionals. The feasibility study provides some evidence that our 'TPB components' were effective, but validation in a powered trial is necessary. Statement of contribution What is already known on this subject? People with lung cancer often delay presenting symptoms to health services. Some patients (or their family/friends) look up symptoms online before their diagnosis, to decide whether they should see a doctor. Interventions are needed to ensure people can find useful information online that will encourage them to seek help for relevant symptoms. What does this study add? Theory-mapping and user involvement facilitated systematic intervention development. Lung cancer help-seeking interventions should address salient beliefs and personal relevance. The potential for differential dropout in online randomized trials requires careful consideration.
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Affiliation(s)
- Julia Mueller
- School of Health SciencesUniversity of ManchesterUK
- Manchester Academic Health Science CentreUK
- School of Computer ScienceUniversity of ManchesterUK
| | - Alan Davies
- School of Computer ScienceUniversity of ManchesterUK
| | - Caroline Jay
- School of Computer ScienceUniversity of ManchesterUK
| | - Simon Harper
- School of Computer ScienceUniversity of ManchesterUK
| | - Fiona Blackhall
- Manchester Academic Health Science CentreUK
- Department of Medical OncologyThe Christie NHS Foundation TrustManchesterUK
- Division of Molecular and Clinical Cancer SciencesUniversity of ManchesterUK
| | - Yvonne Summers
- Manchester Academic Health Science CentreUK
- Department of Medical OncologyThe Christie NHS Foundation TrustManchesterUK
| | - Amelie Harle
- Department of Medical OncologyPoole Hospital NHS Foundation TrustPooleUK
| | - Chris Todd
- School of Health SciencesUniversity of ManchesterUK
- Manchester Academic Health Science CentreUK
- Manchester University Foundation NHS TrustUK
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127
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Diener HC, Holle-Lee D, Nägel S, Dresler T, Gaul C, Göbel H, Heinze-Kuhn K, Jürgens T, Kropp P, Meyer B, May A, Schulte L, Solbach K, Straube A, Kamm K, Förderreuther S, Gantenbein A, Petersen J, Sandor P, Lampl C. Treatment of migraine attacks and prevention of migraine: Guidelines by the German Migraine and Headache Society and the German Society of Neurology. CLINICAL AND TRANSLATIONAL NEUROSCIENCE 2019. [DOI: 10.1177/2514183x18823377] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In collaboration with some of the leading headache centres in Germany, Switzerland and Austria, we have established new guidelines for the treatment of migraine attacks and the prevention of migraine. A thorough literature research of the last 10 years has been the basis of the current recommendations. At the beginning, we present therapeutic novelties, followed by a summary of all recommendations. After an introduction, we cover topics like drug therapy and practical experience, non-effective medication, migraine prevention, interventional methods, non-medicational and psychological methods for prevention and therapies without proof of efficacy.
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Affiliation(s)
- Hans-Christoph Diener
- Klinik für Neurologie und Westdeutsches Kopfschmerzzentrum, Universitätsklinikum Essen, Essen, Germany
| | - Dagny Holle-Lee
- Klinik für Neurologie und Westdeutsches Kopfschmerzzentrum, Universitätsklinikum Essen, Essen, Germany
| | - Steffen Nägel
- Klinik für Neurologie und Westdeutsches Kopfschmerzzentrum, Universitätsklinikum Essen, Essen, Germany
| | - Thomas Dresler
- Klinik für Psychiatrie und Psychotherapie, Universität Tübingen, Tübingen, Germany
- Graduiertenschule & Forschungsnetzwerk LEAD, Universität Tübingen, Tübingen, Germany
| | - Charly Gaul
- Migräne- und Kopfschmerzklinik Königstein, Königstein im Taunus, Germany
| | | | | | - Tim Jürgens
- Universitätsmedizin Rostock, Zentrum für Nervenheilkunde, Klinik und Poliklinik für Neurologie, Rostock, Germany
| | - Peter Kropp
- Institut für Medizinische Psychologie und Medizinische Soziologie, Universitätsmedizin Rostock, Zentrum für Nervenheilkunde, Rostock, Germany
| | - Bianca Meyer
- Institut für Medizinische Psychologie und Medizinische Soziologie, Universitätsmedizin Rostock, Zentrum für Nervenheilkunde, Rostock, Germany
| | - Arne May
- Institut für Systemische Neurowissenschaften, Universitätsklinikum Hamburg Eppendorf (UKE), Hamburg, Germany
| | - Laura Schulte
- Institut für Systemische Neurowissenschaften, Universitätsklinikum Hamburg Eppendorf (UKE), Hamburg, Germany
| | - Kasja Solbach
- Klinik für Neurologie, Universitätsklinikum Essen, Essen, Germany
| | - Andreas Straube
- Neurologische Klinik, Ludwig-Maximilians-Universität München, Klinikum Großhadern, München, Germany
| | - Katharina Kamm
- Neurologische Klinik, Ludwig-Maximilians-Universität München, Klinikum Großhadern, München, Germany
| | - Stephanie Förderreuther
- Neurologische Klinik, Ludwig-Maximilians-Universität München, Klinikum Großhadern, München, Germany
| | | | - Jens Petersen
- Klinik für Neurologie, Universitätsspital Zürich, Zürich, Swizterland
| | - Peter Sandor
- RehaClinic Bad Zurzach, Bad Zurzach, Swizterland
| | - Christian Lampl
- Ordensklinikum Linz, Krankenhaus der Barmherzigen Schwestern Linz Betriebsgesellschaft m.b.H., Linz, Austria
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128
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Firet L, de Bree C, Verhoeks CM, Teunissen DAM, Lagro-Janssen ALM. Mixed feelings: general practitioners' attitudes towards eHealth for stress urinary incontinence - a qualitative study. BMC FAMILY PRACTICE 2019; 20:21. [PMID: 30684962 PMCID: PMC6347743 DOI: 10.1186/s12875-019-0907-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 01/15/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUND Stress urinary incontinence (SUI) is the most prevalent subtype of urinary incontinence and is a bothering condition in women. Only a minority of those with SUI consult a general practitioner (GP). EHealth with pelvic floor muscle training (PFMT) is effective in reducing incontinence symptoms and might increase access to care. The role of the GP regarding such an eHealth intervention is unknown. The aim of the study is to gain insight into the attitudes towards a PFMT internet-based, eHealth, intervention for SUI. METHODS A qualitative study was conducted. Data were collected through semi-structured interviews among purposively sampled GPs. Audio records were fully transcribed, and analysed thematically. RESULTS Thirteen GPs were interviewed, nine females and four males. Three themes emerged: appraisal of eHealth as a welcome new tool, mixed feelings about a supportive role, and eHealth is no cure-all. GPs welcomed eHealth for SUI as matching their preferences for PFMT and having advantages for patients. With eHealth as stand-alone therapy GPs were concerned about the lack of feedback, and the loss of motivation to adhere to the intervention. Therefore, GPs considered personal support important. The GP's decision to recommend eHealth was strongly influenced by a woman's motivation and her age. GPs' treatment preferences for elderly are different from those for young women with SUI; both PFMT and eHealth are perceived less suitable for older women. CONCLUSION EHealth with PFMT fits into the GPs' routine practice of SUI and adds value to it. Although there is evidence that eHealth as a stand-alone intervention is effective, GPs consider personal support important to supplement the perceived shortcomings. Probably GPs are not aware of, or convinced of the existing evidence. Training should address this issue and should also focus on common misunderstandings about regular care for women with SUI, such as the idea that PFMT is not suitable for the elderly. Improving GPs' knowledge that eHealth can be a stand-alone therapy for SUI facilitates the implementation in daily care.
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Affiliation(s)
- Lotte Firet
- Department of Primary and Community Care, Unit Gender in Primary and Transmural Care, Radboud university medical center, Geert Grooteplein 21, 6500, HB, Nijmegen, the Netherlands.
| | - Chrissy de Bree
- Department of Primary and Community Care, Unit Gender in Primary and Transmural Care, Radboud university medical center, Geert Grooteplein 21, 6500, HB, Nijmegen, the Netherlands
| | - Carmen M Verhoeks
- Department of Primary and Community Care, Unit Gender in Primary and Transmural Care, Radboud university medical center, Geert Grooteplein 21, 6500, HB, Nijmegen, the Netherlands
| | - Doreth A M Teunissen
- Department of Primary and Community Care, Unit Gender in Primary and Transmural Care, Radboud university medical center, Geert Grooteplein 21, 6500, HB, Nijmegen, the Netherlands
| | - Antoine L M Lagro-Janssen
- Department of Primary and Community Care, Unit Gender in Primary and Transmural Care, Radboud university medical center, Geert Grooteplein 21, 6500, HB, Nijmegen, the Netherlands
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129
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Hermes EDA, Lyon AR, Schueller SM, Glass JE. Measuring the Implementation of Behavioral Intervention Technologies: Recharacterization of Established Outcomes. J Med Internet Res 2019; 21:e11752. [PMID: 30681966 PMCID: PMC6367669 DOI: 10.2196/11752] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 10/18/2018] [Accepted: 10/20/2018] [Indexed: 01/23/2023] Open
Abstract
Behavioral intervention technologies (BITs) are websites, software, mobile apps, and sensors designed to help users address or change behaviors, cognitions, and emotional states. BITs have the potential to transform health care delivery, and early research has produced promising findings of efficacy. BITs also favor new models of health care delivery and provide novel data sources for measurement. However, there are few examples of successful BIT implementation and a lack of consensus on as well as inadequate descriptions of BIT implementation measurement. The aim of this viewpoint paper is to provide an overview and characterization of implementation outcomes for the study of BIT use in routine practice settings. Eight outcomes for the evaluation of implementation have been previously described: acceptability, adoption, appropriateness, feasibility, fidelity, implementation cost, penetration, and sustainability. In a proposed recharacterization of these outcomes with respect to BIT implementation, definitions are clarified, expansions to the level of analysis are identified, and unique measurement characteristics are discussed. Differences between BIT development and implementation, an increased focus on consumer-level outcomes, the expansion of providers who support BIT use, and the blending of BITs with traditional health care services are specifically discussed. BITs have the potential to transform health care delivery. Realizing this potential, however, will hinge on high-quality research that consistently and accurately measures how well such technologies have been integrated into health services. This overview and characterization of implementation outcomes support BIT research by identifying and proposing solutions for key theoretical and practical measurement challenges.
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Affiliation(s)
- Eric DA Hermes
- Veterans Affairs Connecticut Healthcare System, West Haven, CT, United States.,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Aaron R Lyon
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, United States
| | - Stephen M Schueller
- Department of Psychological Science, University of California at Irvine, Irvine, CA, United States
| | - Joseph E Glass
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
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130
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Ghanvatkar S, Kankanhalli A, Rajan V. User Models for Personalized Physical Activity Interventions: Scoping Review. JMIR Mhealth Uhealth 2019; 7:e11098. [PMID: 30664474 PMCID: PMC6352015 DOI: 10.2196/11098] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 10/01/2018] [Accepted: 10/26/2018] [Indexed: 02/06/2023] Open
Abstract
Background Fitness devices have spurred the development of apps that aim to motivate users, through interventions, to increase their physical activity (PA). Personalization in the interventions is essential as the target users are diverse with respect to their activity levels, requirements, preferences, and behavior. Objective This review aimed to (1) identify different kinds of personalization in interventions for promoting PA among any type of user group, (2) identify user models used for providing personalization, and (3) identify gaps in the current literature and suggest future research directions. Methods A scoping review was undertaken by searching the databases PsycINFO, PubMed, Scopus, and Web of Science. The main inclusion criteria were (1) studies that aimed to promote PA; (2) studies that had personalization, with the intention of promoting PA through technology-based interventions; and (3) studies that described user models for personalization. Results The literature search resulted in 49 eligible studies. Of these, 67% (33/49) studies focused solely on increasing PA, whereas the remaining studies had other objectives, such as maintaining healthy lifestyle (8 studies), weight loss management (6 studies), and rehabilitation (2 studies). The reviewed studies provide personalization in 6 categories: goal recommendation, activity recommendation, fitness partner recommendation, educational content, motivational content, and intervention timing. With respect to the mode of generation, interventions were found to be semiautomated or automatic. Of these, the automatic interventions were either knowledge-based or data-driven or both. User models in the studies were constructed with parameters from 5 categories: PA profile, demographics, medical data, behavior change technique (BCT) parameters, and contextual information. Only 27 of the eligible studies evaluated the interventions for improvement in PA, and 16 of these concluded that the interventions to increase PA are more effective when they are personalized. Conclusions This review investigates personalization in the form of recommendations or feedback for increasing PA. On the basis of the review and gaps identified, research directions for improving the efficacy of personalized interventions are proposed. First, data-driven prediction techniques can facilitate effective personalization. Second, use of BCTs in automated interventions, and in combination with PA guidelines, are yet to be explored, and preliminary studies in this direction are promising. Third, systems with automated interventions also need to be suitably adapted to serve specific needs of patients with clinical conditions. Fourth, previous user models focus on single metric evaluations of PA instead of a potentially more effective, holistic, and multidimensional view. Fifth, with the widespread adoption of activity monitoring devices and mobile phones, personalized and dynamic user models can be created using available user data, including users’ social profile. Finally, the long-term effects of such interventions as well as the technology medium used for the interventions need to be evaluated rigorously.
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Affiliation(s)
- Suparna Ghanvatkar
- Department of Information Systems and Analytics, School of Computing, National University of Singapore, Singapore, Singapore
| | - Atreyi Kankanhalli
- Department of Information Systems and Analytics, School of Computing, National University of Singapore, Singapore, Singapore
| | - Vaibhav Rajan
- Department of Information Systems and Analytics, School of Computing, National University of Singapore, Singapore, Singapore
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Goel A. Internet-delivered exposure therapy was cost-effective for increasing treatment response in fibromyalgia. Ann Intern Med 2019; 170:JC11. [PMID: 30641562 DOI: 10.7326/acpjc-2019-170-2-011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Anupam Goel
- UnitedHealthcareClarendon Hills, Illinois, USA
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Reupert A, Bartholomew C, Cuff R, Foster K, Matar J, Maybery DJ, Pettenuzzo L. An Online Intervention to Promote Mental Health and Wellbeing for Young Adults Whose Parents Have Mental Illness and/or Substance Use Problems: Theoretical Basis and Intervention Description. Front Psychiatry 2019; 10:59. [PMID: 30828308 PMCID: PMC6384231 DOI: 10.3389/fpsyt.2019.00059] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Accepted: 01/25/2019] [Indexed: 11/13/2022] Open
Abstract
The transition to adulthood can be a vulnerable period for certain population groups. In particular, young adults aged 18-25 years who have a parent with mental illness and/or substance use problems face increased risks to their mental health compared to same aged peers. Yet these young adults may not have access to age-appropriate, targeted interventions, nor engage with traditional face-to-face health services. To support this vulnerable group, services need to engage with them in environments where they are likely to seek help, such as the Internet. This paper describes the risk mechanisms for this group of young adults, and the theoretical and empirical basis, aims, features and content of a tailored online group intervention; mi.spot (mental illness: supportive, preventative, online, targeted). The participatory approach employed to design the intervention is described. This involved working collaboratively with stakeholders (i.e., young adults, clinicians, researchers and website developers). Implementation considerations and future research priorities for an online approach targeting this group of young adults conclude the paper.
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Affiliation(s)
- Andrea Reupert
- Faculty of Education, Krongold Clinic, Monash University Melbourne, VIC, Australia
| | - Catherine Bartholomew
- Wellways Australia Incorporating Australian HealthCall Group Melbourne, VIC, Australia
| | - Rose Cuff
- The Bouverie Centre Melbourne, VIC, Australia
| | - Kim Foster
- School of Nursing, Midwifery & Paramedicine, Australian Catholic University Melbourne, VIC, Australia.,NorthWestern Mental Health Melbourne, VIC, Australia
| | - Jodie Matar
- Faculty of Education, Krongold Clinic, Monash University Melbourne, VIC, Australia
| | - Darryl J Maybery
- Department of Rural Health, Monash University Clayton, VIC, Australia
| | - Laura Pettenuzzo
- Faculty of Education, Krongold Clinic, Monash University Melbourne, VIC, Australia
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Expectations regarding eHealth among women with stress urinary incontinence. Int Urogynecol J 2018; 30:1955-1963. [PMID: 30594948 PMCID: PMC6834728 DOI: 10.1007/s00192-018-3849-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 12/03/2018] [Indexed: 12/26/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Stress urinary incontinence (SUI) is a common condition with a major impact on quality of life (QoL). Various factors prevent women from seeking help. However, eHealth (Internet-based therapy) with pelvic floor muscle training (PFMT) is an effective and satisfying intervention for these women. We hypothesize that women with symptoms after regular therapy will profit from eHealth. This study explores the expectations regarding an eHealth intervention among women who still suffer from SUI despite treatment. METHODS A qualitative study with semistructured interviews was conducted using a grounded theory approach. The study included women with SUI who had ever sought help for their condition. RESULTS Thirteen women were interviewed, most whom had experience with PFMT and still suffered from moderate-to-severe incontinence. Two themes emerged from data analysis: the need to meet, and eHealth as a tool to bridge obstacles. Women greatly emphasized that a healthcare professional, preferably one they know, should be available with eHealth. Several women indicated that the absence of personal contact caused lack of trust in success. However, several women were willing to use eHealth because its anonymity and flexibility could overcome obstacles in regular care. CONCLUSIONS eHealth based on PFMT is currently not a preferable treatment modality for women who still suffer from SUI despite treatment. eHealth cannot act as a substitute for their positive experience with personal contact. Some women are willing to use eHealth because of its advantages over regular care. Future experiences with eHealth might enable women with SUI to trust digital care.
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Moore BA, Buono FD, Lloyd DP, Printz DMB, Fiellin DA, Barry DT. A randomized clinical trial of the Recovery Line among methadone treatment patients with ongoing illicit drug use. J Subst Abuse Treat 2018; 97:68-74. [PMID: 30577901 DOI: 10.1016/j.jsat.2018.11.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 11/12/2018] [Accepted: 11/23/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Relapse, drug use, and treatment dropout are common challenges facing patients receiving methadone. Though effective, multiple barriers to face-to-face counseling exist. The Recovery Line (RL), an automated, self-management system based on Cognitive Behavioral Therapy, is a phone-based adjunctive treatment that provides low cost, consistent delivery and immediate therapeutic availability 24 h a day. METHODS The current study was a 12-week randomized clinical efficacy trial of treatment-as-usual (TAU) only or RL + TAU for methadone treatment patients with continued illicit drug use (N = 82). Previous small trial phases evaluated methods to increase participant engagement and use of the RL and were incorporated into the current RL version. Primary outcomes were days of self-reported illicit drug abstinence and urine screens negative for illicit drugs. RESULTS Days of self-reported illicit drug abstinence improved for patients in RL + TAU but not in TAU. Percent of urine screens negative for illicit drugs, coping skills efficacy, and retention in methadone treatment did not differ by condition. Patients in RL + TAU attended more substance use disorder treatment and self-help group sessions during treatment than those in TAU. RL system use was generally low and more system use was correlated with abstinence outcomes. CONCLUSIONS Although the RL did not impact urine screen outcomes, it increases self-reported abstinence. Additional methods to increase patient engagement with automated, self-management systems for substance use disorder are needed.
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Affiliation(s)
- Brent A Moore
- Department of Psychiatry, Yale School of Medicine, New Haven, 06511, CT, USA; VA Connecticut Healthcare System, West Haven, 06516, CT, USA; APT Foundation, New Haven, 06511, CT, USA.
| | - Frank D Buono
- Department of Psychiatry, Yale School of Medicine, New Haven, 06511, CT, USA; VA Connecticut Healthcare System, West Haven, 06516, CT, USA; APT Foundation, New Haven, 06511, CT, USA
| | - Daniel P Lloyd
- Department of Psychiatry, Yale School of Medicine, New Haven, 06511, CT, USA; APT Foundation, New Haven, 06511, CT, USA
| | - Destiny M B Printz
- Department of Psychiatry, Yale School of Medicine, New Haven, 06511, CT, USA; VA Connecticut Healthcare System, West Haven, 06516, CT, USA; APT Foundation, New Haven, 06511, CT, USA
| | - David A Fiellin
- Department of Internal Medicine, Yale University School of Medicine, New Haven, 06510, CT, USA
| | - Declan T Barry
- Department of Psychiatry, Yale School of Medicine, New Haven, 06511, CT, USA; APT Foundation, New Haven, 06511, CT, USA
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Pulantara IW, Parmanto B, Germain A. Clinical Feasibility of a Just-in-Time Adaptive Intervention App (iREST) as a Behavioral Sleep Treatment in a Military Population: Feasibility Comparative Effectiveness Study. J Med Internet Res 2018; 20:e10124. [PMID: 30530452 PMCID: PMC6303679 DOI: 10.2196/10124] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 08/22/2018] [Accepted: 09/10/2018] [Indexed: 01/23/2023] Open
Abstract
Background Although evidence-based cognitive behavioral sleep treatments have been shown to be safe and effective, these treatments have limited scalability. Mobile health tools can address this scalability challenge. iREST, or interactive Resilience Enhancing Sleep Tactics, is a mobile health platform designed to provide a just-in-time adaptive intervention (JITAI) in the assessment, monitoring, and delivery of evidence-based sleep recommendations in a scalable and personalized manner. The platform includes a mobile phone–based patient app linked to a clinician portal. Objective The first aim of the pilot study was to evaluate the effectiveness of JITAI using the iREST platform for delivering evidence-based sleep interventions in a sample of military service members and veterans. The second aim was to explore the potential effectiveness of this treatment delivery form relative to habitual in-person delivery. Methods In this pilot study, military service members and veterans between the ages of 18 and 60 years who reported clinically significant service-related sleep disturbances were enrolled as participants. Participants were asked to use iREST for a period of 4 to 6 weeks during which time they completed a daily sleep/wake diary. Through the clinician portal, trained clinicians offered recommendations consistent with evidence-based behavioral sleep treatments on weeks 2 through 4. To explore potential effectiveness, self-report measures were used, including the Insomnia Severity Index (ISI), the Pittsburgh Sleep Quality Index (PSQI), and the PSQI Addendum for Posttraumatic Stress Disorder. Results A total of 27 participants completed the posttreatment assessments. Between pre- and postintervention, clinically and statistically significant improvements in primary and secondary outcomes were detected (eg, a mean reduction on the ISI of 9.96, t26=9.99, P<.001). At posttreatment, 70% (19/27) of participants met the criteria for treatment response and 59% (16/27) achieved remission. Comparing these response and remission rates with previously published results for in-person trials showed no significant differences. Conclusion Participants who received evidence-based recommendations from their assigned clinicians through the iREST platform showed clinically significant improvements in insomnia severity, overall sleep quality, and disruptive nocturnal disturbances. These findings are promising, and a larger noninferiority clinical trial is warranted.
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Affiliation(s)
- I Wayan Pulantara
- Health and Rehabilitation Informatics Laboratory, Department of Health Information Management, University of Pittsburgh, Pittsburgh, PA, United States
| | - Bambang Parmanto
- Health and Rehabilitation Informatics Laboratory, Department of Health Information Management, University of Pittsburgh, Pittsburgh, PA, United States
| | - Anne Germain
- Sleep and Behavioral Neuroscience Center, Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States
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Bendig E, Bauereiß N, Daniel Ebert D, Snoek F, Andersson G, Baumeister H. Internet- Based Interventions in Chronic Somatic Disease. DEUTSCHES ARZTEBLATT INTERNATIONAL 2018; 115:659-665. [PMID: 30381130 PMCID: PMC6234467 DOI: 10.3238/arztebl.2018.0659] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 12/18/2017] [Accepted: 07/18/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Clinical guidelines recommend psychosocial care as an integral part of medical treatment, but access is often limited. Technology-based approaches provide an attractive opportunity to optimize health outcomes and quality of life in people with chronic somatic diseases e.g. by means of Internet- and mobile-based interventions (IMIs). The present article provides an overview on the basics of IMIs, applications and their evidence base for people living with chronic somatic diseases. METHODS We conducted a selective literature search in the PubMed and Cochrane databases. Reviews which included randomized controlled trials investigating psychological IMIs were discussed pertaining to their relevance for the population described. RESULTS IMIs lead to a change in unfavorable behavior connected to chronic somatic diseases. IMIs can foster protective factors like balanced physical activity or risk factors like smoking or alcohol consumption. However, studies reveal small effect sizes of d=0.25 for physical activity and an averaged effect size of d=0.20 for smoking and alcohol consumption. Additionally, IMIs can be used for the (co-)treatment of chronic somatic diseases, for instance to increase disease-specific selfefficacy in patients with diabetes (d=0.23). Studies included in meta-analyses are often highly heterogenous and are investigated in research contexts with limited health care services relevance. CONCLUSION IMIs are potentially effective when aiming at lifestyle changes and supporting medical treatment in people with chronic somatic diseases. However, results are still heterogenous and the evidence base is limited regarding specific settings, compounding the discussion of possible ways of implementing IMIs into our healthcare systems.
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Affiliation(s)
- Eileen Bendig
- Institute of Psychology and Education, Department of Clinical Psychology and Psychotherapy, University of Ulm, Ulm, Germany
| | - Natalie Bauereiß
- Institute of Psychology and Education, Department of Clinical Psychology and Psychotherapy, University of Ulm, Ulm, Germany
| | - David Daniel Ebert
- Department for Psychology, Clinical Psychology and Psychotherapy, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Frank Snoek
- Department of Medical Psychology, VU University Medical Center and Academic Medical Center, Amsterdam, Netherlands
| | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linköpings University, Linköping and Department of Clinical Neuroscience, Karolinska Institut, Stockholm, Sweden
| | - Harald Baumeister
- Institute of Psychology and Education, Department of Clinical Psychology and Psychotherapy, University of Ulm, Ulm, Germany
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Paris M, Silva M, Añez-Nava L, Jaramillo Y, Kiluk BD, Gordon MA, Nich C, Frankforter T, Devore K, Ball SA, Carroll KM. Culturally Adapted, Web-Based Cognitive Behavioral Therapy for Spanish-Speaking Individuals With Substance Use Disorders: A Randomized Clinical Trial. Am J Public Health 2018; 108:1535-1542. [PMID: 30252519 PMCID: PMC6187780 DOI: 10.2105/ajph.2018.304571] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2018] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To evaluate whether adding Web-based cognitive behavioral treatment (CBT) to standard outpatient psychiatric or addiction treatment improved substance use outcomes. METHODS We conducted a randomized clinical trial in New Haven, Connecticut, between 2014 and 2017 comparing 8 weeks of standard outpatient treatment to the same treatment with access to a culturally adapted version of Web-based CBT with a 6-month follow-up. Participants were 92 treatment-seeking individuals with Spanish as their primary language and current substance use disorder, with few other restrictions. RESULTS Treatment completion and data availability were high (98% of the randomized sample). For the primary outcome (change in frequency of primary substance used), there was a significant effect of treatment condition by time (t 1, 718 = -2.64; 95% confidence interval = -0.61, 0.09; P = .01), indicating significantly greater reductions for those assigned to Web CBT, which were durable through the 6-month follow-up. The knowledge test indicated significantly greater increases for those assigned to Web CBT. CONCLUSIONS Adding a culturally adapted version of Web-based CBT to standard treatment improved substance use outcomes. Public Health Implications. This approach has high potential to address health disparities by providing an easily accessible, inexpensive form of evidence-based treatment to a range of Latinos with substance use disorders.
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Affiliation(s)
- Manuel Paris
- All authors are with the Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Michelle Silva
- All authors are with the Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Luis Añez-Nava
- All authors are with the Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Yudilyn Jaramillo
- All authors are with the Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Brian D Kiluk
- All authors are with the Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Melissa A Gordon
- All authors are with the Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Charla Nich
- All authors are with the Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Tami Frankforter
- All authors are with the Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Kathleen Devore
- All authors are with the Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Samuel A Ball
- All authors are with the Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Kathleen M Carroll
- All authors are with the Department of Psychiatry, Yale University School of Medicine, New Haven, CT
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Higgins KS, Tutelman PR, Chambers CT, Witteman HO, Barwick M, Corkum P, Grant D, Stinson JN, Lalloo C, Robins S, Orji R, Jordan I. Availability of researcher-led eHealth tools for pain assessment and management: barriers, facilitators, costs, and design. Pain Rep 2018; 3:e686. [PMID: 30324177 PMCID: PMC6172815 DOI: 10.1097/pr9.0000000000000686] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 08/07/2018] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Numerous eHealth tools for pain assessment and management have been developed and evaluated with promising results regarding psychometric properties, efficacy, and effectiveness. Although considerable resources are spent on developing and evaluating these tools with the aim of increasing access to care, current evidence suggests they are not made available to end users, reducing their impact and creating potential research waste. METHODS This study consisted of 2 components: (1) a systematic review of eHealth tools for pediatric pain assessment and/or management published in the past 10 years, and (2) an online survey, completed by the authors of identified tools, of tool availability, perceived barriers or facilitators to availability, grant funding used, and a validated measure of user-centeredness of the design process (UCD-11). RESULTS Ninety articles (0.86% of citations screened) describing 53 tools met inclusion criteria. Twenty-six survey responses were completed (49.06%), 13 of which (50.00%) described available tools. Commonly endorsed facilitators of tool availability included researchers' beliefs in tool benefits to the target population and research community; barriers included lack of infrastructure and time. The average cost of each unavailable tool was $314,425.31 USD ($3,144,253.06 USD total, n = 10). Authors of available tools were more likely to have followed user-centered design principles and reported higher total funding. CONCLUSION Systemic changes to academic and funding structures could better support eHealth tool availability and may reduce potential for research waste. User-centered design and implementation science methods could improve the availability of eHealth tools and should be further explored in future studies.
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Affiliation(s)
- Kristen S. Higgins
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Canada
- Centre for Pediatric Pain Research, IWK Health Centre, Halifax, Canada
| | - Perri R. Tutelman
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Canada
- Centre for Pediatric Pain Research, IWK Health Centre, Halifax, Canada
| | - Christine T. Chambers
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Canada
- Centre for Pediatric Pain Research, IWK Health Centre, Halifax, Canada
- Department of Pediatrics, Dalhousie University, Halifax, Canada
| | - Holly O. Witteman
- Centre de recherche sur les soins et les services de première ligne de l'Université Laval, Québec City, Canada
- CHU de Québec, Québec City, Canada
- Ottawa Hospital Research Institute, Ottawa, Canada
| | - Melanie Barwick
- Child Health Evaluative Sciences Research Institute, The Hospital for Sick Children, Toronto, Canada
- Department of Psychiatry and Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Penny Corkum
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Canada
- Department of Psychiatry, Dalhousie University, Halifax, Canada
- Colchester East Hands ADHD Clinic, Colchester East Hants Health Authority, Truro, Canada
| | - Doris Grant
- Industry Liaison and Innovation, Dalhousie University, Halifax, Canada
| | - Jennifer N. Stinson
- Child Health Evaluative Sciences Research Institute, The Hospital for Sick Children, Toronto, Canada
- Chronic Pain Program, The Hospital for Sick Children, Toronto, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Chitra Lalloo
- Child Health Evaluative Sciences Research Institute, The Hospital for Sick Children, Toronto, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Sue Robins
- Patient Advocate and Partner, Bird Communications, Vancouver, Canada
| | - Rita Orji
- Faculty of Computer Science, Dalhousie University, Halifax, Canada
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Stubberud A, Linde M. Digital Technology and Mobile Health in Behavioral Migraine Therapy: a Narrative Review. Curr Pain Headache Rep 2018; 22:66. [PMID: 30066141 DOI: 10.1007/s11916-018-0718-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE OF REVIEW This article reviews the recent research and development of electronic health (eHealth) and, in particular, mobile health (mHealth) strategies to deliver behavioral treatment for migraine. Prospects for future development and research of mobile health in migraine are suggested. RECENT FINDINGS Advances in digital technology and mobile technology have led to an era where electronic and mobile approaches are applied to several aspects of healthcare. Electronic behavioral interventions for migraine seem to be acceptable and feasible, but efficacy measures are uncertain. Clinical trials on mHealth-based classical behavioral therapies, such as relaxation, biofeedback, and cognitive behavioral therapy are missing in the literature. Within mHealth, headache diaries are the most researched and scientifically developed. Still, there is a gap between commercially available apps and scientifically validated and developed apps. Digital technology and mobile health has not yet lived out its potential in behavioral migraine therapy. Application of proper usability and functionality designs towards the right market, together with appraisal of medical and technological recommendations, may facilitate rapid development of eHealth and mHealth, while also establishing scientific evidence.
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Affiliation(s)
- Anker Stubberud
- Department of Neuromedicine and Movement Science, NTNU Norwegian University of Science and Technology, NO-7489, Trondheim, Norway.
| | - Mattias Linde
- Department of Neuromedicine and Movement Science, NTNU Norwegian University of Science and Technology, NO-7489, Trondheim, Norway.,Norwegian Advisory Unit on Headache, Department of Neurology and Clinical Neurophysiology, St. Olavs Hospital, NO-7006, Trondheim, Norway
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Nguyen MH, Bol N, van Weert JCM, Loos EF, Tytgat KMAJ, Geijsen D, Drenth E, Janse M, Smets EMA. Optimising eHealth tools for older patients: Collaborative redesign of a hospital website. Eur J Cancer Care (Engl) 2018; 28:e12882. [PMID: 30015998 PMCID: PMC6588263 DOI: 10.1111/ecc.12882] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 04/26/2018] [Accepted: 06/01/2018] [Indexed: 12/12/2022]
Abstract
Most hospital websites have not been developed in collaboration with patients and, therefore, rarely take into account the preferences and abilities of older patients. This study describes the systematic redesign of an existing hospital website in a co‐design process with patients and professional stakeholders (e.g. researchers, physicians, nurses, department heads, policymakers, website designers), with the aim to make it more user‐friendly for older patients with colorectal cancer (CRC). The redesign process consisted of three phases, where (I) both existing content and design were evaluated among CRC patients; (II) a prototype website was developed based on these insights; which (III) was evaluated again before making final adjustments. Mixed research methods were used for the redesign process. Specifically, insights from existing literature, outcomes from qualitative and quantitative empirical studies conducted by our team, and expert knowledge from relevant stakeholders, were collected and discussed in multidisciplinary consensus meetings, and served as input for the redesigned website. While the existing website was evaluated poorly, the qualitative evaluation of the prototype website in phase 3 showed that the newly redesigned website was usable for older CRC patients. A practical roadmap on how to collaboratively redesign and optimise existing eHealth tools to make them suitable for and operational in clinical settings is provided.
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Affiliation(s)
- Minh Hao Nguyen
- Amsterdam School of Communication Research (ASCoR), University of Amsterdam, Amsterdam, The Netherlands
| | - Nadine Bol
- Amsterdam School of Communication Research (ASCoR), University of Amsterdam, Amsterdam, The Netherlands
| | - Julia C M van Weert
- Amsterdam School of Communication Research (ASCoR), University of Amsterdam, Amsterdam, The Netherlands
| | - Eugène F Loos
- Amsterdam School of Communication Research (ASCoR), University of Amsterdam, Amsterdam, The Netherlands
| | | | - Debby Geijsen
- Department of Radiation Oncology, Academic Medical Center, Amsterdam, The Netherlands
| | - Ellen Drenth
- Gastro-Intestinal Oncological Center Amsterdam, Academic Medical Center, Amsterdam, The Netherlands
| | - Meriam Janse
- Gastro-Intestinal Oncological Center Amsterdam, Academic Medical Center, Amsterdam, The Netherlands
| | - Ellen M A Smets
- Department of Medical Psychology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Abstract
PURPOSE OF REVIEW Cannabis is globally the most commonly cultivated, trafficked and consumed illicit drug of abuse. The current article provides an updated overview of existing comprehensive interventions for preventing and reducing cannabis use. RECENT FINDINGS The PubMed database was searched for evidence regarding comprehensive interventions for preventing and reducing cannabis use from June 2016 to January 2018. The search resulted in 274 articles. Twenty-one studies were selected for assessment and 13 fulfilled the inclusion criteria. Six systematic reviews regarding preventive, psychosocial, pharmacological and risk reduction interventions were identified. Psychosocial interventions included therapist-assisted and computerized interventions. Four therapist-assisted, one computerized and two pharmacological clinical trials were published over the review period. Overall, considering the three different approaches (preventive, psychosocial or pharmacological) promising results have been found in certain interventions in reducing cannabis use among different types of users. In addition, recommendations to reduce adverse health outcomes related to cannabis use have also been reviewed. SUMMARY Although relevant findings have been found so far, further research with adequately powered trials assessing comprehensive interventions for reducing cannabis use remains a need before definitive treatment recommendations can be established.
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Srikesavan C, Williamson E, Cranston T, Hunter J, Adams J, Lamb SE. An Online Hand Exercise Intervention for Adults With Rheumatoid Arthritis (mySARAH): Design, Development, and Usability Testing. J Med Internet Res 2018; 20:e10457. [PMID: 29950288 PMCID: PMC6041557 DOI: 10.2196/10457] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 04/16/2018] [Accepted: 04/24/2018] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND The Strengthening and Stretching for Rheumatoid Arthritis of the Hand (SARAH) program is a tailored, progressive 12-week exercise program for people with hand problems due to rheumatoid arthritis. The program was shown to be clinically and cost-effective in a large clinical trial and is recommended by the UK National Institute for Health and Care Excellence (NICE) guidelines for rheumatoid arthritis in adults. OBJECTIVE We have developed an online version of the SARAH program (mySARAH) to make the SARAH program widely accessible to people with rheumatoid arthritis. The purposes of this study were to develop mySARAH and to evaluate and address its usability issues. METHODS We developed mySARAH using a three-step process and gaining feedback from patient contributors. After initial development, mySARAH was tested in two iterative usability cycles in nine participants using a simplified think-aloud protocol and self-reported questionnaires. We also evaluated if participants executed the SARAH exercises correctly after watching the exercise videos included on the website. RESULTS A preliminary version of mySARAH consisting of six sessions over a 12-week period and delivered via text, exercise videos, images, exercise plan form, exercise calendar, and links to additional information on rheumatoid arthritis was developed. Five participants (1 male; 4 females; median age 64 years) and four participants (four females; median age 64.5 years) took part in the first and second usability testing cycles respectively. Usability issues identified from Cycle 1 such as having a navigation tutorial video and individualised feedback on pain levels were addressed prior to Cycle 2. The need for more instructions to complete the mySARAH patient forms was identified in Cycle 2 and was rectified. Self-reports from both cycles indicated that participants found the program useful and easy to use and were confident in performing the SARAH exercises themselves. Eight of the nine participants correctly demonstrated all the exercises. CONCLUSIONS mySARAH is the first online hand exercise intervention for people with rheumatoid arthritis. We actively involved target users in the development and usability evaluation and ensured mySARAH met their needs and preferences.
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Affiliation(s)
- Cynthia Srikesavan
- Rehabilitation Research in Oxford, Nuffield Department of Orthopedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Esther Williamson
- Rehabilitation Research in Oxford, Nuffield Department of Orthopedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Tim Cranston
- Oxford Clinical Trials Research Unit, Nuffield Department of Orthopedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Headington, Oxford, United Kingdom
| | - John Hunter
- Rehabilitation Research in Oxford, Nuffield Department of Orthopedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Jo Adams
- Centre for Innovation and Leadership in Health Sciences, Faculty of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Sarah E Lamb
- Rehabilitation Research in Oxford, Nuffield Department of Orthopedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
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143
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Fleming T, Bavin L, Lucassen M, Stasiak K, Hopkins S, Merry S. Beyond the Trial: Systematic Review of Real-World Uptake and Engagement With Digital Self-Help Interventions for Depression, Low Mood, or Anxiety. J Med Internet Res 2018; 20:e199. [PMID: 29875089 PMCID: PMC6010835 DOI: 10.2196/jmir.9275] [Citation(s) in RCA: 280] [Impact Index Per Article: 46.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 02/28/2018] [Accepted: 03/17/2018] [Indexed: 01/19/2023] Open
Abstract
Background Digital self-help interventions (including online or computerized programs and apps) for common mental health issues have been shown to be appealing, engaging, and efficacious in randomized controlled trials. They show potential for improving access to therapy and improving population mental health. However, their use in the real world, ie, as implemented (disseminated) outside of research settings, may differ from that reported in trials, and implementation data are seldom reported. Objective This study aimed to review peer-reviewed articles reporting user uptake and/or ongoing use, retention, or completion data (hereafter usage data or, for brevity, engagement) from implemented pure self-help (unguided) digital interventions for depression, anxiety, or the enhancement of mood. Methods We conducted a systematic search of the Scopus, Embase, MEDLINE, and PsychINFO databases for studies reporting user uptake and/or usage data from implemented digital self-help interventions for the treatment or prevention of depression or anxiety, or the enhancement of mood, from 2002 to 2017. Additionally, we screened the reference lists of included articles, citations of these articles, and the titles of articles published in Internet Interventions, Journal of Medical Internet Research (JMIR), and JMIR Mental Health since their inception. We extracted data indicating the number of registrations or downloads and usage of interventions. Results After the removal of duplicates, 970 papers were identified, of which 10 met the inclusion criteria. Hand searching identified 1 additional article. The included articles reported on 7 publicly available interventions. There was little consistency in the measures reported. The number of registrants or downloads ranged widely, from 8 to over 40,000 per month. From 21% to 88% of users engaged in at least minimal use (eg, used the intervention at least once or completed one module or assessment), whereas 7-42% engaged in moderate use (completing between 40% and 60% of modular fixed-length programs or continuing to use apps after 4 weeks). Indications of completion or sustained use (completion of all modules or the last assessment or continuing to use apps after six weeks or more) varied from 0.5% to 28.6%. Conclusions Available data suggest that uptake and engagement vary widely among the handful of implemented digital self-help apps and programs that have reported this, and that usage may vary from that reported in trials. Implementation data should be routinely gathered and reported to facilitate improved uptake and engagement, arguably among the major challenges in digital health.
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Affiliation(s)
- Theresa Fleming
- Faculty of Health, Victoria University of Wellington, Wellington, New Zealand.,Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand
| | - Lynda Bavin
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand
| | - Mathijs Lucassen
- School of Health, Wellbeing and Social Care, The Open University, Milton Keynes, United Kingdom
| | - Karolina Stasiak
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand
| | - Sarah Hopkins
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand
| | - Sally Merry
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand
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144
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Ingersoll K, Frederick C, MacDonnell K, Ritterband L, Lord H, Jones B, Truwit L. A Pilot RCT of an Internet Intervention to Reduce the Risk of Alcohol-Exposed Pregnancy. Alcohol Clin Exp Res 2018; 42:1132-1144. [PMID: 29741798 PMCID: PMC5984155 DOI: 10.1111/acer.13635] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 03/18/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND Preventing alcohol-exposed pregnancies (AEPs) could reduce the incidence of fetal alcohol spectrum disorders. Previous face-to-face interventions significantly reduced risk for AEP, but a scalable intervention is needed to reach more women at risk. METHODS This study compared a 6 Core automated, interactive, and tailored Internet intervention, the Contraception and Alcohol Risk Reduction Internet Intervention (CARRII), to a static patient education (PE) website for its effect on AEP risk. Participants were recruited online to a pilot randomized clinical trial (RCT) with baseline, 9 weeks posttreatment, and 6-month (6-M) follow-up assessments. Seventy-one women completed online questionnaires and telephone interviews and were randomized to CARRII (n = 36) or PE (n = 35). Primary outcomes were rates of risky drinking, unprotected sex episodes, and AEP risk, collected from online prospective diaries. RESULTS CARRII participants showed significant reductions in rate of unprotected sex from pretreatment (88.9%) to posttreatment (70.6%) (p < 0.04) and to 6-M follow-up (51.5%) (p = 0.001); rate of risky drinking from pretreatment (75.0%) to posttreatment (50.0%) (p < 0.02), but insignificant change from pretreatment to 6-M follow-up (57.6%) (p < 0.09); and rate of AEP risk from pretreatment (66.7%) to posttreatment (32.4%) (p = 0.001) and to 6-M follow-up (30.3%) (p = 0.005). PE participants demonstrated no significant changes on all 3 variables across all time points. Intent-to-treat group-by-time tests were not significant, but power was limited by missing diaries. Over 72% of CARRII participants completed all 6 Cores. Exploratory analyses suggest that higher program utilization is related to change. CONCLUSIONS These data show that CARRII was acceptable, feasible, promising to reduce AEP risk, and merits further testing in a fully powered RCT.
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Affiliation(s)
- Karen Ingersoll
- Center for Behavioral Health and Technology, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Christina Frederick
- Center for Behavioral Health and Technology, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Kirsten MacDonnell
- Center for Behavioral Health and Technology, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Lee Ritterband
- Center for Behavioral Health and Technology, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Holly Lord
- Center for Behavioral Health and Technology, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Brogan Jones
- Center for Behavioral Health and Technology, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Lauren Truwit
- Center for Behavioral Health and Technology, University of Virginia School of Medicine, Charlottesville, Virginia
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145
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Hermes E, Burrone L, Perez E, Martino S, Rowe M. Implementing Internet-Based Self-Care Programs in Primary Care: Qualitative Analysis of Determinants of Practice for Patients and Providers. JMIR Ment Health 2018; 5:e42. [PMID: 29776898 PMCID: PMC5984276 DOI: 10.2196/mental.9600] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 02/14/2018] [Accepted: 03/13/2018] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Access to evidence-based interventions for common mental health conditions is limited due to geographic distance, scheduling, stigma, and provider availability. Internet-based self-care programs may mitigate these barriers. However, little is known about internet-based self-care program implementation in US health care systems. OBJECTIVE The objective of this study was to identify determinants of practice for internet-based self-care program use in primary care by eliciting provider and administrator perspectives on internet-based self-care program implementation. METHODS The objective was explored through qualitative analysis of semistructured interviews with primary care providers and administrators from the Veterans Health Administration. Participants were identified using a reputation-based snowball design. Interviews focused on identifying determinants of practice for the use of internet-based self-care programs at the point of care in Veterans Health Administration primary care. Qualitative analysis of transcripts was performed using thematic coding. RESULTS A total of 20 physicians, psychologists, social workers, and nurses participated in interviews. Among this group, internet-based self-care program use was relatively low, but support for the platform was assessed as relatively high. Themes were organized into determinants active at patient and provider levels. Perceived patient-level determinants included literacy, age, internet access, patient expectations, internet-based self-care program fit with patient experiences, interest and motivation, and face-to-face human contact. Perceived provider-level determinants included familiarity with internet-based self-care programs, changes to traditional care delivery, face-to-face human contact, competing demands, and age. CONCLUSIONS This exploration of perspectives on internet-based self-care program implementation among Veterans Health Administration providers and administrators revealed key determinants of practice, which can be used to develop comprehensive strategies for the implementation of internet-based self-care programs in primary care settings.
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Affiliation(s)
- Eric Hermes
- VA Connecticut Healthcare System, Veterans Health Administration, West Haven, CT, United States.,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Laura Burrone
- VA Connecticut Healthcare System, Veterans Health Administration, West Haven, CT, United States
| | - Elliottnell Perez
- VA Connecticut Healthcare System, Veterans Health Administration, West Haven, CT, United States
| | - Steve Martino
- VA Connecticut Healthcare System, Veterans Health Administration, West Haven, CT, United States.,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Michael Rowe
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
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146
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Jonas B, Tensil MD, Tossmann P, Strüber E. Effects of Treatment Length and Chat-Based Counseling in a Web-Based Intervention for Cannabis Users: Randomized Factorial Trial. J Med Internet Res 2018; 20:e166. [PMID: 29739738 PMCID: PMC5964299 DOI: 10.2196/jmir.9579] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 01/29/2018] [Accepted: 02/23/2018] [Indexed: 11/24/2022] Open
Abstract
Background Digital interventions show promise in reducing problematic cannabis use. However, little is known about the effect of moderators in such interventions. The therapist-guided internet intervention Quit the Shit provides 50 days of chat-based (synchronous) and time-lagged (asynchronous) counseling. Objective In the study, we examined whether the effectiveness of Quit the Shit is reduced by shortening the program or by removing the chat-based counseling option. Methods We conducted a purely Web-based randomized experimental trial using a two-factorial design (factor 1: real-time-counseling via text-chat: yes vs no; factor 2: intervention duration: 50 days vs 28 days). Participants were recruited on the Quit the Shit website. Follow-ups were conducted 3, 6, and 12 months after randomization. Primary outcome was cannabis-use days during the past 30 days using a Timeline Followback procedure. Secondary outcomes were cannabis quantity, cannabis-use events, cannabis dependency (Severity of Dependence Scale), treatment satisfaction (Client Satisfaction Questionnaire), and working alliance (Working Alliance Inventory-short revised). Results In total, 534 participants were included in the trial. Follow-up rates were 47.2% (252/534) after 3 months, 38.2% (204/534) after 6 months, and 25.3% (135/534) after 12 months. Provision of real-time counseling (factor 1) was not significantly associated with any cannabis-related outcome but with higher treatment satisfaction (P=.001, d=0.34) and stronger working alliance (P=.008, d=0.22). In factor 2, no significant differences were found in any outcome. The reduction of cannabis use among all study participants was strong (P<.001, d≥1.13). Conclusions The reduction of program length and the waiver of synchronous communication have no meaningful impact on the effectiveness of Quit the Shit. It therefore seems tenable to abbreviate the program and to offer a self-guided start into Quit the Shit. Due to its positive impact on treatment satisfaction and working alliance, chat-based counseling nevertheless should be provided in Quit the Shit. Trial Registration International Standard Randomized Controlled Trial Number ISRCTN99818059; http://www.isrctn.com/ISRCTN99818059 (Archived by WebCite at http://www.webcitation.org/6uVDeJjfD)
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Affiliation(s)
- Benjamin Jonas
- Delphi Gesellschaft für Forschung, Beratung und Projektentwicklung, Berlin, Germany
| | - Marc-Dennan Tensil
- Delphi Gesellschaft für Forschung, Beratung und Projektentwicklung, Berlin, Germany
| | - Peter Tossmann
- Delphi Gesellschaft für Forschung, Beratung und Projektentwicklung, Berlin, Germany
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147
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Srikesavan C, Bryer C, Ali U, Williamson E. Web-based rehabilitation interventions for people with rheumatoid arthritis: A systematic review. J Telemed Telecare 2018; 25:263-275. [PMID: 29669470 DOI: 10.1177/1357633x18768400] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Rehabilitation approaches for people with rheumatoid arthritis include joint protection, exercises and self-management strategies. Health interventions delivered via the web have the potential to improve access to health services overcoming time constraints, physical limitations, and socioeconomic and geographic barriers. The objective of this review is to determine the effects of web-based rehabilitation interventions in adults with rheumatoid arthritis. METHODS Randomised controlled trials that compared web-based rehabilitation interventions with usual care, waiting list, no treatment or another web-based intervention in adults with rheumatoid arthritis were included. The outcomes were pain, function, quality of life, self-efficacy, rheumatoid arthritis knowledge, physical activity and adverse effects. Methodological quality was assessed using the Cochrane Risk of Bias tool and quality of evidence with the Grading of Recommendations Assessment, Development and Evaluation approach. RESULTS Six source documents from four trials ( n = 567) focusing on self-management, health information or physical activity were identified. The effects of web-based rehabilitation interventions on pain, function, quality of life, self-efficacy, rheumatoid arthritis knowledge and physical activity are uncertain because of the very low quality of evidence mostly from small single trials. Adverse effects were not reported. CONCLUSION Large, well-designed trials are needed to evaluate the clinical and cost-effectiveness of web-based rehabilitation interventions in rheumatoid arthritis.
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Affiliation(s)
- Cynthia Srikesavan
- 1 Centre for Rehabilitation Research in Oxford, University of Oxford, UK
| | | | - Usama Ali
- 3 Centre for Statistics in Medicine, Oxford Clinical Trials Research Unit & Centre for Rehabilitation Research in Oxford, University of Oxford, UK
| | - Esther Williamson
- 1 Centre for Rehabilitation Research in Oxford, University of Oxford, UK
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148
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Knight R, Karamouzian M, Salway T, Gilbert M, Shoveller J. Online interventions to address HIV and other sexually transmitted and blood-borne infections among young gay, bisexual and other men who have sex with men: a systematic review. J Int AIDS Soc 2018; 20. [PMID: 29091340 PMCID: PMC5810340 DOI: 10.1002/jia2.25017] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Accepted: 10/02/2017] [Indexed: 12/14/2022] Open
Abstract
Introduction Globally, young gay, bisexual and other men who have sex with men (gbMSM) continue to experience disproportionately high rates of HIV and other sexually transmitted and blood‐borne infections (STBBIs). As such, there are strong public health imperatives to evaluate innovative prevention, treatment and care interventions, including online interventions. This study reviewed and assessed the status of published research (e.g. effectiveness; acceptability; differential effects across subgroups) involving online interventions that address HIV/STBBIs among young gbMSM. Methods We searched Medline, Embase, PsycINFO, CINAHL, and Google Scholar to identify relevant English‐language publications from inception to November 2016. Studies that assessed an online intervention regarding the prevention, care, or treatment of HIV/STBBIs were included. Studies with <50% gbMSM or with a mean age ≥30 years were excluded. Results Of the 3465 articles screened, 17 studies met inclusion criteria. Sixteen studies assessed interventions at the “proof‐of‐concept” phase, while one study assessed an intervention in the dissemination phase. All of the studies focused on behavioural or knowledge outcomes at the individual level (e.g. condom use, testing behaviour), and all but one reported a statistically significant effect on ≥1 primary outcomes. Twelve studies described theory‐based interventions. Twelve were conducted in the United States, with study samples focusing mainly on White, African‐American and/or Latino populations; the remaining were conducted in Hong Kong, Peru, China, and Thailand. Thirteen studies included gay and bisexual men; four studies did not assess sexual identity. Two studies reported including both HIV+ and HIV− participants, and all but one study included one or more measure of socio‐economic status. Few studies reported on the differential intervention effects by socio‐economic status, sexual identity, race or serostatus. Conclusion While online interventions show promise at addressing HIV/STBBI among young gbMSM, to date, little emphasis has been placed on assessing: (i) potential differential effects of interventions across subgroups of young gbMSM; (ii) effectiveness studies of interventions in the dissemination phase; and (iii) on some “key” populations of young gbMSM (e.g. those who are: transgender, from low‐income settings and/or HIV positive). Future research that unpacks the potentially distinctive experiences of particular subgroups with “real world” interventions is needed.
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Affiliation(s)
- Rod Knight
- British Columbia Centre on Substance Use, Vancouver, Canada
| | - Mohammad Karamouzian
- British Columbia Centre on Substance Use, Vancouver, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, Canada.,HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Travis Salway
- School of Population and Public Health, University of British Columbia, Vancouver, Canada.,British Columbia Centre for Disease Control, Vancouver, Canada
| | - Mark Gilbert
- School of Population and Public Health, University of British Columbia, Vancouver, Canada.,British Columbia Centre for Disease Control, Vancouver, Canada
| | - Jean Shoveller
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
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149
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Mira JJ. Tecnologías móviles e inalámbricas para cuidar nuestra salud. J Healthc Qual Res 2018; 33:183-186. [PMID: 31609231 DOI: 10.1016/j.jhqr.2018.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 09/04/2018] [Indexed: 10/28/2022]
Affiliation(s)
- José Joaquín Mira
- Departamento de Salud Alicante-Sant Joan, Universidad Miguel Hernández de Elche, Grupo Investigación Prometeo-173, Generalitat Valenciana, Editor del Journal Quality Healthcare Research.
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150
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Bosak K, Park SH. Characteristics of Adults Seeking Health Care Provider Support Facilitated by Mobile Technology: Secondary Data Analysis. JMIR Hum Factors 2017; 4:e33. [PMID: 29269337 PMCID: PMC5754563 DOI: 10.2196/humanfactors.8246] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 07/17/2017] [Accepted: 09/15/2017] [Indexed: 11/29/2022] Open
Abstract
Background Mobile health technology is rapidly evolving with the potential to transform health care. Self-management of health facilitated by mobile technology can maximize long-term health trajectories of adults. Little is known about the characteristics of adults seeking Web-based support from health care providers facilitated by mobile technology. Objective This study aimed to examine the following: (1) the characteristics of adults who seek human support from health care providers for health concerns using mobile technology rather than from family members and friends or others with similar health conditions and (2) the use of mobile health technology among adults with chronic health conditions. Findings of this study were interpreted in the context of the Efficiency Model of Support. Methods We first described characteristics of adults seeking Web-based support from health care providers. Using chi-square tests for categorical variables and t test for the continuous variable of age, we compared adults seeking Web-based and conventional support by demographics. The primary aim was analyzed using multivariate logistic regression to examine whether chronic health conditions and demographic factors (eg, sex, income, employment status, race, ethnicity, education, and age) were associated with seeking Web-based support from health care providers. Results The sample included adults (N=1453), the majority of whom were female 57.60% (837/1453), white 75.02% (1090/1453), and non-Hispanic 89.13% (1295/1453). The age of the participants ranged from 18 to 92 years (mean 48.6, standard deviation [SD] 16.8). The majority 76.05% (1105/1453) of participants reported college or higher level of education. A disparity was found in access to health care providers via mobile technology based on socioeconomic status. Adults with annual income of US $30,000 to US $100,000 were 1.72 times more likely to use Web-based methods to contact a health care provider, and adults with an annual income above US $100,000 were 2.41 to 2.46 times more likely to access health care provider support on the Web, compared with those with an annual income below US $30,000. After adjusting for other demographic covariates and chronic conditions, age was not a significant factor in Web-based support seeking. Conclusions In this study, the likelihood of seeking Web-based support increased when adults had any or multiple chronic health conditions. A higher level of income and education than the general population was found to be related to the use of mobile health technology among adults in this survey. Future study is needed to better understand the disparity in Web-based support seeking for health issues and the clinicians’ role in promoting access to and use of mobile health technology.
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Affiliation(s)
- Kelly Bosak
- School of Nursing, University of Kansas Medical Center, Kansas City, KS, United States
| | - Shin Hye Park
- School of Nursing, University of Kansas Medical Center, Kansas City, KS, United States
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