Acceptability of healthcare interventions: an overview of reviews and development of a theoretical framework

Developing and evaluating a health pack to support dog owners to manage the weight of their companion animals

Introduction

Obesity is a serious and prevalent problem in dogs. The causes are multifactorial, but owners play a key role and so this paper reports the development and evaluation of a health pack designed to help owners to manage the weight of their dogs.

Method

The pack was informed by previous research, behavior change theory (i.e., the COM-B model), and interviews with 12 veterinary professionals to identify challenges and potential solutions. Six workshops with a total of 28 dog owners provided feedback on the initial ideas. The pack included information on the importance of weight management, how to weigh and assess body condition score (BCS), a journal to track progress, an infographic illustrating the calorific value of treats, cards to help owners manage difficult situations, and a collar tag for the dog. The acceptability of the materials and potential outcomes were evaluated in a pre-registered pilot trial with a sample of 78 dog owners who were posted a health pack, 49 of whom completed a follow-up questionnaire.

Results

The findings suggested that owners were willing to weigh their dog, found the pack acceptable, and there was preliminary evidence that the weight and BCS of dogs was lower at follow-up than at baseline.

Discussion

The findings illustrate the potential of a health pack for supporting dog owners and provide the basis for a larger RCT to formally evaluate effectiveness.

Assessing Non-Oral PrEP Alternatives Among Young Black Women in the Southern USA

Young Black women in the southern US face a high HIV burden. While daily oral HIV pre-exposure prophylaxis (PrEP) can effectively prevent HIV, its use is low among Black women. The acceptability of and perceived intention to use emerging PrEP products among young Black women in the southern US are not well understood. Non-oral PrEP alternatives could address challenges to PrEP uptake and reduce health disparities. We conducted virtual semi-structured interviews with Black women aged 18-34 in Atlanta, GA; Baton Rouge, LA; and Jackson, MS, to explore their perspectives on three emerging PrEP products: a long-acting injection, a subdermal implant, and a dual-purpose contraception and HIV prevention intravaginal ring. Seventy-five interviews were conducted from January to October 2021 and analyzed using inductive thematic analysis with NVivo software. Most participants were open to using medication to prevent HIV. The intravaginal ring was the most preferred, primarily due to its dual-purpose function, although it was also frequently rejected. The long-acting injection was the second most preferred and least rejected, perceived as the least invasive. The skin implant was the least preferred and most rejected, viewed as the most invasive. Our findings highlight the need for multiple PrEP options to meet individual preferences. Detailed descriptions, instructions, and experiential learning methods are crucial for choosing non-oral PrEP modalities. Practitioners should address questions and offer peer-based learning opportunities. Designing and promoting PrEP strategies for young Black women should involve close consultation with these consumers.

Home high-flow therapy during recovery from severe chronic obstructive pulmonary disease (COPD) exacerbation: a mixed-methods feasibility randomised control trial

INTRODUCTION

Patients recovering from severe acute exacerbations of chronic obstructive pulmonary disease (AECOPD) have a 30-day readmission rate of 20%. This study evaluated the feasibility of conducting a randomised controlled trial to evaluate clinical, patient-reported and physiological effects of home high-flow therapy (HFT) in addition to usual medical therapy, in eucapnic patients recovering from AECOPD to support the design of a phase 3 trial.

METHODS

A mixed-methods feasibility randomised controlled trial (quantitative primacy, concurrently embedded qualitative evaluation) (ISRCTN15949009) recruiting consecutive non-obese patients hospitalised with AECOPD not requiring acute non-invasive ventilation. Participants were randomised to receive usual care or usual care and home HFT (37°C, 30 L/min) with weekly home-based follow-up for 4 weeks to collect data on: device usage, breathlessness (modified Borg scale, visual analogue scale, Multidimensional Dyspnoea Profile), health-related quality of life (COPD Assessment Test (CAT), Clinical COPD Questionnaire), pulse oximetry, spirometry and inspiratory capacity, parasternal electromyography and actigraphy. Semistructured interviews were conducted in week 4. Trial progression criteria were: ≥40% of eligible patients randomised, ≤20% attrition, ≥70% complete data, and no device-related serious adverse events (SAE).

RESULTS

18 of 45 eligible patients were randomised (age 69±5 years, 44% female, body mass index 23±5 kg/m2, forced expiratory volume in 1 second 32±12%). One withdrew following non-respiratory hospitalisation. Complete outcome measures were collected in >90% of home assessments. There were no device-related SAE. Daily HFT usage was 2.7±2.2 hours in week 1, falling to 2.3±1.4 hours by week 4. Temperature and flow settings were modified for comfort in 6 cases. Higher HFT usage was associated with lower symptom burden (CAT p=0.01). Interviews highlighted ease of device use, reduced salbutamol usage, and improved sputum production and clearance.

CONCLUSIONS

The data from this feasibility study support the progression to a phase 3 randomised clinical trial investigating the effect of home (HFT) on admission-free survival in COPD patients recovering from a severe exacerbation.

TRIAL REGISTRATION NUMBER

The study received ethical approval (REC19/LO/0194) and was prospectively registered (ISRCTN15949009).

Experiences, acceptability and barriers to calcium supplementation during pregnancy in Dar es Salaam, Tanzania

Calcium supplementation in pregnancy is recommended in contexts with low dietary calcium intake to reduce the risk of pre-eclampsia and its complications. The World Health Organisation suggested high-dose calcium supplementation (1500-2000 mg/day), divided into three doses and taken at different times from daily iron-folic supplements. We conducted a mixed methods evaluation study to assess experiences, acceptability and barriers to high-dose calcium supplementation from the perspectives of pregnant women and antenatal health care providers at two public health facilities in Dar es Salaam, Tanzania. Descriptive statistics and thematic analysis were used to characterise acceptability, barriers and overall experiences of using high-dose calcium supplementation. Pregnant women in the cohort were aged 19-41 years, with 32.4% being primiparous. The proportion of pregnant women who liked calcium supplements 'a lot' decreased from 50.2% at the first visit to 31.8% at the last antenatal follow-up visit. Adherence was 71.3% (interquartile range: 50.5%, 89.3%), with only 24.0% of the participants taking 90% or more of the required supplements. Although participants expressed positive attitudes towards using calcium supplements, they also voiced concerns about the large size, side effects, the potential to forget and the burden of taking calcium supplements three times per day. Antenatal health care providers also affirmed the high burden of taking calcium supplements in addition to iron-folic acid supplements. Participants expressed the acceptability of using calcium supplements during pregnancy, but adherence to three doses per day posed challenges to pregnant women. Reducing the number of calcium supplement doses per day may improve adherence.

Evaluating Ovarian Cancer Risk-Reducing Salpingectomy Acceptance: A Survey

SIGNIFICANCE

This study found that many participants were willing to consider RRS to prevent ovarian cancer. Further research on RRS should be undertaken to understand how this can be best used for ovarian cancer prevention.

Implementation of Billing for Patient Portal Messages as E-visits in a Large Integrated Health System

BACKGROUND

Patient-provider communication through the patient portal has markedly increased in recent years. Some health care facilities implemented programs to enable providers to bill for responding to patient-initiated messages that require substantive medical decision making through an e-visit.

OBJECTIVE

To evaluate the effect of billing eligible patient-initiated portal messages as e-visits using a mixed-methods approach.

DESIGN

Retrospective observational pre-post comparison and prospective survey.

SETTING

Large integrated health system with sites in 4 U.S. states.

PARTICIPANTS

Patients initiating portal message threads and health system providers completing an online survey.

INTERVENTION

E-visit billing was implemented 18 August 2023.

MEASUREMENTS

The volume of patient-initiated medical advice message threads pre- versus postimplementation of e-visit billing was compared. Health system provider perceptions of e-visit billing were assessed using an online survey.

RESULTS

In the 6 months after e-visit billing implementation (18 August 2023 through 18 February 2024), the volume of patient-initiated medical advice message threads decreased by 8.8% (from 1 813 818 to 1 653 708) compared with the same dates the year prior (P = 0.002). A total of 5183 (0.3%) medical advice messages were billed. There was no difference in 7-day use of emergency services (emergency department visits or hospitalizations) in patients who proceeded with sending a message versus those that did not send a message after viewing the billing disclaimer on the patient portal. Providers reported overall acceptance of e-visit billing but expressed concerns about increased workload with the current process.

LIMITATION

Cannot assess changes in other forms of contact, including telephone calls.

CONCLUSION

These findings suggest that implementation of e-visit billing was associated with a modest decrease in patient-initiated portal message volume and was overall acceptable to providers in a large integrated health system.

PRIMARY FUNDING SOURCE

None.

SQuID (subcutaneous insulin in diabetic ketoacidosis): Clinician acceptability

BACKGROUND

We previously implemented the SQuID protocol (subcutaneous insulin in diabetic ketoacidosis [DKA]) demonstrating safe, effective treatment of low- to moderate-severity DKA in a non-intensive care unit setting. Since success and sustainability of interventions rely on staff buy-in, we assessed acceptability of SQuID among emergency department (ED) and inpatient clinicians.

METHODS

We conducted a cross-sectional study in an urban academic hospital (March 2023-November 2023), surveying ED nurses (RNs) and physicians (MDs) and floor RNs and MDs treating patients on SQuID via emailed survey links. Clinicians could only take the survey once. We used Sekhon's Theoretical Framework of Acceptability, validated for staff acceptability of a new intervention, assessing eight domains with 5-point Likert responses. Clinicians were asked about prior experience with SQuID, and we assessed ED MD and RN preference (SQuID vs. intravenous [IV] insulin). Surveys included free-text boxes for comments. We present descriptive statistics including proportions with 95% confidence interval and medians with interquartile ranges (IQRs) and conducted thematic analysis of free-text comments.

RESULTS

Our overall response rate (107/133) was 80% (34/42 ED RNs, 13/16 floor RNs, 47/57 ED MDs, 13/17 floor MDs), with first-time users of SQuID ranging from 7.7% (hospitalist MDs) to 35.3% (ED RNs) of participants. ED clinicians preferred SQuID over IV insulin (67% vs. 12%, 21% no preference). Acceptability was high across all domains and clinician types (median 4, IQR 4-5). Overall percentage of positive responses (4s and 5s) across domains was 92% (ED RNs [89%], floor RNs [89%], ED MDs [97%], floor MDs [87%]). We identified several themes among participant comments.

CONCLUSIONS

Acceptability was high across clinician types; 65% of ED clinicians preferred SQuID to IV insulin. Clinicians liked SQuID (affective attitude), found it easy to use (burden), were confident in its use (self-efficacy), felt that it improved outcomes (perceived effectiveness), found that it was fair to patients (ethicality), found that it made sense (intervention coherence), and found that it did not interfere with other activities (opportunity cost).

Perceived acceptability and appropriateness of a web-based program targeting risk for anxiety in young children and their parents

OBJECTIVE

This mixed-methods study examined perceived acceptability and appropriateness of a novel digital mental health program targeting anxiety risk (i.e., perfectionism or error sensitivity) in 5-to-7-year-old children and their parents.

METHODS

Parent-child dyads participated in a modular, web-based cognitive-behavioral program targeting negative overreactions to making mistakes. The program, "Making Mistakes", consisted of a 6-month series of short video clips, journaling activities, and weekly reminders, and modules were delivered to caregivers and children separately. 86 dyads completed self-report measures, 18 of whom participated in semi-structured interviews, following completion of the primary program module. A standard thematic analysis was used to elucidate themes from the parent and child interview content.

RESULTS

Our quantitative and qualitative results were generally aligned. Children and parents viewed the novel digital mental health program as acceptable and appropriate, favoring the cognitive behavioral strategies such as modeling positive reactions to mistakes, responding positively to child mistakes, and emphasizing effort over outcome. Participants also provided helpful feedback related to program content, delivery, and engagement, as well as suggestions to enhance the program.

CONCLUSIONS

Findings have implications for design and content features of parent-based and dyad-based programs, as well as digital mental health programs focused on reducing anxiety risk.

A Brief Intervention for Injury-Related Traumatic Stress: Results From a Feasibility Study

BACKGROUND

Post-traumatic stress disorder (PTSD) significantly impacts post-injury quality of life; however, many injured patients struggle to access necessary psychosocial care. A brief intervention, Talk, Listen, Communicate to Recover (TLC to Recover), may facilitate access to psychosocial care in low resource trauma centers.

OBJECTIVE

This study assessed staff and patient perceptions regarding the feasibility and acceptability of implementing TLC to Recover at a Level I trauma center.

METHODS

This study used a mixed methods approach to examine the implementation of a brief dyadic intervention intended to mitigate the effect of potential post-injury mental health sequelae. The study took place from April 2021 to April 2024. Participants included adult patients who received post-injury care and were at risk for post-injury PTSD and/or depression. Outpatient trauma clinic staff participated in formative and summative evaluations of the intervention. Recruitment, retention rates, and engagement were assessed. Symptom measurements were administered to patients at baseline, two week follow-up, and one month to measure the effectiveness of TLC to Recover. Semistructured interviews and focus groups explored the acceptability of TLC to Recover among staff and patients. Summative template analysis was utilized to analyze qualitative data and integrated with the theoretical framework of acceptability.

RESULTS

A total of N = 26 participants were included in the summative and formative evaluations, of which n = 15 were patients and n = 11 were clinic staff. The surgical clinic was an acceptable and feasible context to deliver a brief intervention to patients at risk for post-injury PTSD and/or depression.

CONCLUSION

This study offers insight into opportunities for implementation of brief post-injury psychosocial interventions in a surgical context.

Effectiveness and Acceptability of Interventions Offered for Those Bereaved by Parental Loss to Suicide in Childhood: A Mixed Methods Systematic Review

OBJECTIVES

Identify interventions offered for children bereaved by parental suicide, investigate reported effectiveness and explore the acceptability of identified interventions.

METHOD

Six electronic databases were systematically searched for primary studies investigating intervention effectiveness and acceptability, (August 2011 to June 2023). Eligibility required inclusion of participants bereaved by parental suicide during childhood among sample populations. Methodological quality was evaluated applying JBI critical appraisal tools. Narrative synthesis was conducted using parallel-results convergent design.

RESULTS

Of the 22 eligible reports, 19 articles reported on 12 manual-based supports provided during childhood; three papers described users' experiences of various specified intervention types offered following childhood loss. Twenty-one studies reported on interventions offered for heterogeneous participant groups that included children bereaved by parental suicide. Time from loss to intervention generally included both recent (1 < 30mths) and more distant loss, with just one intervention described as solely for recently bereaved children. Eight interventions (n = 12 studies) demonstrated significant positive effects (p < 0.05), for maladaptive grief, mental health, quality of life. Only one study investigated suicide-related outcomes. Qualitative findings (n = 8 studies) facilitated development of four acceptability themes: Perceived utility, Relationships, Components and Delivery.

CONCLUSIONS

Heterogeneity in causes of loss/trauma and relationships with the deceased limit specific conclusions regarding effectiveness/acceptability of reviewed interventions for children bereaved by parental suicide. Few sub-group analyses of effects were reported, and qualitative evidence specifically from children bereaved by parental suicide was limited. Further research is recommended regarding mixed-user interventions, specifically for children bereaved by parental suicide.

Acceptability, tolerability and safety of the BRIGhTMIND trial: Connectivity-guided intermittent theta-burst stimulation versus F3- repetitive transcranial magnetic stimulation for treatment-resistant depression

BACKGROUND

The BRIGhTMIND study was a double-blind RCT comparing repetitive transcranial magnetic stimulation at a standard simulation site (the "F3" location given by the International 10-20 system, F3-rTMS) versus connectivity-guided intermittent theta burst stimulation (cgiTBS) for treatment-resistant depression. This present study reports the acceptability, safety, and tolerability of F3-rTMS versus cgiTBS.

METHODS

The present study used quantitative and qualitative methods. Two hundred fifty-four participants were included in the quantitative BRIGhTMIND acceptability and safety analysis (n = 126 F3-rTMS, n = 128 cgiTBS). Qualitative analysis included interviews for 15 participants (n = 7 F3-rTMS, n = 8 cgiTBS) and 582 written comments made by any participant randomised to the BRIGhTMIND trial regarding their experience of TMS and the study. Statistical analyses were used to explore differences between F3-rTMS and cgiTBS, as well as associations between acceptability, impression of change and safety. Qualitative data was analysed using an inductive thematic framework approach.

OUTCOMES

Acceptability, TMS benefits/negative effects and impression of improvement ratings did not differ across the two treatment protocols, with ratings maintained long-term (71.4 % rated TMS acceptable, 48.8 % indicated benefits of TMS outweighed negative effects and 52.2 % feeling somewhat or much better at 26 week follow-up n = 203). Impression of improvement was positively associated with acceptability and TMS benefits. Qualitative themes included participants' TMS experience, TMS response variability, and lay theories of effectiveness. Safety profiles were comparable between F3-rTMS and cgiTBS, with 74.5 % of participants (n = 190/254) experiencing at least one adverse event possibly, probably, or definitely related to TMS. The majority of adverse events were transient and mild, with a sizeable number requiring simple treatments or small adjustments to TMS intensity and coil positioning. The F3-rTMS group had a significantly greater proportion of participants that required small adjustments to TMS to tolerate treatment compared to the cgiTBS group. Serious adverse events were rare, with one serious event in each treatment arm possibly related to TMS (F3-rTMS- psychotic episode, cgiTBS-manic episode).

CONCLUSION

F3-rTMS and cgiTBS are comparably safe, tolerable and highly acceptable interventions for treatment-resistant depression. BRIGhTMIND systematically collected data from a large sample, providing evidence to meet the information needs of patients, clinicians and policy makers.

Implementing an Online Instrument to Measure Nurse Practitioner Workload: A Feasibility Study

INTRODUCTION/OBJECTIVES

Nurse practitioners (NPs) improve access to care in community-based primary care. Determining an appropriate workload for NPs is complex. The number of patients seen by NPs represents an important consideration. We sought to determine the feasibility, acceptability and appropriateness of implementing the online NP workload measurement index (NP-WI).

METHODS

Feasibility study supported by the Theoretical Framework of Acceptability, conducted across 3 health regions in Québec, Canada. Data were collected from January to July 2024 using the online NP-WI (n = 66), 8-item acceptability questionnaire (n = 47), weekly implementation team meetings with NPs and decision-makers (n = 11), field notes and interviews (n = 13). Data analysis completed using descriptive statistics and content analysis, with data integration using joint displays.

RESULTS

NPs indicated that the NP-WI was easy to use. Acceptability scores were positively rated. Daily data entry took 5 to 7 min to complete. NPs deemed a 4-week collection period sufficient to capture a representative workload sample. The NP-WI captured patient, provider and organizational characteristics and the number of patients seen by NPs.

CONCLUSIONS

NP-WI implementation was feasible. The instrument can support healthcare workforce planning with more adequate estimations of NP workload in community-based primary care, and provide greater equity in resource allocation and distribution of NP workload.

Feasibility and Acceptability of the We See You, Sis Sister Circle for Black Women With Depression Symptoms

OBJECTIVE

To test the feasibility and acceptability of We See You, Sis, a therapeutically grounded virtual sister circle intervention for Black women with depression symptoms.

DESIGN

A two-group quasi-experimental design.

SETTING

Virtual on the Zoom version 5.13 platform.

PARTICIPANTS

Black women who were at least 40 years of age, with current depression symptoms, who had reliable access to Zoom (N = 30).

METHOD

We See You, Sis is a virtual sister circle intervention that is therapeutically grounded in the core processes of Pulling Out of Fire, a culturally adapted version of acceptance and commitment therapy. Groups 1 and 2 received the 6-week intervention during Weeks 1 through 6 and 7 through 12, respectively. The main outcomes were feasibility (recruitment, retention, and completion) and acceptability. The theoretical framework of acceptability informed the focus group guide used to assess acceptability. We used thematic analysis to code the qualitative data and to identify salient themes across participants' narratives.

RESULTS

Recruitment (70%), retention (83.3%), and completion (82%) rates demonstrated that the intervention was feasible. Participants perceived the intervention to be acceptable, especially because it fit with their personal and collective values. We generated two overarching themes: Becoming More Whole and Having a Trusted Space to Address Depression Symptoms and Related Experiences, which represented the interconnected processes of personal growth and collective healing that occurred throughout the intervention.

CONCLUSION

The findings provide evidence to support the delivery of peer-delivered mental health interventions for middle-age and older Black women.

A mixed-methods pilot randomized control trial of ultrasound visual biofeedback versus standard intervention for children with cleft palate ± cleft lip: Parents' and children's perspectives

BACKGROUND

Ultrasound visual biofeedback (UVBF) has the potential to be useful for the treatment of compensatory errors in speakers with cleft palate ± lip (CP±L), but there is little research on its effectiveness, or on how acceptable families find the technique. This study reports on parents' and children's perspectives on taking part in a pilot randomized control trial of UVBF compared with articulation intervention.

AIMS

To determine the acceptability of randomization, UVBF and articulation intervention to families. We set feasibility criteria of at least 75% of responses rated as acceptable or positive in order to determine progression from a pilot to a full randomized control trial.

METHODS & PROCEDURES

A total of 19 families who received UVBF therapy (11 families) and articulation intervention (eight families) were invited to participate. Mixed methods were employed: two questionnaires to determine the acceptability of UVBF and articulation intervention, respectively; and semi-structured focus groups/interviews. Questionnaires were analysed for frequency of positive versus negative acceptability and the focus groups/interviews were analysed using thematic analysis and coded using the theoretical framework of acceptability.

OUTCOMES & RESULTS

More than 75% of families rated randomization as acceptable and more than 75% of families rated both interventions as acceptable, with the caveat that half of the participants did not wish to continue articulation intervention after the study. For some families, this was because they felt further intervention was not required. Six families (three in each intervention) volunteered to take part in the focus groups/interviews. Results showed more positive than negative themes regarding acceptability, particularly affective attitude where high levels of enjoyment were expressed, although some participants found the articulation intervention 'boring'. In both groups, there was a considerable burden involved in travelling to the hospital location.

CONCLUSIONS & IMPLICATIONS

Randomization in a clinical trial is acceptable to families; UVBF and articulation intervention are acceptable and indeed enjoyable. The burden of the additional outcome measures required for a clinical trial is manageable, although there is a travel burden for participants. Future studies should seek to mitigate the travel burden by considering additional locations for intervention.

WHAT THIS PAPER ADDS

What is already known on the subject UVBF shows potential for teaching children with speech sound disorders new articulations. Previous studies looking at the acceptability of using ultrasound in speech intervention have only asked for the drawbacks of the intervention: finding the ultrasound gel to be cold and sticky and the probe to be uncomfortable. SLTs, however, believe that the technique offers advantages due to its ability to visualize tongue movements. What this paper adds to the existing knowledge This study asks parents and children for their full views about using ultrasound in speech intervention and compared this to articulation intervention. We also asked parents how they feel about being randomized to one of these interventions. Results were positive for both interventions, with parents highlighting the importance of intelligible speech to their child. Children enjoyed both interventions, though the articulation intervention could be 'boring' or 'repetitive'. For all families, there was a considerable burden travelling to clinics. What are the potential or actual clinical implications of this work? Clinicians can be assured that both articulation therapy and ultrasound therapy are acceptable to families. Efforts could be made to ensure that articulation intervention is not repetitive and that appointments are offered at locations which are accessible to families where possible.

Implementation-effectiveness of the power over pain portal for patients awaiting a tertiary care consultation for chronic pain: A pilot feasibility study

Background

The Power Over Pain (POP) Portal is a digital platform that provides people living with pain (PLWP) flexible access to chronic pain self-management resources.

Aims

To (1) determine the feasibility of an adequately-powered multisite trial of the POP Portal in tertiary settings; (2) understand the acceptability and usability of the POP Portal; and (3) explore clinical effectiveness among PLWP awaiting a first visit to a tertiary care pain clinic.

Methods

Mixed-methods pilot-feasibility study to inform a future definitive trial. Feasibility was assessed using recruitment and retention rates. Acceptability, usability, and patient outcomes were measured using validated surveys completed at baseline and 3-month follow-up, and semistructured interviews conducted after 3-month follow-up.

Results

Forty-one participants completed follow-up surveys and nine completed interviews. We reached a recruitment and retention rate of 83.75% and 61.19%, respectively. There was a reduction in pain interference (p = .024) and belief in a medical cure (p = .033) after using POP for 3 months. Surveys and interviews indicate PLWP were satisfied with the POP Portal, and it had good usability. Some participants indicated that POP was overwhelming, and certain resources were difficult to access, indicating that modifications could be made to improve ease of use.

Conclusions

The POP Portal was deemed acceptable with good usability; however, modification may be made for improvement. A definitive trial can proceed with enhancements to the portal, modification of the protocol, and close monitoring.

Exposure therapy acceptability among pregnant Latinas with anxiety: A qualitative content analysis

OBJECTIVE

Exposure therapy is the frontline treatment for anxiety among adults but is underutilized during pregnancy. We qualitatively assess the prospective acceptability of exposure therapy among pregnant Latinas with elevated anxiety, a group that experiences mental health disparities.

METHOD

Pregnant Latinas (N = 25) with elevated anxiety were interviewed regarding their acceptability of exposure therapy following the receipt of an informational clinical video vignette. Interviews were analyzed using deductive content analysis guided by the Theoretical Framework of Acceptability to understand pregnant Latinas' views about exposure therapy.

RESULTS

Nineteen themes were identified across seven theoretically driven subdomains of acceptability. Women expressed acceptability enhancing factors for exposure therapy including feeling hopeful about its effects, a belief that treatment could benefit their broader family, and a preference for treatment during pregnancy as opposed to the postpartum period. Women also expressed challenges to exposure therapy acceptability such as managing family reactions to prenatal psychotherapy, conflict with cultural conceptions of the maternal role, and perceived difficulty using exposure for avoidance related to prenatal health.

CONCLUSION

Identified themes provide insights about exposure acceptability among pregnant women and can be used to bettter engage Latinas in anxiety interventions, ultimately improving clinical outcomes. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Feasibility and acceptability of the brief patient-reported experience measure consideRATE within the hospital setting for patients with palliative care needs, their families/carers and clinicians

BACKGROUND

Supporting clinical teams to improve care for inpatients with palliative care needs and their carers is a known priority. Patient reported experience measures (PREMs) may assist in improvement work. Evidence about how to collect and feedback PREM data for this population and context is required.

AIM

To determine the feasibility of implementing a brief, validated PREM, consideRATE and appraise its acceptability as perceived by inpatients with palliative care needs, their carers and clinicians.

DESIGN

A prospective study using: 1) PREM administration, screening log and field note completion; and; 2) a focus group with clinicians.

SETTING/PARTICIPANTS

Eligible participants recruited from three wards (cancer care and internal medicine) of an Australian tertiary metropolitan hospital. Participants included patients screened to have palliative care needs (using the SPICTTM criteria), their carers and multidisciplinary clinicians (including clinical managers).

RESULTS

Feasibility: A 71% response rate was achieved (n = 80 from 112 eligible patients approached). Mean screening time to inform eligible patients for PREM completion was 7.5 min. More than half of eligible participants (n = 47, 59%) opted for electronic completion of consideRATE and mean completion time was 6.12 min. A third of participants required assistance for PREM completion (n = 27, 34%). Score distribution varied across response options, albeit with a positive skew towards 'very good' and 'good'. Two thirds of respondents (n = 50, 62.5%) provided ⩾1 free-text response. Acceptability: Clinicians valued consideRATE data noting feedback needed to be: accessible, supported by free-text and responsive to local contexts.

CONCLUSIONS

It is feasible to implement consideRATE for inpatients with palliative care needs. Clinicians note consideRATE data is acceptable in informing improvement foci.

"Like Someone Is Paying Attention to You, Listening to You, and Guiding You": Acceptability of a Mental Health Chatbot Among Caregivers of Adolescents Living With HIV

BackgroundThis study assessed the acceptability, among caregivers, of a mental health chatbot designed for adolescents living with HIV aged 10 to 19 years.MethodsFifteen caregivers interacted with the mental health chatbot. Pre-post assessments and semistructured interviews evaluated acceptability. Data were analyzed using a Framework Analysis approach.ResultsCaregivers aged 31 to 70 years found the chatbot acceptable on individual, interpersonal, and environmental levels. They appreciated the educational content and self-help tools, feeling the chatbot would benefit them personally. Caregivers also saw potential in the chatbot to improve communication with their children, particularly during critical periods like HIV diagnosis. Despite concerns about data costs or internet access, most viewed the chatbot as an accessible supplement to traditional mental health services.ConclusionThis study suggests that a mental health chatbot for Peruvian adolescents living with HIV was acceptable to their caregivers, potentially benefiting caregivers' mental health, enhancing caregiver-adolescent interactions, and fostering better communication.

The Tools for Integrated Management of Childhood Illness (TIMCI) study protocol: a multi-country mixed-method evaluation of pulse oximetry and clinical decision support algorithms

Effective and sustainable strategies are needed to address the burden of preventable deaths among children under-five in resource-constrained settings. The Tools for Integrated Management of Childhood Illness (TIMCI) project aims to support healthcare providers to identify and manage severe illness, whilst promoting resource stewardship, by introducing pulse oximetry and clinical decision support algorithms (CDSAs) to primary care facilities in India, Kenya, Senegal and Tanzania. Health impact is assessed through: a pragmatic parallel group, superiority cluster randomised controlled trial (RCT), with primary care facilities randomly allocated (1:1) in India to pulse oximetry or control, and (1:1:1) in Tanzania to pulse oximetry plus CDSA, pulse oximetry, or control; and through a quasi-experimental pre-post study in Kenya and Senegal. Devices are implemented with guidance and training, mentorship, and community engagement. Sociodemographic and clinical data are collected from caregivers and records of enrolled sick children aged 0-59 months at study facilities, with phone follow-up on Day 7 (and Day 28 in the RCT). The primary outcomes assessed for the RCT are severe complications (mortality and secondary hospitalisations) by Day 7 and primary hospitalisations (within 24 hours and with referral); and, for the pre-post study, referrals and antibiotic. Secondary outcomes on other aspects of health status, hypoxaemia, referral, follow-up and antimicrobial prescription are also evaluated. In all countries, embedded mixed-method studies further evaluate the effects of the intervention on care and care processes, implementation, cost and cost-effectiveness. Pilot and baseline studies started mid-2021, RCT and post-intervention mid-2022, with anticipated completion mid-2023 and first results late-2023. Study approval has been granted by all relevant institutional review boards, national and WHO ethical review committees. Findings will be shared with communities, healthcare providers, Ministries of Health and other local, national and international stakeholders to facilitate evidence-based decision-making on scale-up.Study registration: NCT04910750 and NCT05065320.

The PROCAN-B study protocol: Early diagnosis of PROstate CANcer for Black men-a community-centred participatory approach in Scotland and the North-East of England

BACKGROUND

Prostate cancer is the most common cancer in the UK and Black African-Caribbean men are twice as likely to develop prostate cancer as white men. These cancer inequalities need urgent tackling. Barriers to early diagnosis are complex and require complex solutions. Culturally-tailored, community-centred and participatory approaches show promise in tackling cancer inequalities. We aim to co-design a culturally appropriate intervention to tackle barriers to early diagnosis of prostate cancer for Black men in Scotland and the North-East of England using a community-centred participatory approach.

METHODS

The PROCAN-B study is a mixed methods study set in Scotland and the North-East of England. A Public Involvement and Community Engagement (PICE) group (n = 12), is involved at every step of the research. Drawing on principles of the Integrated Screening Action model (I-SAM), the study has 8 objectives: 1) to explore barriers to early diagnosis of prostate cancer among Black men (45+) through focus groups (n = 12); 2) to co-design a culturally acceptable peer-led intervention to tackle barriers to early diagnosis of prostate cancer in Black men; 3) to train members of the community as 'peer-facilitators' (n = 8); 4) to deliver the intervention in each location, facilitated by peer-facilitators, with a purposive sample (n = 20) of Black men (45+); 5) to qualitatively evaluate the intervention through focus groups; 6) to refine the intervention based on qualitative feedback; 7) to pilot the refined intervention with another purposive sample (n = 40) through a cross-sectional survey pre- and post-intervention; 8) to qualitatively evaluate the refined intervention through focus groups to further refine the intervention.

DISCUSSION

Community-centred and culturally tailored interventions have potential to be effective in addressing barriers to early diagnosis of prostate cancer, and thus ultimately reduce morbidity and mortality rates through earlier diagnosis in Black communities.

'I am happy to be listened to': co-creation of a simple tool to measure women's experiences of respectful maternity care in urban Tanzania

BACKGROUND

Rights-based Respectful Maternity Care (RMC) is crucial for quality of care and improved birth outcomes, yet RMC measurements are rarely included in facility improvement initiatives. We aimed to (i) co-create a routine RMC measurement tool (RMC-T) for congested maternity units in Dar es Salaam, Tanzania, and (ii) assess the RMC-T's acceptability among women and healthcare stakeholders.

METHOD

We employed a participatory approach utilizing multiple mixed methods. This included a scoping review, stakeholder engagement involving postnatal women, healthcare providers, health leadership, and global researchers through interviews, focus groups, and two surveys involving 201 and 838 postnatal women. Cronbach's alpha and factor analysis were conducted for validation using Stata 15. Theories of social practice and Thematic Framework of Acceptability guided the assessment of stakeholder priorities and tool acceptability.

RESULTS

The multi-phased iterative co-creation process produced the 25-question RMC-T that measures satisfaction, communication, mistreatment (including physical, verbal, and sexual abuse; neglect; discrimination; lack of privacy; unconsented care; post-birth clean-up; informal payments; and denial of care), supportive care (such as food intake and mobility), birth companionship, post-procedure pain relief, bed-sharing, and newborn respect. The pragmatic validation process prioritized stakeholder feedback over strict statistics, lowering Cronbach's alpha from 0.70 in version 1 to 0.57 for the RMC-T. Women valued the opportunity to share their experiences.

CONCLUSIONS

The RMC-T is contextualized, validated, and acceptable for measuring women's experiences of RMC. Routine use in facility-based quality improvement initiatives, along with targeted actions to address gaps, will advance rights-based RMC. Further validation and community-based studies are needed.

Selected health characteristics are associated with urban Canadians' acceptability of policies promoting healthier restaurant food environments

OBJECTIVE

The adoption of policies promoting healthier restaurant food environments is contingent on their acceptability. Limited evidence exists regarding individual characteristics associated with restaurant food environment policy acceptability, especially health-related characteristics. This study examined associations between health characteristics and restaurant food environment policy acceptability among urban Canadians.

DESIGN

Links between health characteristics and complete agreement levels with selected policies were examined using data in the cross-sectional Targeting Healthy Eating and Physical Activity survey study, that is, a large pan-Canadian study on policy acceptability. For each policy, several logistic multilevel regression analyses were conducted.

SETTING

Canada's seventeen most populated census metropolitan areas.

PARTICIPANTS

Urban Canadian adults responded to the survey (n 27 162).

RESULTS

Body mass index was not associated with acceptability after adjustments for other health and sociodemographic characteristics were made. Across all policies and analyses, those reporting excellent or very good health statuses were more likely to be in complete agreement with targeted policies than those with good health statuses. For selected policies and analyses, those reporting poor health statuses were also more likely to be in complete agreement than those describing their health status as good. For all policies and analyses, both those consuming restaurant-prepared foods daily and those never consuming these foods were more likely to be in complete agreement than those consuming these foods once per week.

CONCLUSIONS

More research is needed to explain discrepancies in acceptability according to health characteristics. Bringing this study's findings to the attention of policymakers may help build momentum for policy enactment.

Implementation and impact of NHS-funded tobacco dependence services in England: a mixed-method evaluation protocol

INTRODUCTION

Tobacco smoking remains a leading cause of ill-health, premature mortality and a driver of health inequalities. To support smokers in England, a comprehensive approach to treating tobacco dependence is being implemented. This includes offering support to all people admitted to hospitals, as well as women and pregnant people within NHS settings. We aim to describe the protocol for an evaluation of this tobacco-dependence service.

METHODS AND ANALYSIS

This is a national evaluation across five regions in England (i.e., South West, West Midlands, Greater Manchester, North East and North Cumbria, Yorkshire and Humber) including 11 NHS Foundation Trusts. It is funded from September 2021 to September 2025. Evaluation settings are acute hospital, maternity and inpatient mental health.Work package (WP) 1 involves qualitative key informant interviews to characterise the policy implementation context. WP 2 involves an online survey to assess the routinisation of the service in practice and staff attitudes regarding tobacco dependence, plus in-depth interviews with relevant practitioners to explore survey findings and interviews with smokers to investigate its usefulness and impact. WP 3 involves descriptive statistical analysis of routinely collected data to assess service uptake and impact on health and care outcomes (e.g., smoking status). WP 4 involves an economic analysis of routinely collected data to determine the financial impact of the service. Qualitative data (WP 1, WP 2) will be analysed using Thematic Analysis and Framework Analysis, respectively. WP 2 survey data will be analysed using descriptive statistics.

ETHICS AND DISSEMINATION

This evaluation received favourable ethical opinion from Newcastle University (17756/2021) and NHS Wales Research Ethics Committee (22/WA/0203). It has also received Confidentiality Advisory Group support (22CAG0103).

Assessing tafenoquine implementation in Brazil: a qualitative evaluation of perceptions of healthcare providers and Plasmodium vivax patients (QualiTRuST Study)

BACKGROUND

To eliminate malaria by 2035, Brazil must address Plasmodium vivax. Previously, first-line treatment was chloroquine plus 7-day primaquine (PQ) without glucose-6-phosphate dehydrogenase (G6PD) deficiency testing. In 2021, point-of-care quantitative G6PD testing and single-dose tafenoquine (TQ) were piloted in two municipalities. This study evaluated healthcare professional (HCP) and patient perceptions of TQ implementation.

METHODS

This qualitative observational study in Manaus and Porto Velho municipalities evaluated the pilot implementation of the new P. vivax malaria treatment algorithm in high/medium-complexity healthcare units (phase one), then low-complexity units (phase two). Qualitative data collection began 30 days after the first TQ treatment in each phase, i.e., October 2021 and March 2022. Perceptions of TQ were assessed using semi-structured in-depth interviews and field notes until saturation. Data were analysed through debriefing sessions, and systematic organization in Excel and MAXQDA, with themes derived by inductive and deductive analysis.

RESULTS

The study included 55 patients who received TQ and 94 HCPs. HCPs viewed the TQ single-dose regimen as a significant advancement over 7-day PQ, enhancing adherence. Patients appreciated the shorter duration of treatment and perceived a rapid clinical recovery and fewer side effects. HCPs also noted that TQ resulted in fewer recurrences of P. vivax. The single-dose administration of TQ facilitated complete supervision of the treatment, reduced HCP workload and ensured that patients received the necessary care and did not share the medication with family members. TQ packaging instilled patient trust, though HCPs working in the community found the packaging too bulky. Prescription insecurities among HCPs after initial training prompted requests for additional training. While some patients initially doubted single-dose efficacy, confidence grew with experience. TQ implementation increased awareness of pharmacovigilance and enhanced patient communication, with HCPs adhering to protocols for monitoring haemolysis symptoms.

CONCLUSION

Single-dose TQ for P. vivax malaria in Brazil's Amazon region was positively received by HCPs and patients. Positive perceptions of the medication may aid in improving patient adherence to malaria treatment, thereby reducing malaria recurrences. The findings underscore the importance of adaptive training to optimize P. vivax radical cure implementation.

Effectiveness and feasibility of a theory-informed intervention to improve Mediterranean diet adherence, physical activity and cognition in older adults at risk of dementia: the MedEx-UK randomised controlled trial

BACKGROUND

Despite an urgent need for multi-domain lifestyle interventions to reduce dementia risk, there is a lack of interventions which are informed by theory- and evidence-based behaviour change strategies, and no interventions in this domain have investigated the feasibility or effectiveness of behaviour change maintenance. We tested the feasibility, acceptability and cognitive effects of a personalised theory-based 24-week intervention to improve Mediterranean diet (MD) adherence alone, or in combination with physical activity (PA), in older-adults at risk of dementia, defined using a cardiovascular risk score.

METHODS

Participants (n = 104, 74% female, 57-76 years) were randomised to three parallel intervention arms: (1) control, (2) MD, or (3) MD + PA for 24 weeks and invited to an optional 24-week follow-up period with no active intervention. Behaviour change was supported using personalised targets, a web-based intervention, group sessions and food provision. The primary outcome was behaviour change (MD adherence and PA levels), and the secondary outcomes included feasibility and acceptability, cognitive function, cardiometabolic health (BMI and 24-h ambulatory blood pressure) and process measures.

RESULTS

The intervention was feasible and acceptable with the intended number of participants completing the study. Participant engagement with group sessions and food provision components was high. There was improved MD adherence in the two MD groups compared with control at 24 weeks (3.7 points on a 14-point scale (95% CI 2.9, 4.5) and 48 weeks (2.7 points (95% CI 1.6, 3.7)). The intervention did not significantly change objectively measured PA. Improvements in general cognition (0.22 (95% CI 0.05, 0.35), memory (0.31 (95% CI 0.10, 0.51) and select cardiovascular outcomes captured as underpinning physiological mechanisms were observed in the MD groups at 24 weeks.

CONCLUSIONS

The intervention was successful in initiating and maintaining dietary behaviour change for up to 12 months which resulted in cognitive benefits. It provides a framework for future complex behaviour change interventions with a range of health and well-being endpoints.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03673722.

An interdisciplinary e-learning intervention for professionals working with breast cancer survivors and chronic pain: a realist evaluation

PURPOSE

Chronic pain is prevalent among breast cancer survivors. Bio-psychosocial factors interplay in its exacerbation and maintenance. Therefore, prevention and treatment require an interdisciplinary response and the integration of various approaches. To deliver this way of working, healthcare professionals may need training. We developed an e-learning intervention, aimed at increasing awareness and interdisciplinary collaboration in response to pain after cancer. We aimed to gain insight into the intervention's implementation, mechanisms, and outcomes through a realist evaluation.

METHODS

A mixed-methods pre- and post-test design with follow-up was used. Via questionnaires, professionals reported on the feasibility of the e-learning and their knowledge, beliefs, confidence, and professional role in pain prevention and treatment. Six-month post-intervention, interviews were conducted to explore transferability in practice.

RESULTS

An interdisciplinary group of 22 professionals completed the intervention. Overall, e-learning was deemed a feasible format for training. An increase in confidence was found, whereas no changes were detected in knowledge and professional role. Configurations were outlined between these mechanisms and behaviors in practice, influenced by implementation processes and context-related factors.

CONCLUSIONS

E-learning holds promise in stimulating knowledge, beliefs, confidence, and professional role. In this, the value of asynchronous discussion forums, case-based exercises, practical tools, and models were emphasized.

Health System Factors Influencing the Integration of Pre-Exposure Prophylaxis into Antenatal and Postnatal Clinic Services in Cape Town, South Africa

INTRODUCTION

Oral pre-exposure prophylaxis (PrEP) is an effective and safe option to prevent HIV acquisition and vertical HIV transmission in pregnant and breastfeeding women. Understanding health system factors influencing the integration of PrEP into care for pregnant and breastfeeding women is key to increasing access. We explored managers' and health care workers' (HCWs) experiences with integrating PrEP into antenatal care and postnatal care services in primary health care clinics in Cape Town, South Africa.

METHODS

This exploratory qualitative study used codebook thematic analysis, where HCWs were purposively, heterogeneously sampled from an implementation science study. Semistructured individual interviews were conducted with 9 managerial-level staff, and 3 focus group discussions were conducted with HCWs (nurses, midwives, and HIV counselors) providing PrEP (6-7 HCWs per group) between November 2022 and January 2023 (N=28). Interview guides covered health system facilitators, barriers, and recommendations. The Health Systems Dynamics framework guided data analysis and presentation of results.

RESULTS

PrEP integration into antenatal care services was described as acceptable and feasible; however, changes to HIV testing policy and indicators in breastfeeding women are needed to integrate PrEP into postnatal clinics, together with identification of mother and baby as a dyad in visits. Results showed that supportive policies facilitated wider, simplified PrEP provision. The availability and accessibility of prescribing nurses and lay HIV counselors, PrEP (both within facilities and in communities), and information about PrEP for implementers and pregnant and breastfeeding women will be pivotal to facilitating integration.

CONCLUSION

Facilitators for PrEP integration include task-shifting PrEP education and identification of women for PrEP initiation to HIV counselors, changes to national guidelines defining who can prescribe PrEP, revision and integration of PrEP training for HCWs, community-level interventions for PrEP demand creation and stigma reduction, and provision of differentiated PrEP delivery options.

Acceptability of a resource-oriented approach (DIALOG+) among patients with chronic physical illnesses in primary health care-Uganda, a qualitative study

BACKGROUND

Chronic physical illnesses are often associated with significant psychological distress and chronic mental illnesses are often co-morbid with physical illnesses. Efforts to integrate mental health into primary health care in Uganda are underway. However, there are enormous logistical challenges. Effective resource-oriented and evidence-based interventions such as DIALOG + have the potential to improve treatment outcomes for patients with chronic conditions. We aimed to assess the acceptability of DIALOG + among patients with chronic physical illnesses in Uganda.

METHODS

This was a qualitative aspect of a mixed methods exploratory non-controlled study conducted in chronic physical illness out-patient clinics at two hospitals in Uganda. We conducted fifteen in-depth interviews with patients, ten key informant interviews with clinicians, and four focus group discussions with patients. Thematic data analysis was done through an iterative process.

RESULTS

The results support the acceptability of the intervention as evidenced by willingness to participate, better relationships between patients and clinicians, and improved control of both physical illnesses and psychological distress. Participants also talked about ways in which the implementation of DIALOG + could be improved.

CONCLUSION

DIALOG + is acceptable among patients with chronic physical illness in primary health care settings in Uganda.

Supplemental tube feeding: qualitative study of patient perspectives in advanced pancreatic cancer

OBJECTIVES

Malnutrition is associated with poor quality of life and survival outcomes for patients with cancer, but is challenging to prevent or treat in pancreatic cancer due to the multifactorial drivers of nutritional decline. A novel application of percutaneous endoscopic gastrostomy with a jejunal extension tube to deliver supplementary nutrition may improve outcomes, and will be tested in a randomised controlled trial. This study explored the perspectives of people living with pancreatic cancer regarding the acceptability of this proposed intensive nutrition intervention, to elucidate appropriateness and anticipated barriers, and facilitate informed design of the planned trial.

METHODS

Participants were patients with pancreatic cancer previously enrolled in a Pancreaticobiliary Cancer Biobank. Qualitative semi-structured interviews were conducted by telephone and transcribed verbatim for deductive thematic analysis. The Framework Model was used, with the Theoretical Framework of Acceptability as the analytical framework.

RESULTS

10 participants were recruited. Four overarching themes were developed from interviews: (1) deterioration in physical and mental well-being are consequences of debilitating nutrition impact symptoms; (2) willingness to participate depends on an individual threshold for nutritional deterioration; (3) predicted perceived effectiveness outweighed anticipated burdens and (4) adequate dietetic support is needed for maintaining a percutaneous endoscopic gastrostomy with jejunal extension feeding tube at home with confidence.

CONCLUSIONS

Most participants believed that the intervention would benefit people with advanced pancreatic cancer to maintain their nutrition throughout chemotherapy. Regular and ad hoc support was considered essential, and the degree of individual nutritional deterioration was identified as an important indicator for trial participation.

Blurring the lines: an empirical examination of the interrelationships among acceptability, appropriateness, and feasibility

BACKGROUND

Acceptability, appropriateness, and feasibility are established implementation outcomes used to understand stakeholders' perceptions of an intervention. Further, they are thought to provide insight into behaviors, such as adoption. To date, measurement instruments for the three outcomes have focused on their individual assessment whilst nodding to the idea that they may interrelate. Despite this acknowledgment, there is little empirical evidence of the association among these constructs. Using the example of genetic health professionals providing additional genomic results to patients, this study aimed to examine the interrelationships among acceptability, appropriateness, and feasibility.

METHODS

A sequential explanatory mixed methods approach was employed. All genetic counsellors and clinical geneticists involved in a large research program were invited to complete pre/post surveys using existing measures of acceptability, appropriateness, and feasibility. Follow-up interviews, informed by the survey results, explored clinicians' perspectives of the three outcomes in relation to providing additional genomic results to patients. To categorize interrelationships and generate feedback loops, survey data were analyzed using descriptive and correlation statistics and interpreted alongside interview data analyzed using content analysis.

RESULTS

The survey results (pre n = 53 and post n = 40) for each outcome showed a similar midpoint mean, wide ranges, and little change post implementation (Acceptability: pre M = 3.55, range 2-5 post M = 3.56, range 1.5-5; Appropriateness: pre M = 3.35, range 1-5, post M = 3.48, range 1-5; Feasibility: pre M = 3.30, post M = 3.32; range 1.25-5). The strength of correlation among outcomes ranged from 0.54 to 0.78. Five interrelationships were categorized from analysis of interview data (n = 14) and explain how clinicians' perceptions of the intervention, positive or negative, were determined by interrelating factors of acceptability, appropriateness, and feasibility and that in different scenarios, the function and emphasis of importance among outcomes switched.

CONCLUSIONS

Rather than existing separately, our study promotes the need to consider interrelationships among acceptability, appropriateness, and feasibility to better characterize clinicians' perceptions of complex health care interventions and aid in the development of implementation strategies that have real world impact. Further, in the interest of reducing research waste, more research is needed to determine if the outcomes could serve as proxies for each other.

Community Health Worker Optimization of Antihypertensive Care in HIV (COACH): Study protocol for a pilot trial of an intervention to improve hypertension care among Tanzanians with HIV

OBJECTIVE

This study will evaluate the feasibility and preliminary effectiveness of the COACH (Community Health Worker Optimization of Antihypertensive Care in HIV) intervention, which integrates hypertension management into existing HIV care for people living with HIV (PLWH) in Tanzania.

METHODS

The study will be conducted at two HIV Care and Treatment Centers (CTCs) in Tanzania. In a single-arm pre-post feasibility trial, 100 PLWH with hypertension will be enrolled and will receive the six-month intervention. The COACH intervention includes six monthly hypertension educational sessions delivered by community health workers (CHWs) and integrated within HIV CTC visits, monthly blood pressure monitoring, follow up care coordination, fully subsidized antihypertensive medications, a standardized antihypertensive treatment algorithm, and training for providers. The intervention's implementation outcomes will be evaluated using the Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) framework, and the primary study outcome (reach of the intervention) will be the proportion of all scheduled intervention sessions attended by participants, a measure of feasibility. Secondary clinical effectiveness outcomes will include adherence to antihypertensive medication, blood pressure control, body mass index, cardiovascular risk, and hypertension knowledge.

SIGNIFICANCE

The COACH intervention has the potential to significantly improve hypertension management among PLWH in Tanzania by leveraging the existing HIV care infrastructure and CHWs. This study will provide crucial insights into the feasibility and potential effectiveness of the intervention in integrating hypertension care into HIV services, informing larger-scale implementation and policy changes in Tanzania and other resource-limitted settings.

TRIAL REGISTRATION

Clinical trials.gov Identifer: NCT06503991.

Cognitive behavioral therapy for insomnia to treat major depressive disorder with comorbid insomnia: A systematic review and meta-analysis

OBJECTIVE

Cognitive behavioral therapy for insomnia (CBT-I) has demonstrated efficacy for both insomnia and depression. With a tenfold increase in expected participant numbers, we aimed to update the systematic review and meta-analysis of CBT-I for major depressive disorders (MDD).

METHODS

Multiple databases were searched up to March 27th 2024 to include all randomized controlled trials examining CBT-I among adults with MDD. The certainty of evidence was evaluated using GRADE. The primary outcome was depression response at post-treatment. Secondary outcomes included insomnia remission and all-cause dropout at post-treatment. Frequentist random-effects pairwise meta-analyses were performed using odds ratio (OR) for dichotomous outcomes. This study was prospectively registered (https://osf.io/kcndz/).

RESULTS

Nineteen trials with 4808 randomized participants were identified (mean age, 33.2 [standardized deviation 15.0] years, 73.2 % women. Mean Insomnia Severity Index 19.2 [5.4], median Patient Health Questionnaire-9 16 [range, 8-21]). CBT-I was more beneficial than control conditions for depression response (OR 2.28 [95 % Confidence Interval (CI), 1.67-3.12; GRADE certainty of evidence: moderate), insomnia remission (OR 3.57 [95%CI, 2.48-5.14]: moderate) but could lead to more dropout (OR 1.69 [95%CI, 0.98-2.89]: low). Depression improvement was seen beyond the sleep domain. With a control condition depression response rate of 17 % at post-treatment (median 8 weeks), CBT-I yielded a 32 % response rate (95 % CI, 26 %-39 %).

CONCLUSIONS

This meta-analysis indicates that CBT-I has significant effects on depressive symptoms beyond the sleep domain among people with MDD. Despite higher dropout rates, these findings suggest CBT-I is an effective treatment for depression comorbid with insomnia.

The feasibility of a social media-based foot self-management education and support program for adults with diabetes: A partially randomized preference trial

Aim

To assess the feasibility of Diabetic Foot Care Group (DFCG), a social media-based self-management education and support intervention, for people with diabetes (PWD) empowerment in diabetes-related foot ulceration prevention.

Methods

A partially randomized preference trial was conducted among 32 PWD. DFCG was implemented through Facebook. Participants in the intervention group joined the DFCG in addition to their usual care, while the control group received usual care. Data were collected online using questionnaires on participants' DFCG acceptance, engagement and preliminary efficacy on nine diabetes foot care-related outcomes at baseline, one, and three months post-intervention.

Results

The participants' study intervention acceptability and engagement rates were 84.2% and 55.2%, respectively. DFCG efficacy rate compared to usual care was 88.9% to 22.2%. Three diabetes foot care-related outcomes increased significantly in the intervention group three-month post-intervention: foot self-care adherence (p = 0.001, ηp 2 = 0.35), preventive foot self-care practice (p = 0.002, ηp 2 = 0.33), and physical health status (p < 0.02, ηp 2 = 0.23).

Conclusion

DFCG is feasible and could effectively improve diabetes foot care-related outcomes.

Innovation

Social media is an innovative approach healthcare professionals could utilize to virtually support PWD in ongoing learning and engagement in optimal foot self-care activities.

Trial registration

ClinicalTrials.gov, Identifier: NCT04395521.

Managing preschool wheeze: a qualitative study of parents' views and experiences

OBJECTIVE

The aim of this study was to explore parents' views and experiences of managing preschool wheeze, including opinions on the use of investigations to inform treatment pathways.

DESIGN

Purposive sampling was used to recruit 16 participants from 14 families across England and Wales. Qualitative data were collected via semi-structured interviews with parents of children aged 1-5 years with preschool wheeze, conducted on Microsoft (MS) Teams. Data were transcribed and analysed using thematic analysis, facilitated by NVivo software package.

RESULTS

Analysis generated four themes: (1) pathway to diagnosis, (2) medication management, (3) living with preschool wheeze and (4) improving preschool wheeze healthcare. Findings suggest a negative impact of preschool wheeze on families' lives, including high levels of worry and limiting capacity for work and travel. Barriers to effective management of preschool wheeze included inconsistent terminologies and diagnostic uncertainty alongside limited education and management support. Other barriers included parental concerns about medications, delayed investigations and challenges with accessing specialist care. Parents were in favour of performing investigations to guide treatment pathways.

CONCLUSION

Parents' views highlight the problem of diagnosing and treating preschool wheeze at multiple system levels. To improve management and ensure that services for children with preschool wheeze are effective, there is an urgent need for consistent terminology, a unified approach to guide investigations and treatments and for upskilling healthcare professionals in primary and secondary care.

A Gender-Informed Smoking Cessation App for Women: Protocol for an Acceptability and Feasibility Study

BACKGROUND

Tobacco smoking remains the leading preventable cause of death and disease among women. Quitting smoking offers numerous health benefits; however, women tend to have less success than men when attempting to quit. This discrepancy is partly due to sex- and gender-related factors, including the lower effectiveness of smoking cessation medication and the presence of unique motives for smoking and barriers to quitting among women. Despite the gendered nature of smoking, most smoking cessation apps are gender-neutral and fail to address women's specific needs.

OBJECTIVE

This study aims to test the acceptability and feasibility of a smartphone app that delivers gender-informed content to support women in quitting smoking.

METHODS

We co-developed a smoking cessation app specifically tailored for women, named My Change Plan-Women (MCP-W). This app builds upon our previous gender-neutral app, MCP, by retaining its content grounded in behavioral change techniques aimed at supporting tobacco reduction and cessation. This includes goal setting for quitting, identifying triggers to smoking, creating coping strategies, tracking cigarettes and cravings, and assessing financial savings from quitting smoking. The MCP-W app contains additional gender-informed content that acknowledges barriers to quitting, such as coping with stress, having smokers in one's social circle, and managing unpleasant emotions. This content is delivered through testimonials and animated videos. This study is a prospective, single-group, mixed methods investigation in which 30 women smokers will trial the app for a period of 28 days. Once participants provide informed consent, they will complete a baseline survey and download the app on their smartphones. After 28 days, participants will complete follow-up surveys. Acceptability will be assessed using the Theoretical Framework of Acceptability, which evaluates whether participants perceive the app as helpful in changing their smoking. The app will be deemed acceptable if the majority of participants rate it as such, and feasible if the majority of the participants use it for at least 7 days. Furthermore, after the 28-day trial period, participants will complete a semistructured interview regarding their experience with the app and suggestions for improvement.

RESULTS

Development of the MCP-W app was completed in September 2023. Participant recruitment for testing of the app commenced in February 2024 and was completed in July 2024. We will analyze the data upon completion of data collection from all 30 participants. We expect to share the results of this acceptability trial in the middle of 2025.

CONCLUSIONS

Offering smoking cessation support tailored specifically to address the unique needs of women through a smartphone app represents a novel approach. This study will test whether women who smoke perceive this approach to be acceptable and feasible in their journey toward smoking cessation.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/60677.

Practitioners' Use and Acceptability of Time-Out

Time-out is an empirically supported component of parenting interventions for child conduct problems; however, it is receiving increasing criticism among parents and some practitioners. This study aimed to investigate practitioners' use and acceptability of time-out for child conduct problems; examine whether perceived effectiveness and knowledge of evidence-based parameters of time-out implementation influence use and acceptability of time-out; and explore practitioners' perceptions about alternatives to time-out. One hundred and ten Australian and New Zealand practitioners who have worked with children and families completed an online survey investigating their use and acceptability of time-out for children with conduct problems. Results showed that 55.5% of the sample have used timeout, with 38.0% considered current TO users. Acceptability of the strategy varied, with some practitioners critical of time-out. Increased knowledge of evidence-based parameters of time-out implementation was associated with increased frequency of time-out use and acceptability, while perceived effectiveness was associated with increased acceptability only. Practitioners perceived a number of other parenting strategies as effective alternatives to time-out. These findings have important implications for improving practitioners' implementation of time-out with parents of children with conduct problems.

Protocol for an embedded randomised controlled trial of Early versus Late Stopping of Antibiotics in children with Febrile Neutropenia (ELSA-FN)

In children with cancer, febrile neutropenia (FN) is one of the most common complications of treatment, a leading cause of unplanned and prolonged hospital admission and is the key driver of antibiotic exposure. Co-designed with key stakeholders, 'Early versus Late Stopping of Antibiotics in high-risk FN' (ELSA-FN) is a randomised controlled, non-inferiority trial that compares stopping antibiotics in clinically stable patients after 48 hours with the current standard of care, continuing antibiotics until absolute neutrophil recovery. As an Australian first, we will exploit the potential of electronic medical record (EMR) systems, embedding all key aspects of the trial including screening, consent, randomisation and data collection into standard clinical and EMR workflows. We aim to randomise 320 children with high-risk FN and prospectively collect data on safety, acceptability to clinicians and families, as well as several secondary outcomes related to antibiotic exposure. The findings will contribute to optimal antibiotic use in children with FN internationally and inform design and implementation of future EMR-embedded trials.

Acceptability of virtual restraint fitting to extend the reach of child restraint fitting services: A pilot randomized controlled trial

OBJECTIVE

Incorrect use of child restraints is a long-standing issue, limiting the protection offered by child restraints in the event of a crash. Child restraint fitting services are a measure to reduce incorrect use but have limited reach and availability to underserved populations. Virtual child restraint fitting services have the potential to increase the reach and availability, but as with any digital intervention, need to be acceptable to users to be effective. The acceptability of such interventions has not been studied before.

METHODS

Using a three-arm randomized controlled trial, this study evaluated the acceptability of: (1) a video with child restraint fitting advice (Control), (2) a traditional in-person child restraint fitting service (In-person), and (3) a virtual child restraint fitting service (Virtual). Additionally, the effectiveness in reducing incorrect use was evaluated.

RESULTS

There was a significantly higher level of overall acceptability for the in-person service, and significantly fewer errors in child restraint use in this group compared to the control. There were no significant differences in overall acceptability or errors between the virtual service and the control. However in-depth analysis of the constructs of acceptability demonstrated participants in the in-person and virtual service groups held similar views on four of the seven constructs including the usefulness of the services and the impact of the service on comprehension of key information for correct restraint use. Areas where the views differed between these groups included perceived burden, appropriateness, and opportunity costs. Qualitative feedback suggested these negative perceptions on the virtual service may be remediated with some improvements to the technology.

CONCLUSIONS

Overall, child restraint fitting services provided virtually show promise as an alternative to in-person but attention to how services are provided via this technology, together with technology improvement, might be needed to fully realize its potential.

Advancing user-centric design and technology adoption for aging populations: a multifaceted approach

The global demographic shift toward an aging population necessitates a nuanced approach to developing and adopting assistive technologies tailored for older adults. This paper synthesizes key challenges, strategies, and recommendations identified in addressing the complex landscape of technology adoption and usage among aging populations. User-centric design and co-creation initiatives are vital for developing assistive technologies that meet the needs of older adults. These initiatives involve engaging older adults in activities like workshops, focus groups, and design sessions to gather feedback and refine technology solutions, ensuring they are accessible, intuitive, and effective. Challenges such as participant selection, cultural attitudes, and trust-building mechanisms are paramount in ensuring meaningful user involvement in technology development processes. Accurate assessment of older adults' technological literacy is identified as critical for designing and implementing digital solutions. The unreliability of self-reported proficiency necessitates objective measures in assessments to counter potential biases and ensure accurate insights into user capabilities. The fragmented digital ecosystem and resulting digital divide among older adults pose significant barriers to technology adoption and usage. The role of caregivers in technology acceptance highlights the need for integrated models that encompass the caregiver perspective, reducing adoption barriers and fostering meaningful engagement with assistive technologies. Interdisciplinary collaboration and robust research standards are essential in advancing technology adoption and addressing societal inequalities. Prioritizing user-centric design, integrating caregivers into technology adoption models, and fostering collaborative efforts across disciplines can significantly improve technology acceptance and enhance the quality of life for older adults in an increasingly digital era.

Remotely Delivered Video Interaction Guidance for Families of Children With an Intellectual Disability Referred to Specialist Mental Health Services: Protocol for a Feasibility Randomized Controlled Trial

BACKGROUND

Children with an intellectual disability (ID) are 3-4 times more likely to present with behaviors that challenge and mental health problems than typically developing children. Parenting and the quality of parent-child relationships are risk factors for these families. The COVID-19 pandemic further exacerbated difficulties, leading to an increase in child mental health problems and behaviors that challenge, a deterioration in parental mental health, and further strain on family relationships. Remote family interventions could be an effective solution for both families and specialist mental health services. Video interaction guidance (VIG) has shown promise for improving child mental health. However, it is unclear whether it is widely acceptable to families and feasible to implement across specialist child mental health services.

OBJECTIVE

This randomized controlled trial aims to evaluate the feasibility of delivering VIG as a remote intervention for parents of children aged 6-12 years with ID who have been referred to specialist mental health services.

METHODS

The study will be undertaken across 5-7 National Health Service specialist mental health services in England, involving 50 participants randomly allocated on a 1:1 basis to either the intervention group (receiving remote VIG) or the treatment-as-usual (TAU) group. The intervention group will engage in 3-5 cycles of VIG delivered remotely over 12 weeks. The primary feasibility outcomes include the recruitment rate, retention at 6-month follow-up, and VIG cycle completion rate. The secondary outcomes will assess the acceptability of VIG and the feasibility of remote implementation, including fidelity to the intervention protocol. Data will be gathered through online surveys and telephone interviews at baseline, 3 months, and 6 months. Feasibility outcomes will be summarized using descriptive statistics, while thematic analysis will be applied to qualitative data from semistructured interviews with participants, VIG practitioners, and service managers. An embedded process evaluation will explore barriers and facilitators to engagement with VIG, and a parallel health economics evaluation will assess the feasibility of capturing service use data and intervention costs.

RESULTS

The trial was open to recruitment between December 2022 and March 2024. The first results should be available in 2025.

CONCLUSIONS

The study is the first randomized evaluation of VIG as offered to parents of children with ID who have been referred to specialist mental health settings. The outcomes from this feasibility trial will inform the decision to proceed with a definitive trial, using a traffic light system to evaluate recruitment, retention, and VIG completion rates alongside qualitative insights and economic evaluations.

TRIAL REGISTRATION

ISRCTN Registry ISRCTN13171328; http://www.isrctn.com/ISRCTN13171328.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/54619.

Acceptability, User Satisfaction, and Feasibility of an App-Based Support Service During the COVID-19 Pandemic in a Psychiatric Outpatient Setting: Prospective Longitudinal Observational Study

BACKGROUND

Patients with mental disorders often have difficulties maintaining a daily routine, which can lead to exacerbated symptoms. It is known that apps can help manage mental health in a low-threshold way and can be used in therapeutic settings to complement existing therapies.

OBJECTIVE

The aim of this study was to evaluate the acceptability, usability, and feasibility of an app-based support service specifically developed for outpatients with severe mental disorders in addition to regular face-to-face therapy during the COVID-19 pandemic.

METHODS

Patients in a psychiatric outpatient department at a German university hospital were invited to use an app-based support service designed transdiagnostically for mental disorders for 4 weeks. The app included 7 relaxation modules, consisting of video, audio, and psychoeducational text; ecological momentary assessment-like questionnaires on daily mood answered via a visual smiley-face scale; and an activity button to record and encourage daily activities. Standardized questionnaires at baseline (T0; preintervention time point) and after 4 weeks (T2; postintervention time point) were analyzed. Feedback via the smiley-face scale was provided after using the app components (T1; during the intervention). Measures included depressive symptoms, quality of life, treatment credibility and expectancy, and satisfaction. Furthermore, participation rates, use of app modules and the activity button, and daily mood and the provided feedback were analyzed (T2).

RESULTS

In total, 57 patients participated in the study, and the data of 38 (67%) were analyzed; 17 (30%) dropped out. Satisfaction with the app was high, with 53% (30/57) of the participants stating being rather satisfied or satisfied. Furthermore, 79% (30/38) of completers stated they would be more likely or were definitely likely to use an app-based support service again and recommend it. Feasibility and acceptability were high, with nearly half (18/38, 47%) of the completers trying relaxation modules and 71% (27/38) regularly responding to the ecological momentary assessment-like questionnaire between 15 and 28 times (mean 19.91, SD 7.57 times). The activity button was used on average 12 (SD 15.72) times per completer, and 58% (22/38) felt "definitely" or "rather" encouraged to perform the corresponding activities. Depressive symptomatology improved significantly at the postintervention time point (P=.02). Quality of life showed a nonsignificant increase in the physical, psychological, and social domains (P=.59, P=.06, and P=.42, respectively) and a significant improvement in the environment domain (P=.004). Treatment credibility and expectancy scores were moderate and significantly decreased at T2 (P=.02 and P<.001, respectively). Posttreatment expectancy scores were negatively associated with posttreatment depressive symptomatology (r=-0.36; P=.03).

CONCLUSIONS

App-based programs seem to be an accessible tool for stabilizing patients with severe mental disorders, supporting them in maintaining a daily routine, complementing existing face-to-face treatments, and overall helping respond to challenging situations such as the COVID-19 pandemic.

Acceptability of a Self-Help Programme to Address the Use of Indecent Images of Children

The use of indecent images of children (IIOC) is of continued concern and growing prevalence. A multi-agency approach to this online crime is necessary, as it cannot be eradicated by law enforcement alone. Previous research has examined the pathways to offending for this population, and prevention strategies that could be used to deter offending in the first instance, or to stop behaviour once it has begun. The current qualitative study aimed to explore acceptability of a prevention initiative; a self-help focussed service (a website and calls with a professional). Semi-structured interviews with eight individuals who had accessed IIOC and engaged in this self-help focussed service were conducted. Transcripts were analysed using qualitative framework approach, using the Theoretical Framework of Acceptability (TFA) domains as deductive codes. All seven domains of the TFA were identified in the transcripts, indicating the applicability of the framework. Overall, participants reported mixed acceptability of and satisfaction with the self-help programme and calls with practitioners, but high perceived effectiveness in the service supporting them stop their illegal behaviours. The implications of the study are considered in line with improvements that could be made to this existing self-help prevention initiative.

Acceptability of two mobile applications to support cross-sectoral, person-centred and empowering stroke rehabilitation - a process evaluation

AIM

To evaluate the acceptability of two co-designed mobile applications Mit Sygehus [a knowledge-based solution] and Genoptræn.dk [a self-training solution] to support a cross-sectoral, person-centred and empowering stroke rehabilitation.

SETTING

The applications were implemented and tested throughout two stroke rehabilitation trajectories in Southern Denmark, comprising two acute, two sub-acute and two municipal stroke rehabilitation settings.

METHODS, PARTICIPANTS AND ANALYSIS

A process evaluation focusing on acceptability was conducted. Individual and dyadic interviews were performed with ten stroke survivors (three women and seven men, aged 50-84) with moderate stroke and seven significant others (five women and two men, aged 50-78) post-rehabilitation. A constructivist Grounded Theory analysis was used to explore what, why, when, and how the apps worked or did not work throughout the stroke rehabilitation trajectory and if adaptions were needed.

RESULTS

Participants found that Mit Sygehus provided adequate and sufficient knowledge and was easy to use, however, acceptability of Mit Sygehus declined throughout the rehabilitation process. Also, knowledge on 'return-to-work' and 're-gaining driver's license/permission to drive' needed to be developed. The content in Genoptræn.dk was perceived as acceptable, through content being person-centred, motivating and meaningful. Genoptræn.dk furthermore, supported the transfer between rehabilitation settings, provided a sense of progress throughout the rehabilitation process, facilitated positive habits regarding self-training, and relieved the burden on significant others. Genoptræn.dk was perceived most acceptable in the sub-acute rehabilitation setting and declined when rehabilitation continued in the municipal setting.

CONCLUSION

Stroke survivors and their significant others found Mit Sygehus and Genoptræn.dk acceptable to support cross-sectoral, person-centred and empowering stroke rehabilitation, however acceptability declined throughout the rehabilitation process. Further investigations are required to determine how cognitive rehabilitation can play a greater role in app-supported stroke rehabilitation and how the need for more long-term follow-up can be supported.

Novel Guided Self-Help for the treatment of Binge Eating Disorder: Feasibility, Acceptability, and Preliminary Efficacy

Purpose: Binge eating disorder (BED) is a prevalent eating disorder. Many individuals with BED do not receive evidence-based care due to many barriers. This preliminary study evaluated the feasibility, acceptability, and potential efficacy of a manualized guided self-help (GSH) intervention with support in the form of a culturally adapted manual for a French-Canadian population.Method: Twenty-two women with overweight or obesity meeting the BED diagnostic criteria participated in an 8-week open trial. The GSH programme combined a self-help book and weekly support phone calls. Participants were assessed at baseline, at week 4, postintervention, and 12 weeks following its end. Feasibility was measured by attrition rates, participation, and satisfaction. Acceptability was measured by a questionnaire based on the Theoretical Framework of Acceptability. Potential efficacy outcomes were objective binge eating days, eating disorder symptomatology, depressive symptoms, and propensity to eat intuitively.Results: The GSH programme has proven feasible (4.5% attrition, 91% completion, 95.5% satisfaction) and acceptable. Potential efficacy results showed promising improvements on all outcomes (19% abstinence, 70.9% reduction in objective binge eating days).Conclusion: Although preliminary, this programme warrants further study as it may be an efficient and cost-effective way to deliver GSH for BED patients with accessibility barriers.

Prescriber Acceptability of a Direct-to-Patient Intervention for Benzodiazepine Receptor Agonist Deprescribing and Behavioural Management of Insomnia in Older Adults

Behavioural treatments are recommended first-line for insomnia, but long-term benzodiazepine receptor agonist (BZRA) use remains common and engaging patients in a deprescribing consultation is challenging. Few deprescribing interventions directly target patients. Prescribers' support of patient-targeted interventions may facilitate their uptake. Recently assessed in the Your Answers When Needing Sleep in New Brunswick (YAWNS NB) study, Sleepwell (mysleepwell.ca) was developed as a direct-to-patient behaviour change intervention promoting BZRA deprescribing and non-pharmacological insomnia management. BZRA prescribers of YAWNS NB participants were invited to complete an online survey assessing the acceptability of Sleepwell as a direct-to-patient intervention. The survey was developed using the seven construct components of the theoretical framework of acceptability (TFA) framework. Respondents (40/250, 17.2%) indicated high acceptability, with positive responses per TFA construct averaging 32.3/40 (80.7%). Perceived as an ethical, credible, and useful tool, Sleepwell also promoted prescriber-patient BZRA deprescribing engagements (11/19, 58%). Prescribers were accepting of Sleepwell and supported its application as a direct-to-patient intervention.

A pilot randomised controlled trial of a telehealth-delivered brief 'Sleeping Sound Autism' intervention for autistic children

BACKGROUND

Access to behavioural sleep intervention is beneficial for autistic children, yet many families face barriers to access associated with location and time. Preliminary evidence supports telehealth-delivered sleep intervention. However, no studies have evaluated brief telehealth sleep intervention. To address this, we evaluated telehealth delivery of the brief behavioural Sleeping Sound Autism intervention, using a two-armed, parallel-group, non-blinded, pilot randomised controlled trial (RCT) design (trial registration: ANZCTR12620001276943).

METHOD

Sixty-one families of autistic children without intellectual disability (5-12 years, 46% female) with caregiver-reported moderate-severe behavioural sleep problems participated Australia-wide, randomised to an intervention (n = 30) or treatment as usual control group (n = 31). Intervention group participants were invited to attend two video-conference telehealth sessions and one follow-up phone call with a trained clinician. Survey data was collected from caregivers at baseline and three- and six-months post-randomisation, to evaluate feasibility, acceptability, and efficacy. Ten intervention group caregivers participated in end-of-study semi-structured interviews to explore their experiences.

RESULTS

Forty-nine caregivers completed surveys. At baseline, 87% felt positive and 84% felt confident about participating via telehealth, and 75% believed the program would improve child sleep. At three-months, intervention group caregivers (n = 24) reported the usefulness (100%) of and preference for (71%) telehealth, and 95.8% would recommend this sleep program to other families. A significant group by time difference was observed in child sleep (Children's Sleep Habits Questionnaire) with large effect sizes (d = 0.87-1.05), emotion and behaviour (Developmental Behavior Checklist 2) with moderate effect sizes (d = 0.40-0.57), and caregiver mental health (Kessler 10) with small to moderate effect sizes (d = 0.60-0.28), favouring the intervention group (n = 23). There were no significant group differences in child (Child Health Utility instrument) or caregiver (Assessment of Quality of Life) quality of life. However, there were individual differences in the clinical significance of improved child sleep. Qualitative data showed that whilst telehealth was convenient for caregivers, without attenuating the benefits of most key intervention features, not all children were able to engage effectively with the clinician via telehealth.

CONCLUSIONS

This first pilot RCT of a brief telehealth behavioural sleep intervention for primary-school-aged autistic children suggests that telehealth delivery is acceptable, feasible and likely efficacious in improving sleep in the short-term. Providing families with ongoing choice of mode of delivery (telehealth/in-person) and examining the person-environment fit of telehealth for autistic children is important.

Ecological virtual reality-based cognitive remediation among inpatients with schizophrenia: A pilot study

Schizophrenia presents a considerable clinical challenge due to limited progress in promoting daily-life functioning among diagnosed individuals. Although cognitive remediation (CR) has emerged as a promising approach to improving cognitive and functional outcomes in schizophrenia, its effectiveness among inpatients and within hospital environments-where opportunities to practice skills in real-world contexts are limited-remains unclear. Here, we aimed to establish the feasibility and initial efficacy of a short, ecological virtual reality-based CR training (CR-EVR) in acute mental health inpatient settings. Efficacy was assessed at four levels: training engagement, near transfer, far transfer, and ecological transfer. Twenty-three inpatients with schizophrenia (Male: 33.3 ± 8.5; 4 Female) completed 8, 20-min CR-EVR sessions, with exercises training the cognitive abilities of inhibition, planning, working memory, shifting, self-initiation, persistence, and attention. Their cognitive functioning, schizophrenia symptoms, functional capacity, and participation in occupations were evaluated pre- and post-training to address four levels of effectiveness. Of the recruited participants, 25.8 % dropped out. Inpatients who completed the full protocol reported high rates of satisfaction (1-not satisfied; 5-very satisfied)) from the intervention (Median = 4, IQR:3.5-5). Post-training, significant improvements were found in the trained cognitive components (intervention engagement: -6.58 < t/Z < 2.02, p < .05), general cognitive functioning (-2.59 < t/Z < 2.29, p < .05), functional capacity (t = -2.9, p < .05), and diversity of participation in everyday activities (t = -3.36, p < .05). This preliminary study suggests that CR-EVR may be a feasible and practical tool to enhance cognitive and ecological outcomes in short-stay acute inpatient settings. Subject to further research, such intervention may be considered an add-on to current practices that promote recovery and health among inpatient populations.

The Acceptability, Safety and Impact of a Play Co-Developed With Public Contributors as a Format for Disseminating Research on a Sensitive Subject

INTRODUCTION

Patient and public involvement (PPI) and dissemination of research findings are key parts of the pathway to research impact; however, traditional approaches often fail to engage non-academic audiences. Creative methods such as co-developed plays can be effective ways of making the research process and findings more engaging and accessible to the public. Not much is known about how to safely involve patients and the public in the development and delivery of plays disseminating research on sensitive subjects. Members of a PPI group on a study about mindfulness for women with a history of domestic abuse co-developed and performed a play about their experiences. This study aimed to evaluate the impact, acceptability and safety of a co-developed play in publicizing PPI and findings from research on domestic abuse.

METHODS

We conducted a mixed-methods study with the play team and audience. We collected 20 quantitative and 56 qualitative survey responses from audience members, carried out 4.25 h of direct observations of play performances and interviewed seven audience members and eight play team members. Data were analyzed using the framework method and descriptive statistics, using a 'following a thread' approach to integrate qualitative and quantitative findings in themes answering our study aim.

FINDINGS

We developed three integrated themes with ten sub-themes. The 'Value' theme summarized the plays' impact on audience understanding, potential mechanisms of impact and its effectiveness in depth over breadth of dissemination. The 'Re-traumatization' theme described potential harms of the play, the risks of re-traumatizing actors and distressing audiences. The 'Reducing the risks' theme summarized ways of reducing these risks of harm.

CONCLUSION

A play co-developed and performed by study PPI members raised awareness of domestic abuse. However, there were divergent opinions on its value in disseminating messages about PPI in research on sensitive subjects. The value of the play for research dissemination was linked to its ability to emotionally engage the public, and to its accessibility. Implementing strategies to reduce the risk of re-traumatizing audience members and the project team is recommended.

PATIENT OR PUBLIC CONTRIBUTION

Everyone with direct experience of co-creating and performing the play contributed to this study. This included four public contributors: a community theatre producer, two actors with lived experience of domestic abuse who were members of the study PPI group and one community actor already working with the community theatre. A participatory workshop with PPI contributors was held to refine our research questions and data collection instruments, using a public involvement evaluation tool, The Cube. PPI contributors checked and commented on the draft manuscript.